Total Meatlove posted:

knox_harrington posted:

Wow look at Spain go. NB logarithmic scale on the Y axis.

knox_harrington posted:

I picked up swine flu back in 2009 which permanently hosed my lungs and gave me asthma. Very keen not to get this one.


I don't think this stuff about myocarditis is actually true, it's a nasty respiratory virus.

E: OK there is apparently some risk of myocarditis
https://www.preprints.org/manuscript/202003.0180/v1

OwlFancier posted:

ThomasPaine posted:

UK a promising underdog in the back there lmao

just another posted:

This came up on Facebook today. I don't know how legit it is but my friend who re-posted it is himself a doctor.

quote:

quote:
This is from a front-line ICU physician in a Seattle hospital
This is his personal account:
* we have 21 pts and 11 deaths since 2/28.
* we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen.
* US has been past containment since January
* Currently, all of ICU is for critically ill COVIDs, all of floor medsurg for stable COVIDs and EOL care, half of PCU, half of ER. New resp-sx pts Pulmonary Clinic offshoot is open
* CDC is no longer imposing home quarantine on providers who were wearing only droplet iso PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne iso PPE for aerosol-generating procedures in ANY pt in whom you suspect COVID, just to prevent the mass quarantines.
* we ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs, which is not the manufacturer's recommendation. Not surprised on N95s as we use mostly CAPRs anyway, but still.
*terminal cleans (inc UV light) for ER COVID rooms are taking forever, Enviro Services is overwhelmed. Bad as pts are stuck coughing in the waiting room. Rec planning now for Enviro upstaffing, or having a plan for sick pts to wait in their cars (that is not legal here, sadly).
* CLINICAL INFO based on our cases and info from CDC conf call today with other COVID providers in US:
* the Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data very skewed by late and very limited testing, and the number of our elderly pts going to comfort care. - being young & healthy (zero medical problems) does not rule out becoming vented or dead - probably the time course to developing significant lower resp sx is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb). - based on our hospitalized cases (including the not formally diagnosed ones who are obviously COVID - it is quite clinically unique) about 1/3 have mild lower resp sx, need 1-5L NC. 1/3 are sicker, FM or NRB. 1/3 tubed with ARDS. Thus far, everyone is seeing: - nl WBC. Almost always lymphopenic, occasionally poly-predominant but with nl total WBC. Doesn't change, even 10days in. - BAL lymphocytic despite blood lymphopenic (try not to bronch these pts; this data is from pre-testing time when we had several idiopathic ARDS cases) - fevers, often high, may be intermittent; persistently febrile, often for >10d. It isn't the dexmed, it's the SARS2. - low ProCalc; may be useful to check initially for later trending if later concern for VAP etc. - up AST/ALT, sometimes alk phos. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis at admit (150-200) correlates with clinical deterioration and progression to ARDS. LFTs typically begin to bump in 2nd week of clinical course. - mild AKI (Cr <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.
* characteristic CXR always bilateral patchy or reticular infiltrates, sometimes perihilar despite nl EF and volume down at presentation. At time of presentation may be subtle, but always present, even in our pts on chronic high dose steroids. NO effusions. CT is as expected, rarely mild mediastinal LAD, occ small effusions late in course which might be related to volume status/cap leak.
* Note - China is CT'ing everyone, even outpts, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs. Etc. 2 of our pts had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than CXR. - when resp failure occurs, it is RAPID (likely 7-10d out from sx onset, but rapid progression from hospital admit). Common scenario for our pts is, admit 1L NC. Next 12hrs -> NPPV. Next 12-24hrs -> vent/proned/Flolan. - interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you'd notice and say hmmm. - thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate. - given the inevitable rapid progression to ETT once resp decompensation begins, we and other hosps, including Wuhan, are doing early intubation. Facemask is fine, but if needing HFNC or NPPV just tube them. They definitely will need a tube anyway, & no point risking the aerosols. - no MOSF. There's the mild AST/ALT elevation, maybe a small Cr bump, but no florid failure. except cardiomyopathy. - multiple pts here have had nl EF on formal Echo or POCUS at time of admit (or in a couple of cases EF 40ish, chronically). Also nl Tpn from ED. Then they get the horrible resp failure, sans sepsis or shock. Then they turn the corner, off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less, then either VT->VF-> dead or PEA-> asystole in less than a day. Needless to say this is awful for families who had started to have hope. - We have actually had more asystole than VT, other facilities report more VT/VF, but same time course, a few days or a week after admit, around the time they're turning the corner. This occurs on med-surg pts too; one today who is elderly and chronically ill but baseline EF preserved, newly hypoTN overnight, EF<10. Already no escalation, has since passed, So presumably there is a viral CM aspect, which presents later in the course of dz. - of note, no WMAs on Echo, RV preserved, Tpns don't bump. Could be unrelated, but I've never seen anything like it before, esp in a pt who had been HD stable without sepsis.
Treatment -
*Remdesivir might work, some hosps have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, pts improve much more rapidly than expected in usual ARDS.
*Recommended course is 10d, but due to scarcity all hosps have stopped it when pt clinically out of the woods - none have continued >5d. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting then rapidly back to normal - suggests not a primary toxic hepatitis.
*unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID pts. Also CrCl>30, which is fine. CDC is working with Gilead to get LFT reqs changed now that we know this is a mild viral hepatitis.
-currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin can't remember where.
*steroids are up in the air. In China usual clinical practice for all ARDS is high dose methylpred. Thus, ALL of their pts have had high dose methylpred. Some question whether this practice increases mortality.
*it is likely that it increases seconday VAP/HAP. China has had a high rate of drug resistant GNR HAP/VAP and fungal pna in these pts, with resulting increases mortality. We have seen none, even in the earlier pts who were vented for >10d before being bronched (prior to test availability, again it is not a great idea to bronch these pts now).
- unclear whether VAP-prevention strategies are also different, but wouldn't think so?
- Hong Kong is currently running an uncontrolled trial of HC 100IV Q8.
- general consensus here (in US among docs who have cared for COVID pts) is that steroids will do more harm than good, unless needed for other indications.
- many of our pts have COPD on ICS. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far pts are tolerating that, no major issues with ventilating them that can't be managed with vent changes. We also have quite a few on AE-COPD/asthma doses of methylpred, so will be interesting to see how they do.
Plz share info.

