Conoravirus ...

[kimbottles]

Glad to know you're doing well, Kim. Godspeed.

Thanks Keith, better than I thought I would be at this point. Just hunkered down at home alternating light doses of Aleve and Tylenol.
Susan is a very good nurse.

[blackjenner]

Hey! Not bad for a guy with a Stigmata

Take care, my friend! Kerry is cheering for you.

[IrieMon]

Susan is a very good nurse.

Best care in the world ! So glad you're home !!!

[kimbottles]

Susan is a very good nurse.

Best care in the world ! So glad you're home !!!

Glad I am home, but kind of bored with all the restrictions they have placed on me.
Fortunately there is Ham Radio. Been on the radio much more than usual.
Follow up visit with Amy (the surgeon) on Thursday.
Hope to get these damn drain tubes removed soon, they are a PITA!

[Olaf Hart]

The hand washing and not touching your face advice seems to be the story, feedback suggests most cases are related to direct contact rather than droplet or aerosol spread.

Makes sense as there is a long prodromal period before symptoms occur.

Most effective hand wash contains 60% alcohol. Hard to find here but I have successfully made some mixing regular gel hand wash with common methylated spirits (methyl alcohol) from the hardware store.

Thinking of making some small lots using those plastic cosmetic travel bottles for when we are out and about, public toilets seem to be the main risk area .

[Olaf Hart]

Just an aside, we are still working on the play house, my alcohol and hand gel mix seems to be particularly effective in removing spray paint hand overspray...

I should have used gloves.

[Tigger]

There's hope. At the hockey game tonight, the lineup to wash your hands was longer than the lineup to pee.

Mind you, many folks brought their beer to the bathroom, put it on the top of the urinal, did their business, and then picked up the cup. Sigh.

[BeauV]

I just took a look at the doubling rate of new cases, it's 4 days in the US. (That means that the rate of new cases is doubling every 4 days.)

Part of this is certainly a backlog of testing that we're plowing through, part of it is folks finally admitting that those poor souls on the cruise ship really were sick. But, if the doubling rate stays anywhere near 4 days, we'll have tens of thousands of cases by the end of April. We tech guys know about doubling rates and this one looks ugly.

So, let's assume that once the backlog of tests is cleared and we finally get enough test kits to test everyone who was anywhere near someone who is sick. That could extend the doubling rate to 15 days. That still puts us at about 50,000 cases across the US by the end of April.

Good news for our kids is almost all the fatalities in the US have been in 60, 70, and 80-year-olds. No one below 40 has died of this stinker of a disease. Little kids don't even appear to get it. (Or they don't get sick enough for anyone to notice and they just act as germ carriers. )

[SemiSalt]

I just took a look at the doubling rate of new cases, it's 4 days in the US. (That means that the rate of new cases is doubling every 4 days.)

Part of this is certainly a backlog of testing that we're plowing through, part of it is folks finally admitting that those poor souls on the cruise ship really were sick. But, if the doubling rate stays anywhere near 4 days, we'll have tens of thousands of cases by the end of April. We tech guys know about doubling rates and this one looks ugly.

So, let's assume that once the backlog of tests is cleared and we finally get enough test kits to test everyone who was anywhere near someone who is sick. That could extend the doubling rate to 15 days. That still puts us at about 50,000 cases across the US by the end of April.

Good news for our kids is almost all the fatalities in the US have been in 60, 70, and 80-year-olds. No one below 40 has died of this stinker of a disease. Little kids don't even appear to get it. (Or they don't get sick enough for anyone to notice and they just act as germ carriers. )

Though it's been reported that the supply of test kits is adequate, I've not seen anything that suggests that the rate of testing has shot up, or that the restrictions on testing have been relaxed.

[BeauV]

I just took a look at the doubling rate of new cases, it's 4 days in the US. (That means that the rate of new cases is doubling every 4 days.)

