Wuhan Coronavirus

[Divemaster]

This disease is being discussed on the Pandemic Flu thread. Since the coronavirus is not influenza, I thought it deserves it's own thread. I am not in the medical field, but I am in the affected region. I'll kick this off with my now removed post from the flu thread:

Under 3,000 total Wuhan Coronavirus cases globally (vast majority in China) and 80 deaths (all in China). Surgical masks are now almost impossible to find in China and Hong Kong. By contrast, here's a fun infographic on what the flu has done in the United States alone just since 01 OCT. Everyone take a step back and breathe...through your mask if you have one.

[cbtengr]

Staggering numbers but we have gotten use to the flu whereas this new bug is well it's new and folks tend to be perhaps more afraid of the unknown. Gonna have to give this sometime and see what takes place. I live in the middle of the largest community of Amish West of the Mississippi, they do not visit China and neither do I.:munchin

[Old Dog New Trick]

Every time I hear about this I think the last hangover I had down in Mexico. :D:p

[tom kelly]

This disease is being discussed on the Pandemic Flu thread. Since the coronavirus is not influenza, I thought it deserves it's own thread. I am not in the medical field, but I am in the affected region. I'll kick this off with my now removed post from the flu thread:

Under 3,000 total Wuhan Coronavirus cases globally (vast majority in China) and 80 deaths (all in China). Surgical masks are now almost impossible to find in China and Hong Kong. By contrast, here's a fun infographic on what the flu has done in the United States alone just since 01 OCT. Everyone take a step back and breathe...through your mask if you have one.
My Team Sgt. told me "Statistics are just numbers, unless you're one of them...

[Golf1echo]

This event aught to give us a perspective on the global supply chain and get folks thinking about the problems with our sourcing much of our manufacturing to China and other countries. The masks being just one example.

I remember learning back in the nineties the government was still offering subsidies regarding mohair, and insulation we needed in WWII and Korea. At the time I had no problem with that because it supported domestic ranching... except the part that many had bought the subsidies for investment and didn’t seem to be in a position to produce if needed. Today I think its safe to say we’ve moved in from mohair insulation and we actually produce some excellent synthetic insulation domestically for Berry Amendment Compliant products however I’ll bet your civilian garments are using imported types...food for thought.

Edit: Regarding the situation as it stands now, I thought this was informative and offered some practical advice from an MD.
advice. https://m.*******.com/watch?v=QA5AbqlCHuc

[Mustang Man]

It's worse than what the Chinese government is reporting but not worth worrying about, for now at least. China was more concerned protecting their markets and trade, under reporting the initial outbreak. Now they've built a new hospital within a week and quarantined millions.

[Badger52]

My Team Sgt. told me "Statistics are just numbers, unless you're one of them...LOL, good stuff. That was exactly the answer I gave to a previous Commie governor when we were pushing for a carry bill, right after he'd made a big statement in the paper, to wit: "Statistically, our state is among the safest in the nation."

[twistedsquid]

I wonder if it's because of their fucked up food handling/ consumption practices.

[EricV]

This disease is being discussed on the Pandemic Flu thread. Since the coronavirus is not influenza, I thought it deserves it's own thread. I am not in the medical field, but I am in the affected region. I'll kick this off with my now removed post from the flu thread:

Under 3,000 total Wuhan Coronavirus cases globally (vast majority in China) and 80 deaths (all in China). Surgical masks are now almost impossible to find in China and Hong Kong. By contrast, here's a fun infographic on what the flu has done in the United States alone just since 01 OCT. Everyone take a step back and breathe...through your mask if you have one.


Fools think alike!! :D I had the same idea about the flu. I used this site https://nyshc.health.ny.gov/web/nyapd/new-york-state-flu-tracker
elsewhere to compare China's problem to US flu. But my conclusion is that the Chinese are lying about the numbers. They are shutting down provinces and cities over a mere 3000+- sick and 80 +- dead?? Rushing to build hospitals??

Color me cynical. I'm inclined to believe that a lot of other governments are not poo pooing the numbers so as not to cause panic in their own countries.

[Old Dog New Trick]

^^ my WAG is this is much worse than the Chinese are allowing to leak out. No one rapidly builds quarantine centers (aka hospitals) because less than one-millionths of the local population gets a cold.

Not holding my breath on this, let’s see what it takes to treat this and what the mortality rate ends up being.

[Badger52]

^^ my WAG is this is much worse than the Chinese are allowing to leak out. No one rapidly builds quarantine centers (aka hospitals) because less than one-millionths of the local population gets a cold.
In the nature of such governments. Anyone remember a little burg called Chernobyl?

I will also, as you say, take a wait & see attitude however. The building of quarantine centers would not be irrational in many places. How many actual physical facilities, or even numbers of beds - existing right now - are in the US to handle more than a few affected with any number of such illnesses? I mean no shit, real certified, quarantine facilities.

[frostfire]

Under 3,000 total Wuhan Coronavirus cases globally (vast majority in China) and 80 deaths (all in China). Surgical masks are now almost impossible to find in China and Hong Kong. By contrast, here's a fun infographic on what the flu has done in the United States alone just since 01 OCT. Everyone take a step back and breathe...through your mask if you have one.

Practically, surgical masks have a modest ability to prevent an infected person from spreading respiratory infections but really do not actually prevent an uninfected person. The take home message here is you want to get masks on sick people, especially if they are coughing and sneezing to minimize risks to others. Putting a surgical mask on healthy people really does not change their risk.

CDC has better resources than sensationalist websites.
https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

Also a no-nonsense tips from BTDT
https://foreignpolicy.com/2020/01/25/wuhan-coronavirus-safety-china/

I for one am monitoring the stock market....and getting ready to buy the dip on airline stocks :o

[Flagg]

Here’s a useful map that is in near real-time using WHO/CDC+ datasets:

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[InTheBlack]

How often does the CDC say "This is a serious public health threat." ???
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html

I'd like to know what I should obtain for my disaster medical kit, now, before it becomes unobtanium.

How does one dose & administer ACE2 inhibitors - wait until a cytokine storm is in progress? Administer when bedridden but prior? Better case is hospital bed / MD available and I can hand the MD my personal stash of a drug.

Need to find an MD willing to prescribe it for such a purpose.

[Ret10Echo]

Out from DOT NHTSA








Novel Coronavirus (2019-nCoV) Update




Chinese health officials have identified a new (novel) coronavirus (2019-nCoV) as the cause of an outbreak of pneumonia in Wuhan, Hubei Province, China, which has led to a number of confirmed and suspected cases and several deaths in China. There have been cases identified in several Asian countries and two confirmed cases with other potential cases under investigation in the United States. A multi-agency Federal response is ongoing at this time to monitor the outbreak and implement preparedness and response activities. Among those agencies, the CDC is following and addressing the clinical aspects of this issue. The most up-to-date information can be found at https://www.cdc.gov/coronavirus/2019-nCoV/.

At this time, the potential risk of infection of the US population, including health care practitioners such as EMS clinicians is low. The CDC is conducting health screenings at a number of airports around the U.S. (JFK, SFO, LAX, ORD, ATL) by actively assessing passengers at those ports of entry determined to be at possible risk. EMS agencies that service those airports have already been contacted by the CDC Quarantine Stations at those airports. A number of EMS agencies around the country have initiated protocols and policies to address concerns regarding appropriate procedures for EMS clinicians to follow. The Office of EMS is working closely with Federal agencies for awareness of needs of the EMS and 911 community.

Coronaviruses are common throughout the world and typically cause mild to moderate illness. The 2019 novel Coronavirus (2019-nCoV) is a member of this family, which includes SARS-CoV and MERS-CoV which can lead to severe illness. Limited human-to-human transmission has been observed with an incubation period of about 6 to 14 days. Known and suspected systems include fever, difficulty breathing, cough and potentially other mild to severe respiratory symptoms including severe pneumonia. Available treatment is currently limited to supportive care.

While the risk to the U.S. population is low, this is a serious and evolving situation. At this time, specific screening protocols for 911 or emergency medical dispatch are not required. If a caller volunteers information about travel to China within the past 2 weeks or close contact* potential exposure to a patient / person under investigation (PUI), that information should be relayed to responding field crews.
Routine exposure control precautions will offer protection to first responders. EMS clinicians are advised to maintain a high index of suspicion in patients who present with fever and respiratory symptoms with a travel history to Wuhan, China.

SPECIFIC EMS MANAGEMENT AND TRANSPORT CONSIDERATIONS:
1. If the patient exhibits symptoms of an acute febrile** lower respiratory infection (fever, shortness of breath/difficulty breathing, cough):
a. Place a surgical mask on the patient AND
b. Obtain a detailed travel history to affected countries within the past 14 days*** or close contact with someone under investigation for 2019-nCoV
2. If there is a history consistent with concern for potential 2019-coronavirus (2019-nCoV), initiate standard contact and airborne precautions (gloves, gown, N95 respirator) and eye protection (goggles) for EMS clinicians.
3. Notify the receiving hospital (according to local protocols) of potential infection as soon as possible to allow for emergency department preparation.
4. Use caution with aerosol generating procedures.
5. Properly doff and dispose of PPE according to protocol.
6. Cleaning and disinfection using EPA registered disinfectants with known effectiveness against human coronaviruses.
7. Waste management per policy for medical waste (red bag).

*Close contact is defined as being within about 6 feet, or within the same room or care area, of a patient with confirmed 2019-nCoV without wearing PPE for a prolonged period of time OR having direct contact with 2019-nCoV patient secretions.

**Fever may not be present in all patients; those who are immunocompromised, very young, elderly or taking fever-lowering medications.

***The list of affected countries may change over time and can be confirmed at the CDC site: https://www.cdc.gov/coronavirus/2019-nCoV/.

Continue to work with your agency infection control staff and local hospitals, emergency department and public health agencies to coordinate all response activities and notifications.

We will continue to follow this event and work with our Federal partners to provide updated information to the EMS and 911 communities.
For more information, please visit https://www.cdc.gov/coronavirus/2019-nCoV/.

[Airbornelawyer]

In the 2003 SARS coronavirus outbreak, 95% of cases and 93% of deaths were in the PRC or areas near China with significant Chinese populations (Taiwan, Hong Kong, Singapore, Vietnam and the Philippines). The one outlier was Canada, which accounted for 5%-6% of deaths.

A few days ago, an article appeared on globalnews.ca entitled "Doctor on front lines of SARS outbreak says Canadian hospitals prepared for coronavirus". A quote from the article:

But [Dr. Michael] Gardam says if any cases are reported, hospitals in Canada will be ready.

“Canadian hospitals learned a great deal from SARS, and then we learned more from H1N1 in 2009, and then we learned more after the Ebola scare a few years ago,” said Gardam.

...

“Our experience with SARS was that it’s not great to make stuff up as you go along,” the doctor explained.

“We didn’t know what the virus was, we didn’t have a test for it. We didn’t focus on handwashing in hospitals, which is all you hear about over the last decade; we didn’t have stockpiles of personal protective equipment (PPE).

“We didn’t screen people for fevers.”
I'm sorry. Hospitals didn't focus on handwashing until after 2003? Washing your hands is something 21st century health professionals needed to be told?

Is this a Canadian thing? I know hygiene issues are a big problem with disease outbreaks in the Third World, but I did not realize Toronto was in the Third World.

[Ret10Echo]

I'm sorry... couldn't resist...

[Old Dog New Trick]

Is this a Canadian thing? I know hygiene issues are a big problem with disease outbreaks in the Third World, but I did not realize Toronto was in the Third World.

Enlightenment is a terrible thing. I’m sure the native Canadians didn’t see it coming either...but then it happened...they became Chinese, Iranian, Turkish, Syrian, and Somalian in just the last 40 years. Toronto is the Paris of North America.

[EricV]

If your a male Asian, you might be SoL...

Here's an interesting bit out of a pre-print paper thought granted it is not peer reviewed and is an extremely small data set: https://www.biorxiv.org/content/10.1101/2020.01.26.919985v1.full


Quote:
"We further compared the characteristics of the donors and their ACE2 expressing patterns. No association was detected between the ACE2-expressing cell number and the age or smoking status of donors.

“Of note, the 2 male donors have a higher ACE2-expressing cell ratio than all other 6 female donors (1.66% vs. 0.41% of all cells, P value=0.07, Mann Whitney Test). In addition, the distribution of ACE2 is also more widespread in male donors than females: at least 5 different types of cells in male lung express this receptor, while only 2~4 types of cells in female lung express the receptor. “

“This result is highly consistent with the epidemic investigation showing that most of the confirmed 2019-nCov infected patients were men (30 vs. 11, by Jan 2, 2020)."

"We also noticed that the only Asian donor (male) has a much higher ACE2-expressing cell ratio than white and African American donors (2.50% vs. 0.47% of all cells). This might explain the observation that the new Coronavirus pandemic and previous SARS-Cov pandemic are concentrated in the Asian area."

"The result indicates that the ACE2 virus receptor expression is concentrated in a small population of type II alveolar cells (AT2). Surprisingly, we found that this population of ACE2-expressing AT2 also highly expressed many other genes that positively regulating viral reproduction and transmission. A comparison between eight individual samples demonstrated that the Asian male one has an extremely large number of ACE2-expressing cells in the lung"

[bblhead672]

Is This The Man Behind The Global Coronavirus Pandemic? (https://www.zerohedge.com/health/man-behind-global-coronavirus-pandemic)

In light of growing speculation, most of it within less than official circles, that the official theory for the spread of the Coronavirus epidemic, namely because someone ate bat soup at a Wuhan seafood and animal market...... is a fabricated farce, and that the real reason behind the viral spread is because a weaponized version of the coronavirus (one which may have originally been obtained from Canada), was released by Wuhan's Institute of Virology (accidentally or not), a top, level-4 biohazard lab which was studying "the world's most dangerous pathogens", perhaps it would be a good idea for the same Wuhan Institute of Virology to remove the following "help wanted" notice, posted on November 18, 2019, according to which the institute is seeking to hire one or two post-doc fellows, who will use "bats to research the molecular mechanism that allows Ebola and SARS-associated coronaviruses to lie dormant for a long time without causing diseases."

[PSM]

Radio talk show host, Chris Plante, called it Kung Flu this morning. :D

[Flagg]

In the 2003 SARS coronavirus outbreak, 95% of cases and 93% of deaths were in the PRC or areas near China with significant Chinese populations (Taiwan, Hong Kong, Singapore, Vietnam and the Philippines). The one outlier was Canada, which accounted for 5%-6% of deaths.

A few days ago, an article appeared on globalnews.ca entitled "Doctor on front lines of SARS outbreak says Canadian hospitals prepared for coronavirus". A quote from the article:


I'm sorry. Hospitals didn't focus on handwashing until after 2003? Washing your hands is something 21st century health professionals needed to be told?

Is this a Canadian thing? I know hygiene issues are a big problem with disease outbreaks in the Third World, but I did not realize Toronto was in the Third World.

In the lead up to the 1997 handover of Hong Kong, there was a wave of Chinese who gained residency and citizenship in Canada, Australia, New Zealand, and USA as a hedge against PRC heavy handed ness in Hong Kong, with the biggest single clusters in Vancouver, Sydney, Auckland, and LA/San Francisco.

A generation later, with the wealth boom in Mainland China, many Chinese decided to hedge their bets in western countries buying real estate “life boats” and sending their kids to be educated in the same locations theirs aunts/uncles/cousins set up a generation prior.

Based on those really strong network connections, those are the places I suspect have some of the highest risk of viral “break-in” to 4 of the FVEY.

Just my amateur anthropological 0.02c

[JJ_BPK]

Radio talk show host, Chris Plante, called it Kung Flu this morning. :D

ā sō desu ka?

I started a new thread with this announcement of a Harvard Prof's arrest for selling bio info to china as it was to tin foilish,,

Maybe not??

Does it need to be moved to this thread?

https://www.professionalsoldiers.com/forums/showthread.php?t=54633

[mugwump]

So WHO has finally declared an international healthcare emergency. Which changes absolutely nothing. It’s been one since the first h2h outside of China.

The human-to-human transmission in the US also means nothing...the new case is in the spouse of the confirmed Chicago infection. Your ears should perk up when there are reports of new infections with no known connection to a confirmed case. That means some undiscovered infection locus is out there.

The Ro, virulence, and future course of this disease are all unknowns with conflicting reports and prognostications.

The fact is nobody knows what is going to happen. The next month should give you a feeling for where this is going. It’s either going to start tapering off, in which case we have the equivalent of another bad case of the flu going around, or it’s going to explode.

So...frequent hand washing, increased avoidance of risky social interactions, and reasonable preps for the worst case, if it develops.

[Badger52]

The fact is nobody knows what is going to happen. The next month should give you a feeling for where this is going. It’s either going to start tapering off, in which case we have the equivalent of another bad case of the flu going around, or it’s going to explode.

So...frequent hand washing, increased avoidance of risky social interactions, and reasonable preps for the worst case, if it develops.Sounds solid, given the CHICOMs have earned their place in the Top-2 probably in the category of draconian information control.

[EricV]

Supplies are already drying up. N95 masks are out of stock at a lot of places. Hand sanitizer too. If you have not stocked, now might be the time to get off your duff.

[Pete]

This Doc does some pretty good analysis on the virus.

I've watched a few of his earlier ones.

https://www.*******.com/watch?v=nW3xqcGidpQ

[T-Rock]

A virus similar to the Chinese Coronavirus (2019-nCoV) was engineered at UNC around 2015 and researcher #8, listed in the study - is listed as one “Zheng-li Shi” attached to*the*“Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences,*Wuhan, China.”

I'm not certain of the validity of the following linked article, however, it makes sense and sounds as if this may be a case of research gone wrong......


Another Chinese virologist, Xing-Yi Ge, appears as an author on the 2016 UNC paper and is also attached to the lab in Wuhan. Previously in 2013, he’d*successfully isolated a SARS-like coronavirus from bats which targets the ACE2 receptor, just like our present virus, the Wuhan Coronavirus 2019-nCoV.

Link below:


https://harvardtothebighouse.com/2020/01/31/logistical-and-technical-analysis-of-the-origins-of-the-wuhan-coronavirus-2019-ncov/?fbclid=IwAR0fMoQIo0P10qx8fFfwdcxy_AshNk4oCmRpin3k lYM0evZS8GJlKzyZ4xA

[JJ_BPK]

I'm not certain of the validity of the following linked article, however, it makes sense and sounds as if this may be a case of research gone wrong......



I tried to get some background on Harvard to the Big House site.

The site leads to Dan Sirotkin on LinkedIn, Twitter, & Instagram

https://www.instagram.com/harvard2thebighouse/
https://twitter.com/Harvard2H

Appears to be a one-man show.
"big house" like-in he did/doing some jail time.
See Maryland SOR entry at the bottom.

Adding what I found,
Making no judgment on this guy,
BUT he resumes is weak??




Dan Sirotkin
Dan has a account

Writer at Harvard to the Big House

Washington D.C. Metro Area 47 connections Contact info

Harvard to the Big House
Harvard University

About

Looking to parlay my 1,300 days of incarceration into a meaningful career in criminal-justice reform.
Experience

Harvard to the Big House
Writer

Company Name

Harvard to the Big House
Dates Employed Sep 2018 – Present
Employment Duration 1 yr 6 mos
Location www.HarvardToTheBigHouse.com

Looking to change everything about our criminal-justice system
Seasons 52 Restaurant
Server

Company Name

Seasons 52 Restaurant
Dates Employed Nov 2018 – Feb 2019
Employment Duration 4 mos
Location North Bethesda, MD

Three months of service before someone at corporate finally got around to running a background check.
Montgomery County Government
Janitor

Company Name

Montgomery County Government
Dates Employed Jun 2017 – Sep 2017
Employment Duration 4 mos
Location Clarksburg, MD

Correctional janitor trained and certified in hazardous waste disposal on the medical ward. When inmates threw poop at guards, I got to clean it up.
Maryland Correctional Training Center
Special Education Teacher

Company Name

Maryland Correctional Training Center
Dates Employed Sep 2015 – May 2017
Employment Duration 1 yr 9 mos
Location Hagerstown, MD

Educational aide and secretary in my prison's sole classroom serving inmates with educational disabilities, aged 18-22. Mentored, tutored, and imbued hope into fellow inmates.

Education

Harvard University
Harvard University

Degree Name Bachelor's degree

Field Of Study Political Science and Government

Grade 3.1

Activities and Societies: Two years of wrestling and two years of lacrosse, boxed from sophomore year on until graduation.

https://www.linkedin.com/in/dan-sirotkin-928882180/



needs verification, but hi LinkedIn pic and jail pic are simular
...




September 17, 2014 | by Krista Brick
Previous
Next
Former Tutor and Coach Sentenced in Sex Abuse Case

A former tutor and private athletic coach was sentenced today to seven years in prison for sexually abusing a 14-year-old girl. Daniel Mandel Sirotkin, 30 of Germantown, pleaded guilty in the case against him. Montgomery County Judge Richard E. Jordan sentenced Sirotkin to 35 years but suspended all but seven years. Sirotkin must also register […
https://www.mymcmedia.org/tag/daniel-sirotkin/



http://www.dpscs.state.md.us/sorSearch/search.do?searchType=detail&anchor=true&id=5827652

[Badger52]

I tried to get some background on Harvard to the Big House site.Not counting the fact that those of us of a certain vintage enjoy our nappy-poo's, you just did in 8 hours more vetting than was done for murderous Saudi aviation exchange students.
:lifter

[T-Rock]

Thanks JJ BPK! I'm guessing since that article seems footnoted fairly well with links to scientific articles, the prisoner must not have written it. Lol

Edited to add:

From what I can tell, it appears the author of the article on "Harvard to the Big House" blog originated from "Medium(dot)com" and was posted by "@siradrianbond" whoever that is.

[mugwump]

This coming weekend (Feb 8/9) will be interesting. When this first started three epidemiological curves of infection rates were predicted from SARS/MERS experience showing optimistic, expected, and worst-case plots of the growth of total cases. Basically, they predicted scenarios when the total number of infections would peak and then flatten and decline. The virus has blown past the optimistic and expected peaks. The pessimistic number should be achieved Thurs/Fri. If we hear of flat numbers this weekend that would be sublime---the disease will taper off in China and contagion pressure will ease. If not, we're looking at pandemic, most likely. Even then, we probably need to wait til the end of of the month to understand what's going to happen here in NA.

There's going to be a long hard look at the Wuhan's Institute of Virology when the dust settles. And, I hope, forensic accounting investigations of the top WHO cats.

Everyone is holding their breath and looking at Lagos, Mumbai, Mexico City.

How dangerous this truly is is all over the map. They need the total number of cases to make that estimate and they just don't have the data (lies, exhaustion, insufficient test supplies, lack of resource). Epidemiologists were totally counting on Hong Kong (considered first-world reliable) to report hard data on the prevalence of mild/asymptomatic cases. They're just not seeing them, at least not yet. So that's disappointing, and a blow to the hopes that this is a mild infection that's only culling the weak.

The fatalities aren't dying quickly, many taking 5-7 days to succumb. This is leading a lot of amateurs (and unsophisticated docs) to say "200 deaths, 12,000 cases, that's <2%--bad but severe-flu bad, not catastrophic." The problem is those 200 folks who died contracted the disease 10-15 days ago, when there were only 4,000 cases. Meaning a 5% death rate. Less good. The people who exhibit symptoms today are going to contribute to fatality stats in a week or so. If you see new cases flatten this weekend while deaths keep increasing, it's expected--within reason.

The bottom line is, no one knows how serious this is. It could be less than 1%, maybe much less if there are lots and lots of mild cases. Or it could be >5%, which would be bad bad bad to the supply chain and heartbreaking on the personal level.

