Coronavirus COVID-19 - Global Health Emergency #4

[Herat]

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 )



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.

And the ECMO ( extra-corporeal membrane perfusion) used in the most critically ill patients in Wuhan is not a commonly available procedure in most US community hospitals, even those that do open heart surgery and have perfusionists to monitor the cardiac bypass procedures. The number of available units and the personnel to run them would likely be limited and mostly in large secondary or tertiary care facilities.

I think there will even be severe shortages of the most commonly used non-high tech equipment such as suction catheters, ET tubes, IV lines, Oxygen tubing, disposable gloves, swabs, masks, nasal cannulas, all of which are trashed, not reusable or recyclable.

There is also the problem with medication shortages. Right now several really important drugs are non-obtainable, some of which are antibiotics. The Thai Hospitals had reported better results (unverified) with a combination of conventional antivirals and anti-HIV drugs. How long before shortages appear?

 

[dixiegirl1035]

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

Please, tell us in an article what the CT scan showed. (talking to the article, not the poster)

This is where it gets really iffy/uncomfortable with front line workers and WHO.

Actually was it was China/Wuhan that wanted to redefine perhaps the definition as to the CAT scans being positive and test being negative to help other countries as they were seeing such.

Again MSM, What does his CT scan say?

I really think this is an issue that will be asked by media in the am if they are on top of this. WHO said paraphrase from what I transcribed "big fish/big net, small fish/small net". Actually, the CT scan needs to be a part of the WHO dx now everywhere (only now in Hubei province allowed into numbers per WHO) as it catches more (I originally was outspoken here that I thought opposite before it was explained, now have learned the error of my thinking)

 

[Simply Southern]

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

The scientific community is at the mercy of the Chinese government and selected information the chose to release. Of course, the diagnostic testing is not accurate. We don't know of we even have the correct information to create an accurate test.

The CDC has offered to assist the Chinese government and the offered was not accepted. WHO is tip toeing in every public statement.

China is saying its not that bad, but uses military force to contain and lock down millions, trying to sterilize money, curtaining social media, detaining physicians and media, refusing CDC assistance.

IMO, COVID-19 was genetically engineered in Wuhan.

They know the world will be furious, business and foreign trade will be reduced and many US companies will be forced by the American people to cut ties with China.

To date, we do not know how long the virus lives on hard surfaces. I'm not buying any product from China, today or in the future. Unless Apple get the heck out of China I won't be upgrading any products in the near future. Am I an alarmist, maybe, but I'll be dang if I will support a government that will not allow the CDC in to help, for the benefit of human life and mankind. They'll let their people die first.

 

[Simply Southern]

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

The scientific community is at the mercy of the Chinese government and selected information they chose to release. Of course, the diagnostic testing is not accurate. We don't know of we even have the correct information to create an accurate test.

The CDC has offered to assist the Chinese government and the offer was not accepted. WHO is tip toeing in every public statement.

China is saying its not that bad, but uses military force to contain and lock down millions, trying to sterilize money, curtaining social media, detaining physicians and media, refusing CDC assistance.

IMO, COVID-19 was genetically engineered in Wuhan.

They know the world will be furious, business and foreign trade will be reduced and many US companies will be forced by the American people to cut ties with China.

To date, we do not know how long the virus lives on hard surfaces. I'm not buying any product from China, today or in the future. Unless Apple get the heck out of China I won't be upgrading any products in the near future. Am I an alarmist, maybe, but I'll be dang if I will support a government that will not allow the CDC in to help, for the benefit of human life and mankind. They'll let their people die first.

 

[Betty P]

CT's


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.

If those privately owned physician hospitals and clinics benefit from taxpayer funds (e.g. Medicare or insurance plans under ACA) then they should be required to be part of an overall plan to isolate and treat COVID-19 patients, without reducing care for people with other health conditions. Similar actions have been taken before, doctors should put public service ahead of personal profit, JMO. Most of these facilities are classified as non-profit, so pay no taxes, so that's also some leverage.

It's probably safe to assume the massive health care resources of the US military would continue to be utilized. We might as well get something for our tax dollar, right?

