Coronavirus COVID-19 *Global Health Emergency* #15

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  • #161
It's almost legitimate to question whether there is a problem where people think that Asians are aliens who have a strange weakness to viruses.

I think part of the problem is that the virus really has been described as an old, sick people problem. However, in reading about it, my impression is that people of all ages can become very sick and require medical care. Those who recover may have permanent damage to lungs and other internal organs. This would mean that there will be reduced life expectancy.

It's also possible that there will be a second wave. Going from memory, but didn't the 1918 flu hit a different age group in the second more deadly wave?
BBM. I totally agree. The sickest patient in Omaha right now is a 36 yo woman who traveled to the UK with her dad in February and wasn't sick enough for medical care until over a week after she returned from her trip. The metro area of over 1 million people still doesn't know where she was or what she did in that more than one week after her return from the UK. They haven't revealed what Methodist ER she first visited.

Today, it was said she is in very serious condition and that she may have Adult Respiratory Distress Syndrome. I think the point officials are trying to make is that this is a complicated disease and not to make any assumptions based solely on age.

JMO
 
  • #162
What I find so strange is that everyone can look at China and learn how serious this virus is, yet they don't. They seem to think that they need to reinvent the wheel rather than learn from others.

@otto, I thought you were going to end this by saying, "They seem to think that they need to go on their spring holiday, go to the movies, not wash their hands, not prepare to shelter in place, have the Olympics and travel the globe as if nothing is happening"!
 
  • #163
Have a look at what the virus did to this healthy man. Imagine that every 35 year old with the virus needs this level of care at the same time.

"On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China. The patient stated that he had seen a health alert from the U.S. Centers for Disease Control and Prevention (CDC) about the novel coronavirus outbreak in China and, because of his symptoms and recent travel, decided to see a health care provider."​

https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
Thanks. Sent this to my daughter, who likely will be treating patients when it presents there.
 
  • #164
BBM. I totally agree. The sickest patient in Omaha right now is a 36 yo woman who traveled to the UK with her dad in February and wasn't sick enough for medical care until over a week after she returned from her trip. The metro area of over 1 million people still doesn't know where she was or what she did in that more than one week after her return from the UK. They haven't revealed what Methodist ER she first visited.

Today, it was said she is in very serious condition and that she may have Adult Respiratory Distress Syndrome. I think the point officials are trying to make is that this is a complicated disease and not to make any assumptions based solely on age.

JMO

We don't know what happened in China, and why death rates are higher for people over 60, but it is possible that decisions were made regarding prioritizing patients. Prioritizing doesn't necessarily mean that the most vulnerable are treated first. It might be that priority was given to very sick younger people.
 
  • #165
It's almost legitimate to question whether there is a problem where people think that Asians are aliens who have a strange weakness to viruses.

I think part of the problem is that the virus really has been described as an old, sick people problem. However, in reading about it, my impression is that people of all ages can become very sick and require medical care. Those who recover may have permanent damage to lungs and other internal organs. This would mean that there will be reduced life expectancy.

It's also possible that there will be a second wave. Going from memory, but didn't the 1918 flu hit a different age group in the second more deadly wave?
Yes, a second and third wave in the 1918 flu.

I traveled through Southeast Asia . Certainly the lifestyle can be shocking to us in the west. It is sad that epidemics originate in the Asian continent. But, more pathetic is that our world is so unprepared and our leaders can't lead.
 
  • #166
@otto, I thought you were going to end this by saying, "They seem to think that they need to go on their spring holiday, go to the movies, not wash their hands, not prepare to shelter in place, have the Olympics and travel the globe as if nothing is happening"!

Good point. That is exactly what people under 40 are thinking today. It could be one very ugly wake up call when healthy people under 40 are so sick that they need medical care and there are no facilities to provide care.
 
  • #167
  • #168
Yes, a second and third wave in the 1918 flu.

I traveled through Southeast Asia . Certainly the lifestyle can be shocking to us in the west. It is sad that epidemics originate in the Asian continent. But, more pathetic is that our world is so unprepared and our leaders can't lead.

Two of my sisters in law are born, raised and educated in China. They don't eat bat soup. They're regular people. We had a big family dinner last week at a Chinese buffet and they were cracking jokes throughout the night about the strange remarks that people make about China and the virus.

There was so much criticism of China's politics and efforts to hide the epidemic, but we seem to be seeing that politics and economics interfere with epidemic management in all countries.
 
