PlagueWatch 2020-23 - Coronavirus

[Kdogg]

Possibly. I thought there was a $50k per employee cap. Not even close to relevant in my business...

$100k cap per employee.

[Jeffrey]

Possibly. I thought there was a $50k per employee cap. Not even close to relevant in my business...

His ~ 50 small businesses probably employ 1,500 or more aggregate employees. Maybe he only gets $20 million for free. It’s a hard life!

[Jeffrey]

$100k cap per employee.

Great, I’m back to my $25-50 million estimate. Life is not so hard anymore!

[proelitedota]

https://www.nytimes.com/2020/04/03/w...l#link-5b34591

I think our president should follow the CDC guidelines and wear a DIY mask to lead by example.

[sagegrouse]

Possibly. I thought there was a $50k per employee cap. Not even close to relevant in my business...

Well, I believe it is capped at $100K, including some measure of benefits (retirement contributions, maybe). Read the Q&A yesterday -- couldn't find it right now.

[Mtn.Devil.91.92.01.10.15]

Well, I believe it is capped at $100K, including some measure of benefits (retirement contributions, maybe). Read the Q&A yesterday -- couldn't find it right now.

If you make $100k in eight weeks, God bless you.

[Dr. Rosenrosen]

https://www.nytimes.com/2020/04/03/w...l#link-5b34591

I think our president should follow the CDC guidelines and wear a DIY mask to lead by example.

An instructional picture might help:

462390A7-33E7-4882-A8FC-D40BDE15FCA9.jpeg

[Kdogg]

If you make $100k in eight weeks, God bless you.

100k per year. If you make 120k or 10 million the max that can be used for the calculation is 100k divided by 12 for the base figure.

[proelitedota]

An instructional picture might help:

462390A7-33E7-4882-A8FC-D40BDE15FCA9.jpeg

I don't understand your point.

Are you suggesting we shouldn't wear face covering because it's un-American, when the science is pointing to asymptomatic people as the main source of the spread of virus?

Also the mask that Xi is wearing is not a DIY mask like the CDC is recommending.

[Kdogg]

I don't understand your point.

Are you suggesting we shouldn't wear face covering because it's un-American, when the science is pointing to asymptomatic people as the main source of the spread of virus?

Also the mask that Xi is wearing is not a DIY mask like the CDC is recommending.

I think it is more of a “Lead by example” thing.

At the the press conference saying masks should be used he said he would not use them (implying a vanity justification.) I don’t think any kings, queens, dictators or prime ministers (his words) will be coming to the White House anytime some.

[cato]

His ~ 50 small businesses probably employ 1,500 or more aggregate employees. Maybe he only gets $20 million for free. It’s a hard life!

He might not qualify under the affiliation rules. Curious if you have read about the program?

[Jeffrey]

He might not qualify under the affiliation rules. Curious if you have read about the program?

Not really. I’ve only read a one page overview. That’s why I was asking questions here.

He is a partial (usually majority) owner in 50-100 small businesses. Most are in his family trust. His bank is his only business with more than 500 employees and would not qualify.

[cato]

Not really. I’ve only read a one page overview. That’s why I was asking questions here.

He is a partial (usually majority) owner in 50-100 small businesses. Most are in his family trust. His bank is his only business with more than 500 employees and would not qualify.

I haven’t drilled down on the affiliation rules, but as I understand it, the punchline is that PE and VC financed companies will likely not qualify, with exceptions for restaurant/hospitality businesses, which are considered on a location by location basis.

[Dr. Rosenrosen]

I think it is more of a “Lead by example” thing.

At the the press conference saying masks should be used he said he would not use them (implying a vanity justification.) I don’t think any kings, queens, dictators or prime ministers (his words) will be coming to the White House anytime some.

