Another respiratory virus from China (Coronavirus Megathread)

Spanz

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Reuse of N95 masks (disinfection):

View attachment 341912

Note the warning about use of alcohol or chlorine as disinfectants on the masks. While they will disinfect these materials, they will also have an affect on the diffusive properties of the material which is key attribute towards capturing of the virii.
Where did you find that chart. The WHO was saying 15 minutes at 133 deg F would kill the virus
 
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They just calling everything coronavirus now.

You come to a doctor with twisted ankle - their diognose is corona virus
 

92G

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Well that is really the question of the day - isn't it?

What is the "acceptable number of deaths"?

As a society - we've already demonstrated MULTIPLE TIMES OVER HUNDREDS OF YEARS - that death is "acceptable".

When Japs bombed Pearl Harbor - we entered WW2 , and the people in charge KNEW there was going to be death - a lot of it. In fact they had been maneuvering to get into that war even before Pearl Harbor - they just needed the excuse. The "death" thing really wasn't a major decision point - was it?

How many men did we lose in Vietnam? Something like 50,000 ? (going off the top of my head - feel free to correct me). Obviously death wasn't a major decision point stopping them from proceeding, because even with the country practically in revolt - it didn't stop the war.

Abortion: what's the death count there? I've seen figures in the millions. And the lefties are actually approving of full birth "abortion" now - so once again: obviously death isn't a major mitigating factor to making the decision.

Anybody remember that famous Madelaine Albright quote about how it was acceptable that there be Iraqi children starving to death as long as the political goals were met? Once again (I repeat ad nauseum) - death wasn't really a major sticking point - was it?

How many Germans, Japanese, Koreans, Vietnamese, Iraqis, Afghanis has the United States military killed during all the wars of the last 120 years or so? Again going by memory here - but I'm pretty sure the body count is in the double digit MILLIONS, so once again: death isn't really a mitigating factor in making political decisions - is it? And I've go further with this specific example and say spare me all the righteous indignation about "not caring" - because it's plainly phucking obvious that when it comes to "death" - we don't give two shits.

Notice anything about all of the above examples ? All of the people killed were either young (military age males) , very young (aborted babies), or "enemy" (all of the people killed in other countries during all of our wars).

What's one of the major distinctive factors of all the people who typically die from this cornholeya H1B virus? : They're either old - or they're compromised. I see a lot of news stories trying to point out that the young are dying too , but those seem like very carefully placed propoganda given how they "conveniently" show up directly after the "authorities" bitch and moan about how all the young people aren't paying attention.

So what are you trying to tell me - that old people and sick compromised people are worth more and are worth wrecking the economy and society for - but young virile males are not?

Sorry - but that's just stupid. The harsh truth is that young males are worth far more to the health of society than the old and sick are. So the current policies - taken in the larger context - just seem stupid - and even possibly suicidal over the longer term.

Look - I'm old (mid 50's) - and I don't really want to die by drowning in my own fluids. More than that - I have a young son that I REALLY need to stick around for because there isn't a lot of backup familial support if I end up dying. But........... if you kill my job and I go bankrupt and have to live in a box - or you pull apart all the threads of society and it all goes shitshow and we end up in war - either me or my son stand a pretty good chance of dying there too.

So now we've got the "pay me now or pay me later" factor to take into account as well.

Like JPK said: some of these policies just seem asinine - especially given that we could probably get most of the way there by just requiring that everybody wear masks - from what I'm seeing most people STILL aren't.

In previous pandemics - society pretty much kept functioning without a shutdown - and then moved on after the dead were buried. There is no precedent that I know of for this total shutdown. There WILL be repercussions from this - you can count on it. And in my opinion medical "professionals" are extremely myopic and are probably fundamentally unqualified to make decisions that affect things outside their small world.
very wrong
how many patients with CoV have you managed?
I have cared for ~40 of them in the past week, all of them requiring admission
some have rapidly decompensated faster than we can managed

the likelihood that I develop this thing in the next month is high
do I care? not really. I have a family that's the only part I personally care about
your ignorance on the matter is of no consequence

so you think it affects the old and sick?
is that based on experience?
many of you people have no idea what we are up against

BTW, you wrote a lot but still haven't answered the question
 
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10thSFFD

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Well thats what happens WHEN YOU SHUT EVERYTHING DOWN!!
Let's go back to what we were doing well on this thread: Predicting next steps based on what is going on in other parts of the world.

Europe is warning already that there will be a shortage of fruits of vegetables mostly due to transportation problems. Fruits and vegetables in the supermarket can be a source. We do not know how to solve it.

Post office may stop deliveries in 3-4 months.

Again, this is going to be a long run. Make sure you check your cars, do you need battery, filters. What are you going to do when your AC will kick in in the summer. Will ot blow viruses from other apartments? Think about long run!
 

rep308

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Please, make Youtube video. You would not believe how helpful that would be now all over the world.
My mom is in lockdown with no video access, she got the info for a church group and someone is collecting them for distribution. She has a separate set for my daughter and son in law both nurses at a local medical center.
 

hminsky

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Shit just got real; all you manly men and flu bro's out there, you might want to take extra precautions to avoid getting this, unless you would like more cleavage of your very own:

"Common symptoms of hypogonadism in men include abnormally large breasts and erectile dysfunction."

