Outside Topic Covid-19 considerations - Printable Version
+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: Outside Topic Covid-19 considerations (/thread-19023.html)
+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: Outside Topic Covid-19 considerations (/thread-19023.html)
RE: Stanford COVID-19 update - Farm93 - 03-15-2020
(03-14-2020, 11:57 AM)Spiny_Norman Wrote:That probably would vary by class.(03-14-2020, 08:49 AM)winflop Wrote: We are deciding whether our son will even enroll at Santa Clara for Spring Quarter. I'm thinking it's highly likely that the entire quarter at many schools will be done online, and sorry but at the prices they're charging that's just not worth it. And they sure as heck should not be charging room & board...
I wonder if some percentage of Stanford undergrads will just stop out.
Freshmen still have a number of required or essential classes to complete.
Seniors may have a class or two required to complete to graduate.
And it would vary by economic status too, I suspect.
Those on financial aid likely would be uncertain if they could just stop out, and would worry about what that might mean for their scholarships, grants and loans.
Those from wealthier families with no particular need to graduate in 4 years might opt elect to stop out or spend several months at the family beach or lake house. Of course, those same families probably can create amazing remote learning rooms in one of their homes for their children.
In some ways remote meetings, remote learning, remote teaching are all going to play a larger role in the future, so getting part of your education online and adapting to this dynamic situation are likely to be important life lessons.
RE: Covid-19 considerations - OutsiderFan - 03-15-2020
Maybe this video will resonate with people? Bourbon Street in New Orleans:
[tweet]https://twitter.com/ProudResister/status/1239094016949374976[/tweet]
RE: Covid-19 considerations - cardcrimson - 03-15-2020
Business as usual? Not sure where some of you are, but life in the East Bay burbs has changed drastically.
Schools closed for at least 2-3 weeks (will be longer, I imagine).
No athletics, practice, competitions and camps all canceled; the fields, gyms and parks are empty, the pools, too.
Churches are all online. Not even providing the sacrament.
Kaiser in San Ramon was empty on Wednesday. No unnecessary appointments given, even the pharmacy was fairly empty (it's shelves, too.)
Restaurants and shops suffering from no customers; some owners fearing permanent closure..
Mid market businesses ($5-150 million) holding emergency sessions to plan actions.
Rush hour traffic later last week non-existent.
Tahoe finally getting snow, and just heard that most ski area are closing. Vail Resorts and Alterra closing all their properties nationwide.
No, it is not business as usual here. . . .
(03-14-2020, 05:25 PM)cardcrimson Wrote:So did the Bucks defender guarding Gobert. . . .3rd NBA player to test positive.(03-14-2020, 03:39 PM)magnus Wrote: Apparently a child who got an autograph from Rudy Gobert last week (pre symptoms) has tested positive. Health officials discount any connection I'm guessing because it was pre symptoms. If fullmetal's post is proved correct, they could very well be linked.I would imagine his teammate got it from him presymptoms or vice versa, as well.
RE: Covid-19 considerations - burger - 03-15-2020
Here's a brief (and reference-less) counterpoint on the ACE2 inhibitor thing: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang?utm_source=share&utm_medium=ios_app&utm_name=iossmf
My 2 cents is this: doctors, like the authors of the above piece, are inherently conservative ("first do no harm"). That is an excellent guiding precept in normal times, but it should go out the window in a crisis. Now is this time to experiment, take risks, etc. I don't think anyone is saying that people should go off their blood-pressure meds and let their BP skyrocket. But if there are equally effective alternatives that don't pose a theoretical danger, why not? Also, if the piece I linked to is correct, then someone still needs to explain why high blood pressure is a predisposing factor for greater mortality with covid19.
RE: Covid-19 considerations - 2006alum - 03-15-2020
Hi folks,
Since a number of you have commented on the twitter images/posts I've shared and that you've found useful, I created a twitter account that is 100% retweets of those useful posts: https://twitter.com/COVIDResponse. Feel free to follow it or look at it from time to time. No commentary, no tweets, just 100% retweets of useful information with the bare minimal amount of political/partisan inflection. Almost everything I retweet has been folks in the field in Asia and Europe or else public health/epidemiologists in the US and UK.
