Coronavirus

[y66]

Some governments learned from SARS and MERS. Some didn't.

 

From Dennis Normile at Science:

 

Behind its success so far has been the most expansive and well-organized testing program in the world, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. South Korea has tested more than 270,000 people, which amounts to more than 5200 tests per million inhabitants—more than any other country except tiny Bahrain, according to the Worldometer website. The United States has so far carried out 74 tests per 1 million inhabitants, data from the U.S. Centers for Disease Control and Prevention show.

[Cyberyeti]

Some governments learned from SARS and MERS. Some didn't.

 

From Dennis Normile at Science:

 

I've seen a counter argument to that in another article which says that SK is largely an outbreak among nonsmoking young women, whereas Italy it's largely older male smokers, so the Koreans get recovered much faster and are presumably infectious for a shorter time.

 

The test is also not particularly good, I've heard claims of only 60% accuracy as it works off a throat swab and the virus concentrates in lung tissue.

[y66]

From Ezra Klein at Vox:

 

America does not have enough ICU beds for the coronavirus outbreak

America has about 924,000 hospital beds, about 98,000 of which can be used for people who need intensive care, according to the American Hospital Association. The number of Covid-19 cases that will require ICU care could expand far beyond what the US is currently capable of providing.

 

The Imperial College London projections are just one set of estimates among many (based largely on modeling for influenza outbreaks instead of the current facts on the ground), but they paint a grim picture. The short version is that even the most aggressive mitigation strategies — general social distancing, quarantines, closing schools — will not be enough to prevent US hospitals from being overwhelmed eventually unless we commit to such drastic measures until a vaccine becomes available.

 

Source: Imperial College London

For people 60 and older, between 17 percent and 25 percent of cases are expected to require hospitalization; of those, 25 percent or more will require intensive care (as many as 70 percent for patients 80 and older), according to this analysis. The ability of hospitals to provide that care will be imperative if we are to protect those most vulnerable populations.

States are starting to take drastic steps to try to increase the number of hospital beds available, but there are limits on what they can do. New York Gov. Andrew Cuomo said Monday he would order the National Guard and building developers to convert existing facilities — dormitories and former nursing homes, for example — into makeshift hospitals. That order is expected to add 9,000 new beds to the 53,000 already available in the state. Maryland Gov. Larry Hogan issued a similar order the same day, adding 6,000 beds to the 9,000 existing beds in his state. Governors are urging the Trump administration to get the Army Corps of Engineers and the US military involved to set up temporary hospitals.

 

Complicating matters further is a shortage of basic medical supplies — masks, gloves, gowns, etc. — that hospital staff need to care for patients and protect themselves. The strain on health care workers will only get worse if nurses and doctors get sick because they lacked protective gear and then are unable to work.

 

I’ve spoken with nurses at major US hospitals who are certain they have already been exposed to the coronavirus because of these shortages and some lax protocols in the early coronavirus panic.

 

“We just need supplies,” Melissa Tizon, a spokesperson for the Providence St. Joseph hospital system, which has facilities in Seattle, the worst-hit US city so far, told me. “That’s the main thing we need to care for our patients.”

[FelicityR]

Oh dear! What I don't particularly like is Boris Johnson's slide into Winston Churchill (his hero) mode that has happened in the last few days.

 

"We will act like [the] wartime Government and beat this enemy."

 

Whilst other commentators on this forum have detailed at length - thank you - how the scientific community were up-to-speed on strategy on tackling this virus, the government should have brought in more draconian measures earlier.

 

I feel the panic buying in the shops has been caused due to the ill-thought out statement that a household will have to isolate for 14 days. Whilst the time period is correct to make sure that no-one spreads the virus into the wider community, he never explained how everyone was going to get basic provisions whilst under this 'viral house arrest'.

 

No statement that the army or social services were going to be involved, etc. And it says a lot for the Sikh community in this country that there are prepared to deliver groceries to families and individuals who are under this self-isolation.

