Coronavirus COVID-19 - Global Health Pandemic #76

[ilovewings]

Another COVID-19 Medical Mystery: Patients Come Off Ventilator But Linger In A Coma
August 24, 20205:01 AM ET
MARTHA BEBINGER

Leslie Cutitta said yes, twice, when clinicians from Massachusetts General Hospital in Boston called asking whether she wanted them to take — and then continue — extreme measures to keep her husband, Frank Cutitta, alive.
[snip]

So the Cutittas hung on and a small army of ICU caregivers kept working. On April 21, after 27 days on a ventilator, Frank's lungs had recovered enough to remove the breathing tube.

After the removal, it typically takes hours, maybe a day, for the patient to return to consciousness. The body needs that time to clear the drugs that keep the patient sedated and comfortable — able to tolerate intubation and mechanical ventilation. But doctors across the U.S. and in other countries have noted a troubling phenomenon associated with some COVID-19 cases: Even after extubation, some patients remain unconscious for days, weeks or longer. There's no official term for the problem, but it's being called a "prolonged" or "persistent" coma or unresponsiveness.

Frank Cutitta, 68, was one of those patients. He just didn't wake up.
[snip]

"Because this disease is so new and because there are so many unanswered questions about COVID-19, we currently do not have reliable tools to predict how long it will take any individual patient to recover consciousness," says Dr. Brian Edlow, a critical care neurologist at Mass General.

Given all the unknowns, doctors at the hospital have had a hard time advising families when a patient has remained unresponsive for weeks, post-ventilator. Some families in that situation have decided to remove other life supports so the patient can die. Edlow can't say how many.

"It is very difficult for us to determine whether any given patient's future will bring a quality of life that would be acceptable to them," Edlow says, "based on what they've told their families or written in a prior directive."
(snip)
---------

This is a story worth reading IMO.

In short, Frank Cutitta did eventually wake up. He and his wife praised Mass General Hospital doctors and nurses for their efforts to help him recover.

It's terrible to think of patients in this situation who died because hospital resources were insufficient to provide the care needed. It's also terrible for those who survive but suffer from severe problems as a result. MOO

Every time i read more horror stories about the complications of this virus, i
cant get over how little we know about it, and how evil it is..This man is fortunate
the didnt disconnect him from other life support measures.

 

[10ofRods]

College is a time for meeting new people, enjoying the "party". Honestly, if you just have to hunker down in a dorm room, may as well stay home and do classes online.

I agree. And the cost - to the students' parents, the college, etc of keeping dorms open (for what purpose?) could be spent toward redesigning learning spaces for the eventual return.

If the students are going to be watching and hearing lectures from their dorm rooms, it's really a waste of resources.

Today is my first full day back (my DH's too). It's exhausting and it's so weird - hearing nothing from the class. If I make a joke, I can't hear them laugh (because they must all be muted because too many of them have noise in their backgrounds, including screeching feedback from my output hitting their input). If I ask questions, to promote discussions, no one will speak (that rarely happens in the real world). Most of them refused to have their faces shown (and we can't require it).

So, sitting in a dorm room, by oneself, invisible, listening to a talking head (or just listening - or just pretending to be in classroom, because when I called on people individually to answer questions - most of them were not there).

What will really be happening is that students want to be out of their parents' houses (and the parents want them out for "social development"), the parents will foot the bill or the kid will run up loans, the kid goes off - signs on to "lectures" that they do not attend or use to ask questions - and which can be cram-watched later and trust me, they won't be "hunkered down" in the dorm during all this - they will be doing what students always do. It's complete freedom to do whatever - and that's what a lot of them are doing.

The ones who still live at home are a bit more responsible.

 

[10ofRods]

I am especially curious about how the young daughter managed to avoid it altogether when she was apparently spending 24/7 in the same household as both her parents and her two siblings who had it with varying degrees of severity.

It's actually pretty common and one of the giant mysteries of CoVId. Wuhan has quite a bit of evidence, since they literally locked families together in apartments for quarantines lasting up to 3 weeks. The transmission within those households was mainly between spouses, but even then, it was less than expected.

One theory is that some people have already had a coronavirus and the mucus membranes of their noses and sinuses have a rapid response - so that it never gets to the lungs to be pushed out to the whole body.