Here's a thread from this morning that really terrifies me:
[tweet]https://twitter.com/ASlavitt/status/1238817274590629888?s=20[/tweet]
His thread preceded NY Governor Cuomo's call for Trump to bring in the military, but it clearly presages the fact that many mayors and governors are apparently bracing for a need beyond what the civilian medical infrastructure alone can provide.
The other concerning thing is that, at least in France, it does not appear to be only the elderly that have been hit hard:
[tweet]https://twitter.com/mikiebarb/status/1238929011050496001?s=20[/tweet]
As I say, feel free to follow my account if you'd like more information along these lines. I will occasionally post them here as well when I think they inject new information into the ongoing conversation.
(03-15-2020, 09:15 AM)burger Wrote: Here's a brief (and reference-less) counterpoint on the ACE2 inhibitor thing: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang?utm_source=share&utm_medium=ios_app&utm_name=iossmfI retweeted this on my feed but worth bringing to your attention on this point:
My 2 cents is this: doctors, like the authors of the above piece, are inherently conservative ("first do no harm"). That is an excellent guiding precept in normal times, but it should go out the window in a crisis. Now is this time to experiment, take risks, etc. I don't think anyone is saying that people should go off their blood-pressure meds and let their BP skyrocket. But if there are equally effective alternatives that don't pose a theoretical danger, why not? Also, if the piece I linked to is correct, then someone still needs to explain why high blood pressure is a predisposing factor for greater mortality with covid19.
[tweet]https://twitter.com/davidasinclair/status/1238972082756648960?s=20[/tweet]
Author indicates that SARS-COV-2 (you can think of this like the disease HIV, and COVID-19 as the AIDS illness someone gets from it) not only destroys pneumocytes in the lungs but also the blood vessels, which means that your lungs are less able to uptake oxygen, and your body is less able to carry it. This is probably why those with heart disease, diabetes, and HPB may be more susceptible:
[tweet]https://twitter.com/davidasinclair/status/1238972090889449472?s=20[/tweet]
RE: Covid-19 considerations - cardcrimson - 03-15-2020
(03-15-2020, 09:15 AM)burger Wrote: Here's a brief (and reference-less) counterpoint on the ACE2 inhibitor thing: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang?utm_source=share&utm_medium=ios_app&utm_name=iossmf
My 2 cents is this: doctors, like the authors of the above piece, are inherently conservative ("first do no harm"). That is an excellent guiding precept in normal times, but it should go out the window in a crisis. Now is this time to experiment, take risks, etc. I don't think anyone is saying that people should go off their blood-pressure meds and let their BP skyrocket. But if there are equally effective alternatives that don't pose a theoretical danger, why not? Also, if the piece I linked to is correct, then someone still needs to explain why high blood pressure is a predisposing factor for greater mortality with covid19.
Changed on Wednesday. What's the harm switching if I can still control the BP? Adjusting to the new meds, on a low dose and BP is still a touch high. We shall see.
RE: Covid-19 considerations - OutsiderFan - 03-15-2020
Hey, closing airports was my idea! Although I must admit, I would have suggested a 2-week grounding of planes, not 30 days. The Flight Aware map I saw last night was just as disturbing as the packed customs areas at ORD and DFW.
In any case, keep the cargo going and close the terminals.
RE: Covid-19 considerations - Mick - 03-15-2020
(03-14-2020, 08:17 AM)2006alum Wrote: Also, there's a of immense proportions, of immense proportions difference between 200k deaths and 1.7m deaths (from the estimates in the source BC provided yesterday) in terms of the impact to businesses, etc. The variation among those figures will also dictate whether we are closing schools and businesses for 4-6 weeks or 4-6 months, which in turn will necessitate a very different federal legislative response. I suspect Congress may want to see how this unfolds before directing broader, long-term relief.
Not to be maudlin, but my take is that 96% of the deaths are likely to occur after one is retired, using age 65 as the retirement age and using the statistics from China's outbreak. So the impact to businesses is probably lesser than we might otherwise believe.
https://ourworldindata.org/coronavirus#case-fatality-rate-of-covid-19-by-age
TreesAndBirds - TreesAndBirds - 03-15-2020
Drive thru testing at Stanford, from Palo Alto Online. Sorry if reported elsewhere.
