COVID-19

Health, Fitness, Insurance, ...
black_son_of_gray
Posts: 452
Joined: Fri Jan 02, 2015 7:39 pm

Re: COVID-19

Post by black_son_of_gray »

black_son_of_gray wrote:
Mon Mar 16, 2020 2:24 pm
San Francisco essentially locked down starting tomorrow. Rest of California Bay Area expected to be similar.
For those of you who are curious what a lockdown situation might look like in your part of the USA, here is a FAQ about the SF lockdown, which starts tomorrow 3/17 and continues until 4/7 at least.

https://sf.gov/stay-home-except-essential-needs
Vulnerable populations must stay home. Everyone should stay home except to get food, care for a relative or friend, get necessary health care, or go to an essential job.
The FAQ restates a lot of similar questions to really drive home the point.
These essential services will remain open:

City/County government services: Police stations, fire stations, hospitals/clinics and healthcare operations, jails, courts, garbage/sanitation, transportation (including Muni), utilities (water, power and gas), and certain city offices. Use online or mobile services whenever possible.
Gas stations
Pharmacies
Food: Grocery stores, farmers markets, food banks, convenience stores, take-out and delivery restaurants
Hardware stores/plumbers
Banks
Community benefit organizations on a case-by-case basis
Laundromats/laundry services
I know @jacob mentioned a scenario where a pipe bursts and you need a plumber/hardware to fix it. They've taken that into consideration.
What can't I do?

You cannot engage in group activities in person with others.
You cannot have dinner parties. You cannot invite friends over to your home to hang out.
You cannot go to bars or nightclubs.
You cannot go to a nail salon or get your hair cut by a stylist or barber.
You cannot go shopping for non-essential goods.
You cannot take unnecessary trips on public transport or in your car or motorbike.
Is this mandatory or is it just guidance?

It is mandatory. This Order is a legal Order issued under the authority of California law. You are required to comply, and it is a misdemeanor crime not to follow the order (although the intent is not for anyone to get into trouble).

It is critical for everyone to follow the Order to prevent the spread of COVID-19 and protect themselves, their loved ones, friends, neighbors and the whole community.

All persons, businesses, and other entities are required to comply if they do not fall within the exemptions that are specified in the Order.
No visiting friends or family unless in a care-giving capacity and generally, no visiting sick loved ones at the hospital either. Deliveries from online shopping are considered essential services and will still happen.

It'll be really interesting in the next week or two to see: 1) if the data start to show that this is working (might be tricky considering how little testing data there actually are to begin with); 2) if other states/cities implement something similar or go for something more/less strict; 3) if being "early" relative to other places in the US really does help dramatically (I sure hope so!)

black_son_of_gray
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Re: COVID-19

Post by black_son_of_gray »

From the FAQ (emphasis mine):
Why now?

This Order is being issued now because the infection rates in the Bay Area have reached a level that means the situation is either critical or will be soon. Some jurisdictions believe their health care systems may start becoming overwhelmed in the next week. For those jurisdictions, the spread has to be stopped immediately. For the other jurisdictions in the Bay Area, which are just a week or so behind, now is the time to take the strongest action possible to avoid allowing the disease to reach the point in the next few weeks that may overwhelm the health care system. The sooner these extreme measures are taken, the more effective they are because of how the virus spreads.
Soooo..... 1-2 weeks more of business as usual and the Bay Area heath care systems might become overwhelmed? :shock:

classical_Liberal
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Joined: Sun Mar 20, 2016 6:05 am

Re: COVID-19

Post by classical_Liberal »

I have some ears in the healthcare grapevine in the Midwest region. Hospitals are beginning to stop scheduled non-emergent surgeries in preparation. My hospital system is taking this very seriously with many measures now in place. I won't go into specifics, but I'm pretty impressed, given we do not have an epicenter of cases in our region.

Person to person talk in the healthcare biz; we are all gearing up personally for some potentially heavy loads. Please do your part in prevention and patience. If you have any healthcare workers in your tribe, reach out to give them some support if it gets tough in your area, I'll be appreciated.

