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Posted by zugmann on Saturday, March 28, 2020 2:25 PM

SD70Dude
We haven't had those in Canada for years.

That's why we need to send troops to that border!  

It's been fun.  But it isn't much fun anymore.   Signing off for now. 


  

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Posted by daveklepper on Saturday, March 28, 2020 10:12 PM

Prime Minister Benjamin Netanyahu ordered authorities over the weekend to prepare to significantly tighten restrictions on movement starting Sunday, aiming to further reduce the number of people leaving their homes - and hopefully, contain the spread of the novel coronavirus pandemic.
Should there not be a change in the trend of infections over the weekend, Netanyahu warned, a full shutdown of the country will be necessary. The warning followed a meeting with ministers and ministry director-generals, during which the Finance Ministry was tasked with developing a plan for a further reduction of the country’s labor force.
 
The prime minister also ordered stepped up enforcement in supermarkets and pharmacies to ensure that people adhere to the Health Ministry’s directives regarding crowding.
However, according to ministry officials, as of Saturday there was slower than expected growth in the number of infections: Some 3,619 Israelis have been diagnosed with coronavirus - an increase of 926 cases over the weekend. Twelve people have died to date - all elderly individuals with underlying health conditions. Among the confirmed cases, 54 are in serious condition, including 43 intubated individuals. So far, 89 people have recovered.
An 82-year-old man, Shmuel Sifri from Haifa who was vacationing in Italy, also died of coronavirus, the Foreign Ministry said on Saturday. The Israeli consul in Rome, Eitan Avraham, is assisting the family following the man's death.
The greatest challenge seems to be within the haredi (ultra-Orthodox) neighborhoods, where the numbers per 10,000 people are among the highest: 53 in Kiryat Ye’arim, 38 in Kfar Chabad and 13 in Bnei Brak, in comparison to 4 in Tel Aviv and 1.5 in Haifa.
“What is happening in Bnei Brak is like Italy,” one doctor from a major hospital in central Israel told Channel 12. “Almost every haredi who is tested for the virus is found positive. There are families with 100% infection. The Health Ministry needs to go door to door, and take the sick from their homes. If not, in another few weeks, we will see them coming in by masses.”
In an interview with the television channel, Health Ministry director-general Moshe Bar Siman Tov explained that behavioral changes had been noted in both the haredi and Arab neighborhoods, but that “the potential for infection is greater in places with greater population density.”
Highlighting the difficulty for effective isolation within high-density areas and large families, Bar Siman Tov said ministers had agreed to open dedicated isolation centers for both haredi and Arab individuals.
Netanyahu’s proclamation came on the backdrop of an announcement by the Health Ministry that it will increase the number of people it tests for coronavirus to 30,000 per day within a month. On Friday, some 6,000 tests were taken, and that number is expected to increase to 10,000 by mid-week, a decision that Defense Minister Naftali Bennett called “tremendous news.”
Due to a technical problem, however, the Health Ministry said test results from the country’s 27 laboratories were delayed on Saturday.
Morris Dorfman, head of regulation at the Health Ministry’s Digital Health and Information Systems Directorate, said that the results of eight tests were reported incorrectly by two laboratories to the ministry. The results had not yet been transferred to the patients in question, he said, and operations at the laboratories were continuing as normal.
As the number of confirmed cases and deaths from the pandemic continue to soar worldwide, including a death toll exceeding 10,000 in Italy, Netanyahu spoke on the phone with Italian Prime Minister Giuseppe Conte. He sent condolences in the name of the Israeli government over the country’s large number of deaths. Netanyahu was set to convene a meeting with finance officials late on Saturday to finalize a delayed plan to support the economy and businesses struggling as a result of measures to contain the coronavirus.
On Saturday evening, Netanyahu is set to convene a meeting with finance officials to finalize a delayed plan to support the economy, as well as businesses struggling as a result of measures to contain the coronavirus.
The scope of the financial aid package requested by Netanyahu is set to be about NIS 80 billion, or 6% of GDP, including increased government-backed loans, deferred compulsory business payments and deferred taxation. It was also decided to include an NIS 5b. fund to bail out large businesses.
The plan, which will likely be presented for approval at Sunday’s cabinet meeting, will be in addition to NIS 8b. in support already allocated to businesses, primarily in the form of low-interest, government-backed loans.
On Friday, the government approved a series of emergency financial support regulations, including the provision of unemployment benefits for citizens over the age of 67 – estimated to stand at some 135,000 people. Individuals will receive up to NIS 4,000 if they were forced to leave work due to the outbreak.
“This is a significant and unprecedented step that shows the ongoing assistance of elderly citizens, especially those in the employment sector over retirement age,” Labor Minister Ofir Akunis said.
Among the latest casualties of the coronavirus was a 73-year-old man from Haifa with underlying conditions. His wife, 71, remains hospitalized at Haifa’s Rambam Medical Center with the virus.
A 93-year-old man hospitalized at Soroka Medical Center, an 80-year-old man admitted to Wolfson Hospital and a 76-year-old woman treated at Rabin Medical Center also died over the weekend.
As of Saturday afternoon, police said they have issued 1,296 fines to date to individuals and businesses for defying Health Ministry directives.
A total of 849 fines between NIS 500 and NIS 5,000 were issued for prohibited activities in public; 152 fines for being present in a banned location; 108 for refusing to disperse from crowded locations; 105 for operating a forbidden business; and 73 for defying self-isolation orders.
Idan Zonshine contributed to this article.
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Posted by Euclid on Sunday, March 29, 2020 7:55 AM

zugmann
 
Euclid
The way that public officials ridicule the idea of testing everybody leads me to believe that they have never grasped the purpose.

 

We can't even get people to stay at home for a few days.  You really think everybody is going to voluntarily go in for testing?

 

The testing I described on previous page cannot be voluntary.  If it was, people would delay until they were convinced they have the virus.  And during the delay, they would infect others.  In the same way, all the rules about distancing and hand washing will see very hit and miss compliance because they are voluntary. 

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Posted by Overmod on Sunday, March 29, 2020 1:01 PM

This in this morning, of probable interest to Euclid and others:

There is an early signature of IGm relative to IGg that is diagnostic of early infection (at least in most individuals retaining immune responses) and this is supposedly detectable with very small blood sample volume - comparable to blood-glucose meters.

So it should be possible to make large numbers of readers, possibly 'multiple-spectrum' depending on the type of strip inserted (or wells/circuits printed on that strip) which are then able to dereference data and transmit as the thermometers do (and, ideally, associated with those data) to give much better and quicker ID of infection.  I suspect, but can't prove yet, that an approach like this might distinguish between H1N1 influenza and corona spp.

Note the implications vs. typical intrusive blood testing or 'lab-centric' swabs...

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Posted by zugmann on Sunday, March 29, 2020 1:10 PM

Euclid
The testing I described on previous page cannot be voluntary.

Good luck with that one. 

It's been fun.  But it isn't much fun anymore.   Signing off for now. 


  

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Posted by Overmod on Sunday, March 29, 2020 1:48 PM

zugmann
 
Euclid
The testing I described on previous page cannot be voluntary.

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Posted by Euclid on Sunday, March 29, 2020 1:50 PM

zugmann
 
Euclid
The testing I described on previous page cannot be voluntary.

 

Good luck with that one. 

 

I don't expect it to be done.  It is just the basic tool to prevent pandemics.  Lesser tools doing a less effective job might be good enough.  What I descibed needs a new test method and new communication link.  It needs system of operation.  Ideally, it needs to be international because the virus is international.  Operating internationally would probably be impossible.  People would also balk at the intrusivenss of being tested all the time. 

