COVID-19

[fiby41]

On 23rd March the nation went under a complete lockdown including pharmaceutical industry.
21 days later today 14th April at midnight this lockdown was to be lifted although an exception had been made for pharmaceutical production earlier.
Today the prime minister addressed the nation at 10 am extending the lockdown until 3rd May.

[ertyu]

Does anyone on here support this guy any more ?

You would be surprised. A large pocket of them only follow fox news and other "infotainment" stations and have been taught by trump himself to see other media as fake news and untrustworthy. They will reelect him, partially because of gerrymandering, partially because of social media shenanigans, and partially because for many, to change their mind about trump would mean to admit they've been duped - and who could possibly take *that* ego hit.

They will reelect him. Unless rona does her business first

[IlliniDave]

https://www.smh.com.au/world/north-amer ... 54jka.html

Has anyone seen Trumps latest debacle. Does anyone on here support this guy any more ? He seems so freaken bad.

Well, it's campaign season and right now the pandemic is the only issue. His opponents have co-opted the situation, and he has an uncontrollable reflex to punch back. Initially he was accused of overreacting, travel bans were called racist and pathetically xenophobic. People were encouraged by certain local politicians to flout the initial cdc guidance in large coastal cities even into the latter half of March (because obviously soaked in Trumps racism in their view). Then somewhere that narrative flipped and suddenly he was guilty of underreacting and doing nothing.

I watched the first few daily briefings until it was clear the press pool had no interest in extracting and reporting useful information. I'd guess an argument could be made that a blanket eroding of the population's confidence in their government's activities and guidance regarding the pandemic at its height based on what some perceive as false representation would justify presenting a counter narrative. It's a world of soundbites and optics and montages and chyrons, sadly. The response used the format of the accusations. (apparently, haven't seen the whole thing yet).

I have no idea which version of events is the more accurate. Clearly in the US and elsewhere there were some stumbles coming out of the gate on this. Reporting from China and echoed by the WHO maybe was not 100% reliable. Our bureaucracy bungled the testing situation right out of the gate. In the US we have this recent dynamic where the "media narrative" is always the opposite of the "Administration's narrative". Always. Maybe the historians will work it out. It makes it nearly impossible to figure out what is true, and really to even discuss the various puzzle pieces rationally. The overlap of the Venn diagrams is null set.

I would guess Trump's base is still in his corner. The people who have opposed him since 2016 generally still oppose him. At least as of a couple weeks ago his approval rating had inched up as the pandemic response was ramping up. But as the economic devastation mounts, that's likely to change. What would have got Trump reelected was the strong economy. To his credit he threw that under the bus to follow what the cdc/nih people told him was necessary. Depending on how bad things get, it could cost him the election.

I think it's too late, but aside from electoral politics arguably the key going forward is to thread the needle regarding the balance of the population's medical health and economic health. We're now on the precipice of having another generation swallowed up the same way many Millennials were swallowed up by the aftermath of the 2007-2009 financial crisis. One thing we can count on is that the administration and the large majority of the news media will be diametrically opposed to one another in terms of how any aspect of the situation is represented. That's apparently the prime directive ground rule. Not a helpful thing, but being aware of it helps put things in context. The truth probably lies somewhere in the middle.

[bostonimproper]

@iDave The nature of catastrophe is that it often requires failure of many independent systems. Apportionment of blame will differ based on an individual's sense of who is responsible for what, which originates from their own personal ideology.

[slowtraveler]

Well said iDave. I began his presidency vehemently opposed to him. While I loathe many of the actions taken by the administration, the response to Covid of actually giving a decent check to people and small businesses with very few hoops is applaudable. The strong stance for ip rights and being cheated in trade wars against the ccp is something I didn't see any other country do, they just rolled over and took whatever they could get from the ccp without any pause. He's more calculated than the media portrays him.

The ccp and who are known to have contributed at this point. You don't need the maybe to soften anything. This article was posted a few pages back but it's the most well cited timeline I've ever seen*.

https://www.nationalreview.com/the-morn ... ting-lies/

[ertyu]

I'm hoping Michael Lewis is writing a 3-part series on the pandemic response. He'd do a good job of it

[Ego]

Interesting twist. Intubation and mechanical ventilation is killing people.