I'm not sure if this will make any of you feel any better, but it should. Your nurses and doctors have your back, as best as we will be able. Stay healthy!

ertyu
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Joined: Sun Nov 13, 2016 2:31 am

Re: COVID-19

Post by ertyu »

In my country, nurses have been quitting over what they perceive as inadequate preparation and hazard pay. (They are probably right). RIP.

classical_Liberal
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Re: COVID-19

Post by classical_Liberal »

theanimal wrote:
Mon Mar 16, 2020 8:03 pm
Aggressive testing and isolation of those who test positive. SK tests over 10k per day. The US has only tested something like ~14k in total.
Second quote on this, sorry @theanimal. It looks like politico is aggregating state data for us. https://www.politico.com//interactives/ ... new-cases/
As I suspected, some of the barriers for testing seem to have come down. As of 3/12 there had only been about 10,000 total tests. That number has surged to over 41,000 as of 3/16. So about 8,000 per day since last Friday.

steveo73
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Re: COVID-19

Post by steveo73 »

These situations really make me realize (and my wife) how important it is to save money. We've lost a lot of money but it's only paper money and if we batten down the hatches and spend at bare minimum level I think we could survive indefinitely. My wife isn't going into work because she is paranoid about the whole situation but we can actually afford to do that. She is still getting paid but her boss is putting pressure on her to come into work. She has no problems refusing. It's work from home or sick leave. If they aren't cool with that she will quit.

thedollar
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Re: COVID-19

Post by thedollar »

@Jacob

I think you're right regarding your forecast. People hospitalised with Covid-19 more than doubled overnight: https://i.imgur.com/hYMotI6.png which I guess is an indicator of how things are developing.

Let's see where we are at in a week's time. I think a curfew is unavoidable by now and will be imposed before next week.

As far as I can understand the testing capability is not overwhelmed. They have changed the strategy from containment to trying to slow it down and the advice is to just stay home if you get sick - no tests. Everyone is to be considered a disease carrier.

Update: Statens seruminstitut is now estimating 9,000 to 90,000 cases in Denmark.
Last edited by thedollar on Tue Mar 17, 2020 3:53 am, edited 1 time in total.

AnalyticalEngine
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Joined: Sun Sep 02, 2018 11:57 am

Re: COVID-19

Post by AnalyticalEngine »

@c_L - I think you're right. They most certainly have to mean either that 50%-75% are mild or that pre-symptomatic transmission happens in 50%-75% of cases. 50%-75% completely without any symptoms just doesn't match the data we have. If it were true that only a quarter people show symptoms, we'd see things like only a quarter of family members getting it or a quarter of healthcare workers. Instead what we've seen is that transmission inside of households is a massive driver of new cases. Plus data in places like China, SK, cruise ship, etc show that most people do have symptoms. This is just a slow burning virus that can take many days to develop.

In other news, the job offer I was going to get fell through. The company decided to wait on hiring due to "city wide shutdowns." It's probably for the best to wait until after a quarantine here, but I just hope this doesn't trigger a recession such that they can never hire me. At least I still have my old job.

Colorado banned all seating at restaurants state wide for the next 30 days. Numerous small restaurant owners have had to lay off all their employees. With only ~160 cases, Colorado is choosing to be proactive. It's the right thing to stop the spread, but I'm really concerned for all the laid off workers and owners who can't pay rent on their buildings. I hope this doesn't have to be long and that the state economy will pull through...

ETA: Found a paper that describes the asymptomatic rate at 18%. That's a lot more reasonable: https://www.eurosurveillance.org/conten ... l_fulltext

Peanut
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Re: COVID-19

Post by Peanut »

steveo73 wrote:
Tue Mar 17, 2020 3:18 am
She is still getting paid but her boss is putting pressure on her to come into work. She has no problems refusing. It's work from home or sick leave. If they aren't cool with that she will quit.
She should stand firm and dare them to fire her, which they won't.

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Ego
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Re: COVID-19

Post by Ego »

More news from the Lancet on ibuprofen.

https://www.thelancet.com/journals/lanr ... 8/fulltext
Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs). Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2.5 ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.
Suggestions on alternatives to ibuprofen as a fever reducer that does not increase ACE2 expression?

Important Note: This is not a study. It is a hypothesis. Buyer beware.

ETA: I believe Turmeric is an ACE inhibitor so I have stopped adding it to my daily tea for the time being. I might be reading this wrong.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252471/

ETA2: No simple answers: http://www.nephjc.com/news/covidace2

bostonimproper
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Re: COVID-19

Post by bostonimproper »

@Ego French MoH is suggesting acetaminophen as alternative.

Though there's also the school of thought you should avoid taking fever reducers when you're sick.

#notadoctor

ertyu
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Re: COVID-19

Post by ertyu »

Italy 2,158 dead out of 27,980 infected. 7.7% mortality rate. Yes, their population might be aged. But consider:

- The Lombardy region's health care system is close to the best there is in a world-wide context (unsure how it ranks in developed countries)
- Italy was Europe's first hotspot. Thus, there are still regions of the world which can assist with humanitarian shipments. No one is getting 31 tonnes of medical supplies from here on.
- So far, with the exception of Iran where we have no reliable figures, the hotspots have been either in developed, well-resourced nations (SK, IT, HK, SG) or, if you want to pull teeth about China, in a country which has a vast base of resources and the ability to mobilize it (I don't see anyone else shipping 10k medical personnel from another part of their country to a hotspot area, bulldozing roads to secure quarantine, or ordering producers of PPE to roll, or else).