But my main point was to wonder why I hear people apparently not understanding the point of testing everybody. 

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Posted by zugmann on Sunday, March 29, 2020 1:54 PM

Overmod
What's needed is a distributed solution, easy to use, ideally with some kind of incentive to use it rather than 'other people's compulsion' -- this is still America.  Then make the tracking architecture very low bandwidth and reasonably asynchronous... all the work we did decades ago when rural 'broadband' was still science fiction still applies now.  

Free gun with testing!

It's been fun.  But it isn't much fun anymore.   Signing off for now. 


  

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Posted by daveklepper on Sunday, March 29, 2020 2:11 PM
Three more Israelis died from coronavirus on Sunday, bringing the total number of victims to 15, as numbers of infected people surpassed 4,000 and discussions about increasing restrictions on the public continued.
 
On Sunday, Prime Minister Benjamin Netanyahu, officials from Health, Finance and Defense ministries shifted their focus slightly to considering restrictions on some specific pockets of society, such as the Haredim (ultra-Orthodox), many who continue to ignore certain guidelines.
 
“What is happening in Bnei Brak is like Italy,” one doctor from a major hospital in central Israel told Channel 12 over the weekend. “Almost every Haredi who is tested for the virus is found positive. There are families with 100% infection. The Health Ministry needs to go door to door, and take the sick from their homes. If not, in another few weeks, we will see them coming in by masses.”
 
Haredim constitute as much as 50% of coronavirus patients hospitalized throughout the country, Channel 12 reported: Schneider Hospital 50%; Sheba Medical Center, Tel Hashomer 60% in ICU, 50% in other units; Shaare Zedek 50% to 60%; Hadassah Ein Kerem 40%.
 
The Health Ministry is considering instituting a full lockdown only on those areas where cases are particularly widespread, such as Bnei Brak in general or neighborhoods within the largely Haredi town.
 
The government is still considering expanding restrictions throughout the country, too, which could include decreasing the number of workers allowed in the office from 30% to 15%, requiring staff to work in shifts, or asking employees if they have symptoms before they are allowed to enter the workplace.
 
At the same time, the government has committed to increasing coronavirus tests per day to 30,000 within two weeks.
 
On Sunday, the Health Ministry tested close to 6,000 people and is expected to reach 10,000 people per day sometime this week. Senior health officials say increased screening will enable the Health Ministry to better understand how much the disease has spread throughout the country and help identify coronavirus hot spots.
 
On Monday, the Defense and Health ministries, the Homefront Command, two Rami Levy grocery stores and one Victory supermarket will pilot a new program in which shoppers will be tested for coronavirus upon entering the stores. If the pilot is successful, this could become the new normal.
 
Back to the victims: Victim No. 15 is an 84-year-old woman who was being treated at Jerusalem’s Shaare Zedek Medical Center. Victim 14 is a 90-year-old woman who had been hospitalized at Mayanei Hayeshua Medical Center in Bnei Brak, and the 13th dead is a 92-year-old man who was admitted last week in serious condition to Shaare Zedek.
 
All of those who died had pre-existing medical conditions.
 
At press time, 4,247 Israelis had coronavirus, according to the Health Ministry - 74 people were in serious condition, among them a young man in his 20s who was hospitalized at Samson Assuta Ashdod University Hospital.
 
The numbers represent an increase of 628 people in 24 hours. 
 
The young man, who doesn’t have any pre-existing medical conditions, began his treatment with mild symptoms, a spokesperson for Assuta said. But in recent days his situation deteriorated and doctors decided to intubate him.
 
"Toward morning, the patient's respiratory condition worsened," said ICU head Meir Ami, who noted that his condition is stable and he is responding well to treatment.
 
In an interview with Channel 12, the patient’s mother cried, describing how she told her husband, “Our son is sick and we cannot be by his side, we cannot help him.”
 
She noted that he had returned to Israel from the United States with two friends last week, both who have coronavirus too. But only he is in critical condition.
 
So far, the majority of coronavirus patients in Israel are between the ages of 20 and 29 (67.5 out of 100,000), the Health Ministry reported. The second largest group of infected people (56.7 out of 100,000) are between the ages of 50 and 59.
 
Of those diagnosed with the virus, the majority continue to have mild symptoms: 3,944. The rest have moderate symptoms (82) or have recovered from the virus (132).
 
There are 500 people hospitalized with the virus and 59 on respirators, according to the Health Ministry.
 
In addition, as of Sunday morning, some 3,637 medical professionals are in isolation, among them 892 doctors and 1,229 nurses; some 141 who have been diagnosed with coronavirus.
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Posted by daveklepper on Sunday, March 29, 2020 2:29 PM

Leader of ultra-Orthodox worldcalls for lone prayer due to coronavirus
Rabbi Kanievsky ruled that anyone not obeying social-distancing orders is like someone trying to murder another, is responsible for causing their death; permits reporting them to secular authorities.
By JEREMY SHARON   
MARCH 29, 2020 18:49Twitter  fb-messenger
After weeks of stalling, the most senior rabbinic leader of the ultra-Orthodox world, Rabbi Chaim Kanievsky, has ordered members of the community to obey social-distancing orders, pray alone instead of in a prayer quorum and report anyone who violates the orders to the police.
Kanievsky’s instructions were notable for the level of trust they imparted to officials and experts regarding the coronavirus epidemic in contrast to previous comments the rabbi has made, as well as to a prevailing attitude in the community itself which often puts greater trust in rabbis than officials of any other kind, including state and medical ones.
Two weeks ago, despite the widening coronavirus epidemic, Kanievsky and Rabbi Gershon Edelstein, the other senior leader of the ultra-Orthodox world, both decided not to close ultra-Orthodox boys schools and yeshivas, on the basis that children studying Torah provides physical protection to the Jewish people.
On Sunday however, after data was released showing rates of infection among the ultra-Orthodox public to be particularly high, Kanievsky finally issued several rulings instructing the community to take the epidemic seriously.
In response to a list of six questions apparently posed to him by members of the public in recent days, Kanievsky took a strong stance on the importance of adhering to social distancing instructions and obeying the instructions of doctors.
The rabbi was asked whether people, who claim they trust that God will prevent them from become infected with the COVID-19 coronavirus and therefore violate social-distancing orders issued by the Health Ministry, should be considered “like a rodef” – someone "pursuing" people in order to kill them. Kanievsky responded yes.
In Jewish law, extreme measures can be taken against a rodef to halt their actions.
Kanievsky added that if a person violated the social-distancing orders and thereby infected someone else and caused their death, that person would bear liability for that person's death.
The rabbi also ruled that people should leave a cell phone on over Shabbat and answer it in case a doctor is trying to contact them in an emergency situation.
Using a phone on Shabbat usually violates Jewish law unless there is a matter of life and death, so Kanievsky’s ruling demonstrates the seriousness with which he is now taking the coronavirus epidemic.
In addition, the leading legal authority ruled that it was permitted to inform law enforcement agencies about an individual, a synagogue and educational institutions which violate the Health Ministry orders, even if it means that fines or even imprisonment will be imposed on such violators.
Kanievsky said in summation that the general public should pray to stop the epidemic.
Since Kanievsky and Edelstein ruled to keep boys' schools and yeshivas open, many such institutions continued to operate for several days on a near-normal basis.