 

How has this government handled the crisis so far? My opinion: badly. Containing this virus and keeping the vast majority of people safe is a logistical nightmare, I admit Jobs, schools, children, working parents, the ill and the elderly all have to be all accounted for. But Winston Churchill and the wartime cabinet wouldn't have been so casual and indecisive as this government have been.

 

What was needed was decisiveness from the beginning, real strategies that inspired confidence and set out what was going to happen, instead of trying to 'wing' their way through this crisis.

 

Winston Churchill made his mistakes during WWII, but the British public generally had confidence as him as a leader.

 

Boris Johnston as Winston Churchill (the second)? Delusions of self-grandeur.

[Cyberyeti]

Felicity - a point that many professionals have made is that self isolation in itself is bad for mental health, hence you don't want to do it before it's absolutely necessary or for longer than you have to.

 

I feel that unlike in the US, the government is going with what the scientists tell them,and that's all we can reasonably ask them to do.

[Winstonm]

I've seen a counter argument to that in another article which says that SK is largely an outbreak among nonsmoking young women, whereas Italy it's largely older male smokers, so the Koreans get recovered much faster and are presumably infectious for a shorter time.

 

The test is also not particularly good, I've heard claims of only 60% accuracy as it works off a throat swab and the virus concentrates in lung tissue.

 

This seems to sum up nicely the difficulties we all have with information: one person posts an link to an article from Science magazine - an article with quotes from people we can track down and verify if we so wish - and the other responds about "something I saw" and "something I heard."

 

These two sources cannot be treated as equivalent. Agreed?

[Cyberyeti]

This seems to sum up nicely the difficulties we all have with information: one person posts an link to an article from Science magazine - an article with quotes from people we can track down and verify if we so wish - and the other responds about "something I saw" and "something I heard."

 

These two sources cannot be treated as equivalent. Agreed?

 

I get most of my news over the radio, so attributable sources are difficult, but when 30 or 40 different scientists say this like it's uncontroversial, I tend to believe it.

 

Also the bit about the effect on mental health was said by both Boris and his chief scientific adviser in one of their daily press conferences.

 

There are plenty of articles like https://www.medicinenet.com/script/main/art.asp?articlekey=228250 on the accuracy of the tests, yes this is not a peer reviewed paper, but some facts like:

 

"Reports suggest some people test negative up to six times even though they are infected with the virus, according to the BBC and Chinese media. Such was the case with Dr. Li Wenliang, the ophthalmologist who first identified the outbreak and was reprimanded by Chinese authorities when he tried to warn others.

 

Dr. Wenliang developed a cough and fever after unknowingly treating an infected patient. He was hospitalized, testing negative for coronavirus several times before eventually receiving a positive result. On Jan. 30 the doctor posted: "Today nucleic acid testing came back with a positive result, the dust has settled, finally diagnosed," according to the BBC. Dr. Wenliang passed away on February 7 in Wuhan, the epicenter of the outbreak."

 

are well known

[hrothgar]

Winston Churchill made his mistakes during WWII, but the British public generally had confidence as him as a leader.

 

Perhaps that's because most of his victims were Indians, Africans, and Australians....

[Winstonm]

I get most of my news over the radio, so attributable sources are difficult, but when 30 or 40 different scientists say this like it's uncontroversial, I tend to believe it.

 

Also the bit about the effect on mental health was said by both Boris and his chief scientific adviser in one of their daily press conferences.

 

There are plenty of articles like https://www.medicinenet.com/script/main/art.asp?articlekey=228250 on the accuracy of the tests, yes this is not a peer reviewed paper, but some facts like:

 

"Reports suggest some people test negative up to six times even though they are infected with the virus, according to the BBC and Chinese media. Such was the case with Dr. Li Wenliang, the ophthalmologist who first identified the outbreak and was reprimanded by Chinese authorities when he tried to warn others.

