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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)

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For folks in states that have had sit-down restaurants shut down.... does that include fast food?  Are they doing drive-through only?  

For now I'm still working from my office and absolutely need the hour away from my desk.  
I think anyone who goes and gets food from a fast food restaurant is kinda nuts. Nearly none of the fast food joints offer their employees paid sick leave. They also make peanuts and are typically living paycheck to paycheck. All sorts of sick people are going to be preparing your food

 
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I'm older than him if it makes you feel better. His Skype IMs slowed down after I told him his friends were idiots. I wanted to feel bad about hurting his feelings but I just really couldn't because, well, this is just high-level stupid.
In his defense, he didn't know the girl's husband tested positive or went to Milan before agreeing to go to the movies.  Also, do you know for sure she was in contact with the husband?  Maybe he was positive and went straight to quarantine away from her?

 
I have to take my brother to an outpatient surgical center tomorrow.  I’ve made efforts to really isolate myself and my family but there is no getting out of this one.  I’m scared

 
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I went out with some buddies on Saturday night.  Sat at bar table in an upscale Mexican restaurant.  Went for another drink at another place.  Ended up not bar-hopping.  Now it looks like bars are going to close for the foreseeable future.  

School is closed until 3/27, thinking it will go beyond that.

Wife works nights at Starbucks and they're closing at 8pm, so not sure how  she's going to be affected.

Good luck out there, everyone.  Wash those hands!  :)

 
SoBeDad said:
The same thing is happening in Miami Beach. Early closing and reduced capacity at restaurants. The most touristy  part of Ocean Drive is closed to prevent large crowds. Shutting it down completely is a last resort, whose time may come. But there will be tremendous economic consequences to workers and the county tax base which depends on tourist taxes. 
Have heard bars and restaurants asked to close by 11 in Miami.  Am sitting in a terminal in Philadelphia right now awaiting a flight to South Beach.

 
It is what it is . . . I was just replying to someone else who was depressed about Little League games being cancelled.
I get it.    It is disappointing.  My cousin coaches a HS BB team and he felt he had a legit shot at a state title. Everyone is in the same boat.

 
I'm older than him if it makes you feel better. His Skype IMs slowed down after I told him his friends were idiots. I wanted to feel bad about hurting his feelings but I just really couldn't because, well, this is just high-level stupid.
Maybe you could share some of the stuff we've had here?  Especially the WaPo visualization about staying home and how that will benefit everyone?  Also, he should self-quarantine for at least 10 days now.

 
Worst case scenarios are for projections which are reasonably possible.  Something with an 0.001 percent chance do no qualify.  
why do you think 0.001% chance for my worst case?  I gave you my numbers I used to estimate 11M+ dead Americans:

327M population (your google is as good as mine)

70% infection rate - Angela Merkel says 60%-70% of Germans will catch COVID.  Why would we assume less here, especially when considering worst case?

5% mortality - Hubei province is at 4.57%.  you can bet they have tested everyone possible there - this isn't a spot where the number of cases is a function of lack of testing... further, Italy is currently at 7.31%.  If anything, 5% is entirely realistic, barring governmental intervention.

330M * 70% * 5% = 11.4M.  period.  That's worst case.  You can say worst case is not likely and I would agree with you but you specifically said that worst case, this won't scratch top 10 deaths in US.

By the way - the #10 cause of death in the US is suicide at 47k.   At the rate we are presently going (assuming fatalities increase by 20% per day, which is a pretty good estimate of what we have seen for the past couple of weeks), we will eclipse 47k on April 5th.

 
It is what it is . . . I was just replying to someone else who was depressed about Little League games being cancelled.
Yea I think all spring sports for schools might be cancelled. Right now they're just postponed until 4/1. I think that will be longer though.

 
I think anyone who goes and gets food from a fast food restaurant is kinda nuts. Narly none of the fast food joints offer their employees paid sick leave. They also make peanuts and are typically living paycheck to paycheck. All sorts of sick people are going to be preparing your food
yeah, but Shamrock Shakes are only there a couple of more days. 

 
Italy reports 3,233 new cases and 349 new deaths.  Their death rate is horrific and so unbelievably sad.

