COVID-19

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AnalyticalEngine
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Re: COVID-19

Post by AnalyticalEngine »

I personally draw the line at sustained community transfer. That is, the point where contract tracing breaks down. Once you start getting infections in town where they can't pin point where they came from because enough people are sick, that's where you've entered danger territory. The plague ship is a good example of this. While they initially knew patient 0 on there, it's spread so much that they have no idea where it's coming from.

The goal post moving is a real issue I've already seen. I was talking to someone from China who lives in one of the high risk areas. She mentioned she was staying inside most of the time, but then the screen protector to her phone broke. So she went out the next day to go buy one. Or another person living in Wuhan who needed to go buy gas to cook with. She went outside wearing a mask, but then bought orange juice and drank it by slipping it under the mask. (Which completely defeats the point of wearing a mask!) When you get infections going on for months, people definitely do adjust to "new normal" and start making questionable judgement calls.

Or we have this woman who turned down the state department trying to rescue her from the plague ship:
New York Times wrote:Some remained hesitant. Linda Tsukamoto, 63, a retired retail manager from Marina del Rey, Calif., said she had signed up for an evacuation flight, but changed her mind at the last minute.

Ms. Tsukamoto stuck a Post-it note on her door reading, “I’m staying.” Three military doctors came to her door and advised her to go. Their emphatic tone, she said, was “scary,” but she was standing her ground.

“I’d rather go home first class on United Airlines than a cold, noisy military charter when the Japanese Ministry of Health releases us,” she said. “I refuse to be fearful but respect the U.S. government to help others who feel more comfortable rushing home.”
Ultimately, avoiding infection comes down to stacking months of probability in your favor. Having a 10% a day chance of infection vs. 1% a day is going to make a significant difference over the course of a month. 10% gives you only a 4% chance of staying healthy. Reducing that to 1% leaves you with 74% chance of avoiding the disease. So even if being a complete shut in isn't realistic, taking every precaution you can (wash hands, don't touch face, stay away from sick people, avoid restaurants, say no to your friends who invite you lick door knobs, etc) will add up.

There is probably a point where one becomes a social pariah, but resisting the goal post moving by personally avoiding the theater during the Spanish flu is the best I can do.

classical_Liberal
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Re: COVID-19

Post by classical_Liberal »

Ego wrote:
Mon Feb 17, 2020 12:19 pm
I've said on more than one occasion above that my goal is to avoid hospitals. That is not completely accurately.
Good. This was my biggest concern. Or that others may think it's a good idea as well.
Ego wrote:
Mon Feb 17, 2020 12:19 pm
I guess what I am doing is imagining a world where a reasonable, knowledgeable person such as classic_Liberal would agree that going to an overwhelmed, understaffed, undersupplied hospital is worse than staying at home and self treating with basic tools. It will probably never happen but it costs almost nothing.
There's nothing wrong with being prepared for SHTF. For some things though, practicing for SHTF when it hasn't happened yet, can be dangerous and counterproductive. I think not taking advantage of medical care when it is still available is one of those.

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Ego
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Re: COVID-19

Post by Ego »

classical_Liberal wrote:
Mon Feb 17, 2020 6:07 pm
Or that others may think it's a good idea as well.
I sure hope nobody here is dumb enough to follow my example.

Point taken.

In other news, a Japanese firefighter who helped with the cruise ship passengers was infected despite using full protection.
https://asia.nikkei.com/Spotlight/Coron ... n-outbreak

and

600 packages of toilet paper were stolen by knife wielding assailants in Hong Kong.

https://www.nytimes.com/2020/02/17/worl ... virus.html

7Wannabe5
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Re: COVID-19

Post by 7Wannabe5 »

"They Came Like Swallows" (1939) by William Maxwell is a lovely novel set in a small Illinois town during the 1918 Spanish Influenza epidemic. By happenstance, it also directly touches on the theme of how extended family can fill a void in nuclear family in time of crisis. Highly recommended. One of my favorites.


