*** OFFICIAL *** COVID-19 CoronaVirus Thread. Fresh epidemic fears as child pneumonia cases surge in Europe after China outbreak. NOW in USA (17 Viewers)

[msommer]

The "hydration and cooling" folks, unless quite elderly, aren't going to have hospital stays. They've visit GPs or urgent care centers or similar. They will almost all convalesce at home.

The pneumonia/debris-in-lungs folks will require ventilators -- not necessarily place in an ICU room. Some Chinese communities have built COVID wards out of gymnasiums -- no private rooms or anything, just a bunch of bed+ventilator set-ups laid out in a grid. Some curtains separating some people, some other patients sharing floor space. Reminded me of a M*A*S*H unit set up indoors. I've seen pics, and can find them to post here.

From what I know of that type of ventilators, they have to be monitored (prettys sure they don't have bluetooth or wifi built in). But see @Redwes25's post above about the scarcity of ventilators compared to ICU beds.

 

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Facebook Cancels Annual Developer Conference (F8) this May because of Coronavirus: 

https://www.f8.com/

 

 

[hagmania]

I think the point about room/unit conversion is valid. I am also told at least twice a month in my company that we have a doctor and nurse shortage. So many units are using staffing these days.

 

[Doug B]

There are less of those then beds - https://www.ncbi.nlm.nih.gov/pubmed/21149215

This is a valid point. The response re: ventilators will be multifaceted.

For starters ... ventilator access will be triaged. Some hard decisions will be made and DNR notifications made effective. I'll leave it at that.

Secondly, similar machines such as pediatric and neonatal ventilators may need to be jury-rigged and brought to the fore.

Thirdly, ventilators will have to be shunted to where needed -- if Place A has a few spares and Place B has a need, ventilators will be moved.

Fourth and fifth are theoretical -- any ventilator equipment manufacturer that's in production (e.g. Chinese makers may or may not have to sit out) will need to give it all the gas they've got. If they can ramp up 10%, they ramp up. If they can only ramp up 1%, they do that. Additionally, companies that make other types of breathing apparatus (CPAPs, SCUBA, decompression equipment, NASA contractors, mining, etc.) will need to pitch in however they can -- direct manufacturing, parts, personnel, planning, etc.

 

[beer 30]

Consider as well, we are talking in absolutes regarding ICU availability. Assume we have 100k beds available, when this gets into full swing, what do we do with the folks currently occupying those beds? It's not like because the Wuhan Flu is in town nobody else gets critical care. Most ICU's I've been in are typically full up.

 

[hagmania]

An indirect consequence of these types of events will be disruption to the "normal" clinical care that goes on in a hospital. When units are taxed with abnormal conditions (be it patient demographic, acuity, staffing, nurse experience, etc) they perform differently, usually more poorly. It could lead to an overall strain of all clinical outcomes.

I really hope this is all just overreaction on my part.

 

[Redwes25]

What's the name of the podcast you're referring to?  Sorry if you've already said.  This thread is moving too fast to catch everything.

TIA

https://podcasts.apple.com/us/podcast/eric-feigl-ding-the-coronavirus-pandemic-is-inevitable/id1438148082?i=1000466793429

 

[Apple Jack]

At Denver airport and I've seen 8-10 people with masks. People are tripping out.  

 

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At Denver airport and I've seen 8-10 people with masks. People are tripping out.  

You do you. Let them do them. 

If you don't want to wear a mask, I don't blame ya. That's your call.  

If you're mocking people for wearing masks in a large international airport right now, you're CLEARLY either not paying attention, or not very bright.

I'll let you decide which one of the two it is, as I am trying to "be excellent"

 

[Doug B]

From what I know of that type of ventilators, they have to be monitored (prettys sure they don't have bluetooth or wifi built in).

My mother-in-law was on a ventilator for a few weeks last summer after a stroke. They're monitored remotely -- a handful of nurses (say, 3 to 10 depending on when you visited) kept track of several dozen patients' ventilators and other equipment. EDIT: There were also floor nurses and doctors who made rounds and could intervene -- and they could monitor ventilators either in the room directly or at various workstations set up in the hallways.