Part of this is certainly a backlog of testing that we're plowing through, part of it is folks finally admitting that those poor souls on the cruise ship really were sick. But, if the doubling rate stays anywhere near 4 days, we'll have tens of thousands of cases by the end of April. We tech guys know about doubling rates and this one looks ugly.

So, let's assume that once the backlog of tests is cleared and we finally get enough test kits to test everyone who was anywhere near someone who is sick. That could extend the doubling rate to 15 days. That still puts us at about 50,000 cases across the US by the end of April.

Good news for our kids is almost all the fatalities in the US have been in 60, 70, and 80-year-olds. No one below 40 has died of this stinker of a disease. Little kids don't even appear to get it. (Or they don't get sick enough for anyone to notice and they just act as germ carriers. )

Though it's been reported that the supply of test kits is adequate, I've not seen anything that suggests that the rate of testing has shot up, or that the restrictions on testing have been relaxed.

Semi,

I find it particularly frustrating that the CDC and FDA would not let the Seattle Flu Project re-purpose thousands of nasal swabs to test for COVID-19 because the testing would have been in a "research lab" vs a "clinical lab". That kind of political nonsense is complete BS!

I'd be interested in your thoughts on some analysis I've been doing. Could you (and anyone else who cares to) comment on the following?

Summary: Here’s probably more than you want to read, but you are correct, while we have many decades of history with the flu, we have only one month of history with COVID-19. The weakness in the analysis is that we don’t know the denominator. Said another way, as you correctly say, we don’t know the number of COVID-19 cases so we don’t know the number into which we divide the number of confirmed cases with certainty.

Estimated fatality rate of the flu in the US = 0.09%
My best Est. fatality rate of the COVID-19 in the US = 0.5%
(But, for details - see below)

This makes the COVID-19 virus 5.55 times more deadly than the flu. (0.5%/0.09%=5.555)

The Details: The WHO has estimated that the mortality rate of COVID-19 as of March 3rd was 3.4%. They recognize the issue you’ve raised and believed they’ve included it. Here in the US, we have a far lower mortality rate, even if we just count on the number of cases known. There are multiple reasons for this including - being willing to respond honestly about the initial outbreak (although we’re not perfect), somewhat better initial hospitalization capacity (although China responded extremely rapidly once they knew they had a problem), and we are currently dealing with a very small number of cases compared to hospital capacity. Thus, our fatality rate should and is much lower than it has been in China.

Total fatalities confirmed in the US = 29
Total cases confirmed in the US = 1050
Calculated US Fatality Rate = 2.7%
(Source: Johns Hopkins as of 3/10/2020)

Like the flu, it is dubious that we will ever know the true total number of cases. Currently, the CDC estimates the total case of the flu based on careful studies of representative samples, not medical records. (Source: CDC) This is because the vast majority of people with the flu never visit a doctor. For the 2018-2019 flu season, 35.5 million people contracted the flu (Source: CDC) Of those, 34,200 people died (Source: CDC).

Similarly, given that younger people feel this disease much more mildly than older ones, there could be a large population walking around with COVID-19 who don’t know they have it.

Early estimates from China state that up to 80% of people with this disease have not sought medical care. If that applied to the denominator for the US (quite an assumption), we would get about 5000 current cases. So the math would be:

Total fatalities confirmed in the US = 29
Total cases estimated in the US = 5000
Estimated US Fatality Rate = 0.5%

That estimated fatality rate is 5.55 times the fatality rate for the flu in the US. Given there were 61,200 fatalities from flu in the 2018-2019 flu season (Source: CDC), that means we'll have about 340,000 fatalities from COVID-19 if the same population catches it. In my opinion, it is highly likely that COVID-19 will spread to the same population. Having over one-third of a million people in the US die of any disease will be a shock to our Country.

Most importantly, is the simple fact that these fatality rates assume a medical system in the US which is functional. We may not have that for long as the number of flu, COVID-19, and other respiratory diseases compete for a relatively fixed supply of isolation beds.

