I am commingling 'we' in a couple of different contexts; thank you for pointing this out.
My wife's cleaning business is retasking to provide 'best practice' action in the upcoming weeks -- much of the technological and chemical comments refer to that company (and its associated blogs and publicity in helping separate effective treatment from shelf-stripping wives' tales.
The latter 'we' is those of us in the United States waiting to see how the COVID-19 thing evolves... think of us as a nation of potential victims, or not-quite-yet-infected cases, waiting to see if credible palliative and supportive treatment gets to "mainstream" medical attention before any actual immunological treatment gets out of phase III trials. Any given outbreak that actually spreads the virus around to common contact may become rapidly dangerous; I am not entirely sanguine on how effective a resulting large-scale 'sanitization' can be conducted on the corresponding limited notice (and, presumably, dramatic rise in panic responses). Meanwhile the CDC continues to note that even 'recovering' cases of COVID-19 may continue to be sources of viral contamination; at least part of a 'vaccine' development effort may have to be paired with something like 3CLpro inhibitor therapy to periodically knock that down (see some of the early AIDS treatments for the general idea) -- this implies that very large stocks of properly-adjusted protease inhibitor might need to be produced and pre-distributed either at affordable cost or with full insurance/aid coverage in order to keep novel infection foci from becoming more and more widespread...
Overmod tree68 Which simply reinforces why people don't need to be walking around with masks on. We're more likely to put them on the patient so they don't spread germs (cough/sneeze) in our presence. This is not influenza; the likelihood of straight airborne transmission appears to be relatively slight according to all relatively current opinion. Where there is coughing, the transmission route is far likelier to be via cough to hands or other parts and subsequent transmission to surfaces ... where the virus remains viable and infectious from 18 up to 48 hours -- combined with its demonstrated high subsequent affinity for ACE2 receptor binding after contact and subsequent transfer to 'affectable' tissue (e.g. by touching mucous membranes at the face). To the extent wearing a mask precludes mechanical transfer, it may be an advantage. Wearing gloves is little help unless they are repeatedly sanitized, as any subsequent contact may make them 'infectious' again. Much of the run on hand sanitizer, various alcohol products, etc. is based on a somewhat distorted comprehension of the above ... as is the compulsive hand-washing (and avoiding contact with the face). Incidentally it's shaping up that about 78% alcohol is the 'optimal' strength first to penetrate the lipid coat and then denature proteins in the viral RNA. We're still looking at advantages and disadvantages of quaternaries in alcohol of that strength, or of using higher concentration that will 'evaporate' down to efficient strength in the necessary dwell time to assure viral 'disinfection'. That the ER doc got sick speaks to the possibility that he may have been using the tools, but not correctly. This is, still a bit surprisingly to me, not that rare in the field. I'm still amazed at Wine's Disease; there was at least one subsequent infection (ISTR Marburg) due to pipetting by mouth, which is Darwin-level with any agent of this determined potential lethality. Of course, concentrating large numbers of patients in an ER-type infrastructure, with a long-lived highly infectious agent involved, is likely to produce a nosocomial problem from Hell no matter how oervasive attempts at continuous disinfection may be tried. Just as it's discouraging that many new outbreaks have high early lethality, it may be encouraging that the prompt lethality in the ones observed so far tends to drop dramatically even a few days 'in' -- as I've said, we have to wait for better long-term statistics to be able to get any meaningful 'percentages' given this. In other good news, at least one of the mechanisms of induced 'breathing difficulty' symptoms has been identified and workable initial strategies to treat it already developed. (Whether this will or will not help the 'ventilator gap' problem is yet to be seen...)
tree68 Which simply reinforces why people don't need to be walking around with masks on. We're more likely to put them on the patient so they don't spread germs (cough/sneeze) in our presence.
This is not influenza; the likelihood of straight airborne transmission appears to be relatively slight according to all relatively current opinion. Where there is coughing, the transmission route is far likelier to be via cough to hands or other parts and subsequent transmission to surfaces ... where the virus remains viable and infectious from 18 up to 48 hours -- combined with its demonstrated high subsequent affinity for ACE2 receptor binding after contact and subsequent transfer to 'affectable' tissue (e.g. by touching mucous membranes at the face).
To the extent wearing a mask precludes mechanical transfer, it may be an advantage. Wearing gloves is little help unless they are repeatedly sanitized, as any subsequent contact may make them 'infectious' again. Much of the run on hand sanitizer, various alcohol products, etc. is based on a somewhat distorted comprehension of the above ... as is the compulsive hand-washing (and avoiding contact with the face).
