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.
Lying figures, Figuring liars.
Your job, should you chose to accept it, is to figure out which is which.
Never too old to have a happy childhood!
BaltACD 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.
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.
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.
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...
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 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.
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...
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.
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.
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.
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.
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.
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.
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.
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.
https://fivethirtyeight.com/features/coronavirus-may-make-millions-of-americans-sick-but-we-only-have-about-100000-ventilators/
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.
That the ER doc got sick speaks to the possibility that he may have been using the tools, but not correctly.
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.
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'.
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...)
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.
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.
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.
And precisely to whom or what does the "we" refer?
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...
OM: Given the quality and speed of decision-making and implementation so far, "not sanguine" is a very mild understatement.
"Not sanguine" is intended as British-style sardonic understatement. I won't post what I really think because Kalmbach says we have to keep it family-friendly.
.
Convicted OneDo 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 your intention, or if not then why this is so.
There is no doubt that substantial dilution from 91% alcohol gives better virucidal action, and for the reasons I mentioned. You can find explanations on the Web that are probably more detailed than the abbreviated version I posted.
In fact, ordinary 70% alcohol is better than 91% too. The stated reason is that the stronger alcohol affects the lipid bilayer in a way that blocks further penetration of the alcohol into the viral RNA, but not irreversibly. What you want is to cause sufficient disruption or permeability in the viral coat to allow the alcohol to penetrate and denature the RNA 'permanently', and from what I have read, somewhere in the high 70s is the 'optimal' range that gives the best combination of actions net of the usual dilution, evaporation, etc. of the alcohol solution after application. Since it is relatively easy to dilute to the 'bioeffective' level by simply mixing a little water with stronger proof, it seemed the logical way to proceed both in designing effective sanitation treatment and in developing explanations about why it is.
[/quote]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.[/quote]
The 'agents' in rubbing alcohol don't really count as 'dilution' as they are in the 30% water, in relatively small concentration -- oil of wintergreen, lanolin, etc. -- not replacing any of the alcohol proper. I have not seen anyone add these to the 91% strength; perhaps the solvent action is so great at that concentration that skin would be affected regardless of practical emollients or whatever. That would be even more likely at the 95-and-a fraction that represents an 'equally evaporating' strength (which would otherwise represent an 'ideal' strength for application to surfaces as for many food-industry and hospital disinfectants, which in the instructions are supposed to remain 'wet' for 10 minutes.
Incidentally, 200 proof alcohol not only dries out skin on contact, it heats it dramatically as it does so. This would certainly have a synergistic effect on 'killing' something susceptible to this level of heating, but the other issues involved with its provision, safe handling, and application in the field are probably too great to recommend its use for viral disinfection over both the proven lower concentrations or alternative agents such as quats.
OvermodThe 'agents' in rubbing alcohol don't really count as 'dilution' as they are in the 30% water, in relatively small concentration -- oil of wintergreen, lanolin, etc. -- not replacing any of the alcohol proper. I have not seen anyone add these to the 91% strength; perhaps the solvent action is so great at that concentration that skin would be affected regardless of practical emollients or whatever
Many of the 'home brew' recipes that I seen for field expedient hand sanitizer suggest a mixof 1 part aloe vera product and 2 parts 91% alcohol.
I had assumed, perhaps incorrectly, that the 'cut' was for mildness to the skin. Your submission suggests it might be more intended to adjust the effectiveness. I was just curious. Thanks
Convicted OneMany of the 'home brew' recipes that I seen for field expedient hand sanitizer suggest a mix of 1 part aloe vera product and 2 parts 91% alcohol.
This is almost surely to match the nominal 60%-alcohol percentage of many commercial hand sanitizer formulations -- and would be accurate in that context. Keep in mind that in at least some cases, the result is going to be substantial 'sliming' of the hands after use (as the alcohol evaporates off, you're left with the aloe-vera lotion on your hands with nothing to wipe it off) and this in addition to being annoying might be outright dangerous if you need to grip something promptly. It's possible that a gel product could assimilate the additional alcohol 'better' than a lotion to produce something more ike typical sanitizer.
The high-70-proof range is not intended as a 'guide' for best general-purpose sanitizing, nor as the 'best' germicidal formula in general. It is more strictly formulated 'by design' against virus composition, particularly that of coronaviruses. (It is quite possible that fine-tuning the alcohol percentage, or some of the 'diluents', would give "better" results for other specific contaminants like H1N1 spp.)
Overmod "Not sanguine" is intended as British-style sardonic understatement. I won't post what I really think because Kalmbach says we have to keep it family-friendly.
I was being approvingly sarcastic.
The dangers of frequent use of higher concentrations of alcohol as a hand rub to preserving an intact skin barriers are considerable, especially in those over 55.
For about the last 10 years, I have used 91% isopropyl alcohol to wash my hands after being in stores and then returning to my vehicle. While in the store, I make a concerted effort to not touch my face. For each hand washing, I pour about 2-3 tablespoons of alcohol into one cupped hand and then wash both hands as is typical. I like the way it thoroughly wets and penetrates. It is okay if some spills off. It dries quickly with no need for toweling off. Fortunately, I have a large stock of alcohol on hand because I have always maintained an oversupply.
I have never used hand sanitizers made as a lotion product. With those, I suspect that people feel they are maintaining a layer that will have an ongoing effect in killing virus, and then they replenish it from time to time. However, I use the alcohol as a momentary cleaning event to kill bacteria that may have accumulated in areas of high numbers of people. After being in certain stores, I wash my arms as well as my hands.
Euclid For about the last 10 years, I have used 91% isopropyl alcohol to wash my hands after being in stores and then returning to my vehicle. While in the store, I make a concerted effort to not touch my face. For each hand washing, I pour about 2-3 tablespoons of alcohol into one cupped hand and then wash both hands as is typical. I like the way it thoroughly wets and penetrates. It is okay if some spills off. It dries quickly with no need for toweling off. Fortunately, I have a large stock of alcohol on hand because I have always maintained an oversupply. I have never used hand sanitizers made as a lotion product. With those, I suspect that people feel they are maintaining a layer that will have an ongoing effect in killing virus, and then they replenish it from time to time. However, I use the alcohol as a momentary cleaning event to kill bacteria that may have accumulated in areas of high numbers of people. After being in certain stores, I wash my arms as well as my hands.
Thanks to Chris / CopCarSS for my avatar.
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