Coronavirus COVID-19 - Global Health Emergency #4

[Herat]

This is a very very good article about the sensitivity of the CORVID-19 testing and the predictive positive and predictive negative results and their impact.

It's quite pithy, but ends up with these conclusions:

"Either way, it is clear that low sensitivity diagnostic tests are a major problem in this COVID-19 outbreak."

The sensitivity of the current CORVID-19 test ( done on a thoat swab) is currently only about 40%.

Contrast that with the current rapid molecular testing for Influenza A or B done in most US hospitals which is about 90-95% sensitive.

This is a huge problem right now for epidemiologists. With a low-sensitivity test in a high-prevalence area, this paper explains you would have to test the same person 8 different times to get a statistically valid negative result. There is just no way any country can do this. Right now the best lab can only process 6,000 specimens a day. If the practice was to re-test negative results up to 8 times to assure they were negative, that would mean they would only test something like 1500 people a day, not 6000

Statistics, Decision Making, And Containing COVID-19 With Unreliable Diagnostic Tests

 

[gregjrichards]

Here it is again.....
_______________________________

"China's central bank will also disinfect and store used banknotes before recirculating them in a bid to stop the virus spreading."

China restricts movement to fight coronavirus

Fresh cash for old: China central bank branch to destroy banknotes from coronavirus-hit sectors

• Paper currency collected from hospitals and buses among those targeted in public health push
• Other notes will be disinfected and stored for 14 days before going back into circulation

South China Morning Post

Central bank branch to destroy banknotes from coronavirus-hit sectors

 

[Herat]

Fresh cash for old: China central bank branch to destroy banknotes from coronavirus-hit sectors

• Paper currency collected from hospitals and buses among those targeted in public health push
• Other notes will be disinfected and stored for 14 days before going back into circulation

South China Morning Post

Central bank branch to destroy banknotes from coronavirus-hit sectors

Ugh. Yes, paper money is disgustingly dirty. If you have to handle paper money, such as for your job, you really should be wearing gloves

 

[dixiegirl1035]

I’m wondering this morning just how soon the WHO will officially declare this to be a pandemic. IMO, it’s time!

With all of the cases that continue to be reported worldwide, to believe that infected individuals haven’t fallen through the cracks of the quarantines would be wishful thinking at best. I will be absolutely amazed if we don’t see localized outbreaks worldwide within the next few weeks (I’m guessing sooner rather than later).
Trying to chase down all individuals that an infected person has had contact with in the general public is difficult at best. All it takes is one infected person to attend a large sporting event or social gathering. Or to forget one detail of where they have been while infected.
I can’t help but think about the early precautions that were being taken as people were arriving on return flights from China. Their temperatures were being taken and anyone without a fever was considered safe. In hindsight, with what we know now, I think most of us on this thread would agree that it wasn’t nearly enough. This particular virus had found various ways to go undetected in the early stages, and for a greater period of time compared to its relatives. Unfortunately, the truth of the matter is, to contain something, you first have to know that it’s there.
Containment through quarantine methods still provides the best opportunity to slow the progression of the outbreak, but IMOO, total containment has failed. IMO, we’re in the midst of a pandemic that has yet to be officially recognized.

I’ve been one of the outspoken “alarmists” on this thread, but I’m really more of a realist. I will again suggest that everyone do at least a little to prepare. Panic, fear, and chaos will more than likely be worse than the virus itself. Take the precautions you can, but don’t be one of the panic stricken if a global breakout does occur. Take extra precautions if you have underlying health issues. But here is the reality for most of us based on what’s being reported thus far....

• This virus spreads very rapidly, but if we look at the number of confirmed cases in China, the percentage is extremely low compared to the 60 million people currently under quarantine. Even with under reported numbers, this means that either only a relatively small percentage has been infected, OR the majority of the cases have produced mild symptoms.
  
• If by chance you do get infected, it currently appears that you have a 95% - 98% chance of recovery. Those are VERY GOOD ODDS!
• Science these days is absolutely amazing - the odds are in humanities favor that a vaccine will be discovered or that new drugs will be created to help fight the disease.
  