Yes. My point was that our president doesn’t want to wear a mask. But he likes pictures. And he likes Xi Jinping. Therefore, a picture of Xi wearing a mask might be helpful in reminding our guy that it’s okay for world leaders to wear a mask and perhaps might even get him to lead by example. (For clarity: it was meant to be tongue in cheek, sarcasm)

[proelitedota]

Yes. My point was that our president doesn’t want to wear a mask. But he likes pictures. And he likes Xi Jinping. Therefore, a picture of Xi wearing a mask might be helpful in reminding our guy that it’s okay for world leaders to wear a mask and perhaps might even get him to lead by example. (For clarity: it was meant to be tongue in cheek, sarcasm)

Ah makes complete sense to me now.

[bundabergdevil]

Had similar discussions with my business partners. The EIDL loans are good... Unless you consider that if your business is unable to reopen and you have an extra six figures of debt.

The metrics are complicated to consider. We're sitting steady for now and hoping things clear up in the next four months. We should be able to reopen if that's the case.

Good luck, Wheat. The outdoor industry should be able to bounce back quickly once things open back up.

Have your or anyone you know successfully applied for the emergency $10K advance grant that's part of the SBA EIDL package? Supposedly, if you qualify, it deposits automatically in your account in 3 days. I have yet to meet anyone that has actually received any monies from this, which doesn't surprise me.

The application for the emergency $10K is very lax and takes 10 minutes. I read the relevant section of the actual bill and this grant is based on self-certification. The money has to be used for certain purposes; as with these other SBA provisions, the definitions of covered entities are expansive and include independent contractors (giggers) and sole proprietorship.

I have several younger family members who participate actively in the 'gig' economy and have been hit economically hard. I believe they could benefit from this emergency advance grant and qualify. Obviously, for those posters giddily discussing multi-million dollar payouts for billionaires, $10K is nothing but for my young kin, it's living expenses for 3-4 months easy.

I'm concerned the promise of depositing in 3 days is BS. I was in some of the ARRA war rooms for one federal agency. It was all hands on deck processing the tens of thousands of applications rolling in --- and that was a fully staffed/functioning agency. This isn't meant as a political comment because it's a fact: the staffing status of most of our federal agencies right now is poor, thousands of Schedule C appointee positions have gone unfilled, and, depending on the agency, they have poor leads managing at the secretarial level. I see the various promises of money in X days unlikely to be fulfilled.

[bedeviled]

An Australian lab determined that ivermectin is effective against SARS-CoV-2 virus in vitro. This adds another hopeful avenue toward treating COVID-19 with a long-established, readily available med.

Perhaps more immediately interesting news, though, is that emergency & critical care physicians in the US are compiling loads of experience in the past week. As a result, there **may** be a paradigm shift in management of COVID-19 in the emergency and ICU settings - note, this is still very early in the process...if it happens at all. Thus far, COVID-19 has been approached using established protocol for acute respiratory distress syndrome (ARDS), with current guidance including a quick readiness for invasive ventilation if necessary. Here's an excellent technical video walking through the rationale of the clinical care management (eg prone positioning, cardiac monitoring, ventilation settings).

However, some physicians are signalling that the COVID-19 disease process is not behaving like typical ARDS and caution AGAINST intubating when the data would normally suggest intubation (specifically, oxygen saturation levels which would normally indicate that an ARDS pt was crashing...COVID-19 pts seem able to tolerate this hypoxemic state and may be more similar to pts with dyshemoglobinemia or high altitude pulmonary edema). This is significant because:

1. intubated COVID-19 patients have high mortality and are anecdotally known to go downhill suddenly and quickly. It is possible that intubated pts simply do worse because the worst pts are the ones who need intubation, but it's also been suggested that the intubation/ventilation itself is worsening the condition (probably due to pressure injury to the alveoli (air sacs), causing extravasation of fluid into the lungs, or secondary to a cardiovascular response)
2. there may be a shift toward extended management of pts without invasive ventilation. This is good news because pts would be maintained on more available resources, including things like CPAP machines designed for home use if need be! However, it is unclear if CPAP and high flow nasal cannula would aerosolize the virus, increasing the risk of spreading. Sooooo, there would be less need for ventilators but stricter need for personal protective equipment
3. if we find that the process is analogous to dyshemoglobinemia or HAPE, it gives hints at more treatment approaches

Bonus 1: Clinical management guidelines 1 and guidelines 2 for DBR members who want to get in the weeds. These guidelines have already incorporated the new paradigm to avoid invasive ventilation
Bonus 2: An NYC MD's Video1 and Video 2 about his dissatisfaction with intubation in COVID-19, for DBR members who need to get their information in a more dramatic form (his Twitter)

[fisheyes]

An Australian lab determined that ivermectin is effective against SARS-CoV-2 virus in vitro. This adds another hopeful avenue toward treating COVID-19 with a long-established, readily available med.