I don't think it's Bluetooth or WiFi, but the ventilators can and are monitored remotely. There are also automatic alarms that the ventilator (or the sensors placed on the heart/chest, O2 sensor on finger) throw if something untoward is sensed. There's not a human being sitting in front of the machine constantly 24/7 watching the readings.

 

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Consider as well, we are talking in absolutes regarding ICU availability. Assume we have 100k beds available, when this gets into full swing, what do we do with the folks currently occupying those beds? It's not like because the Wuhan Flu is in town nobody else gets critical care. Most ICU's I've been in are typically full up.

An indirect consequence of these types events will be disruption to the "normal" clinical care that goes on in a hospital. When units are taxed with abnormal conditions (be it patient demographic, acuity, staffing, nurse experience, etc) they perform differently, usually more poorly. It could lead to an overall strain of all clinical outcomes.

Bingo. Two best posts in the last several pages. 

 

[beer 30]

This is a valid point. The response re: ventilators will be multifaceted.

For starters ... ventilator access will be triaged. Some hard decisions will be made and DNR notifications made effective. I'll leave it at that.

Secondly, similar machines such as pediatric and neonatal ventilators may need to be jury-rigged and brought to the fore.

Thirdly, ventilators will have to be shunted to where needed -- if Place A has a few spares and Place B has a need, ventilators will be moved.

Fourth and fifth are theoretical -- any ventilator equipment manufacturer that's in production (e.g. Chinese makers may or may not have to sit out) will need to give it all the gas they've got. If they can ramp up 10%, they ramp up. If they can only ramp up 1%, they do that. Additionally, companies that make other types of breathing apparatus (CPAPs, SCUBA, decompression equipment, NASA contractors, mining, etc.) will need to pitch in however they can -- direct manufacturing, parts, personnel, planning, etc.

Funny you mention ventilators. From the Doc Feigl-Ding podcast, China has companies manufacturing 24/7 all the ventilators they can. I'm doubting they are going to part with production to help their GB's to the West in our time of need. They're consuming all they can put out now. Thik we're kinda screwed if we're relying on China right now, really anyone outside of the US.

 

[Sand]

Cruise ship is a pretty solid indicator.  Already (we are early) 4 deaths from 703 cases.  That’s 5 times as deadly as flu and that number should rise.  

What's the age profile of this group?  Cruise ship customers tend to be much older than the general population.

 

[Doug B]

Funny you mention ventilators. From the Doc Feigl-Ding podcast, China has companies manufacturing 24/7 all the ventilators they can. I'm doubting they are going to part with production to help their GB's to the West in our time of need. They're consuming all they can put out now. Thik we're kinda screwed if we're relying on China right now, really anyone outside of the US.

You do what you can do. If they can't come from China, you get them from somewhere else. You don't just say "Welp ... I guess we're not going to have ventilators!"

(There are Machiavellian businessmen in China -- if they can get cash for ventilators, they'll send them)

 

[Doug B]

Cruise ship is a pretty solid indicator.  Already (we are early) 4 deaths from 703 cases.  That’s 5 times as deadly as flu and that number should rise.  

What's the age profile of this group?  Cruise ship customers tend to be much older than the general population.

Without looking, I think one death from the Diamond Princess was in his/her 60s, the rest over 80. Gotta look it up.

Extrapolating mortality rate from the patients on that ship alone is a mistake, IMHO.

 

[culdeus]

Without looking, I think one death from the Diamond Princess was in his/her 60s, the rest over 80. Gotta look it up.

Extrapolating mortality rate from the patients on that ship alone is a mistake, IMHO.

It's the best group we got now because it's been a month since they locked them down. 

 

[Doug B]

Funny you mention ventilators. From the Doc Feigl-Ding podcast, China has companies manufacturing 24/7 all the ventilators they can. I'm doubting they are going to part with production to help their GB's to the West in our time of need. They're consuming all they can put out now. Thik we're kinda screwed if we're relying on China right now, really anyone outside of the US.

