Is the Corona Virus really all what it's made to be?

[blackribbon]

@rambot



From the WHO situation report for March 6:

For COVID-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than what is observed for influenza infection

Here is what that five percent looked like in Italy:


Coronavirus cases are pushing Italy's hospitals to the brink

Lombardy, the region around Milan that accounts for more than a fifth of Italy’s economic output, is by far the worst-affected part of the country. It had 5,469 cases, including 440 in intensive care, as of Monday afternoon.

Cases have since increased

More than 80% of the region’s 1,123 acute care beds are dedicated to coronavirus, after many other patients have been moved elsewhere and 223 extra places have been opened to cope with the emergency. About half of those are occupied, Gallera said.

Some doctors have said that they sometimes make the call on who gets treatment based on the age of the patient. In some areas, hospitals are suspending other treatments to focus personnel on the contagion.

A doctor who asked not to be named because of potential repercussions painted a dire picture of the situation in a hospital in Milan. While the coronavirus is best known for causing severe disease in elderly patients, even some young people are affected, the doctor said, and without sufficient beds and ventilators, some can’t be treated.

The hundreds of patients needing treatment for pneumonia have swamped the supply of available specialists, the Milan doctor said. Physicians such as gastroenterologists, who normally focus on the digestive system, have been conscripted to help out with lung patients, and they’re still not enough, the doctor said.


Coronavirus: 'We must choose who to treat,' says Italian doctor


Since there is, unfortunately, a disproportion between hospital resources, resuscitation beds and critically ill patients, not everyone can be intubated,” Salaroli said. “We decide based on age and state of health,” he added.

The Extraordinary Decisions Facing Italian Doctors

Today, Italy has 10,149 cases of the coronavirus. There are now simply too many patients for each one of them to receive adequate care. Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air.

Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow in these extraordinary circumstances.

Those who are too old to have a high likelihood of recovery, or who have too low a number of “life-years” left even if they should survive, will be left to die. This sounds cruel, but the alternative, the document argues, is no better. “In case of a total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”

In addition to age, doctors and nurses are also advised to take a patient’s overall state of health into account: “The presence of comorbidities needs to be carefully evaluated.” This is in part because early studies of the virus seem to suggest that patients with serious preexisting health conditions are significantly more likely to die. But it is also because patients in a worse state of overall health could require a greater share of scarce resources to survive: “What might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients.”


This is also the concern in the USA:


Hospitals gird for coronavirus surge after years of cutbacks

With a potential surge of coronavirus patients, there may not be enough beds, equipment and staff to handle an epidemic. Executives face tough decisions about who could have to be isolated and, in some cases, need oxygen, ventilators and protective gear that’s already in short supply.

The hospitals have already worked through a bad flu season, which has some worried that there may not be enough beds should the coronavirus cases surge, as some models predict.

“This is not going to be a financial issue,” said New York Gov. Andrew Cuomo. “If anything … it will be a capacity issue, the number of beds.”

“Given that we’ve had a month or more of prep time, we have created contingency plans and will have additional beds available … but the actual ICU beds and ventilators are somewhat fixed and those numbers are what they are,” said Mark Mulligan, director of NYU Langone Health’s division of infectious diseases and immunology.

“Every hospital has limited, finite ability to surge,” said NYU Langone's Mulligan.

Large number of older patients who have other conditions that make them more at risk for severe situations have "do not resuscitate" orders already on file. Most of these people have a refusal to intubate as part of this order. My mother is not sick beyond controlled hypertension (no other heart problems) but at 78 has made it clear she does not want to be intubated. We could NOT intubate these people.

My last hospital was a trauma center and had multiple types of ICU where ventilators would be available for appropriate patients. There is oxygen in every patient room in the US. There are also a lot of trauma centers. The reason to be on a ventilator would be that the virus has caused pneumonia (fluid in the lungs) so the same reason a person would be intubated for the flu.

I have read about Italy and their high numbers are being credited to having an older population, a large number of life long smokers (lungs are already compromised), and social habits that help droplet viruses spread fast...like kissing as a greeting.