The top three medical supply producers (China, India, Thailand) have halted all exports to conserve supplies for local use. No masks, gowns, IV sets, O2 cannulae...Every time I hear some US health administrator boasting about their preparedness I wince. Hubris. Gods. Eek. STFU

Social distancing remains the only option and it's a legitimate and successful tactic. Avoid all crowds as much as possible. Wash hands like an obsessive-compulsive at an STD clinic. Hand sanitizer. "Gel in, gel out" as the medicos say. Doorknobs/handles, handrails, grocery cart handles, elevator buttons, etc...all are enemies. Use your elbows and shoulders to open doors. Shoes and outerclothes off outside. Don't touch your face. Plan on wanting to stay indoors for extended periods.

Good luck to us all.

[InTheBlack]

Good luck to us all.

Mug, are you doing all your posting in this thread now, not the original Pandemic Flu thread?

I'll repeat a couple of items:
1) Where can we find info on "how to use" ACE2 inhibitors if the hospitals are full and someone is sick? Better case is there are beds but you have to provide your own meds, or you can contact an MD for advice.

2) what should one ask his MD for NOW, in the way of a prescription for a supply of ACE2 inhibitor, to put it in our disaster med kit?

3) Is alcohol hand sanitizer sufficient to kill virii?

I see there are BAC based hand sanitizers (Benzalkonium Chloride), and one using something they call BAC-D which claims to have an ionic charge added to it, which disrupts cell walls. And to remain active on the skin for hours.

You can get 2% BAC disinfectant by the gallon at any big box hardware store, in the janitorial supply section.

[mugwump]

I’m not really posting much anywhere since the first flurry because I don’t have any inside gouge. I’m following the suggestion to post here.

Chinese docs on Weibo were begging for injectable ACE2 inhibitors but those are not available in the US. No real use, normally. The Celestials obvs make it for something but I don’t know what. There are reagent grade samples sold here but I think my daughter or one of her colleagues figured it cost about $12.5K per 500mg dose, two doses per day x 10 days. They sell in micrograms and you administer in grams. “A mite dear” as granny used to say.

So, nothing to ask for.

ACE1 inhibitors for the cytokine storm are an unknown to me. I’ve seen no talk of their use. Those are as common as mud...lisinopril and the like.

There’s a cocktail of old school AIDS antivirals that’s supposed to work against the virus but now we’re fighting supply chain voids and I just assume none will be around. Leronlimab, Abbvie’s alluvia, I think and some ebola antiviral I can't remember the name of. Lisinopril/ACE1 for h5n1 was a possibility because it worked, it’s common as mud and just as cheap, but aids antiretrovirals for someone without aids would be a stretch. Maybe a scrip from a medical marijuana hack with a few gold eagles jingling in your hand. Dunno. But all this stuff is made in India/Thailand/China so a scrip might be useless anyway.

Hand gel works. Bar soap with good method for >20 seconds works. Social distancing works. Buy bar/liquid soap. The gougers are on the purell.

Hand sanitizer is 62-65% ethanol. If you can’t get bulk purell buy 151 rum and dilute :) The water %age is an important part of the process I hear. All the Purell looks to be gone on amazon (I wasn’t exhaustive) with that ‘available March 5th’ joke, same as masks, gloves. Pro tip: it’s not going to be available March 5 :) Maybe on a local shelf.

I know nothing first hand about BAC. Maybe that is what the Chinese are spraying on every surface in the vids? It’s still available on amazon and claims efficacy so ???



The good news is youngsters are currently underrepresented in the Chinese dead. They are catching it but not dying. So there’s that. There are also decent odds this won’t be terribly virulent, will be contained, at least here, blah blah.

That said just be ready for supply chain disruption. China has its hooks into Nigeria via debt/infrastructure and thousands were going back and forth. If Lagos starts to burn it’ll be magnitude 9 on the cable news Richter scale. Investor panic. Payments late on Hamptons vacay homes. Kias on Wall and Broad instead of range rovers.

My daughter keeps telling me that critical meds are short now, any worse and people die. get that 90 days ASAP, even if nothing develops twitter could kill you. Sorry to ramble

[Divemaster]

Macau stops shaking it's money maker. They will be closing their casinos for two weeks (I expect it will be longer).

Macau just got its 10th case. Hong Kong is at 15 with one death. The fatality was a 39 yr old male.

Most HK land crossings with the mainland are closed. The 2-3 remaining open are naturally seeing increased traffic, which puts more pressure on the ability to conduct medical screening. HK medical workers went on strike to protest the lack of a total closure.

The ferry service between HK & Macau has temperature screening at the customs and immigration points.

Some hotels in HK are taking temps of new guest arrivals and turning away those who come up hot.

If Hong Kong is closed entirely, no in/out international flights or shipping, the impact to global markets will be not good.

[InTheBlack]

Mug - Prayers for you. Don't ring the bell !!! You still have knowledge, you can still do good.

Questions for all:

I don't know the difference between ACE1 and ACE2, but reading indicates ACE2 is the choice. I thought the ACE2 class was a commonly used oral drug? If so, what are some brand & generic names? Or is it still a researchers' unicorn ?

I have dug out my notes from October 2006 in the Pandemic Flu thread.

Statins, like Zocor, 20mg twice a day at first hint of symptoms, and once a day for family members who are asymptomatic. Seems like 10-12 day course probably reasonable risk.

ACE2 seemed to be "new" vs flu in 2006 -- No dosage info.

By now, doesn't WHO etc have a medical protocol for treating SARS & MERS etc which specifies drugs & dosage etc ? I am searching but the web is full of spam; need to find a portal to real physician information.

Wondering if "vasodilatory shock" is synonymous with ARDS (acute respiratory distress syndrome). Not sure if this article contains useful knowledge:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067786/
Angiotensin II: a new therapeutic option for vasodilatory shock

Angiotensin II (Ang II), part of the renin–angiotensin–aldosterone system (RAS), is a potent vasoconstrictor and has been recently approved for use by the US Food and Drug Administration in high-output shock.

Though not a new drug, the recently published Angiotensin II for the Treatment of High Output Shock (ATHOS-3) trial, as well as a number of retrospective analyses have sparked renewed interest in the use of Ang II, which may have a role in treating refractory shock.

We describe refractory shock, the unique mechanism of action of Ang II, RAS dysregulation in shock, and the evidence supporting the use of Ang II to restore blood pressure.

Evidence suggests that Ang II may preferentially be of benefit in acute kidney injury and acute respiratory distress syndrome, where the RAS is known to be disrupted.

Additionally, there may be a role for Ang II in cardiogenic shock, angiotensin converting enzyme inhibitor overdose, cardiac arrest, liver failure, and in settings of extracorporeal circulation.
********

Don't know about dehydration & fluids. How many liters of IV bags might be needed? What type of fluid? Is subcutaneous administration feasible in adults (I know how to do that).

Goldpharma.com still exists, but maybe it only allows drug searches if you register first. I can't get anything but the home page to show.

[InTheBlack]

More from the 2006 thread:
Get vaccinated for HiB and Pneumovax II. Sometimes this is a combined shot.

[Divemaster]

Ferry service between Hong Kong & Macau is suspended as of 0000 04 FEB HK time.

turbojet.com.hk/en/routing-sailing-schedule/hong-kong-macau/sailing-schedule-fares.aspx

[InTheBlack]

Gone down the rabbit hole.

1) US Dept Health & Human Services
Chemical Hazards Emergency Medical Management
Home > Medical Countermeasures Database > Statins
https://chemm.nlm.nih.gov/countermeasure_statins.htm

Above article on statins. Cites lots of research articles. Opinions seem to be mixed as to whether statins lower mortality.

edit: No dosing information for ARDS:
"2. Chemical Defense therapeutic area(s)
— including key possible uses

Statins can be used as anti-inflammatory treatment for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) induced by pulmonary agent such as phosgene."


2) You have to register here, but you can do so as a non-medical pro. Site provides info & Continuing Education credits for the medical field.

Everything you could ever want to know about diagnosing & treating ARDS:
Drugs & Diseases > Critical Care
Acute Respiratory Distress Syndrome
Updated: Oct 17, 2018

https://emedicine.medscape.com/article/165139-overview

ALSO:
Drugs & Diseases > Critical Care
Acute Respiratory Distress Syndrome Questions & Answers
Updated: Oct 17, 2018

https://emedicine.medscape.com/article/165139-questions-and-answers

[InTheBlack]

Long post. PART 1
Trying to treat ARDS in the field seems futile.

My summary drawn from:
https://emedicine.medscape.com/article/165139-overview
Acute Respiratory Distress Syndrome
Updated: Oct 17, 2018
*****

Early use Corticosteriods seem NOT to improve mortality, but I have not necessary seen the latest study data on that.

FLUIDS: "Type one reflects primarily acute lung injury without antecedent systemic processes like sepsis or pancreatitis. Type two is acute lung injury with an overwhelming systemic insult like sepsis.

Important to note, type one patients benefit from a fluid-restrictive management strategy (infra vide)"


VENTILATION: One item is that those positive-pressure breathing masks (CPAP) so many people have can, so some extent, substitute for a real ventilator. Lots of technical issues in the pressure curves and oxygen saturation, but in the field helping respiration might be the best you can do.

"The use of positive end-expiratory pressure (PEEP) to diminish alveolar collapse and the use of low tidal volumes and limited levels of inspiratory filling pressures appear to be beneficial in diminishing the observed VALI.

"Generally, oxygen concentrations higher than 65% for prolonged periods (days) can result in DAD, hyaline membrane formation, and, eventually, fibrosis.

ARDS is uniformly associated with pulmonary hypertension"

MORBIDITY PREDICTORS:
"Indices of oxygenation and ventilation, including the PaO2/FiO2 ratio, do not predict the outcome or risk of death. The severity of hypoxemia at the time of diagnosis does not correlate well with survival rates. However, the failure of pulmonary function to improve in the first week of treatment is a poor prognostic factor.

Peripheral blood levels of decoy receptor 3 (DcR3), a soluble protein with immunomodulatory effects, independently predict 28-day mortality in ARDS patients.

In a study comparing DcR3, soluble triggering receptor expressed on myeloid cells (sTREM)-1, TNF-alpha, and IL-6 in ARDS patients, plasma DcR3 levels were the only biomarker to distinguish survivors from nonsurvivors at all time points in week 1 of ARDS. [11] Nonsurvivors had higher DcR3 levels than survivors, regardless of APACHE II scores, and mortality was higher in patients with higher DcR3 levels."

PRESENTATION:
"With the onset of lung injury, patients initially note dyspnea with exertion. This rapidly progresses to severe dyspnea at rest, tachypnea, anxiety, agitation, and the need for increasingly high concentrations of inspired oxygen.

Physical Examination

Physical findings often are nonspecific and include tachypnea, tachycardia, and the need for a high fraction of inspired oxygen (FiO2) to maintain oxygen saturation. The patient may be febrile or hypothermic. Because ARDS often occurs in the context of sepsis, associated hypotension and peripheral vasoconstriction with cold extremities may be present. Cyanosis of the lips and nail beds may occur.

Examination of the lungs may reveal bilateral rales. Rales may not be present despite widespread involvement."

"Because cardiogenic pulmonary edema must be distinguished from ARDS, carefully look for signs of congestive heart failure or intravascular volume overload, including jugular venous distention, cardiac murmurs and gallops, hepatomegaly, and edema."


COMPLICATIONS:
"ventilator-associated pneumonia (VAP) and line sepsis. The incidence of VAP in ARDS patients may be as high as 55% and appears to be higher than that in other populations requiring mechanical ventilation. Preventive strategies including elevation of head of the bed, use of subglottic suction endotracheal tubes, and oral decontamination."

"Renal failure is a frequent complication of ARDS, particularly in the context of sepsis. Renal failure may be related to hypotension, nephrotoxic drugs, or underlying illness. Fluid management is complicated in this context, especially if the patient is oliguric. Multisystem organ failure, rather than respiratory failure alone, is usually the cause of death in ARDS.

Other potential complications include ileus, stress gastritis, and anemia. Stress ulcer prophylaxis is indicated for these patients. Anemia may be prevented by the use of growth factors (erythropoietin)."

FIELD EXPEDIENT WORKUP ITEMS:
"Approach Considerations

Acute respiratory distress syndrome (ARDS) is defined by the acute onset of bilateral pulmonary infiltrates and severe hypoxemia in the absence of evidence of cardiogenic pulmonary edema. Workup includes selected laboratory tests, diagnostic imaging, hemodynamic monitoring, and bronchoscopy. ARDS is a clinical diagnosis, and no specific laboratory abnormalities are noted beyond the expected disturbances in gas exchange and radiographic findings.

Laboratory Tests

In ARDS, if the partial pressure of oxygen in the patient’s arterial blood (PaO2) is divided by the fraction of oxygen in the inspired air (FiO2), the result is 300 or less. For patients breathing 100% oxygen, this means that the PaO2 is less than 300.

In addition to hypoxemia, arterial blood gases often initially show a respiratory alkalosis. However, in ARDS occurring in the context of sepsis, a metabolic acidosis with or without respiratory compensation may be present.

As the condition progresses and the work of breathing increases, the partial pressure of carbon dioxide (PCO2) begins to rise and respiratory alkalosis gives way to respiratory acidosis. Patients on mechanical ventilation for ARDS may be allowed to remain hypercapnic (permissive hypercapnia) to achieve the goals of low tidal volume and limited plateau pressure ventilator strategies aimed at limiting ventilator-associated lung injury."

MANAGEMENT:
" A study by Martin-Loeches et al concluded that the early use of corticosteroids was also ineffective in patients with the pandemic H1N1 influenza A infection, resulting in an increased risk of superinfections. [23] This finding was also echoed in a study by Brun-Buisson et al, who found no evidence of benefit associated with corticosteroids in patients with ARDS secondary to influenza pneumonia but did find that early corticosteroid therapy may be harmful. [24]

Numerous pharmacologic therapies, including the use of inhaled synthetic surfactant, intravenous (IV) antibody to endotoxin, ketoconazole, simvastatin, and ibuprofen, have been tried and are not effective. [25]

A study that examined the use and outcomes associated with rescue therapies in patients with ARDS determined that these therapies offered no survival benefit. [26] The study also determined that rescue therapies are most often used in younger patients with more severe oxygenation deficits.

Inhaled nitric oxide (NO), a potent pulmonary vasodilator, seemed promising in early trials, but in larger controlled trials, it did not change mortality rates in adults with ARDS. [27, 28] A systematic review, meta-analysis, and trial sequential analysis of 14 randomized controlled trials, including 1303 patients, found that inhaled nitric oxide did not reduce mortality and results in only a transient improvement in oxygenation. [29]

Although no specific therapy exists for ARDS, treatment of the underlying condition is essential, along with supportive care, noninvasive ventilation or mechanical ventilation using low tidal volumes, and conservative fluid management.

Because infection is often the underlying cause of ARDS, early administration of appropriate antibiotic therapy broad enough to cover suspected pathogens is essential," ...
...

"With the development of the National Institutes of Health (NIH)–sponsored ARDS Clinical Trials Network, several large well-controlled trials of ARDS therapies have been completed. Thus far, the only treatment found to improve survival in ARDS is a mechanical ventilation strategy using low tidal volumes (6 mL/kg based upon ideal body weight).

The main concerns are missing a potentially treatable underlying cause or complication of ARDS. In these critically ill patients, pay careful attention to early recognition of potential complications in the intensive care unit (ICU), including pneumothorax, IV line infections, skin breakdown, inadequate nutrition, arterial occlusion at the site of intra-arterial monitoring devices, DVT and pulmonary embolism (PE), retroperitoneal hemorrhage, gastrointestinal (GI) hemorrhage, erroneous placement of lines and tubes, and the development of muscle weakness."

[InTheBlack]

Long post. PART 2

FLUID MANAGEMENT : too detailed to summarize here.

" Noninvasive Ventilation and High-Flow Nasal Cannula

Because intubation and mechanical ventilation may be associated with an increased incidence of complications, such as barotrauma and nosocomial pneumonia, alternatives to mechanical ventilation such as a high-flow nasal cannula or noninvasive positive-pressure ventilation (NIPPV) may be beneficial in patients with ARDS. "
SNIPPED MORE DETAILS

"Mechanical Ventilation

The goals of mechanical ventilation in ARDS are to maintain oxygenation while avoiding oxygen toxicity and the complications of mechanical ventilation. Generally, this involves maintaining oxygen saturation in the range of 85-90%, with the aim of reducing the fraction of inspired oxygen (FiO2) to less than 65% within the first 24-48 hours. Achieving this aim almost always necessitates the use of moderate-to-high levels of positive end-expiratory pressure (PEEP)."
SNIPPED DETAILS

"Positive end-expiratory pressure and continuous positive airway pressure

ARDS is characterized by severe hypoxemia. When oxygenation cannot be maintained despite high inspired oxygen concentrations, the use of CPAP or PEEP usually promotes improved oxygenation, allowing the FiO2 to be tapered." SNIPPED DETAILS OF HOW TO CONFIGURE THE APPARATUS

"Prone positioning

Some 60-75% of patients with ARDS have significantly improved oxygenation when turned from the supine to the prone position. The improvement in oxygenation is rapid and often substantial enough to allow reductions in FIO2 or level of CPAP. The prone position is safe, with appropriate precautions to secure all tubes and lines, and does not require special equipment. The improvement in oxygenation may persist after the patient is returned to the supine position and may occur on repeat trials in patients who did not respond initially.
snip

However, a subsequent randomized controlled trial in which patients with severe ARDS were placed in the prone position early and for at least 16 hours a day showed a significant mortality benefit. [48] In this study, patients with severe ARDS (PaO2/FiO2 of < 150) were randomized to prone position after 12-24 hours of stabilization. The 28-day mortality rate was 16% in the prone group and 32.8% in the supine group. Patients were turned manually. A specialized bed was not required."

"Nutritional Support

Institution of nutritional support after 48-72 hours of mechanical ventilation usually is recommended. Enteral nutrition via a feeding tube is preferable to IV hyperalimentation unless it is contraindicated because of an acute abdomen, ileus, GI bleeding, or other conditions.

A low-carbohydrate high-fat enteral formula including anti-inflammatory and vasodilating components (eicosapentaenoic acid and linoleic acid) along with antioxidants has been demonstrated in some studies to improve outcome in ARDS. [52, 53]"

"Activity Restriction

Patients with ARDS are on bed rest. Frequent position changes should be started immediately, as should passive—and, if possible, active—range-of-motion activities of all muscle groups. Elevation of the head of the bed to a 45° angle is recommended to diminish the development of VAP.


THE MEDICATION SECTION SHOULD BE READ IN FULL BY THOSE INTERESTED, recall that you need to register:
https://emedicine.medscape.com/article/165139-medication

"Medication Summary

No drug has proved beneficial in the prevention or management of acute respiratory distress syndrome (ARDS).

Early administration of corticosteroids to septic patients does not prevent the development of ARDS.

Numerous pharmacologic therapies, including the use of inhaled or instilled synthetic surfactant, intravenous (IV) antibody to endotoxin, ketoconazole, and ibuprofen, have been tried and are not effective.

Statins, which also appeared to have promise in small studies, also did not show benefit in a recently published randomized trial in 60 patients with acute lung injury (ALI). [57]"

[
BUT THE REFERENCED ABSTRACT SAYS IT DID HELP, IF I UNDERSTAND IT CORRECTLY:

NOTE 57:
https://reference.medscape.com/medline/abstract/20870757

A randomized clinical trial of hydroxymethylglutaryl- coenzyme a reductase inhibition for acute lung injury (The HARP Study).
Am J Respir Crit Care Med. 2011; 183(5):620-6 (ISSN: 1535-4970)

Craig TR; Duffy MJ; Shyamsundar M; McDowell C; O'Kane CM; Elborn JS; McAuley DF

RATIONALE: There is no effective pharmacological treatment for acute lung injury (ALI). Statins are a potential new therapy because they modify many of the underlying processes important in ALI.

OBJECTIVES: To test whether simvastatin improves physiological and biological outcomes in ALI.
SNIP

CONCLUSIONS: Treatment with simvastatin appears to be safe and may be associated with an improvement in organ dysfunction in ALI. These clinical effects may be mediated by a reduction in pulmonary and systemic inflammation. Clinical trial registered with www.controlled-trials.com (ISRCTN70127774).

What This Study Adds to the Field
We have found, in a randomized, double-blind trial of 60
patients with ALI, that simvastatin was safe and showed
modest improvements in nonpulmonary organ dysfunction,
improvement in systemic organ dysfunction, and a reduction
in IL-8 in the airspaces of the lung.

FULL STUDY URL:
https://www.researchgate.net/publication/46427265_A_Randomized_Clinical_Trial_of_Hydroxymet hylglutaryl-_Coenzyme_A_Reductase_Inhibition_for_Acute_Lung_In jury_The_HARP_Study/link/00b4952f7bbc1c2fc2000000/download

]

[InTheBlack]

Deeper dive FWIW:
https://www.medscape.com/viewarticle/894046_1

The Relationship Between High-Dose Corticosteroid Treatment and Mortality in Acute Respiratory Distress Syndrome
A Retrospective and Observational Study Using a Nationwide Administrative Database in Japan

Takashi Kido; Keiji Muramatsu; Takeshi Asakawa; Hiroki Otsubo; Takaaki Ogoshi; Keishi Oda; Tatsuhiko Kubo; Yoshihisa Fujino; Shinya Matsuda; Toshihiko Mayumi; Hiroshi Mukae; Kazuhiro Yatera
Disclosures

BMC Pulm Med. 2018;18(28)


Conclusions
Our results suggest that high-dose corticosteroid treatment does not improve the prognosis of patients with ARDS, even in this era. However, this study has limitations owing to its retrospective and observational design.

[InTheBlack]

"Pharmacologic therapies such as β2 agonists, statins, and keratinocyte growth factor, which targeted pathophysiologic alterations in ARDS, were not beneficial and demonstrated possible harm."

FULL TEXT:
https://sci-hub.tw/10.1001/jama.2017.21907

ABSTRACT:
https://www.ncbi.nlm.nih.gov/pubmed/29466596

JAMA. 2018 Feb 20;319(7):698-710. doi: 10.1001/jama.2017.21907.
Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment.
Fan E1,2,3,4, Brodie D5, Slutsky AS1,4,6.

FINDINGS:

Findings:

After screening 1662 citations, 31 articles detailing major advances in the diagnosis or treatment of ARDS were selected. The Berlin definition proposed 3 categories of ARDS based on the severity of hypoxemia: mild (200 mm Hg<Pao2/Fio2≤300 mm Hg), moderate (100 mm Hg<Pao2/Fio2≤200 mm Hg), and severe (Pao2/Fio2 ≤100 mm Hg), along with explicit criteria related to timing of the syndrome's onset, origin of edema, and the chest radiograph findings. The Berlin definition has significantly greater predictive validity for mortality than the prior American-European Consensus Conference definition. Clinician interpretation of the origin of edema and chest radiograph criteria may be less reliable in making a diagnosis of ARDS. The cornerstone of management remains mechanical ventilation, with a goal to minimize ventilator-induced lung injury (VILI). Aspirin was not effective in preventing ARDS in patients at high-risk for the syndrome. Adjunctive interventions to further minimize VILI, such as prone positioning in patients with a Pao2/Fio2 ratio less than 150 mm Hg, were associated with a significant mortality benefit whereas others (eg, extracorporeal carbon dioxide removal) remain experimental.

Pharmacologic therapies such as β2 agonists, statins, and keratinocyte growth factor, which targeted pathophysiologic alterations in ARDS, were not beneficial and demonstrated possible harm.

Recent guidelines on mechanical ventilation in ARDS provide evidence-based recommendations related to 6 interventions, including low tidal volume and inspiratory pressure ventilation, prone positioning, high-frequency oscillatory ventilation, higher vs lower positive end-expiratory pressure, lung recruitment maneuvers, and extracorporeal membrane oxygenation.

[InTheBlack]

None of these studies on statins vs ARDS seem to have started the drug before full-blown ARDS

Using them at the first signs of flu, when it is a deadly flu, and you cannot get lab tests etc, may still be a useful tactic.

