Wuhan Coronavirus

[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?

[InTheBlack]

Wonder if Kirkland was negligent under-response, or not?

https://kuow.org/stories/the-days-le...er-in-kirkland

SNIPPED MOST OF STORY - READ IT

In January, firefighters responded seven times to the Life Care facility. In February, and the first five days of March, they responded 33 times.

Firefighters are now grappling with the idea that coronavirus may have already been circulating at Life Care for weeks and that they, and Life Care workers, residents and visitors, had not been warned to take precautions, And that they may have inadvertently helped spread the virus farther.

In the days leading up to last Friday, Life Care staff and first responders were using nebulizers and CPAP machines to treat patients. “We essentially aerosolized it,” one first responder said, because before last Friday, that was standard protocol to treat patients.

“We made it worse,” he said.

[T-Rock]

I can't seem to find the study from the PrePrint or the New England Journal of Medicine but I'll look for it (case studies with CT/CXR results). IIRC, the take away points were that patients were clocking along just fine until week 2-3 and that was when they fell off the curve hard and fast (The 10% the European Society of Intensive Care Medicine were speaking of?). Full blown ARDS in a matter of hours. If that's the case, O2 would only buy a little time prior to intubation, and of those intubated, they didn't fair so well.

[Pete]

If Emergency Services responded 7 times in January, spread the virus to others and the virus has a three week cook time until you fall off the cliff time ...........

There should be people dropping in the streets by now.......

But there ain't.

[JJ_BPK]

Originally Posted by InTheBlack

Why no plan to use our hospital ships to isolate cases?

Who says there is no plans? Got a quote? source?

There are two US Navy dedicated hospital ships, the USNS Mercy (T-AH-19). and the USNS Comfort (T-AH-20). Normally, the ships are kept in a reduced operating status in Norfolk, VA, and San Diego, CA, by a small crew of civil service mariners and active-duty Navy medical and support personnel. Each ship can be fully activated and crewed within five days.

Here is an article on the Ebola outbreak of 2014. Hospital ships are not a front line tool for infectious diseases. That does not mean they are not in the plan..

There is one other flaw of a hospital ship: it cannot be protected from the infectious disease it has been deployed to fight. And if there is one thing that ship captains fear, it's an outbreak. Military ships are cramped for space and residents share bathrooms and other facilities. Even though the Ebola virus is not airborne, having the infected on board is a massive risk.

https://www.huffpost.com/entry/navy-...bola_n_5998968

[Pete]

As of this story the death rate in South Korea is around .625%

"SEOUL (AFP, THE KOREA HERALD/ASIA NEWS NETWORK) - Two South Korean apartment buildings heavily occupied by members of a sect linked to most of the country's coronavirus cases have been quarantined after dozens of residents tested positive for the disease, an official said on Saturday (March 7).

The move comes as the country, which has the highest number of confirmed Covid-19 cases in the world outside China, reported 448 new infections, taking its total to 7,041.

Another two deaths were reported by the Korea Centres for Disease Control and Prevention, bringing the toll to 44......"

https://www.straitstimes.com/asia/ea...er-coronavirus

[JJ_BPK]

Originally Posted by Pete

As of this story the death rate in South Korea is around .625%

"SEOUL (AFP, THE KOREA HERALD/ASIA NEWS NETWORK) - Two South Korean apartment buildings heavily occupied by members of a sect linked to most of the country's coronavirus cases have been quarantined after dozens of residents tested positive for the disease, an official said on Saturday (March 7).

The move comes as the country, which has the highest number of confirmed Covid-19 cases in the world outside China, reported 448 new infections, taking its total to 7,041.

The only land bridge between China and South Korea is thru the little fat kid's backyard. NK has to be hurting?

[Pete]

Could not find the link - it's one of those rolling headline sites.

New numbers coming out for Iran is showing a death rate of 2.5%. Big difference compared to Korea.

[grog18b]

Originally Posted by Pete

If Emergency Services responded 7 times in January, spread the virus to others and the virus has a three week cook time until you fall off the cliff time ...........

There should be people dropping in the streets by now.......

But there ain't.

Saw a good documentary on the Spanish Flu of 1918... Healthy dudes in their 20s were diagnosed at 10am and dead by 4pm... after the first symptoms appeared.

[Old Dog New Trick]

Not comparing but just found this, I had asked earlier if someone knew.

The figure of infections dwarfs other major outbreaks such as SARS, MERS and Ebola. The virus is still much less widespread than annual flu epidemics, which cause up to 5 million severe cases around the world and 290,000 to 650,000 deaths annually, according to the World Health Organization. (USA Today)

We are a long way from those kinds of numbers and I understand that those are ‘annual’ numbers and we’re only into this a ‘quarter’ already. Time will tell.

Also, a 360,000 spread sounds more of a WAG!

[T-Rock]

I'm not an alarmist, just a realist. I tweak ventilator knobs for a living, pass out nebulizers for bronchospasms, and manage patient airways during code blues. I'm a Jack of all trades when the shit hits the fan in a hospital, but a master of none. Whatever I've posted in this thread should be taken with a "huge" grain of salt. I'm guilty of reading into things way too much. However, if the high tower IQ talking heads are correct, we're gonna face a shitstorm in the coming months. May as well be prepared, even if they're wrong. Protecting your family, loved ones, and ensuring you're protected won't hurt at all. Below is what a PhD Assoc. Director of Science & Technology, ChemBE posted based on the numbers coming out of Italy (Lombardy/Milan). I'll post what was said below and the link if you're inclined to read it.
https://twitter.com/LizSpecht/status...459003909?s=20