PlagueWatch 2020-23 - Coronavirus

[Reddevil]

Since there is so much conflicting information going around, it is unfortunate that we are entering the spring seasonal allergy period. I am in it now with cedar pollen. Every sneeze, sniffle, baggy eye, etc. Is going to be scrutinized. If it weren't for my parents in their late 70's, I wouldn't worry at all. I know there are exceptions, and things could change, but seeing an interview with a woman that looked to be in her 60's from an infected cruise ship saying she had a 3 hour fever and that was about it is reassuring to me. For the most part it's the flu. Maybe a bit more serious to some, but this is one we learn from before a more massive killer virus comes.

[proelitedota]

Since there is so much conflicting information going around, it is unfortunate that we are entering the spring seasonal allergy period. I am in it now with cedar pollen. Every sneeze, sniffle, baggy eye, etc. Is going to be scrutinized. If it weren't for my parents in their late 70's, I wouldn't worry at all. I know there are exceptions, and things could change, but seeing an interview with a woman that looked to be in her 60's from an infected cruise ship saying she had a 3 hour fever and that was about it is reassuring to me. For the most part it's the flu. Maybe a bit more serious to some, but this is one we learn from before a more massive killer virus comes.

What part of Italy's 11 million people lockdown is conflicting information? Did you read some news that denied that it happened? Do you think the Italian government would do this for something that's just slightly worse than a flu?

[FUBARDoorBuster]

Long-time listener first time caller. Street creds below. I’ve been reading the excellent opinions posted here about basketball since 2009, and see below for explanation of User name.

I am a pediatrician in the mountains in North Carolina and face infectious diseases every day. Friday I had a patient with myotonic dystrophy, A three-year-old who was recently tracheostomy dependent with ventilator, and came in with a fever, runny nose, and mild fussiness according to their RN healthcare nurse. Pt was flu negative. I submitted a test to Labcorp for Covid 19, the first time that we’ve had the chance to do that test. There are no known contacts, and the flow I was supposed to follow list to notify local health department RN’s.
It is horrible that we have had no test to follow for the last six weeks. Am I right that Germany provided a test according to world health organization (WHO), but the FDA and CDC required the US to use a different test and could not provide adequate results for over six weeks. Of note this test required that MERS and SARS would not create a false positive, although they are not circulating. Hong Kong actually used SARS samples to confirm their test worked for all recent coronaviruses including Covid 19, while the US version had to distinguish between the two, causing a huge delay in diagnostic capacity.
It’s clear that some contributors here have a health background and I want to contribute the following items:
1. Are there potential antibodies that survivors have formed that could be used in the ICU to prevent progression of illness. As pediatricians, we always think that our continued exposure to illness may provide “serological “solutions. RSV man worked for Medimmune, a company that provided a huge solution for premature babies, in what is now a monoclonal antibody for RSV that’s offered monthly. Does this idea provide any solutions for coronavirus, IVIG, Monoclonal antibodies , before any other specific treatments are available? Specifically, does recent exposure to other coronaviruses offer contributory antibodies. Unfortunately there are reports at some patients that have had the infection twice. The conclusions were that the antibodies produced were transient, but see number 3.
2. Does the fact that this virus targets the angiotensin converting enzyme two receptor in the lower respiratory tract offer any targets for current medical treatments? Autopsies in Chinese medical reports have shown that the illness Postmortem looks like combination of SARS and HIV.
3. Also Chinese reports have shown two different strains have developed. One is called L which seems to be the parent strain and a lower morbidity. A derivative called S seems to be more virulent and may represent how epidemics are affected both by super strains that provoke worse outcomes, but also that die off quicker because they cannot pass from hosts that they kill before they can spread. This may have a huge impact in the R number, and the prognosis in different settings
4. There are also reports that some survivors face debilitating pulmonary fibrosis, some of whom have been referred or possibly already had lung transplants. This also implies that they were young and healthy enough to undergo a possible transplant. No chickenpox parties for this one. This seems to be the underlying finding that forced the Chinese government to report cases when test weren’t available, as those new reports were based on x-ray or CT findings that were not typical for pulmonary infections. Also a 22 yo Iranian National Futsal team member dies quickly. I don’t know why being young prevents the illness, if there is no shared protection from other coronaviruses. I am worried that other cultures have different exposure patterns that have prevented children from being sick, and I’m worried that we will see different patterns of exposure in different societies that may affect children differently. My patients that are premature, cystic fibrosis, asthma, muscular dystrophy, seem to be at huge risk. We
5. Just looking at the Johns Hopkins dashboard reveals multiple first world countries going through mortality rates at or higher than reported levels of 2 to 3%. Ironically these are countries that are reporting the number of tests positive as well as total tests. UK can report all tests done, for instance. As in so many areas the US cannot do this and we are drifting from any “first world” status in healthcare. My town, county, region does not have the beds available when this hits the fan

This illness is worse than any influenza and has a capacity to affect thousands or millions. The Italian experience cannot be ignored, and there ICU doctors are warning the rest of Europe that the strain on our health system has been overwhelming. The flu has 1. Annual vaccines 2. Worldwide Monitoring for virologic changes. 3 rapid diagnostic test 4.a proven medicine 5 a similar medicinal treatment for prevention of progression through a family. Influenza does not cause a fibrosis or post infectious sequelae. It still kills too many people every year, as it spreads through schools to affect different families in the community, because people don’t pay attention to the advice of the medical establishment .

