Coronavirus Sars-CoV-2/Covid-19 Megathread

[Eddie Teach]

Is hockey over already?

[katmai]

Is hockey over already?

no. It's just forgettable 

[Barrister]

Is hockey over already?

no. It's just forgettable 

[Razgovory]

Has anyone here lived through an unconstrained pandemic?  I mean besides Grumbler who survived the plague of Pericles.  This is sort of outside my experience.

[viper37]

Pence said the CDC suppliers are supposed to send out 1 million tests Monday and up to 4 million by the end of the week. We're kinda in limbo until then and limiting who we're testing. He may be full of bullshit and covering for Trump, though.

It doesn't really matter if they send 350 million tests Monday.  There is no capacity to test that many people at the moment.

[viper37]

By the way, how is Canada doing? I'm not hearing about any big clusters popping up or people dying.

As of yet, no one has died.  I know Quebec has had 3 cases (2 coming back from Iran), word is they are doing ok, all of them are self isolated at home, not recquiring any ER care.

I am unsure about the total number of cases in all of Canada, but I think it's somewhere around 28 in BC and maybe 15 in Ontario?  I'm pretty sure it's below 100 cases overall though.

I was told today by someone that our controls at the frontier are very lax.  Maybe more cases are to be expected.  So far, the provinces are doing ok, Trudeau is keeping his mouth shut, stock markets haven't deeply crashed but with the drop on oil prices, I figure we'll take a beating tomorrow morning.

[viper37]

the nba is only league in season and they have had discussions to do so already.

I take it back. Soccer just started and baseball will begin shortly too.

ahem. aren't you forgetting some game?

The NHL has barred journalists from the locker rooms.

[Barrister]

Has anyone here lived through an unconstrained pandemic?  I mean besides Grumbler who survived the plague of Pericles.  This is sort of outside my experience.

My grandfather lived through polio.  He had a limp leg for the entire time I knew him (he died when I was 12), and I heard a couple of stories about that time for him.

I remember from my high school which had grad pics for almost 100 years on the walls... there was no 1919 picture - the only year missing - due to the Spanish Flu.

[katmai]

the nba is only league in season and they have had discussions to do so already.

I take it back. Soccer just started and baseball will begin shortly too.

ahem. aren't you forgetting some game?

nothing important

[viper37]

Has anyone here lived through an unconstrained pandemic?  I mean besides Grumbler who survived the plague of Pericles.  This is sort of outside my experience.

I haven't.  But I have found a nice article that deals with the subject.  But it's written in the world's greatest language to have ever existed since 6000 years ago when the Earth was created, and unfortunately, not many of you can read it.
Coronavirus: Amergeddon or bullshit (in French, in case anyone doubted me )

The specific numbers concers Belgium, but I'll give you a quick translation of the stats.  Google translate might work too.


Contagion is defined as R0.
R0 of regular flu= 1.3
R0 of Covid19 = 2.2
R0 of Rubella = 6  (rubella is also called "german measle" apparently)

Average incubation period of covid19 is 6 days.
If one sick individual is among 100 people, at:
- D-6 you have 2,2 sick people + the first infected= 3,2 infected individual.
- D-12 you have 2,2 sick people each contaminating 2,2 people that makes 3.2+2.2+2.2=7,6 sick people
- At D-18 you have 24 sick people = 24% of your population.

To compare covid19 with regular flu, it's 1,7 times more contagious.

In Belgium regular flu hits 500 000 people on average per year.
If we don't do anything, covid19 will infect 850 000 people.

Chinese and italian numbers are similar, and that's bad news because we hoped Europe would fave better with a more robust healthcare system.  These numbers report:
- 13,8% of affectedpeople develop pneumonia and require oxygen+hospitalisation
- 6,1% of affected people develop pneumonia with many defective organs

On 850 000 people that makes:
- 117 000 hospitalized people
- 52 000 people necessitating intensive care

There are 30 000 accute beds in Belgium's hospitals.  Among those, 1400 beds for intensive care with artificial respirator and dyalisis, etc that can be used to manage the worst of the covid19 cases.

Once these beds are filled, the patients will no longer be provided with advanced healthcare and will be sent home where he will be taken care of as good as he can.  That explains why there is an higher death toll in places where the hospital network is overwhelmed.  Italy has a 2,6 deathrare from the virus, but it climbs to 3,6% in places where hospitals are saturated.

Currently, in Belgium, occupation rate of intensive care beds sits at 90% (NFT: mostly due to seasonal flu).  That leaves 140 beds to treat 52 000 potentiel covid19 infected patients.

There is a high risk of then climbing to a 3,9% mortality rate, so 33 150 deaths on an 11 million population.  It is not "much" (we ain't all gonna die as we sometimes hear), but it still 100 times more than the number of annual deaths by road accidents.

How should authorities react:
1st thing to do is preventing the virus from achieving 850 000 contaminated people.

Phase 1)
We work so that the virus will not enter the country (quarantine).  It has been done, but it has failed: the virus is here and we're already at phase 2 since March 1st.  In fact, phase 1 always fail and only serves to give us time so treatments could be found or organize solutions.  You can't blame ministers on this.

Phase 2)
We work to minimize the propagation.  We begin by telling people to respect basice hygiene measures:

   
• Say hello from far away: don't shake hands, don't kiss
• Wash your hands with water and soap or with al alcohol based solution after all contact with bodily fluid
• use throwable tissues
• Sneeze and cough in your elbow
• Stay at home with the least possible visitations if you are sick
• I'll talk of the use of mask later, it's not magical

It does not seem like much, but many epidemics have been anihilated by such measures (i.e. ebola).