tl;dr based on what I could translate:

- Chinese stats on mild/serious/critical were generally accurate (80%/14%/6%)
- For those who die, progress is rapid at around ~10 days from onset of symptoms to death
- Fucks with families a la radiation poisoning by having a period where symptoms improve before things go catastrophically wrong
- No change in white blood cell count even 10 days after onset of symptoms (?!?!)
- Fever, sometimes intermittent, for 10+ days
- For hospitalized cases, 1/3 have mild respiratory symptoms, 1/3rd need something like a non-rebreather mask, 1/3rd end up on an intubator

edit:
old news sorry

quote:

Then they get the horrible resp failure, sans sepsis or shock. Then they turn the corner, off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less, then either VT->VF-> dead or PEA-> asystole in less than a day.

ThomasPaine posted:

as a historian of health can I just take the time to say how wonderfully interesting this whole thing is going to be once i'm not immediately at risk of dying from it

TheRat posted:

From the corona-thread:


tl;dr based on what I could translate:

- Chinese stats on mild/serious/critical were generally accurate (80%/14%/6%)
- For those who die, progress is rapid at around ~10 days from onset of symptoms to death
- Fucks with families a la radiation poisoning by having a period where symptoms improve before things go catastrophically wrong
- No change in white blood cell count even 10 days after onset of symptoms (?!?!)
- Fever, sometimes intermittent, for 10+ days
- For hospitalized cases, 1/3 have mild respiratory symptoms, 1/3rd need something like a non-rebreather mask, 1/3rd end up on an intubator

edit:
old news sorry

CareyB posted:

I’m pretty sure most of this came out in the press conference before the wknd. There’s not enough to test everyone no matter how you slice it.

It’s pretty clear there’s not much to be done to prevent the spread of the virus so it’s pointless pissing your pants about it. You do need to remain calm and do your best to protect the vulnerable with the knowledge that this is going to impact us for the next few months...

Some of the angst on these forums is ridiculous. As someone who would never vote Tory and thinks bojo has been a terrible politician for the country.. I’m not sure what they can be expected to do differently... this is all coming from the scientist and doctors anyhow. I do trust them...

sassassin posted:

We're responding even worse than the US as over there state governors are locking down their own people and it's cascading from there through much of the country (mostly the blue parts).

The earlier we shut down everything the sooner the NHS starts to get some relief from the two week shitstorm we've already bought and paid for with our inaction up to now. As the WHO guy said, you have to get ahead of the virus, rapid and decisive action saves lives. Waiting until the time is right (with no testing to determine when that might be, if such a time even exists) is insanity.

The graph the government showed was mislabelled, as a sick joke.

knox_harrington posted:

Your perspective on this would be really interesting, I'd love to read it once the epidemic has all blown over.

quote:

Professor Alan McNally, Professor in Microbial Evolutionary Genomics at the University of Birmingham, said:

“I believe that mass gatherings could and should have been banned earlier. I can’t say if it’s a U-turn as only the government will know if this was the next phase of their plan or not. However the lack of action last week did receive robust and just criticism and the decision of organisations such as football and rugby authorities to cancel sporting fixtures has rather taken the decision out of the governments hands.

“Social distancing is required urgently, unless the government can provide data and models that counter that argument. Social distancing has worked in China, Singapore and other countries. However it is also important to note that this alone will not be sufficient. The decision to abandon community testing is I believe ill advised, and there needs to be combination of social distancing and extensive testing followed by quarantine of infected individuals to contain the epidemic. That quarantine should not be at home, where we will see large levels of familial transmission but in dedicated quarantine facilities.”



Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“The evidence base used to make the UK decisions draws on the international evidence base, but importantly has a specific focus on the UK context. There are good reasons for that. At this current time, I think the Uk response is appropriate.

“Do not underestimate the impact of social and behavioural responses in infectious disease outbreaks. Really, the epidemiology is a little easier. Judging how people will respond individually and en masse is much harder, and unlike epidemiology, social science doesn’t have a straightforward ‘number’ or easily digestible soundbite result for people to assess. Thus, in my view, behavioural scientists are the most underrated people around, and are often mocked because they provide perceived soft wavy answers where soundbites demand things like death rates and p values.

“So, the evidence base around how people respond in urgent situations is difficult to assess. Here in the UK, it’s partly focused on 2009 swine flu pandemic (since we as a country don’t have many opportunities for real live practice) though it is regularly reviewed in between outbreaks.

“The UK population by and large have significant control over their daily life. You choose when to pop out for a pint of milk, or if you’re off to the concert. Significant disruptions greatly reduce that control and thus need high population acceptance and compliance. You won’t get that over a long period of time. As a taster for what’s to come, people already can’t be trusted to buy toilet-roll properly, so how about long-term compliance when significant levels of freedom and control are removed, when fun is temporarily cancelled and there’s a need to stay indoors for long periods of time? How will compliance be then? The evidence base, as we have it right now, suggests it will decline.

“Thus, when do you introduce shutdown measures? Not too early. We are still very early in the outbreak. So, for as short a time as possible, at some point in the coming weeks.

“It’s understandable if the perceived lack of a response appears to be counter-intuitive, when there’s opportunities to “DO SOMETHING BIGGER!”. But, counter-intuitive means its harder to get your head around, not that it’s wrong.

So for example, other European countries policies, are they

a) evidence-driven in their own local context

or b) politically (and thus knee-jerk) driven?

“I genuinely don’t know the answer to that. What evidence are Norway, Ireland, Italy and the others using? It’s quite hard to find (it shouldn’t be). So, what is being considered elsewhere, and is it specific to their context, and why would it be relevant in the UK context?

“The UK approach is driven by evidence that is appropriate for the local context. And what other countries are doing with their populations, with subtle or markedly different cultural and social expectations and habits, does not mean the UK is doing the wrong thing. “They’re-doing-something-different” is in itself not a good reason for doing the same here. Decision-making has to be more nuanced than that. Context-specific evidence. That’s what we need. We are certainly not China, or Iran. We’re not even Italy or Ireland. We can all learn from each other, but don’t be surprised by the presence of locally-driven responses that are quite different.

“More stringent interventions (shutdowns etc) will come, potentially very soon. We know that. We’ve been told that. But, even though it might be counter-intuitive, going-gung-ho right now does not appear to be the best response. Many people are vocal, saying gung-ho should be the UK response. The usual justification that comes with that is “because they’re doing it over there”.

“That’s not providing the evidence base that supports those views. So if you disagree with the UK response then, as we sometimes say, ‘citations required’. I think a plain English summary from the Department of Health around decision-making and the evidence it is using would be helpful in guiding public understanding.

“Decision-making is an imperfect art, using imperfect evidence and so requiring pragmatic views. The evidence base as it stands tells us to manage the increases in cases carefully with a variety of factors (including self-isolation, the potential emergence of herd immunity etc) influencing a smoother path forward that might otherwise be the case.

“Here’s one final thought – decision making here in the UK is very overseen by the Chief Medical Officer (and other senior colleagues and advisors of course), who is a supremely intelligent experienced and thoughtful individual, backed up by an excellent team of analysts, researchers, policymakers etc. Just because he is pragmatic and softly-spoken, and not shouting as loudly as the next person, why assume he is wrong?”

Darth Walrus posted:

While I recognise that our response has been crap so far, can you really draw that many conclusions about death trajectory when they're in the low double digits? That seems like it could be very much affected by simple luck.

oxford_town posted:

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

knox_harrington posted:

I said some unkind stuff.

Anyway I think he is clearly wrong? There appears to be pretty solid data from other countries that social distancing works.

Darth Walrus posted:

While I recognise that our response has been crap so far, can you really draw that many conclusions about death trajectory when they're in the low double digits? That seems like it could be very much affected by simple luck.

jaete posted:

The thing about exponential growth is that inaccuracy in estimates doesn't matter unless it's supermassive. For example, given that the number of cases rises by 30% each day, this means the number of cases doubles in roughly three days. Imagine your estimate of current cases is off by a factor of two. How much more, or less, time do you actually have? Three days.

Ms Adequate posted:

Coronavirus is coronavirus. You can't say it's only a half.

Lobster God posted:

https://twitter.com/TomTugendhat/status/1239312624346693633?s=19

What in the actual gently caress.

oxford_town posted:

Here are some responses from 'experts', as linked by a public health consultant who I think is a good egg:

https://www.sciencemediacentre.org/expert-comment-on-uk-government-response-to-covid-19/

To quote selectively (most are broadly supportive but these two are probably the most divergent):