I came of age when the modem called through the telephone line. I will try to add the references, by number, in a follow up post. The coronavirus is a big deal and the only thing that might save us is that our society has different dynamics and if the less virulent strain is the one spreading now. Nothing our government is doing is helping to prevent the spread of this illness, and in fact has wasted practically two months since the genetics of the illness was posted for the Chinese government January 10.

Said my piece/peace.

Street CRED: graduated BSE in biomedical engineering 1990. Worked in migrant health for three years and graduated from Med School Wake 1997. Raised my daughter well, and she is entering class of 2024 at Duke. GTHC
Did Brickey fly higher than Cassius?
Finally, there may be a broken door in the old FUBAR dorm due to Seton Hall in 1989 Final Four. Not my fault!

[Rich]

Seems to me that if it mostly has worst effects on the elderly and inform, younger, healthier folks would be best served to catch it, stay home, and recover.

I'm not suggesting chicken pox parties, but wouldn't it be sensible to contract the virus before it has hospitals at capacity and limits how much social interaction everyone else can have?

Obviously, this is mostly a tongue in cheek suggestion, but is there a downside I am missing?

Do we know for sure that if you get it your body is immunized from getting it again after recovery?

[Nick]

The NCAA has declared that the Tournament games will go on with fans in the stands.

[PackMan97]

The NCAA has declared that the Tournament games will go on with fans in the stands.

They will change their minds before the Sweet 16.

[CameronBornAndBred]

I submitted a test to Labcorp for Covid 19, the first time that we’ve had the chance to do that test. There are no known contacts, and the flow I was supposed to follow list to notify local health department RN’s.

Welcome to the boards, and how long until you get results on that test?

[Acymetric]

The NCAA has declared that the Tournament games will go on with fans in the stands.

Correct decision.

[proelitedota]

Correct decision.

From a short term financial standpoint yes.

[Acymetric]

From a short term financial standpoint yes.

Nothing short term about the impacts of some of the things people here and elsewhere are advocating for.

There is a balance between taking appropriate precautions/preparing/implementing preventative measures to limit the spread/impact of the disease and kneecapping the economy in a panic that will have negative consequences for years/decades to come.

I'm not saying treat this like the common cold, or even the flu. I'm saying you can take it more seriously than the flu or other communicable diseases without wanting to basically shut the whole country down.

[FUBARDoorBuster]

Sorry to bring up these thoughts. My wife (RN/PNP, worked with early AIDS orphans at CNMC in DC in '80's) said I should call CDC hotline, but who would answer.?.
Anyway, here are references. Maybe will spark a bigger debate? Not sure if these are live links or need to be copy/pasted. Like I said...beep, beep. Modem connecting...

Severity
https://twitter.com/Channel4News/sta...94748005085186 Dude studied at Vandy but worked some at Duke, see twitter responses. CEO of Epidemic business,

https://jamanetwork.com/journals/jam...rticle/2761044
Asymptomatic Contacts, poss index case in Europe. R number is 3?4? more?
https://www.nejm.org/doi/full/10.105..._railB_article
Also, https://www.independent.co.uk/news/w...-a9384541.html
https://wwwnc.cdc.gov/eid/article/26/5/20-0198_article

1.https://www.news.com.au/lifestyle/he...35e9bc2e73423e
2. https://www.news.com.au/lifestyle/he...c54e2d2b9305ca
3, https://www.news.com.au/lifestyle/he...a1f8d1dcf78209
https://academic.oup.com/nsr/advance...searchresult=1
For what its worth https://twitter.com/PDChina/status/1...a1f8d1dcf78209
4. https://www.sciencedirect.com/scienc...73309920300864
https://english.alarabiya.net/en/cor...Qom-Rokna.html
5. https://www.gov.uk/guidance/coronavi...for-the-public
Twitter from https://twitter.com/LizSpecht/status...95180459003909 or thread on https://threadreaderapp.com/thread/1...459003909.html

https://www.independent.co.uk/news/h...-a9384356.html Italian experience with ICU doctors. Scary?
See another government's ineffective 'religious' response, courtesy of Robin Wright
https://www.newyorker.com/news/our-c...virus-outbreak also see New Yorkder stories of March 2 and March 6
wahttps://english.alarabiya.net/en/News/middle-east/2020/03/07/Iranian-MP-Fatema-Rahbar-dies-due-to-coronavirus-Reports.htmls

Here are my references, said my piece/peace. Sorry the links don't appear to be active. copy and paste.??
GTHC. I learned 9F from this forum!!!

[proelitedota]

Nothing short term about the impacts of some of the things people here and elsewhere are advocating for.