Sorry, that was so long, but I wanted to be complete. There is a lot of political nonsense floating around about these issues, with politicians conflating the total number of cases of established disease (flu) with the total number of cases of a rapidly emerging disease (COVID-19), and refusing to discuss the percentage risk in a rational manner. I want us to inoculate ourselves against such nonsense.

Without a doubt, this disease appears much more deadly than the flu. However, it is also certainly not a death sentence. The coronavirus MERS has a mortality rate of 34%. (Source: WHO) We can all be thankful it has been contained.

[TheOffice]

There are not enough test kits to test members of congress who have been near someone with the virus. They must exhibit symptoms first, so members are staying home. In some cases, we are better off!

My step-daughter's spring break started 3 days early after one of her classmates was exposed. After break there will be at least 2 weeks of online classes.

DC is prohibiting gatherings of over 1,000 people.

Joel

[Jamie]

It’s officially a pandemic.

[Olaf Hart]

Beau, I have been involved in managing a couple of outbreaks, the data issues you discuss are the norm.

The incidence data is usually an unknown, what we end up measuring is encounter data with the health system, usually a much smaller number.

Then deaths, which are usually pretty reliable figures.

The frustrating thing is this makes it impossible to design prospective studies, the only ones we can mount are retrospective ones, which generally don’t turn up being useful as we cant standardise the data.

As an example, in a large Legionella outbreak in the late eighties, I was able to demonstrate a potential protective effect from influenza vaccination. The problem was a confounding variable, a large number of legionella sufferers smoked, and the smokers had a much lower influenza immunisation rate. We were unable to find relative risk data for smokers, so had to take them out of the study.

So we were left with a quarter of the cases, and combined with the difficulty standardising retrospective data, we were still able to demonstrate a protective effect but not to the statistical models medical publications understood.

[Olaf Hart]

A couple of general comments.

Delaying the progress of this thing is a good idea, to manage the demand on acute hospitals, and also because we have more information on this virus every day, for example hypertension seems to be a particular death risk.

It was obvious from the beginning this thing would not be contained, I really don’t understand all the panic.

The death rate question is really is this thing just a bad cold, that is going to take out people who would have died in the next few influenza outbreaks a couple of years sooner?

I am more concerned by the reported deaths in younger health care workers, suggesting this is a more than that.

Will the disease move back to a companion animal reservoir making it an ongoing risk?

What will happen when this hits alongside another respiratory virus, like influenza?

The big news to me is this outbreak is highlighting the gaps in our public health response, which we can hopefully plug before we have a really serious disease outbreak...

It reminds me that we have nothing to fear but fear itself.

[BeauV]

OH,

Thanks for those posts - really helpful. I certainly agree that it appears that this disease will be with us for a long time, maybe forever. It also appears that our Government in the US is astoundingly screwed up. Those poor people on the Cruise ship would still be out there if the Feds had their way. It took the State of CA stepping in to force the solution. The issue? It seems that the President didn't want those sick folks counted as being "in the US". Good grief!

OK, I'm going to get back to my drink and watch something boring on TV.

Again, thanks!

B

[Steele]

Olaf's notes are correct. The data we have is incomplete and subject to multiple confounding variables.
The total number of infected is still unknown. In the Seattle area the virus seemed to spread through several generations from the first case from china to the care facility where we have had the most deaths. So far we do not know how many infections occured in between as there were no direct links. We are still not able to test mild or low risk cases so the denominator for illness and death rates is unknown. The health care system is strained we are encouraging non critical patients to isolate at home so they will never be counted.
Many of the US deaths so far were related to already ill people in nursing facilities, many of whom would have died eventually in those places even with out covid-19. The numbers from china are not only slewed by the delay in officially recognizing the epidemic, but also by differences in the health care system and overall health. It is estimated that 60% of males in china smoke, a recognized risk factor for respiratory illnesses.
In our area the benefit of slowing progression by avoiding contact is catching on fast. Taffic is light, schools are shuttered, restaurants are closing. It is actually getting kind of eerie. People are not panicking, but we are now locking up masks and hand gel since it was disappearing at an alarming rate.