[InTheBlack]

graph & numbers:

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[InTheBlack]

Has it been proven that REDUCING fever is the correct action with SARS & MERS?

Presumably would be the same for this virus.

[InTheBlack]

Anyone know what type is correct? I see "sport" products that probably don't necessarily contain everything needed in a medical situation.

Pedialyte is the only "name brand" I know, but its formulated for infants -- is it really correct for adults?

Obviously the powder form is best to stockpile, but its not clear how many liters per "sale unit" on Amazon.

[mugwump]

Sorry, never take an ambien and post. Lesson learned.

[InTheBlack]

In 2006 we were talking about a vaccine called Pneumovax II.

Nowadays it seems to be Pneumovax 23.

Different things, or has 23 replaced II ?

And how do we explain to the MD why we want HiB vaccine? (Haemophilia Influenza Type B) when they think its for kiddie earaches? When was that vaccine invented -- what age group did not get it as a kid?

My excellent MD retired a few months ago, and now i'm stuck in Big Box Medicine, and the guy is a Door Closer, not a Helper.

[InTheBlack]

Sorry, never take an ambien and post. Lesson learned.

Getting stuff out is healthy. Ambien can uncork it.

[mugwump]

Thanks for this. I wasn’t aware that prone vs supine produced proven superior oxygenation, ie the patient being face down is better than face up. Had no effect on mortality statistics in ventilated patients but the home cook will never be baking that cake anyway. If I’m nursing a sick patient with pneumonia, they’ll be face down.

[mugwump]

Getting stuff out is healthy. Ambien can uncork it.

I refer you to the esteemed philosopher Bill Barr: real men repress their feelings.

[InTheBlack]

How many days or worst case liters might be needed?

Some info on dosing & amounts of electrolytes in ORT products:
https://www.drugs.com/mmx/pedialyte.html#s00111839

You will need 4 - 8 liters per day of ... any of these products it seems.

1 carton of Pedialyte powder (6 packets) makes a total of 2.8 l
10 days x 8 = 80 l
divided by 2.8 l / carton = 29 cartons
Amazon price $32.94 x 29 = $955

There must be a much cheaper generic product. Some are named in the above reference.

There is a difference between Dextrose based and Rice based, for the carbohydrate content, and it has to do with gut function; I don't know if one is preferable in our circumstance.

Also in using Bicarbonate vs Citrate for one of the electroytes.

[Divemaster]

Both American and United have suspended flights to and from Hong Kong. Now no U.S. carriers service the SAR. The last United flight out is 7 FEB HK time.

Other carriers like Singapore, Eva, and HK based Cathay Pacific are still flying. However, Cathay is seriously slashing it's flight schedule.

Taiwan will quarantine at home for 14 days any of its residents returning from Hong Kong.

And, unrelated, Michael Yon was detained today by HK immigration and denied entry (according to his Twitter account).

It looks like HK is beginning to become isolated from the rest of the world.

[doctom54]

Both American and United have suspended flights to and from Hong Kong. Now no U.S. carriers service the SAR. The last United flight out is 7 FEB HK time.


It looks like HK is beginning to become isolated from the rest of the world.

The nurses and Doctors wanted the HK government to shut down all travel completely between HK and mainland china.

"If the government listened to us, if they had closed down that high-speed rail, if they closed down the borders, all of this could have been prevented," Wong says. "We have been advocating for this for weeks now. We have been advocating for this since early January. But they haven't done anything." Dr. Wong cardiologist HK Feb 1st talking about the threatened nurses strike if HK doesn't close the borders.

[PSM]

Hmmmmm:

Tencent may have accidentally leaked real data on Wuhan virus deaths
Tencent briefly lists 154,023 infections and 24,589 deaths from Wuhan coronavirus

By Keoni Everington, Taiwan News, Staff Writer
2020/02/05 18:59

TAIPEI (Taiwan News) — As many experts question the veracity of China's statistics for the Wuhan coronavirus outbreak, Tencent over the weekend seems to have inadvertently released what is potentially the actual number of infections and deaths, which were astronomically higher than official figures.

On late Saturday evening (Feb. 1), Tencent, on its webpage titled "Epidemic Situation Tracker", showed confirmed cases of novel coronavirus (2019nCoV) in China as standing at 154,023, 10 times the official figure at the time. It listed the number of suspected cases as 79,808, four times the official figure.

The number of cured cases was only 269, well below the official number that day of 300. Most ominously, the death toll listed was 24,589, vastly higher than the 300 officially listed that day.

Moments later, Tencent updated the numbers to reflect the government's "official" numbers that day. Netizens noticed that Tencent has on at least three occasions posted extremely high numbers, only to quickly lower them to government-approved statistics.

https://www.taiwannews.com.tw/en/news/3871594

[InTheBlack]

Tencent is a huge tech company... Not convinced they would possess the "real" numbers. Certainly the grunt typing in the web page numbers won't be given the data. Most likely input errors.

[mugwump]

Tencent is a huge tech company... Not convinced they would possess the "real" numbers. Certainly the grunt typing in the web page numbers won't be given the data. Most likely input errors.

Doubt they’re entry errors. I think it’s 1) misinformation or 2) real data. I saw one of the earlier ‘leaked’ screenshots and it was consistent with case projections curves from epidemiologists using a Ro of 3ish I believe. The ‘official’ numbers are all suspiciously low.

Whoever is doing this is risking their freedom/life. It’s entirely reasonable to assume someone who does know the official numbers is collaborating with a Tencent techie.

[mugwump]

My daughter's clinic in Madison WI confirmed a case today. Sent home to quarantine in place. Phone contact every 2 hours.

'Recent international travel' is all they’re releasing.

I don’t know if it’s released yet so, shhhh, don’t tell anyone lol

[mugwump]

Tencent is a huge tech company... Not convinced they would possess the "real" numbers. Certainly the grunt typing in the web page numbers won't be given the data. Most likely input errors.

And if it is a bureaucrat collaborating with a Tencent techie it’s grim news: 15%-18% fatality rate. Once you get to the point of hospitalization there’s very little hope of recovery, 'leaked' figures showing much lower 'recovered' and much much higher confirmed cases vs official figures.

The curve that these ‘leaked’ numbers lie on projects >1B cases by the end of March. This is consistent with the 'worst case' epidemiological projections. Logarithmic grown is a terrifying thing.

[mugwump]

The celestials have confirmed fecal, surface, aerosol, airborne xmission. Everything except teleportation. It almost sounds like a bioweapon. Surface survival period is unknown/not released, but they consider every public surface infectious. PLA wearing PPE are marching shoulder to shoulder spraying disinfectant in cities.

Viruses usually survive better under colder less humid conditions—winter. Wash hands like a mofo.

This is an 18-24 month marathon, not a sprint. Best case in the US now, IMO only, will be numerous small 100 case hotspots that are controlled. Worst case is bad.

In countries with less robust health systems (Asia/Africa/S and Central America <cough Mexico>) there will likely be 2-3 pandemic waves over 18-24 months before it burns through every naive human. At least that’s what past pandemics show. Who knows what the mind of man hath wrought with this engineered little beauty. Then it’ll settle into something like the seasonal flu.

In Africa the number of available test kits number in the hundred I shit you not and only 2 countries can test at all. I stopped reading before I learned the country names.

[mugwump]

If this does break out and hordes of desperate Mexicans swarm toward the border seeking medical care, like a rich commie fleeing to HK, I wonder if we'll shoot.

[InTheBlack]

My new Big Box Medicine doctor (my 20 year guy retired) will not give me the HiB or Pneumovax shots. Says they don't even stock the HiB. Mumbles something about "have to follow CDC Guidelines." Idiot.

So where the hell does one look, before the meds are controlled by govt fiat? Local health department maybe?

[mugwump]

My new Big Box Medicine doctor (my 20 year guy retired) will not give me the HiB or Pneumovax shots. Says they don't even stock the HiB. Mumbles something about "have to follow CDC Guidelines." Idiot.

So where the hell does one look, before the meds are controlled by govt fiat? Local health department maybe?

Lol I get my vaccinations at Walgreens. Try them or CVS. My PA Laurie sends me there, cheaper. She’s a peach. Sharp as a tack and the only person I let put their finger up my butt. If I see an MD it’s ruh roh, I just turned ‘complicated’.

[Flagg]

Tencent is a huge tech company... Not convinced they would possess the "real" numbers. Certainly the grunt typing in the web page numbers won't be given the data. Most likely input errors.

Yup, Tencent owns WeChat.

Chinese citizens pretty much need WeChat for essential functions in China.

Penetration is pretty much universal at 1 billion users, covering everyone bar young children and the aged.

[TWITCHY]

Doubt they’re entry errors. I think it’s 1) misinformation or 2) real data. I saw one of the earlier ‘leaked’ screenshots and it was consistent with case projections curves from epidemiologists using a Ro of 3ish I believe. The ‘official’ numbers are all suspiciously low.

Whoever is doing this is risking their freedom/life. It’s entirely reasonable to assume someone who does know the official numbers is collaborating with a Tencent techie.

Caveat: I’m not a virologist or epidemiologist. I spent a good deal of time chatting back and forth with a Dr. James Wilson, CEO of M2 Medical Intelligence, on LinkedIn. Apparently, his company provides consultation and analysis to “clients”. He argues that China has been forthright and exemplary in their response to the situation. My questions primarily focused on the fact that we have no reason to trust China on this and based on their actions, alone, shouldn’t we assume it is much worse than the lowball numbers being disseminated?. I even provided the Tencent link to him for consideration. He questioned its authenticity, which we should all be hesitant to accept as fact.

Running his business for “clients” (could be multinational companies, etc) I’m sure requires him to present as stable of an analysis as possible; however, I find it foolhardy and dangerous to to assume China is being truthful or that they are a model to follow. Maybe I’m cynical, but one only need look to the CCP treatment of Uighurs, Christians, political dissidents, and student protesters to know that they do NOT give a damn about people’s lives.

I’ve appreciated your information and outlook on this. Thanks.

ETA: If you’re interested, here are links to his company site and LinkedIn. https://www.m2medintel.com/
http://linkedin.com/in/jamesmwilsonv

[Divemaster]

This website shows the location where all the Hong Kong cases (21 now) have stayed in the past 14 days.

https://chp-dashboard.geodata.gov.hk/nia/en.html

However, there is not a dot for each case. This indicates either multiple cases in some buildings, or incomplete data. Unknown is how many other buildings/locations each infected person entered while infectious.

One location was the Four Seasons hotel in Central, the main business area of the city. Obviously, this hotel is full of people traveling internationally.

The website also provides basic info on each patient, age, sex, date of hospitalization.

[InTheBlack]

Lol I get my vaccinations at Walgreens. Try them or CVS.

No, HiB and Pneumovax require a prescription.
And the pharmacist can't explain to me the difference between Pneumovax 13 and Pneumovax 23, and why the 13 is given a year after the 23.

Even the county health dept says "HiB is for children." Dunno how to enforce my right to choose my own medical care.

[PedOncoDoc]

No, HiB and Pneumovax require a prescription.
And the pharmacist can't explain to me the difference between Pneumovax 13 and Pneumovax 23, and why the 13 is given a year after the 23.

Even the county health dept says "HiB is for children." Dunno how to enforce my right to choose my own medical care.

On our re-vaccination schedules we typically give the 13-valent earlier than the 23 valent - the 13 vs 23 is number of strains of pneumococcus for which antigens are included in the vaccine - those in the 13 are not entirely redundant in the 23-valent vaccine.

HiB was a major cause of infant meningitis and subsequent hearing loss prior to vaccination.

[InTheBlack]

Health Dept says they can only give the HiB vaccine up to 5 years old.
WTF?
I'm OLD, and it didn't exist when I was 5 years old !!!

Now looking for an MD who takes cash for service...

[InTheBlack]

https://time.com/5777541/coronavirus-craig-spencer-ebola-doctor/

Panic swept through New York City in fall 2014 when Dr. Craig Spencer became the first person in the giant metropolis to be diagnosed with Ebola. The physician had contracted the deadly disease while helping sick patients in the hard-hit West African country of Guinea as a volunteer.

Spencer, 38, [NOW] the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center.

snip

Now, amid another public health emergency as the novel coronavirus outbreak spreads internationally, Spencer says the U.S. is less prepared for a pandemic now than at the end of the Ebola outbreak, and he fears racism and xenophobia will worsen the crisis.

“It’s worrisome,” Spencer tells TIME, echoing experts who’ve expressed concerns about the Trump administration’s ability, and willingness, to ensure there are enough financial and other resources available to fight a pandemic. “We’re in trouble.”

snip

Spencer stresses that influenza is far deadlier than the coronavirus. The flu has killed up to 61,000 people annually since 2010, according to the CDC. But Spencer understands the grip fear can have on a person, because he’s experienced it himself.

[InTheBlack]

Seems to have an "emergency medicine" RSS feed, and obviously others... not sure how to work it but there is a Search box...

https://medworm.com/

[Divemaster]

Anyway, back to 2019nCoV. Hong Kong is up to 24 confirmed cases now. The word I'm hearing on the number of cases from the mainland just outside one of the open border crossings to HK is, putting it mildly, not good.

[bblhead672]

https://time.com/5777541/coronavirus-craig-spencer-ebola-doctor/

Panic swept through New York City in fall 2014 when Dr. Craig Spencer became the first person in the giant metropolis to be diagnosed with Ebola. The physician had contracted the deadly disease while helping sick patients in the hard-hit West African country of Guinea as a volunteer.

Spencer, 38, [NOW] the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center.

snip

Now, amid another public health emergency as the novel coronavirus outbreak spreads internationally, Spencer says the U.S. is less prepared for a pandemic now than at the end of the Ebola outbreak, and he fears racism and xenophobia will worsen the crisis.

“It’s worrisome,” Spencer tells TIME, echoing experts who’ve expressed concerns about the Trump administration’s ability, and willingness, to ensure there are enough financial and other resources available to fight a pandemic. “We’re in trouble.”

snip

Spencer stresses that influenza is far deadlier than the coronavirus. The flu has killed up to 61,000 people annually since 2010, according to the CDC. But Spencer understands the grip fear can have on a person, because he’s experienced it himself.

Spencer's panties remain ruffled because of citizen Trump's remarks about his activities before showing symptoms of Ebola.
Had Trump been POTUS then and required a 2-3 week quarantine of anyone returning from countries with Ebola outbreaks, Spencer probably wouldn't have liked that either.

[mugwump]

Caveat: He questioned its authenticity, which we should all be hesitant to accept as fact.

There is no disputing that this could be Taiwanese nationalists spreading disinformation. They’d have to be damn good hackers to get into Tencent, though, which has a reputation for airtight security. That said, anything is possible.

The xenophobia/racism narrative among public health types seems linked to Trump derangement syndrome. Rarely will you see ‘racism’ mentioned without Trump in the same sentence.

Their only basis for believing Chinese stats is faith. They believe because they believe. I’ve watched Chinese nationals lie, cheat, and steal entire corporate research databases from under the noses of gormless American tech groups for years. My baseline position now is incredulity. It’s not race based, it’s culture based.

Given the risk to freedom and life, it’s hard to discount leaks coming out of China.

Nobody knows, is the bottom line. Just as Wall Street quants use satellite imagery to count Chinese lights at night because no one trusts their gdp numbers, there are all sorts of secondary stats that people are using to try to get a handle on the true impact of the pandemic, including the use of satellite imagery for counting reefer trucks pulling up to crematoria. I’m just :munchin and chillin', nothing much else to do.

[InTheBlack]

https://rehydrate.org/solutions/packaged.htm

Need to figure the weight of ordinary glucose (L-glucose) vs the anyhdrous specified. And verify dextrose (D-glucose) is equivalent wrt digestion.

2 COLUMN FORMATTING WILL NOT PASTE:

The New Reduced Osmolarity formula for the ORS packet recommended by WHO and UNICEF contains:

Reduced osmolarity ORS


grams
/litre


Reduced osmolarity ORS


mmol/
litre

Sodium chloride


2.6


Sodium


75

Glucose, anhydrous


13.5


Chloride


65

Potassium chloride


1.5


Glucose, anhydrous


75

Trisodium citrate, dihydrate


2.9


Potassium


20


Citrate


10
Total Weight 20.5

Total Osmolarity


245


The above ingredients are to be dissolved in one litre of clean water.

WHO said the new formula would reduce the severity of diarrhoea and vomiting, the number of hospitalisations, the need for costly intravenous fluid treatment and the length of illness. This formula also gives the packets a longer shelf life and is at least as effective in correcting acidosis and reducing stool volume as the old formula. Packets containing sodium bicarbonate are still safe and effective.
How do I make the solution?
SNIP

[InTheBlack]

Look up a drug, and scroll down to see an entry box for a drug to check against it. Also has a complete list below.

https://reference.medscape.com/drug/zocor-simvastatin-342463

Interactions
Enter a drug name
and cimetidine
1 Interaction Found
Serious - Use Alternative

cimetidine + simvastatin

cimetidine will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

[TWITCHY]

There is no disputing that this could be Taiwanese nationalists spreading disinformation. They’d have to be damn good hackers to get into Tencent, though, which has a reputation for airtight security. That said, anything is possible.

I’m with you on this. I honestly think it is in his best interest to paint a best-possible scenario for his “clients”. For all we know they are multinational, US-based companies with major interests in China. China’s actions defy the stats, in my non-expert opinion, indicating the situation is much worse than they want the world to believe. And, like you said, any leaks from citizens, who are risking death, must be taken seriously. And, we’ll find out in time what the real story is.

[doctom54]

[
How do I make the solution?
SNIP

https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2018/09/Homemade-Oral-Rehydration-Solutions-9-2018.pdf

Do some research on Dr. Robert K. Crane who won a Nobel prize for co-transport

Crane's discovery of cotransport led directly to the development of oral rehydration therapy.[6][7] This treatment counterbalances the loss of water and electrolytes caused by cholera via a glucose containing salt solution that accelerates water and electrolyte absorption. This is possible because cholera does not interfere with sodium-glucose cotransport.[8][9]

Oral rehydration therapy saves the lives of millions of cholera patients in underdeveloped countries since the 1980s.[10] In 1978, The Lancet wrote: "the discovery that sodium transport and glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water, was potentially the most important medical advance this century."[11]


After you read and understand all of this come back

[T-Rock]

Well this is interesting. Correspondence/New England Journal of Medicine - 17 Docs from Munich.

Supposedly the virus can be spread during the incubation period while no symptoms are present, but now it also appears (not certain) that someone who's contracted and recovered from the CoronaVirus can still shed the virus after they've convalesced and still be contagious to others.

[QUOTE]
".......the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery....."
/QUOTE]


Link:
https://www.nejm.org/doi/full/10.1056/NEJMc2001468


Edited to add:
If the hypothesis by those 17 Docs from Germany is true, this virus has the potential to get a little sporty worldwide. Let's hope it doesn't.

Research gone wrong is what this appears to be, IMHO. It is interesting that 2 of the scientists who researched and engineered a similar virulent Virus at UNC in 2014/2015 were, and are now; doing similar research at the Wuhan Institute of Virology, in Wuhan, China. Coincidence?
https://www.nature.com/articles/nm.3985

[InTheBlack]

...now it also appears (not certain) that someone who's contracted and recovered from the CoronaVirus can still shed the virus after they've convalesced and still be contagious to others.


That's not exactly what it says. They don't know if the virus is still active. And since these patients all had very short & mild cases, maybe this is a very weak strain.

[InTheBlack]

But the retraction only addresses that patient zero actually did have symptoms during the time she was in contact with the subsequent patient.

It does NOT retract that the samples from the recovered patient (not patient zero) still had high viral loads. Unless I am completely misunderstanding that part of the data. Someone please check me on that aspect.

https://www.sciencemag.org/news/2020/02/paper-non-symptomatic-patient-transmitting-coronavirus-wrong?et_rid=287521239&et_cid=3198419


EDIT:
https://www.sciencemag.org/news/2020/02/beast-moving-very-fast-will-new-coronavirus-be-contained-or-go-pandemic?et_rid=287521239&et_cid=3198419

THIS DATED 5FEB20
snip
So far it has been difficult to get a handle on this question. Some data from China seem to support asymptomatic transmission, but none are clear-cut. A widely reported 30 January letter in The New England Journal of Medicine described the case of a Chinese businesswoman who touched off a cluster of four cases in Germany before she became sick herself. But 4 days later, it became clear the researchers had not contacted the woman, who had flown back to China, before the paper was published. In a later phone interview, she said she had experienced some symptoms while in Germany.

In follow-up results announced in a 4 February press release, the researchers noted that some patients they studied shed virus even though their symptoms were mild. That’s almost as bad as asymptomatic transmission, says virologist Christian Drosten of the Charité University Hospital in Berlin: Patients with mild symptoms are unlikely to seek medical care and may not even stay home, giving the virus ample opportunities to spread far and wide.

[Stobey]

I read an article on Gateway Pundit that said that a recorded case of Coronavirus was treated successfully using a still-experimental anti-viral drug called Remdesivir.

The following is a quote from a comment to the article:
"Remdesivir metabolizes into its active form GS-441524. GS-441524 is an adenosine nucleotide analog that confuses viral RNA polymerase and evades proofreading by viral exonuclease (ExoN)goog, causing a decrease in viral RNA production. It is unknown whether it terminates RNA chains or causes mutations in them."
-----------------
Basically, Remdesivir wrecks the capacity of some viruses to replicate themselves. This is a good thing, because infectious viruses must make huge numbers of copies of themselves to succeed.

Are there any virologists here who can verify this information?

GP article:
https://www.thegatewaypundit.com/2020/02/breaking-washington-doctors-successfully-treat-coronavirus-patient-with-experimental-anti-viral-medication-significantly-improved-in-hours-video/

[InTheBlack]

Correction to my statement --
Retraction of paper re German infection

It does ** NOT **
retract that the samples from the recovered patient (not patient zero) still had high viral loads. Unless I am completely misunderstanding that part of the data. Someone please check me on that aspect

[InTheBlack]

I read an article on Gateway Pundit that said that a recorded case of Coronavirus was treated successfully using a still-experimental anti-viral drug called Remdesivir.


Yesterday I read an article saying that the US company which created it filed a patent for it, to treat coronavirii in general, in China, in 2016. They were working with some Chinese partners.

But in January, two days before the Wuhan virus was publicized, several Chinese labs - including a military lab - filed a patent for it SPECIFICALLY to treat the Wuhan coronavirus.

EDIT - here is the story:
https://sanfrancisco.cbslocal.com/2020/02/06/coronavirus-china-scientists-seek-remdesivir-patent-gilead-sciences/

[Penn]

Hell of a test run for an antidote, by the very same people who created the killer virus and then, lets save the world.

[InTheBlack]

Case report for first US case, which is the one that got the experimental REMDESIVIR.


online:
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191?query=featured_home

Downloadable:
https://sci-hub.tw/10.1056/NEJMoa2001191

ITEMS WHICH SEEM NOTABLE TO ME:

Went to clinic on Jan 19th, stated as Illness Day 4.
So Illness Day 1 would be Jan 15.
Hospital Day 1 was Jan 20 so would be Illness Day 5.

On Illness Day 7, his stool & nose showed the virus but serum negative.

The pneumonia developed between illness day 7 (negative x-ray) and 9 (positive x-ray) and his pulse oxygen saturation had dropped to 90%.

On Illness Day 10 he was started on oxygen via cannula.

They started heavy pneumonia antibiotics on illness day 10 but discontinued on illness day 11 when tests showed it was not staph etc.

On illness Day 10 another X-ray showed atypical pneumonia.

They started the REMDESIVIR on illness Day 11.