Be afraid if you want to. Our hospitals are more afraid of the citizens stealing our masks needed to protect the frontline care givers than we are worried about the virus. It could be a surge but we get those on a regular basis when new viruses have outbreaks. We are letting our kids go to social functions that aren't canceled. We are traveling as scheduled. I even know a retired nurse who is enjoying a cruise and thinking about taking another.

 

[blackribbon]

Also, older people who have other medical conditions that make them medically frail stand a good chance of never coming off a ventilator once put on one. That is why so many people refuse to be put on one. You can't talk when on a ventilator and you are giving a paralytic agent so you don't pull it out. If this is the only way you can live, more people are opting to struggle breathing even if it means you likely will die.

We are not talking an asthma attack in a 25 year old triathlete. We are talking about people who already had breathing difficulties that they will never recover from.

 

[blackribbon]

Many Virus don't replicate at 122 degrees F, also your body will naturally strengthen your immune system when your temperature is elevated, also, the sweating and drinking of liquid is helpful. If I was going to expose myself to a virus I would want to fully wash it off afterwards and sauna will help with that as well.

The body has a natural mechanism to maintain your temperature in a certain safe range. It works really well in most people. Once the virus is in your blood, nothing you do is likely to change your body temperature enough to kill the virus. The fever is actually the body's normal immune response to raise temps slightly and try to kill any infections, viral or bacteria (which is why you shouldn't treat a fever less than 102.5). You don't sweat a virus out...though you might sweat if you break a fever....a way the body cool down to a safe comfortable temperature. And drinking warm liquid goes into your GI system...and doesn't affect your overall temp significantly. However, saunas can be hotbed of bacteria that could go airborne and be breathed in to cause a different type of infection including fungal. Just saying.

Soap and water clean a virus off just fine. Comfortably warm water is just fine to do the trick. Washing longer is more important than the water temperature.

FYI: 118 degrees F is the temp that causes 1st burns to skin. Be careful.

 

[blackribbon]

Thabks for the treatment info. That's informative.

By your numbers the flu had a mortality rate of 0.059%.

In the US, you have 1000 cases or covid and 40 deaths. If you get 34 million cases of covid at the same mortality you'll lose About 1.36 million americans.
That suggests it's at least A BIT more of a concern, non?

Only if you get 34 million cases of Covid19. And only if the stats prove to be accurate in our population. Still not worried because it isn't going to happen. I am only worried for the older and immune compromised population. But I am always worried about them.

 

[Citizen of the Kingdom]

We're all looking for ways to stay healthy during the months ahead before the virus even begins to slow down. Thieves oil essential oils was a formula used during the bubonic plaque for that purpose. I've used it for flu season every year and it's been effective. Just a thought for the healthcare workers ...

 

[ZNP]

They shut it down after thousands of diagnosed cases. Not after a few hundred. And they didn't shut down lives for 300 million (the population of the US).

Things are shutting down because of fear...schools wouldn't be shutting down if it was based on facts because children are at low risk with this population and may be safer at school than being at home spreading other viruses to other populations.

Yes, children are low risk at dying, but not being infected and infecting others. Children are very high risk when put into a crowded environment like a school at picking up a virus. They can then spread it to their parents and grandparents. You are also forgetting that schools are where adults work, many of whom are over 50.

Think about the NBA, after 2 millionaire players contracted it the league had to do something, otherwise players that get it could claim negligence on the part of the league, likewise fans who contract it in a stadium could claim negligence on the part of the league.

NYC has banned gatherings of 500 or more. Our school has 2,000 kids and several hundred adults.

 

[Trogdor the Burninator]

Things are shutting down because of fear...schools wouldn't be shutting down if it was based on facts because children are at low risk with this population and may be safer at school than being at home spreading other viruses to other populations.

It's not based on fear but numbers. The objective is to keep new infections low enough so that the hospital system can cope with patient numbers. Children aren't likely to end up in hospital, but a breakout in schools could easily see tens of thousands of children infected, who would then likely pass it on to teachers, school workers and relatives, many of whom would then require hospitalisation.

Closing schools reduces that risk substantially, meaning new infections happen over a longer period. It might seem extreme, but the strategy of places like Singapore of banning large gatherings and cancelling major events (something Australia has just announced today) are paying dividends - their infection rate is much lower than Italy, Korea etc.

