COVID-19

[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/

[jacob]

@iDave - Yeah, there are even well-known (at least to experimentalists and statisticians) methods to optimize the testing/sampling to get the most useful data. I think part of the problem is a shortage of tests but also a very dynamically evolving situation with various combinations of lock down and self-isolation. Does it make sense to randomly test the population? What would that tell us?

There is a complete data sat from one small Italian town where everybody was tested: https://www.livescience.com/small-itali ... sting.html

After the first death, the town was put on strict lock down, no in or out, and all 3,300 residents were tested. 3% were infected and half didn't show symptoms. Two weeks later, only 0.25% were infected and the remaining cases were isolated. What can we derive from that? 3% of 3300 infected with one dead => True CFR ~ 0.99% given access to ICUs.

Since only half survive the critical stage (known with good data from elsewhere), true CFR in an overwhelmed system is 2%. The other parameter that would be nice to know is the average time between infection and death. If we have this with better precision than "3-4 weeks", this it's possible to estimate a lot based on the death count. We can already estimate hospitalization count based on death rates and knowing how many go into critical.

The question is then what level of lock down is required to stop the spread. We know that South Korea and China's methods worked. We also know that Italy's containment methods prior to March 9th (which are ~ the current US measures) didn't work. This creates a bracket. We've yet to know what the natural saturation level is or when herd immunity is generated. Perhaps the US will be the first test case. Several EU countries are also candidates. We'll cross the point where Italy closed down to the current level 8 days from now, perhaps sooner (US numbers are growing very fast.)

[George the original one]

State of Washington published count as of 3:25p Wed, 18 Mar
- 1187 Positives
- 15918 Negatives
- 66 deaths

Cases by County (County seats)
- 2 Chelan (Wenatchee)
- 4 Clark (Vancouver)
- 1 Columbia (Dayton)
- 1 Franklin (Pasco)
- 8 Grant (Ephrata)
- 1 Grays Harbor (Montesano)
- 16 Island (Coupeville)
- 4 Jefferson (Port Townsend)
- 562 King (Seattle)
- 9 Kitsap (Port Orchard)
- 4 Kittitas (Ellensburg)
- 1 Klickatat (Goldendale)
- 1 Lewis (Chehalis)
- 1 Lincoln (Davenport)
- 1 Mason (Shelton)
- 56 Pierce (Tacoma)
- 14 Skagit (Mount Vernon)
- 310 Snohomish (Everett)
- 4 Spokane (Spokane)
- 6 Thurston (Olympia)
- 7 Whatcom (Bellingham)
- 7 Yakima (Yakima)
- 167 Unassigned (labs are having trouble keeping up and Dept of Health is working to determine the proper county)

Cases by Age
- 2% 0-19
- 8% 0-29
- 12% 30-39
- 14% 40-49
- 17% 50-59
- 15% 60-69
- 16% 70-79
- 16% 80+

Cases by Sex at Birth
- 51% Female
- 46% Male
- 3% Unknown

187 new cases, adding Benton & Clallam counties.

State of Washington published count as of 3:00p Thu, 19 Mar
- 1376 Positives
- 15918 Negatives
- 74 deaths

Cases by County (County seats)
- 1 Benton (Prosser)
- 2 Chelan (Wenatchee)
- 1 Clallam (Port Angeles)
- 4 Clark (Vancouver)
- 1 Columbia (Dayton)
- 2 Franklin (Pasco)
- 8 Grant (Ephrata)
- 1 Grays Harbor (Montesano)
- 17 Island (Coupeville)
- 4 Jefferson (Port Townsend)
- 693 King (Seattle)
- 12 Kitsap (Port Orchard)
- 4 Kittitas (Ellensburg)
- 2 Klickatat (Goldendale)
- 1 Lewis (Chehalis)
- 1 Lincoln (Davenport)
- 1 Mason (Shelton)
- 75 Pierce (Tacoma)
- 18 Skagit (Mount Vernon)
- 348 Snohomish (Everett)
- 9 Spokane (Spokane)
- 6 Thurston (Olympia)
- 7 Whatcom (Bellingham)
- 7 Yakima (Yakima)
- 151 Unassigned (labs are having trouble keeping up and Dept of Health is working to determine the proper county)

Cases by Age
- 2% 0-19
- 8% 0-29
- 13% 30-39
- 14% 40-49
- 16% 50-59
- 16% 60-69
- 15% 70-79
- 16% 80+

Cases by Sex at Birth
- 51% Female
- 46% Male
- 3% Unknown

[EdithKeeler]

Look out @EK, they are located in Memphis

We’re currently at 10 confirmed cases in Memphis, with confirmed community spread now, so I think we’re going to see a significant increase in local numbers, especially as testing increases. They confirmed an employee at a local Lowe’s had it (and worked); I’m sure there’s tons more exposure.

I’m not leaving the house, and my brother is not invited anymore—they had several people call in with fevers where he works, but they have tons of people call in sick all the time, so I’m putting some of those sick calls down as an opportunity to avoid work.

The insidious thing is that sometimes the symptoms are so mild—an acquaintance (different state) had a slight fever for three days but really no other symptoms. Tested positive, in quarantine now, but no fever and no other symptoms, and he’s in his 50’s. Coworker’s kid ran a high fever for a couple days, had some body aches, but is fine now. He’s waiting for his test to come back, but I bet he’s got it because he tested negative for flu.

I feel certain there are a ton of people out there who are infected but just hanging out at home eating chicken soup and drinking OJ, treating it like any other cold.

[steveo73]

Also don't trust brazilian's numbers now; we have to wait about a month to get a test unless it's very serious.

All the numbers aren't going to be perfect because it's too hard to test everyone.

The way the virus should be spread by now, it looks like it will be a disaster in this country.

Please take care. We all need too.