Improved on Illness Day 12 - taken off oxygen, his own saturation was 94-96%, rales gone, "His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea. "


>
initial mild symptoms at presentation with progression to pneumonia on day 9 of illness.

presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever.

body temperature of 37.2°C, blood pressure of 134/87 mm Hg, pulse of 110 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 96% while the patient was breathing ambient air. Lung auscultation revealed rhonchi, and chest radiography was performed, which was reported as showing no abnormalities (Figure 1).

TESTS FOR STANDARD VIRII NEGATIVE
A rapid nucleic acid amplification test (NAAT) for influenza A and B was negative. A nasopharyngeal swab specimen was obtained and sent for detection of viral respiratory pathogens by NAAT; this was reported back within 48 hours as negative for all pathogens tested, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and four common coronavirus strains known to cause illness in humans (HKU1, NL63, 229E, and OC43).

Given the patient’s travel history, the local and state health departments were immediately notified.

BECAUSE HE HAD BEEN IN CHINA THEY CONTACTED CDC & WUHAN VIRUS TESTS THE NEXT DAY WERE POSITIVE. SO ADMITTED HIM FOR OBSERVATION & ISOLATION. SEEMS LIKE HE REMAINED UN-ISOLATED FOR THAT DAY, UNTIL THE TESTS CAME BACK.

On admission, the patient reported persistent dry cough and a 2-day history of nausea and vomiting; he reported that he had no shortness of breath or chest pain. Vital signs were within normal ranges.

On physical examination, the patient was found to have dry mucous membranes. The remainder of the examination was generally unremarkable. After admission, the patient received supportive care, including 2 liters of normal saline and ondansetron for nausea.

On days 2 through 5 of hospitalization (days 6 through 9 of illness), the patient’s vital signs remained largely stable, apart from the development of intermittent fevers accompanied by periods of tachycardia (Figure 2). The patient continued to report a nonproductive cough and appeared fatigued.

On the afternoon of hospital day 2 [ILLNESS DAY 6], the patient passed a loose bowel movement and reported abdominal discomfort. A second episode of loose stool was reported overnight;

The stool and both respiratory specimens later tested positive by rRT-PCR for 2019-nCoV, whereas the SERUM remained negative.

Treatment during this time was largely supportive. For symptom management, the patient received, as needed, antipyretic therapy consisting of 650 mg of acetaminophen every 4 hours and 600 mg of ibuprofen every 6 hours. He also received 600 mg of guaifenesin for his continued cough and approximately 6 liters of normal saline over the first 6 days of hospitalization.

The nature of the patient isolation unit permitted only point-of-care laboratory testing initially; complete blood counts and serum chemical studies were available starting on hospital day 3. Laboratory results on hospital days 3 and 5 (illness days 7 and 9) reflected leukopenia, mild thrombocytopenia, and elevated levels of creatine kinase (Table 1).

In addition, there were alterations in hepatic function measures: levels of alkaline phosphatase (68 U per liter), alanine aminotransferase (105 U per liter), aspartate aminotransferase (77 U per liter), and lactate dehydrogenase (465 U per liter) were all elevated on day 5 of hospitalization.

Given the patient’s recurrent fevers, blood cultures were obtained on day 4; these have shown no growth to date.

A chest radiograph taken on hospital day 3 (ILLNESS DAY 7) was reported as showing no evidence of infiltrates or abnormalities (Figure 3).

However, a second chest radiograph from the night of hospital day 5 [ILLNESS DAY 9] showed evidence of PNEUMONIA in the lower lobe of the left lung (Figure 4).

These radiographic findings coincided with a change in respiratory status starting on the evening of hospital day 5 [ILLNESS DAY 9], when the patient’s oxygen saturation values as measured by pulse oximetry dropped to as low as 90% while he was breathing ambient air.

On HOSPITAL day 6 [ILLNESS DAY 10], the patient was started on supplemental oxygen, delivered by nasal cannula at 2 liters per minute.

Given the changing clinical presentation and concern about hospital-acquired pneumonia, treatment with vancomycin (a 1750-mg loading dose followed by 1 g administered intravenously every 8 hours) and cefepime (administered intravenously every 8 hours) was initiated.

On hospital day 6 (illness day 10), a fourth chest radiograph showed basilar streaky opacities in both lungs, a finding consistent with atypical pneumonia (Figure 5), and rales were noted in both lungs on auscultation.


STARTED WITH EXPERIMENTAL REMDESIVIR ON HOSPITAL DAY 7 (ILLNESS DAY 11)
Given the radiographic findings, the decision to administer oxygen supplementation, the patient’s ongoing fevers, the persistent positive 2019-nCoV RNA at multiple sites, and published reports of the development of severe pneumonia3,4 at a period consistent with the development of radiographic pneumonia in this patient, clinicians pursued compassionate use of an investigational antiviral therapy. Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development10,11) was initiated on the evening of day 7, and no adverse events were observed in association with the infusion.

Vancomycin was discontinued on the evening of day 7 [ILLNESS DAY 11], and cefepime was discontinued on the following day, after serial negative procalcitonin levels and negative nasal PCR testing for methicillin-resistant Staphylococcus aureus.

On hospital day 8 [ILLNESS DAY 12], the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present. His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea.

As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the exception of his cough, which is decreasing in severity.

[InTheBlack]

The patient below seems not to have had severe fluid loss. But they did give him an anti-nausea drug. What OTC and "reasonably safe" prescription drugs might one put into their kit for nausea?

My philosophy is to have stuff in my disaster kit that I don't know how to use, because I can probably find someone who does know how to use it.

[InTheBlack]

This coming weekend (Feb 8/9) will be interesting. When this first started three epidemiological curves of infection rates were predicted from SARS/MERS experience showing optimistic, expected, and worst-case plots of the growth of total cases. Basically, they predicted scenarios when the total number of infections would peak and then flatten and decline. The virus has blown past the optimistic and expected peaks. The pessimistic number should be achieved Thurs/Fri. If we hear of flat numbers this weekend that would be sublime---the disease will taper off in China and contagion pressure will ease. If not, we're looking at pandemic, most likely. Even then, we probably need to wait til the end of of the month to understand what's going to happen here in NA.

So the graph HAS flattened...
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

if you hover over the little graph, an X will appear & click on that for full page. Click again to collapse it.

[PedOncoDoc]

The patient below seems not to have had severe fluid loss. But they did give him an anti-nausea drug. What OTC and "reasonably safe" prescription drugs might one put into their kit for nausea?

My philosophy is to have stuff in my disaster kit that I don't know how to use, because I can probably find someone who does know how to use it.

Not a lot of good OTC meds for nausea - diphenhydramine (benadryl) can be used, but it has sedating effects. Pepto-Bismol and similar compounds may help some.

Best safe antiemeitc by prescription in my book is ondansetron (zofran) - and I treat a lot of nausea in my profession.

[mugwump]

So the graph HAS flattened...
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

if you hover over the little graph, an X will appear & click on that for full page. Click again to collapse it.

No, my opinion only, but it hasn't flattened. I suspect transmission has accelerated. Watch what they do, not what they say.

Another 40 million are under draconian lockdown since Friday, they're welding doors shut on apartment tower blocks SE of Beijing, the "stay home from work" order has been extended from feb 10 to feb 20, two new social order laws with the death penalty are on the books (evading quarantine, telling the truth on social media i.e. "fear mongering"), and all ships at sea holding hospital supplies are ordered to return to port.

They are crashing their economy and risking every strategic initiative of the last 10 years: Belt and Road, Loan/Build/Foreclose on strategic African assets, the South China Seas Rodeo Roundup, 2025 tech dominance initiatives, etc. They all require China humming on all cylinders, and they're risking it all.

Add in the fact that the economy is drowning in provincial and corporate debt--denominated in $USD BTW--that most thought required inspired finesse and good luck to get past, they are risking a huge problem by effectively shutting 7 of the worlds 10 largest ports.

Something scares them more.

No other country in the world has the totalitarian will and sheer ruthlessness to effect the measures the Chinese are implementing. They are excising great swaths of their people and economy in an attempt to save whats left. I don't think it's going to work but I sure hope it does. Then again, I also don't think it matters: imagine this virus in India, Nigeria, Mexico.

If you want another line in the sand, the Celestials have granted two highly visible exceptions to the "stay home" order: Foxconn and Tesla. They will be flogging and threatening and cajoling those companies to stay open. If Foxconn resumes iphone production and maintains it for a week, cool--I'm full of shit. Again. :) If it can't stay open then you have your answer. Canary. Coal mine.

[mugwump]

Personally, Twitter is certainly more dangerous to my health than this virus currently is--what a herd of eff-tards, I'm like to stroke out--but if you're selective and follow the right people you can get the real story from primary sources...assuming you can believe the translations that are being rendered. (But there are enough western SJW Chinese apologists to keep the "Taiwanese agitators", the current Commie trope, honest.) These guys are risking their lives.

The most disconcerting recent trend is the circulation of "this is a Satan USA bioweapon" from what I assume is the Chinese troll farm. It ties into another trope--"WHO and the USA refuse to help"--which is exactly counter to the facts.

I think they know the scientific community will reach a consensus that this was a genetically engineered virus and they are positioning themselves for that day. I also thing that's why Trump called for a crash assessment of the virus's provenance last week. Boy, did THAT trigger the twitter lefties.

Add in the fact that H5N1 bird flu has started raging through the poultry flocks and 2/3 of all Chinese pigs have died due to an uncontrolled hemorrhagic fever epidemic and you have a populous primed to believe they're the victim of a series of biowarfare attacks.

Interesting times.

[mugwump]

Just don't voice an opinion on twitter. Read, and STFU.

I said that I've worked with Chinese researchers and IT guys for 20 years and found them great fun over a beer and totally unscrupulous in their zeal to scoop up every bit of data they could.

Banned, lol.

Say Trump is sodomizing Baron and live streaming it to Putin: local hero. State an opinion counter to the SJW mantra: banned.

[Badger52]

Interesting times.Indeed. Was perusing a blogger today (ER Nurse x many decades in major metro area). He reported just for shits & grins he tallied up some major items he uses in the ER (you know, stuff in the drawers, on the shelves, but stuff you gotta have on hand, most rikki-tik). 43% produced/sourced in China.

Ponderable: What might be eventually falliing into the "Unobtainium" category if they suddenly decide they need it worse than we do?

What a time to be alive. :cool:

[InTheBlack]

I recall that in WWII, there was some biowarfare in Asia - Japan to China I think. Involved bats or birds or fleas incoculated with bubonic plague, put in little cages with little balloons and a release timer.

There is also an island used for testing... something... still quarantined 40 or 50 years later.

EDIT - well, Japan came cleaner on their CBW in 2018:
Unit 731: Japan discloses details of notorious chemical warfare division

https://www.theguardian.com/world/2018/apr/17/japan-unit-731-imperial-army-second-world-war

Didn't know about this webpage on Unit 731:
http://www.ww2pacific.com/unit731.html

Book:
http://www.china.org.cn/english/China/91409.htm

Daniel Barenblatt, author of, A Plague Upon Humanity
>
The biowarfare weapons were sprayed by aircraft on villages, or distributed in food, or passed on through bacteria put in wells. Some early weaponry involved dropping ceramic-shelled bombs filled with live disease-carrying flies and jellied cholera emulsion.
...
The biowar effort -- founded with explicit approval by Japan's Emperor Hirohito, himself a trained biologist
>

Published research:
Proc (Bayl Univ Med Cent). 2004 Oct; 17(4): 400–406.
doi: 10.1080/08998280.2004.11928002
PMCID: PMC1200679
PMID: 16200127
Biological warfare and bioterrorism: a historical review
Stefan Riedel, MD, PhDcorresponding author1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200679/

[InTheBlack]

Ponderable: What might be eventually falliing into the "Unobtainium" category if they suddenly decide they need it worse than we do?


An autoclave might be really useful. Knives, bandages, sterilize any object...

There are quaternary ammonium powders etc that are used as well for sterilization by soaking, probably cheaper to buy a supply. But not really good for sterilizing bandages.

[echoes]

Not a lot of good OTC meds for nausea - diphenhydramine (benadryl) can be used, but it has sedating effects. Pepto-Bismol and similar compounds may help some.

Best safe antiemeitc by prescription in my book is ondansetron (zofran) - and I treat a lot of nausea in my profession.


Agree, have had zofran while in the hospital, and it did work very well.

Have had OTC Emetrol here at home for nausea, and it works adequately. Can be found at walmart, cvs, etc... 4oz cherry liquid around 6$.

FWIW, we are always adding to our "be prepared" kit.


Holly

[Old Dog New Trick]

An autoclave might be really useful. Knives, bandages, sterilize any object...

There are quaternary ammonium powders etc that are used as well for sterilization by soaking, probably cheaper to buy a supply. But not really good for sterilizing bandages.

Pressure cooker or insta-pot works just fine.

[InTheBlack]

Pressure cooker or insta-pot works just fine.

Got instructions - time & temp & pressure for various materials? Otherwise your results can't be presumed to be any better than just boiling in an open pot. I don't even know how long for that...

I'm having trouble finding details on killing various organisms; its become a black-box process with commercial autoclaves.

https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/steam.html


https://ehs.research.uiowa.edu/biological/autoclaving-guidelines#accord-content-id-6

Standard Autoclave Cycles for Commonly Used Material

Laundry: 121°C for 30 minutes with 15 minutes pre-vacuum of 27 inches of mercury (in. Hg).
Glassware and trash: 121°C for 1 hour with 15 minutes pre-vacuum of 27 in. Hg.
Liquids: 121°C for 1 hour for each gallon.

[doctom54]

Pressure cooker or insta-pot works just fine.

I agree they would work just fine as an autoclave

[mugwump]

Latest analysis from Neil Ferguson at Imperial College: case fatality ratio estimated at 18% in #Wuhan, 1.2-5.6% outside China, 1% if you include all infections (i.e. asymptomatic). Singapore is estimating 0.2%. Flu is 0.1%.

How’s that for a range? From a bad case of the flu to Raccoon City. Statistical confidence limits in the analysis are comparable to wild-ass guess. We still don’t know what’s going on, or why things are so much worse in China.

Singapore is the current global gold standard in pandemic response. As with most things they have it all in one sock. It’s a hopeful sign that if we emulate their response we too can keep this thing manageable. On the other hand, they were hammered by SARS and have relatively huge stockpiles of PPE and medical supplies.

[mugwump]

And that drop in “confirmed” cases being reported by China. They changed the definition from positive test=confirmed case, to positive test+symptoms=confirmed case. So if you get tested positive prior to symptoms, then go home and croak you weren’t a confirmed case. Congratulations.

If you can’t show progress, move the goalposts.

[InTheBlack]

And that drop in “confirmed” cases being reported by China. They changed the definition from positive test=confirmed case, to positive test+symptoms=confirmed case.

I don't understand why they would administer a test to anyone who is not showing symptoms. Is "test" defined as checking the DNA/RNA or something less? They can't have been going door to door taking sputum samples.

EDIT: a bit more detail on the changed definition, but Zero Hedge needs some salt with it...

https://www.zerohedge.com/health/how-china-rigging-number-coronavirus-infections

IMO the problem is that China is not making any raw data available. Not possible to back-calculate previous data, or to continue the "old" methodology going forward.

I don't understand how their government can be so stupid as to not realize that the free world won't be fooled for long.

[InTheBlack]

Latest analysis from Neil Ferguson at Imperial College: case fatality ratio estimated at 18% in #Wuhan, 1.2-5.6% outside China, 1% if you include all infections (i.e. asymptomatic). Singapore is estimating 0.2%. Flu is 0.1%.

Does "asymptomatic" mean "not bad enough to a) goto the doctor or b) get hospitalized or c) something else ? There must be some epidemiologic math guesstimation to come up with an "asymptomatic" number.

How do these fatalities compare with various years of seasonal flu?
1) Chance of death if you are bad enough to go to the hospital.
2) Chance of being infected by the flu.
3) Chance of death for all cases of the flu (mild + hospitalized).

4) Any breakdown yet on severity vs age and underlying bad health?

[JJ_BPK]

I agree they would work just fine as an autoclave

Doesn't the autoclave & pressure cookers break/disturb most bonding agents? Fine for metal medical tools, but not so good for things that are made using epoxy glues, wood, plastics? :confused:

[Old Dog New Trick]

Got instructions - time & temp & pressure for various materials? Otherwise your results can't be presumed to be any better than just boiling in an open pot. I don't even know how long for that...

I'm having trouble finding details on killing various organisms; its become a black-box process with commercial autoclaves.

https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/steam.html


https://ehs.research.uiowa.edu/biological/autoclaving-guidelines#accord-content-id-6

Standard Autoclave Cycles for Commonly Used Material

Laundry: 121°C for 30 minutes with 15 minutes pre-vacuum of 27 inches of mercury (in. Hg).
Glassware and trash: 121°C for 1 hour with 15 minutes pre-vacuum of 27 in. Hg.
Liquids: 121°C for 1 hour for each gallon.

I can’t recall specifics from school (too many years ago) but both a pressure cooker with water turned to steam for 50 or more minutes or the newer insta-pots with a steam sterilization cycle would sufficiently sterilize many hard items or even bandages (they then would need to be dried before use.)

IIRC boiling technique to sterilize a variety of hard or silicon items is 15-minutes. But this only a field expedient method to kill bacteria.

An oven or toaster oven is another technique above 250* for more than hour or above 350* for 30-minutes or more.

Obviously without test strips, heat tape, or other devices used to insure sterilization you are guessing but it is better to error on the side of caution than to just dump stuff in cold sterilization techniques available over the counter. (i.e., Hydrogen-Peroxide, > 70% to 90% Alcohol, bleach, soap and hot water, and well of course drinkable alcohols - whiskey, vodka what’s available.)

As for most household items used to treat or obtain information like an oral/rectal thermometer (laser and touch ones more better), stethoscope or cups used for administering medications either use disposable items or clean thoroughly with rubbing alcohol, bleach wipes and allow to air dry several hours before use and wash hands well before and after all contact. Washing clothes and bedding more often and if the washer or dryer have steam cycles use them.

[Old Dog New Trick]

Doesn't the autoclave & pressure cookers break/disturb most bonding agents? Fine for metal medical tools, but not so good for things that are made using epoxy glues, wood, plastics? :confused:

Mostly correct. Anything that absorbs moisture and retains that moisture would not be a good candidate for steam sterilization.

Most hard plastics would be fine and most silicons are okay to steam sterilization but yes it’s mostly for hard metal tools and to disinfect/sterilize waste before disposal.

Been awhile but when sterilizing medical instruments everything is wrapped with layers of cotton cloth to keep metal from metal or other tools from touching each other and placed within and outside that wrapping were heat activated test strips so you could inspect before use. IIRC When things came out of an autoclave or other steam pressure device they are still a bit damp and needed to sit on drying racks before returned to service.

[doctom54]

Doesn't the autoclave & pressure cookers break/disturb most bonding agents? Fine for metal medical tools, but not so good for things that are made using epoxy glues, wood, plastics? :confused:

That is true. There are other sterilization methods but none that work well enough on wood (too porous). There are cold sterilization techniques, such as the liquid gluteraldehyde, or gas ethylene oxide.

Here is a nice quick accurate overview of the options.

http://www.vetsurgeryonline.com/sterilization-techniques

[doctom54]

I can’t recall specifics from school (too many years ago) but both a pressure cooker with water turned to steam for 50 or more minutes or the newer insta-pots with a steam sterilization cycle would sufficiently sterilize many hard items or even bandages (they then would need to be dried before use.)

Your memory is pretty good

IIRC boiling technique to sterilize a variety of hard or silicon items is 15-minutes. But this only a field expedient method to kill bacteria.
True it won't kill bacterial spores

An oven or toaster oven is another technique above 250* for more than hour or above 350* for 30-minutes or more.

Obviously without test strips, heat tape, or other devices used to insure sterilization you are guessing but it is better to error on the side of caution than to just dump stuff in cold sterilization techniques available over the counter. (i.e., Hydrogen-Peroxide, > 70% to 90% Alcohol, bleach, soap and hot water, and well of course drinkable alcohols - whiskey, vodka what’s available.)
Bleach is also a very good disinfectant

As for most household items used to treat or obtain information like an oral/rectal thermometer (laser and touch ones more better), stethoscope or cups used for administering medications either use disposable items or clean thoroughly with rubbing alcohol, bleach wipes and allow to air dry several hours before use and wash hands well before and after all contact. Washing clothes and bedding more often and if the washer or dryer have steam cycles use them.
Hand sanitizer is even more effective than washing from some studies recently done with surgeons

[InTheBlack]

When did the WHO small group arrive in China? I _think_ these statements ought to be updated once WHO gets closer to the data...

https://www.reuters.com/article/us-health-china-who-issues-factbox-idUSKBN2041KZ?taid=5e41713d0f91f60001a28893

Reuters February 10, 2020 / 1:37 PM
Here is what WHO experts are watching on the coronavirus' spread

To what extent people who have mild disease,
which according to Chinese data on 18,000 cases is some 82%, shed the virus and potentially expose others. Some 15% of cases are severe and 3% critical, according to its data shared with WHO.

Why some people die.
People who are older or have underlying medical conditions - including cancer, diabetes, and hypertension - are most at risk. The overall death rate among reported cases is some 2%. People above 80 have the highest death rates, WHO says, citing Chinese data. WHO wants more data about the disease that can cause pneumonia and organ failure.

“We have recently released a clinical case report form which we are encouraging hospitals and clinicians to use so that standardised data collection can be captured from patients who are hospitalised,” van Kerkhove said.

[InTheBlack]

What's the "d" stand for?

>
The name Covid-19 is made up of the first letters of the words ‘coronavirus’, ‘virus’ and ‘disease’, Dr Ghebreyesus said.
>
“We had to find a name that did not refer to a geographical location, an animal, or an individual or group of people,” WHO's director-general, Dr. Tedros Adhanom Ghebreyesus, said in a call with reporters.

It’s also easy to pronounce, he added.
>
"‘Having a name matters to prevent the use of other names that can be inaccurate or stigmatising."
>

Such PC nonsense. Its useful for a name to reveal something about it.

How about "WuWACK?"

Wuhan
Weaponized
Asian
Chinese
Killer

[mugwump]

A new study from China was released yesterday and is undergoing peer review.

“...The team collected data from 1,099 confirmed coronavirus patients at 552 hospitals in 31 Chinese provinces and municipalities, the report said.

Analysis found that the average incubation period was three days – shorter than 5.2 days suggested in a previous paper – but the range of the a patient’s incubation period could extend from zero to 24 days.”

That’s why they test asymptomatic cases, In the Black. The study points to the mechanism behind the reported “super spreaders”. Three weeks being infectious without symptoms. Yikes. Up a full 10 days from the 14 days previously reported.

The same study states that the virus is viable and infectious on surfaces for up to 9 days. Which might explain the mass disinfection attempts by the PLA fogging/spraying everything in sight.

[mugwump]

DOD/DHS are setting up more quarantine centers on military bases:

JB Pearl Harbor-Hickam, Hawaii (HNL)
Great Lakes Training Center Navy Base, Illinois (ORD)
Naval Air Station Joint Reserve Base, Texas (DFW)
March ARB, California (LAX)
Travis AFB, California (SFO)
Dobbins ARB, Georgia (ATL)
Fort Hamilton, New York (JFK)
Naval Base Kitsap, Washington (SEA)
Joint Base Anacostia, Washington DC (IAD)
Joint Base McGuire-Dix-Lakehurst, New Jersey (EWR)
Fort Custer Training Center, Michigan (DTW)

The Department of Defense already has quarantine centers at Fort Carson in Colorado, Travis Air Force Base and Marine Corps Air Station Miramar in California, and Lackland Air Force Base in Texas.

https://www.miamiherald.com/news/nation-world/national/article240078853.html#storylink=cpy

[Old Dog New Trick]

DOD/DHS are setting up more quarantine centers on military bases:

JB Pearl Harbor-Hickam, Hawaii (HNL)
Great Lakes Training Center Navy Base, Illinois (ORD)
Naval Air Station Joint Reserve Base, Texas (DFW)
March ARB, California (LAX)
Travis AFB, California (SFO)
Dobbins ARB, Georgia (ATL)
Fort Hamilton, New York (JFK)
Naval Base Kitsap, Washington (SEA)
Joint Base Anacostia, Washington DC (IAD)
Joint Base McGuire-Dix-Lakehurst, New Jersey (EWR)
Fort Custer Training Center, Michigan (DTW)

The Department of Defense already has quarantine centers at Fort Carson in Colorado, Travis Air Force Base and Marine Corps Air Station Miramar in California, and Lackland Air Force Base in Texas.

https://www.miamiherald.com/news/nation-world/national/article240078853.html#storylink=cpy

Is this not the most forward thinking and simplistic approach ever...thank you Mr. President, for providing real leadership. Most presidents before you would have floundered.