The two rabbis never rescinded that decision, but last week the winter term ended and ultra-Orthodox schools and yeshivas are now on their Passover vacatio

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Posted by blue streak 1 on Sunday, March 29, 2020 8:25 PM

Dave:  have noticed that the countries near you are not reporting many  cases.  Is there any hint as to what is happening in those countries ?  Has Isreal closed its borders yet ?  Here is link to latest world wide infections.

 

https://www.worldometers.info/coronavirus/#countries 

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Posted by Flintlock76 on Sunday, March 29, 2020 9:13 PM

zugmann

 

 
Overmod
What's needed is a distributed solution, easy to use, ideally with some kind of incentive to use it rather than 'other people's compulsion' -- this is still America.  Then make the tracking architecture very low bandwidth and reasonably asynchronous... all the work we did decades ago when rural 'broadband' was still science fiction still applies now.  

 

Free gun with testing!

 

That reminds me, where the hell did I leave those flints?  Hmm

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Posted by Erik_Mag on Sunday, March 29, 2020 10:18 PM

Overmod
 

A simple incentive would be assurance that I am "virus free". The protocol in San Diego county per the county COVID-19 webpages is that people are only supposed to be tested when showing symptoms of infection. These same pages go on to say that 80% of those infected would not show enough symptoms to warrant testing.

One take-away is that no meaningful figure can be given for fatality rate as there is no true number for infections i.e. fatality rate computed from SDC Health department reports will be much higher than reality.

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Posted by Convicted One on Sunday, March 29, 2020 10:25 PM

Erik_Mag
A simple incentive would be assurance that I am "virus free"

How about a test for anti-bodies, confirming previous exposure? I'd much prefer that.

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Posted by daveklepper on Monday, March 30, 2020 1:39 AM

Answering Blue Streak.  Several low-level wars going on beteen one Muslem country and another, a residue of the hatred that was a fall-out of the real hatred against Jews taught by the 1926-appointed Mufti Haaj Al-Husseini, friend of Adolf Hitler.  (Make hatred part of religion and the hatred spreads, one kind of Muslem against another kind).  This makes accurate reporting very difficult, let alone actual control of the illness.  I think Jordan's figures are reliable, but none of the other immediate neighbors.

With very few exceptions, all visitors to Israel must endure 14-day quarenteen.

The conldition of foreign workers in Quatar is known to be particularly horrible, a real human-rights violation, inexcusable considering the wealth of that country and its relatively peaceful borders.

We are trying to help in both Gaza and the West Bank (Judea and Samaria).  But they stilll teach childfen the virus is a "Zionist Plot."

Israel reports on the number of cured, whch has been vastly outstripping the dyikng.  Why donl't I see USA figures on cures?

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Posted by daveklepper on Monday, March 30, 2020 3:26 AM

BESA Center Perspectives Paper No. 1,511, March 30, 2020

EXECUTIVE SUMMARY: The coronavirus (COVID-19) pandemic is causing an online revolution—one that provides opportunities but also creates risks. Surveillance of infected and quarantined individuals through mobile applications is helping to slow the spread of the contagion, but contains an implicit threat to privacy. Cybersecurity is being tested as hackers look for ways to use the unprecedented situation to strike governments, companies and individuals. 

The identification and isolation of individuals infected and quarantined with coronavirus (COVID-19), as well as people with whom they have been in contact, is considered a priority in the international fight against the pandemic. Government policies differ on methods of monitoring these citizens and the legal terms under which their data can be held and shared.

New York Times article discusses online surveillance practices currently being applied in Australia, China, Italy, Mexico, Singapore, South Korea, and the US to trace the movements of coronavirus patients or send warning messages. In Israel, PM Benjamin Netanyahu announced that all means—both technological and digital—will be used to fight the spread of the virus.

Under normal circumstances, the use of online surveillance tools would spark an immediate and intense debate about privacy implications. The mission of the UN Global Pulse initiative is to ensure that big data, artificial intelligence, and emerging technologies are harnessed safely and responsibly for the public good.

But at the present moment, saving lives is deemed a more urgent concern. A March 2020 study conducted at the University of Oxford shows that several methods of direct online contact, including first-degree instantaneous contact tracing and the practice of informing users when they can move about safely or when they should seek medical help and avoid vulnerable individuals, have the potential to stop the spread of the epidemic if used correctly by enough people.

A team of medical research and bioethics experts from the same institution is supporting several European governments in their effort to devise a coronavirus mobile app for instant contact tracing. In Israel, the Health Ministry has already launched a phone app to help prevent the spread of the virus.

Internet usage in the coronavirus era creates both opportunities and risks, and those risks extend beyond the potential for unaccountable and irresponsible use of data by governments or companies. According to Reuters, hackers attempted to break into the World Health Organization at the beginning of March. The US Department of Health and Human Services was also attacked, and the Canadian Centre for Cyber Security issued an alert on risks to national health organizations that are involved in the response to coronavirus.

Cyber and biological weapons can be combined with malicious intent with potentially disastrous results. In a reflection of this concern, cybersecurity is mentioned in the American National Biodefense Strategy. Erel Margalit, founder and chairman of Jerusalem Venture Partners, goes so far as to argue that though there is no proof that the current virus is the result of a cyberattack, it could be.

While the origins of coronavirus are still being debated and researched, a new study in Nature calls the scenario of a laboratory-based creation “improbable.” But even if the virus is not a biological weapon, the matter of cybersecurity surrounding its outbreak is far from trivial. Cybercriminals seek ways to capitalize on crises, including pandemic scenarios like coronavirus. National security could be jeopardized as politicians, diplomats, and military officials are forced to substitute teleworking and virtual summits for face-to-face meetings. Well-equipped offices are going unused as users resort to remote access and connectivity via computers and smartphones. Measures have been taken in most countries to guarantee the safety of online communications, but efforts to intercept talks will certainly multiply. Carelessness and weaknesses in communication links are gifts for hackers.

Employees in both the public and private sectors will need to work from home for a long period. Unless their agencies, organizations, or companies have provided them with secure tools and applications, their data will be easy to steal. Israel’s expertise at preventing this can be beneficial for other countries.

Dangers can be financial, such as credit card leaks and breaching of private bank accounts. Interpol has warned about financial fraud via phishing scams and fake calls about supposed medical cures, international donations, state aid, or tax breaks. And there is another danger: hackers can access private genetic information, either to blackmail companies or individuals to obtain money in exchange for non-publication of sensitive data or to sell the information to interested parties.

Coronavirus is not only affecting public health and the economy. It is also bringing other challenges to the forefront, such as how to handle the sudden “virtual” revolution. When the pandemic is over, world leaders will need to work together to improve digital literacy and international cyber governance. The question is whether the internet will be turned into a new frontier for cooperation or a competitive battleground.

Dr. George N. Tzogopoulos is a BESA Research Associate, Lecturer at the Democritus University of Thrace, and Visiting Lecturer at the European Institute of Nice.

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Posted by Overmod on Monday, March 30, 2020 4:42 AM

Convicted One
How about a test for anti-bodies, confirming previous exposure? I'd much prefer that.

It may have gotten lost in the sauce... but the immunoglobulins g and m (the IGg and IGm) I mentioned are principal antibodies in viral infections.  They are much likelier to be detected quickly than virus 'particles' would be in the early stages of infection while most virus is still bound to cells or replicating internally where noninvasive testing would probably not reach.