• I’ve always believed that a viral pandemic could/would decimate the human population, but unless there are major mutations that make this virus more deadly - this is not the one that will have a huge impact on the world population.
  
• The world as a whole will go through an “adjustment period”, and though this virus (again - in my opinion) is much worse than the flu, we have to keep in mind that the flu IS a very deadly virus, but we have learned to live with it and do what we can to minimize it.

Getting through the adjustment period is going to be the difficult part. A little preparedness and continued education on the subject are key. A little bit of fear will keep us alert and will ensure that we stay focused on our precautions. Panic and chaos will only make any situation more dire.

Ok - stepping off of my soap box!

I’m hoping this post will help calm the nerves and lessen the anxiety of some folks that are following along.
Even in the worst of situations, it’s best to look at the entire picture and keep things in perspective. Cool heads will prevail!

So many folks here posting that are eloquent, thank you for yours.

Agree as to above. We will see outbreaks in other areas in the future. Some scientists are saying it is a Coronavirus and will end when the temps get warmer (optimists) and some say not. No one, NO ONE knows for sure at the moment MOO. Leaders in the world mostly have been optimistic yet are preparing. What else, really, can they do? Scream the sky is falling Henny Penny style, yet some scientists are saying will trail off with warmer weathers and give a reprieve? Don't know the answer.. only time will tell.

One thing that China has done that could be fabulous...if, and only if, can be done in the "free world" (analogy, as their apps are called different than in the US etc.)

They developed an app that brings in e.g. our Google travel which is in our cell phones (do Apple phones have that) we it tracks all the places we have been. The got with the developer in China to do an app for the virus to know "were you here when this infected person was" in addition to the interview. WOW!!! But... would that fly in the US with so many issues (even with terrorism) where the parent companies HERE say no... invasion of privacy ... you the government cannot have. Dunno... China could do.. and would be great.. but privacy laws etc. may prevent in other countries although would be great to have. Heck, I cannot remember where I was 3 days ago as I don't pay attention, much less where I was 10 - 20 days ago and what time. iykwim.

Anyway, yes, it's coming ... and I'm amazed that the financial markets have had such monetary influx from governments and World Bank etc. to prop up the markets. 401k monies go into index accounts... so reaction is delayed. But MOO it's gonna hit sooner or later there too as supply chains are gonna get worse and worse as to availabilty. The company I worked for.. and retired from.. will go under if China is cut off.

 

[What if...]

Those possibilities are why there are WHO videos, and why most countries are taking it seriously.

Right now, outside of Hubei, if you fall ill, it's more likely to be a cold or flu. A lot more likely. People can die from the flu, it's not a totally non-serious condition in itself. But right now, you're more likely to have a cold or flu causing a cough or fever, and this month you are more likely to die in a car crash than of Covid-19.

And we desperately need for it to stay that way.

ITA, based on where the situation stands TODAY.

My post was in no way intended to downplay the severity of the flu, but rather to shine light on the POTENTIAL dangers of the COVID-19 virus in comparison. The seasonal flu IS and ALWAYS HAS BEEN a deadly virus that should never be underestimated or discounted.
My sincere apologies if any part of my post was perceived as downplaying the severity of the flu. That was definitely not my intent.

 

[mickey2942]

After 9/11, the financial markets and ripple effects on the economy didn't really hit until a year later.

 

[dixiegirl1035]

This is a very very good article about the sensitivity of the CORVID-19 testing and the predictive positive and predictive negative results and their impact.

It's quite pithy, but ends up with these conclusions:

"Either way, it is clear that low sensitivity diagnostic tests are a major problem in this COVID-19 outbreak."

The sensitivity of the current CORVID-19 test ( done on a thoat swab) is currently only about 40%.

Contrast that with the current rapid molecular testing for Influenza A or B done in most US hospitals which is about 90-95% sensitive.

This is a huge problem right now for epidemiologists. With a low-sensitivity test in a high-prevalence area, this paper explains you would have to test the same person 8 different times to get a statistically valid negative result. There is just no way any country can do this. Right now the best lab can only process 6,000 specimens a day. If the practice was to re-test negative results up to 8 times to assure they were negative, that would mean they would only test something like 1500 people a day, not 6000

Statistics, Decision Making, And Containing COVID-19 With Unreliable Diagnostic Tests

Hard to get through that after reading scientific articles as this media article says " suppose" 10 times in the article. (it is not science paper)

And the author for his figures says "I assume" e.g. he states "I assume a 40% sensitivity." vs. what this post says "The sensitivity of the current CORVID-19 test ( done on a thoat swab) is currently only about 40%."