Next step of phase 2 is to reduce the risk of massively exchanging the virus.  At this point we forbid mass gathering.


The controversial phase 3 is to reduce moderate gatherings: we shut down schools, trains, buses, we forbid people from highly contaminated areas to come to work, etc, etc.  This phase has not clearly demonstrated its effectiveness but it must anyway come AFTER all other steps.

It's possible phase 2 and 3 will contain the propagation of the virus.  Only a few hundred people will have contaminated and hospitals won't be overbooked.  It is what we hope.

After this only comes the hospitalization phase.  Hospitals will be fulled and staff will be reduced as they are at higher risk of being contaminated.  In China, 12% of the contaminated patients were hospital workers.  It would mean here 100 000 contaminated hospital staff.  And we already have a shortage of white blouse in Belgium.

Hospitals will be full.  We will then activate the pandemic plan coordinated by the minister and detailed in all hospitals:

• First, all scheduled hospitalisation (i.e. knee surgery) will be cancelled/indefinately delayed, unless it's a vital emergency

• hospitals will be divided in an infected zone and a non infected zone
  • then we will shorten the hospital stay as much as possible: people will exit faster than usual and we will admit less easily people who come at the ER. There will be some deaths due to these policies, but less than due to covid19
    • Then we will "push" the beds: respirators from operating and wake up room will be use to make "extensions" to intensive care units, single occupancy rooms will be converted in multiple occupancy rooms,...
      • If we're still swamped after that, we will apply the ethical principal of distributive justice: between the young 40 years old with an infarctus and the old 90 yo with covid19, we will reserved the bed for the yound and send the old home.  There will be no other choice.
        • The staff will also fall ill and there's no magical solution, so we will try to reduced their numbers as much as possible: split staff working with infecteds from the others, make them wear gloves and overalls, having them wear a special mask named FFP2 as the regular surgical mask is ineffective against the virus.

Currently, there is a shortage of these masks as drugstores are back ordered on these and the minister does not answer when we ask her if general practitionner will receive some.  We've known since 1918 that when we are in this situation there is an increase in the number of deaths linked to other diseases (cardiac arrests, etc) on non infected due to the number of non infected units and lack of staff to treat non infected patients.

We risk going from 33 000 direct deaths to 50 000 direct and indirect deaths.  That is the worst scenario.

Who will be these 50 000 dead people? Aged people and/or people with chronic diseases (like diabetese): stats show that an 80-something is 10x more likely to die than a 60-something.  No children, even with chronical disease, as died as of this day.


Conclusion:
Absolute priority is to not reach these 850 000 infected people. It can still be done.  It largely depends on adequate behavior from everyone.  That's why the authorities are making so much noise: it's like the firefighters in the forests of Provence: when the fire is not spreading, we say they exagerate.  If the fire spreads, they will be samped...  You have your share of responsibilities: apply hygiene measures.

The risk of having a severe problem in hospitals is real, no hospital direction is taking this litely.

We are not all going to die: worst case scenario will be 0,4% of Belgians will die, mostly ones aged 80 or more.  Stop with the psychosis.  Educate people around you to basic hygiene measures, share this text, but stay assured, unless you are 80+, the risk of dying from this are at 0,1%.

With everyone's help the virus will be contained and the death toll will be in the hundreds like the seasonal flu.  The grumpies who understood nothing will say we alarmed the population for nothing. Such is life.

****



My own take this is that in the US, phase 1 has utterly failed, phase 2 has mostly failed and you're at phase 3 with a grim look at reaching worst case scenario.

[Barrister]

the nba is only league in season and they have had discussions to do so already.

I take it back. Soccer just started and baseball will begin shortly too.

ahem. aren't you forgetting some game?

nothing important

Asshole.

[viper37]

the nba is only league in season and they have had discussions to do so already.

I take it back. Soccer just started and baseball will begin shortly too.

ahem. aren't you forgetting some game?

nothing important

Asshole.

We'll go beat him with a hockey stick until he recants.   

[merithyn]

Today some people started talking about making a "selection" of who to admit to ICU rooms, based on age, preexisting conditions, and availability of beds in the area 

L.

Jesus. That's sobering. 

[katmai]

the nba is only league in season and they have had discussions to do so already.

I take it back. Soccer just started and baseball will begin shortly too.

ahem. aren't you forgetting some game?

nothing important

Asshole.

dont you forget it lips

[jimmy olsen]

Yikes!
https://twitter.com/AbraarKaran/status/12366803304568094724

THREAD

1/ Of all the articles I read this week on #COVID19, this @nytimes ⬇️ really caught my eye. https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html

It was an interview w/ Dr. Bruce Aylward, the lead on the @WHO team that visited China to examine their response.

It surprised me for multiple reasons.

2/ The first surprise was the speculation by many that the case fatality rate will be much lower once we find all of these "mild" and "asymptomatic" cases, which you don't as easily pick up early on in an outbreak.

Apparently the data @WHO has doesn't support this theory.

3/ The team went back & tested 320,000 samples originally taken for flu and other screening; only 0.5% returned positive.

Is this a perfect way to know if we had missed mild/asymptomatic cases? No.

But is it another point of data. Yes.

4/ Another surprise: the Chinese data where the 80% "mild" cases number comes from —that was not a "mild cold".

That was: you have a fever, possibly even a full pneumonia. Not your run-of-the-mill sniffles.

"Severe" (which was ~15%) meant you were on oxygen or a ventilator.