It does presume that the body's ability to form the required concentration of these antibodies (made via two distinct pathways) is reasonably present.  That leaves some of the population unable to get simple confirmatory tests -- and the 'right' mix of their own preservation vs. the rights of others 'not to be infected' would guide social policy regarding that.  I am not sure what kind of test that doesn't have more or less mad-scientist flavor can be used to quickly determine propensity to manifest IG responses by previously-untracked people -- without it a great deal of the point of enhanced testing is badly compromised.

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Posted by daveklepper on Monday, March 30, 2020 5:21 AM

Our Jerusalem government is responsive to challenges.  Got this note from Steve, confirming a Jerusalem Post report:

Dear all, 

If you are in 'lock-down' -the curfew-  and you have no opportunity to go out and get food - {or you are either OLD-FOLKS,  or poor }
then call 106 at your municipality -or use their web-site  under the ReVaa'Hah section - רווחה - and then the city to deliver food to you. (They will do it).....   _these are pre-packaged KOSHER meals -that just need to be heated up.
Deena & I have has them delivered this week- and they are good!
Shabbat Shalom
Hodesh TOV

 

Steve

 

 

 

I do not plan on using this service because I can get all the help I need from my adoptive famolies at the Yeshiva.
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Posted by daveklepper on Monday, March 30, 2020 8:50 AM

 
Anantha P. Chandrakasan <deanofengineering@mit.edu>
To:daveklepper@alum.mit.edu



’ve never been prouder to be a part of MIT. Not only is our entire community stepping up and uniting in remarkable ways, but faculty and researchers from across the School have ramped up efforts to directly combat this virus. We are donating personal protective equipment to local hospitals and healthcare centers, developing rapid testing kits, producing inexpensive ventilators, leveraging AI for early infection diagnostics, developing systems to quickly produce masks, designing robots and sensors that can rapidly take vital signs in the emergency room, investigating ways to minimize risk to healthcare workers—we are tackling this pandemic in every conceivable way.

 

Anne Trafton | Jennifer Chu | David L. Chandler | MIT News Office
March 12, 2020

As more Covid-19 cases appear in the United States and around the world, the need for fast, easy-to-use diagnostic tests is becoming ever more pressing. A startup company spun out from MIT is now working on a paper-based test that can deliver results in under half an hour, based on technology developed at MIT’s Institute for Medical Engineering and Science (IMES).

Cambridge-based E25Bio, which developed the test, is now preparing to submit it to the FDA for “emergency use authorization,” which would grant temporary approval for using the device on patient samples during public health emergencies.

Elsewhere around MIT, several other research groups are working on projects that may help further scientists’ understanding of how coronaviruses are transmitted and how infection may be prevented. Their work touches on fields ranging from diagnostics and vaccine development to more traditional disease prevention measures such as social distancing and handwashing.

Faster diagnosis

The technology behind the new E25Bio diagnostic was developed by Lee Gehrke, the Hermann L.F. von Helmholtz Professor at IMES, and other members of his lab, including Irene Bosch, a former IMES research scientist who is now the CTO of E25Bio.

For the past several years, Gehrke, Bosch, and others in the lab have been working on diagnostic devices that work similar to a pregnancy test but can identify viral proteins from patient samples. The researchers have used this technology, known as lateral flow technology, to create tests for Ebola, dengue fever, and Zika virus, among other infectious diseases.

The tests consist of strips of paper that are coated with antibodies that bind to a specific viral protein. A second antibody is attached to specialized nanoparticles, and the patient’s sample is added to a solution of those particles. The test strip is then dipped in this solution. If the viral protein is present, it attaches to the antibodies on the paper strip as well as the nanoparticle-bound antibodies, and a colored spot appears on the strip within 20 minutes.

Currently, there are two primary types of Covid-19 diagnostics available. One such test screens patient blood samples for antibodies against the virus. However, antibodies are often not detectable until a few days after symptoms begin. Another type of test looks for viral DNA in a sputum sample. These tests can detect the virus earlier in the infection, but they require polymerase chain reaction (PCR), a technology that amplifies the amount of DNA to detectable levels and takes several hours to perform.

“Our hope is that, similar to other tests that we’ve developed, this will be usable on the day that symptoms develop,” Gehrke says. “We don’t have to wait for antibodies to the virus to come up.”

If the U.S. Food and Drug Administration grants the emergency authorization, E25Bio could start testing the diagnostic with patient samples, which they haven’t been able to do yet. “If those are successful, then the next step would be to talk about using it for actual clinical diagnosis,” Gehrke says.

Another advantage of this approach is that the paper tests can be easily and inexpensively manufactured in large quantities, he adds.

RNA vaccines

On Feb. 24, only about a month after the first U.S. case of coronavirus was reported, the Cambridge-based biotech company Moderna announced it had an experimental vaccine ready to test. That speedy turnaround is due to the unique advantages of RNA vaccines, says Daniel Anderson, an MIT professor of chemical engineering, who also works on such vaccines, though not specifically for coronavirus.

“A key advantage of messenger RNA is the speed with which you can identify a new sequence and use it to come up with a new vaccine,” Anderson says.

Traditional vaccines consist of an inactivated form of a viral protein that induces an immune response. However, these vaccines usually take a long time to manufacture, and for some diseases, they are too risky. Vaccines that consist of messenger RNA are an appealing alternative because they induce host cells to produce many copies of the proteins they encode, provoking a stronger immune response than proteins delivered on their own.

RNA vaccines can also be quickly reprogrammed to target different viral proteins, as long as the sequence encoding the protein is known. The main obstacle to developing such vaccines so far has been finding effective and safe ways to deliver them. Anderson’s lab has been working on such strategies for several years, and in a recent study he showed that packing such vaccines into a special type of lipid nanoparticles can enhance the immune response that they produce.

“Messenger RNA can encode the viral antigens, but in order to work, we need to find a way to deliver these antigens to the correct part of the body so that they get expressed and generate an immune response. We also need to make sure that the vaccine causes appropriate immune stimulation to get a strong response,” Anderson says.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), has estimated that it will take at least 12 to 18 months to fully test any potential Covid-19 vaccine for safety and effectiveness.

Keep your distance

Over the last decade, Lydia Bourouiba, an associate professor directing the Fluid Dynamics of Disease Transmission Laboratory at MIT, has focused on characterizing and modeling infectious disease dynamics and transmission at various scales. Through experiments in the lab and clinical environment, she has reported that when a person coughs or sneezes, they do not emit a spray of individual droplets that quickly fall to the ground and evaporate, as scientists had once thought. Instead, they produce a complex cloud of hot and moist air that traps droplets of all sizes together, propelling them much further through the air than any individual droplet would travel on its own.

On average, her experiments have revealed that a cough can transmit droplets up to 13 to 16 feet, while a sneeze can eject them up to 26 feet away. Surrounding air conditions can act to further disperse the residual droplets in upper levels of rooms.

Bourouiba notes that the presence of the high-speed gas cloud is independent of the type of organism or pathogen that the cloud may contain. The droplets within it depend on pathogenesis coupled with a patient’s physiology — a combination which her laboratory has focused on deciphering in the context of influenza. She is now expanding her studies and modeling to translate the work to Covid-19, and says now is a critical time to invest in research.

“This virus is going to stay with us for a while — and certainly data suggest that it is not going to suddenly disappear when the weather changes,” she says. “There’s a fine and important balance between safety, precautions and action that is important to strike to enable and dramatically accelerate research to be done now so we can be better prepared and informed for actions in the weeks and months to come when the worst of the pandemic will unfold.”