[InTheBlack]

I hate having to play six degrees of Kevin Bacon to find the actual research behind claims.

NOTE: that B.A.C is less effective than alcohol.

https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext

Journal Pre-proof
Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal
agents
Gunter Kampf, Daniel Todt, Stephanie Pfaender, Eike Steinmann
PII: S0195-6701(20)30046-3
DOI: https://doi.org/10.1016/j.jhin.2020.01.022
Reference: YJHIN 5905
To appear in: Journal of Hospital Infection
Received Date: 31 January 2020
Accepted Date: 31 January 2020

Summary
Currently, the emergence of a novel human coronavirus, temporary named 2019-nCoV, has become
a global health concern causing severe respiratory tract infections in humans. Human-to-human
transmissions have been described with incubation times between 2-10 days, facilitating its spread
via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available
information about the persistence of human and veterinary coronaviruses on inanimate surfaces as
well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare
facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute
Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or
endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic
for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62-71%
ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents
such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no
specific therapies are available for 2019-nCoV, early containment and prevention of further spread
will be crucial to stop the ongoing outbreak and to control this novel infectious thread.
Keywords: coronavirus; persistence; inanimate surfaces; chemical inactivation; biocidal agents;
disinfection

[InTheBlack]

"That’s why they test asymptomatic cases, In the Black."

Yes but how do they determine whom to test? An asymptomatic person is not going to the doctor -- are they doing a random epidemiologic survey within some geographic area?

And its been claimed that they only have the capacity to perform 3000 tests a day, so would they use that precious capacity to test people who are not at all sick?

[mugwump]

"That’s why they test asymptomatic cases, In the Black."

Yes but how do they determine whom to test? An asymptomatic person is not going to the doctor -- are they doing a random epidemiologic survey within some geographic area?

And its been claimed that they only have the capacity to perform 3000 tests a day, so would they use that precious capacity to test people who are not at all sick?

A better question is why do they test symptomatic patients in the middle of a pandemic? Odds are, if they have symptoms, they’ve got it. And if they throw a few folks with the common cold into quarantine, luck of the toss. Shoulda stayed home.

They’re not trying to help people, they’re trying to identify spreaders. Asymptomatic family members of sick folk, medical and transport staff, the actual testing staff themselves, response teams interacting with the public, just a few types of asymptomatic people I’d test. You don’t want one med tech bringing down the whole shift. Testing symptomatic people seems a waste of resources in their situation.

[mugwump]

If you want to attend a masterclass on public communication, search “ PM Lee urges Singapore to take courage amid coronavirus outbreak”. Short, clear, emphasis on flexibility of response. The guy's freaking brilliant.

[Stobey]

Not a lot of good OTC meds for nausea - diphenhydramine (benadryl) can be used, but it has sedating effects. Pepto-Bismol and similar compounds may help some.

Best safe antiemeitc by prescription in my book is ondansetron (zofran) - and I treat a lot of nausea in my profession.


Speaking of sedating effects from diphenhydramine, is compazine still available for nausea?

[InTheBlack]

Looked thru the report I referenced below. Here's another URL to it, the Pre-Press draft:
https://sci-hub.tw/10.1016/j.jhin.2020.01.022

In-Press version:
https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext#sec3.1

They seem to be different drafts, at least the tables appear differently formatted on my computer.

They aggregated a lot of recent studies. But its not very good for answering "does the stuff under my kitchen sink work?"

ETHANOL at 78% for 30 seconds reduced infectivity by >5.5 on a log scale. But is there any hard liquor with that much? Some state's don't sell grain alcohol, vodka is only 50% alcohol...

For hand sanitizing, does alcohol gel hand have that much, in effective contact? I think its only 70%.

70% ethanol took 10 minutes to get to 3.3 or 3.9 (different strains). It will evaporate before that in real life, unless you are soaking something in a closed container.

SO HAND CLEANING IS DIFFICULT - 78% is harder on your skin.

Lysol Spray is only 58% ethanol, and 0.10% B.A. saccharinate (not B.A.C.), which was not tested in these research papers.


B.A.C. (BENZALKONIUM CHLORIDE) at 0.2% for 10 minutes killed ZERO. Very odd. But 0.5% required 10 minutes to reach >3.7, so similar to 70% ethanol for 10 min . But a smaller concentration for 10 days still killed something... its not clear if they inoculated that surface after 10 days to learn the effectiveness of the residual product, or merely checked it.

SO ACHIEVING THE RIGHT DILUTION FOR BAC IS PROBLEMATIC


SODIUM HYPOCHLORITE (BLEACH) 0.21% took 30 seconds to reduce by >= 4.0.
>
Inactivation of coronaviruses by biocidal agents in suspension tests
...
Sodium hypochlorite required a minimal concentration of at least 0.21% to be effective.
...

Inactivation of coronaviruses by biocidal agents in carrier tests
Concentrations of 0.1- 0.5% sodium hypochlorite ... <3.0
...

Discussion
Human coronaviruses can remain infectious on inanimate surfaces at room temperature for up to 9
days. At a temperature of 30°C or more the duration of persistence is shorter. Veterinary
coronaviruses have been shown to persist even longer for 28 d
...
The typical use of bleach is at a dilution of 1:100 of 5% sodium hypochlorite
resulting in a final concentration of 0.05% [13]. Our summarized data with coronaviruses suggest that a concentration of 0.1% is effective in 1 min (Table 3). That is why it seems appropriate to recommend a dilution 1:50 of standard bleach in the coronavirus setting
>

But I think they probably used lab grade, known fresh -- the bleach by your washing machine could be old, and my Clorox bottle does not even state its percentage anymore !!! EDIT: the powder form is Calcium hypochlorite, I think sometimes used for pools, but less of a disinfectant?

What is a "suspension" vs a "carrier" situation?


HYDROGEN PEROXIDE 0.5% for 1 minute reduced by >4.0.
My Lysol spray cleaner says its 0.88% but of course no data on the percentage a month after you have opened the container.

[Razor]

DOD/DHS are setting up more quarantine centers on military bases:

JB Pearl Harbor-Hickam, Hawaii (HNL)
Great Lakes Training Center Navy Base, Illinois (ORD)
Naval Air Station Joint Reserve Base, Texas (DFW)
March ARB, California (LAX)
Travis AFB, California (SFO)
Dobbins ARB, Georgia (ATL)
Fort Hamilton, New York (JFK)
Naval Base Kitsap, Washington (SEA)
Joint Base Anacostia, Washington DC (IAD)
Joint Base McGuire-Dix-Lakehurst, New Jersey (EWR)
Fort Custer Training Center, Michigan (DTW)

The Department of Defense already has quarantine centers at Fort Carson in Colorado, Travis Air Force Base and Marine Corps Air Station Miramar in California, and Lackland Air Force Base in Texas.

https://www.miamiherald.com/news/nation-world/national/article240078853.html#storylink=cpy

Is that just now hitting the press? We were working the coordination for Travis, Lackland, Miramar, and Carson for over a week, and the other locations since last Friday. Frankly, several of those were supposed to drop off the table due to lack of DHHS need, but senior folks want to press on 'just in case'.

[mugwump]

Is that just now hitting the press? We were working the coordination for Travis, Lackland, Miramar, and Carson for over a week, and the other locations since last Friday. Frankly, several of those were supposed to drop off the table due to lack of DHHS need, but senior folks want to press on 'just in case'.

Hit the news last Friday and Saturday I think. Great Lakes certainly made the local news here then. I certainly hope none of them are needed but it makes sense to be prepared. I wonder what the recent event at Miramar is doing to base procedures. Rhetorical question. CDC didn’t exactly cover them selves with glory on that one—testing snafu let a confirmed positive back into the base instead of hospital quarantine.

[InTheBlack]

Is that just now hitting the press? We were working the coordination for Travis, Lackland, Miramar, and Carson for over a week, and the other locations since last Friday. Frankly, several of those were supposed to drop off the table due to lack of DHHS need, but senior folks want to press on 'just in case'.

What capacity are they aiming for? Makes sense to have a location near to every airport that handles international traffic.

[PSM]

Makes sense to have a location near to every airport that handles international traffic.

Sucks that it's near our possible frontline troops.

[InTheBlack]

Trying to square different units of measure in different references:

Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents kampf PRE PROOF

https://sci-hub.tw/10.1016/j.jhin.2020.01.022

The typical use of bleach is at a dilution of 1:100 of 5% sodium hypochlorite
resulting in a final concentration of 0.05% [13].

Our summarized data with coronaviruses suggest that a concentration of 0.1% is effective in 1 min (Table 3). That is why it seems appropriate to
recommend a dilution 1:50 of standard bleach in the coronavirus setting.
>

1:50 is 2/100 is 20,000 parts per million (ppm) from 5% stock. That's an odd stock solution, unless hospitals make it themselves. Or does Clorox sell a hospital product to the trade ???

vs

Disinfecting and Sanitizing with Bleach
Guidelines for Mixing Bleach Solutions for Child Care and Similar Environments - 2015 WA State Dept Health.

https://www.doh.wa.gov/Portals/1/Documents/8340/970-216-Disinfect-en-L.pdf


Background: Sodium hypochlorite is the active ingredient in household bleach or chlorine bleach.

It is economical, and is an effective disinfectant with a broad spectrum of antimicrobial activity. It has been the primary disinfectant used in early learning programs in Washington State for more than 30 years.

During this time, most household chlorine bleach was available at strengths of 5.25- 6.25%. The recommended concentration for disinfection has been 600-800 ppm of chlorine bleach and 50 to 200 parts per million (ppm) for sanitizing.

In 2012, some manufacturers changed their chlorine bleach formulation to a strength of 8.25% with a registered non-food contact surface disinfection level of 2400 ppm, the level often used in hospitals. Their sanitizing level is 200 ppm, the upper end of the range allowed by the Food and Drug Administration (FDA).
>

It shows a chart to make 600-800ppm from 3 stock concentrations. But that is disinfection, not sanitization which I believe would be the 20,000ppm amount stated in the research paper.

But I don't know if there is a simple linear relationship, ie 33 x 600ppm amount = 20,000, because chlorine chemistry is a balancing act between several chemical species. So it might call for more or less than a linear amount of chemical. Anyone know?

I suppose 1:50 of a 5.25% stock won't be too strong, but 8.25% might be worth doing some math to get it correct.

[mugwump]

Markets are going nuts because cases are “leveling off” yet reports coming from frontline medics are saying all Hubei province test kits were expended 09 Feb. They’re scrambling to make more. Even with bilateral lung lesions on CAT scan the current rules state a case can’t be reported confirmed until tested. Why no cases in Indonesia? Africa? Are the majority of cases mild? Sure hope so.

[mugwump]

While this will be a huge shock to Wall Street tomorrow, it's actually very, very good news...

China’s Hubei province reported 14,840 new cases and 242 additional deaths today, reversing the "leveling off" narrative. They've abandoned the official definition of a "confirmed case" (positive RNA test with no symptoms=no case) and they have added in the obvious--cases with confirmed lesions in the lungs and those patient presenting with the symptoms they've come to know accompany this disease.

Word is, the final straw for Hubei was the lack of testing (because of NO test kits since the 9th) leading to the narrative of "leveling off". Things are not leveling off.

36204

[mugwump]

It'll be very, very interesting to see if Beijing contradicts the Hubei province's official figures. There has to be a war going on internally in Beijing between the camp that wants transparency and the bureaucrats who are trying to salvage the economy, "move along, nothing to see..."

If Hubei has gone rogue, someone has very big brass balls.

When I said watch what happens with this selective "return to work initiative" for businesses deemed critical to the internal supply chain? Well, it blew up. One example: A whole shift showed up to a chip fab operation, one worker became ill on the job, and now they've got 200 critical employees huddled together under quarantine in the plant cafeteria. They somehow organized getting quilts but there's apparently no food. May god help them.

Maybe that was the straw that broke the camel's back with the daily stats and the sudden and heretofore missing outbreak of honesty.

Note that even this apparently shocking increase in cases is probably an order of magnitude low, IMO only. It can't count the poor slobs sheltering in place at home and I'm guessing they are legion, given they'd only be forced into a quarantine facility if they sought treatment. And there's no treatment to be had anyway. Oxygen is gone. An ICU bed is a dream.

Things are not good in China.

[Surf n Turf]

Things are not good in China.

Mugwump

SAN DIEGO LAB DISCOVERS CORONAVIRUS VACCINE IN 3 HOURS :confused:

Maybe some hope….. it may settle the current unrest in China, and perhaps stop a selloff on our markets…..IF IT IS TO BE BELIEVED

SnT

Inovio Pharmaceuticals created a vaccine that is going through pre-clinical trials.
SAN DIEGO — In a race against the clock, a San Diego lab is scrambling to get a COVID-19 vaccine out and on the market. As the days go by, Inovio Pharmaceuticals is getting closer to releasing the desperately needed vaccine against the deadly virus.

Inovio Pharmaceuticals, which is located in Sorrento Valley, has also created a vaccine for the Zika virus, the Middle East Respiratory Syndrome (MERS), and the vaccine for Ebola.
https://www.kvue.com/amp/article/news/health/coronavirus/coronavirus-vaccine-san-diego/509-e18e37f6-347c-4b08-ad33-910968abb04f?__twitter_impression=true

[mugwump]

Hope the vaccine story is true, but I don’t see how they could know if it works in the wild. They’re doing early Phase I trials, which is my rice bowl, and in those “turn blue” studies they just confirm that the vaccine doesn’t kill healthy, young volunteers. They’ll do antibody titers, sure, but that’s not the goal at this stage. Hope I’m wrong but the consensus I’m hearing is 18 months until there’s a legit vaccine, manufactured in sufficient quantity to be useful.

The only guys with the production capacity and know how to spin up vaccine in quantity are Glaxo, Merck, and Sanofi. I can say now I was on the Glaxo team during the last scare, and they in particular were badly burned by two-faced pols and lost buckets of money, enough to really hurt. I’m sure they’ll do the right thing but the pols have to get their indemnity and funding in line fast. It’s gonna be bloody expensive even if they do it on a break even basis. And then who gets the vaccine first from a Brit company? Or Sanofi in France? Hope Merck's involved.

We may just have to stand and take a beating with this one.

[mugwump]

A top journal preprint (undergoing peer review) funded by DARPA and Los Alamos (I’m guessing supercomputer time) has calculated the Ro to be 4.7-6.6. Which is yikes, we're buggered.

We collected extensive individual case reports and estimated key epidemiology parameters, including the incubation period. Integrating these estimates and high-resolution real-time human travel and infection data with mathematical models, we estimated that the number of infected individuals during early epidemic double every 2.4 days, and the R0 value is likely to be between 4.7 and 6.6. We further show that quarantine and contact tracing of symptomatic individuals alone may not be effective and early, strong control measures are needed to stop transmission of the virus.

The last hope is for the majority of cases to be mild. CIDRAP is guesstimating we're only catching and quarantining 1/3 of the positives flying in, so essentially, it’s here and containment will be difficult. So pray for <1% mortality and not the 5%-I don’t even want to say that researchers are estimating for China.

Gotta go, I have to clear my browser history.

[mugwump]

I’m not privy to anything not publicly sourced, but there seems to be a quiet consensus growing that this is so infectious that up to 60% of the world will have to be infected before this burns out. The disease has to achieve a Ro <1.0 before it even plateaus. We can achieve that with a vaccine, non-pharmacologic means (quarantine, hand washing, etc.) or a population that becomes immune by surviving the disease.

If we're truly starting with a Ro in the 5 range, getting below 1 is going to probably mean all three measures will come into play. Pray it has many mild cases. Pray that summer heat will give some respite, although surface viability rest have shown surprising heat tolerance.

It’s a f***ing weapon and it’s doing what is was designed to do.

[InTheBlack]

Hope I’m wrong but the consensus I’m hearing is 18 months until there’s a legit vaccine, manufactured in sufficient quantity to be useful.

The only guys with the production capacity and know how to spin up vaccine in quantity are Glaxo, Merck, and Sanofi.

China has thousands of bipedal lab rats already infected. You know that the Chinese are trying to get it via backdoor means and start injecting it to see if it works.

And what about the other vaccine which was already used on the first USA case, in Washington state? remdesivir. They should be updating his status in some publication.

I can't find the article on how the company developing remdesivir applied for a Chinese patent in 2016... Anyone got a URL to that info? The name of the company ?

[InTheBlack]

A top journal preprint (undergoing peer review) funded by DARPA and Los Alamos (I’m guessing supercomputer time) has calculated the Ro to be 4.7-6.6.
...
CIDRAP is guesstimating we're only catching and quarantining 1/3 of the positives flying in, so essentially, it’s here and containment will be difficult. So pray for <1% mortality and not the 5%-I don’t even want to say that researchers are estimating for China.

Got the URL or title to that preprint?

What is CIDRAP ?

[InTheBlack]

So Emetrol is nothing more than a flat Coke !!! Well, I haven't check the Potassium content... is that a critical ratio of ingredients? Why is it effective?

https://healthjade.com/emetrol/
>
Emetrol is a phosphorated carbohydrate (sugar) solution used for the relief of upset stomach associated with nausea due to overindulgence in food and drink. Emetrol active ingredients in each 5 mL are: 1.87 g Dextrose (glucose) + 1.87 g Levulose (fructose) + 21.5 mg Phosphoric acid

Inactive ingredients: FD&C red no. 40, flavors, glycerin, methylparaben, and purified water.
>

[mugwump]

https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1

[echoes]

So Emetrol is nothing more than a flat Coke !!! Well, I haven't check the P content... is that a critical ratio of ingredients? Why is it effective?

https://healthjade.com/emetrol/
>
Emetrol is a phosphorated carbohydrate (sugar) solution used for the relief of upset stomach associated with nausea due to overindulgence in food and drink. Emetrol active ingredients in each 5 mL are: 1.87 g Dextrose (glucose) + 1.87 g Levulose (fructose) + 21.5 mg Phosphoric acid

Inactive ingredients: FD&C red no. 40, flavors, glycerin, methylparaben, and purified water.
>

Interesting analysis. Obviously I am no doctor, it is just what works for our family, and has for decades. Funny too because we are a household that does not drink sodas of any kind.

I did check with my doc this morning though, and he gave the all clear for Emetrol use. :munchin


JMHO, back to the discussion...


Holly

[mugwump]

Largest study to date from China CDC of first 4021 laboratory confirmed cases w/ #2019nCoV #COVID19 from 30 provinces. Preprint, undergoing peer review now.

R0 ~3.77 (95% CI 3.51-4.05)

Case fatality rates (CFR) ~3.06% with significant gender difference
- Male 4.45%
- Female 1.25%

Case fatality rates (CFR) difference between age groups are even more pronounced than gender:

<60 y 1.43%
≥ 60 y 5.30%

https://www.medrxiv.org/content/10.1101/2020.02.10.20021675v1

I urge everyone to start identifying as a 22 yo female. Immediately.

[mugwump]

Why I think you shouldn’t count on a vaccine or pharmacological therapy...no time.

The projection below assumes no effective non-pharmacological measures (i.e. whatever they're doing in China, and ultimately here, won’t work), a Ro of 2.5 (which is low in light of current US and Chinese studies) and no significant drop in cases during warm weather (which seems possible from surface infectivity studies).

Note we're way ahead of this “worst case” projection now, probably because their Ro assumption is low/wrong. And note the staggering growth near the bottom of the chart...exponential growth is an absolute bitch.

Prepare to isolate. Don’t assume you'll get water when you turn on the tap. Or power. Or grocery deliveries. If the bottom of the chart comes true it’s going to get Old Testament biblical for a period of time. We may lose an entire crop. Remember the chain for getting seeds in the ground and harvested: functioning financial systems, power, fertilizer/insecticide/herbicide synthesis, transport, fuel delivery, spare parts, healthy farmers. And this is coming on the heels of one of the worst harvests since the Great Depression.

Supply chain disruption could cause more deaths than the virus.

Pray the chart is wrong.


36206

[PedOncoDoc]

Why I think you shouldn’t count on a vaccine or pharmacological therapy...no time.

The projection below assumes no effective non-pharmacological measures (i.e. whatever they're doing in China, and ultimately here, won’t work), a Ro of 2.5 (which is low in light of current US and Chinese studies) and no significant drop in cases during warm weather (which seems possible from surface infectivity studies).

Note we're way ahead of this “worst case” projection now, probably because their Ro assumption is low/wrong. And note the staggering growth near the bottom of the chart...exponential growth is an absolute bitch.

Prepare to isolate. Don’t assume you'll get water when you turn on the tap. Or power. Or grocery deliveries. If the bottom of the chart comes true it’s going to get Old Testament biblical for a period of time. We may lose an entire crop. Remember the chain for getting seeds in the ground and harvested: functioning financial systems, power, fertilizer/insecticide/herbicide synthesis, transport, fuel delivery, spare parts, healthy farmers. And this is coming on the heels of one of the worst harvests since the Great Depression.

Supply chain disruption could cause more deaths than the virus.

Pray the chart is wrong.


36206

Time will tell with regards to this outbreak - they cast similar predictions with other viral outbreaks starting in China over the past 20 years. Necessity may lead to some care breakthroughs if things continue to escalate.

What I'm most worried about is those "Cum Infections" they mention in that chart. - those working girls are going to have to be extra careful! :eek:

:D

[Surf n Turf]

Hope I’m wrong but the consensus I’m hearing is 18 months until there’s a legit vaccine, manufactured in sufficient quantity to be useful.

The only guys with the production capacity and know how to spin up vaccine in quantity are Glaxo, Merck, and Sanofi. . And then who gets the vaccine first from a Brit company? Or Sanofi in France? Hope Merck's involved.



Mugwump,

Looks like funding and participation are not going to be a problem this time

Hate to use NPR as a source for anything…..but this was the only place I could find the current players.

Also noted, they replaced previous “The previous day, the People’s Liberation Army Daily reported that Chen Wei, China’s top expert in biological warfare, has been leading the efforts to overcome the deadly, pneumonia-like pathogen for the last nine days.”

I wonder if CEPI is a division of DARPA

SnT

(From the middle of the Article)

Both Chappell's team in Australia and Weiner's team in Philadelphia, in collaboration with the pharmaceutical company Inovio, are getting financial support from a fairly new organization called CEPI, the Coalition for Epidemic Preparedness Innovations. CEPI is a global partnership of public, private and philanthropic organizations; it's also supporting efforts at the biotech companies Moderna and CureVac.

Among other vaccine efforts worldwide, the pharmaceutical giant Johnson & Johnson is working on a vaccine, and GSK has also offered to help new vaccine efforts. Researchers at Imperial College London have developed a vaccine that's already being tested in animals, and vaccine efforts are also reportedly underway in China.

https://www.npr.org/sections/health-shots/2020/02/12/804628081/timetable-for-a-vaccine-against-the-new-coronavirus-maybe-this-fall

[EricV]

Mugwump,

Looks like funding and participation are not going to be a problem this time

Hate to use NPR as a source for anything…..but this was the only place I could find the current players.

