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*** OFFICIAL *** COVID-19 CoronaVirus Thread. Fresh epidemic fears as child pneumonia cases surge in Europe after China outbreak. NOW in USA (12 Viewers)

Estimated during the very early period of the outbreak in Wuhan, yes, before there was much in the way or organized response.

A little bit of an imperfect mathematical exercise ... I could see different research teams looking at similar data and coming up with different estimates for R0. Even in the study you linked, the 95% confidence interval for R0 ranges from 4.4 to 7.7. Let me hasten to add than an R0 of 4.4 is well bad enough.

 
Estimated during the very early period of the outbreak in Wuhan, yes, before there was much in the way or organized response.

A little bit of an imperfect mathematical exercise ... I could see different research teams looking at similar data and coming up with different estimates for R0. Even in the study you linked, the 95% confidence interval for R0 ranges from 4.4 to 7.7. Let me hasten to add than an R0 of 4.4 is well bad enough.
to be fair, we didn't have an organized response here either until 3/13 and one could argue that we still don't (lets save that argument for the PSF).

 
My company is having difficulty classifying our COVID patients within our Electronic Health Records (EHR). If you thought wrangling 50 of something into some sort of order (states) was less than ideal, imagine that with 190 things (our hospitals). We have labs being sent off as "miscellaneous" instead of being specifically categorized as COVID. Some hospitals are reporting an uptick in flu, which is its own awful kettle of fish. Our staff is fighting so hard, but it's easy to see where things fall through in regards to 100% accurate reporting.

Example of inconsistencies:
COVID patients + Persons Under Investigation (PUI, designated as such because we are pending labs) is around 1200 + 1900 = 3100.
Baseline ventilator usage is 250 a day across the company. We are hovering at 1800 vents used a day for yesterday and n-2.
EHR reported COVID patients on vents = 400.
There are basically 1150 vents being used not attributed to our standard baseline of patients + documented COVID patients.

Some of that number would be PUI. Some are probably from the flu rearing its ugly head at the most inopportune time (I mentioned waaaaaaaaay back in February we had received guidance about influenza season had not peaked yet for 2019-2020). Some of those are just patients not documented correctly because our nurses are way more concerned about delivering care than filling out documentation (and rightfully so).

Edit: I just read through the past page and see that flu overall is way down, most likely to social distancing. Maybe even those patients are being documented incorrectly. Who knows.

I do have some possibly good rumors from our staff. @gianmarco @Terminalxylem @ProstheticRGK @Tecumseh (sorry if you're clinical and I missed you - THANK YOU SO MUCH FOR WHAT YOU ARE DOING) - it has been floated that proning patients may be a breakthrough in respiratory therapy. Have you all experienced anything like that?
Thanks for that, hags! Interesting to see numbers from other health systems. I definitely saw an uptick in bad flu cases, right as this pandemic was starting to be taken seriously here.

Re: proning. Proning people is one of the measures we commonly use with ARDS. Normally, we have enough special beds in the area that we order from a supplier, and they deliver it. The special beds are almost like a rotisserie set-up: you put the person on the bed, pad them all over and strap them in and then turn them prone for 12-16 hour stretches. Basically, what proning does is increase the surface area of the lungs that's available for air exchange.

My hospital started two weeks ago, putting together a proning team and training people to do it without using the special beds. We are anticipating the need to do it much more than usual, and are planning on there being a shortage of the specialty beds. It is a really labor-intensive and time-consuming process, though, because there are tons of safety features to take into consideration. Proned patients have always had a 1:1 ratio pt:staff. I worry that might not be possible if we are impacted and bad outcomes take place, as a result.

Another bottleneck is that most ARDS patients need CRRT or ECMO as adjunct therapy. Any numbers on the use of those in your health system?

 
How are those with children who are not yet school age handling daycare? We've been keeping our almost 15 month old son since March 9th and told daycare he will be home through April at least. 

My wife and I can both work from home so we are lucky there, but we basically have to take turns between working and watching our son. There is just too much we don't know for me to feel comfortable sending him back now or anytime soon, but there is no way my wife and I could keep this up beyond 2/3 months without losing our sanity. I'm so confused. 

 
Something I've been pondering but haven't seen any data on is how many smokers/former smokers are among the number of deaths/hospital stays for this. We talk a lot about underlying and preexisting conditions, but this isn't something that I've seen brought up a lot. May have no correlation at all. Just seems like compromised lungs would have a hard time with this.