She is also working with others to evaluate ways to limit a cloud’s dispersal and slow Covid-19 transmission to health care workers and others in shared spaces. “A surgical mask is not protective against inhalation of a pathogen from the cloud,” she says. “For an infected patient wearing it, it can contain some of the forward ejecta from coughs or sneezes, but these are very violent ejections and masks are completely open on all sides, and fluid flows through the path of least resistance.”

Based on the data, she recommends that health care workers consider wearing a respirator, whenever possible. And, for the general public, Bourouiba emphasizes that the risk of contracting COVID-19 remains relatively low locally, and that risk should be thought of in the context of the community.

Wash those hands

Another good way to protect yourself against all of those tiny infectious droplets is to wash your hands. (Again, and again, and again.)

Ruben Juanes, an MIT professor of civil and environmental engineering, and of earth, atmospheric and planetary sciences, published a study in December showing the importance of improving rates of handwashing at key airports in order to curtail the spread of an epidemic. Now, he says, following the Covid-19 outbreak, governments around the world have imposed unprecedented restrictions on mobility, including the closure of airports and suspension of flight routes.

At the same time, the World Health Organization, U.S. Centers for Disease Control, and many other health agencies all recommend hand-hygiene as the number one precaution measure against disease spread. “Following our recent paper on the impact of hand-hygiene on global disease spreading,” Juanes says, “we are now investigating the combined effect of restrictions on human mobility and enhanced engagement with hand-hygiene on the global spread of COVID-19 through the world air-transportation network.”

Juanes says he and Christos Nicolaides PhD ’14, a professor at the University of Cyprus who was the lead author of the previous study, are working “with fine-grained, worldwide air-traffic data that accounts for all flights for the period between Jan. 15, 2020 until today (accounting for closures/cancellations) and the corresponding period of 2019 (base level) to elucidate the role of travel restrictions on the global spread of Covid-19 through detailed epidemiological modeling.”

“Furthermore,” he adds, “we simulate different hand-hygiene strategies at airports on top of travel restrictions with the goal of proposing an optimal strategy that combines travel restrictions and enhanced hand hygiene, to mitigate the advance of Covid-19 both in the short term (weeks) and the long term (the next flu season).”

Juanes says they will make the results immediately available via medarXiv, while the work follows peer-review in a journal. This would also allow the information to reach other academic and government institutions in a more timely way, he says.

David L. Chandler | MIT News Office
March 26, 2020

One of the most pressing shortages facing hospitals during the Covid-19 emergency is a lack of ventilators. These machines can keep patients breathing when they no longer can on their own, and they can cost around $30,000 each. Now, a rapidly assembled volunteer team of engineers, physicians, computer scientists, and others, centered at MIT, is working to implement a safe, inexpensive alternative for emergency use, which could be built quickly around the world.

The team, called MIT E-Vent (for emergency ventilator), was formed on March 12 in response to the rapid spread of the Covid-19 pandemic. Its members were brought together by the exhortations of doctors, friends, and a sudden flood of mail referencing a project done a decade ago in the MIT class 2.75 (Medical Device Design). Students working in consultation with local physicians designed a simple ventilator device that could be built with about $100 worth of parts. They published a paper detailing their design and testing, but the work ended at that point. Now, with a significant global need looming, a new team, linked to that course, has resumed the project at a highly accelerated pace.

The key to the simple, inexpensive ventilator alternative is a hand-operated plastic pouch called a bag-valve resuscitator, or Ambu bag, which hospitals already have on hand in large quantities. These are designed to be operated by hand, by a medical professional or emergency technician, to provide breaths to a patient in situations like cardiac arrest, until an intervention such as a ventilator becomes available. A tube is inserted into the patient’s airway, as with a hospital ventilator, but then the pumping of air into the lungs is done by squeezing and releasing the flexible pouch. This is a task for skilled personnel, trained in how to evaluate the patient and adjust the timing and pressure of the pumping accordingly.

The innovation begun by the earlier MIT class, and now being rapidly refined and tested by the new team, was to devise a mechanical system to do the squeezing and releasing of the Ambu bag, since this is not something that a person could be expected to do for any extended period. But it is crucial for such a system to not damage the bag and to be controllable, so that the amount of air and pressures being delivered can be tailored to the particular patient. The device must be very reliable, since an unexpected failure of the device could be fatal, but as designed by the MIT team, the bag can be immediately operated manually.

The team is particularly concerned about the potential for well-meaning but inexperienced do-it-yourselfers to try to reproduce such a system without the necessary clinical knowledge or expertise with hardware that can operate for days; around 1 million cycles would be required to support a ventilated patient over a two-week period. Furthermore, it requires code that is fault-tolerant, since ventilators are precision devices that perform a life-critical function. To help curtail the spread of misinformation or poorly-thought-out advice, the team has added to their website verified information resources on the clinical use of ventilators and the requirements for training and monitoring in using such systems. All of this information is freely available at e-vent.mit.edu.

“We are releasing design guidance (clinical, mechanical, electrical/controls, testing) on a rolling basis as it is developed and documented,” one team member says. “We encourage capable clinical-engineering teams to work with their local resources, while following the main specs and safety information, and we welcome any input other teams may have.”

The researchers emphasize that this is not a project for typical do-it-yourselfers to undertake, since it requires specialized understanding of the clinical-technical interface, and the ability to work in consideration of strict U.S. Food and Drug Administration specifications and guidelines.

Such devices “have to be manufactured according to FDA requirements, and should only be utilized under the supervision of a clinician,” a team member said. “The Department of Health and Human Services released a notice stating that all medical interventions related to Covid-19 are no longer subject to liability, but that does not change our burden of care.” he said. “At present, we are awaiting FDA feedback” about the project. “Ultimately, our intent is to seek FDA approval. That process takes time, however.”

The all-volunteer team is working without funding and operating anonymously for now because many of them have already been swamped by inquiries from people wanting more information, and are concerned about being overwhelmed by calls that would interfere with their work on the project. “We would really, really like to just stay focused,” says one team member. “And that’s one of the reasons why the website is so essential, so that we can communicate with anyone who wants to read about what we are doing, and also so that others across the world can communicate with us.”

“The primary consideration is patient safety. So we had to establish what we’re calling minimum clinical functional requirements,” that is, the minimum set of functions that the device would need to perform to be both safe and useful, says one of the team members, who is both an engineer and an MD. He says one of his jobs is to translate between the specialized languages used by the engineers and the medical professionals on the team.

That determination of minimum requirements was made by a team of physicians with broad clinical backgrounds, including anesthesia and critical care, he says. In parallel, the group set to work on designing, building, and testing an updated prototype. Initial tests revealed the high loads that actual use incurs, and some weaknesses that have already been addressed so that, in the words of team co-leads, “Even the professor can kick it across the room.” In other words, early attempts focused on super “makability” were too optimistic.

New versions have already been fabricated and are being prepared for additional functional tests. Already, the team says there is enough detailed information on their website to allow other teams to work in parallel with them, and they have also included links to other teams that are working on similar design efforts.

In under a week the team has gone from empty benches to their first realistic tests of a prototype. One team member says that in the less than a week full they have been working, motivated by reports of doctors already having to ration ventilators, and the intense focus the diverse group has brought to this project, they have already generated “multiple theses worth” of research.

The cross-disciplinary nature of the group has been crucial, one team member says. “The most exciting times and when the team is really moving fast are when we have an a design engineer, sitting next to a controls engineer, sitting next to the fabrication expert, with an anesthesiologist on WebEx, all solid modeling, coding, and spreadsheeting in parallel. We are discussing the details of everything from ways to track patients’ vital signs data to the best sources for small electric motors.”