Due to the fact that I had chronic severe asthma until my late 30s, I expect I will die if infected with COVID-19. Luckily, my children are completely independent adults and I have already had more than my fair share of fun. My last remaining wish would be that the members of this forum continue to make use of the phrase "lentil baby" in slim chance that it may eventually enter the common vernacular.

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Ego
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Re: COVID-19

Post by Ego »

The Lancet published the recommended treatment strategy for Convid-19.

https://www.thelancet.com/journals/lanr ... 0/fulltext

Image

Any ideas on the cost per day of ICU isolation? I would imagine that those who are un/under-insured will be reluctant to submit themselves to the mercy of the flowchart. If it actually makes it here it will be an interesting test case for health insurance during a pandemic. Will the government agree to cover to costs for all so that they don't avoid treatment?

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

Re: COVID-19

Post by AnalyticalEngine »

Notably in the Clade X simulation, they discussed what would happen to the hospital system in the US. They had some cases of hospitals refusing to take Clade X patients. Because while US emergency rooms are required to stabilize you, a private hospital isn't required to accept transfer patients. Additionally, Clade X drove many hospitals to bankruptcy. Running a private hospital is a lot more expensive than many Americans think it is.

Anyway, the "happy" ending of Clade X was that the government had to nationalize the healthcare system as private hospitals and insurances went bankrupt. :lol:

I'm not quite sure how it would actually go down in the US, but bankruptcy across all layers of healthcare (patient, provider, insurance) isn't unlikely. Many of these ICU patients need to be there for 2 weeks. Caring for critical viral pneumonia in an isolation ward ain't cheap for anyone.

jacob
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Re: COVID-19

Post by jacob »

https://www.amazon.com/dp/0786884401/ is a good book touching on the priority of public and private health respectively. Infectious diseases are a good example of public health issues spilling over into private health. It appears to be cyclical in that an era of few public health issues leads to down-prioritizing the public aspect and vice versa. For example, public health and sanitation became an issue in the 1920s after people who could afford private health care couldn't pay their way out of getting infected by those who could not afford it. In that sense, it's similar to the cycles of regulation and deregulation that follows the economic cycles.

Add: Since it pertains to zoonosis, I also recommend https://www.amazon.com/dp/0140250913/ from the same author.

Lemon
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Joined: Sat May 30, 2015 2:29 am

Re: COVID-19

Post by Lemon »

This is a nice podcast which may be of interest to people:

https://soundcloud.com/bmjpodcasts/talk ... r-covid-19

It covers Pathengenicity. Current R0. Effectiveness of masks for preventing spread. Current potential therapies.

black_son_of_gray
Posts: 504
Joined: Fri Jan 02, 2015 7:39 pm

Re: COVID-19

Post by black_son_of_gray »

An insider's account of how the Diamond Princess quarantine was being handled: https://www.youtube.com/watch?v=vtHYZkL ... u.be&t=240

Not. Reassuring. At. All. :shock:

Keep in mind the Tokyo Olympics start in something like ~5 months.

ertyu
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Re: COVID-19

Post by ertyu »

Today's batshit theory I overheard: the virus only really infects people with slanted eyes. The proof? Most infections are in China, HK, TW, and JP. All slanty-eye people there.

Darwin award nominee.

naturelover
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Joined: Wed Feb 12, 2020 10:39 am

Re: COVID-19

Post by naturelover »

I planned on going to Tokyo in a few months but am seriously considering cancelling my tickets and doing something else instead. To make matters more complicated, I have a health condition they don't quite use the same treatment I need there and if I was stuck I'd be in a world of hurt.

I might be giving into panic but I'm fairly risk averse.