Agree it is an issue... yet I'm down the rabbit hole on Google Scholar vs. media making assumptions and suppositions (ha! but I'm doing it here also... so guess I shouldn't throw stones.. but media needs $$ on headlines etc.. I don't)

Here are some I've kept up on screen as I thought interesting and informative papers/pre-publications/published in journals

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200343 Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Te s t i n g

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30359-7.pdf Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure

https://watermark.silverchair.com/c...qK7bINdP4gdnHlfnwleTWD8kY_baCqk-my1mADB29K3BW © Consistent detection of 2019 novel coronavirus in saliva


https://www.medrxiv.org/content/medrxiv/early/2020/02/11/2020.02.09.20021261.full.pdf The effect of travel restrictions on the spread of the 2019novel coronavirus (2019-nCoV) outbreak

https://arxiv.org/ftp/arxiv/papers/2002/2002.04739.pdf Forecastof the evolution of the contagious disease caused bynovel coronavirus (2019-nCoV)inChina

e.d. That the test isn't comparable to a test which has been around for years and years etc... and just developed within a few weeks misses some... that would be expected. I'm amazed that they have tried to do such and gotten such a test out even though it misses some. Tests usually take years to get to market. Expected MOO and there is already a new and improved that has come out.. and will continue to MOO

 

[Herat]

And more analysis of the mortality rate and why it's not as low as the initial reports say:

Novel Coronavirus Case-Fatality Is Not Good

 

[KALI]

Those heros in the video are awesome! Also happy to see food available! What great people.

CGTN / 10 hours ago
Vlog: Inside a 'sealed' neighborhood in Wuhan

—-
CGTN / 3 hours ago:
Grassroots heroes in Wuhan help contain COVID-19

 

[dixiegirl1035]

ITA, based on where the situation stands TODAY.

My post was in no way intended to downplay the severity of the flu, but rather to shine light on the POTENTIAL dangers of the COVID-19 virus in comparison. The seasonal flu IS and ALWAYS HAS BEEN a deadly virus that should never be underestimated or discounted.
My sincere apologies if any part of my post was perceived as downplaying the severity of the flu. That was definitely not my intent.

And apologies from me if I post anything that is objectionable to the poster. Not my intention, as we all come from different viewpoints and is a discussion. Please don't take personal when my personal MOO is expressed that differs from you. WE NEED differing opinions on this thread for us all to understand, and actually pick/choose information. I have jumped back over the fence on some things and opinion changed based on what someone here shared. MOO. IMHO, the best posts are those that are eloquent, and those that disagree with my point of view and leads me to look into and consider further.

Thanks to all posting.

And to those that are apologizing for reposting stuff or powerposting... it's just like criminal cases here... folks come in later and don't know.. and folks like me have memory like a rock and need to be reminded of stuff, so thanks!

 

[Herat]

dixiegirl - Thanks for these articles.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200343 Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Te s t i n g

This article points out that in 3% of cases, the CT findings indicated high scores for the disease but were negative by the CORVID-19 throat swab RT-PCR testing.

I can't imagine the US being able to provide the CT time ( allowing for machine downtime), the radiology technologist staffing, the radiologists, even the isolation facilities to do CORVID-19 screening by CT.

I don't think there is any US hospital that could keep up with the demand for CT testing of potential CORVID-19 patients without overburdeding the imaging facilities and denying other patients CTs ( for example, the ER patients with likely appendicitis, diverticulitis, severe abdominal pain, trauma, oncology screenings or follow-ups, workup of pulmonary embolism, etc etc etc)

And that issue is magnified in Europe and in Central and Southern America.

 

[dixiegirl1035]

The two US planes were schedule to depart by now.. still on ground. I'll do an update or ETA when they are in the air.

Come home! Glad you are off the ship!