I suppose if you're looking for good news, they reported 3,497 new cases on Saturday and 3,590 on Sunday.

So perhaps the quarantine is finally having an impact as the exponential growth appears to be slowing down.

 
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Italy reports 3,233 new cases and 349 new deaths.  Their death rate is horrific and so unbelievably sad.

I suppose if you're looking for good news, they reported 3,497 new cases on Saturday and 3,590 on Sunday.

So perhaps the quarantine is finally having an impact as the exponential growth appears to have stopped.  
That actually does seem like positive news, relatively speaking 

 
moleculo said:
cliffs notes?
Sorry - just getting to this.  Nothing earth shattering but he was just reiterating that people need to essentially quarantine themselves if they have the option.  Anything that is not required should be eliminated for now.  No going to dinner, no going to other peoples houses, no play dates, etc.  It's just not worth it and every little bit does help some.  If we can get people to just do this it will help - we'll probably never know how much but it will undeniably help.

 
I think anyone who goes and gets food from a fast food restaurant is kinda nuts. Nearly none of the fast food joints offer their employees paid sick leave. They also make peanuts and are typically living paycheck to paycheck. All sorts of sick people are going to be preparing your food
They also have no problem skipping work when they are sick or not sick on a very regular basis. I would be far more worried about a place that the employees rely on tips.  

 
Waingro said:
One of my buddies is an MD and has been treating Coronavirus patients for the last 72 hours. He sent out an email sharing his experience. I figure I'd share here. 


  Reveal hidden contents
Hey everyone,

I thought I would write this to shed some light on my own experience with Coronavirus over the last 72 hours in my ER. Currently I work in White plains and I was supposed to start a new position in their observation unit March 1st ( this is basically a urgent care) within the ER but they asked me if would volunteer for their "COVID" station and without hesitation I agreed. 

First of all it has been affecting all ages except people under 17 years old and the sickest patients that I have seen have been females from 20 - 40 years old with no previous medical history.

The contagiousness of a disease is recorded by something called an R value. Currently the R value of coronavirus is a 2 to 4 meaning its on the same wavelength as the FLU. Just because you have been in direct contact with someone or even sleep next to someone does not mean that you are going to acquire it. It is spread through something called droplet meaning that a regular mask will help but you need something called an N - 95 mask which lets smaller particles through for true protection. If you really want pure protection you need a PAPR( powered air purifying respirator) which is something that I wear when evaluating patients  

The virulence of the disease has been interesting to me. I have sent home multiple people with just mild cough and body aches. The persons who have been really sick have been presenting more with abdominal pain . Temperature has not really been indicative of COVID 19. Their are 2 main things I am seeing on lab values that are correlating with worse morbidity and that is lymphopenia and elevated liver functions primarily AST and alk phos. ( going back to above probably related to the abdominal pain.) 

The course of the disease is also very indolent until day 3 - 5  where a very small amount of patients are presenting with ARDS ( acute respiratory distress syndrome) this is a fancy word for meaning patients lungs are filling up with fluid due to something called interstitial capillary leak. We have intubated a handful of healthy young individuals due to this progression. We have not had any deaths at our hospital yet however we have needed the help of positive airway pressure these are those masks that people wear called BIPAP ( very similar to the CPAP masks that you use for sleep apnea. ) If you continue to need more airway pressure then you have to be intubated and  may require something called ECMO ( extra corporal membrane oxygenation : fancy word for a lung machine.) It basically bypasses your lungs and breathes for you. We have had only 1 case over the last weekend requiring this.

Overall in a 72 hour period of seeing coronavirus patients the majority of them are coming in complaining of cough / malaise ( not feeling well). Few have been healthy young adults requiring intubation.

The things we have found out about treating these patients is that NOT giving IV fluids is key ( this is something that goes against every principle about acute care medicine ) . Also some medications that have been helping are antivirals ( ketruda ) something we use for AIDS and also hydroxychloroquine something we use for rheumatological disease like arthritis. Steroids do not seem to help so far from what I have observed. 

Overall I have been asked a million questions and I made a small Q and A here :

Can children get it?

I have seen zero people under the age of 17 with coronavirus. I believe this is because the virus likes to attack mature lymphocytes which are not yet competent in children so they are not being affected.

