COVID-19

[horsewoman]

Some numbers from Germany - Schools and lots of shops are closed, there is no curfew like in Austria but people are strongly encouraged to stay home.
Source: https://interaktiv.morgenpost.de/corona ... -weltweit/

(1) confirmed cases, (2) recovered (3) deaths

March 16 19:00 (1) 7.241 (2) 65 (3) 15
March 17 17:00 (1) 8.616 (2) 67 (3) 23
March 18 20:00 (1) 12.327 (2) 105 (3) 28
March 19 16:00 (1) 14.292 (2) 113 (3) 43

[FRx]

As a physician seeing patients in South Central Los Angeles it's been an interesting experience. The lack of reliable information disseminated to us docs is simply odd. We can't get the CEO's of the clinic or gov't officials to give us proper guidance on what to do. Each workflow creates another problem. We can't send patients to the ER but we can't test them or properly examine them.
The telemedicine rules are more lax but most clinics are still afraid of excess malpractice risk and we certainly don't have the infrastructure to see these growing number of patients who are on the fringes of healthcare to begin with.

And still, as a physician, I don't know if I'm missing something or simply am too naive to recognize this as nothing more than a flu virus, not much different from H1N1 or other SARS outbreaks. Deaths will occur as they always do. Medications, even though available for flu viruses, are still quite ineffective for most outpatient cases and even inpatient cases. We've always known they are mostly bullshit but if you don't prescribe tamiflu to a patient with a flu you'll get your ass sued back to the dark ages.

Still, I'm sad that I don't have any support from the major medical establishments to give me more guidance. It's just panic and chaos and hiding behind carefully phrases online sentences. I don't even have access to instagram or twitter and other websites on my work computer because someone decided that those are "social media" sites and don't warrant access for a physician. I even get blocked out of some website where there are images of genitals and breasts because the brilliant software things it's porn - but that's been the case for years, nothing new.

I still haven't heard anyone say that I'll have a reprieve from being sued if I mistake the flu for corona or vice versa. As such, most of my colleagues are tweaking their documents properly and sending specific patients home because we don't want to miss something or be held liable for not following some guideline which was never given to us. Patients are lying about their symptoms, understandibly so because they are afraid of being labeled as "corona-ish".

[Sclass]

@FRx thanks for sharing. Very interesting stuff there.

[CS]

@FRx
I think some hospital admins deserve to have their heads on the chopping blocks at this point. They don't want to stock the necessary equipment reserves because *costs* but then always have enough for their salaries. When I was on a contract in NC, a law passed mandating public sharing of salaries for those folks and it was enraging to see where the money was going. No admin rationally deserves 1million+ a year.

Just by chance, someone today posted this detailed handbook on another forum I read. It is based on experiences of the Chinese doctors. The translation was funded by Jack Ma.

Handbook of Covid-19 Prevention and Treatment from Hospital with 0% fatality
https://video-intl.alicdn.com/Handbook% ... atment.pdf

Disclaimer - I have not had time to study it. I'm in danger of blowing a book deadline so have to get back to it. I did open it and take a look. It looks legit. There are protocols for testing, management and nursing. The whole process.
We are so short of on equipment, it is criminal.

A smuggled out video of what the hospitals were like:
https://twitter.com/BNONews/status/1220 ... 22784?s=20

Cuomo is already talking about this reality. They are going to waive laws about space (the 15' wide rule and all that for hallways, etc) because it is going to be sardines in a can. If we're lucky.
https://youtu.be/l2mFu9IilAI

[FRx]

In healthcare we have a culture of having to comply with so many damn laws that most of us just pretend to follow the rules to get admin off our backs. There are many rules which are impossible to implement because they are made up by people who aren't even in the room seeing patients. That's why, reading that first document, such as all the cleaning procedures and testing protocols which are recommended, they would never be enforceable in a clinic in the US. We simply don't have the culture to stick to the rules and regulations and the managers and admin wouldn't be willing to enforce them.
We don't have any tests, we don't have enough gowns and masks to properly even collect specimens even if we had the test. We don't even have a protocol to check skin/body temps on patients. Nobody is willing to spring for ventilation systems and we aren't even willing to open certain windows and doors because of fire safety laws.

[CS]

@FRx
I understand. I've worked in healthcare for 30 years in hospitals. It is... frightening and infuriating all a the same time.

At least Cuomo is saying (paraphrasing) 'tell me what you need, whatever law is in your way, tell me and we will fix this.' Some people get it.

I believe that doc was written by their healthcare workers who see their patients. Their culture is just much better for such enforcement, it seems.

Edit - I followed the safety rules during my career. It is disturbing to hear that it is common trend to ignore them and simply pretend to do so.

[ertyu]

what do you guys make of italy's fatalities outstripping china's today.

[jacob]

... that an immediate and full lock down would have been the smartest thing to do. I expect much of the rest of the western world to learn this the hard way.

[theanimal]

@Seppia- Can you comment on the quality of Italy's healthcare system? The OECD rating is 9.9/10 for the Lombardy region and other wealthy areas of the country are reported to be high quality as well. There aren't really any media or other reports on how the healthcare system is poor. Yet, I have an aunt who lives there (moved over ~25 years ago) and she keeps bemoaning the continual positive reports on the quality of Italy's healthcare system and she thinks that foreigners have the wrong understanding. She specifically says there was a report to the govt in 2019 (idk what report) that talked about huge staff reductions and pushing a lot of specialized services from public hospitals to private clinics (which aren't prepared for emergency services).

