Coronavirus thread

[YVK]

Is myocarditis something you see ever with influenza?

It is well described in literature but I've never seen one myself. I suspect they are underdiagnosed because somebody needs to think of getting an ECHO on a known flu patient who's not doing well. On the other hand, we don't run flu tests on patients presenting myocarditis if they don't have flu symptoms.

[EricM]

Is there any data out on hydrogen peroxide vapor effectiveness on the bug? About a decade ago, the lab I was at would spray down the inside of a Tupperware with H2O2, insert whatever components we were bringing into a clean room, put it in the pass through, spray it again. I never saw the data, but 40 minutes later or so, all the microbes inside the Tupperware were allegedly shredded.

The reason I ask is because I'm seeing reports of folks using alcohol to disinfect used masks, and it accelerating break down of the masks.

Just read about this from Duke... (click for summary and details)

Facing a critical shortage of N95 face masks that block the coronavirus, Duke Health research and clinical teams have confirmed a way to use existing vaporized hydrogen peroxide methods to decontaminate the masks so they can be reused.

The process uses specialized equipment to aerosolize hydrogen peroxide, which permeates the layers of the mask to kills germs, including viruses, without degrading the mask material. “This is a decontamination technology and method we’ve used for years in our biocontainment laboratory,” said Scott Alderman, associate director of the Duke Regional Biocontainment Laboratory.
...
The use of hydrogen peroxide to decontaminate N95 masks was tested and published by others in 2016, but did not result in widespread adaptation. The earlier studies did not include fit testing after cleaning – basically sizing the masks for individual wearers - to prove efficacy in the real world, which Duke has now done.

[RoyGBiv]

Apologies for not tagging the Docs posting here. It's been a long day/night. If somebody could help me remember and quote/tag the right folks I'd appreciate it.

I'm working with a charity that's wanting to donate a bunch of PPE to NY area hospitals.
I understand that the answer to this question is "send everything", but, I'd appreciate some guidance on the relative quantities of use for the following items.

Given the current situation...... For every 1,000 masks (N95 or equivalent), you are using.....
-- How many patient/procedure masks?
-- How many Goggles (eyewear)?
-- How many ISO suits?

Also.....
Are folding masks commonly used in hospital setting or should we be pushing the supply chain for drop-down cup-type masks if we can get them?
If you could get 50% more folding masks for every cup type mask, which would you choose? (we're still waiting for pricing/availability on cup masks, so I'm guessing here).
Is a rubber strap worth the extra $2 on a ISO suit, or would you rather have a few more suits?
Are procedure masks in short supply? If not, we can skip them and spend that $$ on more of the other stuff.

ETA: Charity is reaching out to their target hospitals to ask about local needs, of course. I'm just working up a proposal as a reference point.

Many thanks!

Handy list from NIOSH, FYI.

[YVK]

@RoyGBiv

I am afraid I can't tell you the exact numbers.

From what we're hearing from our supply people, the surgical masks are non-issue. From clinical / infection teams we're getting a strong message that eye-pro is underutilized and less available although it is easier to decontaminate than N95. Every time a provider dons an N95, the eyepro should go on too. We've not been recommended to use ISO suits at all; I wonder if regular gowns would be a better choice.
Keep in mind that my state has under 500 cases as of yesterday, very few hospitalized, and so far 2 deaths only. The supply projections might change one week from today.

[TGS]

I haven't heard of anyone using "iso suits" with the exception of the Dept of State OpMed repatriation flights, who used PAPRs and tyvek suits.

Gowns are what are currently recommended by the CDC.

N95 respirators are recommended by the CDC, not surgical masks. For mandatory intimate patient contact, the latter are only being worn if N95s aren't available. Keep in mind that N95s come in different sizes and that matters for getting a good seal, so encourage your org to buy different sizes. In your comms with local hospitals, I suggest you ask what the breakdown of sizes are, or at the very least what sizes they're short on (they could've had someone donate 10,000 mediums, when hospitals actually need much great amounts of smaller sizes given the demographics employed).