Perhaps more immediately interesting news, though, is that emergency & critical care physicians in the US are compiling loads of experience in the past week. As a result, there **may** be a paradigm shift in management of COVID-19 in the emergency and ICU settings - note, this is still very early in the process...if it happens at all. Thus far, COVID-19 has been approached using established protocol for acute respiratory distress syndrome (ARDS), with current guidance including a quick readiness for invasive ventilation if necessary. Here's an excellent technical video walking through the rationale of the clinical care management (eg prone positioning, cardiac monitoring, ventilation settings).

However, some physicians are signalling that the COVID-19 disease process is not behaving like typical ARDS and caution AGAINST intubating when the data would normally suggest intubation (specifically, oxygen saturation levels which would normally indicate that an ARDS pt was crashing...COVID-19 pts seem able to tolerate this hypoxemic state and may be more similar to pts with dyshemoglobinemia or high altitude pulmonary edema). This is significant because:

1. intubated COVID-19 patients have high mortality and are anecdotally known to go downhill suddenly and quickly. It is possible that intubated pts simply do worse because the worst pts are the ones who need intubation, but it's also been suggested that the intubation/ventilation itself is worsening the condition (probably due to pressure injury to the alveoli (air sacs), causing extravasation of fluid into the lungs, or secondary to a cardiovascular response)
2. there may be a shift toward extended management of pts without invasive ventilation. This is good news because pts would be maintained on more available resources, including things like CPAP machines designed for home use if need be! However, it is unclear if CPAP and high flow nasal cannula would aerosolize the virus, increasing the risk of spreading. Sooooo, there would be less need for ventilators but stricter need for personal protective equipment
3. if we find that the process is analogous to dyshemoglobinemia or HAPE, it gives hints at more treatment approaches

Bonus 1: Clinical management guidelines 1 and guidelines 2 for DBR members who want to get in the weeds. These guidelines have already incorporated the new paradigm to avoid invasive ventilation
Bonus 2: An NYC MD's Video1 and Video 2 about his dissatisfaction with intubation in COVID-19, for DBR members who need to get their information in a more dramatic form (his Twitter)

Must spread some comments...yada yada yada...

Thanks!

This is great information. I agree, prone positioning with high flow nasal oxygen may reduce the need for intubation. I wouldn't have predicted that a fan based basketball site would be so helpful!

[devildeac]

An Australian lab determined that ivermectin is effective against SARS-CoV-2 virus in vitro. This adds another hopeful avenue toward treating COVID-19 with a long-established, readily available med.

Perhaps more immediately interesting news, though, is that emergency & critical care physicians in the US are compiling loads of experience in the past week. As a result, there **may** be a paradigm shift in management of COVID-19 in the emergency and ICU settings - note, this is still very early in the process...if it happens at all. Thus far, COVID-19 has been approached using established protocol for acute respiratory distress syndrome (ARDS), with current guidance including a quick readiness for invasive ventilation if necessary. Here's an excellent technical video walking through the rationale of the clinical care management (eg prone positioning, cardiac monitoring, ventilation settings).