 

[ZNP]

It's not based on fear but numbers. The objective is to keep new infections low enough so that the hospital system can cope with patient numbers. Children aren't likely to end up in hospital, but a breakout in schools could easily see tens of thousands of children infected, who would then likely pass it on to teachers, school workers and relatives, many of whom would then require hospitalisation.

Closing schools reduces that risk substantially, meaning new infections happen over a longer period. It might seem extreme, but the strategy of places like Singapore of banning large gatherings and cancelling major events (something Australia has just announced today) are paying dividends - their infection rate is much lower than Italy, Korea etc.

Yes, read about what happens in Italy when the hospital is overwhelmed. Look at the numbers, we'll have 1 million infected worldwide by the end of March. One concert, one basketball game, one graduation could leave 100+ infected in a single town.

 

[pitabread]

Yes, we know that kids for some reason don't suffer from this virus very often. None of the deaths in China were in children.

This doesn't mean they can't transmit the virus though. Right now there doesn't appear to be any data on that, so erring on the side of caution seems the most prudent move. That means closing schools.

It is hype in that we don't act the same way for other highly communicable diseases that people are dying from on a daily basis and in higher numbers.

The concern seems to be around the relative lethal nature of coronavirus coupled with its transmissability and the rapid rise in infection.

Yes, lots of people get things like influenza and die from it every year. But our health care systems already expect and can reasonably cope with those circumstances.

A new virus with a higher mortality rate and a rapid rise in infections on the other hand... we're watching the real-time consequences of that unfold in countries like China, Italy, Iran.

I wish that I could take advantage of the super cheap airfares and cruises.

I'm sorry, but that sounds utterly irresponsible.

 

[blackribbon]

I'm sorry, but that sounds utterly irresponsible.

Based on what? Why am I more likely to get infected or pass on an unknown infection sitting on a beach in a warm state than I am running to the grocery store near my home? However, it is a moot point. I am not going on vacation anytime soon or likely anytime in the next year.

However, that said, I am following the state requested limitations of large gatherings because I recognize that it is important to help them to come up with a plan to control both the virus and the fear. I am working on doing things to minimize my exposure and build my immunity in preparation for my new employee training in week and then getting thrown into a potentially very busy hospital situation. Since I am an experienced nurse, I likely will have my orientation period shorten because I don't need the full time period normally offered.

I don't live in fear and that is what I have been trying to express. However, I do recognize the risk involved in ANY highly transmittable virus our communities are exposed to.

Again, I do not expect tens of thousands of Americans to die of this. I do expect the hospitals to be very busy though. I also hope that the ERs aren't full of people that should be healing at home so that the people who do have the more complicated symptoms such as breathing problems can get seen faster.

 

[tall73]

Large number of older patients who have other conditions that make them more at risk for severe situations have "do not resuscitate" orders already on file. Most of these people have a refusal to intubate as part of this order. My mother is not sick beyond controlled hypertension (no other heart problems) but at 78 has made it clear she does not want to be intubated. We could NOT intubate these people.

Indeed, some of the ones who are very ill already do have that. But then, there are plenty more who will need those resources.

And note the statements from the Italian doctors, it was not just old people who were there.

My last hospital was a trauma center and had multiple types of ICU where ventilators would be available for appropriate patients. There is oxygen in every patient room in the US. There are also a lot of trauma centers. The reason to be on a ventilator would be that the virus has caused pneumonia (fluid in the lungs) so the same reason a person would be intubated for the flu.

Except the rates are higher. And the people actually in charge in the hospitals and of the response are not as sanguine as you are about the number of ventilators. Moreover, the flu season is still ongoing, so there is overlap.

I have read about Italy and their high numbers are being credited to having an older population, a large number of life long smokers (lungs are already compromised), and social habits that help droplet viruses spread fast...like kissing as a greeting.

They do have an older population. And like Wuhan, many have a history of smoking. However, one of the reasons they have an older population is they were ahead of the USA in addressing cardiovascular risk factors, and have less history of cardiovascular disease. Per the mortality statistics out of the major Wuhan study, cardiovascular issues are the top driver of mortality with Covid 19, even above respiratory issues.