 

Dr. Wenliang developed a cough and fever after unknowingly treating an infected patient. He was hospitalized, testing negative for coronavirus several times before eventually receiving a positive result. On Jan. 30 the doctor posted: "Today nucleic acid testing came back with a positive result, the dust has settled, finally diagnosed," according to the BBC. Dr. Wenliang passed away on February 7 in Wuhan, the epicenter of the outbreak."

 

are well known

 

I think you missed the most important part of the article - why are some tests incorrect. From your linked article:

 

The study authors note that RT-PCR tests may produce false negatives due to: 1) laboratory error or insufficient amount of viral material collected from the patient. 2) Samples that are stored or handled improperly also result in false negatives.

 

Tests may result in false negatives 3) if the patient is tested too early in the course of infection and there is 4) insufficient amount of virus to be detected. Improper sampling may result in a false negative.

 

Another potential problem with test kits: 5) Faulty reagents. The CDC recently admitted test kits they distributed resulted in inconsistent results due to a problematic reagent required for the test. They are now manufacturing the reagents using stricter quality control measures.

my numbering and emphasis

 

If you will note, none of the reasons is the test itself. Provided the above errors do not occur, the tests are accurate. That is not to say the testing process is perfect - it is not. But that the test is not sensitive enough to detect virus in the very early stages is not the same as saying it is inaccurate.

 

Word choices matter.

[Cyberyeti]

 

If you will note, none of the reasons is the test itself. Provided the above errors do not occur, the tests are accurate. That is not to say the testing process is perfect - it is not. But that the test is not sensitive enough to detect virus in the very early stages is not the same as saying it is inaccurate.

 

Word choices matter.

 

But that means it's not that useful as the very early stages are when you need to pick this up to avoid the spread. Hopefully the antibody test for people who've had the virus will come onstream soon for both measurement and control purposes.

 

https://edition.cnn.com/2020/03/16/opinions/south-korea-italy-coronavirus-survivability-sepkowitz/index.html was the SK/Italy one.

[pescetom]

Today's statistics in Italy: positive 28710 (+10%), dead 2978 (+19%), no longer infected 4025 (+7%). Intensive care 2257 (+10%). Fatality rate 9.4%.

So another moderate drop in growth rate, starting to look like a trend at last.

 

The fatality rate has a trend all of it's own, however.

[Winstonm]

But that means it's not that useful as the very early stages are when you need to pick this up to avoid the spread. Hopefully the antibody test for people who've had the virus will come onstream soon for both measurement and control purposes.

 

https://edition.cnn.com/2020/03/16/opinions/south-korea-italy-coronavirus-survivability-sepkowitz/index.html was the SK/Italy one.

 

Yes, but spreading information that the test us unreliable is being disingenuous. The test - like any - has limits. Calling it unreliable is the kind of borderline disinformation that prevents people from testing.

 

Just like it is O.K. to not be perfect, it is O.K. to tell people the limits on testing. And testing still has been the most effective method of control, judging by South Korea.

[Cyberyeti]

Yes, but spreading information that the test us unreliable is being disingenuous. The test - like any - has limits. Calling it unreliable is the kind of borderline disinformation that prevents people from testing.

 

Just like it is O.K. to not be perfect, it is O.K. to tell people the limits on testing. And testing still has been the most effective method of control, judging by South Korea.

 

I'm sorry, which part of it giving a sizable proportion of false negatives is incompatible with saying it's unreliable. It doesn't mean it's not useful (it doesn't AFAIK give false positives), just that you can't rely on it, and can't use it for one of the most critical functions you would want to (health worker with a cough, is it this virus, or can I go back to work as I would if it wasn't), you have to assume it is the virus.

 

Also SK put in place MUCH more draconian measures much earlier in the outbreak than many other places (the streets of some big cities were already deserted well into February) so this would have majorly contributed to the control of the outbreak as well as the testing.

[FelicityR]

The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest, most prestigious, and best known general medical journals. This is what the editor-in-chief had to say about how the UK handled the covid-19 outbreak today.