Incidentally it's shaping up that about 78% alcohol is the 'optimal' strength first to penetrate the lipid coat and then denature proteins in the viral RNA. We're still looking at advantages and disadvantages of quaternaries in alcohol of that strength, or of using higher concentration that will 'evaporate' down to efficient strength in the necessary dwell time to assure viral 'disinfection'.
That the ER doc got sick speaks to the possibility that he may have been using the tools, but not correctly.
This is, still a bit surprisingly to me, not that rare in the field. I'm still amazed at Wine's Disease; there was at least one subsequent infection (ISTR Marburg) due to pipetting by mouth, which is Darwin-level with any agent of this determined potential lethality. Of course, concentrating large numbers of patients in an ER-type infrastructure, with a long-lived highly infectious agent involved, is likely to produce a nosocomial problem from Hell no matter how oervasive attempts at continuous disinfection may be tried.
Just as it's discouraging that many new outbreaks have high early lethality, it may be encouraging that the prompt lethality in the ones observed so far tends to drop dramatically even a few days 'in' -- as I've said, we have to wait for better long-term statistics to be able to get any meaningful 'percentages' given this. In other good news, at least one of the mechanisms of induced 'breathing difficulty' symptoms has been identified and workable initial strategies to treat it already developed. (Whether this will or will not help the 'ventilator gap' problem is yet to be seen...)
And precisely to whom or what does the "we" refer?
OvermodWearing gloves is little help unless they are repeatedly sanitized, as any subsequent contact may make them 'infectious' again.
For EMS, gloves come under the heading of "BSI," body substance isolation. Wearing them from one patient to the next is, indeed, of little use if the goal is to prevent patient-to-patient transfer. That's why there are boxes at virtually every bedside.
At an incident (especially a traffic incident) with several serious casualties it's not unusual to see quite a few discarded pairs.
I carry a pair at all times (and have, for upwards of 40 years) to protect me from the patient, and the patient from me. There are more on our brush truck (which runs our EMS calls) and at the station. And in the ambulance, for that matter.
Knowing how to properly take the gloves off is as important as wearing them in the first place.
As I may have said - SARS-CoV - the first version, arrived in 2003. By 2004 there were no recorded cases, outside a couple of lab accidents. We can hope that SARS-CoV-2 ends up being a similar "one and done" phenomenon.
Larry Resident Microferroequinologist (at least at my house) Everyone goes home; Safety begins with you My Opinion. Standard Disclaimers Apply. No Expiration Date Come ride the rails with me! There's one thing about humility - the moment you think you've got it, you've lost it...
OvermodIncidentally it's shaping up that about 78% alcohol is the 'optimal' strength first to penetrate the lipid coat and then denature proteins in the viral RNA. We're still looking at advantages and disadvantages of quaternaries in alcohol of that strength, or of using higher concentration that will 'evaporate' down to efficient strength in the necessary dwell time to assure viral 'disinfection'.
Do you mean that 78% alcohol concentration is more lethal to the virus than 91%? That is the way I read your comment, and I'm just trying to sort out if I have misread you intention, or if not then why this is so. I was under the impression that the only reason why they were recommending dilution at all was to incorporate skin-soothing agents to combat the alcohol's tendency to dry out the skin.
tree68Which simply reinforces why people don't need to be walking around with masks on. We're more likely to put them on the patient so they don't spread germs (cough/sneeze) in our presence.
Electroliner 1935Larry, What are your EMT's using to protect thmselves? Seattle has an ER Dr. that used appropriate protective gear now in critical condition in a hospital with the virus.
Which simply reinforces why people don't need to be walking around with masks on. We're more likely to put them on the patient so they don't spread germs (cough/sneeze) in our presence. But I digress.
Our protection starts at dispatch, where they will be asking those requesting EMS some screening questions. If there is suspicion, we'll be advised to call dispatch via landline to get specifics.
My fire department runs "first responder," meaning we don't transport. If there is an issue, we'll stage and wait for the ambulance, who can then come in fully "dressed." If a patient needs immediate interventions, we'll go in ahead of the ambulance crew for that.
We'll have masks (they're still hard to get), and we always have gloves anyhow. Pretty much standard precautions. Should our calls start to include infected patients, we'll ramp up accordingly. We normally only run one or two calls per week anyhow.
After that, it's soap and water.
https://fivethirtyeight.com/features/coronavirus-may-make-millions-of-americans-sick-but-we-only-have-about-100000-ventilators/
tree68Government agencies are going to "essential personnel only."
Larry, What are your EMT's using to protect thmselves? Seattle has an ER Dr. that used appropriate protective gear now in critical condition in a hospital with the virus.
