Coronavirus thread

[peterb]

I think we are going to have to accept population weighted test like this must be used in lieu of full population testing to start opening things back up.

It simply isn't going to be feasible to test 330,000,000 million people before lock downs are relaxed. Our current testing rate per day is around 150,000. That would give us a total time to test everyone of around 6 years. That's unworkable unless you are rooting for the Thunderdome outcome.

There's talk of newer testing being able to produce 4,000,000 per month which would add 133,333 per day bring the daily total to 283,333 per day. That gets our total time to test down to a little over 3 years. Still not gonna fly.

Supposedly if things go well we could be testing 20,000,000 per month by June, which give a total population test time of around 16 months. Meaning we might have everyone tested by the time the first vaccine trials are wrapping up.

I also suspect we are only a few months or less away from unemployment reaching great depression levels. The closer we get to that the worse the "cure" of social distancing becomes.

There's also the practical matter of how long any stay at home order can be effective. Right now the majority of people seem to be adhering to the order. What does that compliance percentage look like in June? July? November? What percentage of compliance means there's no point anymore?

Sweden rolled the dice all at once. That may have been a mistake or it may pay off. Depends on what the testing shows a year and a half from now. I don't think we should take the Sweden approach all of a sudden. But we're going to have to take some best guesses in the short term based studies of acceptably small sample sizes.

According to colleagues in China, there are still travel restrictions for going outside one's home city, with home quarantine for 14 days if you go somewhere and return. Travel inside the city is less restricted. Would it make sense to intensively test limited areas and then allow those areas to open, as opposed to scattered testing over wider areas?

[TGS]

@Nephrology,

6% of patients overall admitted to the hospital with Covid died, and 20% of them who found their way into the ICU perished?

Pfff. Flu, bro.

[Half Moon]

In the morning Zoom meeting with my group from work -- all working from home -- we were thinking that the next step might be some sort of rotation at the office to reduce density and transmission potential. The hospital where a friend works has split the staff and is doing week on, week off to reduce transmission, and to increase the chance that someone positive will show symptoms before they go back in.

Sticking your head into someone's cubicle to ask a question will be much less popular.

It's a lot harder to see how you'd phase in things like bars and restaurants. Limit capacity? Only seat every other table? Bars give out masks with straw holes?

FWIW, at my workplace those of us not on furlough and still physically reporting onsite are split into two teams with a team 'in' 14 days and then 'out' 14 days. Neither team overlaps physically and disinfecting occurs multiple times a day. The thinking is the 2 week periods allows for the 2 to 14 day asymptomatic timeline of the infection.

[Nephrology]

I have never claimed to be a brightest bulb but I don't know how that data is reassuring. I don't particularly care if their projected prevalence based on serology is 85 times higher than what RNA testing estimates. What I see there is that 95%+ don't have antibodies and therefore are still susceptible to the virus.

It does seem to imply that overall case fatality rate may be lower than what we are currently estimating based on PCR + patients. Per the article:

We can use our prevalence estimates to approximate the infection fatality rate from COVID-19 in Santa Clara County. As of April 10, 2020, 50 people have died of COVID-19 in the County, with an average increase of 6% daily in the number of deaths. If our estimates of 48,000-81,000 infections represent the cumulative total on April 1, and we project deaths to April 22 (a 3 week lag from time of infection to death22), we estimate about 100 deaths in the county. A hundred deaths out of 48,000-81,000 infections corresponds to an infection fatality rate of 0.12-0.2%. If antibodies take longer than 3 days to appear, if the average duration from case identification to death is less than 3 weeks, or if the epidemic wave has peaked and growth in deaths is less than 6% daily, then the infection fatality rate would be lower. These straightforward estimations of infection fatality rate fail to account for age structure and changing treatment approaches to COVID-19. Nevertheless, our prevalence estimates can be used to update existing fatality rates given the large upwards revision of under-ascertainment.

They do mention however that their study participants were not not representative of their desired sample county demographics, but uncertain how that influences their findings.

I'm still planning on wearing an N95 outside...