Let's peel this back a bit -- are we correct in assuming that China is a major player in ventilator manufacture? I mean, they make them for their own use for sure ... especially now. But who else is out there making them?

Global Ventilators Market - 50% Market Share Held by 5 Top Companies (8/31/2016)

The ventilators market is projected to reach $ 1,012.3 million by 2021, growing at a CAGR of 7.9% during the forecast period of 2016 to 2021 propelled by increasing number of hospitals and increasing per capita income while hospitals and clinics end-user segment accounted for the largest share of the global ventilators market ...

The global ventilators market is consolidated at the top with 5 companies accounting for more than half of the global market share.

The major players in the market include Philips Healthcare (Netherlands), ResMed Inc. (U.S.), Medtronic plc (Ireland), Becton, Dickinson and Company (U.S.), and Getinge Group (Sweden). Some of the other players in this market are Dräger Group (Germany), Smiths Group plc (U.K.), Teleflex Incorporated (U.S.), Hamilton Medical AG (Switzerland), and GE Healthcare (U.S.). 

EDIT: More recent info.

TOP 10 COMPANIES IN VENTILATORS MARKET (1/13/2020) (link fixed)

The U.S. has three of the top ten (mentioned above). Six are in Western Europe, and the remaining one is a New Zealand firm.

 

[Doug B]

Without looking, I think one death from the Diamond Princess was in his/her 60s, the rest over 80. Gotta look it up.

Extrapolating mortality rate from the patients on that ship alone is a mistake, IMHO.

It's the best group we got now because it's been a month since they locked them down. 

Not a good enough reason to accept them as a rest-of-the-world proxy, IMHO.

 

[culdeus]

Not a good enough reason to accept them as a rest-of-the-world proxy, IMHO.

Ok.  What do you plan on using and when then?

 

[shader]

Right. Which elements are a dire necessity for a coronavirus patient? I get the point on "ICU Beds" but it appears a ton of nuance is being bulldozed in the fervor and fever. 

No one in this thread is doing the "fervor and fever" dance.  No one knows what treatment is required.  China had enough issues "at one time" that they started building hospitals.  That's not going to happen in the USA.  No one is saying to panic and that we're all going to die.  We're highlighting some challenges that the US is going to face.  If you look around the internet, I think you'll find this thread is one of the most level-headed threads out there.  

If there are 327 million people in the US and 150M get the Wuhan virus, then that's a base-point.  Obviously it won't all happen at once...

If the Chinese study which states that 5% of people get severe cases, that would mean that 7.5M people will get severe cases.  Maybe spread over a period that's fine in your eyes.  I don't agree, but then I'm also not a medical professional.  I'm just pointing out some difficulties.

And yeah, there are one million beds in the US, but there aren't 1 million empty beds.  It's a major problem, but hopefully 150M people won't get the Wuhan virus.

 

[JerseyToughGuys]

Ok.  What do you plan on using and when then?

Are we using that cohort to wildly speculate about proper prep? Something more constructive? I think the answer matters. 

 

[Smack Tripper]

Preach on.

...

The "not enough ICU beds!" thing must be a talking point somewhere -- I'm going to go so far as to say that number of ICU beds doesn't matter a whit.

A broom closet with a comfy bed and a ventilator ... that's your bare-bones COVID treatment room. I exaggerate, but little.

In my experience, the most important part of the icu was in general general better ratios of doctors and nurses 

 

[JerseyToughGuys]

No one in this thread is doing the "fervor and fever" dance.  No one knows what treatment is required.  China had enough issues "at one time" that they started building hospitals.  That's not going to happen in the USA.  No one is saying to panic and that we're all going to die.  We're highlighting some challenges that the US is going to face.  If you look around the internet, I think you'll find this thread is one of the most level-headed threads out there.  

If there are 327 million people in the US and 150M get the Wuhan virus, then that's a base-point.  Obviously it won't all happen at once...