“Stanford Health Care announced on Sunday, March 15, that drive-through appointments for Stanford Medicine's COVID-19 test are now available for patients who have been referred by their medical providers. Patients remain in their cars for the tests, which take a few minutes and are administered by a physician, advanced practice provider or nurse outfitted in protective clothing, including a gown, goggles, mask and gloves, Stanford Health Care said. Patients will be notified of their COVID-19 test results within 24 hours; if the result is positive, their doctors will make sure they get appropriate care, which can range from hospitalization for people showing severe symptoms to telemedicine visits and self-quarantine for those with mild cases. The drive-through tests are available from 9 a.m. to 6 p.m., seven days a week, at Express Care's Hoover Pavilion location in Palo Alto. Patients can call 650-498-9000 to speak with a nurse who will assess the next step for their care.”
RE: Covid-19 considerations - 82 Card - 03-15-2020
(03-15-2020, 03:05 AM)M T Wrote: Whew, it is a good thing that Santa Clara County included this in the order limiting gatherings:
Quote:A "gathering" does not include normal operations at airports or spaces where persons may be in transit.If those lines were at the San Jose airport, SCC wouldn't need to have the sheriff come in and cite the airport or the immigration authorities.
I don't know. Are those lines normal operations? They look extraordinary.
RE: Covid-19 considerations - dabigv13 - 03-15-2020
Haven't posted for a while but wanted to check in here. Looks like in typical Cardboard fashion you guys have been on the ball with this.
It's going to get worse, much worse before it gets better.
I think it's probably been emphasized before, but more people will die from other medical causes being unable to be properly handled, than from the virus itself. Will be like Katrina across our country's hospitals. Where I work we are already saving old masks in a bin for later in case we run out and have to sterilize these with lysol and reuse. We are trying to transition as much as possible to telephone and video visits, but not everyone wants tha t, and of course some things need to be seen. Friday however, I saw a young healthy person for a deviated septum, a whole coughing family for a long missed and delayed check on ear tubes, and an 85 year old who wanted earwax cleaned. This going forward I'm sure will be untenable. Will probably have to cancel some OR cases next week. Some can wait without major consequence, but for patients who might have cancer and need a biopsy to know and get treated, it must be horrible to have to wait. Hopefully I can still accommodate these patients, but in NYC and Seattle nonemergency cases are already being cancelled.
Right now our hospital in LA is rumored to have a couple cases. I think this is certainly the tip of the iceberg and the weeks ahead will be bad. Hopefully social distancing is happening quickly and by enough people to blunt the deluge.
I am looking in 20 people's throats a day. I really wish I had an n95 mask to wear, and I really wish our leadership didn't piss away the precious weeks China bought us.
Things I'd like in an ideal world-
1) Enough tests. Automated PCR machines to run them. The reagents to run them. Probably a ways away, but some private labs like quest are finally up and running. Kaiser has had a few drive in tents but still just trial runs. This will be weeks away still. Probably too late to make a big big difference.
2) Enough masks. For everyone to wear in public and especially for health care providers to protect themselves and limit spread of disease. A regular surgical mask may only trap what you're pushing out but everyone doing so, like in many parts of Asia, would help.
3) An antibody assay to assess for possible immunity. In the weeks and months ahead, knowing who has immunity will be really important in putting this all back together. Since many, particularly the young, may not have symptoms, we may not know this. Clarifying if people do develop immunity after exposure will of course be critical, but I think most people with a normal immune system would develop at least partial immunity to a second exposure.
4) Sometime to convince Elon to stop building Teslas in his tent factories and start churning out ventilators.
Stay safe everybody
RE: Covid-19 considerations - stupac2 - 03-15-2020
(03-15-2020, 11:21 AM)dabigv13 Wrote: but in NYC and Seattle nonemergency cases are already being cancelled.
In another forum I'm on a guy has a mitral valve replacement scheduled for this Friday, and it's probably going to be called off. That seems like a pretty tough line on what to cancel.