If you must buy surgical masks, the ones with a face shield are a good idea as it's combination mask/eye pro, and while not as encompassing as goggles it means that they'll at least be wearing eyepro of some type, as opposed to goggles that will probably be left on the isolation cart.

[Nephrology]

Apologies for not tagging the Docs posting here. It's been a long day/night. If somebody could help me remember and quote/tag the right folks I'd appreciate it.

I'm working with a charity that's wanting to donate a bunch of PPE to NY area hospitals.
I understand that the answer to this question is "send everything", but, I'd appreciate some guidance on the relative quantities of use for the following items.

Given the current situation...... For every 1,000 masks (N95 or equivalent), you are using.....
-- How many patient/procedure masks?
-- How many Goggles (eyewear)?
-- How many ISO suits?

Also.....
Are folding masks commonly used in hospital setting or should we be pushing the supply chain for drop-down cup-type masks if we can get them?
If you could get 50% more folding masks for every cup type mask, which would you choose? (we're still waiting for pricing/availability on cup masks, so I'm guessing here).
Is a rubber strap worth the extra $2 on a ISO suit, or would you rather have a few more suits?
Are procedure masks in short supply? If not, we can skip them and spend that $$ on more of the other stuff.

ETA: Charity is reaching out to their target hospitals to ask about local needs, of course. I'm just working up a proposal as a reference point.

Many thanks!

Handy list from NIOSH, FYI.

The biggest shortage AFAIK are the N95s themselves. I know common protocol across a few denver hospitals is 1 N95 per shift/day, and to wear procedural/surgical masks over them to prevent soiling. Like YVK said hospitals here aren't (yet) using Tyvek suits but instead gloves/gowns/eyepro/N95 for droplet precautions. Don't know about goggles, the only eye pro I've worn in hospitals looks like this:



Not sure if that's rate limiting but probably not. Either way calling around to individual hospitals will give you a better idea as their needs change day to day. Honestly, no matter what you import, you'll probably move it to someone eventually. The demand will be high.

[pangloss]

My institution asked for new or gently used eye pro that anyone is willing to donate. They seem to be casting a pretty wide net in terms of what would be acceptable. I'm sure some of those items will end up in the trash, but beggars can't be choosers. Our PPE stock is okay for now, so the administration is being pro-active on this point. We're also looking into hydrogen peroxide sterilization of N95s. Sterilizing via irradiation has also been given some consideration, but that is quite a bit more difficult to arrange.

[RoyGBiv]

@YVK @TGS @Nephrology
Thanks for the quick feedback...

We don't have supply lined up for gowns, but will have my folks look into it.
Surprisingly, we're not finding a lot of "sized" KN95's. We're advising folks to buy a variety of brands and models to get a variety of fits.
Worst case, someone will fit them... Unless they use a poor fit mask because it's the only one available. That's worse.

We're hearing from folks in home healthcare that patient masks are unavailable and or expensive. But I figured hospitals would still be well supplied for now. Thanks for confirming.

I've seen too many images on TV of ISO wards, I suppose. Figured that gear would be helpful. We'll pull back for now.

Sounds like masks should be 100% of this round unless we can qualify a gown supplier.

Read a story this morning about TX AG shutting down a mask auction because the price went to $5. Threatened the seller with big penalties. Reality is that buying up available brand name supply from the China market is running >>2.25/pc and more. (changes every few days), freight is crazy expensive (was quoted $10/kg yesterday, normally around <$7). Warehouse, labor, gotta pay cash for everything, no credit terms. The good stuff sells out fast, if you're not paying cash, someone else will. Yes, the price 3 months ago at Home Depot was $25/20 off brand. About 2x that for 3M. Good luck finding anything for sale at that price.

Maye that auction seller bough masks at pennies 3 months ago. I would have had them appraised and donated them. Reality is that bringing in new supply at market cost is nowhere near what it was 3 months ago.

[Balisong]

You're awesome Roy, thanks for everything you're doing for our country

[Caballoflaco]

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