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

Re: COVID-19

Post by AnalyticalEngine »

Looks like Professor Iwata may have taken down his YouTube video. Here's another source for that information: https://www.nbcnews.com/news/amp/ncna1138846

Pretty damn concerning. :? I almost had hopes they were containing this, but if what Professor Iwata said is true, it means COVID-19 has jumped from the plague ship to the doctors/dmat staff in Tokyo. These people are now wandering Tokyo, which means it's highly likely to cascade into general community transmission, creating Tokyo as a second epicenter. :?

I've postponed some of the travel I had planned recently too. I was going to go to Seattle in April, but Seattle is one of the high screening zones for the CDC. So now I've decided to go on a local trip instead.

bostonimproper
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Re: COVID-19

Post by bostonimproper »

@AnalyticalEngine Wouldn't Seattle being a screening zone mean you're more likely to know if there's an outbreak, thereby making it safer? I'm in Boston and kind of annoyed they're not doing screening here given we also have tons of international travel and a known case.

AnalyticalEngine
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Re: COVID-19

Post by AnalyticalEngine »

@botonimproper - Safety is relative, and where I live is pretty low risk at the moment (Denver). Anyway, it's not even so much Seattle as wanting to avoid all air traffic/airports entirely if I can. If I had to go to Seattle for an important reason, I still might do it, but this trip is easy enough to postpone, and there are a lot of cool places in CO to go to for now anyway. It's really just a matter of swapping two things I wanted to do at some point anyway. I'm perhaps being paranoid, but it's not a big sacrifice for me to give up.

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Ego
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Re: COVID-19

Post by Ego »

https://www.nejm.org/doi/full/10.1056/NEJMc2001737
The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients. These findings are in concordance with reports that transmission may occur early in the course of infection5 and suggest that case detection and isolation may require strategies different from those required for the control of SARS-CoV.
So, everyone was operating on the assumption that the asymptomatic infections were a fluke where someone had a low viral load but happened to infect someone else. Turns out people without symptoms can have the same amount of viruses in their blood as someone who is coughing and feverish.

AnalyticalEngine
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Re: COVID-19

Post by AnalyticalEngine »

Slight nitpick, but the virus isn't actually in your blood:
We monitored SARS-CoV-2 viral loads in upper respiratory specimens obtained from 18 patients (9 men and 9 women; median age, 59 years; range, 26 to 76) in Zhuhai, Guangdong, China, including 4 patients with secondary infections (1 of whom never had symptoms) within two family clusters (Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). The patient who never had symptoms was a close contact of a patient with a known case and was therefore monitored. A total of 72 nasal swabs (sampled from the mid-turbinate and nasopharynx) (Figure 1A) and 72 throat swabs (Figure 1B) were analyzed, with 1 to 9 sequential samples obtained from each patient. Polyester flock swabs were used for all the patients.
Influenza is like this too. You can't actually catch flu from someone's blood because the virus lives in your respiratory system. SARS-CoV-2 attacks lung and digestive system cells, so you're gonna catch it from respiratory droplets or from the fecal-oral transmission route.

ETA: Also, how truly problematic asymptomatic transmission is depends on how frequently it occurs. If, say, only 1 in 50 cases show asymptomatic transmission, traditional public health measures may still work. However, if asymptomatic transmission is common, then it does become much more difficult. I think what's hard about this virus is we know very little about it. I still think it's wise to take precautions, but also we need to realize research is going to be incomplete.

I'm hoping we get lucky like we did with the 2009 flu pandemic. They initially thought the case fatality rate was a lot higher than it ended up being.

(Then again, they underestimated SARS at first, but let's not talk about that :lol: )

bostonimproper
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Re: COVID-19

Post by bostonimproper »

Others may have found this already, but this Google spreadsheet is the best tracker I've seen by far.

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Ego
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Re: COVID-19

Post by Ego »

AnalyticalEngine wrote:
Wed Feb 19, 2020 9:58 pm
Slight nitpick, but the virus isn't actually in your blood:
http://www.cidrap.umn.edu/news-perspect ... ion-routes
Currently, testing for and confirmation of infection with COVID-19 is conducted via oral swabs. But in a study published in Emerging Microbes & Infections, Chinese scientists report evidence of an oral-fecal transmission route for COVID-19 viruses and show that, in hospitalized patients, the virus is found in anal swabs and in blood samples.
That said, you may be right that the amount of viruses in the blood is not the same as in the respiratory tract, and the infectivity of an asymptomatic person may be much lower than a symptomatic one because they are not coughing like a fiend.