RE: Covid-19 considerations - Goose - 03-15-2020
(03-15-2020, 03:05 AM)M T Wrote: The Feb 24 US-China Joint Mission final report indicated
Quote:According to preliminary data from Guangzhou CDC as of 20 February, virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset
However, I believe that is updated by newer data.
<snip>
Thanks M T! From what you have presented, it appears that the "n" in my question is in the 1-2 range, but there are some people who are shedding virus (and would test positive) that never experience symptoms. It is good to see some hard data that is based on actual measurements of a significant number of cases. The mean incubation period being about 8 days is also useful. It seems almost certain that there is pre-symptomatic transmission, although the mean length of this interval should be on the order of "n", or 1-2 days. No way to to avoid that except some form of mandatory social distancing.
The graphs on https://www.worldometers.info/coronavirus/country/us/ clearly show the exponential increase in total cases. We are still in a situation where there are many unknowns, and unfortunately it will play out over what will seem like a very long time.
RE: Covid-19 considerations - dabigv13 - 03-15-2020
Quote:In another forum I'm on a guy has a mitral valve replacement scheduled for this Friday, and it's probably going to be called off. That seems like a pretty tough line on what to cancel.
As with our entire national response, this is ad hoc, at a department level, at an institutional level. Our federal leadership is absent, getting dragged along by the decisions industries are making and being barely reactive and not at all proactive. Local and state response, in general, only slightly better.
We're still operationally not affected by coronavirus care, yet. But in anticipation of the increasing demand for PPE and hospital beds this is probably a necessary move. I think I will still be able to do my really necessary patients, but still going to be tough. And everything we dont do now, means only more that will need to be done once the pandemic is over. So ending this as soon as possible really important, and why it's really dumb we still have open bars and nightclubs and schools.
BTW what Boris Johnson is doing in the UK trying to build up herd immunity should land him in prison after a tribunal in that country.
RE: Covid-19 considerations - magnus - 03-15-2020
(03-15-2020, 11:21 AM)dabigv13 Wrote: 2) Enough masks. For everyone to wear in public and especially for health care providers to protect themselves and limit spread of disease. A regular surgical mask may only trap what you're pushing out but everyone doing so, like in many parts of Asia, would help.
Health care providers, please also wear goggles and/or a face shield when treating patients. That's what docs (not necessarily the front-line ones) in Taiwan are doing, yet many of our docs in the US (even in Seattle) are still walking around mask-less.
RE: Covid-19 considerations - dabigv13 - 03-15-2020
The past week I started wearing a mask with face shield when examining patients. This was of my own accord, from what I have been reading. One of my colleagues has been as well. She is from China and knows MDs there, and has been reading their primary literature. We've been trying to get our department up to snuff because what CDC is telling us is not enough.
RE: Covid-19 considerations - 82lsju - 03-15-2020
Quote:Stanford Community Offerings
Hi! If you've found your way to this form, then you're likely a kind community member looking to offer something to assist the Stanford community.
...
To protect people's privacy, as of 10:51AM 3/13 the "Stanford Community Offerings/Resources" spreadsheet is only accessible to those with verified email addresses from the Stanford community (to protect people's privacy—there's a lot of personal information on the spreadsheet).
So community members are asked to use this form to submit what they're able to offer.
If you have any urgent questions, please email me at willshan@stanford.edu, and I'll do my best to respond quickly.
https://docs.google.com/forms/d/e/1FAIpQLSfcbza9_0zC-1RAZwHEdsNIlmLt3o1C-B7WQJmetDoWfHw_sQ/viewform
RE: Covid-19 considerations - Leftcoast - 03-15-2020
I do not know what Kaiser is doing in other areas but as a member I can share that Kaiser in Santa Clara loosened their testing requirement threshold on Friday as more testing labs came online. This was relayed to me in phone consultation with my primary care physician.