 

[dixiegirl1035]

• 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.

Yes, the protocol for all .. two tests 12-24 hours apart must be negative. There was one post i did back in thread that had the maritime information. I'll try to find later and repost. My guess, some of the CDC maritime guidelines that I posted are gonna change! The Princess is going to have the crew isolate for 2 weeks after the passengers are gone (when will that be) and the go into dry dock for "cleaning".

 

[Henry2326]

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

Thanks for sharing.....he has a series of articles that do a great job of explaining why this situation is serious.

 

[dixiegirl1035]

And the ECMO ( extra-corporeal membrane perfusion) used in the most critically ill patients in Wuhan is not a commonly available procedure in most US community hospitals, even those that do open heart surgery and have perfusionists to monitor the cardiac bypass procedures. The number of available units and the personnel to run them would likely be limited and mostly in large secondary or tertiary care facilities.

I think there will even be severe shortages of the most commonly used non-high tech equipment such as suction catheters, ET tubes, IV lines, Oxygen tubing, disposable gloves, swabs, masks, nasal cannulas, all of which are trashed, not reusable or recyclable.

There is also the problem with medication shortages. Right now several really important drugs are non-obtainable, some of which are antibiotics. The Thai Hospitals had reported better results (unverified) with a combination of conventional antivirals and anti-HIV drugs. How long before shortages appear?

ECHMO indeed not common at community hospitals. Again, Wuhan medical folks must be so distraught at not being able to help. My heart goes out.

And my family laughs at me because I keep outdated antibiotics. Well, I learned that only one I used actually is no good after time... the rest.. marketing to make a repurchase.

 

[Herat]

It's probably safe to assume the massive health care resources of the US military would continue to be utilized. We might as well get something for our tax dollar, right?

In theory, yes

In practicality: The last place you want severely ill COVID-19 patients is in the VA Hospital system.

And that's not to discredit the fine men and women who work there

 

[Hatfield]

JMO

For those that are paying attention to the news about this new virus, like many of us here, the good news is we have learned a lot more about it than most. And we are also learning techniques that can help us to not catch this or any other similar communicable sickness.

For the Princess Cruise, I hope authorities and governments have now learned what not to do. Isolating everyone (sick and healthy alike) together is not a good idea. The idea should be to separate the sick people away from the healthy people as soon as the sick are identified.

Which is why I dont agree with China locking huge apartment buildings up and not letting anyone leave. That sounds foolish to me because I am guessing there will be some sick people in those apartments that will be afraid to let authorities know they are sick and other healthy people in those apartments will end up infected. Its like every locked up apartment high rise is like the Princess Cruise ship.

This is a horrible global event that has happened and we as a global society must be careful to make the right decisions going forward. Wrong decisions can have devastating impacts and make this virus worse than it already is.

I hope other countries are learning from the mistakes and not just following bad techniques but coming together to agree on the right protocols and make the right decisions going forward.

 

[Herat]

"To date, we do not know how long the virus lives on hard surfaces. I'm not buying any product from China, today or in the future. Unless Apple get the heck out of China I won't be upgrading any products in the near future. Am I an alarmist, maybe, but I'll be dang if I will support a government that will not allow the CDC in to help, for the benefit of human life and mankind. They'll let their people die first."

I share a lot (although not all ) of your concern.

I think that practically speaking, you won't really know what products have Chinese-components. NPR had a news segment on this and the permeation of Chinese components in everything is very deep. I bought a sweater that was labeled "Made in Italy". But I found through googling that the yarn was produced in China, dyed in Italy and the garment constructed in China. I think you are going to have a hard time finding products that don't have a Chinese component or manufacture. If something is labeled "Made in Vietnam" what does that really mean? Was the base material made there? Was it just assembled there? Was it packaged there?

Our own US industry is just rife with this, having exported so many of our jobs to China (also Indonesia, Vietnam, Phillipines, Malaysia, India, Sri Lanka), because of cost. Are any of them going to risk having "Made in China" on their label

 

[dixiegirl1035]

Crossing fingers.. the two flights from Tokoyo to the two US AFB are about 2 hours delayed and not lifted off yet. Prayers going up that all is well and they can get off.. I'm going to have to walk AFK for a bit as I'm getting too anxious they aren't coming soon. They were supposed to leave around 1:00 am their time... and 2 hours later... not.