 

https://www.msn.com/en-gb/news/uknews/uk-failures-over-covid-19-will-increase-death-toll-says-leading-doctor/ar-BB11mTqs?ocid=spartandhp

 

I suppose what will happen next is that the people who have been hospitalised, and the relatives of the dead, will seek legal redress against the government.

[Winstonm]

I'm sorry, which part of it giving a sizable proportion of false negatives is incompatible with saying it's unreliable. It doesn't mean it's not useful (it doesn't AFAIK give false positives), just that you can't rely on it, and can't use it for one of the most critical functions you would want to (health worker with a cough, is it this virus, or can I go back to work as I would if it wasn't), you have to assume it is the virus.

 

Also SK put in place MUCH more draconian measures much earlier in the outbreak than many other places (the streets of some big cities were already deserted well into February) so this would have majorly contributed to the control of the outbreak as well as the testing.

 

South Korea is not a draconian state. It is a democratic republic.

[Cyberyeti]

South Korea is not a draconian state. It is a democratic republic.

 

Sorry Winston, you're losing it, you don't have to be a draconian state to have a few draconian laws, some could say the UK gun laws were.

 

Compulsory testing and movement restrictions very early in the outbreak were the sort of thing I was talking about. It also helps that their people were much better at taking some of the advice that went with the restrictions.

[cherdano]

Today's statistics in Italy: positive 28710 (+10%), dead 2978 (+19%), no longer infected 4025 (+7%). Intensive care 2257 (+10%). Fatality rate 9.4%.

So another moderate drop in growth rate, starting to look like a trend at last.

 

The fatality rate has a trend all of it's own, however.

Are there numbers on how many tests Italy is doing?

[mythdoc]

The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest, most prestigious, and best known general medical journals. This is what the editor-in-chief had to say about how the UK handled the covid-19 outbreak today.

 

https://www.msn.com/en-gb/news/uknews/uk-failures-over-covid-19-will-increase-death-toll-says-leading-doctor/ar-BB11mTqs?ocid=spartandhp

 

I suppose what will happen next is that the people who have been hospitalised, and the relatives of the dead, will seek legal redress against the government.

 

Is this allowed in the U.K., suing the government?

 

In any case, it is another blot on the face of the do-nothing, know-nothing political parties around the world, and the media that support them.

[mythdoc]

Just as one hypothetical question. If you had to make the choice between saving one person from a virus but it required throwing 7.5 billion people into total poverty and destitution what would you do.

 

The question is so exaggerated it seems like a rhetorical question. One person is all we get for throwing the entire world into TOTAL poverty and destitution? Back in the real world...

 

What if it was, saving say 20 million people, and the consequence was that the entire world would have to learn a different mode of living than rampant consumption, instant gratification-seeking and expenditure?

[Winstonm]

Sorry Winston, you're losing it, you don't have to be a draconian state to have a few draconian laws, some could say the UK gun laws were.

 

Compulsory testing and movement restrictions very early in the outbreak were the sort of thing I was talking about. It also helps that their people were much better at taking some of the advice that went with the restrictions.

You're confusing China's response and saying it was South Korea. Wrong. https://www.scmp.com/week-asia/health-environment/article/3075164/south-koreas-coronavirus-response-opposite-china-and

 

Whereas China, where the virus originated, and more recently Italy have placed millions of their citizens on lockdown, South Korea has not restricted people’s movements – not even in Daegu, the southeastern city at the centre of the country’s outbreak.

Instead, authorities have focused mandatory quarantine on infected patients and those with whom they have come into close contact, while advising the public to stay indoors, avoid public events, wear masks and practise good hygiene.

Please note that the "mandatory quarantine" was on infected patients - meaning they had been tested, and the tests were valid.

 

There is also this from Huffington Post:

 

March 18, SEOUL - In late January, South Korean health officials summoned representatives from more than 20 medical companies from their lunar New Year celebrations to a conference room tucked inside Seoul’s busy train station.

 

One of the country’s top infectious disease officials delivered an urgent message: South Korea needed an effective test immediately to detect the novel coronavirus, then running rampant in China. He promised the companies swift regulatory approval.