 

[essentialsaltes]

I expect that yellow exponential looking curve (cases outside China) in the lower right of the JH tracker to surpass the orange curve in a few weeks, and it will then shoot much higher now that community spread has been established in many different locations.

weeks? it's only been 3 days, and looks like it won't take more than a few more days.

 

[Fusion77]

At this point, I see very little if any “media hype”. There’s really no need to sensationalize the facts Surrounding the situation. Several countries are shut down, The US is shutting down a lot of things. Local, State and Federal emergencies these are all factual.

One may argue that there is an overreaction by international, Federal, state, local officials and certain entities. Another may argue these steps are rightly justified.

 

[tall73]

It could be a surge but we get those on a regular basis when new viruses have outbreaks.

https://www.washingtonpost.com/heal...us-numbers-we-really-should-be-worried-about/

The United States has roughly 2.8 hospital beds per 1,000 people. South Korea, which has seen success mitigating its large outbreak, has more than 12 hospital beds per 1,000 people. China, where hospitals in Hubei were quickly overrun, has 4.3 beds per 1,000 people. Italy, a developed country with a reasonably decent health system, has seen its hospitals overwhelmed and has 3.2 beds per 1,000 people.

 

[durangodawood]

....One may argue that there is an overreaction by international, Federal, state, local officials and certain entities. Another may argue these steps are rightly justified.

To the extent that these measure are successful there will be people saying they were overreactions.

For evidence they will point to their success.

 

[blackribbon]

Indeed, some of the ones who are very ill already do have that. But then, there are plenty more who will need those resources.

And note the statements from the Italian doctors, it was not just old people who were there.



Except the rates are higher. And the people actually in charge in the hospitals and of the response are not as sanguine as you are about the number of ventilators. Moreover, the flu season is still ongoing, so there is overlap.


They do have an older population. And like Wuhan, many have a history of smoking. However, one of the reasons they have an older population is they were ahead of the USA in addressing cardiovascular risk factors, and have less history of cardiovascular disease. Per the mortality statistics out of the major Wuhan study, cardiovascular issues are the top driver of mortality with Covid 19, even above respiratory issues.

I don't want to argue with you. I don't work on a ventilator unit. Maybe they are worried but they are not telling the staff about it if so.

Smoking is a cardiovascular issue. So respiratory diagnoses and cardiovascular issues are both concerns. (if you smoke, your cardiovascular system is carrying a lot of carbon monoxide to the bodies cells instead of oxygen which weakens the whole body).

This can be a bad disease. So can the flu. It won't be for most people. It will be awful for some. And it will be hard on the healthcare system but I believe we can handle it. We are trained to be prepared for mass casualties and have systems in place. Likely some areas are better prepared than others. Hopefully, the larger hospitals can be organized to handle the most sick people and the smaller ones can handle the moderately sick ones. If it gets really bad, we may be moving patients to the hospitals of our choosing and not just the one the patient picks to go to. And people we would normal care for might be discharged or sent to other sites that don't normally care for acute patients. However, we will find a way to make it work. We are very well trained and good at what we do. We also aren't surprised like Italy was. We have their experience to use to exam our preparation.

I do not believe it will get that bad...but we are constantly reassessing the situation and preparing.

I am reading and watching. However, I am not expecting as large of a crisis. I hope I am right because I will be on the front line if not. I have adult aged children so I will be among those that volunteer to stay if needed...and luckly live within 10 miles of the hospital that I will soon be working at. My unit is primarily geriatric (old people) with cardiovascular problems so I will be in it deep. I am using this time to rest and relax as much as possible.

 

[blackribbon]

https://www.washingtonpost.com/heal...us-numbers-we-really-should-be-worried-about/

The United States has roughly 2.8 hospital beds per 1,000 people. South Korea, which has seen success mitigating its large outbreak, has more than 12 hospital beds per 1,000 people. China, where hospitals in Hubei were quickly overrun, has 4.3 beds per 1,000 people. Italy, a developed country with a reasonably decent health system, has seen its hospitals overwhelmed and has 3.2 beds per 1,000 people.