If the Chinese study which states that 5% of people get severe cases, that would mean that 7.5M people will get severe cases.  Maybe spread over a period that's fine in your eyes.  I don't agree, but then I'm also not a medical professional.  I'm just pointing out some difficulties.

And yeah, there are one million beds in the US, but there aren't 1 million empty beds.  It's a major problem, but hopefully 150M people won't get the Wuhan virus.

 

[Doug B]

Not a good enough reason to accept them as a rest-of-the-world proxy, IMHO.

Ok.  What do you plan on using and when then?

You aggregate the data sets from the most open countries fighting COVID right now -- South Korea, Italy, Japan, Singapore, etc. The U.S. and Germany will also very soon will start having enough helpful in-country data to add.

EDIT: and JerseyToughGuy's question is a good one. What does a right-now mortality rate tell us that direct experience with patients doesn't? In terms of how to fight an outbreak?

 

[shader]

Without looking, I think one death from the Diamond Princess was in his/her 60s, the rest over 80. Gotta look it up.

Extrapolating mortality rate from the patients on that ship alone is a mistake, IMHO.

I don't think anyone is doing that

 

[Apple Jack]

You do you. Let them do them. 

If you don't want to wear a mask, I don't blame ya. That's your call.  

If you're mocking people for wearing masks in a large international airport right now, you're CLEARLY either not paying attention, or not very bright.

I'll let you decide which one of the two it is, as I am trying to "be excellent"

The CDC does not recommend masks.

 

[msommer]

Ok.  What do you plan on using and when then?

What about South Korea? 

ETA: first case was about a month ago (just before Diamond Princess afaics

 

[Doug B]

I don't think anyone is doing that

Want me to link to it?

EDIT: See a few posts down. C'mon man ... own the extrapolation  

 

[JerseyToughGuys]

Pretty concise well-organized info on the normal flu burden here:

https://www.cdc.gov/flu/about/burden/index.html

obv corona is more serious. 

 

[Doug B]

The CDC does not recommend masks.

Been over this. Not your fault ... your new to the thread. Just know and accept that Icon is wearing his masks when out and about.

 

[moleculo]

No one in this thread is doing the "fervor and fever" dance.  No one knows what treatment is required.  China had enough issues "at one time" that they started building hospitals.  That's not going to happen in the USA.  No one is saying to panic and that we're all going to die.  We're highlighting some challenges that the US is going to face.  If you look around the internet, I think you'll find this thread is one of the most level-headed threads out there.  

If there are 327 million people in the US and 150M get the Wuhan virus, then that's a base-point.  Obviously it won't all happen at once...

If the Chinese study which states that 5% of people get severe cases, that would mean that 7.5M people will get severe cases.  Maybe spread over a period that's fine in your eyes.  I don't agree, but then I'm also not a medical professional.  I'm just pointing out some difficulties.

And yeah, there are one million beds in the US, but there aren't 1 million empty beds.  It's a major problem, but hopefully 150M people won't get the Wuhan virus.

Here's some rough numbers I just ran:

assume:

• US population = 300M
  
• 60% contract COVID-19
  
• assume an equal distribution (not realistic, but the math is simple): spread that over a year, and we are looking at 3% every two weeks
  
• That gives us 7.5M people being diagnosed with COVID-19 every two weeks
  
• assume 5% are severe
  
• that puts 375k with severe condition
  

That means we have to double the number of beds?  that doesn't seem impossible.  of course, there will be peak times where the bed requirement is MUCH higher. 

Really, this should highlight why slowing the spread is super, super important.

 

[Doug B]

Cruise ship is a pretty solid indicator.  Already (we are early) 4 deaths from 703 cases.  That’s 5 times as deadly as flu and that number should rise.

Good point. Thanks! 

And crap. 

Shader -- it was you! I thought it was culdeus who posted the extrapolation. My mistake.

 

[ProstheticRGK]

Plus, "number of ICU beds" is not a finite number -- or necessarily even a relevant number.