  • #169
Good point. That is exactly what people under 40 are thinking today. It could be one very ugly wake up call when healthy people under 40 are so sick that they need medical care and there are no facilities to provide care.
@otto, agree completely. I wish that the photos from the article you posted earlier about the 35 yo male whose lungs were severely impacted could be shown broadly in the media vs many of the stories without images that we are seeing or the press coverage of mild cases that are explained to be 'similar to the flu'.

Article you posted earlier:
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
 
  • #170
Cuomo - "We prioritize the categories to be tested to fit with our capacity"

Interesting. So prioritizing patients could happen across the world, where old people could be sent home due shortage of hospital beds, while those who seem to have a better chance of survival are treated? It will be interesting to see how this plays out in countries that are hopelessly unprepared and who under-estimate the severity of the epidemic.
 
  • #171
Two of my sisters in law are born, raised and educated in China. They don't eat bat soup. They're regular people. We had a big family dinner last week at a Chinese buffet and they were cracking jokes throughout the night about the strange remarks that people make about China and the virus.

There was so much criticism of China's politics and efforts to hide the epidemic, but we seem to be seeing that politics and economics interfere with epidemic management in all countries.
I, for one, do not fault China's handling of the epidemic. China gave us time that we squandered. I do feel ashamed of the U.S. government's handling of what will clearly be named a pandemic.
 
  • #172
Two of my sisters in law are born, raised and educated in China. They don't eat bat soup. They're regular people. We had a big family dinner last week at a Chinese buffet and they were cracking jokes throughout the night about the strange remarks that people make about China and the virus.

There was so much criticism of China's politics and efforts to hide the epidemic, but we seem to be seeing that politics and economics interfere with epidemic management in all countries.
I, for one, do not fault China's handling of the epidemic. China gave us time that we squandered. I do feel ashamed of the U.S. government's handling of what will be named a pandemic.
 
  • #173
@otto, agree completely. I wish that the photos from the article you posted earlier about the 35 yo male whose lungs were severely impacted could be shown broadly in the media vs many of the stories without images that we are seeing or the press coverage of mild cases that are explained to be 'similar to the flu'.

Article you posted earlier:
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191

Permanent lung damage has been documented in people who have recovered from the virus. Re-infection has also been documented. If someone with damaged lungs is re-infected, I'm assuming that likelihood or mortality is increased.

The first wave is people over 60, perhaps the second wave will be people age 30-60 with compromised lungs.
 
  • #174
From the same link that @otto posted earlier, Bill Gates wrote an article about responding to COVID19.

https://www.nejm.org/doi/full/10.1056/NEJMp2003762?query=recirc_mostViewed_railB_article

Quotes from article:

In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The Covid-19 pandemic is a case in point. We need to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.

The long-term challenge — improving our ability to respond to outbreaks — isn’t new. Global health experts have been saying for years that another pandemic whose speed and severity rivaled those of the 1918 influenza epidemic was a matter not of if but of when.1 The Bill and Melinda Gates Foundation has committed substantial resources in recent years to helping the world prepare for such a scenario.

Now we also face an immediate crisis. In the past week, Covid-19 has started behaving a lot like the once-in-a-century pathogen we’ve been worried about. I hope it’s not that bad, but we should assume it will be until we know otherwise. [BBM]

There are two reasons that Covid-19 is such a threat. First, it can kill healthy adults in addition to elderly people with existing health problems. The data so far suggest that the virus has a case fatality risk around 1%; this rate would make it many times more severe than typical seasonal influenza, putting it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%).2

Second, Covid-19 is transmitted quite efficiently. The average infected person spreads the disease to two or three others — an exponential rate of increase. There is also strong evidence that it can be transmitted by people who are just mildly ill or even presymptomatic.3 That means Covid-19 will be much harder to contain than the Middle East respiratory syndrome or severe acute respiratory syndrome (SARS), which were spread much less efficiently and only by symptomatic people. In fact, Covid-19 has already caused 10 times as many cases as SARS in a quarter of the time.

National, state, and local governments and public health agencies can take steps over the next few weeks to slow the virus’s spread. For example, in addition to helping their own citizens respond, donor governments can help low- and middle-income countries (LMICs) prepare for this pandemic.4 Many LMIC health systems are already stretched thin, and a pathogen like the coronavirus can quickly overwhelm them. And poorer countries have little political or economic leverage, given wealthier countries’ natural desire to put their own people first.