ETA: I also read somewhere (can't find it) that those who recovered are showing signs of kidney problems and (male) infertility. They believe the virus is getting into the cells that line the kidneys, urinary tract and testes. Fun stuff.

ETA 2: Found it https://www.taiwannews.com.tw/en/news/3878295

Nature finding a way to cull the herd?

AnalyticalEngine
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Re: COVID-19

Post by AnalyticalEngine »

It is concerning how little we know about this virus. I'm about to speculate, so take this with a grain of salt. It's probably possible for it to get into your blood during late stages of the illness, due to sheer inflammation/cell death if anything. I just wouldn't expect it in the early stages of illness or for patients who have mild disease. Your body is shockingly good at containing viruses to certain organs, and the ones that do break free often do so by hijacking your immune system.

Example, measles. It lives in your lungs for a solid 10 days without causing major symptoms due to your body's natural defenses. But it eventually infects dendritic cells, which carry the virus to your lymph nodes, and from there they can spread everywhere. (Even your brain!!) Then it basically kills your whole immune system and causes severe illness for weeks while being one of the most contagious diseases known to humanity. (Measles is so horrible it makes me want to go get vaccinated for it again twice)

Anyway, SARS-CoV-2 needs to attack respiratory cells as the first way to get into your body. (Admittedly an assumption on my part but it would be typical for other respiratory viruses) So if it somehow got into your blood stream but not your lungs (sharing needles with end stage COVID-19 patients?!), I'm not sure if it would actually do much damage because the viruses in your blood would get cleared out by Macrophage et al before they could make it to a lung cell.

Which is why they test for it in a nasal swab first. That would be a lot more typical for other flu/coronavirus illnesses. And blood transmission is less likely since only severely ill patients have it in their blood, and they're not like to transmit it due to being on death's door.

It's also why we need to do way more research though because this is all speculation. I'd just be careful about reading too much into any one paper until we know for sure.

ETA: your digestive tract/respiratory tract are all connected, so it would be easy for you to cough up virus then swallow it. From there it infects your intestinal tract. Viruses would then be excreted and could travel from the anus to the urethra and attack the kidneys in a similar way to urinary tract infections.

One thing I'm very curious about though is if the virus is in the mucous membranes of the vagina and could be transmitted in childbirth. It actually seems like the virus isn't more lethal to pregnant women than non-pregnant women, which is somewhat of a good sign because pregnancy suppresses the immune system. Spanish flu was also way more deadly to pregnant women for this reason.

genughaben
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Re: COVID-19

Post by genughaben »

What I do not understand is, why active case count and its rate of change is relatively underreported. There is no specific graph or map specific about active cases that I know of. I began one myself, but only began it yesterday, so not so much info yet.
My reasoning for the importance of active case count and its rate of change is, that I expect is a better estimate (worst case: lower boundary) for the current risk of transmissibility, though I do not expect dead and recovered patients do be of great importance in terms of transmissibility.

What do you think?

Not about that, but I get the impression that we are seeing the goal post moving already. What concerns me is the very long incubation time and the transmission potential of asymptomatic patients. In any case, I restocked my pantry and should be able to stay home for at least 40 days straight, now, should things get out of hand. I am a bit concerned about infection potential that may arise from our buildings ventilation system, should we get a full-blown epidemic where I live. Maybe I am a bit too anxious, but I think: better safe than sorry. Has anybody thought about that and suggestions?
bostonimproper wrote:
Wed Feb 19, 2020 10:19 pm
Others may have found this already, but this Google spreadsheet is the best tracker I've seen by far.

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