Another theory is that some people have really great upper respiratory immune systems (perhaps from birth, perhaps from lots of colds).

We do know that some people have super-strong immune systems (about 5% of the population) but we're not completely sure how to test for it and it would be really awful to tell people they might have such a system if they didn't.

Young people definitely don't get it as frequently - but it's still weird that an entire family can be quarantined and one would expect both spouses to get it - but that only happens sometimes.

It would be interesting to know if in some households there was constant ventilation, perhaps fans running, and whether people unconsciously or consciously distanced themselves.

 

[10ofRods]

All makes sense but they leave out the entire subject of children transmitting the virus to others.

Baby brother at home...
Mom, dad, grandpa, siblings...
Friends...
Neighbors...
Their dentist...
Doctor...
Teachers and staff...
In stores.....
Babysitter...
Repair person...
Friendly postman...
ECT....

So yes, most kids likely could go to school and walk around without hardly any symptoms and end up perfectly fine but unless they are in a bubble at boarding school they will spread the virus out to their communities.

Opinion only.

At a boarding school, the only people they'd spread it to would be the school personnel (who would acknowledge the risk when they took the job). Everyone would know what situation they were in. No one would be leaving or coming into the setting. The entire group could be tested once a week (which is apparently what's happening in the boarding schools that are longterm operational here in SoCal).

Students would not spread it to their families. It's like the NBA bubble - it works.

The teachers who are showing up for this employee, as I keep mentioning, tend to be younger. Young teachers, socially distanced, wearing PPE...pretty safe in a school environment. Private schools can also move outdoors more easily (and do, nearly all have way more outdoor activities than public schools).

At any rate, it would be much easier to control than having every single student go home to an undetermined group (possibly a crowd) of other people. No one would be going to their ballet lessons (which people are doing even though there's a quarantine). Or to Sturgis. Many families have a super-spreader somewhere in their midst, but that super-spreader would be outside the private school bubble.

It would also be easier to mandate and enforce testing. I was surprised to learn that a private school teacher I know (teaches biology) has to be tested once a week. The testing started 2 weeks before school started. He wears a mask and face shield in the classroom. Students were already only 12 per class prior to CoVid. Classrooms are large and airy, with big windows that open.

That must be nice. In the public schools, many teachers teach in trailers with poor ventilation or classrooms with only small opening windows on one side of the room - and private fans are often banned (there are electrical standards for fans in public schools...)

I've taught in both kinds of schools. The ease with which a private school can mandate or pivot is something to behold.

 

[tresir2012]

Ten countries kept out Covid. But did they win?

 

[Cool Cats]

At a boarding school, the only people they'd spread it to would be the school personnel (who would acknowledge the risk when they took the job). Everyone would know what situation they were in. No one would be leaving or coming into the setting. The entire group could be tested once a week (which is apparently what's happening in the boarding schools that are longterm operational here in SoCal).

Students would not spread it to their families. It's like the NBA bubble - it works.

The teachers who are showing up for this employee, as I keep mentioning, tend to be younger. Young teachers, socially distanced, wearing PPE...pretty safe in a school environment. Private schools can also move outdoors more easily (and do, nearly all have way more outdoor activities than public schools).

At any rate, it would be much easier to control than having every single student go home to an undetermined group (possibly a crowd) of other people. No one would be going to their ballet lessons (which people are doing even though there's a quarantine). Or to Sturgis. Many families have a super-spreader somewhere in their midst, but that super-spreader would be outside the private school bubble.

It would also be easier to mandate and enforce testing. I was surprised to learn that a private school teacher I know (teaches biology) has to be tested once a week. The testing started 2 weeks before school started. He wears a mask and face shield in the classroom. Students were already only 12 per class prior to CoVid. Classrooms are large and airy, with big windows that open.

That must be nice. In the public schools, many teachers teach in trailers with poor ventilation or classrooms with only small opening windows on one side of the room - and private fans are often banned (there are electrical standards for fans in public schools...)

I've taught in both kinds of schools. The ease with which a private school can mandate or pivot is something to behold.

In my post I assumed private boarding schools would be safer since kids are not going home to spread the virus. You mention that "bubbles" work, like in boarding schools and NBA.