It remains to be seen if it is seasonal, we hope so since it would give us a chance to catch up, but comparisons to the seasonal flu are risky. We really do not know.

[Ajax]

I am most concerned for my parents and my father in-law. They are all 70 years old.
My mother is about to start chemo for lung cancer which will crush her immune system. The timing is terrible.

My wife was diagnosed as "pre-diabetic" but she's on Ozempic and her numbers are very good, well under control. She's lost 35 lbs. Diabetes is described as an "underlying condition" that makes Covid-19 more lethal. We're not sure how much more vulnerable she is and we're really not interested in finding out.

[Jamie]

My friends in China who a pretty well connected say that there is a huge discrepancy in the data pre and post the change out of government in WuHan. Might the fact you have a population with broad exposure to SARS also explain things like the much lower death rate in Guangzhou? Smoking rate and I’m told the high pollution are factors too. This should be exciting when it gets to India.

My question about the US is can we intubate enough people with our “efficient “ low bed stay, low number of ICU beds per population, high utilization of existing beds?

[Ajax]

I don't wanna be intubated.

[Jamie]

I don't wanna be intubated.

20, 20, 20, 4, hours to go
I wanna be intubated
Nothing to do, nowhere to go, oh
I wanna be intubated

[Ajax]

Lotta old people here. I'm not sure if any of you are familiar with the Real Housewives/Smudge the Cat memes. If you are, you'll get the joke.

[kimbottles]

I get to go to the hospital today......not sure if I should be happy or wary.
Maybe I will get the damn drain tubes removed.
I am assuming all the staff are taking serious precautions.
We have the strong hand cleaner and we will NOT get out of the car on the ferry.
(I do get to go visit FRANCIS at CSR on the way. No hugs with Cathy, Colin, Nigel, Jeff or any of my other buddies there.)
This will be my first venture out into the world since coming home from the mastectomy.

At least I get to see Amy again, as requested she made a nice looking Stigmata for me.

[Slick470]

Travel safely Kim. Hope you get the drain tubes removed too.

[Panope]

.......I have breast cancer and will have a modified radical mastectomy of my left breast tomorrow. Then after the surgery recovery I will have chemo and radiation..........

Kim, I haven't been around much lately, had to go back a few pages to figure out what's going on. Sorry to hear of your illness. If you need anything, don't hesitate to call.

Steve

[Charlie]

Stay healthy, Kim. Wishing you continued progress.

[BeauV]

Steele, thank you for those thoughts. Just FYI, I just got off a call with a friend in Amsterdam. He is Italian and is worried sick about his family who is locked down at home near Milan. We discussed smoking as a problem and his remark was: "Smoking, Italy, nobody smokes in Italy. Wait while I lite up." it is endemic, to Italy.

For those who haven't already read it. This piece on Medium is the best description I've read of the problem that the US faces. We are a lot more like Italy and France than we are like China. This is because we STILL aren't testing anything like enough people. I thought that the title was overly dramatic until I read the piece. https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

My son at Princeton headed home to Washington DC, all classes are canceled or will be remote until further notice. Two regattas our sailing team was scheduled to attend at various YCs around the country have been canceled. Our wine tasting event at the YC Friday is canceled. There is a debate going on about canceling all the Jr. sailing out of the Club (4 afternoons/week). Three of my standing meetings have been moved to video conferencing. I'm about to start my second video conference today. We have over 10 fellow members trapped in Europe after a regatta, they believe that US citizens are still being allowed back from Europe but the planes don't appear to be flying.

We've canceled our family vacation to Disney World. My little Granddaughters were deathly worried about their YaiYai and Opa. Their parents were too. We're all staying home while our #2 son and son-in-law take their truck into town to load up on long-storage-duration food. (We all need it anyway for earthquakes.)