PDF https://www.atsjournals.org/doi/pdf/10. ... 004-1076ED

Only a small proportion of patients—largely those in a cardiac arrest situation—“require” mechanical ventilation. In most instances, mechanical ventilation is instituted preemptively out of fear of an impending catastrophe. These patients are receiving mechanical ventilation and it is impossible to prove that they “required” it when first implemented.

and

The surest way to increase Covid-19 mortality is liberal use of intubation and mechanical ventilation.

Everyone is doing it because everyone else is doing it, even though it literally goes against ventilation use textbooks from as far back as the 90s. How did that begin?

There will be books written on the perverse incentives hospitals have experienced.

[ZAFCorrection]

I can always count on the media to simplify things to meaninglessness, but I'm wondering that since the ventilators available number was the key metric being thrown about, how much higher is actual hospital capacity? What's the next rate-limiting resource?

[Ego]

@ZAF, yeah ventilators were the "sky is falling" element of panic in the decisions to lockdown in order to flatten the curve so as to avoid overwhelming hospital capacity. Now it appears that ventilators are not only not useful but are harmful with covid inflamed lungs, except for those with heart complications. It also appears that at least some physicians knew it and are now quoting their old med school respiratory care textbooks as proof. Yet most followed their hospital's treatment protocol. The emergency reimbursement pays hospitals much more for a ventilated patient that a regular covid patient. Hospitals have been struggling to keep afloat without the more profitable elective procedures so it causes one to wonder.

I don't have the slightest idea what would be the next limiting factor in the ability of hospitals to cope. Staff? Medications? Beds? It will be interesting to see if there is much talk about this or if it just fades into oblivion.

https://www.kff.org/uninsured/issue-bri ... -covid-19/

To project how much hospitals would get paid by the federal government for treating uninsured patients, we look at payments for admissions for similar conditions. For less severe hospitalizations, we use the average Medicare payment for respiratory infections and inflammations with major comorbidities or complications in 2017, which was $13,297. For more severe hospitalizations, we use the average Medicare payment for a respiratory system diagnosis with ventilator support for greater than 96 hours, which was $40,218. Each of these average payments was then increased by 20% to account for the add-on to Medicare inpatient reimbursement for patients with COVID-19 that was included in the CARES Act

[George the original one]

Oregon Health Authority as of 8:00a Mon, Apr 13
- 1584 Positives
- 29537 Negatives
- 53 Deaths

Cases by County
- 23 Benton (Corvallis) - Note two are actually in Washington state, though they're residents of Benton County.
- 132 Clackamas (Oregon City)
- 6 Clatsop (Astoria)
- 12 Columbia (St. Helens)
- 1 Coos (Coquille)
- 1 Crook (Prineville)
- 3 Curry (Gold Beach)
- 54 Deschutes (Bend)
- 16 Douglas (Roseburg)
- 1 Grant (Canyon City)
- 4 Hood River (Hood River)
- 47 Jackson (Medford)
- 19 Josephine (Grants Pass)
- 25 Klamath (Klamath Falls)
- 41 Lane (Eugene)
- 4 Lincoln (Newport)
- 52 Linn (Albany)
- 4 Malheur (Vale)
- 280 Marion (Salem)
- 5 Morrow (Heppner)
- 398 Multnomah (Portland)
- 30 Polk (Dallas)
- 1 Sherman (Moro)
- 4 Tillamook (Tillamook)
- 16 Umatilla (Pendleton)
- 4 Union (La Grande)
- 1 Wallowa (Enterprise)
- 10 Wasco (The Dalles)
- 360 Washington (Hillsboro)
- 30 Yamhill (McMinnville)

Cases by Age Group
- 38 19 or younger
- 178 20-29
- 242 30-39
- 295 40-49
- 276 50-59
- 275 60- 69
- 173 70-79
- 105 80 and over
- 2 Not available

Hospitalized by Age Group
- 3 19 or younger
- 16 20-29
- 21 30-39
- 54 40-49
- 52 50-59
- 99 60- 69
- 73 70-79
- 50 80 and over
- 1 Not available

Hospitalized
- 369 Yes
- 1065 No
- 150 Not provided

Sex
- 867 Female
- 708 Male
- 9 Not available

Hospital Capacity
- 325 Available adult ICU beds
- 2035 Available adult non-ICU beds
- 86 Available pediatric NICU/PICU beds
- 148 Available pediatric beds
- 760 Available ventilators
- 295 COVID-19 admissions
- 81 COVID-19 patients in ICU beds
- 52 COVID-19 patients on ventilators

49 new cases. Hospital admissions up, ventilators in use down.