Is the virus only affecting the elderly?

Definitely not. The sickest patients at our hospital have been young healthy women from the ages of 20 - 40

Is there medications to combat this?

no there are none currently that a proven effective however we are using 2 medications which may help. Chloroquine helps to block viral entry into the cells. Keytruda is something called a protease inhibitor used in HIV / AIDS patients to help stop the replication of the virus.

What are the most typical symptoms?

Cough and fever. There have been multiple presentations of the disease so it is hard to diagnose just by physical exam. 

Can you get tested for it? and should you get tested for it?

Yes you can get tested for it. I have tested over 50 people the last 3  days and the turnaround time was about 2 days however this will be prolonged with more tests being taken.  However testing does not change your overall outcome of the disease. If you are experiencing significant signs of shortness of breath we will admit you to the hospital. If you are experiencing typical flu like symptoms the smartest thing is to remain at home and try and ride it out.  

What is the mortality rate?

Its impossible to determine because we cannot accurately say how many people have the disease since most are walking around asymptomatic. However you can calculate the case fatality rate which is 3.4 % from multiple sources I have read 

Will hospitals be able to handle this?

yes. for now. My hospital has done a great job of creating negative pressure beds which helps stop the spread of the virus and they have given us the highest level of protective gear. They have moved out as many patients as possible to gear up for this upcoming week. 

Is there a vaccine for it?

No. Vaccines take a while for virus'

Is the Quarantine necessary ?

Yes for now. This helps hospitals not be overwhelmed especially if we need ventilators / ECMO machines to help those in real need.

How long is the quarantine?

We are mandating 2 weeks

I have included a great one page summary of Coronavirus that was forwarded to me from a friend who is currently working at an ICU in Seattle. Overall I believe the government did the right thing of shutting everything down so we could get a hold of this thing and understand its true potential. Only time will tell to see how this virus truly behaves over the next week. I hope this was insightful for those who have been worried. As of right now I am not that concerned about it but this may change... I have only been dealing with this disease for 72 hours. 

Stay safe everyone I hope this helps from my own personal experience. Feel free to share this with friends if it helps put them at ease. Also if anyone has any questions feel free to ask 

xxx xxxxxx MD
Every health care professional who is on the front lines of this thing deserve a ton of respect and applause. Stay safe everyone.  
Keytruda is not an antiviral nor is it used for HIV.

AlsonI’d be very surprised if EDs are employing the kind of treatments he mentions.

Which makes me think that perhaps he heard this information second hand from his hospitalist/intensivist colleagues, explaining his error. Thus I take the rest with a grain of salt and let’s all remember to avoid generalizations from anecdotes.

 
and it's not just sports with the kids ... my daughter has confirmation, grammar school graduation, spring dance recital, spring choir concert, her guitar & piano concerto, spring track championships, Girl Scouts camping weekend -  all postponed or cancelled at this time.  she's worked and practiced and studied her ### off for all of that, just as much as any kid playing baseball, etc (and more pricey, i assure you).

 but what can ya do?

there's a bigger world out there than just sports, people.  kids do other things.  

 
My father in law is a stubborn pain in the ###. He's 82. He had a doctor's appointment scheduled for today. My wife and her sister told him several times to cancel it but of course he goes. The doctor gave him the 3rd degree and lectured him on just how big an idiot he is. He told my wife to take his keys if you need to because he is the most vulnerable from this thing. 

Now it could have been anger to scare my FIL but he was saying it's going to be a minimum of 12 weeks isolation. They are showing a 15% death rate in his age group. Pretty much the whole school year, business and sports are going to be done. He went on about how we're going to lose a lot of our elderly population in the next few months. 

Take it for what it is. A doctor maybe trying to scare a stubborn old man into being safe or he himself is scared about what he's been shown. 

 
Big League Chew said:
If you were the daycare provider what would you do?
I used to be involved in the daycare business and still know some people in it, including an in-law that operates a 200+ child facility. They got a directive from the state DHS yesterday saying they are "...committed to helping keep child care programs open during this time of crisis. Child care is a vital resource for many of our first responders who are actively assisting our friends, family, and neighbors."

