Coronavirus Sars-CoV-2/Covid-19 Megathread

[The Larch]

A few cases in my uncle's care home. He seems fine so far. Fortunately neither my dad nor his siblings have been there since the party started.

My dad's aunt passed away from CV19 last week, and she caught it at the care home she was staying. That particular care house has been, AFAIK, the largest source of cases in my hometown.

[DGuller]

I've looked at various data from NYC, which it makes available, and I think it peaked as well.  I think that even obviously imperfect measures are sufficient to retard the spread of the disease enough (enough being the key word, not completely), and the imperfect data collection is just massively adding to the lag of realizing when the measures have started working.

[Grey Fox]

Wheres this?
That Confucius mountain?

Huangshan mountain park, last Saturday. They closed the park at 8 AM, after 20,000 people had entered already.

It is still China.

[Sheilbh]

Second day in a row that the UK death figures have fallen (I think we're still waiting for Northern Ireland so this is just England, Wales and Scotland but it's unlikely Northern Ireland will change the picture) - which is promising, but it's the weekend so we'll need to see tomorrow's numbers. Nicola Sturgeon is certainly warning that the "worst is yet to come".

Also London is at 127 which is within that 100-160 range we've been in for several days now, so it does seem like it's plateauing here. Midlands and the North East & Yorkshire are both back under 100 at 75 and 67, which is again promising that they're not escalating.

[mongers]

Second day in a row that the UK death figures have fallen (I think we're still waiting for Northern Ireland so this is just England, Wales and Scotland but it's unlikely Northern Ireland will change the picture) - which is promising, but it's the weekend so we'll need to see tomorrow's numbers. Nicola Sturgeon is certainly warning that the "worst is yet to come".

Also London is at 127 which is within that 100-160 range we've been in for several days now, so it does seem like it's plateauing here. Midlands and the North East & Yorkshire are both back under 100 at 75 and 67, which is again promising that they're not escalating.

Yes, as you say promising, but still early days.

And could be noise in the signal, perhaps we should move to a fixed weekly average, say Saturday-Friday, with "today figures being added to this week's (rolling) average so far of X per day"   "Which compares well with ( or is somewhat worse than ) last week's deaths" ?

Would that sort of official announcement be more useful and suppress the no-hospital deaths spike?

[celedhring]

First the drones, now this...

https://www.youtube.com/watch?v=hwaKlUWwyyE

[Sheilbh]

Derbyshire Police are out of control!

[Sheilbh]

Another one of those small stories that describes common sense and helpful thing, but really makes how grim this all is hit home:

Detectives will work with body recovery teams to check if there are any suspicious circumstances surrounding the deaths of suspected coronavirus victims who die in the community.

Small police units are undergoing training alongside fire brigade and NHS staff to collect the dead across London and ease pressure on under-strain hospitals and the London Ambulance service.

The teams, who have been given personal protective equipment (PPE), will attend houses, care homes, and hospices to confirm the death and identity of the deceased.

Pandemic Multi-Agency Response Teams began working in the capital last Tuesday amid projections that around one third of suspected Covid-19 deaths could happen outside hospitals.

Team members are understood to have volunteered to take on the role, with Scotland Yard Superintendent Wayne Matthews telling them they should not "underestimate how unpleasant this task is going to be".

"What we are asking the officers to do is essentially deal with one fatality, then another and then another," he told the PA news agency.

"So obviously the mental robustness and physical aptitude to be able to do this is why we asked for volunteers, people who felt they were able to do this."

After dealing with a case, the teams have the option of a "decompression period" to help them deal with the mental toll.

[celedhring]

Stills from an ER room in a Madrid hospital.

https://twitter.com/JCarriel84/status/1246807119313145861/photo/3

Yep, nearly empty. Lots of similar reports from hospitals in Spain.

[Razgovory]

I've looked at various data from NYC, which it makes available, and I think it peaked as well.  I think that even obviously imperfect measures are sufficient to retard the spread of the disease enough (enough being the key word, not completely), and the imperfect data collection is just massively adding to the lag of realizing when the measures have started working.