The intensity of the work, with people putting in very long hours every day, has been tiring but hasn’t dulled their enthusiasm. “We all work together, and ultimately the goal is to help people, because people’s lives understandably hang in the balance,” he said.

The team can be contacted via their website.

 

 

Jennifer Chu | MIT News Office
March 24, 2020

Keeping our distance from each other for an extended period of time is the most effective way to reduce Covid-19’s reach. But the prospect of prolonged social isolation is uncharted territory for many.

To get some perspective on how we all might navigate lives of temporary separation, MIT News checked in with three MIT alumni who have spent months at a time living quite literally away from the rest of the world, on humanity’s only outpost in space. Cady Coleman ’83, Mike Fincke ’89, and Greg Chamitoff ’92 have all served long-duration missions aboard the International Space Station (ISS) as NASA astronauts. While orbiting some 250 miles above Earth, they lived and worked in quarters about the size of a large house, with only the occasional opportunity to step outside of that house, on spacewalks to repair or maintain the station.

Even as they were physically isolated from the rest of the planet for months at a time, the astronauts found ways to bridge the distance with family and friends, over the phone, and through video chats. Just as importantly, they also made sure to find time for themselves, and embrace their isolation. Coleman, Fincke, and Chamitoff shared some of the lessons they learned from living in space, and how we can all commit to a mission to live, at least for now, at a distance.

Q: What was it like for you to be isolated from the rest of the world for long durations, even with the ability to email and video-chat with people on the ground?

CHAMITOFF: Living on the International Space Station is very much like being stuck in your house with a few people for a very long period of time. The ISS has about as much living space as a six-bedroom house. And hopefully you like your roommates and have established mechanisms for getting along even when there are disagreements. In space you feel separated from the rest of society — you are the only ones off the entire planet!

I expected to feel lonely during my six months in space, but it was quite the opposite. Having a daily sense of purpose, countless tasks and experiments to perform, and communication with people all over the world provided so much engagement with the world that loneliness was not a factor. There are some lessons here, perhaps, for everyone who now has to stay at home during this crisis.  

COLEMAN: I think what makes everything work is the mission. As an astronaut, I was on the forward edge of exploration, representing the many people who make the ISS mission and experiments happen. Right now our mission is to keep each other safe here on Earth. I think keeping that mission in mind makes it easier to wash your hands that one more time when you really don’t feel like it, and to tell friends who are more casual about social distancing things like, “No, I really don’t think it’s safe to do that together for now.”

FINCKE: We’re such social creatures that it is going to be a challenge for a lot of people to be a little homebound and not go out. For astronauts it’s something we’re used to — it comes with the territory.

Q: What do you remember of some of your more challenging times of isolation in space? How did you work through it, mentally or physically?

FINCKE: My first long-duration mission was during a time when the space shuttle was grounded because of an accident, and there were only two of us aboard the ISS for six months, with no visitors. When you’re in a confined space with someone else, you really have to make an extra effort to get along. We probably are all hard to live with. Some things I’ve learned in space I’ve taken back to the ground, for instance to tell my wife I appreciate her that much more, and things like that. You really learn to value relationships.

COLEMAN: We had one crew member whose mom passed away fairly unexpectedly while we were in space. We established we’d have our own memorial service at the same time as the funeral back home. And I looked at the world map and realized we were going to be passing over his hometown at the time of the funeral. So the six of us were there in the cupola together, and we had a few moments of silence, and I really felt we were together with all the family on the ground. When the mission you’ve chosen forces you to be isolated, you find a way to be the best you can.

CHAMITOFF: Hurricane Ike struck Houston during my long-duration mission. Johnson Space Center shut down and people were evacuating the city. Operations on the ISS came to a near standstill. For almost a week onboard, we were much more isolated than usual, and were determined to get useful things done. We had a task list of unscheduled activities, and if we could do them without ground support, we did. Admittedly, we watched more movies, did more exercise, slept more, and spent longer periods together talking at meals. We were worried about our loved ones on the ground, but the slower pace was good for our morale and camaraderie onboard.  

Q: Are there any tips that you can share to help people get through and perhaps even embrace this social-distancing period?

FINCKE: Maintaining a schedule, things to look forward to, and things to do and check off your list, can be a tool to help us all. Onboard the space station, as the mission progressed, we had things to look forward to, like the next cargo ship that came to give us new food, or a spacewalk, which is a really big deal. Same thing here: Just because I don’t have to go into work doesn’t mean I shouldn’t get up and be showered and dressed just like I would. Going to the grocery store tomorrow, even if it’s a little thing, is something to look forward to.

Also, find out what your motivators are. For me, I read science fiction, and at one point, NASA was able to give me an e-reader and I read about 50-60 books when I was up there. That was my thing. It can be a little lonely. So you need to know what your own motivators are.

CHAMITOFF: Engage with people using FaceTime, Zoom, Skype, or whatever tools you like. Make virtual plans with people. Spend time outside. I believe that when this is all over, we will have stronger and closer relationships because of it. Talk to your family and friends — perhaps more than you usually do. In space, I spoke to a friend or family member every night. It was a highlight of my day.  

COLEMAN: One of the things you have to do is figure out how to have some ways you have your space, whether mental or physical. If there’s someone in the house coming up to you every time they see a new notice about the coronavirus, you may have trouble having a straight thought about what we’re trying to do. So maybe say, let’s read those things twice a day. There are a lot of things we can’t control now. What are the things we can? We can control the things we learn. I’m thinking I may take some Skype lessons for playing the flute, and learning Chinese has always been on my list, as well as practicing my Russian. There are projects I have on my list, from finishing my website to cleaning out my attic, and right now it feels like I may, in a joyful and not so joyful way, get them all done.

Q: What about the experience of being isolated for so long was surprising or unexpected for you?

COLEMAN: I think about the things I wish I did when I was up on the space station. One is get enough sleep. Probably my whole life I’ve never gotten enough sleep, especially at MIT, right? So taking care of yourself is a really good thing ­— prioritize that. And also, some kind of journaling or recording: Jot a few notes, capture this time for yourself, whether you plan to share it with anyone or not. Take pictures that help people realize what it was like for you. Because your experiences may be valuable to others in the future.

FINCKE: Having been more isolated, it’s times like these, where an outside forcing function is bringing us together, that I value this time with my family even more. Take this time to focus on the human relationships — reach out, send an email, call someone, because there’s a little more opportunity now.

CHAMITOFF: Life will be a bit different, but you will adapt to it quickly. We are an incredibly adaptable species. We live in all sorts of extreme environments, including zero-gravity. One thing we do need, however, is each other. We can’t do this alone. Consider reaching out to others if you know they are alone. As long as we have family and friends to share this experience with, we will be okay. 

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Posted by GERALD L MCFARLANE JR on Monday, March 30, 2020 3:47 PM

daveklepper

~SNIP~

Israel reports on the number of cured, whch has been vastly outstripping the dyikng.  Why donl't I see USA figures on cures? 

Really, you ask for a report on "cures" for a disease that at this point in time has no cure?  The only number that should be reported is RECOVERED patients, those that recovered on their own and those with assistance from the medical community, but reporting people being cured is just a FALSE narrative, there has not been one single person "cured" as of yet, and until there is a "cure" no one will be.  That's why we don't report the number of "cured" patients in the U.S. and will(if we don't yet) report the number of recovered patients, the same thing that most countries are reporting.