 

Though there were only four known cases in South Korea at that point, “we were very nervous. We believed that it could develop into a pandemic,” one attendee, Lee Sang-won, an infectious diseases expert at the Korea Centers for Disease Control and Prevention, told Reuters.

 

“We acted like an army,” he said.

 

A week after the Jan. 27 meeting, South Korea’s CDC approved one company’s diagnostic test. Another company soon followed. By the end of February, South Korea was making headlines around the world for its drive-through screening centers and ability to test thousands of people daily.

[thepossum]

The question is so exaggerated it seems like a rhetorical question. One person is all we get for throwing the entire world into TOTAL poverty and destitution? Back in the real world...

 

What if it was, saving say 20 million people, and the consequence was that the entire world would have to learn a different mode of living than rampant consumption, instant gratification-seeking and expenditure?

 

Sorry mythdoc. I deleted my post but hadnt realised you answered. It wasnt so much expecting a response as just trying to communicate the issue to some who maybe dont understand what has to be balanced by those in positions of power

, and by all of us really

 

It was indeed rhetorical

 

And I will also add the other part of my deleted post is that are many killers in this world other than one new virus and many of those could be much worse after the pandemic response. That is not expressing an opinion on the response, just a point of view on something that is a known and unquestionnable fact about poverty and its impacts

 

PS I'm not interested in debating my rhetorical since it is an impossible debate and would get us nowhere at all. It was simply something for people to ponder if they care about my posts

 

But I will address your point nd hope that its the end of your desire for an argument. If my question was extreme with 1 versus the whole world then tell me your acceptable equation of deaths from one virus to devastation to millions around the world. You clearly have some easily caluclated equation and figure in your head how to do that calculus

 

But its also clear from your attempt to answer my question that you have some other agenda such as imposing a radical oppressive new structure on the world and would like to take this opportunity to prosecute that case. Despite the fact that your view is held by a minority and countless people are losing everything. The billions of people whose lives you would seemingly happily and cruelly destroy earn what little they have through honest hard work in whatever capacity. Yet you slander them all implicity as corrupt, greedy etc

 

Yoou do realise that already countless people in many countries around the world, including the poorest of the poor are losing the ability to earn enough even to fulfil their basic daily needs for themselves and family - as a result of the lockdown. I imagine you are not one of those people who lives like that day by day

 

So much of this ideaological agenda and argument comes from people in positions of extreme privilege who wish to impose some radical agenda on people who do not wish to have their agenda imposed - especially not under the pretence of measures allegedly brought in to care for their well-being.

 

Maybe everyone needs to learn more about the real world (you used those words) and get out of their privileged little bubbles for once in a while

[Winstonm]

There are a lot of sick individuals in this world - some even have Covid-19.

[FelicityR]

Is this allowed in the U.K., suing the government?

 

In any case, it is another blot on the face of the do-nothing, know-nothing political parties around the world, and the media that support them.

 

That would be a difficult one to judge given the timeframe. Whilst Britain formally left the EU on 31st January 2020, the virus outbreak started late last year. I would guess - and this is only a guess - that the British government could still be taken to the European Court.

 

As far I am aware, in the UK the time limit to sue for medical negligence is still three years I believe, and that you can sue either an individual or an institution (National Health Service).

 

Given the potential large sum compensation claims, most lawyers probably work on a no-win no-fee basis, especially if they represent 100s of people at a time with the same or a similar grievance.

[Cyberyeti]

You're confusing China's response and saying it was South Korea. Wrong. https://www.scmp.com/week-asia/health-environment/article/3075164/south-koreas-coronavirus-response-opposite-china-and

 

 

Actually I'm not, I got my post from an article that said the exact opposite.