Given that, they are doing everything they can to stay open. Lots of families of hospital workers and the like attend their center. But they are very worried right now, not just about their business, but about everyone involved. Parents, kids, employees all relying on them.

 
Everyone in this thread interested in COVID treatment needs to read this. There are a lot of things that "everybody knows" about COVID that are directly countered in this post.

1) COVID will present with a fever almost every time, so a fever is a good marker: Not so.

2) Under 40s have little to fear. Plus women fare better than men: This doctor's most serious patients so far have been women aged 20-40.

3) Newly hospitalized COVID patients will need the standard IVs flu patients typically get: Instead, they are finding that IVs are a bad idea. The pull quote below gives some not-widely-known info about front-line treatment of COVID.

"The things we have found out about treating these patients is that NOT giving IV fluids is key ( this is something that goes against every principle about acute care medicine ) . Also some medications that have been helping are antivirals ( Keytruda ) something we use for AIDS and also [hydroxychloroquine that] we use for rheumatological disease like arthritis. Steroids do not seem to help so far from what I have observed."


In all fairness this is a tale about 72 hours if I read it right. So, should be prefaced with "preliminary observations"


We even sure that is a real post? How many communities outside of washington would even have had that many cases to deal with? 

Didnt white plains only have 3 cases two days ago? 
I think it fair to be skeptical. 

The email and the individual are definitely real however I think it is fair to still take his observations and experiences with a grain of salt. This is just one MD's experience, only 72 hours of anecdotal data, only a handful of patients, etc... 

I think the larger point is that there is still so much that we do not know about the disease and treatments. As far as how we approach our own day to day lives, IMO, it is best to approach the next few weeks/months with extreme caution. Isolate yourselves, wash your hands, sanitize, wear a mask and gloves in public, avoid crowds etc.... 

Be safe friends.

 
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Keytruda is not an antiviral nor is it used for HIV.

AlsonI’d be very surprised if EDs are employing the kind of treatments he mentions.

Which makes me think that perhaps he heard this information second hand from his hospitalist/intensivist colleagues, explaining his error. Thus I take the rest with a grain of salt and let’s all remember to avoid generalizations from anecdotes.
Definitely fair. 

He shared with his family and friends and thought it was worth sharing with this community. 

 
Keytruda is not an antiviral nor is it used for HIV.

AlsonI’d be very surprised if EDs are employing the kind of treatments he mentions.

Which makes me think that perhaps he heard this information second hand from his hospitalist/intensivist colleagues, explaining his error. Thus I take the rest with a grain of salt and let’s all remember to avoid generalizations from anecdotes.
So you don't believe that they are using Keytruda as an emergency experimental treatment based on phase 1 trial results in HIV patients with cancer and that this guy that works in a city that has only had a few cases can be relied on to give all of these sweeping generalizations??? 

Pfffft. Whats next, you will tell me that there arent kids named orangejello and lemonjello? I mean three separate FBGs have said that their wives or friends have kids at their schools named that, has to be reliable. 

 
and it's not just sports with the kids ... my daughter has confirmation, grammar school graduation, spring dance recital, spring choir concert, her guitar & piano concerto, spring track championships, Girl Scouts camping weekend -  all postponed or cancelled at this time.  she's worked and practiced and studied her ### off for all of that, just as much as any kid playing baseball, etc (and more pricey, i assure you).

 but what can ya do?

there's a bigger world out there than just sports, people.  kids do other things.  
My daughter's junior prom will almost certainly be cancelled. I don't think she's realized that yet...

 
Statorama said:
Numbers Update

I know this is a time of great panic, and I don't want to minimize anyone's suffering if they've experienced a loss due to this virus.  But I want to take a second to point out a positive

Total number of confirmed global cases = 170,150
Total number of confirmed global deaths = 6,513
Total number of confirmed recoveries = 77,254

On a planet of 7.8 BILLION people, the numbers show that if you are one of the few that contracts it, chances are pretty dang good you'll recover (especially if you're not in a high risk group).  The more we find out about it, those numbers could get even better.

It's ok to try and post silver linings right?  Or are we in 'We're all doomed' mode forever?
No no keep these coming 

 
So I have a staff member who had his wife come back from Colorado and was feeling not so great. He was sitting in a meeting and she text him she's running a fever 99.5. 