[Jakus]

According to colleagues in China, there are still travel restrictions for going outside one's home city, with home quarantine for 14 days if you go somewhere and return. Travel inside the city is less restricted. Would it make sense to intensively test limited areas and then allow those areas to open, as opposed to scattered testing over wider areas?

Obviously testing smaller communities fully is easier than NYC, but most smaller communities are employing large numbers of people. Also with how common relatively long distance travel was before this its hard to see keeping things contained.

Testing needs to be sample sizes large enough to inspire confidence in the population, but it cannot be 100% of the entire population. Masks, social distancing, hand washing, etc are all here to stay, but we're going to have to start easing some restrictions to get people back to work for all kinds of reasons.

Take Michigan for example. Does anyone think the governors approach of complete lock down is a good idea? To me she's gone so far off the deep end as to make the whole thing look like a farce. And now we're seeing some members of law enforcement turn on her ideas. She's loosing control and fast.

I know it can be hard to treat people like adults, but I don't think we have a choice. Level with people. This thing is gonna be here for a while. You need to take precautions X, Y, and Z. The whole mask use debacle didn't inspire any confidence. Mass gatherings probably should stay gone for a while, but that doesn't mean you can't buy paint or plants or any other damn thing for that matter.

[Half Moon]

@Nephrology,

6% of patients overall admitted to the hospital with Covid died, and 20% of them who found their way into the ICU perished?

Pfff. Flu, bro.

Flu?!? Don't get all crazy. I hear it's like the common cold...

[YVK]

It does seem to imply that overall case fatality rate may be lower than what we are currently estimating based on PCR + patients.

I am not sure if it is that important in itself. Obviously it would be nice to know that true CFR is the same as seasonal flu but it comes at the expense of high prevalence. 50% prevalence and CFR of 0.1% is still about 160,000 dead nationwide, and if their numbers of 95% being naive to infection are true, then what's going to prevent that 50% prevalence. Interestingly, the preliminary data from San Miguel county mirrors the immunity, or lack thereof, numbers.
As much as I am trying to understand this shit, almost everything I read raises more questions than answers. I am so fed up with this fucking virus.Then again, I have already admitted I wasn't the brightest bulb.

[Isaac]

3 more coworkers have it, one clerk two nurses. So for n/v diarrhea fever chills all around. One has mild cough and mild DIB/SOB. All expected to be back after their paid 14 days off.

Proning continues help, as does not initially rushing to intervene when sats dip to levels we aren’t used to. Seeing more Vapotherm nc. Not much new to report. PPE supply is adequate. And we are getting tons of free food haha.

Our system sends out an email daily with #s coming off vents, deaths. Etc. and a graph that shows an aggressive down turn in new +/ pending admits.


-typed on phone, just observations.

[Nephrology]

I am not sure if it is that important in itself. Obviously it would be nice to know that true CFR is the same as seasonal flu but it comes at the expense of high prevalence. 50% prevalence and CFR of 0.1% is still about 160,000 dead nationwide, and if their numbers of 95% being naive to infection are true, then what's going to prevent that 50% prevalence. Interestingly, the preliminary data from San Miguel county mirrors the immunity, or lack thereof, numbers.

Yeah, agreed, prevalence is the issue. Their study also sort of flies in the face of what we're seeing in NYC. If this really was closer to, say, bad seasonal influenza in terms of morbidity/mortality, we wouldn't be seeing entire hospitals full of dyspneic COVID+ patients. Even here, where our division believes we are past the peak, we still have a census of ~60 mechanically ventilated COVID+ patients on top of the rest of the MICU service. Normal MICU census there is usually 30-40.

As much as I am trying to understand this shit, almost everything I read raises more questions than answers. I am so fed up with this fucking virus.Then again, I have already admitted I wasn't the brightest bulb.

I feel the same way. It's been a great time to be writing a thesis on ARDS - I get the feeling I will get a lot of questions about it about on the residency interview trail - but this pandemic makes me feel like I am intellectually not far past 8th grade. Certainly could be something I could spend the rest of my career studying and still feel small in comparison.

[blues]

One small virus for man,

One giant pandemic for mankind.