OvermodLikely go right back to radical spread.
I'm sure the political leaders will be crowing about how they arrested the spread with the quarantines, etc, and will be surprised when the rebound occurs. Of course, they'll redouble the closings at that time.
As of tonight, most normal gathering places (bars, restaurants, clubs) and all schools in NY are closed. Government agencies are going to "essential personnel only." No gatherings of over ten people.
While many suggest that this is a good opportunity to reconnect with your spouse and your kids, in some cases that will be a bad thing. I expect to start hearing more domestic incident calls as this drags on.
Schools are making arrangements to get lunches and other food to the kids.
MidlandMike Overmod Nothing yet, fancy controversial statistical analysis or otherwise, has changed the previous assessment that about 98% of those infected will have what is essentially a bad cold for a couple of weeks, and that the others are at risk for more severe symptoms. That is a gross mischaracterization to say that the 98% (stats are closer to 96%) who don't die get "a bad cold". About 20% will require hospitalization. Many will require acute care including respirator. Hospital doctors are going before news cameras saying that they foresee a shortage of ICU facilities.
Overmod Nothing yet, fancy controversial statistical analysis or otherwise, has changed the previous assessment that about 98% of those infected will have what is essentially a bad cold for a couple of weeks, and that the others are at risk for more severe symptoms.
That is a gross mischaracterization to say that the 98% (stats are closer to 96%) who don't die get "a bad cold". About 20% will require hospitalization. Many will require acute care including respirator. Hospital doctors are going before news cameras saying that they foresee a shortage of ICU facilities.
I'm glad to see that corrected. Ventilators and respirators are in short supply and Ma and Pa Kettle aren't going to be able to hook one up in their garage. Or an IV bag.
MidlandMikeNo telling what will happen if and when they relax controls.
Likely go right back to radical spread. Indication I saw from CDC is that many who recover from symptomatic COVID-19 will continue to shed virus, perhaps at substantial levels, which will remain contagious to the 'rest' of the as-yet-unexposed people.
If there is a silver lining, it is that we are getting an increased handle on some of the respiratory complications, and how we might treat them clinically.
OvermodNothing yet, fancy controversial statistical analysis or otherwise, has changed the previous assessment that about 98% of those infected will have what is essentially a bad cold for a couple of weeks, and that the others are at risk for more severe symptoms.
PJS1China reported 80,991 confirmed cases. Deaths were 3,180. Thus, approximately .0056% cent of China’s population contracted the disease; .00022% of the population died as a result, and 3.93% of those that contracted the disease died.
China took drastic steps to contain the virus. Cities locked down. Widely reported news videos of their people dragged kicking and screaming to confinement. No telling what will happen if and when they relax controls.
blue streak 12. Why is the rate of deaths so far exponential by age for those over 60 years of age ? Hopefully not enough cases to know for sure.
As noted, the problem is the "piling on" of SARS-CoV-2 atop respiratory problems people may have. This is why the elderly are at bigger risk - they are more likely to have those underlying problems.
Youth are at far less risk (few, if any, deaths under around age 8 at this point) because such underlying problems are rare.
A friend's 1+ YO son was ill a few weeks ago, including time in the hospital. At the time, testing for SARS-CoV-2 was non-existent. It's possible that's what he had.
And that could be a problem - people with the malady may think they've got a case of the flu that wasn't covered by the shot this year, or a really bad cold. A good many of the cases being discovered have no known vector - authorities can't figure out how they contracted it.
The good part for those with underlying issues is that they know they have them and take certain precautions already.
The good part for everyone else is that we've suddenly figured out the why of handwashing. And that you need 500 rolls of TP if you're going to quarantined for four weeks.
Keeping it simple, the biggest problem the healthcare system faces is for the 15-22% of identified cases who have serious respiratory challenges. They typically need ventilators which are in limited supply at hospitals. It is the "hotspots" that could be overwhelmed.
10-20% of those at risk (>60; certain chronic conditions) who are infected will likely die. Healhcare workers in ERs at considerable risk also, maybe even higher.
blue streak 11. Once a person recovers is that person still able to pass the virus to others?
So far there has been a relatively low group of those 'fully recovered' to test against, but several individuals have been identified who 'test positive for infection' and have remained wholly or largely asymptomatic but shed infectious virus profusely. It may well be possible that other 'recovered' patients may still shed virus after clinical symptoms have ended. Time will tell if 'acquired immunity' works effectively at eliminating the whole of the infection.
2. Why is the rate of deaths so far exponential by age for those over 60 years of age? Hopefully not enough cases to know for sure.