He was taking good precautions but was in close proximity to other staff members. Sent him home immediately. 

Another staff member has a son returning from Colorado from a County that should be quaratnined when they return to KS. He stays at her house. I assume she is quaratined too if he stays with her. 

The first one is more questionable. Quarantine him? What about the staff members close to him?  

 
Doug B said:
Ah. Well, the touching only matters if the handler coughed/sneezed/licked/nuzzled on their hands and did not 'wash up + don gloves' before handling your order. Straight-up coughing on your food shouldn't be happening, but ... that's a matter that speaks to each individual's risk tolerance.
I bought store cut/packaged fruit yesterday without it occurring to me until the check-out line. Went ahead and bought it.

 
Italy reports 3,233 new cases and 349 new deaths.  Their death rate is horrific and so unbelievably sad.

I suppose if you're looking for good news, they reported 3,497 new cases on Saturday and 3,590 on Sunday.

So perhaps the quarantine is finally having an impact as the exponential growth appears to be slowing down.


Deadliest day for Italy so far. Nearly 400 deaths in 1 day.
Starting this by saying the deaths are awful and I feel terrible for them and their families. But just wanted to point out that, and I mean this with all the compassion possible by saying this, deaths are a lagging indicator while new cases are a leading indicator. If this new case 3 day trend in Italy holds, it does seem to appear that they may have stemmed the tide of exponential growth. Those 3 numbers are fairly level. I want to end this by reiterating how awful the deaths are but that there may be a favorable trend in new cases there.

 
They are a mess. We got 5x as many people. If we were in as bad a shape as them, I would think we would have passed them right up by now in 'serious or worse' cases.
Yeah, I don't think you understand quite how this works.

Give it a couple weeks.

 
Starting this by saying the deaths are awful and I feel terrible for them and their families. But just wanted to point out that, and I mean this with all the compassion possible by saying this, deaths are a lagging indicator while new cases are a leading indicator. If this new case 3 day trend in Italy holds, it does seem to appear that they may have stemmed the tide of exponential growth. Those 3 numbers are fairly level. I want to end this by reiterating how awful the deaths are but that there may be a favorable trend in new cases there.
new cases are lagging too...I remember reading an article wher eit took about a week for shutting everything down in Wuhan to show up in a decrease in new cases... i.e. it takes about a week or more for infections to present themselves to the point where the pserson needs checked out from the time they are initially infected.

 
This is what's truly scary.  In our town we have one serious case.  Guy is 40 years old.   I know someone who knows 2 people ages 28 and 30 who are in serious condition.  It's starting to feel like this isn't an older person problem as we were led to believe.   
Reports have been for months that this impacts young people as well (other than kids). Reporting has been very bad on that as well as public officials discussing it. 

 
So I have a staff member who had his wife come back from Colorado and was feeling not so great. He was sitting in a meeting and she text him she's running a fever 99.5. 

He was taking good precautions but was in close proximity to other staff members. Sent him home immediately. 

Another staff member has a son returning from Colorado from a County that should be quaratnined when they return to KS. He stays at her house. I assume she is quaratined too if he stays with her. 

The first one is more questionable. Quarantine him? What about the staff members close to him?  
Those can be difficult I'm sure. I guess the other big part of the equation is how possible is they can be productive in working from home? That kind of thing factors in too as you well know. Best to you there in trying to manage. I know you're doing your best there. Hang in there. 

 
new cases are lagging too...I remember reading an article wher eit took about a week for shutting everything down in Wuhan to show up in a decrease in new cases... i.e. it takes about a week or more for infections to present themselves to the point where the pserson needs checked out from the time they are initially infected.
That’s true, probably should have said new cases are “more of a leading indicator”, technically speaking they are a lagging indicator by definition. IIRC, I believe Italy instituted their full quarantine around a week or so ago. So having said that, to your point, it would seem that around a week later cases would level off, which appears to hopefully be the case in Italy now. I’m certainly no expert in anything BTW, but given what countries have done to help stem the tide on this, we really need to be extreme with our social distancing to the point where we are all basically self quarantinning. For the good of everyone.

 
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