Oregon Health Authority as of 8:00a Tue, Apr 14
- 1584 Positives
- 30730 Negatives
- 55 Deaths

Cases by County
- 24 Benton (Corvallis) - Note two are actually in Washington state, though they're residents of Benton County.
- 135 Clackamas (Oregon City)
- 6 Clatsop (Astoria)
- 11 Columbia (St. Helens)
- 1 Coos (Coquille)
- 1 Crook (Prineville)
- 3 Curry (Gold Beach)
- 55 Deschutes (Bend)
- 19 Douglas (Roseburg)
- 1 Grant (Canyon City)
- 4 Hood River (Hood River)
- 47 Jackson (Medford)
- 19 Josephine (Grants Pass)
- 26 Klamath (Klamath Falls)
- 42 Lane (Eugene)
- 4 Lincoln (Newport)
- 52 Linn (Albany)
- 4 Malheur (Vale)
- 289 Marion (Salem)
- 5 Morrow (Heppner)
- 420 Multnomah (Portland)
- 30 Polk (Dallas)
- 1 Sherman (Moro)
- 5 Tillamook (Tillamook)
- 16 Umatilla (Pendleton)
- 4 Union (La Grande)
- 1 Wallowa (Enterprise)
- 10 Wasco (The Dalles)
- 365 Washington (Hillsboro)
- 32 Yamhill (McMinnville)

Cases by Age Group
- 38 19 or younger
- 182 20-29
- 249 30-39
- 303 40-49
- 289 50-59
- 287 60- 69
- 178 70-79
- 107 80 and over
- 2 Not available

Hospitalized by Age Group
- 3 19 or younger
- 18 20-29
- 21 30-39
- 54 40-49
- 54 50-59
- 103 60- 69
- 76 70-79
- 52 80 and over
- 0 Not available

Hospitalized
- 381 Yes
- 1112 No
- 140 Not provided

Sex
- 907 Female
- 717 Male
- 9 Not available

Hospital Capacity
- 328 Available adult ICU beds
- 2134 Available adult non-ICU beds
- 85 Available pediatric NICU/PICU beds
- 187 Available pediatric beds
- 794 Available ventilators
- 311 COVID-19 admissions
- 88 COVID-19 patients in ICU beds
- 44 COVID-19 patients on ventilators

[Peanut]

Yes, perhaps the daily WA/OR numbers could be its own thread?

[wheatstate]

George, I appreciate you posting the Oregon numbers. I have family in two of Oregon counties. The data helps me understand what is going on 1/2 way across the country. Thanks.

[bostonimproper]

Should we be thinking about COVID-19 as an inflammation->blood clotting/cardiac disorder rather than (or in addition to) a respiratory illness?

Scott Gottlieb:

There's a growing body of data to strongly suggest #COVID19 predisposes to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and diffuse intravascular coagulation. This may explain some of rapid decline patients experience.

Provider urgently need good data to guide practice. Reports on incidence of thrombotic complications are limited. Doctors weren't routinely doing pulmonary embolism studies or echocardiograms, in part because protocols were to limit patient contact as a way to control spread.

...

One etiology may be #COVID19-associated coagulopathy (CAC). Patients with severe COVID-19 infection can develop clotting events meeting criteria for DIC criteria with fulminant activation of coagulation, resulting in widespread microvascular thrombosis.

...

This clotting phenomenon may, in certain cases, explain rapid decompensation some doctors describe, where patients will become acutely hypoxic and require urgent intubation. Providers tell me they are now more routinely doing studies for pulmonary emboli in these settings.

Similar notes in the NY Times about inflammation induced heart damage.