Also noted, they replaced previous “The previous day, the People’s Liberation Army Daily reported that Chen Wei, China’s top expert in biological warfare, has been leading the efforts to overcome the deadly, pneumonia-like pathogen for the last nine days.”

I wonder if CEPI is a division of DARPA

SnT

(From the middle of the Article)

Both Chappell's team in Australia and Weiner's team in Philadelphia, in collaboration with the pharmaceutical company Inovio, are getting financial support from a fairly new organization called CEPI, the Coalition for Epidemic Preparedness Innovations. CEPI is a global partnership of public, private and philanthropic organizations; it's also supporting efforts at the biotech companies Moderna and CureVac.

Among other vaccine efforts worldwide, the pharmaceutical giant Johnson & Johnson is working on a vaccine, and GSK has also offered to help new vaccine efforts. Researchers at Imperial College London have developed a vaccine that's already being tested in animals, and vaccine efforts are also reportedly underway in China.

https://www.npr.org/sections/health-shots/2020/02/12/804628081/timetable-for-a-vaccine-against-the-new-coronavirus-maybe-this-fall

Sounds great. Sounds like we have Top People on it, Top People!! Course, if Mugwump's chart is correct, most of us will be dead. :eek:

[InTheBlack]

The projection below assumes no effective non-pharmacological measures (i.e. whatever they're doing in China, and ultimately here, won’t work), a Ro of 2.5 (which is low in light of current US and Chinese studies) and no significant drop in cases during warm weather (which seems possible from surface infectivity studies).

36206

The chart does not factor in reduction in rate of increase due to proactive social distancing.

What exactly is the material used to make surgical masks? Wonder if a field expedient would be to use gauze pads which have that woven blue non-stick layer ? Or just the blue woven fabric that is used on beds to keep the patient from touching the sheets directly, and to catch spills? What is that stuff called?

EDIT: followup comment by creator of that chart (dated 27JAN20):
Beyond China
Matt Sterett Feb 10
The model’s early forecasts were, in fact, conservative.
***We actually underestimated the near-term risk***
By a factor of 6x.
Reported figures now tally at >40k infections.
Now, back to our critics.

https://reservereport.substack.com/?no_cover=true

the spreadsheet itself, you can modify presumptions:

https://docs.google.com/spreadsheets/d/1I6zoBTDVjktCdISyyG_o5HzOYT-juqytvomA7f0Qqo8/edit#gid=2146925776

[InTheBlack]

Someone should modify that spreadsheet so you can change the R0 for every row (weekly) -- that would account for social distancing measures.

Figuring out a "good" number for how much quarantines etc reduce R0 might be difficult, or maybe not if data can be analyzed from measles, polio, Ebola, etc outbreaks.

[InTheBlack]

https://www.scmp.com/news/hong-kong/health-environment/article/3050689/how-make-your-own-mask-hong-kong-scientists

The University of Hong Kong-Shenzhen Hospital worked with the Science Park to devise the do-it-yourself method
...

Joe Fan King-man, the institution’s assistant hospital chief executive, said the home-made masks had undergone laboratory tests by City University and were proven to have achieved 80 to 90 per cent of the function of regular surgical masks in terms of their filtration of aerosol and droplets.

How to make your own masks and protective shield at home.

Required items: kitchen roll, strong tissue paper, elastic bands, a hole punch, paper tape, scissors, plastic-coated steel wire, a pair of glasses, plastic file folders and binder clips.

Preparation:
For the mask:
Wash your hands thoroughly with soap and clean your items
Put one piece of kitchen roll, with proper hygiene certification, on top of another
Place a piece of tissue paper, which will act as the bottom layer of the mask, on top of the two pieces of kitchen roll
Cut the stack of paper into two
Use the paper tape to seal off the two sides of the mask
Make two holes at each sealed side with the punch
Attach the metallic wire with paper tape to the top edge of the mask to make the nose bridge wire
Tie four rubber bands through the holes on the mask’s sides

For the protective shield:
Cut the file folder into two pieces
Attach one piece on the edge of the glasses with binder clips
The shield can be reused after disinfection for each usage
Note: The hospital said other materials such as cling film, air conditioner filter paper, and cotton cloth were not suitable for making the masks.

[InTheBlack]

Can you use Denatured Ethyl Alcohol for skin disinfection, or will the denaturants penetrate the skin & be toxic?

EDIT: obviously methanol is toxic, but I'm seeing other denaturants listed instead:

I see there are several chemicals that can be used as denaturants.
2-propanol, 2-methyl (CAS 75-65-0)
tert-Butyl alcohol
denatonium Benzoate (CAS 3734-33-6) as a bitterant.

and probably others.

EDIT: this is good info but I'm still wondering about the amount used:

https://thedermreview.com/alcohol-denat/

Safety

The Cosmetic Ingredient Review Expert Panel (CIR) concluded that safety of ingredients containing denatured alcohol should be predicated on the safety of the denaturants used since dermal application or inhalation of cosmetic products containing these ingredients will not produce significant systemic exposure to ethanol. The Panel considered that the adverse effects known to be associated with alcohol ingestion do not suggest a concern for Alcohol Denat. or SD Alcohols because of the presence of the denaturants.

The safety of the alcohol denaturants Denatonium Benzoate, t-Butyl Alcohol, Diethyl Phthalate, and Methyl Alcohol were reviewed by the CIR Expert Panel in 2008 and found to be safe as used.

Despite the approval of denatured alcohol by the CIR Expert Panel, the safety of this ingredient in skin care products is controversial. When high concentrations of denatured alcohol are used in the formulation of skin care products, this ingredient can cause drying and irritation.

Denatured alcohol can also cause erosion of the skin’s surface layer, leading to a weakened skin barrier. However, according to FutureDerm, if lower concentrations of denatured alcohol are used, this ingredient may simply be acting as a degreasing agent, making for a better texture of the skin care formulation.

Ultimately the safety of Alcohol Denat. in cosmetics and personal care products depends on both the type of denaturant and also the concentration that is used to create the formulation.

References: Cosmetics Info, “Alcohol Denat”, Wikipedia, “Denatured Alcohol”, The Naked Chemist, “Astringent products, their role on the skin”, 2015, Paula’s Choice, “Alcohol in Skincare: The Facts”, Int J Toxicol. 2008;27 Suppl 1:1-43, FutureDerm, “The Most Misunderstood Skincare Ingredient: Alcohol”, 2007.

[The Reaper]

I thought the goal was an N95 mask, not a surgical mask.

TR

[mugwump]

I thought the goal was an N95 mask, not a surgical mask.

TR

Exactly. Surgical masks limit spread, N95 mitigates spread and offers limited protection to the wearer if worn properly

[EricV]

Exactly. Surgical masks limit spread, N95 mitigates spread and offers limited protection to the wearer if worn properly

It shows the system is running out of masks and/or breaking down... no N95 masks available.


This is war. The #wuhan gov announced today all residential complexes will be sealed up. People need to get permission to exit. My mom told me there’s only one food market in our complex, and she couldn’t even get flour. #coronavirus

My aunt’s parents-in-law are in their 80s and my uncle sends 3 meals to them every day. They don’t live in the same complex. Now that the gates are sealed, they can only rely on the community volunteers, who are swamped with other tasks, for food supplies.

My youngest uncle, a middle school PE teacher and Communist Party member, has been sent to work at a remote residential compound as a security guard. It’s a 7-day shift and no masks were provided.


https://twitter.com/xinyanyu/status/1228365678777962496?s=21

[mugwump]

It shows the system is running out of masks and/or breaking down... no N95 masks available.

This is war...

https://twitter.com/xinyanyu/status/1228365678777962496?s=21

Well, yeah, that’s what happens in a pandemic. Supply chains, poof. If you read about plagues it’s the follow-on stuff that really kills people. Famine. Political upheaval. War.

That’s why I wonder about getting a crop in and feeding 1.6B people when there’s also swine fever and avian flu just ripping through their ag system.

[EricV]

I wonder how accurate this is...

This is really a bombshell. Naval University of Engineering in #Wuhan, one of the five comprehensive military universities of PLA (official info: bit.ly/2URmJ5x) issued a lockdown notice on Jan. 2, 18 days BEFORE the gov. admitted there was an epidemic, 21 days BEFORE..
...the city was locked down. Did the army know something beforehand that we didn't know?


https://twitter.com/jenniferatntd/status/1228435742369644544?s=21

[mugwump]

As a dad with a daughter in health care this caught my attention.

The Chinese are openly discussing whether it makes sense to risk 1700 infected doctors and nurses, which is where they’re at right now in Wuhan, to save a few hundred old people. Very few are reported cured once hospitalized.

The CCP seems to be going into salvage mode now, IMO. What can we preserve?

If I was playing the game Civilization, I’d save the doctors, let the burdensome old people die, and build a sports arena to distract the populous<couphTaiwan>.

[mugwump]

I wonder how accurate this is...

This is really a bombshell. Naval University of Engineering in #Wuhan, one of the five comprehensive military universities of PLA (official info: bit.ly/2URmJ5x) issued a lockdown notice on Jan. 2, 18 days BEFORE the gov. admitted there was an epidemic, 21 days BEFORE..
...the city was locked down. Did the army know something beforehand that we didn't know?


https://twitter.com/jenniferatntd/status/1228435742369644544?s=21

Xi has all but admitted this. Beijing replaced the Wuhan P4 bug farm leadership with a PLA biowarfare general, passed a new biosecurity law this week to tighten up procedures and penalties following leaks, etc. and is in general grooming the center to take the fall. Thankfully they aren’t going down the “America did it!” trail like they looked to be doing for a while.

[Surf n Turf]

I wonder how accurate this is...

This is really a bombshell. Naval University of Engineering in #Wuhan, one of the five comprehensive military universities of PLA (official info: bit.ly/2URmJ5x) issued a lockdown notice on Jan. 2, 18 days BEFORE the gov. admitted there was an epidemic, 21 days BEFORE..
...the city was locked down. Did the army know something beforehand that we didn't know?


https://twitter.com/jenniferatntd/status/1228435742369644544?s=21

EricV,

This makes some Sense if the Wuhan lab had a “contagion alert” in the timeframe of late / mid December, and finally had to act in January. It also explains why Major General Chen Wei was “officially”placed in command of the situation, especially if an “event”occurred in HER laboratory ………(which is the way I am currently thinking).

SnT

[InTheBlack]

Brief article comparing R0, Mortality Rate, Latent Period with other diseases.

https://www.medscape.com/viewarticle/924319
...
Seasonal flu, for example, has an R0 of around 1.5.
The Spanish influenza of 1918-1919 had an R0 as high as 2. Fatality to 10%.
Chickenpox, which is fairly infectious, has an R0 of around 5.
...
HIV before treatment was available, with an R0 of around 6 globally and a near 100% mortality rate.
Smallpox, with an R0 of 5 and a mortality rate of 30% in the unvaccinated.
Bubonic plague: R0 of 3, untreated mortality rate of 60%.
...
For the new coronavirus, LATENT PERIOD appears to be around 5 days—not too long.

[InTheBlack]

They won't use the actual name of the virus because it accurately tells people it is related to SARS:

https://www.sciencemag.org/news/2020/02/bit-chaotic-christening-new-coronavirus-and-its-disease-name-create-confusion?
>
COVID-19 is a name for the disease, not for the virus that causes it, which until now had a temporary moniker, 2019-nCoV, signifying it was a novel coronavirus that emerged last year.

But the pathogen also got a new designation, which arrived before Tedros had even finished his press conference, by way of a preprint posted on bioRxiv by the body charged with classifying and naming viruses. The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses, the paper noted, had decided that the virus is a variant of the coronavirus that caused an outbreak of severe acute respiratory syndrome (SARS) in 2002–03. So, it named the new pathogen severe acute respiratory syndrome-related coronavirus 2, or SARS-CoV-2.

But that’s not a name WHO is happy with, and the agency isn’t planning on adopting it. “From a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak in 2003,” a WHO spokesperson wrote in an email to Science. “For that reason and others, in public communications WHO will refer to 'the virus responsible for COVID-19' or 'the COVID-19 virus,' but neither of these designations is intended as replacements for the official name of the virus" that the study group has picked.
>

[InTheBlack]

http://rocs.hu-berlin.de/corona/
>
Event Horizon - COVID-19
2019 Novel Coronavirus Global Risk Assessment

This site compiles results obtained from a computational / mathematical model for the expected global spread of the novel coronavirus that originated in the Chinese province of Hubei in December 2019. The foundation of the model is the worldwide air transporation network that connects over 4000 airports with more than 50000 flight routes.
>

[InTheBlack]

https://www.sciencemag.org/news/2020/02/scientists-are-racing-model-next-moves-coronavirus-thats-still-hard-predict

>
So, how seriously should this model, and the dozens of other computer simulations of the outbreak, be taken? Scientists studying the 2019-nCoV outbreak are getting plenty of data to groundtruth and tweak their models.

A modeling study by a different group DATED 2FEB20

REF TO : https://www.medrxiv.org/content/10.1101/2020.01.31.20019901v1

used the data to assess transmission dynamics, concluding that once a place has three cases, there is more than a 50% chance the virus can become established in the population.
...

The real question from a population standpoint is what is the probability with an Ro of, say, 2.2, that there will be sustained transmission of the virus? With this new virus, Thompson calculates there’s a 54.5% chance of sustained spread starting from a single infected person if nothing, for example a vaccine, prevents transmission.
...

In the lingo of modelers, what matters most is not the unchanging “basic” reproduction number of Ro, but what they somewhat unimaginatively refer to as the reproduction number, or R, that factors in these other variables. R is constantly in flux. Here’s an example of R, expressed as a percentage: Thompson calculates that if 50% of infected symptomatic people are isolated and 20% are asymptomatic, then the risk of sustained transmission is 24.2%.

The take home message from this R analysis is that countries other than China still have a good chance of containing 2019-nCoV.
...

He points to calculations by an international team of scientists that the Wuhan travel restrictions, which those researchers described as the largest quarantine in human history, delayed spread to other cities in China by just 2.91 days. “Keeping Wuhan locked down now would not make a difference for [epidemiological] curves for other cities in China now,” Wu says. “Now, social distancing there is essential.”

Hong Kong, which has 24 confirmed cases to date, waited until today to close its own borders to people from mainland China. “The public had asked the government to reduce the flow from the mainland, and the government had different reasons for not wanting to do that,” Wu says. “Public health is a priority, but the economy is also a major concern. If it cuts people flow, it can also cut the supply chain of necessary products to Hong Kong.”

So the balance between public health and politics factor in to 2019-nCoV’s spread—which means a refined understanding of Ro and R, incubation time, the serial interval, and other variables can only sharpen a model’s predictive powers to a point. As most every honest modeling paper cautions, “There are limits to this analysis.”
>

[doctom54]

I thought the goal was an N95 mask, not a surgical mask.

TR

You are absolutely correct.
N95
There is NO data on this field expedient stuff.

[JJ_BPK]

You are absolutely correct.
N95
There is NO data on this field-expedient stuff.

N95 or Surgical N95 compliant?

Additionally, does the EU & UK use the same NIOSH-Approved Particulate Filtering Facepiece Respirators standards?

Aksing for my kids in the UK.

[T-Rock]

If you work in Health Care, below is the CDC's interim guidance*for personnel with potential exposure. Check out the table at the bottom of the link. If the outbreak of this virus occurs here in large numbers, I can see total decimation of ED staffing. Either that or depletion of PPE since the demand for PPE will outpace the supply. Hopefully I'm wrong. If 6-10 cases turn up positive, after admission, our department would probably be wiped out within 3-4 weeks and all of us would be on a 14 day isolation.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html?fbclid=IwAR0QYp8QmRt2tqU1aZTCFki69SU2eUmv TzQpTPt2ZSiWu7pEQ38u-LmS3Bs

[mugwump]

Mugwump

SAN DIEGO LAB DISCOVERS CORONAVIRUS VACCINE IN 3 HOURS :confused:



Looked into it. Total fabrication by the news service. It’s not even in Phase I, it’s in preclinical animals trials only.

CDC is being pretty forthright throughout all this, and they say “12-18 months at best” because there are a lot of doubts about developing an effective vaccine at all. “We can put a man on the moon but we can’t cure the common cold” because the common cold is a coronavirus, and coronaviruses are really, really good at evading and degrading our immune system. Failed CV vaccines they’ve come up with in the past have tended to fade very quickly.

[doctom54]

..... Either that or depletion of PPE since the demand for PPE will outpace the supply.......
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html?fbclid=IwAR0QYp8QmRt2tqU1aZTCFki69SU2eUmv TzQpTPt2ZSiWu7pEQ38u-LmS3Bs

I have seen that happen with the Ebola scare a few years ago.
ALL the PPE gets bought up, then prices soar (kind of like ammo did a few years ago) and it is scarce.

It is interesting that physicians in Italy wore PPE, to include masks, during the Black Plague
https://en.wikipedia.org/wiki/Plague_doctor

I'm thinking the mask looks almost like some of Louis Pasteur's swan neck bottles that began our understanding of germ theory https://en.wikipedia.org/wiki/Germ_theory_of_disease

[Divemaster]

Latest from the Johns Hopkins dashboard.

[EricV]

when they're robbing you for toilet paper!!

Armed gang steals lavatory rolls as panic-buying hits Hong Kong
The city has been hit by shortages of key household items since the coronavirus started spreading

By
Agence France-Presse
17 February 2020 • 2:17pm

https://www.telegraph.co.uk/news/2020/02/17/armed-gang-steals-toilet-rolls-panic-buying-hit-hong-kong/

[Trapper John]

Looked into it. Total fabrication by the news service. It’s not even in Phase I, it’s in preclinical animals trials only.

CDC is being pretty forthright throughout all this, and they say “12-18 months at best” because there are a lot of doubts about developing an effective vaccine at all. “We can put a man on the moon but we can’t cure the common cold” because the common cold is a coronavirus, and coronaviruses are really, really good at evading and degrading our immune system. Failed CV vaccines they’ve come up with in the past have tended to fade very quickly.

Glad you caught this:lifter
Best case scenario is to use synthetic DNA technology to produce a trial vaccine tested in animals. That would take at least 3 months. Then establishing a satisfactory manufacturing process with QC standards would require another 3 months. Conduct of the IND enabling safety and toxicology would require another 6 months. That's 12 months to the first-in-human clinical trials. Therefore we are looking at 12-18 months for a commercial vaccine.

BTW whenever you read about a vaccine being "discovered" disregard. Vaccines are not "discovered" ;)

[Old Dog New Trick]

Vaccines aren’t cures either they are preventive measures taken before exposure. Unless one serves in the military and is destined to spend time in an affected area the majority of the world population will not be inoculated against any specific diseases or viruses.

Just like getting a flu shot every year to protect from getting it the CDC has to throw a dart at the influenza dart board months before and hope they hit the right strain predicted to be most prevalent. So the proper vaccine will be formulated and stockpiled for distribution.

The only likely people to get inoculated are healthcare professionals and those susceptible to become hosts. So anyone who wins the race to produce a viable and tested anti-virus vaccine...good job.

[mugwump]

Glad you caught this:lifter
Best case scenario is to use synthetic DNA technology to produce a trial vaccine tested in animals. That would take at least 3 months. Then establishing a satisfactory manufacturing process with QC standards would require another 3 months. Conduct of the IND enabling safety and toxicology would require another 6 months. That's 12 months to the first-in-human clinical trials. Therefore we are looking at 12-18 months for a commercial vaccine.

BTW whenever you read about a vaccine being "discovered" disregard. Vaccines are not "discovered" ;)

Excellent synopsis of the timeline, thanks. At least we're not using fertile eggs like in the H5N1 era.

I’m not a NWO guy, but we need an international biowarfare treaty with inspection teeth and a concurrent assumption that countries/NGOs are going to keep cooking up bugs in defiance. Crank up the CDC budget and make their mission getting a vaccine in place in six months. And assume some civilian loon will assemble smallpox just because the genome is published and the desktop technology allows it.

Genetic engineering is getting stupid easy to accomplish. A million bucks and a good postdoc and you can accomplish a lot of mischief. I shudder every time I see one of those Oxford/U of TX/Berkeley loons on ******* spouting off about how humans need to be wiped out to save mother Gaia.

[mugwump]

Pardon my French

[tom kelly]

This is my thinking on this topic of CoVID-19 disease. The virus is SARS-CoV-2 a novel coronavirus some people think was being investigated for development by Naval University of Engineering Virology Lab of Dr. Chen Wi who is a Maj.Gen. in the Chinese Military,Her lab is in Wuhan China and that installation was the FIRST to be locked down by the Gov. on Jan.2, 2020 18 days before China admitted there was an epidemic & 21 days before the city of Wuhan was locked down (pop.11 million). Was Dr. Chen's lab looking for a vaccine or a biological weapon? Dr. Chen Wi is China's top Biowarfare expert. Now that this pathogen is worldwide it will get a lot of attention because it can be deadly, easily spread, difficult to contain,(this particular virus can hang around @9 days on a surface) There is currently NO VACCINE available in the marketplace to combat a worldwide pandemic. If there was a vaccine that was effective it would need clinical trials before production & distribution. The scale-up for a worldwide production by a pharmaceutical company would be very expensive & probably not profitable. Glaxo SK (England) lost big $$$$ on the SARS 2003 .The other 2 companies in the world capable of this vaccine production are Sandofi in France and Merck in the USA.

[InTheBlack]

assume some civilian loon will assemble smallpox just because the genome is published and the desktop technology allows it.

Not if the firmware prevents it. Same way that copy machines won't duplicate money - machine shuts down & phones home too.

Also all desktop printers microprint their unique ID number in yellow on every page. That's why they won't work without a yellow ink cartridge installed.

Governments can print enough money to fund accelerated vaccines -- the question is whether they will commit to it in time. And the totalitarian states won't be shy about testing on humans right away. Plenty of prisoners available.

[InTheBlack]

What are the hazards of an untested vaccine? Mostly that it just won't work, or that the vaccine will kill you?

During a pandemic, you could develop a dozen candidate vaccines and administer them randomly. You would know pretty quick which one works.

[Old Dog New Trick]

What are the hazards of an untested vaccine? Mostly that it just won't work, or that the vaccine will kill you?

During a pandemic, you could develop a dozen candidate vaccines and administer them randomly. You would know pretty quick which one works.

The vaccine is generally the disease in which you plan to build antibodies or antigens to fend off. So at the wrong concentration you get the disease and die or you are not protected against the disease and you die. (Well, get really sick)

[mugwump]

What are the hazards of an untested vaccine? Mostly that it just won't work, or that the vaccine will kill you?

During a pandemic, you could develop a dozen candidate vaccines and administer them randomly. You would know pretty quick which one works.

No, you wouldn’t know. You can just inoculate and then expose, that’s...frowned upon. They can measure antibody titers but it’s not always the whole story. Effectiveness is often assessed statistically, vaccines are always less than 100% effective.

There will hopefully be >1 candidate but there’s a large resource expenditure for each one. And I’m not talking $$$. Only so many people know how to do this stuff.

Manufacturing and distributing an ineffective vaccine is a public health disaster. All risk, no benefit, wasted time.

[mugwump]

The CCP is just despicable. 3,000, not 1,700 HCW, infected with 1,688 in severe/critical condition. People are making plans to fight this virus that the Chinese let loose and they lie through their teeth about every critical stat.

A team at the Chinese Center for Disease Control and Prevention (CDC) studied 72,314 cases as of Feb. 11, among which 44,672 were confirmed cases of coronavirus. The sweeping study was published Monday by the Chinese Journal of Epidemiology.

The researchers found that 3,019 medical workers had been infected, among whom 1,688 patients were in severe or critical condition. As of Feb. 11, the government acknowledged more than 1,700 medical workers nationwide as confirmed with the disease, almost 90% of them in Hubei, according to Chinese National Health Commission deputy chief Zeng Yixin at a press conference Friday.


I don’t see a count of HCW deaths, but they do say that 49% of those in critical condition died.