 

vicorjh

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Where did you find that chart. The WHO was saying 15 minutes at 133 deg F would kill the virus
It was on reddit as a reposting of a QA from some Stanford folk. The PDF containing that info and a bunch of other interesting stuff is in that post, too.

FWIW, WHO is located somewhere near the bottom of my accurate advice scale. Not that it's wrong but it seems they keep provided bad advice and ideas.
 

Spanz

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It was on reddit as a reposting of a QA from some Stanford folk. The PDF containing that info and a bunch of other interesting stuff is in that post, too.

FWIW, WHO is located somewhere near the bottom of my accurate advice scale.
That is a lot hotter than i expected—might degrade the mask! Not sure if it needs to be
 

Duxprep

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Sadly, I suspect the rate decrease in NYC case count is attributable to lack of testing capacity. Notice that the % Positive with regards to testing is increasing. The roll off of the testing numbers matches/outpaces the roll off of the positive cases. We can't expand testing capacity fast enough to keep up with how fast the virus is spreading. :/

Log chart for ease of trend spotting.

View attachment 341870
No - the dropoff is due to revised testing guidance - They are no longer testing Outpatients - Only those who they plan to admit due to severe symptoms - THose who are not yet ready to go to the ICU get to continue to get sicker at home and without having been tested
 

vicorjh

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That is a lot hotter than i expected—might degrade the mask! Not sure if it needs to be
It appears that steam might actually be better mechanism according to the chart. And, there's always the quarantining of the mask, too.

How long does the WHO say to hold it at their temperature recommendation?
 

SpaceCritter

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Shit just got real; all you manly men and flu bro's out there, you might want to take extra precautions to avoid getting this, unless you would like more cleavage of your very own:

"Common symptoms of hypogonadism in men include abnormally large breasts and erectile dysfunction."

THIS is what I was afraid of.
 

calsdad

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...and we're talking about two products that have been around for years and years and YEARS.

It's funny that the very same public health people that are all, "OHMYGAWD! R-Naught Exponential Growth! Shut down ABSOLUTELY EVERYTHING RIGHT NOW!!1!"
when it comes to an intervention - which has EMPIRICALLY demonstrated efficacy - with two products that, once again, have been around many a block, they're all, "Let's... not... be... too... hasty... now."
Exactly.

And everybody wonders why "conspiracy theories" get going from situations like this - when there's things exactly like what you're detailing people start comparing data points - and when things don't line up they start thinking " Ok - now why don't you stop lying to me and tell me what is really going on here?"
 

jpk

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When do we get to start charging/incarcerating hospital administrators for failing so utterly and completely to stock any significant amounts of PPE/Masks/etc?
 

NHCraigT

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Report from New Orleans:
Good morning! Got some much needed sleep last night and am enjoying my day off before returning to the ER tomorrow.

I'm a member of several nurse groups and thought y'all would enjoy reading this that was written by an ER doc in New Orleans. Very interesting read:

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."
 

Spanz

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It appears that steam might actually be better mechanism according to the chart. And, there's always the quarantining of the mask, too.

How long does the WHO say to hold it at their temperature recommendation?
I am not at home. But the WHO said 15 minutes at 134 deg F would reduce coronavirus by 10,000 units.
Not sure what a “unit” means, though

i will try to find a link to the study later
 

calsdad

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I expect exodus from NYC to Boston and NH.

That has probably already been happening. Florida just recently came out with an order that people coming down there from NYC were going to be quarantined for 14 days. Two weeks ago on my way home from my last day of actually going into work - there were an awful lot of vehicles with NY plates headed north on Rte 495.........
 

calsdad

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Today Fauci was touching his face like crazy. They should all wear masks and practice social distancing. We have to learn how to leave our faces alone. Not easy!
I've found that it's easy to stop touching my face - I just keep my hand busy rubbing my peepee. It doesn't work so well in public or when I'm at work, but now that I'm working from home it seems to work pretty good.

Just saying - if you've got restless hands maybe you just need to find something else for them to do............ you can thank me later. :p
 

LuvDog

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I am pretty sure the kopsch aren't going to give someone shit for wearing a surgical mask or respirator right now.... [rofl]
A couple of weeks ago, I said to my wife "Now is a great time to rob a bank because everyone is wearing a mask".

She looked at me and said my mind works in strange ways
 

mcb

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When you see news like that your BS meter needs to peg to 100. We could stop CV in its tracks with compulsory mask use while in public. Not N95 masks, surgical masks.
Found this pic on the Glob this morning and added some notes...

s3___bgmp-arc_arc-feeds_generic-photos_to-arc_shoppers-850x478$large.jpg
 

Duxprep

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Disclaimer: This is a post of a rumor that was heard from a poster's close-family-member on another Forum (so view it as such):
(added: another poster said their local news actually mentioned this)
No reason to doubt that is true - Someone posted a presser yesterday from ACOE about their activities to convert facilities to field hospitals - Building 10K beds just in NYC
 
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