ETA: As of 12:05 pm eastern... they still have not left and both were scheduled to have already left. Hope all is ok and they get to leave and not retained...

ETA: Still not taken off... Ill put up links so when 60 minute ETA is done, others can peek and bump this post if they see they took off please.

Kalitta Air (K4) #581 ✈ 17-Feb-2020 ✈ HND / RJTT - KSKF ✈ FlightAware

Kalitta Air (K4) #585 ✈ 17-Feb-2020 ✈ HND / RJTT - KSUU ✈ FlightAware

Thanks in advance for clicking on and bumping for the rest of us if it shows they took off as my 60 minutes about up for ETA

 

[Simply Southern]

Per Abels 5:30 pm video #54 (4 hours ago)

• Youtube is not allowing anyone to monetize videos about the outbreak or virus or quarantine now per their policy.
• US has offered UK help to extract the folks on the ship.
• Redo on time to get off.. the captain just announced that those who test negative would be able to get off on the 19th onwards. (that is 180 degrees MOO from 12 hours ago as!)
  
• US came with "big army trucks" to pick up US folks and Abels think the plane came into the US airbase, not a commercial airport (that means no following on flight aware unless it shows up on March AFB location?) ETA at 55 minutes... we now know they are Kallita airlines and are flying out of normal Tokoyo airport.. see post below
  
• They got roast beef sandwich and quiche for lunch (yeah! they were so tired of "foreign food")
• Hospital rooms for folks taken off may be 4 hours away from where they are, they don't wanna go and don't want to be separated.
• K49586 /CKS9586 Kalitta Air/747/Estimated arrival Haneda, Tokyo 21:43 GMT +9 Sunday someone posted on their feed that they think is the US flight...fact that David saw first hand the military trucks come for the US folks ?)
• During live feed, the guest services announced luggage pickup for the Americans would be in 25 minutes.
• They said "how great America was for doing this, it couldn't be easy but they did it".

I'll ETA for 60 minutes on this post as I'm halfway through their video

Thank you !!! I'm hoping many are able to get home to the US. So happy for US intervention in bringing home our US Citizens... proud !!!!

 

[Simply Southern]

dixiegirl - Thanks for these articles.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200343 Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Te s t i n g

This article points out that in 3% of cases, the CT findings indicated high scores for the disease but were negative by the CORVID-19 throat swab RT-PCR testing.

I can't imagine the US being able to provide the CT time ( allowing for machine downtime), the radiology technologist staffing, the radiologists, even the isolation facilities to do CORVID-19 screening by CT.

I don't think there is any US hospital that could keep up with the demand for CT testing of potential CORVID-19 patients without overburdeding the imaging facilities and denying other patients CTs ( for example, the ER patients with likely appendicitis, diverticulitis, severe abdominal pain, trauma, oncology screenings or follow-ups, workup of pulmonary embolism, etc etc etc)

And that issue is magnified in Europe and in Central and Southern America.

I would hope hospitals would/could use a segregated/ designated CT, so not to infect others.

 

[SeattleStew]

I finally got a box of 20 delivered this week, ordered from Amazon a couple weeks ago. At least 2 suppliers cancelled, saying they were out, but I finally lucked out with the 3rd seller.

I was at my local Costco yesterday and happened to see a man talking to a store manager about a discount on the pallet cart of thermoreaders he was planning to purchase. Mr. Stew overheard the customer asking for a discount, and the store manager saying he could discount the first 15, but the other 325 units would be regular price.

Then when we were checking out, a woman had a cart of around 50 of the same units. Mr. Stew and I guessed they were going to be shipped "overseas."

 

[Deleted member 158085]

Fresh cash for old: China central bank branch to destroy banknotes from coronavirus-hit sectors

• Paper currency collected from hospitals and buses among those targeted in public health push
• Other notes will be disinfected and stored for 14 days before going back into circulation

South China Morning Post

Central bank branch to destroy banknotes from coronavirus-hit sectors

A bit disturbing. They must not be confident that disinfecting such things would work.

 

[Herat]

• Redo on time to get off.. the captain just announced that those who test negative would be able to get off on the 19th onwards. (that is 180 degrees MOO from 12 hours ago as!)