However, some physicians are signalling that the COVID-19 disease process is not behaving like typical ARDS and caution AGAINST intubating when the data would normally suggest intubation (specifically, oxygen saturation levels which would normally indicate that an ARDS pt was crashing...COVID-19 pts seem able to tolerate this hypoxemic state and may be more similar to pts with dyshemoglobinemia or high altitude pulmonary edema). This is significant because:

1. intubated COVID-19 patients have high mortality and are anecdotally known to go downhill suddenly and quickly. It is possible that intubated pts simply do worse because the worst pts are the ones who need intubation, but it's also been suggested that the intubation/ventilation itself is worsening the condition (probably due to pressure injury to the alveoli (air sacs), causing extravasation of fluid into the lungs, or secondary to a cardiovascular response)
2. there may be a shift toward extended management of pts without invasive ventilation. This is good news because pts would be maintained on more available resources, including things like CPAP machines designed for home use if need be! However, it is unclear if CPAP and high flow nasal cannula would aerosolize the virus, increasing the risk of spreading. Sooooo, there would be less need for ventilators but stricter need for personal protective equipment
3. if we find that the process is analogous to dyshemoglobinemia or HAPE, it gives hints at more treatment approaches

Bonus 1: Clinical management guidelines 1 and guidelines 2 for DBR members who want to get in the weeds. These guidelines have already incorporated the new paradigm to avoid invasive ventilation
Bonus 2: An NYC MD's Video1 and Video 2 about his dissatisfaction with intubation in COVID-19, for DBR members who need to get their information in a more dramatic form (his Twitter)

What a great way to sign into DBR this AM and find an amazing post like this that discusses and provides researched links that discuss the management of a new, bizarre disease from pulmonary/hemodynamic/physiologic/critical care perspectives. Incredibly well done. Thank you for taking the time to organize and post!!

Edit: I see fisheyes woke up earlier than me today and posted 12 minutes prior, as I was reading and typing. I'll cover the sporks.

[scylla]

An Australian lab determined that ivermectin is effective against SARS-CoV-2 virus in vitro. This adds another hopeful avenue toward treating COVID-19 with a long-established, readily available med.

Perhaps more immediately interesting news, though, is that emergency & critical care physicians in the US are compiling loads of experience in the past week. As a result, there **may** be a paradigm shift in management of COVID-19 in the emergency and ICU settings - note, this is still very early in the process...if it happens at all. Thus far, COVID-19 has been approached using established protocol for acute respiratory distress syndrome (ARDS), with current guidance including a quick readiness for invasive ventilation if necessary. Here's an excellent technical video walking through the rationale of the clinical care management (eg prone positioning, cardiac monitoring, ventilation settings).

However, some physicians are signalling that the COVID-19 disease process is not behaving like typical ARDS and caution AGAINST intubating when the data would normally suggest intubation (specifically, oxygen saturation levels which would normally indicate that an ARDS pt was crashing...COVID-19 pts seem able to tolerate this hypoxemic state and may be more similar to pts with dyshemoglobinemia or high altitude pulmonary edema). This is significant because:

1. intubated COVID-19 patients have high mortality and are anecdotally known to go downhill suddenly and quickly. It is possible that intubated pts simply do worse because the worst pts are the ones who need intubation, but it's also been suggested that the intubation/ventilation itself is worsening the condition (probably due to pressure injury to the alveoli (air sacs), causing extravasation of fluid into the lungs, or secondary to a cardiovascular response)
2. there may be a shift toward extended management of pts without invasive ventilation. This is good news because pts would be maintained on more available resources, including things like CPAP machines designed for home use if need be! However, it is unclear if CPAP and high flow nasal cannula would aerosolize the virus, increasing the risk of spreading. Sooooo, there would be less need for ventilators but stricter need for personal protective equipment
3. if we find that the process is analogous to dyshemoglobinemia or HAPE, it gives hints at more treatment approaches

Bonus 1: Clinical management guidelines 1 and guidelines 2 for DBR members who want to get in the weeds. These guidelines have already incorporated the new paradigm to avoid invasive ventilation
Bonus 2: An NYC MD's Video1 and Video 2 about his dissatisfaction with intubation in COVID-19, for DBR members who need to get their information in a more dramatic form (his Twitter)

If this is not typical ARDS but more like HAPE -- is there theoretically a role for a pulmonary vasodilator such as sildenafil (serious question)? I'm not a critical care doc, but I might be called upon by the hospital to help if there are shortages, so thanks for the above guidance.