[Ego]

This clotting phenomenon may, in certain cases, explain rapid decompensation some doctors describe, where patients will become acutely hypoxic and require urgent intubation. Providers tell me they are now more routinely doing studies for pulmonary emboli in these settings.

@BI, the TWiV folks reported they've seen some clots the size of hot dogs. Imagine that! Apparently low molecular weight heparin is helping. Studies have already begin.

[George the original one]

State of Washington published count as of 11:59p, Sun 12 Apr
- 10538 Positives
- NA Negatives
- 516 deaths

Cases by County (County seats)
- 39 Adams (Ritzville)
- 6 Asotin (Asotin)
- 261 Benton (Prosser)
- 59 Chelan (Wenatchee)
- 12 Clallam (Port Angeles)
- 221 Clark (Vancouver)
- 1 Columbia (Dayton)
- 24 Cowlitz (Kelso)
- 20 Douglas (Waterville)
- 1 Ferry (Republic)
- 129 Franklin (Pasco)
- 121 Grant (Ephrata)
- 11 Grays Harbor (Montesano)
- 156 Island (Coupeville)
- 28 Jefferson (Port Townsend)
- 4517 King (Seattle)
- 128 Kitsap (Port Orchard)
- 14 Kittitas (Ellensburg)
- 14 Klickatat (Goldendale)
- 17 Lewis (Chehalis)
- 2 Lincoln (Davenport)
- 19 Mason (Shelton)
- 15 Okanogan (Okanogan)
- 1 Pacific (South Bend)
- 1 Pend Oreille (Newport)
- 931 Pierce (Tacoma)
- 13 San Juan (Friday Harbor)
- 195 Skagit (Mount Vernon)
- 3 Skamania (Stevenson)
- 1876 Snohomish (Everett)
- 266 Spokane (Spokane)
- 7 Stevens (Colville)
- 81 Thurston (Olympia)
- 2 Wahkiakum (Cathlamet)
- 21 Walla Walla (Walla Walla)
- 258 Whatcom (Bellingham)
- 11 Whitman (Colfax)
- 573 Yakima (Yakima)
- 484 Unassigned (labs are having trouble keeping up and Dept of Health is working to determine the proper county)

Hospital Reporting (all lab confirmed)
Apr 3 67 hospitals 596 COVID-19 patients, 222 COVID-19 patients in ICU
Apr 4 52 hospitals 574 COVID-19 patients, 174 COVID-19 patients in ICU
Apr 5 50 hospitals 581 COVID-19 patients, 178 COVID-19 patients in ICU
Apr 6 78 hospitals 638 COVID-19 patients, 191 COVID-19 patients in ICU
Apr 7 82 hospitals 641 COVID-19 patients, 190 COVID-19 patients in ICU
Apr 8 86 hospitals 655 COVID-19 patients, 186 COVID-19 patients in ICU
Apr 9 85 hospitals 649 COVID-19 patients, 191 COVID-19 patients in ICU
Apr 10 78 hospitals 642 COVID-19 patients, 191 COVID-19 patients in ICU
Apr 11 48 hospitals 528 COVID-19 patients, 166 COVID-19 patients in ICU
Apr 12 43 hospitals 387 COVID-19 patients, 98 COVID-19 patients in ICU


Cases by Age
- 3% 0-19
- 27% 20-39
- 35% 40-59
- 25% 60-79
- 10% 80+
- 0% Unknown

Deaths by Age
- 0% 0-19
- 0% 20-39
- 8% 40-59
- 37% 60-79
- 55% 80+
- 0% Unknown


Cases by Sex at Birth
- 51% Female
- 44% Male
- 5% Unknown

156 new cases.