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

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

ETA: Kalitta Air are contractors for the Department of Defense for the United States. They have taken out all the previous folks from Wuhan, and are based out of Michigan.

 

[Wicked Strong]

Crossing fingers.. the two flights from Tokoyo to the two US AFB are about 2 hours delayed and not lifted off yet. Prayers going up that all is well and they can get off.. I'm going to have to walk AFK for a bit as I'm getting too anxious they aren't coming soon. They were supposed to leave around 1:00 am their time... and 2 hours later... not.

View attachment 232484

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

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

I think this is why the US citizen was hesitant to be flown to the US by the government. IMO he was aware that delays might happen.

I also came across this video statement from Diamond Princes on ending the quarantine. It says while the plans have not been confirmed by Japan, they understand that testing may begin on Feb 18th, testing as many as they can each day. It will take 2+ days to determine if the test if negative. So the earliest passengers will be allowed to leave the ship would begin Feb 21st. Also says that people who have been in contact with persons already testing positive will have to start a 14 day quarantine from the date the contact was removed.

Princess Cruises on Twitter

I had also seen a video of Matthew Smith saying when he and his wife are released from the ship, they plan on continuing their stay in Tokyo, returning to their hotel they stayed at before they left on the cruise. Perhaps that is why he didn't want to fly out on the US airplanes?

MOO

 

[Hatfield]

Crossing fingers.. the two flights from Tokoyo to the two US AFB are about 2 hours delayed and not lifted off yet. Prayers going up that all is well and they can get off.. I'm going to have to walk AFK for a bit as I'm getting too anxious they aren't coming soon. They were supposed to leave around 1:00 am their time... and 2 hours later... not.

View attachment 232484

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

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

Thank you for tracking flights again for us. Take as many breaks as you need. I had to step away from the news for a couple days to get a mental break from it all.

 

[Windsorite]

The CDC has offered to assist the Chinese government and the offer was not accepted

Please try not to read too much into this other than basic politics, while I'm sure it might
go a way toward easing the minds of Americans, the WHO team will have at it's disposal all the
top scientists in related fields regardless of their nationality.

 

[mickey2942]

Interesting reading. And I am thinking that a good offense is defense here.

1. Reduce unnecessary travel
2. Stay away from large crowds
3. General procedures for washing hands, using hand sanitizer, not touching facial areas with unclean hands.
4. Face mask, if you are immunosuppressed.

Stay healthy. And away from hospitals and clinics if possible.

 

[What if...]

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.

Speaking of the app, when I first read about it I thought it was a really ingenious tool. But then I thought I probably wouldn’t download the app if I were in China. I would be afraid that if the app identified a possible contact, I might be placed on a “roundup list”, and the government could use my phone’s GPS as a tracking device for the roundup team! Thanks, but no thanks.

 

[ARE]

Having trouble locating appropriate face masks.... I’m assuming that not all n95 masks are made equal?

 

[Hatfield]

JMO
I cannot find any articles that say the special WHO team of 12 has even made it into China yet. I did find many articles say they were going but havent seen any confirmation they are there yet.

I did find this one article that says the WHO director visited there in January to help try to get thier group's approval to actually go there.

If anyone finds an article that claims they are actually in China yet, if you could share it, it would be appreciated.

"WHO director-general Tedros Adhanom Ghebreyesus, who made a trip to Beijing for talks with President Xi Jinping and Chinese ministers in late January, returned with an agreement on sending an international mission.

But it has taken nearly two weeks to get the government’s green light on its composition, which was not announced, other than to say that WHO veteran Dr. Bruce Aylward, a Canadian epidemiologist and emergencies expert, was heading it."

WHO advance team on coronavirus on way to China: Tedros tweet

 

[mickey2942]

Having trouble locating appropriate face masks.... I’m assuming that not all n95 masks are made equal?

An N95 mask needs to actually be fitted to your face to be effective. I think. I was fitted with a mask years ago, during SARS.