I haven't researched into how well "bubbles" work. Thanks for mentioning that they do work. I'll have to look into it more.

It's possible this could become a common model where more and more events, like say, overnight camps could start creating their own "bubble" groups controlling who comes in and out and mandating testing if you want to participate.

 

[10ofRods]

In my post I assumed private boarding schools would be safer since kids are not going home to spread the virus. You mention that "bubbles" work, like in boarding schools and NBA.

I haven't researched into how well "bubbles" work. Thanks for mentioning that they do work. I'll have to look into it more.

It's possible this could become a common model where more and more events, like say, overnight camps could start creating their own "bubble" groups controlling who comes in and out and mandating testing if you want to participate.

Yes - for the time being. My family members who think it's safe are enrolling their kids in football camp (no testing, but in bubbles) or gymnastics (no testing, but in bubbles) or private school (testing + bubbles). They tend to live in more close-knit places, but pop-up private schools are in fact a thing.

 

[mickey2942]

Nursing homes are now doing "surveillance testing" on all employees weekly. Which is interesting, because people are identified as "positive" before they know it. And it is sort of stupid, because an employee may have a test done on Monday, the results are returned, say, by Friday, with a positive response, the employee has already worked a full week, and exposed patients to the virus.

Then, there is the issue of "False Positive" and "False Negative" tests, which is running as high as 10% in some places.

What a mess.

 

[COSCitizen]

Nursing homes are now doing "surveillance testing" on all employees weekly. Which is interesting, because people are identified as "positive" before they know it. And it is sort of stupid, because an employee may have a test done on Monday, the results are returned, say, by Friday, with a positive response, the employee has already worked a full week, and exposed patients to the virus.

Then, there is the issue of "False Positive" and "False Negative" tests, which is running as high as 10% in some places.

What a mess.

When my friend who had symptoms got her swab test, those of us who had been hanging with her on her patio a few days before stayed isolated until she got her negative results.

 

[MrX]

Ten countries kept out Covid. But did they win?

"In short, you can keep the virus out, but you can’t beat it. Covid-19 gets you one way or the other." This appears to be a consistent theme, even where the virus has been fought with severe measures.

From New Zealand:
"This extension may well be the last straw."

I just wonder what happens if there is a realization that local virus elimination is a practical impossibility. Will countries, like New Zealand, ever be able to change course, or will they just keep closing until there's nothing left to open?

 

[mickey2942]

When my friend who had symptoms got her swab test, those of us who had been hanging with her on her patio a few days before stayed isolated until she got her negative results.

Right, but that is not how "surveillance testing" works. Employers cannot test employees and tell them to go home until they get results. Remember, they are testing people who have zero symptoms. That is the difference.

 

[Trino]

And so it begins...
Minnesotans who attended the Sturgis rally now up to 27.
A dozen more Minnesotans who went to Sturgis test positive for COVID-19 – Twin Cities

 

[MrX]

ADHS - Data Dashboard

Rt COVID-19

I really hope somebody takes a hard look at all of this, someday. AZ continues on it's journey from "Worst to First" with hardly any mitigation effort. There's no contact tracing or enforcement. 4200 restaurants with liquor licenses have been open for business since May 11. Casinos are all open and busy. A friend went to dinner over the weekend and reported an hour wait, every table full (no tables closed for distancing and running at 100% capacity versus mandated 50%) and no, what he called, "checker board" stickers on the floor. And this was a chain restaurant, not some local rebel. The obvious answer would be that maybe the numbers are being manipulated, but the fall in Covid cases at hospitals can't be faked. The virus really did just seem to pack up leave - maybe to avoid the heat. On Thursday the Governor will, once again, thank us all for our tireless efforts to fight the virus, but he, and we, know that's not the reason.

 

[tresir2012]

"In short, you can keep the virus out, but you can’t beat it. Covid-19 gets you one way or the other." This appears to be a consistent theme, even where the virus has been fought with severe measures.

From New Zealand:
"This extension may well be the last straw."

I just wonder what happens if there is a realization that local virus elimination is a practical impossibility. Will countries, like New Zealand, ever be able to change course, or will they just keep closing until there's nothing left to open?

That article I posted about Paui and the other 9 islands mentioned perhaps having a travel arrangement/pact just with NZ for tourism perhaps.