Life is changing.

[Ajax]

My opinion is, if we'd just grit our teeth and swallow the medicine, the pain would be sharp but short-lived.

Cancel all mass gatherings and enforce nationwide isolation for 2 weeks with the stated option (and likely intent) to implement 2 more weeks of isolation. Then, reevaluate and see where we go from there.
It would be brutal economically and socially. I approve of stated measures to suspend insurance co-pays and not charge for Covid testing. I approve of stimulus measures necessary to protect small businesses so that they don't fold and wipe out all the jobs that they provide.

You don't need to be a dictatorial regime like China in order to have national willpower. We could do it, if we wanted, and if our politicians would unite.

"Preparedness" has become a running joke in our society. Shows like "Preppers" parade the worst of the tin-foil hat brigade, convincing people that storing 2 weeks of food and water and a 12 pack of batteries is for losers. Preparedness and independence used to be a civic virtue in the U.S.

[kimbottles]

Ferry boat is half empty! Very unusual.

[Ken Heaton (Salazar)]

As of today there are not yet any know cases of COVID-19 in Nova Scotia. There may in fact already be cases, they perhaps just haven't been detected yet. We flew back from Torremolinos, Spain last week (via Zürich and Boston) and our flight was full of your ladies from the US who had been studying in Firenze (Florence ), Italy and thought it best to get themselves home before conditions grew worse.

Our neighbour's directly across the street were very excited last fall when their daughter got a position as an an au pair in Milan, Italy for the winter. The are excited again now, but for much different reasons.

Note: An au pair is a helper from a foreign country working for, and living as part of, a host family. Typically, au pairs take on a share of the family's responsibility for childcare as well as some housework, and receive a monetary allowance for personal use.

With Italy now in lock-down she is desperately trying to get home, but as of yesterday morning, had not found a way out of the country yet. I haven't been speaking to them yet today so I don't know if she has had any success escaping Italy.

[IrieMon]

I am most concerned for my parents and my father in-law. They are all 70 years old.
My mother is about to start chemo for lung cancer which will crush her immune system. The timing is terrible.

My wife was diagnosed as "pre-diabetic" but she's on Ozempic and her numbers are very good, well under control. She's lost 35 lbs. Diabetes is described as an "underlying condition" that makes Covid-19 more lethal. We're not sure how much more vulnerable she is and we're really not interested in finding out.

Rich.... So sorry to hear about your mother. She is a great gal and sorry to hear she has to undergo this treatment. Big prayers to you and your family for a speedy recovery.

My mother is in her 90s and, having had her spleen removed, is obviously in the highest risk category (plus she is very social in her church). Fortunately she has cancelled giving communion to nursing home patients, and has also suspended her "healing hands" services. But she is mildly upset the minister stopped giving wine during the communion service in church (he also wears gloves when handing out wafers, though I'm skeptical in the effectiveness). Her actual suggestion is to use bourbon for communion..... will kill anything. She may have a point God, having a family from Kentucky can be challenging.....

Was going to fly up and see her, but would have to connect through Charlotte, which can be considerably busy with international traffic. My sister and nephew postponed a visit to her as they would leave out of O'Hare. Think I'll do the 7 hr drive.

My wife is a flight attendant, but has been on vacation for 10 days.... think she'll take another 2+ weeks off if not much more. Some websites (ex: Forbes) are spouting the HEPA filters on airliners will minimize the risk..... another gob of misinformation as HEPA filters are only effective down to.3 microns and CoronaV is .12 microns (anyone correct me if mistaken). As stated in this thread, so much misinformation.

Once a vaccine is developed, any estimates on how long trials and (gasp) FDA Approval will take ?!?

Thanks to all for a very informative thread.


edit... here is an inclination the FDA is not allowing expedience:

https://www.nbcnews.com/health/health-c ... g-n1156006