Given this, I will not be surprised if developing countries come closer to a 10-15% cfr rather than the previously hypothesized 3.5%, or even Italy's 7.7%. This holds particularly true for developing countries with ageing populations, such as the former eastern bloc. I am still keeping my fingers crossed for Africa, India, Pakistan, etc., where healthcare infrastructure is weak but the population is on average younger.

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Bankai
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Re: COVID-19

Post by Bankai »

Consider that the numbers quoted are only detected cases, so mortality rate calculated by deaths/detected cases is way overstated. The more people become ill, the lower %age of them is tested and we might soon be in a situation when only the 15% who require hospitalization and go to the hospital are tested (since everyone else, i.e. the 85% with no to mild symptoms just stay home and self-isolate). So, if 'true' death rate is 3%, but you divide 3/15 and not by 100, you'll get a 20% mortality rate instead of 3%.

bigato
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Re: COVID-19

Post by bigato »

Microsoft is tracking the cases in a nice map graph that’s being updated as they get new information:

https://www.bing.com/covid

jacob
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Re: COVID-19

Post by jacob »

@Bankai -

We can already estimate the true death rate in some circumstances based on South Korean numbers. However, until countries start doing random sampling of say 5000 people regardless of whether they're healthy or not, we won't know. Now, they're probably not going to do that because the answers they want now are more localized/the spread is still localized, so it would be a waste of tests. Anyway ... we'll know better in a couple of months or when the infection is fully saturated whether that's in controlled quarantine zones or entire countries if all they did was close the borders externally.

Here's my best estimate based on SK.

If the ICU system is not overwhelmed, then the true case fatality rate is 0.7% (for a country with SK demographics and health stats). We know this because SK has not dropped the ball and also tested widely and inexpensively. Since they have not tested everybody, this is of course an upper estimate, but it just might not be all that much lower than this(?)

Since only half of ICU patients survive, the fatality rate with an overwhelmed ICU system (most don't have access) is 1.4%.

Since 15-20% of those admitted to the hospital ends up in ICU, it kinda depends on what would have happened if they couldn't have have gone. That I don't know, so I can only give the possible range. If they all survived, then the true number stays at 1.4%. If they all died, the CFR increases to 7-9.3%.

The correct number of ultimate deaths for the countries where the system was/gets swamped would be somewhere between 1.4% and 9.3%.

That's out of everybody---if everybody could be tested---at the end of the day(*). Keep in mind that while 20 and 30 yos have a high survival rate, a non-trivial percentage still end up in the hospital insofar it's still available. If seriously sick, triage measures also prioritize the young and healthy, since they already have the best odds.

(*) The end of 2021 more likely.

Augustus
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Re: COVID-19

Post by Augustus »

bostonimproper wrote:
Tue Mar 17, 2020 9:32 am
IMO In general not taking pain killers/medication if you don't really need to is a good thing. Some people seem to chug the stuff without good reason. But if you have a high fever you can have a seizure, so in that case, take tylenol and/or ibuprofen to lower the fever.

J_
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Re: COVID-19

Post by J_ »

@Jacob, I think you are right with your estimate end of 2021! The outbreak can/will rebounce ( see China) Its helps to make good assumptions how things will develop. And then to make your (my) own plans based on a realistic outlook. It helps too to make yourself a realistic mental picture.

Augustus
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Re: COVID-19

Post by Augustus »

George the original one wrote:
Mon Mar 16, 2020 4:22 pm
80:20 ratio from China was serious=hospitalization.
Can we clarify what you mean by hospitalization. Will they die without it? That would make the mortality rate 20% when hospitals are overloaded, which seems much higher than what we're actually seeing. I'm not talking about seeing a Dr and getting medication, I mean actually needs to be in a hospital and will die without it.

theanimal
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Re: COVID-19

Post by theanimal »

@C_L- Curious where you see 41k on that site? The total tests given is showing ~27k on my end. Either way, happy things are trending upwards.

jacob
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Re: COVID-19

Post by jacob »

Augustus wrote:
Tue Mar 17, 2020 10:58 am
Can we clarify what you mean by hospitalization. Will they die without it? That would make the mortality rate 20% when hospitals are overloaded...
I don't think we know those numbers yet (because of the iceberg factor). At least I can't think of a way to extract them from the data. We should know soonish since countries which have run out of testing capacity and are pursuing a mitigation strategy ONLY tests those who make it to the hospital. Presuming that people don't die at home, we can extract the rate based on the "official number" vs the "shadow number".

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