I don't know if this data is true or accurate. I do know we likely have a lot more private rooms where we could put a second bed in if necessary. We also have an extensive subacute system which could be turned into acute care for moderately ill without too many changes. We also have a very large population of healthcare providers who are considered "contingent" and normally only work one or two days a month by choice. So we do have a backup system for staffing.

The hospital I left had 1020 beds. I know it had separate ICUs for medical, surgical, cardiology, and (I believe) pulmonary patients. There are stepdown units that also care for ventilator patients. In a crisis, units like the hospice unit and the inpatient rehab unit could be converted to provide sick beds with those patients being moved to subacute facilities. 50 beds are postpartum...which labor and delivery care could be moved to a nearby smaller hospital in our system and open up those 50 rooms and put an extra bed in each (designed for 2 patients but all postpartum rooms were changed to private years ago). There are also classrooms and conference rooms that have all the in-room oxygen set ups that can be turned into a patient room if we hit overflow status. We might be run short of walkers and bedside commodes since we can run short of those when the hospital is full.

I am saying this to reassure people that our hospitals are capable of finding a way to manage.

I even know of a struggling hospital that only currently has two units, a surgery, and the urgent care open. However, they have many empty rooms that once were used on units that have closed (4 additional floors of rooms that looked like ghost rooms). The hospital would be required to maintain the basics in even the closed units to stay open as a hospital. I suspect that these rooms could be up in running in a very short time if the county would help fund the effort. I know I saw rooms jam packed with beds on one of the floors. The nurses that work the general unit have a lot of ICU and/or surgical experience. They just stayed with the hospital as it had financial problems so went where they were needed.

 

[tall73]

I don't know if this data is true or accurate.

Do you have reason to call into question the statistics, or other statistics that would gainsay it?

 

[pitabread]

Based on what? Why am I more likely to get infected or pass on an unknown infection sitting on a beach in a warm state than I am running to the grocery store near my home?

It's not about whether or not you're personally at greater risk of infection in different locations. It's about the fact that an infected carrier (especially if they don't know they are infected) is at greater likelihood to spread the virus to other parts of the world by traveling. This is exactly why this virus was able to rapidly spread around the world so quickly.

On top of that, at home you at least have much more control over your exposure to others (well, maybe not in your specific circumstances). But by traveling you are relying on other services like hotels, restaurants, transportation, etc, used by many people.

Unless one's idea of travel involves packing a backpack and heading off into the middle of the wilderness for the next month, any travel does not seem like a good idea.

(In fact, the Canadian government just advised people to cancel all non-essential travel.)

 

[blackribbon]

It's not about whether or not you're personally at greater risk of infection in different locations. It's about the fact that an infected carrier (especially if they don't know they are infected) is at greater likelihood to spread the virus to other parts of the world by traveling. This is exactly why this virus was able to rapidly spread around the world so quickly.

On top of that, at home you at least have much more control over your exposure to others (well, maybe not in your specific circumstances). But by traveling you are relying on other services like hotels, restaurants, transportation, etc, used by many people.

Unless one's idea of travel involves packing a backpack and heading off into the middle of the wilderness for the next month, any travel does not seem like a good idea.

(In fact, the Canadian government just advised people to cancel all non-essential travel.)

We haven't had that ban yet. I will honor it if the government even just requests it on a voluntary level. I do worry about the businesses that are going to fail or struggle because everyone is afraid to use their services. If I were able to travel, I'd likely wipe down all solid surfaces in my hotel room. Linens are usually bleached so safe but I might travel with my own sheets and towels (always have debated doing this before every hotel stay). I usually take the spread off and use my own blanket when I travel because I am already a bit freaked out by the various bugs that can be in a room used by multiple people. But like I said, beaches exist only in my dreams this year. I already practice certain safety hygiene practices when traveling before this coronavirus because hotels creep me out.

As for travel, I don't know that the risk is that much greater since the majority of us are not infected. Do you have any statistics that show domestic travel is really a significant risk factor? (Don't worry. I am not going anywhere.)

I do worry about the businesses that will suffer and the people who will be out of work. My son is going to lose half his pay when his job working with children in an afternoon program gets put on hold for 3 weeks since they are closing the schools. Lucky for him, he has another part time job that won't likely be put on hold unless the spread of this virus gets extremely bad. But people are going to suffer even if they stay virus free.