Any thoughts? Is quality actually lower than what's perceived from elsewhere? Thanks.

[George the original one]

Oregon Health Authority as of 8a Wed, Mar 18
- 75 Positives
- 1118 Negatives
- 3 Deaths
- 361 Pending

Cases by County
- 3 Benton (Corvallis) - Note two are actually in Washington state, though they're residents of Benton County.
- 6 Clackamas (Oregon City)
- 6 Deschutes (Bend)
- 1 Douglas (Roseburg)
- 2 Jackson (Medford)
- 1 Klamath (Klamath Falls)
- 2 Lane (Eugene)
- 15 Linn (Albany)
- 8 Marion (Salem)
- 3 Multnomah (Portland)
- 1 Polk (Dallas)
- 2 Umatilla (Pendleton)
- 23 Washington (Hillsboro)
- 2 Yamhill (McMinnville)

Cases by Age Group
- 4 17 or younger
- 4 18-24
- 1 25-34
- 19 35-54
- 47 55+

Oregon Health Authority as of 8a Thu, Mar 19
- 88 Positives
- 1329 Negatives
- 3 Deaths
- 437 Pending

Cases by County
- 2 Benton (Corvallis) - Note two are actually in Washington state, though they're residents of Benton County.
- 6 Clackamas (Oregon City)
- 6 Deschutes (Bend)
- 1 Douglas (Roseburg)
- 2 Jackson (Medford)
- 1 Klamath (Klamath Falls)
- 2 Lane (Eugene)
- 18 Linn (Albany)
- 13 Marion (Salem)
- 7 Multnomah (Portland)
- 1 Polk (Dallas)
- 2 Umatilla (Pendleton)
- 25 Washington (Hillsboro)
- 2 Yamhill (McMinnville)

Cases by Age Group
- 4 17 or younger
- 4 18-24
- 3 25-34
- 23 35-54
- 54 55+

[theanimal]

Are we really believing China's numbers are completely legit?

[ertyu]

likely both jacob and theanimal are right. a full lockdown would've been better -and- china's numbers are suspect.

[Riggerjack]

Are we really believing China's numbers are completely legit?

Are we really believing ANYONE'S numbers are completely legit? We'll get better guesses after it's over, but unlike SARS I, this is common enough and we are so far past contact tracing, we will never have accurate numbers.

What we know is Wuhan locked things down with 495 positive tests. Italy started quarantines with 79 positive tests. And Washington state isn't locked down at present... We will have plenty of data to work with. Plenty of examples to compare and contrast.

[George the original one]

CDC's outcome study published yesterday reasonably matched China's published numbers. 1-in-5 infections required hospitalization. USA millenials drop to 1-in-7 infections while seniors go in the other direction.

[ertyu]

Are we really believing ANYONE'S numbers are completely legit?

I believe Italy's numbers are as legit as can be. Both china and iraq imo have very strong political reasons to doctor the numbers. italy may not have perfect and exact data but it is certainly not hiding deaths and positive cases. they are also testing comparatively extensively.

@george, tbh at this point the us is one of the countries whose data i don't trust. i trust the quality and integrity of front-line american professionals and scientists but i don't trust the scumbags currently in administration.

[George the original one]

And Washington state isn't locked down at present... We will have plenty of data to work with.

Watch Las Vegas (Clark County, Nevada). They had 3 cases a week ago and today they have 87+. For comparison, Oregon, the whole state, reached 88 and it's taken 3 weeks to get here.

[George the original one]

@george, tbh at this point the us is one of the countries whose data i don't trust. i trust the quality and integrity of front-line american professionals and scientists but i don't trust the scumbags currently in administration.

Honestly, the biggest problem with the study is that counties aren't reporting the same level of detail. There's no uniformity and CDC had to cull a sizeable chunk because some counties/states didn't report whether cases were hospitalized nor the ages of the patients. Oregon, for instance, is no longer reporting hospitalization status because testing is shifting to private labs.

Edit: Let's put it this way: I'll take fuzzy data over no data. Two sets of fuzzy data that match is not awful. You can also use South Korea data, but, honestly, South Korea data is absolutely not going to apply to the USA because their monitoring methods violate so many laws here. For instance, patient identities are public and their cellphones are tracking location of the patients.

[jacob]

https://travel.state.gov/content/travel ... issue.html

[Jin+Guice]

My girlfriend's sister's husband appears to have the disease. He's exhibiting all of the symptoms and tested negative for the flu. He's currently just very sick, so no crisis yet (he's in his mid-30s and otherwise healthy). Here's what the process for testing was like:

Go to the doctor and get a flu test.
Results are negative, the doctor tells them that testing is unavailable and that he should quarantine for 7 days.
I'm not sure how, but they were able to find a place that would give them a test.
Wait standing in a line (!) for 3 hours.
The test was $300 (supposedly not covered by insurance).
The results will take 10 days!


Look out @EK, they are located in Memphis.

[IlliniDave]

SIAP, an opinion piece.
https://www.statnews.com/2020/03/17/a-f ... able-data/