Anyone seen anything?
Include vapers as well if I had to guess.

 
That R0 number is more than double the initial estimates, and not to use hyperbole, but pretty frightening.
Yeah, but like case-fatality rate ... R0 is not an intrinsic trait of a pathogen. It's dependent on environmental factors, too.

I'm sure that R0 was very different in Wuhan, say, throughout the month of February.

 
to be fair, we didn't have an organized response here either until 3/13 ...
I don't mean like that. I mean like during the first few weeks in Wuhan when they largely didn't know yet what they were dealing with. COVID was spreading unchecked for those first few weeks.

 
Thanks for that, hags! Interesting to see numbers from other health systems. I definitely saw an uptick in bad flu cases, right as this pandemic was starting to be taken seriously here.

Re: proning. Proning people is one of the measures we commonly use with ARDS. Normally, we have enough special beds in the area that we order from a supplier, and they deliver it. The special beds are almost like a rotisserie set-up: you put the person on the bed, pad them all over and strap them in and then turn them prone for 12-16 hour stretches. Basically, what proning does is increase the surface area of the lungs that's available for air exchange.

My hospital started two weeks ago, putting together a proning team and training people to do it without using the special beds. We are anticipating the need to do it much more than usual, and are planning on there being a shortage of the specialty beds. It is a really labor-intensive and time-consuming process, though, because there are tons of safety features to take into consideration. Proned patients have always had a 1:1 ratio pt:staff. I worry that might not be possible if we are impacted and bad outcomes take place, as a result.

Another bottleneck is that most ARDS patients need CRRT or ECMO as adjunct therapy. Any numbers on the use of those in your health system?
Hope this thread doesn’t get shut down with all this pron talk.  :mellow:

 
How are those with children who are not yet school age handling daycare? We've been keeping our almost 15 month old son since March 9th and told daycare he will be home through April at least. 

My wife and I can both work from home so we are lucky there, but we basically have to take turns between working and watching our son. There is just too much we don't know for me to feel comfortable sending him back now or anytime soon, but there is no way my wife and I could keep this up beyond 2/3 months without losing our sanity. I'm so confused. 
Our daycare is closed so we hired one of the girls who works there to watch our two a couple days a week. More expensive obviously but my job has been good enough to reimburse me part of the cost to keep me coming to work. 

 
Something I've been pondering but haven't seen any data on is how many smokers/former smokers are among the number of deaths/hospital stays for this. We talk a lot about underlying and preexisting conditions, but this isn't something that I've seen brought up a lot. May have no correlation at all. Just seems like compromised lungs would have a hard time with this.

Anyone seen anything?
I saw some early data from that from the Chinese. It showed smoking as a definite co-morbidity, I seem to think that if you got on a ventilator you were 7?x more likely to die? Also, they blamed the higher mortality rate on men on the fact that many more men than women smoke in China.

 
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just a reminder when looking at the data: last Sunday we had a reduction in total deaths - 525 on Saturday, and then 363 on Sunday.  Monday was about the same as Saturday (558), and the giant spike came on Tuesday (912).

This week is following the same pattern: 1330 on Saturday and 1165 on Sunday.  Monday was back up a bit (1255) but today, Tuesday, is shaking up to be especially grim (1522 and counting).

It's almost as if some deaths that happen on Sunday aren't tabulated until Tuesday.
I think we should be using a sliding 7-10 window for looking at these data points.  Daily reporting seems to be incredibly sporadic

 
seeing the # of deaths in the US is making me sick.

stay safe my friends. seriously. 

*******

on a totally unrelated note, but relevent to my community... foreign farm workers have been arriving for the past week, and are required a 14 day quaratine upon arrival. our fruit/veg/wine economy wouldve absolutely died if this didnt happen. 

 
Yeah, but like case-fatality rate ... R0 is not an intrinsic trait of a pathogen. It's dependent on environmental factors, too.

I'm sure that R0 was very different in Wuhan, say, throughout the month of February.
I'm new to all this but I thought the whole idea of R0 is to measure how it would spread independent of other factors.  Like, if there was no vaccine, no social distancing, no immunity, etc... the "intrinsic" R0 is the rate at which this thing spreads unchecked through a community.  Obviously we could lower the "observed" R0 through measures like those above.  Is that incorrect?