 

[tresir2012]

ADHS - Data Dashboard

Rt COVID-19

I really hope somebody takes a hard look at all of this, someday. AZ continues on it's journey from "Worst to First" with hardly any mitigation effort. There's no contact tracing or enforcement. 4200 restaurants with liquor licenses have been open for business since May 11. Casinos are all open and busy. A friend went to dinner over the weekend and reported an hour wait, every table full (no tables closed for distancing and running at 100% capacity versus mandated 50%) and no, what he called, "checker board" stickers on the floor. And this was a chain restaurant, not some local rebel. The obvious answer would be that maybe the numbers are being manipulated, but the fall in Covid cases at hospitals can't be faked. The virus really did just seem to pack up leave - maybe to avoid the heat. On Thursday the Governor will, once again, thank us all for our tireless efforts to fight the virus, but he, and we, know that's not the reason.

Personally I think treatment has improved and maybe those who have it have been serious about quarantine. How is your contact tracing? If all contacts are traced and do as they are told, that would get your R number down pretty quickly too.

 

[24Roses]

Iowa news today: As of 10:30-11:00 a.m. this morning, we had 428 new confirmed cases for a total of 56,585 of which 43,650 have recovered (IMO +161). 5 more had passed away for a total of 1,040. 428 COVID-19 cases, 5 deaths reported in Iowa Monday
Iowa COVID-19 Information
Throngs of UI students at Iowa City bars raise alarm
University of Iowa shares 111 self-reported cases of COVID-19
MercyOne Waterloo reports use of convalescent blood for COVID-19 patients
Indianola sixth grade classes to move online after teachers test positive for COVID-19

 

[MrX]

That article I posted about Paui and the other 9 islands mentioned perhaps having a travel arrangement/pact just with NZ for tourism perhaps.

Those "travel bubbles" sounded like an OK idea, but now that they've seen how easy it is for the virus to find fertile ground, can they ever risk it? What happens when a case is introduced when an airplane mechanic touches something on a plane? Perhaps, being an OCD sufferer, I am aware of the signs, but sometimes it looks like virus elimination takes on obsessive characteristics. I'm really shocked that the latest Melbourne lockdown has been peaceful and compliant - I predicted it would start fraying after a couple weeks. But what happens next time?

 

[tresir2012]

And so it begins...
Minnesotans who attended the Sturgis rally now up to 27.
A dozen more Minnesotans who went to Sturgis test positive for COVID-19 – Twin Cities

Ok so total was 22 including the Nebraska and 1 Sturgis case so 12 more means 34 total that we know of so far. Another few days and we should not expect any more hopefully.

 

[tresir2012]

Those "travel bubbles" sounded like an OK idea, but now that they've seen how easy it is for the virus to find fertile ground, can they ever risk it? What happens when a case is introduced when an airplane mechanic touches something on a plane? Perhaps, being an OCD sufferer, I am aware of the signs, but sometimes it looks like virus elimination takes on obsessive characteristics. I'm really shocked that the latest Melbourne lockdown has been peaceful and compliant - I predicted it would start fraying after a couple weeks. But what happens next time?

I think that is similar to what happened in Hawaii. They allowed tourists but they would not stay in quarantine for the 14 days. Melbourne was due to quarantined travellers also I think.

 

[CSIDreamer]

ADHS - Data Dashboard

Rt COVID-19

I really hope somebody takes a hard look at all of this, someday. AZ continues on it's journey from "Worst to First" with hardly any mitigation effort. There's no contact tracing or enforcement. 4200 restaurants with liquor licenses have been open for business since May 11. Casinos are all open and busy. A friend went to dinner over the weekend and reported an hour wait, every table full (no tables closed for distancing and running at 100% capacity versus mandated 50%) and no, what he called, "checker board" stickers on the floor. And this was a chain restaurant, not some local rebel. The obvious answer would be that maybe the numbers are being manipulated, but the fall in Covid cases at hospitals can't be faked. The virus really did just seem to pack up leave - maybe to avoid the heat. On Thursday the Governor will, once again, thank us all for our tireless efforts to fight the virus, but he, and we, know that's not the reason.

You had a high saturation of cases per million. I wonder if part of it might be herd immunity?