They also have a drive through test tent at a parking lot of their facility near San Jose airport. You need your doctor’s recommendation and a pre-arranged appointment to enter and guards will check your ID and Kaiser card before you are allowed to enter. Throat swabs and (deep, ugh!) nasal swabs are taken. I was told results will take four days. Looked like they were giving the team 5-10 minutes per appointment due to the time of the test plus necessary cleaning and glove swapping. (DaBigV, one but not all, had a full face shield.)
Where previously doctors asked for known contact, high fever, and severe trouble breathing they are now considering other known risk factors including high blood pressure, diabetes and age among others. I qualified on the margins but also have a wife who works with infants so my case was taken to “the panel” and approved.
Good to see testing in one of our hotspots becoming more available. It will be interesting what this does to Santa Clara’s case count.
PS - I’m not overly concerned and am sharing since Santa Clara area test availability has been a frequent discussion point.
RE: Covid-19 considerations - BostonCard - 03-15-2020
(03-15-2020, 11:21 AM)dabigv13 Wrote: Haven't posted for a while but wanted to check in here. Looks like in typical Cardboard fashion you guys have been on the ball with this.
It's going to get worse, much worse before it gets better.
I think it's probably been emphasized before, but more people will die from other medical causes being unable to be properly handled, than from the virus itself. Will be like Katrina across our country's hospitals. Where I work we are already saving old masks in a bin for later in case we run out and have to sterilize these with lysol and reuse. We are trying to transition as much as possible to telephone and video visits, but not everyone wants tha t, and of course some things need to be seen. Friday however, I saw a young healthy person for a deviated septum, a whole coughing family for a long missed and delayed check on ear tubes, and an 85 year old who wanted earwax cleaned. This going forward I'm sure will be untenable. Will probably have to cancel some OR cases next week. Some can wait without major consequence, but for patients who might have cancer and need a biopsy to know and get treated, it must be horrible to have to wait. Hopefully I can still accommodate these patients, but in NYC and Seattle nonemergency cases are already being cancelled.
Right now our hospital in LA is rumored to have a couple cases. I think this is certainly the tip of the iceberg and the weeks ahead will be bad. Hopefully social distancing is happening quickly and by enough people to blunt the deluge.
I am looking in 20 people's throats a day. I really wish I had an n95 mask to wear, and I really wish our leadership didn't piss away the precious weeks China bought us.
Things I'd like in an ideal world-
1) Enough tests. Automated PCR machines to run them. The reagents to run them. Probably a ways away, but some private labs like quest are finally up and running. Kaiser has had a few drive in tents but still just trial runs. This will be weeks away still. Probably too late to make a big big difference.
2) Enough masks. For everyone to wear in public and especially for health care providers to protect themselves and limit spread of disease. A regular surgical mask may only trap what you're pushing out but everyone doing so, like in many parts of Asia, would help.
3) An antibody assay to assess for possible immunity. In the weeks and months ahead, knowing who has immunity will be really important in putting this all back together. Since many, particularly the young, may not have symptoms, we may not know this. Clarifying if people do develop immunity after exposure will of course be critical, but I think most people with a normal immune system would develop at least partial immunity to a second exposure.
4) Sometime to convince Elon to stop building Teslas in his tent factories and start churning out ventilators.
Stay safe everybody
Thanks for the report dabigv. My thoughts go out to all my colleagues on the front lines. I no longer practice, but I can’t imagine what this is going to be like for my former critical care colleagues. There are three confirmed cases in my local hospital and four others with tests pending. The number of hospital beds in the US has been going down for decades as hospitals squeeze out spare capacity in the name of efficiency. Unfortunately, that system is not built for resilience, and while you can defer elective cases, run of the mill reasons for hospitalization, like myocardial infarctions or motor vehicle collisions don’t know to wait until after the pandemic passes. Italy has already been in the position of having to decide between two patients who need a ventilator and only one available. And when healthcare providers start to get sick, it is easy to see how the healthcare system can very quickly become overwhelmed.
Testing is starting to come online, slowly. A serology test has been developed as well, and that may be able to help, especially in figuring out who is already immune, though there are anecdotal reports of patients becoming re-infected.
Good luck out there.
BC
RE: Covid-19 considerations - dabigv13 - 03-15-2020
BC do you have more info on that serology test? I'd be interested in hearing more about it.