 
I think we should be using a sliding 7-10 window for looking at these data points.  Daily reporting seems to be incredibly sporadic
Here's the 7-day rolling total since 3/15 (assumes 2000 today since we're currently at 1786):

  •           244 3/21
  •           345
  •           468 3/23
  •           692
  •           920 3/25
  •        1,264
  •        1,740 3/27
  •        2,057
  •        2,502
  •        3,273 3/30
  •        4,075
  •        4,781
  •        5,709
  •        6,608 4/3
  •        7,850
  •        9,091
  •      10,182
So we've gone from doubling every two days to doubling every ~4 days on a rolling basis.

 
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I'm new to all this but I thought the whole idea of R0 is to measure how it would spread independent of other factors.  Like, if there was no vaccine, no social distancing, no immunity, etc... the "intrinsic" R0 is the rate at which this thing spreads unchecked through a community.  Obviously we could lower the "observed" R0 through measures like those above.  Is that incorrect?
That's it exactly.  Estimates are ~2.5, but we're probably driving that down through all the interventions.  Also appears to vary based on population density.

 
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SC just sent this over the emergency response system:

EMERGENCY ALERT

GO HOME, STAY HOME. TRAVEL ONLY FOR WORK & ESSENTIALS. VIRUS SPREADING IN ALL SC COUNTIES

Better late than never  :thumbup:

 
SC just sent this over the emergency response system:

EMERGENCY ALERT

GO HOME, STAY HOME. TRAVEL ONLY FOR WORK & ESSENTIALS. VIRUS SPREADING IN ALL SC COUNTIES

Better late than never  :thumbup:
I remember what it felt like last year to see that message in my state.

Oh wait,... that was just three weeks ago. 

 
seeing the # of deaths in the US is making me sick.

stay safe my friends. seriously. 

*******

on a totally unrelated note, but relevent to my community... foreign farm workers have been arriving for the past week, and are required a 14 day quaratine upon arrival. our fruit/veg/wine economy wouldve absolutely died if this didnt happen. 
I saw a story a few days ago and a guy had $1 million in blueberries going to be ready in a couple weeks.  His workers were stuck in Ecuador. 

 
The corresponding doubling time is more useful for how my brain processes it. If we can estimate when patient zero landed in the US we can use the doubling time to estimate the current infected number. When do we think patient zero arrived?
The doubling time is a moving target.

My guess is that we're at least 3-4x reported cases.

 
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How are those with children who are not yet school age handling daycare? We've been keeping our almost 15 month old son since March 9th and told daycare he will be home through April at least. 

My wife and I can both work from home so we are lucky there, but we basically have to take turns between working and watching our son. There is just too much we don't know for me to feel comfortable sending him back now or anytime soon, but there is no way my wife and I could keep this up beyond 2/3 months without losing our sanity. I'm so confused. 
My only advice is to be grateful you only have one little kid to watch.  :banned:

 
I remember what it felt like last year to see that message in my state.

Oh wait,... that was just three weeks ago. 
Today is Tuesday, April 7th, 2020  :hifive:

Oddly enough, seeing that on FB helps me to stay focused on the day at hand. I started posting that a few weeks ago after I saw it the first time and realized the benefit. Seems lots of folks are having a hard time with the dates all running together.

 
I'm new to all this but I thought the whole idea of R0 is to measure how it would spread independent of other factors.  Like, if there was no vaccine, no social distancing, no immunity, etc... the "intrinsic" R0 is the rate at which this thing spreads unchecked through a community.  Obviously we could lower the "observed" R0 through measures like those above.  Is that incorrect?
That's it exactly.  Estimates are ~2.5, but we're probably driving that down through all the interventions.  Also appears to vary based on population density.
Ignoratio's question was a good one. From what I can gather, true R0 is meant to specifically exclude spread through a community with significant immunity (either through immunization or through herd immunity). However:

R0 is not a biological constant for a pathogen as it is also affected by other factors such as environmental conditions and the behaviour of the infected population. Furthermore R0 values are usually estimated from mathematical models, and the estimated values are dependent on the model used and values of other parameters. Thus values given in the literature only make sense in the given context and it is recommended not to use obsolete values or compare values based on different models. R0 does not by itself give an estimate of how fast an infection spreads in the population.

 
The corresponding doubling time is more useful for how my brain processes it. If we can estimate when patient zero landed in the US we can use the doubling time to estimate the current infected number. When do we think patient zero arrived?
Doubling time doesn't stay constant, either.