There are at least two groups here so far, one being relatively sensitive to the problems the virus causes through its replication, the other being more and more functionally immunocompromised for the usual geriatric reasons. (The wacky attempts to produce antibodies specific to SARS-CoV-2 clones and inject huge amounts of these into elderly patients 'at risk' is based on aspects of the latter.)
I read some interesting observations about elevated IL6/IL10 in some of these patients being the 'efficient mechanism' leading to death, together with at least one effective treatment to preclude cytokine storm. I suspect more mechanisms will be identified during subsequent prompt outbreaks.
The assumption that 'the health system is going to be overloaded' is something of a question in itself; only those with more severe than 'normal' symptoms will derive much benefit from going to clinics or 'into the hospital' and of course this is almost a poster child for nosocomial infection so my father's dictum 'for God's sake stay out of the hospital!' is more than usually apt here. In my opinion we should concentrate very carefully on isolating the over-60 cohorts as carefully as possible, and having the most potential treatment modalities available for them should anyone in them show infection, rather than have runs on toilet paper as everyone hides out from each other for weeks. When they come out, SARS-CoV-2 will still be waiting... and until everyone has acquired immunity one way or another it'll still be happily and grandly infectious...
Two concerns from a doctor friend
1. Once a person recovers is that person still able to pass the virus to others ?
2. Why is the rate of deaths so far exponential by age for those over 60 years of age ? Hopefully not enough cases to know for sure.
It is too early IMHO to know if #1 is possible. @#2 is a concern if the health system is overloaded and if #1 also possible we are going to have a real disaster that almost all over 60s may eventually get sick.
Nothing yet, fancy controversial statistical analysis or otherwise, has changed the previous assessment that about 98% of those infected will have what is essentially a bad cold for a couple of weeks, and that the others are at risk for more severe symptoms. At least one case misdiagnosed as 'flu' and treated with corticosteroids has suffered dramatically as a more or less direct consequence; I'm sure there will be plenty more of the same as "pneumonia" gets treated the usual ways.
On the more hopeful side, researchers are beginning to better understand the reasons for increased early incidence of death in these coronavirus-induced diseases. That should prove much more useful than a 'search for a vaccine' in the potentially long term it now appears it will be taking to develop one.
In my opinion, the reason we haven't seen statistics on American outbreaks is that people in them haven't had the two weeks or so recovery "yet". There isn't any reason to think there will be an increased number of 'late fatalities' or, particularly, that there will be a rash more secondary infections causing chronic problems -- the rate of bacterial coinfections noted by the CDC data last week, at the time CDC stopped tracking it, was in absolute number of cases rather than a percentage, and that number was four.
The alarming thing remaining about COVID-19 is the relatively high infectiousness from contact with clones of SARS-CoV-2, combined with its long 'life' on normally-contacted surfaces (often 18 to 48 hours). This is why there has been such a run on sanitizers and quaternaries, and why it is relatively amazing that far more advice on effective methods of actually sanitizing things hasn't been given prominent attention.
I don't think it unlikely that most of us will avoid being infected by this thing by the end of the year; I also think that for most of us, it'll be ... like a bad cold, but extended for a week or two.
BaltACD Lying figures, Figuring liars. Your job, should you chose to accept it, is to figure out which is which.
Lying figures, Figuring liars.
Your job, should you chose to accept it, is to figure out which is which.
I took a statistics course in college, and one of the first things on the first day the professor said was "Figures can lie, liars can figure!"
This was NOT to encourage dishonesty, by any means! It WAS to encourage professionalism. Louse up your numbers, he said, and you discredit the whole profession of statistics and statisticians.
Interesting course.
Never too old to have a happy childhood!
tree68Interesting how they show something over 3,700 cases so far in the US, with 69 deaths, but also find a reason to point out that just 73 of the reported cases have recovered. Is that supposed to imply that many of the 3,600+ remaining reported cases are going to die? That flies in the face of even the worst reported death rates.
I assume it means that 3,558 people have the virus. Some of those will live and some will die. The 3,558 people who have neither died nor recovered are alive and in treatment. I assume they are still in quarantine.
Interesting how they show something over 3,700 cases so far in the US, with 69 deaths, but also find a reason to point out that just 73 of the reported cases have recovered. Is that supposed to imply that many of the 3,600+ remaining reported cases are going to die? That flies in the face of even the worst reported death rates.
The earliest quarantine cases are out of quarantine now.
And it's worth noting that it's felt that there are many unreported cases. It would appear that the bulk of them have recovered, although several cases of SARS-CoV-2 have been discovered post mortem. The rest may not have even known they had the disease.