[abc_123]

At what point to you simply triage and isolate to avoid the exposure (and death) risk of medical professionals and resource expenditure?

Infected Male over 60yrs old....this way please..

[mugwump]

Not if the firmware prevents it. Same way that copy machines won't duplicate money - machine shuts down & phones home too.


Well first of all, they don’t do that with sequencers now, and this field is moving so fast that its really difficult to keep up. New capabilities, new gear. Second, while I don’t recommend it without some serious study, you'd be shocked to see what’s for sale on dark markets, including EEPROMs that are plug and play replacements for the mask ROMs that prevent currency copying.

Or, you can just skip the ROM chip rigamarole and buy suitcases full of counterfeit currency that’s reported to be very credible. They grade it as to its pass-ability, just like bonds, from BB- to AA. Even the lowest grade fools those yellow marker pens, pay a bit more and the stuff passes the little zip scanners that stores are now using.

The same garage shop market is going to develop for genetic engineering if it doesn’t already exist. There'll be contract biochem service providers, which I hope are being rooted out with extreme prejudice if they exist now. That said, strong encryption, bitcoin scrubbers, and a keen sense of paranoia could make finding these cats pretty difficult.

Just attempting to do this stuff could wipe out civilization.

Rogue nation states are always with us. Iran, NK, well, everyone including us, are doing this stuff now. Iran has to be looking at China and going “hmmm...that works much better than I imagined.”

The genie is out of the bottle. We need a crash program to develop the capability to produce vaccines in short, short time frames. National priority.

[mugwump]

At what point to you simply triage and isolate to avoid the exposure (and death) risk of medical professionals and resource expenditure?

Infected Male over 60yrs old....this way please..

They’re past the >60 yo male, stage. They’re talking treating anyone is too big a risk. Just send them home and good luck to you. I doubt they will, the rage would be incandescent, but it’s certainly a logical if cold-blooded position.

[Trapper John]

Excellent synopsis of the timeline, thanks. At least we're not using fertile eggs like in the H5N1 era.

I’m not a NWO guy, but we need an international biowarfare treaty with inspection teeth and a concurrent assumption that countries/NGOs are going to keep cooking up bugs in defiance. Crank up the CDC budget and make their mission getting a vaccine in place in six months. And assume some civilian loon will assemble smallpox just because the genome is published and the desktop technology allows it.

Genetic engineering is getting stupid easy to accomplish. A million bucks and a good postdoc and you can accomplish a lot of mischief. I shudder every time I see one of those Oxford/U of TX/Berkeley loons on ******* spouting off about how humans need to be wiped out to save mother Gaia.

I like the way you think! I wrote a scenario a while back on just that point. Much of my professional life has been and still is directed towards the development of the appropriate medical countermeasures. In my twisted mind, it's not a question of "If" it's a question of "When". But I'm guessing that you understand that twisted thinking? ;)

[mugwump]

I like the way you think! I wrote a scenario a while back on just that point. Much of my professional life has been and still is directed towards the development of the appropriate medical countermeasures. In my twisted mind, it's not a question of "If" it's a question of "When". But I'm guessing that you understand that twisted thinking? ;)

It’s nice to know someone's looking ahead. Every time I’ve gotten involved in these things it’s been a panicky game of catch-up. Incredibly stupid.

On the good news front and in line with a proactive approach, Singapore looks Ike they may have beaten this back, at least for now. Community spread is fading and they’re barely keeping up with contact tracing, but barely is good enough.

Do you follow Prime Minister Lee? Amazing guy with amazing cooperation among the Singaporeans. He credits everything to the people—and good luck.

He never takes credit but he’s personally met with taxi drivers, HCWs, hospitality workers, finance groups...and he leaves behind actionable policy directives and a sense of optimism.

Taxi drivers know how to asses symptoms in their fares, exactly where to bring someone w symptoms, how to warn the hospital ER teams they’re coming, how to protect themselves and decontaminate their taxis...Same same with hotel workers, office workers, etc. Damn impressive.

Japan on the other hand is teetering. Fingers crossed.

[Trapper John]

It’s nice to know someone's looking ahead. Every time I’ve gotten involved in these things it’s been a panicky game of catch-up. Incredibly stupid.

On the good news front and in line with a proactive approach, Singapore looks Ike they may have beaten this back, at least for now. Community spread is fading and they’re barely keeping up with contact tracing, but barely is good enough.

Do you follow Prime Minister Lee? Amazing guy with amazing cooperation among the Singaporeans. He credits everything to the people—and good luck.

He never takes credit but he’s personally met with taxi drivers, HCWs, hospitality workers, finance groups...and he leaves behind actionable policy directives and a sense of optimism.

Taxi drivers know how to asses symptoms in their fares, exactly where to bring someone w symptoms, how to warn the hospital ER teams they’re coming, how to protect themselves and decontaminate their taxis...Same same with hotel workers, office workers, etc. Damn impressive.

Japan on the other hand is teetering. Fingers crossed. I have not followed Lee, but based upon what you posted, maybe I should. It sounds as if he is a decentralized bottom-up leader type? That's why he is effective.

Taking a step back and looking at how this whole thing has evolved, clearly points out China's weaknesses and why China will ultimately fail. But I digress! :D

[Last hard class]

I watched "The Big Short" last night. The two young guys who made their money betting on bad things happening seems rather timely. Their philosophy was that people never believe bad things will happen so when it does the outcomes pays big.

Lose small, win big.

I have a few suppliers in China. All have been affected in some way. A couple have not gone back to work yet from the CNY . They were expected back on the 2nd. The others are on restrictions. Allowed out one day and not the next kind of thing. Saw some satellite images of china with much less smog than usual. If China is running below 70% normal capacity we are going to feel it by summer.

Macau casinos have been cleared to reopen. That's either a very good sign or a very foolish decision based on politics. Here's to it being option 1.

For the most part it seems like Americans think the world is not really connected. That a massive tragedy in China wont affect us here. For my own peace of mind I have purchased a few supplies just in case. Things that wont be available if actually needed (always knew that medical cross training we did the morning after a night of drinking would pay off :D). Already seeing price gouging online. Hopefully the virus burns itself out this spring and my supplies will be expensed under Lose Small.




LHC

[InTheBlack]

Lose small, win big.
...
my supplies will be expensed under Lose Small.


I remember when Bitcoin was $10. I would have bought some but could not figure out how to do the damn Wallet. I'd have a million now...

My supplies are an insurance expense.

Still not sure if I can use denatured alcohol for skin decon, or if I have to pay for liquor. OTOH Fed law allows individuals to distill IIRC 25 gallons a year for personal use. Where can I get a hobbyist still?

[mugwump]

Just a personal opinion, but I don’t think any mere mortal has the discipline, PPE, training, and wherewithal to avoid exposure if they’re going out in a pandemic. It's too infectious, with too many vectors. Osterholm at CIDRAP is describing it as “trying to stop the wind.”

Again, my opinion only, but talking of decontamination is ultimately pointless. Complete isolation may help you avoid the first wave, hopefully allowing time for vaccine production. But if you’re going out and about and hoping to decontaminate...good luck to you.

I know I’m repeating myself, but...

First order of business is to prepare for the most likely scenarios. There will be near total stoppage of the medicine supply chain. We’re pretty much there now, we're just not feeling it yet. Work on at least a 90 day supply of prescriptions while you can. You’ll not want to go out or possibly you’ll be placed under quarantine (food, water, entertainment, school lessons for prolonged social distancing). If you can, set aside a bit extra for those that didn’t prepare. Plan on home care for the sick, with otc meds and cleaning supplies. If you can swing it, get a stash of cash and and maybe some hard assets.

Chat with your neighbors and relations. If you/they have kids you have to consider parents going down, leaving helpless children in the home. Talk about mutual cooperation. It may increase your personal risk, but as ethical humans we have to take personal risks to protect our community (I know, I know, with this audience that’s teaching granny to suck eggs.) Phone trees for daily checks on each other. Alternate comms plan if the cells are temporarily down.

Decide if it’s worth risking exposure to aid old farts like me and my wife. Hint, it’s not. Families with kids, a different story.

If what I think is going to happen, happens, a bunch of us will fall ill but the majority will come through just fine. If you prepare and it doesn’t hit, you’ll have some supplies you probably should have around anyway. And if you talk about neighborhood cooperation, maybe you’ll build some additional goodwill within your community. We need that now, big time. You’ll have lost nothing and maybe gained in the long run.

And get that flu shot, even this late. It may be 30% effective but that’s 30% fewer people stressing the healthcare system. Those poor guys are totally slammed with flu cases right now and we have to do all we can to help keep the icu beds free.

[doctom54]

......Again, my opinion only, but talking of decontamination is ultimately pointless. Complete isolation may help you avoid the first wave, hopefully allowing time for vaccine production. But if you’re going out and about and hoping to decontaminate...good luck to you.


1918-1919 Pandemic

Worst affected was Western Samoa, formerly German Samoa, which had been occupied by New Zealand in 1914. 90% of the population was infected; 30% of adult men, 22% of adult women, and 10% of children died.

Samoa was very remote in 1919 and they were affected also!

[doctom54]

And get that flu shot, even this late. It may be 30% effective but that’s 30% fewer people stressing the healthcare system. Those poor guys are totally slammed with flu cases right now and we have to do all we can to help keep the icu beds free.

Yes. Yes. yes.

[mugwump]

1918-1919 Pandemic

Worst affected was Western Samoa, formerly German Samoa, which had been occupied by New Zealand in 1914. 90% of the population was infected; 30% of adult men, 22% of adult women, and 10% of children died.

Samoa was very remote in 1919 and they were affected also!

Every ship was a plane back then.

No place to hide, yes. That’s why you plan to be sick. And hopefully never use it.

[EricV]

Sigh... Went to my local Board of Supervisors meeting last night. Suggested that the five member Emergency Management Team which is missing three members be filled out. Suggested that the township get a web page dedicated to the situation. Give advice on hand washing, hygiene, etc.

Got the vacant, dull eyed stare of open mouth air breathers. One guy in the audience with a Chinese wife proclaimed, in so many words, it's a nothing burger.:rolleyes:

If it all blows over, I'll happily look the fool. If it doesn't, I guess I'll be a "Hero of the People!!"

Meanwhile, I believe there are 5400 people in voluntary lock down in California...:confused:

[T-Rock]

Not sure how reliable twitter is but it appears Qom, Iran, may be under quarantine:

https://mobile.twitter.com/babaktaghvaee1/status/1230257877392162818?s=21

https://www.google.com/amp/s/www.aljazeera.com/amp/news/2020/02/iran-confirms-coronavirus-cases-200220125104907.html

Edited to add:
Looks like a British Columbian who visited Iran tested positive:
https://www.google.com/amp/s/beta.ctvnews.ca/local/british-columbia/2020/2/20/1_4821112.html

[InTheBlack]

I previously linked to this paper. I'd like to know more about the CD8+ T cell issue. Maybe the MD's here can read the citation & interpret?

https://www.frontiersin.org/articles/10.3389/fcimb.2018.00343/full

Back to the Future: Lessons Learned From the 1918 Influenza Pandemic
Kirsty R. Short 1,2, Katherine Kedzierska3* and Carolien E. van de Sand
2018

>
MEDICAL INTERVENTIONS, THERAPIES AND VACCINES: THEN AND NOW
snip

Unfortunately, antibodies elicited by seasonal
influenza vaccines do not provide protection in the case of an
antigenically distinct influenza virus of a novel subtype, such
as A/H5N1 or A/H7N9 (De Jong et al., 2000). Furthermore,
current inactivated seasonal influenza vaccines may even prevent
the induction of cross-reactive CD8+ T cell responses, which
are our primary protection in case of a pandemic outbreak
and may therefore prove to be a double-edged sword (Bodewes
et al., 2009a,b, 2011b,c).

[Ret10Echo]

From LiveScience dot com

Coronavirus 'spike' protein just mapped, leading way to vaccine
By Yasemin Saplakoglu



Stephen Morse, a professor at Columbia University's Mailman School of Public Health who was also not a part of the study agrees. The spike protein "would be the likely choice for rapid development of vaccine antigens" and treatments, he told Live Science in an email. Knowing the structure would be "very helpful in developing vaccines and antibodies with good activity," as would producing higher quantities of these proteins, he added.

[T-Rock]

I can't read Chinese but it looks like Beijing is having some issues:

https://mobile.twitter.com/jenniferatntd/status/1230840909882896386

[JJ_BPK]

I can't read Chinese but it looks like Beijing is having some issues

One of the comments had an interesting side link


Pathogen cross-transmission via building sanitary plumbing systems in a full scale pilot test-rig, Michael Gormley, Thomas J. Aspray, David A. Kelly, Cristina Rodriguez-Gil, Published: February 10, 2017

Abstract

The WHO Consensus Document on the epidemiology of the SARS epidemic in 2003, included a report on a concentrated outbreak in one Hong Kong housing block which was considered a ‘super-spreading event’. The WHO report conjectured that the sanitary plumbing system was one transmission route for the virus.

Empty U-traps allowed the aerosolised virus to enter households from the sewerage system. No biological evidence was presented. This research reports evidence that pathogens can be aerosolised and transported on airstreams within sanitary plumbing systems and enter buildings via empty U-traps.

A sanitary plumbing system was built, representing two floors of a building, with simulated toilet flushes on the lower floor and a sterile chamber with extractor fan on the floor above. Cultures of a model organism, Pseudomonas putida at 106–109 cfu ml-1 in 0·85% NaCl were flushed into the system in volumes of 6 to 20 litres to represent single or multiple toilet flushes. Air and surface samples were cultured on agar plates and assessed qualitatively and semi-quantitatively. Flushing from a toilet into a sanitary plumbing system generated enough turbulence to aerosolise pathogens. Typical sanitary plumbing system airflows (between 20–30 ls-1) were sufficient to carry aerosolised pathogens between different floors of a building.

Empty U-traps allowed aerosolised pathogens to enter the chamber, encouraging cross-transmission. All parts of the system were found to be contaminated post-flush.

Empty U-traps have been observed in many buildings and a risk assessment indicates the potential for high risk cross-transmission under defect conditions in buildings with high pathogen loading such as hospitals. Under defective conditions (which are not uncommon) aerosolised pathogens can be carried on the airflows within sanitary plumbing systems. Our findings show that greater consideration should be given to this mode of pathogen transmission.



https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0171556


Aerosolised Pathogens in the sewer systems. Scary.. :eek::mad:

[mugwump]

One of the comments had an interesting side link



Aerosolised Pathogens in the sewer systems. Scary.. :eek::mad:

Yeah, this was established to be a real thing and caused documented SARS transmission. Chinese plumbing traps are shallow to decrease space between floors; a 30- story Chinese apt. building is significantly shorter than a 30 story American one.

When it's running, tap water needs boiling (fecal contamination), plumbing is a disease vector, all exits are welded shut, and really bad smells are coming from the apartment next door. Millions are in that boat.

ETA: There's a lot of speculation that tap water might be a significant vector in China. Nobody drinks tap water there, but they do use it to wash dishes, brush teeth, etc. It's generally perceived to be undrinkable due to the carcinogens produced by the ridiculously high levels of chlorination needed (high chlorine+organic material=carcinogenic compounds) but plenty of foreign nationals I know have gotten raging cases of the trots from stumbling to the sink and gulping tap water after an obligatory drunkfest. So, poopie is in the water during the best of times.

Recent research shows the virus is shed from the respiratory system in the first half of the infection and then shifts to the gut for the last half. Fecal transmission.

[T-Rock]

Well, JJ PPK, thanks for sharing that post - and that explains why it's spreading so fast in Iran (as well as other countries), and has the potential to spread exponentially (hopefully not) to us here in the US of A (sincerely hope it doesn't). Nevertheless, don't shake the left hand of a Muslim (Sunni or Shia), because their hands are permanently dusted with shit particles and are probably infested with the SARSCoV2 from those in Qom, and the surrounding cities - Studies have shown not only is this thing airborne, it's also spread via the fecal route, seriously. Lol.
https://www.google.com/amp/s/fortune.com/2020/02/20/coronavirus-fecal-transmission/amp/

One study that I've read shows that by September 2020, ( https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1?fbclid=IwAR0JXsrBE1vgqYytG8I K9zandX6uwBIbAXE9ne9twW701VgdiEesYBsnER8 )
This Virus will be totally global with an RO of nearly 6.6 and that won't fair well for our healthcare system here in the USA. The hospital where I work has only 4 (true) airborne isolation rooms. It could be disastrous for our hospital & staff considering the infection rate is nearly 30% among health care workers. If we were to have more than 4 cases in our Hospital we would be toast. Let's hope the draconian isolation measures other countries have taken will work. Hopefully the Virus will end up being nothing but its best to be prepared, right?

[Trapper John]

https://www.cell.com/cell/fulltext/S0092-8674(20)30103-3

Click on the NK cell maturation graphic so you can watch the video and don't have to read Carl. :p

OK youse guys, gather around and take a knee. Smoke 'em if you got 'em!

The problem with this whole pandemic think issue is the absence of adequate medical counter-measures! Why is that you ask? Excellent question, Carl. ;)

Every time a new antibiotic resistant bacterium emerges we go into a full-blown panic to develop a new antibiotic. Same with a new virus with pandemic potential. Rush to develop a new vaccine- e.g. the excitement surrounding the newly discovered "spike protein on the virus.

I call this the "see bug- kill bug approach. So what's wrong with that? Sit down Carl and pay attention. :p Overuse and misuse of antibiotics induces antibiotic resistance. So developing new antibiotics to combat antibiotic resistant bacteria is merely repeating the same experiment while expecting a different outcome.

Humans have been confronted with these challenges over millions of years of evolution and yet here we are. The better question is what are the natural defense mechanisms and how can they be pharmaceutically exploited to provide resistance?

Vaccine development is one strategy. Exploiting the innate arm of the immune response (see link provided above) is another. We are still in the infancy of being able to fully exploit this strategy. I published a paper in 2012 that is the first such attempt. We are continuing to push the envelope on this. [NLRP3 Inflammasome is a Target for Development of Broad-Spectrum Anti-Infective Drugs Antimicrob. Agents Chemother. 2012, 56(4):1921. Carol M. Artlett, Sihem Sassi-Gaha, Mitali Purohit, Richard F. Rest and James D. Thacker]

[InTheBlack]

One study that I've read shows that by September 2020, ( https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1?fbclid=IwAR0JXsrBE1vgqYytG8I K9zandX6uwBIbAXE9ne9twW701VgdiEesYBsnER8 )
This Virus will be totally global with an RO of nearly 6.6

I can't find that bit; "september" is not in the document.

[InTheBlack]

Remember when parents had "measles parties" to make sure that their kid got the measles done with, so it didn't infect them later as an adult? Maybe we should be culturing the virus from people who don't show symptoms...

https://www.medscape.com/viewarticle/925523?nlid=134068_1842&src=WNL_mdplsfeat_200221_mscpedit_wir&uac=361912DK&spon=17&impID=2286507&faf=1

Silent COVID-19 Cases May Stymie Screening Efforts
Brenda Goodman
February 20, 2020

snip
The researchers tested 126 people who were returning to Germany after recent travel from China. On the flight, 10 people were isolated because they were at high risk of being infected — some had symptoms, and others had contact with people who were infected.

As soon as the plane touched down, these 10 passengers were taken to a hospital and tested for the virus. None were positive.

Doctors examined the rest of the passengers at a medical assessment center at the airport. One passenger had a fever, a hard time breathing, and a cough. He was also tested, and was negative for the virus.

In a last step, researchers offered testing to the remaining 115 people who were on board the plane and who had passed their screening checks.

In a surprise twist, two of these seemingly healthy passengers tested positive for the virus. Two different labs confirmed their test results.

The passengers who tested positive were whisked to a hospital, where an exam showed that one had a very slight sore throat and a faint rash. Both remained well and never ran a fever in the week after they were admitted to the hospital.

More worrisome, when the virus that was isolated from the two passengers was placed in a test tube with healthy cells, it was able to infect them. That means it's possible they could have passed the disease on to others, even when they had few to no symptoms themselves.

"We do not yet know if they could have infected other people, but that is conceivable," says Sandra Ciesek, MD, head of the Institute of Medical Virology at the University Hospital Frankfurt. She says there's no evidence that they did.
snip

The New England Journal of Medicine: "Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China."

[T-Rock]

I thought we only had 34 cases? Now there's 70? :confused:

"Costa Mesa Seeks To Block Transfer Of Up To 70 Coronavirus Patients To City"

According to the story they're "California residents."

> https://www.google.com/amp/s/losangeles.cbslocal.com/2020/02/21/costa-mesa-coronavirus/amp/

[Badger52]

In a last step, researchers offered testing to the remaining 115 people who were on board the plane and who had passed their screening checks.

In a surprise twist, two of these seemingly healthy passengers tested positive for the virus. Two different labs confirmed their test results. [So, in other words, testing for asymptomatic persons remains optional? - in the face of evidence that the practice misses the mark.]

The passengers who tested positive were whisked to a hospital, where an exam showed that one had a very slight sore throat and a faint rash. Both remained well and never ran a fever in the week after they were admitted to the hospital.

More worrisome, when the virus that was isolated from the two passengers was placed in a test tube with healthy cells, it was able to infect them. That means it's possible they could have passed the disease on to others, even when they had few to no symptoms themselves.

"We do not yet know if they could have infected other people, but that is conceivable," says Sandra Ciesek, MD, head of the Institute of Medical Virology at the University Hospital Frankfurt. She says there's no evidence that they did. [And you know this because you've been following up everyone they're in contact with?]
Heh. What's the criteria for determining if learning is taking place again...?

[T-Rock]

Asymptomatic transmission up to 27 days.....???? Nothing to see? Really?

https://www.usnews.com/news/world/articles/2020-02-22/coronavirus-incubation-could-be-as-long-as-27-days-chinese-provincial-government-says

https://m.theepochtimes.com/growing-number-of-coronavirus-cases-outside-china-very-worrisome-who-chief_3246071.html

[TOMAHAWK9521]

I was looking up N95 masks a week ago on Amazon and found a set of 2 packs of 10 3M Aura Particulate Disposable Respirator 9211, NIOSH for roughly $55.00 IIRC. As a guy who is always tinkering in the sorcerer's laboratory, those would fit much nicer than the usual clam shell models. However, since this virus is spreading I thought I might go back and move said masks from my "wish list" into my checkout basket. When I clicked on my list this evening, they were listed as "sold out"/"don't know when they'll be available.

I was a bit stunned so I poked around for similar products and clicked on an exact copy of the set from another listing. It read, "See buying options". Click on the button and they're now listed for $185.00. Guess I should have seen that coming.

Other similar products are rated all over the place. 3M are usually listed high while others are criticized as being crap.

[T-Rock]

We're remodeling at our place so while at Lowe's this past week, my wife and I decided to take a stroll down the respirator isle just to see what their inventory was like. The young gentleman stocking on the same isle saw us looking at 2 of the 3M N100/P100 safety masks. He told us if you want those you might wanna go ahead and purchase them, because a group came in earlier and purchased 100 of those masks, all our replacement filters, and those 2 are the only ones we have left at our location. Get em' while you can.

[SF_BHT]

I stock those mask at my office and usually have 100+/- on hand always. I was questioned by my HQ with some other office how many I had and they asked all of us to ship them to the HQ warehouse.

Hummmm:eek:

Sorry to say I only had 2 on hand when they sent the request:rolleyes:

I just renewed our normal order and it will be 3 months before the order is filled.

Guess you had better buy them when you can find them......

[Badger52]

Sorry to say I only had 2 on hand when they sent the request:rolleyes: Yeah, I'd have been "fresh out" of cross-levelling stock for them as well maybe.

[frostfire]

I stock those mask at my office and usually have 100+/- on hand always. I was questioned by my HQ with some other office how many I had and they asked all of us to ship them to the HQ warehouse.