 
I saw a story a few days ago and a guy had $1 million in blueberries going to be ready in a couple weeks.  His workers were stuck in Ecuador. 
This is so confusing to me

We have record unemployment yet we cant find workers

:confused:

 
The corresponding doubling time is more useful for how my brain processes it. If we can estimate when patient zero landed in the US we can use the doubling time to estimate the current infected number. When do we think patient zero arrived?
I believe the current patient zero was confirmed Jan 23 

 
Interesting article on Sweden's approach to combating the virus

Sweden went the opposite route and seem to be thriving

Sweden has courageously decided not to endorse a harsh quarantine, and consequently it hasn’t forced its residents into lockdown. “The strategy in Sweden is to focus on social distancing among the known risk groups, like the elderly. We try to use evidence-based measurements,” Emma Frans, a doctor in epidemiology at Sweden’s Karolinska Institute, told Euronews. “We try to adjust everyday life. The Swedish plan is to implement measurements that you can practice for a long time.”

The problem with lockdowns is that “you tire the system out,” Anders Tegnell, Sweden’s chief epidemiologist, told the Guardian. “You can’t keep a lockdown going for months — it’s impossible.” He told Britain’s Daily Mail: “We can’t kill all our services. And unemployed people are a great threat to public health. It’s a factor you need to think about.”

If social isolation worked, wouldn’t Sweden, a Nordic country of 10.1 million people, be seeing the number of COVID-19 cases skyrocket into the tens of thousands, blowing past the numbers in Italy or New York City? As of today, there are 401 reported COVID-19 deaths in Sweden.

The really good news is that in Sweden’s ICU census, which is updated every 30 minutes nationwide, admissions to every ICU in the country are flat or declining, and they have been for a week.

 
This is so confusing to me

We have record unemployment yet we cant find workers

:confused:
Well the other problem with this is that I don't think any of these jobs do enough to ensure people won't get it. Perhaps blueberry picking is a little different. But why would someone sign up to go work in an Amazon warehouse or a grocery store which seems like the most likely place to pick it up? Especially if you're going to come home to family afterwards. 

Of course, unemployment helps people avoid having to do this but making 50+ year olds go work at a grocery store seems like a bad idea. 

 
I think the notion that there is a “high risk” group has been an obstacle to the general acceptance of social distancing policies. At first it was just the elderly, then it was people with compromising medical conditions. But there have been plenty of otherwise healthy people under 50 who have died from this disease, which suggests we don’t really know what comprises “high risk”. I’ve seen theories that blood type may play a roll (O pos  :gang2: ) or some genetic marker that affects lung functionality. I read a story yesterday about an otherwise healthy 30-year-old couple who both got sick. She had moderate flu-like symptoms and recovered. He had more severe symptoms but seemed to be recovering when he suddenly died. We don’t yet understand the mechanics of this virus, so any notion that we could segregate a small percentage of our population while the rest of us go back to business as usual is foolish and a recipe for disaster.
This was a great point -- a true "low-risk" cohort barely exists. Maybe "hermits and shut-ins under 30 years old". I dunno.
I feel like I would need to understand what both of your "end game" scenarios are for this to understand how you guys feel this way.  

Like 50% of people over 75 that get this end up in the hospital. We cant call them high risk? 

Under 45 even with keeping the underlying conditions data sets in there I think is less than 10%. 

I have made the argument before that from a flattening the curve perspective a stricter lockdown on the high risk groups and getting rid of restrictions on the younger groups does far more to flatten the curve. Right now you have 16% of the population making up the majority of the ICU and deaths. And again this isn't using any qualifier other than age. 

 
How are those with children who are not yet school age handling daycare? We've been keeping our almost 15 month old son since March 9th and told daycare he will be home through April at least. 

My wife and I can both work from home so we are lucky there, but we basically have to take turns between working and watching our son. There is just too much we don't know for me to feel comfortable sending him back now or anytime soon, but there is no way my wife and I could keep this up beyond 2/3 months without losing our sanity. I'm so confused. 
We're doing the same with a 2.5yr old and 6mo old. Basically I'm getting nothing done, but trying to get the urgent work handled as best as possible. Still trying to figure out the end game, because I'm not sure when we'll feel comfortable sending them back to daycare. 

 
This is so confusing to me

We have record unemployment yet we cant find workers

:confused:
Farmers can't compete with international produce if they pay higher wages to workers who pick 30% as efficiently as the skilled laborers they typically use.

 

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