Here is a link to reported stats worldwide. The US number have not changed since about 2300 (0300 GMT ) This link is updated almost every hour.
https://www.bing.com/search?q=covid19+update&qs=SC&pq=covia19+update&sc=8-14&cvid=2EA6632B0C2F44BBB97AD852FFE05D9B&FORM=QBRE&sp=1
Psj: What I presented were the population, number of cases and deaths and mortality rate in Hubei province where well over 75% of the cases and deaths in China occurred. Using the entire population of China is grossly unrepresentative of the deadliness of this virus. Since China is a police state, once they admitted what was happening in Hubei, they tightly sealed the border with adjoining states.
PJS1As of Friday, March 13, 2020, according to the World Health Organization (WHO), there were 132,758 confirmed COVID-19 cases in the world.
It has been opined (by a doctor working in the field - sorry, don't have a link) that SARS-CoV-2 has been in circulation in this country much longer than anyone is aware. Recall that we're told almost every year that the "current" flu shot may not prevent every strain of the flu. Thus someone who came down with a mild case of SARS-CoV-2 may have just figured they got one of the strains that "got away." The malady passes and life goes on.
It took some clusters of the sickness, and clusters of deaths before alarm bells really went off.
SARS-CoV (the original, ca 2003) was gone by 2004.
MidlandMike This is early in the US encounter with the virus. Cases are growing exponentally. What happened in Italy can happen here. Italy has more ICU beds than the US per capita, but their hospital system was overwhelmed. If half the US population got the virus, at 3.5% death rate, that's 5,782,257 deaths. Of course if we had a shortage of ICU/ventilators/techs the death toll could be much higher.
Rio Grande Valley, CFI,CFII
BaltACDPeople can use the data to 'PROVE' any side of the argument they desire.
Figures don't lie but liars figure.
PSJ:
Earlier I cited the relevant statistics for any meaningful comparisions in regard to China. In disease studies, these are incidence and prevalence rates. You stated that those in charge are not up to speed on the data. The people actually in charge are at places like CDC who understand these stats far better than you or I. That is why I asked your coursework in stat. I was required to take four graduate level stat classes and use descriptive and inferential stats quite frequently professionally.
MidlandMike PJS1 Again, the statistics, although the people in charge apparently don’t know how to interpret them or don’t care to. According to the U.S. Census Bureau, the estimated population of the United States is 330,414,717 The estimated population of Texas is 28,995,881. According to the New York Times, as of Saturday morning there were 2,195 actual or presumed cases of COVID-19 in the United States. Deaths were 29. Thus, approximately .00066 percent of the U.S. population has contracted the disease and .000015 percent has died from it. Approximately .00018 percent of Texans have tested positive for COVID-19. No one has died from it. Approximately 96.5 percent of the people that contract COVID-19 survive it. Of those that have died, many of them have had underlying health issues, or they were elderly. Or both! People should be cautious. They should practice good hygiene, as recommended by the CDC, avoid large crowds, and not panic. Get off the roads. Your chances of being killed or seriously hurt in a car crash are probably higher than being taken down by COVID-19. This is early in the US encounter with the virus. Cases are growing exponentally. What happened in Italy can happen here. Italy has more ICU beds than the US per capita, but their hospital system was overwhelmed. If half the US population got the virus, at 3.5% death rate, that's 5,782,257 deaths. Of course if we had a shortage of ICU/ventilators/techs the death toll could be much higher.
PJS1 Again, the statistics, although the people in charge apparently don’t know how to interpret them or don’t care to. According to the U.S. Census Bureau, the estimated population of the United States is 330,414,717 The estimated population of Texas is 28,995,881. According to the New York Times, as of Saturday morning there were 2,195 actual or presumed cases of COVID-19 in the United States. Deaths were 29. Thus, approximately .00066 percent of the U.S. population has contracted the disease and .000015 percent has died from it. Approximately .00018 percent of Texans have tested positive for COVID-19. No one has died from it. Approximately 96.5 percent of the people that contract COVID-19 survive it. Of those that have died, many of them have had underlying health issues, or they were elderly. Or both! People should be cautious. They should practice good hygiene, as recommended by the CDC, avoid large crowds, and not panic. Get off the roads. Your chances of being killed or seriously hurt in a car crash are probably higher than being taken down by COVID-19.
This is early in the US encounter with the virus. Cases are growing exponentally. What happened in Italy can happen here. Italy has more ICU beds than the US per capita, but their hospital system was overwhelmed. If half the US population got the virus, at 3.5% death rate, that's 5,782,257 deaths. Of course if we had a shortage of ICU/ventilators/techs the death toll could be much higher.
People can use the data to 'PROVE' any side of the argument they desire.
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