(03-02-2020, 12:33 AM)akiddoc Wrote: As a physician on the front line, I have a few comments. I work 40% of my time in a Pediatric Urgent Care practice in an affluent part of the Bay Area and 60% of my time in a Federal Clinic in a rather disadvantaged area in the Bay Area. 90% of my exposure to sick patients occurs at that urgent care facility.This is exactly the kind of information I was hoping to get. Other members may have other opinions, but I want to hear them, especially from qualified experts.
Every day in urgent care we see at least 30 children with high fever and cough. Over 200 per week. (We see only a tiny fraction of the sick kids in Alameda County.) Most of these febrile children in our clinic are tested for Influenza. Earlier in the season we were running 80% positive tests for flu. Now we are running about 50%. There are certainly false negatives with this test. The manufacturer actually designed the test that way so that we would have very few false positives. Every test that we use for viral identification either is designed for high specificity (few false positives) or for high sensitivity (few false negatives, but some false positives). I have no idea what the C19 test is designed for in this context, but I guarantee it is not 100%, or even 95%, accurate. If we ever get a test that we can use at the initial point of patient contact, I will know the answer to the sensitivity and specificity question. But getting to the actual point: we have no idea what half of these febrile children have. Very few have the other virus we can test for (RSV). A few have bacterial disease. There are a whole host of viral candidates, but I would be shocked if there is no C19 in this group of patients. 70% of the families we see have parents who were born in Asia. They are almost all in the tech industry. Large numbers of them were in China, Korea, Japan, India and Hong Kong over the Christmas holidays. If none of them have C19 it is an incredible stroke of luck. I spend a lot of my time assuring parents that their children are pretty safe. Their grandparents are not necessarily so lucky.
I want to be sure that people understand that only a few people in the USA are being tested. The CDC has shown itself to be incredibly incompetent in getting dependable testing kits manufactured and distributed. The CDC was the world's most respected organization for analyzing, preparing for and combating infectious diseases until 2016. What is happening now is a tragic farce. Only very sick individuals and their contacts are being tested. We should be testing tens of thousands of people (or more) every week to really understand what is going on. China did it. South Korea can do it. We cannot. Unfortunately, politics are very much part of this. The CDC has been decapitated by the scientifically illiterate know nothings who control the budget and top management of the organization and the federal government.
Other than HIV, there are no viruses that I am aware of that do not have a large number of silent infections that pass without symptoms (well, maybe Ebola and SARS). There are generally a good number of people who catch influenza, the common cold (Rhinovirus, classic human Coronaviruses), hand foot and mouth virus, etc who do not show recognizable symptoms to the infected or their acquaintances. The Chinese are reporting that large numbers of children who are infected have no symptoms at all. But they are contagious. And 80 - 85% of all age groups who are recognized as having the virus basically have the symptoms of the common cold. Therefore, for every case found out in the community in the USA (who are very sick), there are plenty of other individuals who are infected. We are not going to find them all and isolate them all. 1 sick person with the diagnosis likely represents 20 to100 other people with the virus. This will spread. It is spreading now.
We could probably reduce the eventual number of infected individuals, but that would require action that the Trump administration and state governments will not take. China has slowed the spread down considerably and might come out of this in good shape. The USA would have to take similar measures. Close every school. Close almost every business. Bring the country to a standstill. Not going to happen.
On the positive side, almost no children under 10 are going to die from this. They are better off getting Coronavirus than Influenza according to the current statistics. There won't be many deaths in the 10 - 39 year age group either. About the same rate of death as for Influenza. If you are 50 - 59, you'll die at about the same rate as if you catch measles. The anti-vaxxers find that to be an acceptable risk. If you are 60 - 65, your chance of making it another year will move from 98.5 or 99% to about 95% if you catch Coronavirus. No one needs us anyway. If you're over 65 - well, Social Security payouts by the feds will fall quite a bit. That should stave off Social Security insolvency for a while.
On the subject of masks: wearing a surgical mask will give you about 0% protection from the person with C19 standing next to you. Wearing an N95 will give you some protection if it has been properly fitted and you have no facial hair.
My suggestions for surviving: get enough sleep, eat really healthy food, get moderate exercise (not if you are sick), and do not work in a medical facility, especially in the ER or in urgent care. Or go live in rural Montana 100 miles from everyone else. Or be under 10 years old.
Although some might complain that the post discusses and criticizes the CDC, I want to plead right now that I hope this post can stay up unedited. I think the purpose of the post is clearly to share one's expertise and experience and is a sincere attempt to help and inform cardboarders (i.e., the motive is clearly genuine and the intent is not political, personal, inflammatory or disingenuous)