A ready-built ICU room has A LOT of equipment not needed to specifically treat a COVID patient. If a facility needs extra "acute COVID care" wards/rooms, you set them up on the fly out of ordinary patient rooms or whatever floor space you have. (@Terminalxylem ?)

The "number of ICU beds" represent not only physical beds and associated equipment (wall suction, medical gas outlets, emergency power outlets) but, staffing. Even if you could somehow convert regular hospital beds to ICU beds and produce a ton of ventilators and rotoprone beds, you will be left with enlisting a bunch of staff that don't have the requisite training/experience to deal with critically ill people. I can speak from firsthand experience, in the area of the first confirmed community-acquired case, this flu season is already taxing our resources. A huge uptick in critically ill respiratory cases, requiring long-term care (2-3 weeks) will result in a tragedy.

 

[Doug B]

A huge uptick in critically ill respiratory cases, requiring long-term care (2-3 weeks) will result in a tragedy.

"Tragedies", even. But up to a point, you do what you can. Can't lie and pretend everyone can be saved ... that there'll be no bad individual outcomes, etc.

It's a matter of degree -- do resources (facilities, equipment, personnel) get overwhelmed to the point of having 500 COVID deaths in the U.S. or 50,000? Worse? Better? I know that throwing hands up in advance won't help anyone.

 

[MTskibum]

Here's some rough numbers I just ran:

assume:

• US population = 300M
  
• 60% contract COVID-19
  
• assume an equal distribution (not realistic, but the math is simple): spread that over a year, and we are looking at 3% every two weeks
  
• That gives us 7.5M people being diagnosed with COVID-19 every two weeks
  
• assume 5% are severe
  
• that puts 375k with severe condition
  

That means we have to double the number of beds?  that doesn't seem impossible.  of course, there will be peak times where the bed requirement is MUCH higher. 

Really, this should highlight why slowing the spread is super, super important.

100 million people under the age of 25. Assuming that age group never needs to go to the hospital for this then it may mean only 225k at a time needing hospital care.

 

[shader]

Want me to link to it?

EDIT: See a few posts down. C'mon man ... own the extrapolation  

I said it's an important indicator.  But I never said it alone is all we need.  

 

[Redwes25]

Let's peel this back a bit -- are we correct in assuming that China is a major player in ventilator manufacture? I mean, they make them for their own use for sure ... especially now. But who else is out there making them?

EDIT: More recent info.

TOP 10 COMPANIES IN VENTILATORS MARKET (1/13/2020)

The U.S. has three of the top ten (mentioned above). Six are in Western Europe, and the remaining one is a New Zealand firm.

yeah, but where do they make them.  US companies don't always make their stuff in the good old US of A.

 

[msommer]

The "number of ICU beds" represent not only physical beds and associated equipment (wall suction, medical gas outlets, emergency power outlets) but, staffing. Even if you could somehow convert regular hospital beds to ICU beds and produce a ton of ventilators and rotoprone beds, you will be left with enlisting a bunch of staff that don't have the requisite training/experience to deal with critically ill people. I can speak from firsthand experience, in the area of the first confirmed community-acquired case, this flu season is already taxing our resources. A huge uptick in critically ill respiratory cases, requiring long-term care (2-3 weeks) will result in a tragedy.

Monitoring ventilators is not a task that requires much training, you certainly don't need to be a nurse to do that. That said, some trained medical staff oversight for when things go sideways will be required.

 

[Doug B]

100 million people under the age of 25. Assuming that age group never needs to go to the hospital for this then it may mean only 225k at a time needing hospital care.

... way things are looking, you can pretty much throw out all reasonably healthy Americans under 60. I guess your 55-year-old guy that walks an hour a day and eats decently is at somewhat more of a risk than the 30-year-old overweight guy. But in general, that kind of stuff should smooth out in your under-60 set of Americans.

 

[Doug B]

I said it's an important indicator.  But I never said it alone is all we need.  

Don't tell me, tell shader  

 

[ProstheticRGK]

"Tragedies", even. But up to a point, you do what you can. Can't lie and pretend everyone can be saved ... that there'll be no bad individual outcomes, etc.