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Posted by charlie hebdo on Monday, March 30, 2020 9:15 PM

Israel reports 161 recovered,  4695 confirirmed cases and 16 deaths,  as of 9:17 pm CDT. 

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Posted by daveklepper on Monday, March 30, 2020 9:26 PM

OK.  As a doctor's son, I probably should know the difference between recovered and cured.  But I don't.  So please explain it.  In Israel, a recovered person need not be isolated any more than one never sick with the virus.  I'd like to know how many have recovered in the USA.

I received a detailed letter from an old (47-years) Utah friend, and I know it will interest readers of this thread.

We are doing well.  My kids are healthy, working from home and staying healthy. Home schooling has its challenges but they are doing well. One daughter teaches 5th and 6th grade (together) in a rural school just outside of Yosemite National Park. Many of her students do not have internet so she is being creative to stay in contact safely while still enabling their education.   

There is one exception. My youngest son is a research scientist at Biofire, a French-owned company with facilities world-wide, including Salt Lake City. He has been managing field tests in various countries of their virus identification system, particularly Covid-19.  I am finding that this niche of science is not unlike audio and acoustics--lots of myths and nonsense being spouted off by self-styled experts who two months ago had never heard of Covid-any number. I rely on him to answer any questions I might have regarding the pandemic. His advice: follow the FDA's instructions that basically include thorough and frequent hand-washing, keep your hands away from your face, and avoid crowds. Wearing a mask provides little protection to the wearer except to remind him not to put his hands near his face and it does protect those around him from catching anything he might expel through coughing or breathing. 
 
Biofire has been manufacturing diagnostic system for several years, including a device used by government agencies to detect anthrax and other biological weapons that terrorists might send in a package.  Biofire also produces a machine that diagnoses viruses so it was a natural for them to adapt it to detection of Covid-19.  The FDA usually takes 2-3 years to formally approve of such devices but Trump built a fire under them so they now will issue a EUA (Emergency Use Authorization) after thorough but accelerated testing.  The processing time for other systems at the outbreak of the pandemic was 4-5 days and later systems would process the testing in 2-3 hours. Another weakness in those systems was they were what the scientists call, "open," in that the sample and reagents were processed in open vials. The highly trained technicians wore haz mat suits and the slightest error or cross contamination would produce false results. Spilling would contaminate the entire lab, requiring elaborate disinfection. The Biofire system is a closed system with all the reagents sealed in a cassette.  The sample is collected by a health worker with minimal training and injected into the cassette and is inserted into the machine. All of the analysis is performed automatically by the machine and only takes 45 minutes.  It received an EUA last week. 
 
I am still going out to commission completed projects but am careful to avoid crowds, pack a lunch instead of eating in a restaurant,  and to not touch contractor's technician. We have the buildings to ourselves because the Church has cancelled all activities in the meetinghouses.  Members worship as families in their homes.  Priesthood holders within the family are authorized to administer the Sacrament. Local leaders hold their meetings using technology such as Zoom, Facetime, and the like. The two sound engineers at headquarters now work from home. 
 
The Utah governor issued a directive to stay at home but it was strong suggestion and not an official order enforceable by law. State parks are closed except for those citizens residing in the counties in which the park is located. The directive spells out what travel is not permitted such as travel to a movie but does specifically allow outdoor recreational travel as long as social distancing is observed. A few of us went off-roading in the dessert one day last week so we were compliant.  
 
It's good to hear from you. Please be safe.


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Posted by daveklepper on Monday, March 30, 2020 10:38 PM

Nevins was tested for the coronavirus on March 12 and a week later got back a positive result. A week after that, he was tested again. Friday morning, he got the result: All clear.
By BEN HARRIS/JTA  
MARCH 30, 2020 21:59
 
Among the mysteries of the coronavirus is that some patients suffer and ultimately die from the disease while others experience the symptoms as akin to a mild cold.
 
Rabbi Daniel Nevins is in the latter category. The dean of the rabbinical school at the Jewish Theological Seminary, Nevins was laid up for a few days earlier this month with a fever and some aches, and then recovered.
 
Nevins was tested for the coronavirus on March 12 and a week later got back a positive result. A week after that, he was tested again. Friday morning, he got the result: All clear.
 
Within hours, Nevins was hooked up to a machine at Mount Sinai Hospital in New York to donate blood plasma. In the race to develop effective treatments for the disease, researchers are investigating whether antibodies from the blood of people who have successfully fought off the disease may provide treatment for people who with more serious symptoms.
 
Earlier this week, the Food and Drug Administration allowed doctors to treat critically ill coronavirus patients with plasma on an experimental basis. Plasma has been shown effective in treating other infectious diseases, like polio, measles and influenza.
 
“I felt fortunate that my mild case of this illness might turn into a blessing for people who are seriously ill,” Nevins told the Jewish Telegraphic Agency. “The Torah teaches us not to stand idly by the blood of our neighbor. My Midrash [interpretation] is that no, instead lie down in a donor bed and give plasma.”
 
Mount Sinai was among the first hospitals in the country to figure out how to detect antibodies in the blood of people who had recovered from coronavirus, the New York Times reported. Whether or not those antibodies are effective remains to be seen.
 
“It’s kind of difficult scientifically to know how valuable it is in any disease until you try,” said David Reich, the president and chief operating officer of Mount Sinai, told the Times. “It’s not exactly a shot in the dark, but it’s not tried and true.”. 
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Posted by Electroliner 1935 on Tuesday, March 31, 2020 12:03 AM

Dave, The reason I have heard is that if a person has been suspected of being infected by the virus and has all the symptoms but does not go to a hospital but "recovers", no follow up is  recorded and thus there is no statistic to capture. Like the tree falling in the forest and no one is there to know, did it make a sound?

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Posted by daveklepper on Tuesday, March 31, 2020 1:18 AM

Thanks for the explanation.  So recovered includes those cured as well as those who recovered by themselves.

If anyone wisihes to make a face-mask, this site should be of interest.  Comments requested:

https://www.maskbuilders.com/make

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Posted by Overmod on Tuesday, March 31, 2020 7:20 AM

Another potential difference:  'Recovered' means no longer suffering from COVID-19, the disease.  'Cured' means containing no detectable titer of SARS-Cov-2, the virus.

"Recovered" people might well be carriers, or suffer relapse, etc.  They are distinguished from those with chronic effects, some of whom might remain "impaired" even though (as in FIP) no longer an active transmission risk.

Technically 'cured' means made permanently free of disease through active 'care'.  That's not yet the case for COVID-19 in general and should probably be avoided as it shouldn't be a popular 'thesaurus synonym' for either recovered or asymptomatic.

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Posted by Overmod on Tuesday, March 31, 2020 7:33 AM

daveklepper
If anyone wisihes to make a face-mask, this site should be of interest.  Comments requested.

As with surgical masks -- the sole real purpose is to preclude the wearers from proactively infecting those around them, not intercepting viral particles 'inbound'.  The immediate problem with the described design is much the same as addressed in N95 default respirator design: there is no arrangement whatsoever, let alone required seal or filtering, for cough or sneeze venting-- perhaps not even venting from talking or heavy breathing.

This would not be impossible to design around; several groups (including, now, parts of MIT e-Vent) are looking carefully at quick field expedients for effective vent filtration.  But as currently designed the things are more 'feel-good medicine' than functional protection in any sort of outbreak situation.  And reliance on that kind of design in preparing for outbreak conditions is setting up for problems if such masks become widely perceived as adequate for more than mild socially-distanced prophylaxis.