There is a balance between taking appropriate precautions/preparing/implementing preventative measures to limit the spread/impact of the disease and kneecapping the economy in a panic that will have negative consequences for years/decades to come.

I'm not saying treat this like the common cold, or even the flu. I'm saying you can take it more seriously than the flu or other communicable diseases without wanting to basically shut the whole country down.

March madness games having fans are none-essential to the economy. Many large conventions have being cancelled in the United States.
The economic impact of millions of sick people dwarfs the economic impact of such measures.
If our economy can't recover from banning events with lots of people in close contact then that's admitting that the economy is a farce in the first place.
The number of "confirmed" cases in the US is over 500. In a week it'll be guaranteed thousands, and possibly tens of thousands as more are tested after the testing delay is resolved.
I expect NCAA to reverse their decision before final four weekend.

[FUBARDoorBuster]

Welcome to the boards, and how long until you get results on that test?

Thanks for the welcome. I see many that have been on versions of the board since 2007 and felt reluctant to "join in" but the discourse here is different than any other web forum, '90's BB, etc. I have learned much from reading and now want to throw in my 2 cents.

Just learned of Labcorp availability mid-day Friday. Test results 2-3 days. Viral PCR similar to other tests. Not 15 mins but best we have.
Also on Friday, staff meeting declaring NC statement on March 2 or 3 to refer cases to local Health Departments for contact tracing. I can not relay how misinformed this could be for our pediatric patients, based on recent Pertussis outbreaks and Measles in local border counties. If we FINALLy have a test, it needs to be ordered by the medical provider, not referred to multiple layers of health departments, home visits , contact tracing, before a test is denied. As providers, we need to test, then refer positives to local Health Departments. My patient did not travel to China, S Korea, Italy, et al, but that can not be a limitation to testing. If you are a provider, TEST ALL possible patients then refer positives!! Why wait!! We are not only discussing the 90 year olds, but children at risk, leukemia patients in treatment, JIA patients on methotrexate, severe eczema on cyclosporin, transplant patient on azithioprene, as well as similar adult patients.
Here is current website for NC Health. No comment on community spread: note need for contact with a known case. Time wasted..
https://www.ncdhhs.gov/divisions/pub...sting-covid-19

Shaving my 27 y beard so the N95 mask fits better. NB, obviously I am 50+, BUT not technically a Boomer.
https://www.dukechronicle.com/articl...oard-ok-boomer
https://www.dukechronicle.com/articl...eed-your-money
BUT the Chroncle Student Voices Columns is the best source of thoughtful opinion of our best, future generation, despite the entry of class of '77
https://www.dukechronicle.com/sectio...=3&per_page=20

For every generation, unless you speak Swahili, GTHC. BTW, does anyone know how to say GTHC in Swahili? So we can communicate?.. CHeats!!!!

[OldPhiKap]

For every generation, unless you speak Swahili, GTHC. BTW, does anyone know how to say GTHC in Swahili? So we can communicate?.. CHeats!!!!

Nenda Kuzimu, Carolina, nenda Kuzimu.

Kula unga, Dean Smith, kula unga.

[MChambers]

March madness games having fans are none-essential to the economy. Many large conventions have being cancelled in the United States.
The economic impact of millions of sick people dwarfs the economic impact of such measures.
If our economy can't recover from banning events with lots of people in close contact then that's admitting that the economy is a farce in the first place.
The number of "confirmed" cases in the US is over 500. In a week it'll be guaranteed thousands, and possibly tens of thousands as more are tested after the testing delay is resolved.
I expect NCAA to reverse their decision before final four weekend.

Seems likely to me.

[budwom]

right on cue, after March school vacation, a "school employee" at a large, local school came home with what is suspected to be Covid 19...school closed today

[PackMan97]

Nothing short term about the impacts of some of the things people here and elsewhere are advocating for.

There is a balance between taking appropriate precautions/preparing/implementing preventative measures to limit the spread/impact of the disease and kneecapping the economy in a panic that will have negative consequences for years/decades to come.

I'm not saying treat this like the common cold, or even the flu. I'm saying you can take it more seriously than the flu or other communicable diseases without wanting to basically shut the whole country down.

I'd rather kneecap the economy than shoot it in the head. Unfortunately it appears we are going for the head shot.

Watch Seattle, San Fran, LA and NYC at the end of this week. I might change my prediction and see the NCAA will go audience free the first weekend.

[OldPhiKap]

New York telling folks not to take the subway or public transportation "if they can." Yeah, that'll work.

[Kdogg]

New York telling folks not to take the subway or public transportation "if they can." Yeah, that'll work.

Won't that dump people onto the sidewalks where it can already be shoulder to shoulder depending on the time of day? Maybe less surfaces to touch with no handrails, walls etc ?

[Mtn.Devil.91.92.01.10.15]

Won't that dump people onto the sidewalks where it can already be shoulder to shoulder depending on the time of day? Maybe less surfaces to touch with no handrails, walls etc ?

Less people using the same airspace.