Hummmm:eek:

Sorry to say I only had 2 on hand when they sent the request:rolleyes:

I just renewed our normal order and it will be 3 months before the order is filled.

Guess you had better buy them when you can find them......

We are hoarding them at embassy no matter where the requests come from.
The supply has been designed for true SHTF pandemic!
On a related note.... the stock market... ouch 😣 !!!

[PSM]

On a related note.... the stock market... ouch �� !!!

It's a big number, but a small percentage. Don't fall for that. Plus, if you have a 401(k) you are buying in cheaply now. It hurts retirees because they don't usually have more money to invest but, if it was managed correctly, they should be fine. We are and we're fine. (We "lost" the equivalent of a Chevy Suburban today, though. ;) )

[T-Rock]

14.8% of confirmed cases among Health Care workers were classified as severe or critical.
From JAMA:
https://jamanetwork.com/journals/jama/fullarticle/2762130

[mugwump]

It's a big number, but a small percentage. Don't fall for that. Plus, if you have a 401(k) you are buying in cheaply now. It hurts retirees because they don't usually have more money to invest but, if it was managed correctly, they should be fine. We are and we're fine. (We "lost" the equivalent of a Chevy Suburban today, though. ;) )

Wait until the true magnitude sinks in. They’re out of several critical abx at my daughter's shop, a major state health magnet, and are told no resupply is in sight.

A corner was turned last Friday. All major epidemiologist and the CDC have said containment is impossible, expect a major outbreak in the US.

And do you know how many COVID19 diagnostic tests were processed in the last ten days in the US? Sixteen per day. Sixteen. That’s all CDC can do. No surge capacity either. They’re stretched at 16. South Korea has been averaging 1700 tests per day and can handle 4000/day surge.

Every once in a while a legitimate crisis reveals how corrupt things have gotten. We're there.

[mugwump]

The twitterverse is abuzz with news of harsh Chinese crackdowns and the arrests of crematoria managers who yesterday reported that death figures were total fiction. They said each of 15 crematoriums have been processing 100 corpses per day, were running 24/7 for the last two weeks, and the equipment was breaking down and they can’t get spare parts.

Doctors and crematoria staff have been told any discussion of deaths will result in severe punishment.

There are reports, with pics, that 40 portable industrial incinerators have been emplaced in Wuhan that can process 5 tons/day each. The regime says to destroy medical waste.

Buckle up.

[InTheBlack]

??? abx ???
" They’re out of several critical abx at my daughter's shop"

[Badger52]

??? abx ???
" They’re out of several critical abx at my daughter's shop"Assume "antibiotics"

:munchin

[Trapper John]

??? abx ???
" They’re out of several critical abx at my daughter's shop"

If Abx = antibiotics, SO WHAT???? This is a viral infection!

[5thgrp"C"]

It's not just preparing for the virus but what the people around us are going to do because of the virus. I'm on the coast in Savannah and I've been telling people to prepare for a hurricane with a bigger % being medical focused.

The last place I will want to take anyone in my family is any kind of medical treatment facility, which is where everyone who is sick will be. Anything that can be stitched, bandaged, or set at home will be.

I'd continue to monitor all medical stores for shortages and not those just related to antivirals.


If Abx = antibiotics, SO WHAT???? This is a viral infection!

[PSM]

Wait until the true magnitude sinks in. They’re out of several critical abx at my daughter's shop, a major state health magnet, and are told no resupply is in sight.

A corner was turned last Friday. All major epidemiologist and the CDC have said containment is impossible, expect a major outbreak in the US.

And do you know how many COVID19 diagnostic tests were processed in the last ten days in the US? Sixteen per day. Sixteen. That’s all CDC can do. No surge capacity either. They’re stretched at 16. South Korea has been averaging 1700 tests per day and can handle 4000/day surge.

Every once in a while a legitimate crisis reveals how corrupt things have gotten. We're there.

I don't want to be Chicken Little, but I saw a lot of heavy hitters with "deer-in-the-headlights" looks in their eyes last week. http://www.professionalsoldiers.com/forums/showthread.php?t=10148

That was March 18, 2006. That's when I bought the N95 masks that are in our garage now.

I don't want to jinx your record of multiple wrong predictions, but, I've lived through so many of these and other dire predictions that I'm, to say the least, highly skeptical.

[Axe]

If Abx = antibiotics, SO WHAT???? This is a viral infection!

China makes the active pharmaceutical ingredients (API's) for approximately 97% of the antibiotics used in the US. They have the only factory that makes piperacillin.

They make the API's for approximately 50% of the drugs sold in the US. Some of them are the meds that go in crash carts.

As long as China isn't working, we aren't going to be getting a lot of our drugs. I'm personally not betting on China successfully getting everything working again anytime soon. Hence, likely the outage and lack of resupply anytime soon that mugwump is talking about.

It would be wise to stock up on an extra couple of months worth of any Rx meds one needs if one hasn't already as part of their normal preparedness planning.

https://www.latimes.com/world-nation/story/2020-02-21/china-coronavirus-china-factories-economy

https://www.wcnc.com/article/news/health/expert-warns-of-mass-medicine-shortages-if-covid-19-continues-to-ravage-china/275-aeae4c3b-0ba9-45fc-ba4a-659039226b5e

[TWITCHY]

It’s amazing to me that nobody, at some point, didn’t say “Hey, If anything goes bad with China, we’re all screwed!” I’m assuming over a period of at least 50 years our government has decided they are A-Ok with China making the majority of our meds and medical supplies.

[Axe]

It’s amazing to me that nobody, at some point, didn’t say “Hey, If anything goes bad with China, we’re all screwed!” I’m assuming over a period of at least 50 years our government has decided they are A-Ok with China making the majority of our meds and medical supplies.

Yeah. The shortage in 2016 when the piperacillin plant exploded didn't change things.

Star anise, which was the main ingredient in Tamiflu, is pretty much only grown in China. Fortunately for us, in 2018 a method of synthesizing the ingredient from the plant by fermenting E. coli was adopted.

The main ingredient in Levaquin is only made in Japan.

A lot of the API's could be made in India, but China is 40-50% cheaper.

Almost all of our drugs come from China, India, or Puerto Rico.

[Old Dog New Trick]

I’m not an epidemiologist but I sure wish people would put this illness in perspective, and stop freaking out over it.

Really, unless you are over 80 and in decreased health to begin with this virus is not, I repeat not, likely to kill you and you will recover basically on your own as it runs its course. Much like the flu or a common cold. If it’s not affecting children and young adults...why is not affecting those age groups?

Second, it’s a political and business choice to shutter manufacturing, close businesses, schools and other public activities. Is it better and more productive to issue adequate PPE to employees and keep things moving, or send people home and close assembly lines or whatever the process is that can’t be done another way?

Instead of crashing the stock market how about a public health warning that says if you are sick, feeling sick, have a fever and cough stay home, cover your mouth and wash hands often. If you have been to or traveled to an area with an outbreak self quarantine for two more weeks at home before returning to work. If you are sick and test positive for the virus let the professionals know how to back track your travels.

If I’m wrong let the illness prove that to me, we’ve been down this road before and there are a lot more things that kill a lot more people than this had so far.

Maybe I’m wrong, YMMV

[echoes]

I’m not an epidemiologist but I sure wish people would put this illness in perspective, and stop freaking out over it.

Really, unless you are over 80 and in decreased health to begin with this virus is not, I repeat not, likely to kill you and you will recover basically on your own as it runs its course. Much like the flu or a common cold. If it’s not affecting children and young adults...why is not affecting those age groups?

Second, it’s a political and business choice to shutter manufacturing, close businesses, schools and other public activities. Is it better and more productive to issue adequate PPE to employees and keep things moving, or send people home and close assembly lines or whatever the process is that can’t be done another way?

Instead of crashing the stock market how about a public health warning that says if you are sick, feeling sick, have a fever and cough stay home, cover your mouth and wash hands often. If you have been to or traveled to an area with an outbreak self quarantine for two more weeks at home before returning to work. If you are sick and test positive for the virus let the professionals know how to back track your travels.

If I’m wrong let the illness prove that to me, we’ve been down this road before and there are a lot more things that kill a lot more people than this had so far.

Maybe I’m wrong, YMMV

ODNT Sir,


Believe you are spot on with your post, and your summation rings true to many in our camp.

When in charge of kitchens in the past, my instructions to our team were to stay home and get well before coming back in to work. Not only are you not going to potentially contaminate the product, but you will prevent the spread of germs to the rest of the crew.

Sadly, common sense is not the case in all kitchens during cold/ flu season, which is why being very particular when "dining out" is prudent, IMHO.


Great posts on this subject! :munchin


Holly

[Badger52]

That was March 18, 2006. That's when I bought the N95 masks that are in our garage now.Heh, now that's a blast from the past, thanks. I remember that one. While still drawing armyciv.mil $$ I was in a MASCAL planning cell next to a fine logistician who became a good friend to this day. (He wanted commo support from me to support the staging of reefer trailers for the zombies that didn't make it.) I don't think this is what Joni Mitchell meant when she wrote "The Circle Game."

[cbtengr]

Went to see my Cardiologist yesterday, one of the pre-screening questions was "Do you have the Coronavirus?" My wife works at the U of Iowa Hospitals and Clinics and when I told her about the query she said that she was pretty sure the question was not asked in the proper context. How would I specifically know if I had it or not? Probably just asking how I felt in general would have been the best way to broach the topic. ODNT, I am with you, if folks who felt ill would stay home instead of going to work sick there would be a lot less illness in this country

[PedOncoDoc]

Went to see my Cardiologist yesterday, one of the pre-screening questions was "Do you have the Coronavirus?" My wife works at the U of Iowa Hospitals and Clinics and when I told her about the query she said that she was pretty sure the question was not asked in the proper context. How would I specifically know if I had it or not? Probably just asking how I felt in general would have been the best way to broach the topic. ODNT, I am with you, if folks who felt ill would stay home instead of going to work sick there would be a lot less illness in this country

A patient of mine on clinical trial tested positive for coronavirus and the company sponsoring the trial panicked. I had to reassure this was a typical coronavirus strain and not COVID-19. In the past month I've had patients come down with influenza A and B, rhinovirus, respiratory synctial virus, parainfluenza 1 and 3, and multiple non-Kung-Flu strains of coronavirus.

We're in the mist of respiratory viral season and that is a particularly ignorant screening question to ask.

[Old Dog New Trick]

Went to see my Cardiologist yesterday, one of the pre-screening questions was "Do you have the Coronavirus?" My wife works at the U of Iowa Hospitals and Clinics and when I told her about the query she said that she was pretty sure the question was not asked in the proper context. How would I specifically know if I had it or not? Probably just asking how I felt in general would have been the best way to broach the topic.

There is only one answer to a question like this - Yes, yes I do!


I want to make a T-Shirt that says on the front “Just got back from China and all’s I got was this lousy T-Shirt and... (on the back) a fever and a cough!

[doctom54]

A patient of mine on clinical trial tested positive for coronavirus and the company sponsoring the trial panicked. I had to reassure this was a typical coronavirus strain and not COVID-19. In the past month I've had patients come down with influenza A and B, rhinovirus, respiratory synctial virus, parainfluenza 1 and 3, and multiple non-Kung-Flu strains of coronavirus.

We're in the mist of respiratory viral season and that is a particularly ignorant screening question to ask.

No $hit Sherlock!

40,000 people in the USA die on an AVERAGE year from influenza...

I worked the urgent care 2 weeks ago and had 30 proven cases of influenza 1/2 Influenza A and 1/2 Influenza B.

[doctom54]

I’m not an epidemiologist but I sure wish people would put this illness in perspective, and stop freaking out over it.

Really, unless you are over 80 and in decreased health to begin with this virus is not, I repeat not, likely to kill you and you will recover basically on your own as it runs its course. Much like the flu or a common cold. If it’s not affecting children and young adults...why is not affecting those age groups?

Second, it’s a political and business choice to shutter manufacturing, close businesses, schools and other public activities. Is it better and more productive to issue adequate PPE to employees and keep things moving, or send people home and close assembly lines or whatever the process is that can’t be done another way?

Instead of crashing the stock market how about a public health warning that says if you are sick, feeling sick, have a fever and cough stay home, cover your mouth and wash hands often. If you have been to or traveled to an area with an outbreak self quarantine for two more weeks at home before returning to work. If you are sick and test positive for the virus let the professionals know how to back track your travels.

If I’m wrong let the illness prove that to me, we’ve been down this road before and there are a lot more things that kill a lot more people than this had so far.

Maybe I’m wrong, YMMV

You are as right as rain!

[mugwump]

I’m not an epidemiologist but I sure wish people would put this illness in perspective, and stop freaking out over it.

Really, unless you are over 80 and in decreased health to begin with this virus is not, I repeat not, likely to kill you and you will recover basically on your own as it runs its course. Much like the flu or a common cold. If it’s not affecting children and young adults...why is not affecting those age groups?

Second, it’s a political and business choice to shutter manufacturing, close businesses, schools and other public activities. Is it better and more productive to issue adequate PPE to employees and keep things moving, or send people home and close assembly lines or whatever the process is that can’t be done another way?

Instead of crashing the stock market how about a public health warning that says if you are sick, feeling sick, have a fever and cough stay home, cover your mouth and wash hands often. If you have been to or traveled to an area with an outbreak self quarantine for two more weeks at home before returning to work. If you are sick and test positive for the virus let the professionals know how to back track your travels.

If I’m wrong let the illness prove that to me, we’ve been down this road before and there are a lot more things that kill a lot more people than this had so far.

Maybe I’m wrong, YMMV

The bad group is >50, not 80, and one or more comorbidities like obesity, asthma, diabetes 1/2, hypertension, etc. That’s a lot of boomers right there.

While it can be quick, this is generally a long slow grind of a disease with a 10-30 day course before death. The 80 year olds go first and quickest, it’s just how it presents.

The guys closest to this have basically scuttled their South China Sea ambitions, Silk Road, etc. for the next 5 years. If it’s a nothingburger, why?

I agree CFR will come down as we get a clearer picture of numbers, but they already state 80% mild. It’s the 20% remaining where the devil is. Sun city, the villages, etc. are in for a ride.

Equating this with seasonal flu is just not borne out by the current facts, but I guess we’ll see.

[mugwump]

The community case Trump talked about was an intubated patient transferred to UC Davis Medical from another undisclosed hospital, assumed to be in the SF area.

Davis instituted droplet control, but not airborne, within a day and airborne control after 4 more days. But...no special PPE, no special procedures for infectious disease presumedly at hospital number one or Davis.

Everyone who treated the patient at either hospital, or was involved in transport, are exposed.

And, the patient presumedly came from a community cluster. No China contact, or contact with China contact.

I’m assuming we’re looking at school closures in Cali in 7-10 days.

I thought Trump looked ill or exhausted. Maybe he was just scared.

[mugwump]

14% of Recovered covid19 patients in Guangdong tested positive again. This is very worrying, suggesting there is no memory antibody response, just innate immunity. Will make vaccine effort more difficult.

A Laurie Garrett tweet.

This is a coronavirus. Not the flu. This will likely transition to being another disease like the seasonal flu in a couple years, but it will have to burn through the population first.

The tale will be told in a 4 week period now that it’s uncontained in Cali, so I’ll shut up now a watch. Good luck all.

[TOMAHAWK9521]

So now they're saying NorCal has, as far as they know, a "spontaneously" infected individual? So now this thing can pole-vault across the Pacific? :rolleyes:
https://www.sacbee.com/news/local/health-and-medicine/article240674471.html

[JJ_BPK]

So now they're saying NorCal has, as far as they know, a "spontaneously" infected individual? So now this thing can pole-vault across the Pacific? :rolleyes:

:mad: MSN now has something better The Bern Title Wave :mad:

[mugwump]

So now they're saying NorCal has, as far as they know, a "spontaneously" infected individual? So now this thing can pole-vault across the Pacific? :rolleyes:
https://www.sacbee.com/news/local/health-and-medicine/article240674471.html


Cali had 6400 under 'voluntary isolation.' All had China travel. None were tested. No pole vaulting necessary.

[5thgrp"C"]

The latest WHO update says we are in the 3rd bordering the 4th (worst) level of spread and the ability to contain.

https://youtu.be/6bKjQ4Q9fFU

The real test comes a couple days after the schools start closing. After that the local supply chains will have to work hard to keep everyday items (milk, eggs, children's Tylenol) in stock with the majority of the population sitting at home.

[mugwump]

If Abx = antibiotics, SO WHAT???? This is a viral infection!

Yeah sorry antibiotics.

I was talking supply chain effects. There are other diseases and other patients being treated other than flu and covid. No antibiotics, pressors, antineoplastics, etc is kinda a big deal.

No abx for bacterial pneumonia prophylaxis in intubated patients is problematic.

And historically, the community acquired bacterial pneumonia following respiratory disease is a big killer. No abx is a big deal.

[Old Dog New Trick]

Mugwump, I’ll defer to your continued interest in this event and wait and watch all the hysteria as it unfolds. The world is over crowded in certain areas and places like San Francisco needs a good enema anyways.

As for the Iranian leader who helped orchestrate the Tehran hostage ordeal being infected...good for him!

If the Chinese weaponized a strain of Coronavirus that’s been around as long as most of us have been alive to kill us all...then we deserve it. (Watching them first)

[mugwump]

Mugwump, I’ll defer to your continued interest in this event and wait and watch all the hysteria as it unfolds. The world is over crowded in certain areas and places like San Francisco needs a good enema anyways.

As for the Iranian leader who helped orchestrate the Tehran hostage ordeal being infected...good for him!

If the Chinese weaponized a strain of Coronavirus that’s been around as long as most of us have been alive to kill us all...then we deserve it. (Watching them first)

I’m not saying seasonal flu isn’t deadly. I’m saying this is worse.

The genetics of coronaviruses is beyond me, but people I trust say no fingerprints of genetic manipulation. My personal opinion is this is an obscure bat virus that inadvertently escaped containment. That Wuhan level 4 facility has had at least 4 SARS escapes in the last 7 years, quickly contained. I think Xi thought they could contain this one and no one would be wiser. Fail.

There are a lot of good people in SF. Turns out the initial hospital was in Sacramento.

[InTheBlack]

No abx for bacterial pneumonia prophylaxis in intubated patients is problematic.

And historically, the community acquired bacterial pneumonia following respiratory disease is a big killer. No abx is a big deal.

I'm looking for peer reviewed papers or med journal articles that clearly state the degree to which previous vaccination for Pneumovax 13, Pneumovax 23, and HiB (Haemophilus Influenza Type B) reduce the incidence or severity of community or hospital acquired pneumonia, especially in conditions where antibiotics are not available or the patient is allergic to the preferred med.

Seems that nowadays doctors simply won't prescribe anything "off label."

[EricV]

Interestingly enough, a guy I know just kicked Wednesday.

"She said he had a terrible January and finally succumbed to
pneumonia."

I wonder if they did any serious checking what did it on the corpse He was 70.

Can't wait to see how Spring Break goes...:munchin

Meanwhile...

https://www.americanpartisan.org/2020/02/will-china-win-the-pandemic-world-war/

[InTheBlack]

So Japan is closing the schools... but per the BBC "Officials have said child day care centres and after-school facilities can remain open."

wtf ???

[Trapper John]

Yeah sorry antibiotics.

I was talking supply chain effects. There are other diseases and other patients being treated other than flu and covid. No antibiotics, pressors, antineoplastics, etc is kinda a big deal.

No abx for bacterial pneumonia prophylaxis in intubated patients is problematic.

And historically, the community acquired bacterial pneumonia following respiratory disease is a big killer. No abx is a big deal.

Thank you for clarifying! Just need to keep this information highway clear from traffic jams and other speed bumps. ;)

[JJ_BPK]

After reading this thread for a month, I decided to put this great information to good use and get some personal virus protection


I think it's working, As soon as I tried it I received an email from a Nigerian Prince wanting to send me 2M Naira for the advanced version of the ransomware.. :lifter

[PSM]

Trump needs to make MAGA masks to hand out at his rallies.

[grog18b]

Trump needs to make MAGA masks to hand out at his rallies.

Red ones.



Bernie can do it too, but his can have little hammers and sickles on them.



So... just like baby seals, we know who we're clubbing when the time comes.

[Last hard class]

A lot of stock market volatility since my last post on this thread. I hope at least one person here tuned into my message ( I know, it seems so obvious now). We are trained to be complacent with our money even when clear opportunities present themselves. Most of my QP friends are willing to jump into the fire to risk life and limb, but they won't take their wallet with them.




LHC

[Mustang Man]

For swing traders I would avoid these dips for at least a month. The drop in supply and earnings aren't baked into stocks yet. Also, every market reaction is an over reaction, and there will be plenty of catalyst action caused by media coverage of Corona as it spreads in the U.S., causing more panick sells. Be patient and wait for a natural recovery, you wouldn't buy a half dead dog the same way you shouldn't buy a half dead stock.

Overall, as long you have a plan, exit strategy, and aren't investing/trading money you may immediately need, you'll be fine. And take this as a learning experience, now you know who and who not to listen to. People like Last Hard Class with good insight and not the talking head clowns on TV.

And for the record I'm not a CPA.

[Old Dog New Trick]

This is an insightful article from Popular Science on the R0 calculation, disease spread and mortality of a virus/disease. Worth reading.

https://apple.news/ArgncymdGSxGc41mE6emVog

And it’s beginning to show where this COVID-19 falls into other more deadly diseases over the years. Although this one is still so new that things and assessments are changing daily.

And P.S. my 401K has lost about $30k - $40k this week so I’m pretty pissed about the knee jerk reaction to the chicken little sky is falling bullsh!t.

ETA: Another excellent article from Popular Science about preparing for a pandemic outbreak of COVID-19 or the flu.

https://apple.news/AMiD3xO_iSUyr2JjKbx9jzA

P.S.2. It was not a very smart thing to bring infected people from China and Japan to the United States thinking some government agency here is going to do a better job than the failure that was Wuhan and the Diamond Princess. Not only are HHS workers exposed to the virus it seems that “Unknown Victim One and now Unknown Victim Two will probably trace back to Travis AFB and the site of ground zero in California.

Why have islands in the Pacific like Johnson and Midway if we can’t quarantine people and airplanes for a month or longer? Should have never brought these people to the United States.

[Paslode]

And P.S. my 401K has lost about $30k - $40k this week so I’m pretty pissed about the knee jerk reaction to the chicken little sky is falling bullsh!t.


That is an awful feeling, but hen the dust settles you will recoup your losses and then some.

[Old Dog New Trick]

That is an awful feeling, but hen the dust settles you will recoup your losses and then some.

Yes, I know, I still have time left to recover what was lost in 2008 again and again but some people don’t...this hits recent retirees hard and it’s over BS!

Let’s stop hating Trump so much that we would rather see our country fail than see the orange man in the White House succeed.

[PSM]

And P.S. my 401K has lost about $30k - $40k this week so I’m pretty pissed about the knee jerk reaction to the chicken little sky is falling bullsh!t.

You're still working so this is a buying opportunity. I did very well after 9/11 and '08. Hang in there.

P.S.2. It was not a very smart thing to bring infected people from China and Japan to the United States thinking some government agency here is going to do a better job than the failure that was Wuhan and the Diamond Princess. Not only are HHS workers exposed to the virus it seems that “Unknown Victim One and now Unknown Victim Two will probably trace back to Travis AFB and the site of ground zero in California.

Why have islands in the Pacific like Johnson and Midway if we can’t quarantine people and airplanes for a month or longer? Should have never brought these people to the United States.

Excellent point! ETA: Well, except for the housing problem.

[PSM]

Yes, I know, I still have time left to recover what was lost in 2008 again and again but some people don’t...this hits recent retirees hard and it’s over BS!


We're retired and were hit way harder than you and, even through we have only SS as income and can't really buy more, I know that what we have will rebound quickly. Especially after the next election. I don't panic. ;) Unfortunately some do.