 

https://www.pharmaceutical-technology.com/features/coronavirus-affected-countries-south-korea-covid-19-outbreak-measures-impact/

 

2 quotes, my emphasis

 

"People residing in the Daegu and Gyeongbuk regions have been asked to refrain from attending public gatherings and restrictions have been imposed on their movement. "

 

"The South Korean cabinet passed new medical laws on 04 March allowing it to prosecute coronavirus-suspected people who don’t co-operate to get tested for the nCoV. "

[y66]

From Kent Sepkowitz MD at Memorial Sloane Kettering via The Daily Beast:

 

https://www.thedailybeast.com/what-will-we-do-when-americas-doctors-and-nurses-burn-out?ref=author

 

Despite the dazzling ineptitude of America’s initial response to the novel 2019 coronavirus pandemic, it is likely that the COVID-19 outbreak will subside in the next two or three—or four or five—months. All outbreaks, even the Black Death, do end eventually, though sometimes only after exhausting the supply of susceptible human beings in their path.

 

To be sure, there remain unimaginable illness and misery, disruption of society, and near-collapse of the health care system ahead. But movement restrictions will be loosened, and the hallmarks of American life, from sports to dinner out, will slowly start to come back into focus.

 

Yet in that shining city on a future, disease-ridden hill, we will encounter a new version of another uniquely American problem: burnout.

 

Doctors and nurses and everyone who help patients will be burnt to a crisp. Fried. Wiped out. Brains gone. Emotions in some distant deep freeze. Adrenalin spent. Too sleepy to fall asleep. Reading any of a number of reports from running-on-empty Italian practitioners shows just how bad it is and will become.

 

After months of fear, drama, panic (and excitement), health care workers will be asked to return to the chores of daily activities of keeping people healthy. That means writing notes in triplicate—one for the chart, one for your referring doctor, and one the insurance company. Asking you if you took your blood pressure pill. Making sure the new smartphone works everywhere throughout the hospital. And feeling bored and tired.

 

Which will come at a bad time in American medicine. What many initially thought was simply a millennial self-pity party, burnout in general and in health care is a real and real large problem, whether measured by economic (billions of dollars a year) or humanistic perspectives. For example, a pre-pandemic survey of American physicians found that 78 percent (a.k.a. everyone) had burnout and were therefore potentially endangering both their patients and themselves with short-tempered or exhausted or brain-semi-dead decisions.

 

There are differences, of course, in the types of burnout at play here. The recent American survey is about chronic frustration and dissatisfaction over many years, whereas the Italian doctors are delivering an urgent, primal scream of fear and fatigue.

 

Each path to burnout creates similar problems for patients and providers. But the coming wave of post-apocalypse zombie health care providers creates an additional problem. Many may become addicted to life on the high-wire—may need it to feel fulfilled once again, as irrational as that may be. This may cause more restlessness, then more mistakes, and more existential crisis.

 

Add to this an inevitable consequence for all who have done something brave and generous: feeling heroic but neglected.

 

Please note—this is some scary sh!t right now. Health care workers are at risk for acquiring COVID-19 and dying, as happened to some of the first doctors and nurses treating the disease in China. I worry about my friends and colleagues… and myself. All of us have some risk we have decided to take on. Some U.S. doctors and nurses will die. Yet they (we) are showing up for work, leaning in to their societal responsibility and—let’s be immodest here—sort of saving the day.

 

But in the happy future where the emphasis will on returning to normal, to the glib and ironic, to the shrug, to the HBO series COVID starring Someone Handsome, it is pretty unlikely that anyone will want to hear much about what we went through, at least after the first few weeks of calm and cautious celebration. It will become akin to hearing Uncle Maury go on about life as a soldier in the jungles of Vietnam. Haven’t we heard that story 100 times before? Like the last zillion Thanksgiving dinners?

 

Members of the military and first-responders knows well the speed with which society becomes disinterested after crisis has passed. By chance, institutions built for other purposes have provided a group therapy opportunity for them; for example, VFW (Veterans of Foreign Wars) halls throughout the country allow survivors to swap stories and recall old friends and cry a little. Ditto, the Veteran’s Administration (VA) hospital system in the U.S., which provides sick and disabled American veterans a place to be with the only people who can possibly understand and appreciate just exactly what they went through—and continue to go through.