It's a matter of degree -- do resources (facilities, equipment, personnel) get overwhelmed to the point of having 500 COVID deaths in the U.S. or 50,000? Worse? Better? I know that throwing hands up in advance won't help anyone.

I'm with you, brother. Just trying to wrap my head around being front line staff at what might be ground zero. Needless to say, this is going to be an interesting decelopment, and I'm all in on taking this pretty seriously.

 

[B-Deep]

Yashar Ali
@yashar
1h

Per Governor @GavinNewsom, California is monitoring 8,400 people for Coronavirus. "We knew this was inevitable," he says

 

[shader]

Shader -- it was you! I thought it was culdeus who posted the extrapolation. My mistake.

It is a pretty solid indicator.  I honestly don't know where you're going with this.  I never said the cruise ship alone should be used.  But it is solid because it's the first controlled environment from which we can pull some solid numbers.

 

[Redwes25]

100 million people under the age of 25. Assuming that age group never needs to go to the hospital for this then it may mean only 225k at a time needing hospital care.

yeah, and we don't have resources for 225K

 

[jb1020]

Yashar Ali
@yashar
1h

Per Governor @GavinNewsom, California is monitoring 8,400 people for Coronavirus. "We knew this was inevitable," he says

Great!  I fly out to Palm Springs Saturday.  

 

[ProstheticRGK]

Monitoring ventilators is not a task that requires much training, you certainly don't need to be a nurse to do that. That said, some trained medical staff oversight for when things go sideways will be required.

I disagree, and so do all the RN boards and associations around the country. But, besides the point, the risk of other comorbidities and complications requiring critical care require specialized training and experience recognizing how to react to the progression of disease. If you don't have good RNs, you better have really good, diligent Intensivists.

 

[msommer]

I disagree, and so do all the RN boards and associations around the country. But, besides the point, the risk of other comorbidities and complications requiring critical care require specialized training and experience recognizing how to react to the progression of disease. If you don't have good RNs, you better have really good, diligent Intensivists.

Well, I suppose we'd better hope that either you are wrong or the covid-19 fizzles before tragedies occur because of lack of monitoring personnel (and/or union rules) 

 

[moleculo]

100 million people under the age of 25. Assuming that age group never needs to go to the hospital for this then it may mean only 225k at a time needing hospital care.

no - assuming the US population distribution by age is similar to China, these numbers are already baked in.  it simply means that the number of people needing intensive care would skew towards the elderly, which should not surprise anyone.

 

[beer 30]

Here's some rough numbers I just ran:

assume:

• US population = 300M
  
• 60% contract COVID-19
  
• assume an equal distribution (not realistic, but the math is simple): spread that over a year, and we are looking at 3% every two weeks
  
• That gives us 7.5M people being diagnosed with COVID-19 every two weeks
  
• assume 5% are severe
  
• that puts 375k with severe condition
  

That means we have to double the number of beds?  that doesn't seem impossible.  of course, there will be peak times where the bed requirement is MUCH higher. 

Really, this should highlight why slowing the spread is super, super important.

And to further the point home, it's not like all the available beds are in the right place. If Atlanta/Chicago/New York or any other large city gets hit hard, they will be overwhelmed almost overnight. Keep in mind China is welding doors shut to keep their populace isolated, a city of 11 million is a virtual ghost town. That absolutely will not happen here so the ramifications of a mobile populace spreading this #### around has to be astronomically higher.

Karen is going to send little Jimmy to school damnit! Screw the government telling her what to do.

 

[Doug B]

yeah, but where do they make them.  US companies don't always make their stuff in the good old US of A.

None of ResMed's devices are manufactured in China -- plants are in the U.S., Australia, France, and Singapore.

GE Healthcare has a much more distributed manufacturing footprint worldwide, but there are major plants in the Boston and Chicago areas.

Becton Dickinson is also worldwide like GE, but major facilities are in NJ,  Connecticut, Spain, Singapore, and Japan.