Is this whole lock down going to work?

[Grey Fox]

You know how there is a trope where the USA always saves the world? Yeah, well not this time.

Fuck you America.

[Syt]

https://edition.cnn.com/2020/04/06/politics/uss-tr-crozier-modly/index.html

(CNN)The Acting Secretary of the Navy Thomas Modly blasted the now ousted commander of the USS Theodore Roosevelt as "stupid" in an address to the ship's crew Monday morning, in remarks obtained by CNN.

Modly told the crew that their former commander, Capt. Brett Crozier, was either "too naive or too stupid" to be in command or that he intentionally leaked to the media a memo in which he warned about coronavirus spreading aboard the aircraft carrier and urged action to save his sailors.

The acting secretary accused Crozier of committing a "betrayal" and creating a "big controversy" in Washington by disseminating the warning so widely.

"It was a betrayal. And I can tell you one other thing: because he did that he put it in the public's forum and it is now a big controversy in Washington, DC," Modly said, according to a transcript of remarks Modly made to the crew, copies of which have been provided to CNN by multiple Navy officials.

'Too naive or too stupid'

In remarks that were piped over the vessel's PA system, Modly suggested Crozier leaked the memo on purpose or was "too naive or too stupid" to be in command if he didn't think that sending it to over 20 people would not result in it getting out to the public.

"If he didn't think, in my opinion, that this information wasn't going to get out to the public, in this day and information age that we live in, then he was either A, too naïve or too stupid to be a commanding officer of a ship like this," Modly said. "The alternative is that he did this on purpose."

Modly went on to say it was a "betrayal of trust, with me, with his chain of command."

Crozier had written to Navy leadership to alert them to the challenges of trying to contain the disease aboard the USS Theodore Roosevelt and to urgently request sailors be allowed to quarantine off the ship.

"We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset: our Sailors," Crozier wrote in a memo that three US defense officials confirmed to CNN.

When asked if Modly's personal attack on Crozier was appropriate, a senior defense official said Monday, "I don't know what to say."

Modly's use of the word "betrayal" is a loaded because saying an officer has betrayed the Navy is a court martial offense.

A defense official familiar with Modly's remarks offered his opinion of Modly's address, saying the acting secretary "should be fired. I don't know how he survives this day."

As of Monday, 173 of the ship's crew have now tested positive for coronavirus and 61% of the crew have been tested, according to a Navy official. Approximately 2,000 have been evacuated from the ship and moved ashore.

The Navy had set a goal of moving 2,700 sailors ashore in Guam by Friday evening and has fallen several days behind schedule.

Several senior military officials, including the Chief of Naval Operations, Adm. Mike Gilday, recommended against Modly's decision to fire Crozier before an investigation into the matter was complete and in the midst of an evacuation, two US officials tell CNN.

Crozier's popularity with the ship's crew was on display in videos showing sailors giving him a warm and loud send off, clapping and chanting his name as he left the ship for the final time. Modly acknowledged Crozier's popularity with the crew in his remarks to the sailors. "I cannot control or attempt to change whatever anger you have with me for relieving your beloved CO," Modly said, using the slang for commanding officer. "I understand you may be angry with me for the rest of your lives."

[Sheilbh]

So Northern Ireland have now reported.

UK fatalities from yesterday are now confirmed - however there is a weekend dip and we'll see the numbers tomorrow and there may be record numbers again this week - but 439 new deaths, which is an increase of 9%. But going into next week will be the third week of lockdown so, given the lag, hopefully we'll see the impact of that soon.

Also nice to see that Chris Whitty (Chief Medical Officer) has recovered and is back at today's briefing

About 18,000 hospitalised which is still on trend with the last week of around 1-1,500 admissions a day. So this is double the number at this time last week.

