Wuhan Coronavirus

[Cynic]

This disease is very infectious. I would posit that in one year, almost everyone will test positive. People with healthy immune systems, children, and people under the age of 70, will be asymptomatic and/or most likely recover without incident. People with pre-existing chronic conditions and the elderly will more likely die. Current cases are not consistently and reliably reported. As the sample size of verified cases increases, the fatality rates will be smaller if current death profiles remain the same.
All of this is assuming that a vaccine is not found. Polio was deadly once too.
Wash your hands, don’t hoard, and take care of the elderly.
This is just MHO. Your mileage may vary.

[mugwump]

Originally Posted by Cynic

This disease is very infectious. I would posit that in one year, almost everyone will test positive. People with healthy immune systems, children, and people under the age of 70, will be asymptomatic and/or most likely recover without incident. People with pre-existing chronic conditions and the elderly will more likely die. Current cases are not consistently and reliably reported. As the sample size of verified cases increases, the fatality rates will be smaller if current death profiles remain the same.
All of this is assuming that a vaccine is not found. Polio was deadly once too.
Wash your hands, don’t hoard, and take care of the elderly.
This is just MHO. Your mileage may vary.

40% of US males and females are obese vs 5% in China. Obesity is a comorbidity considered on par with heart disease, which many of the obese also have...plus type 2 diabetes.

Don’t assume what you saw in Wuhan will carry over to the US population.

Overweight males of ages down to 30 are dying in Italy. Women, not so much.

[mugwump]

B3D2C08B-7FB4-447B-AC88-7FACFA430B64.jpeg

[twistedsquid]

Heard this from an 82 year old client today..." All the bad stuff comes from China." I couldn't respond.

[Cynic]

Originally Posted by mugwump

40% of US males and females are obese vs 5% in China. Obesity is a comorbidity considered on par with heart disease, which many of the obese also have...plus type 2 diabetes.

Don’t assume what you saw in Wuhan will carry over to the US population.

Overweight males of ages down to 30 are dying in Italy. Women, not so much.

I am assuming nothing based on China. I consider obesity a pre-existing chronic condition. I am pointing out that the reliable sample is still small. Time will tell.

[PSM]

Originally Posted by mugwump

40% of US males and females are obese vs 5% in China. Obesity is a comorbidity considered on par with heart disease, which many of the obese also have...plus type 2 diabetes.

Don’t assume what you saw in Wuhan will carry over to the US population.

Overweight males of ages down to 30 are dying in Italy. Women, not so much.

What about smokers? Chinese males smoke way more than Americans. And this is a respiratory problem.

[InTheBlack]

I need information on oxygen concentrators. Useful in preventing a breathing difficulty from progressing? ARDS patients seem to need ventilators pretty quickly, which is a completely different technology. OTOH might it buy a couple days until maybe the patient will be admitted to a hospital?

Is "bush medicine" but safe usage to turn it up until the pulse oximeter says 95%? What max liters/min capacity might be needed? If things are bad a few months from now, there will probably be a way to get medical advice remotely and use it more effectively.

A good one is a big ticket item; less so with lower liters/min at 90%. But probably not too hard to sell if not needed after a year.

[InTheBlack]

https://academic.oup.com/nsr/advance...waa036/5775463


Accepted manuscript
On the origin and continuing evolution of SARS-CoV-2
Xiaolu Tang, Changcheng Wu, Xiang Li, Yuhe Song, Xinmin Yao, Xinkai Wu, Yuange Duan, Hong Zhang, Yirong Wang, Zhaohui Qian ... Show more
Author Notes
National Science Review, nwaa036, https://doi.org/10.1093/nsr/nwaa036
Published: 03 March 2020

ABSTRACT

The SARS-CoV-2 epidemic started in late December 2019 in Wuhan, China, and has since impacted a large portion of China and raised major global concern. Herein, we investigated the extent of molecular divergence between SARS-CoV-2 and other related coronaviruses. Although we found only 4% variability in genomic nucleotides between SARS-CoV-2 and a bat SARS-related coronavirus (SARSr-CoV; RaTG13), the difference at neutral sites was 17%, suggesting the divergence between the two viruses is much larger than previously estimated.

Our results suggest that the development of new variations in functional sites in the receptor-binding domain (RBD) of the spike seen in SARS-CoV-2 and viruses from pangolin SARSr-CoVs are likely caused by mutations and natural selection besides recombination.

Population genetic analyses of 103 SARS-CoV-2 genomes indicated that these viruses evolved into two major types (designated L and S), that are well defined by two different SNPs that show nearly complete linkage across the viral strains sequenced to date.

Although the L type (∼70%) is more prevalent than the S type (∼30%), the S type was found to be the ancestral version.

Whereas the L type was more prevalent in the early stages of the outbreak in Wuhan, the frequency of the L type decreased after early January 2020.

Human intervention may have placed more severe selective pressure on the L type, which might be more aggressive and spread more quickly.

On the other hand, the S type, which is evolutionarily older and less aggressive, might have increased in relative frequency due to relatively weaker selective pressure.

These findings strongly support an urgent need for further immediate, comprehensive studies that combine genomic data, epidemiological data, and chart records of the clinical symptoms of patients with coronavirus disease 2019 (COVID-19).

[T-Rock]

I'm not so sure simple oxygen delivery devices (masks/nasal cannula's, etc.) will be sufficient. The following is a letter circulating among the European Society of Intensive Care Medicine*.


".....Milan, 4 March 2020
*
*
Dear friends,
*
At this moment in time, we believe it is important to share our first impressions and what we have learned in the first ten days of the COVID-19 outbreak.
*
We have seen a very high number of ICU admissions, almost entirely due to severe hypoxic respiratory failure requiring mechanical ventilation.
*
The surge can be important during an outbreak and cluster containment*has to be in place*to slow down virus transmission.
*
We are seeing a high percentage of positive cases being admitted to our Intensive Care Units, in the range of*10% of all positive patients.
*
We wish to convey a strong message: Get ready!
*
We also want to share with you some key points from our experience:
*

Get ready now - with your ICU’s networks - to define your*contingency plan*in the event of an outbreak in your community

Don’t work “in silo”. Coordinate with your hospital management and other healthcare professionals to prepare your response

Make sure your hospital management and procurement office have a*protocol*in place about*which personal protection equipment (PPE) to stock and re-stock

Make sure your staff is trained in*donning and doffing procedures

Use*education, training and simulation*as much as possible

Identify early hospitals*that can manage the initial surge in a safe way

Increase your total ICU capacity

Get ready to*prepare ICU areas*where to cohort COVID-19 + patients -*in every hospital if necessary

Put in place a*triage protocol*to identify suspected cases, test them and direct them to the right cohort

Make sure you*set clear goals*for care with the patients and their families early on

*
*
With our best regards
*
Prof. Maurizio Cecconi********** Prof. Antonio Pesenti************ Prof. Giacomo Grasselli
President elect, ESICM********** University of Milan*************** University of Milan
Humanitas University, Milan........"
*** * ** * * * * * * * * * * * * * * * * *
*
https://mailchi.mp/esicm/the-future-...e-year-1009715

[InTheBlack]

>
We have seen a very high number of ICU admissions, almost entirely due to severe hypoxic respiratory failure requiring mechanical ventilation.
>

Have these patients been struggling to breath for days & exhausted themselves, prior to going to the hospital? If so, a home oxygen unit sounds useful. Or were they in less-intensive care & on oxygen?