 

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Posted by charlie hebdo on Tuesday, March 31, 2020 10:17 AM

The situation for healthcare workers is very different than for the public.  Those workers are in environments (close proximity to infected patients)  with high concentrations of the virus in small-and large-droplet media.  They need to change n95 masks frequently to maintain safety.  Unfortunately,  due to neglect,  there is a scarcity. 

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Posted by daveklepper on Tuesday, March 31, 2020 10:21 AM
Re: [senior_house] Ventilator Sharing4
Yahoo/Inbox
·       
Jay Cameron <cameron.jay@gmail.com>
To:Alan Lichtenstein
Cc:senior_house@MAILMAN-ALUM.MIT.EDU,Clive Bolton
Tue, Mar 31 at 1:16 PM
Dr. Lichtenstein, 
 
If the recommendation is to one ventilator one patient, do you have a link with a few examples of the standard models of ventilators that are recommended to focus on for this pandemic that hospitals would find the most useful to receive in the next month or two in the current wave of the pandemic, which would be easy to start deploying to use?
 
Regards,
Jay Cameron '05
 
 
On Tue, Mar 31, 2020 at 1:06 AM Alan Lichtenstein <knockuout@zzzzdoc.com> wrote:
I’ve been reading these posts with interest, but up until now have refrained from commenting on them.
 
For a little perspective, I am a cardiac anesthesiologist, working at a Level-II trauma center in Florida.  Clearly, as such, I have great familiarity with ventilated patients, and the problems that they clinically present.  Enough about me.
 
A joint statement from the The Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), American Association of CriticalCare Nurses (AACN), and American College of Chest Physicians (CHEST) dated 3/25/20 issued a consensus statement regarding the concept of placing multiple patients on a single mechanical ventilator:
 
“The abovenamed organizations advise clinicians that sharing mechanical ventilators should not be attempted because it cannot be done safely with current equipment. The physiology of patients with COVID19onset acute respiratory distress syndrome (ARDS) is complex. Even in ideal circumstances, ventilating a single patient with ARDS and nonhomogenous lung disease is difficult and is associated with a 40%60% mortality rate. Attempting to ventilate multiple patients with COVID19, given the issues described here, could lead to poor outcomes and high mortality rates for all patients cohorted. In accordance with the exceedingly difficult, but not uncommon, triage decisions often made in medical crises, it is better to purpose the ventilator to the patient most likely to benefit than fail to prevent, or even cause, the demise of multiple patients."
 
Background: The interest in ventilating multiple patients on one ventilator has been piqued by those who would like to expand access to mechanical ventilators during the COVID19 pandemic. The first modern descriptions of multiple patients per ventilator were advanced by Neyman et al in 20061 and Paladino et al in 2013.2 However, in each instance, Branson, Rubinson, and others have cautioned against the use of this technique.35 With current equipment designed for a single patient, we recommend that clinicians do not attempt to ventilate more than one patient with a single ventilator while any clinically proven, safe, and reliable therapy remains available (i.e., in a dire, temporary emergency).
Attempting to ventilate multiple patients would likely require arranging the patients in a spokelike fashion around the ventilator as a central hub. This positioning moves the patients away from the supplies of oxygen, air, and vacuum at the head of the bed. It also places the patients in proximity to each other, allowing for transfer of organisms. Spacing the patients farther apart would likely result in hypercarbia.
Spontaneous breathing by a single patient sensed by the ventilator would set the respiratory frequency for all the other patients. The added circuit volume could preclude triggering. Patients may also share gas between circuits in the absence of oneway valves. Pendelluft between patients is possible, resulting in both crossinfection and overdistension. Setting alarms can monitor only the total response of the patients’ respiratory systems as a whole. This would hide changes occurring in only one patient. The reasons for avoiding ventilating multiple patients with a single ventilator are numerous.
These reasons include:
·        Volumes would go to the most compliant lung segments.
·        Positive endexpiratory pressure, which is of critical importance in these patients, would be impossible to manage.
·        Monitoring patients and measuring pulmonary mechanics would be challenging, if not impossible.
·        Alarm monitoring and management would not be feasible.
·        Individualized management for clinical improvement or deterioration would be impossible.
·        In the case of a cardiac arrest, ventilation to all patients would need to be stopped to allow the change to bag ventilation without aerosolizing the virus and exposing healthcare workers. This circumstance also would alter breath delivery dynamics to the other patients.
·        The added circuit volume defeats the operational selftest (the test fails). The clinician would be required to operate the ventilator without a successful test, adding to errors in the measurement.
·        Additional external monitoring would be required. The ventilator monitors the average pressures and volumes.
·        Even if all patients connected to a single ventilator have the same clinical features at initiation, they could deteriorate and recover at different rates, and distribution of gas to each patient would be unequal and unmonitored. The sickest patient would get the smallest tidal volume and the improving patient would get the largest tidal volume.
·        The greatest risks occur with sudden deterioration of a single patient (e.g., pneumothorax, kinked endotracheal tube), with the balance of ventilation distributed to the other patients.
·        Finally, there are ethical issues. If the ventilator can be lifesaving for a single individual, using it on more than one patient at a time risks lifethreatening treatment failure for all of them.
References
1.      Neyman G, Irvin CB. A single ventilator for multiple simulated patients to meet disaster surge. Acad Emerg Med. 2006 Nov;13(11):12461249.
2.      Paladino L, Silverberg M, Charcaflieh JG, et al. Increasing ventilator surge capacity in disasters: ventilation of four adulthumansized sheep on a single ventilator with a modified circuit. Resuscitation. 2008 pr;77(1):121126.
3.      Branson RD, Rubinson L. One ventilator, multiple patients: what the data really supports. Resuscitation. 2008 Oct;79(1):171172; author reply 172173.
4.      Branson RD, Rubinson L. A single ventilator for multiple simulated patients to meet disaster surge. Acad Emerg Med. 2006 Dec;13(12):13521353; author reply 13531354.
5.      Branson RD, Blakeman TC, Robinson BR, Johannigman JA. Use of a single ventilator to support 4 patients: laboratory evaluation of a limited concept. Respir Care. 2012 Mar;57(3):399403.
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So, multiple specialties in medicine that are responsible for taking care of these extremely sick patients feel that splitting ventilators is not the best approach.  Massively and rapidly increasing production of conventional ventilators would be far, far safer, and a more productive use of resources.
We have been fortunate, thus far, to not be inundated with Covid-19 patients at my hospital.  But the numbers are growing every day, and we know what the future will bring.  PPE issues are real, and since my specialty is routinely called upon to secure the airways and intubate these patients, we are another group of medical staff that is on the front lines, at high risk.  Much less intubating patients other hospitalized patients who are Covid-19 positive and unaware of it.
None of this is remotely easy.  All of it is difficult.  The dedication of the medical staffs worldwide is astounding!  It breaks our hearts to see first responders get sick and die, EMTs, police, firemen, paramedics, nurses, physicians, respirator therapists – the list goes on and on.
Everyone, please stay safe and stay apart.  I want to scream when I drive by areas and see people walking together, jogging together, sneaking into the beachs, teenagers partying together, etc
  • Member since
    May 2003
  • From: US
  • 25,292 posts
Posted by BaltACD on Tuesday, March 31, 2020 4:29 PM

Will continue updating over time

https://www.accuweather.com/en/us/national/covid-19

Figures indicate a 4.8% death rate on 782365 confirmed cases Worldwide.

Never too old to have a happy childhood!

              

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