[Sheilbh]

Very interesting piece on some of the things London hospitals are learning about this disease and how many of the issues are because it's not as simple as pneumonia:

London hospitals face pump and dialysis machine shortages, leaked memo warns
Letter from senior consultant lays bare reality of NHS under pressure from coronavirus
Peter Foster in London 2 hours ago

Major London hospitals are running short of equipment in intensive care wards, including pumps and blood dialysis machines, according to a leaked memo to senior hospital doctors.

The shortages, which go beyond concerns about the lack of ventilators and protective equipment, emerged from a conference call of some 80 senior NHS doctors. The call highlighted the growing pressure from the influx of coronavirus patients on hospitals in the capital, which so far is the hardest hit part of the UK.

The 1,000-word memo, seen by the Financial Times, is written by Professor Daniel Martin, the head of intensive care for serious infectious diseases at the Royal Free Hospital. It paints a picture of doctors and nurses still scrambling to develop treatments for the virus as the shortages bite.

The summary of the call, which was designed to share information about how best to treat coronavirus patients, warned nurse-to-patient ratios are at six-to-one in intensive care wards with hospitals using everyone "from med students to dental hygienists" to absorb the overload.

The note also revealed Covid-19 is not simply a "one organ" disease that attacks the lungs, but is also causing "high rates" of acute kidney failure.

Dr Martin warned "over zealous" use of diuretics such as Frusemide were leading to "unnecessary" kidney complications and related blood clotting issues.

He also flagged the "higher than predicted need" for kidney treatments, while noting that several London hospitals, including King's College Hospital, are running short of blood filtration machines.

He wrote King's College was "running out of" the "CVVHF" blood filtration machines and an unnamed centre had "run out of pumps" used to administer some drugs.

The note, designed to share insights and develop best practice among colleagues, painted a picture of the pressure on the NHS as hospitals race to train sufficient doctors and staff wards already facing shortages.

"Most centres now getting towards 1:6 nursing ratio with high level of support workers on ICU [Intensive Care Unit]," Dr Martin wrote. "Training has largely fallen by the wayside as it is too large a task. People are being trained on the job," he added.

He also chided colleagues that they need to catch up with other hospitals in seconding staff, and noted some "non-medical staff" were refusing to enter intensive care wards — a practice that needed to end.

"We need one support worker per patient. Other centres are using everyone they have. From med students to dental hygienists. We are behind the curve '++' with this," he wrote.

"Last time I was on a night shift, theatres were full of non-medical staff refusing to help ICU — this is unacceptable," he added.

The account of the call emerged as the NHS across London braced itself for the "peak" of Covid-19 admissions, around Easter, with government models expecting this in the next seven to 10 days.

Dr Martin's note to colleagues also revealed the extent to which doctors are still learning about treatments for the virus, despite all the information being passed back from hotspots hit earlier in the pandemic in Europe, such as Lombardy in northern Italy.

He warned, for example, to avoid ventilation too early in the intensive care process as this "may be harmful", while noting patients were having to go back on to ventilators if taken off too early.

"Not many patients have reached extubation yet in London," he wrote, before adding "re-intubation seems to be common" and his doctors should "wait longer than usual before extubating". "An extubation protocol is needed immediately," he added.

Another evolving area of coronavirus care is the question of "fluid balance" among patients, and how far they should be hydrated. "All centres agreed that we are getting this wrong," he wrote.

Dr Martin concluded with a final note of uncertainty, arguing that colleagues "desperately need to look at our own data to understand whether we are getting this [treatment] right or not".

A spokesman for the Royal Free Hospital declined to comment on the communication. A request for an interview with Dr Martin was declined, citing his work commitments in managing the response to the virus.

[Legbiter]

Here we're pretty much holding steady. We now have almost 1600 cases, almost 40 people are hospitalized and 4 people have died. All were elderly with a laundry list of ailments. The virus has popped up in a couple of retirement homes so that's very concerning. The strain on the health system is starting to be noted. By next week we'll have tested 10% of the entire nation.