Ummm. I would hope those who tested Negative the first time would at least be re-tested once more. Preferably several more times at certain intervals.

 

[SeattleStew]

American Woman Who Left Cruise Ship Tests Positive for Coronavirus

An American woman who left a cruise ship in Cambodia last week and flew to Malaysia with more than a hundred other passengers has tested positive for the coronavirus, alarming health experts who fear that some exposed passengers who then traveled onward could become a new source for global transmission.

snip

Cambodia allowed the ship to dock after five other countries turned it away over concerns about the coronavirus. Officials said that more than 140 other passengers from the Westerdam had flown by Saturday from Cambodia to the airport in Kuala Lumpur, Malaysia’s capital. All but the American woman and her husband were eventually allowed to continue to their destinations, including airports in the United States, the Netherlands and Australia.

As of Sunday, 233 passengers and 747 crew members were still on the ship docked at Sihanoukville, Cambodia, Holland America said. The more than 1,000 other passengers departed Sihanoukville on charter flights to Phnom Penh and were in various stages of transit home, the cruise line said.

It was unclear whether Cambodia would seek to quarantine passengers who are still in the country, or whether those who had left by plane would face quarantine in their own countries when they arrived.

snip

The woman and her husband, 85, also an American citizen, were both hospitalized and in isolation. The husband has also been tested twice for the virus, and the results were negative both times. But he has pneumonia, which is often a sign of the virus that appears before it can be identified through testing.

snip

 

[dixiegirl1035]

dixiegirl - Thanks for these articles.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200343 Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Te s t i n g

This article points out that in 3% of cases, the CT findings indicated high scores for the disease but were negative by the CORVID-19 throat swab RT-PCR testing.

I can't imagine the US being able to provide the CT time ( allowing for machine downtime), the radiology technologist staffing, the radiologists, even the isolation facilities to do CORVID-19 screening by CT.

I don't think there is any US hospital that could keep up with the demand for CT testing of potential CORVID-19 patients without overburdeding the imaging facilities and denying other patients CTs ( for example, the ER patients with likely appendicitis, diverticulitis, severe abdominal pain, trauma, oncology screenings or follow-ups, workup of pulmonary embolism, etc etc etc)

And that issue is magnified in Europe and in Central and Southern America.

For the next few days, I'll try to pick and choose a few that I thought would be interesting each morning and do a post of articles for those who read here who want to view scientific stuff (? don't know how many are interested in viewing? - if not just roll and scroll - I'll try to continue also with WHO daily briefings transcripts )

I would hope hospitals would/could use a segregated/ designated CT, so not to infect others.

So so so so much agree with the hospitals being overwhelmed. The just do not have the capabilities of doing what is needed and don't have the resources. David Abel touched on that this am when he said that some folks taken from the ship were taken far away to other hospitals. That makes sense. I live in a major metro area, and did a google on how many CT's were in my area.... yet I didn't get a number... just that most were merely local / non hospital CT facilities which would NOT be prepared to handle this type of epidemic MOO. They are just community CT for what was posted above as to other non-infectious diseases.

Hubei was overwhelmed... agree with that without a doubt as to resources and their numbers. The tests needed something quicker, CT's help, but then CT space and time is limited. Jeeeeezzzzz just a worst case scenario. And I do believe they are doing their best! I really do.

 

[Herat]

CT's

I would hope hospitals would/could use a segregated/ designated CT, so not to infect others.

I don't believe many hospitals can do that without denying care to critically ill people with non-respiratory diseases.

For example.
Current Medicare Code Stroke Protocol benchmarks for the identification and institution of treatment of stroke patients requires a head CT be completed within 20 minutes of them arriving, and if indicated, receiving the appropriate drug within 30 minutes ( "Door to Drug = 30 minutes")

H0spitals cannot deny these critical patients this care and currently Medicare will penalize hospitals and deny payment for the care of these patients if the benchmarks aren't met. They can't delay care to screen potential COVID-19 patients.

A great many CT's in this country are privately owned by physician clinics. They would not normally be used to screen respiratory patients, but they might have to be should a State of Emergency be declared. There's a huge political fight. Should a for-profit Orthopedic Clinic with a CT be required to take potential COVID-19 patients in a State of Emergency?