State of Washington published count as of 11:59p, Mon 13 Apr
- 10694 Positives
- NA Negatives
- 541 deaths

Cases by County (County seats)
- 39 Adams (Ritzville)
- 6 Asotin (Asotin)
- 265 Benton (Prosser)
- 59 Chelan (Wenatchee)
- 12 Clallam (Port Angeles)
- 229 Clark (Vancouver)
- 1 Columbia (Dayton)
- 24 Cowlitz (Kelso)
- 29 Douglas (Waterville)
- 1 Ferry (Republic)
- 138 Franklin (Pasco)
- 121 Grant (Ephrata)
- 11 Grays Harbor (Montesano)
- 157 Island (Coupeville)
- 28 Jefferson (Port Townsend)
- 4612 King (Seattle)
- 131 Kitsap (Port Orchard)
- 14 Kittitas (Ellensburg)
- 14 Klickatat (Goldendale)
- 19 Lewis (Chehalis)
- 2 Lincoln (Davenport)
- 19 Mason (Shelton)
- 15 Okanogan (Okanogan)
- 1 Pacific (South Bend)
- 1 Pend Oreille (Newport)
- 963 Pierce (Tacoma)
- 13 San Juan (Friday Harbor)
- 198 Skagit (Mount Vernon)
- 3 Skamania (Stevenson)
- 1916 Snohomish (Everett)
- 270 Spokane (Spokane)
- 7 Stevens (Colville)
- 82 Thurston (Olympia)
- 2 Wahkiakum (Cathlamet)
- 23 Walla Walla (Walla Walla)
- 261 Whatcom (Bellingham)
- 11 Whitman (Colfax)
- 614 Yakima (Yakima)
- 383 Unassigned (labs are having trouble keeping up and Dept of Health is working to determine the proper county)

Hospital Reporting (all lab confirmed)
Apr 3 67 hospitals 596 COVID-19 patients, 222 COVID-19 patients in ICU
Apr 4 52 hospitals 574 COVID-19 patients, 174 COVID-19 patients in ICU
Apr 5 50 hospitals 581 COVID-19 patients, 178 COVID-19 patients in ICU
Apr 6 78 hospitals 638 COVID-19 patients, 191 COVID-19 patients in ICU
Apr 7 82 hospitals 641 COVID-19 patients, 190 COVID-19 patients in ICU
Apr 8 86 hospitals 655 COVID-19 patients, 186 COVID-19 patients in ICU
Apr 9 85 hospitals 649 COVID-19 patients, 191 COVID-19 patients in ICU
Apr 10 78 hospitals 642 COVID-19 patients, 191 COVID-19 patients in ICU
Apr 11 48 hospitals 528 COVID-19 patients, 166 COVID-19 patients in ICU
Apr 12 43 hospitals 387 COVID-19 patients, 98 COVID-19 patients in ICU
Apr 13 89 hospitals 645 COVID-19 patients, 194 COVID-19 patients in ICU

Cases by Age
- 3% 0-19
- 27% 20-39
- 35% 40-59
- 25% 60-79
- 10% 80+
- 0% Unknown

Deaths by Age
- 0% 0-19
- 0% 20-39
- 8% 40-59
- 37% 60-79
- 55% 80+
- 0% Unknown


Cases by Sex at Birth
- 52% Female
- 44% Male
- 4% Unknown

[George the original one]

Hey George. I appreciate how diligent you are posting these stats, but at this point I wonder whether people are even reading them

Both states have turned the corner for now, though with some definite hotspots, so I'm open to stopping. Has anybody been noticing the differences between the two states?

[enigmaT120]

I use a different news app and what I was mostly watching was the numbers of new cases each day in Oregon. I am happy to see that those numbers aren't really increasing like we expected. Around 50 new cases per day. And we're finally showing some people as recovered! That took a long time.

[thrifty++]

I keep seeing Israel ranked high up the list for safest countries during the pandemic. And now this one as number one. Im a little surprised. It doesn't look that great that for its population and size on the numbers. And its landlocked in a turbulent political region. But I cant find much info for what Israel is actually doing. Any information on what Israel has been doing to deal with the pandemic? Anyone on here from Israel? Whats going on and how are things?
https://www.thelocal.de/20200414/german ... s-pandemic

[jacob]

@thrifty - They went hard and early essentially treating the pandemic as a terrorist attack. Travel from hotspots were closed off in January and February already. Lock-down/stay-in-shelter was introduced early in the outbreak scaling up to contact tracing using cellphone data with fines for violation.

https://en.wikipedia.org/wiki/2020_coro ... _in_Israel

[Jason]

Israel must have clamped down on the Hasidim because their communities in the US have proven to be intransigent.