By helping African and South Asian countries get ready now, we can save lives and slow the global circulation of the virus. (A substantial portion of the commitment Melinda and I recently made to help kickstart the global response to Covid-19 — which could total up to $100 million — is focused on LMICs.)

The world also needs to accelerate work on treatments and vaccines for Covid-19.5 Scientists sequenced the genome of the virus and developed several promising vaccine candidates in a matter of days, and the Coalition for Epidemic Preparedness Innovations is already preparing up to eight promising vaccine candidates for clinical trials. If some of these vaccines prove safe and effective in animal models, they could be ready for larger-scale trials as early as June. Drug discovery can also be accelerated by drawing on libraries of compounds that have already been tested for safety and by applying new screening techniques, including machine learning, to identify antivirals that could be ready for large-scale clinical trials within weeks.
 
  • #175
If you're saying it's better be sick in China than the US, the entire world begs to differ. jmo

In Beijing the hospitals are very good and they have the most current equipment and you can ask for any test you want, such as MRI, CT scan, etc. Most people have a health plan and a deductible like we have, and they also pay cash for some services.

The interesting thing is that to see a doctor in one of the best hospitals in the city, you have to get there very early in the morning to sign up for an appointment. You can see from the monitors/screens which doctors are the most popular and have the best reputation. Those appointments are gone by 7:00 a.m. or earlier. Some people book an appointment and then stand around and sell the appointment to the highest bidder.

In spite of this, overall I would say that from my experience in Beijing over the years, the quality of care and the knowledge of the experts/physicians is impressive.

I should mention that if you have to be hospitalized, however, you need to have a family member stay in your room with you 24 hours a day, as they don't have the same kind of individual nursing care that we have. Most families will take turns for the 24 hour shifts. Or they have to hire someone to take a shift.
 
  • #176
  • #177
I, for one, do not fault China's handling of the epidemic. China gave us time that we squandered. I do feel ashamed of the U.S. government's handling of what will clearly be named a pandemic.

I think much of the world is shocked that the USA has done nothing to prepare for the virus, and that what they have done at the last minute didn't work properly.

Even Canada is a bit of a farce. $27 million has been allocated to respond to the virus, which is less than $1 per person. The borders remain open as Canada arrogantly welcomes everyone on the basis that they think they can contain the problem.

China built hospitals in a week. Canada is putting the money in research rather than prepping for treating infected people.
 
  • #178
From the World Health Organization

COVID-19 Strategic Preparedness and Response Plan—Draft as of 12 February 2020
Operational Planning Guidelines to Support Country Preparedness and Response

Pillar 2: Risk communication and community engagement

It is critical to communicate to the public what is known about COVID-19, what is unknown, what
is being done, and actions to be taken on a regular basis. Preparedness and response activities should
be conducted in a participatory, community-based way that are informed and continually optimized according to community feedback to detect and respond to concerns, rumours and misinformation. Changes in preparedness and response interventions should be announced and explained ahead of time, and be developed based on community perspectives. Responsive, empathic, transparent and consistent messaging in local languages through trusted channels of communication, using community-based networks and key influencers and building capacity of local entities, is essential to establish authority and trust.

Much more worthwhile guidance at the link.
https://www.who.int/docs/default-so...19-sprp-unct-guidelines.pdf?sfvrsn=81ff43d8_4

While the U.S. government has held press conferences almost daily about COVID-19 (for which I am grateful), I’m not sure the message is being conveyed in the ideal way WHO lays out here, especially in regard to the bolded areas. Concerns, rumors and misinformation are not addressed. Messaging is not transparent and consistent through trusted channels. I don’t think most people watch the pressers, so how else is information conveyed? It’s not consistent or trusted. How can that be improved? If I weren’t here on this thread I would be lost!
 
  • #179
Permanent lung damage has been documented in people who have recovered from the virus. Re-infection has also been documented. If someone with damaged lungs is re-infected, I'm assuming that likelihood or mortality is increased.

The first wave is people over 60, perhaps the second wave will be people age 30-60 with compromised lungs.
We can expect second and third wave, and we are looking at two-three years of this disease, unless an effective vaccine can be produced.
I am seriously not a "debbie-downer", just a realist who has been around the block a time or three.
 
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  • #180
What I find so strange is that everyone can look at China and learn how serious this virus is, yet they don't. They seem to think that they need to reinvent the wheel rather than learn from others.
China should have banned so-called "wet markets" and trade of wild life a long time ago, so lets not praise them too much. They created the perfect conditions for these viruses to spread since they jump from one animal into another and then into people.
 
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