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InvisibleTantrika
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Tantrika] * 1
    #26563974 - 03/28/20 07:04 PM (3 years, 10 months ago)



our cases in Québec have exploded
and Québec is our province with the most of what would be in my consideration "European style" housing and urban centers


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Texas Honey Badger] * 4
    #26563980 - 03/28/20 07:05 PM (3 years, 10 months ago)




That said, keep 2 meters (7ft) distance between people, not 1 meter.

Since COVID-19 usually spreads through larger droplet inhalation, it means that even a cloth before the mouth would reduce the risk somewhat.


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: audiophoenix]
    #26563986 - 03/28/20 07:07 PM (3 years, 10 months ago)

Quote:

audiophoenix said:
I think this is fascinating.

Big brother contestants learning about covid-19 for the first time and being updated.

This is bullshit reality TV but it's still interesting to see people isolated from the world learn about how crazy things can get so quickly.








Thats good TV


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OfflineDarwin23
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Texas Honey Badger]
    #26563992 - 03/28/20 07:09 PM (3 years, 10 months ago)

Quote:

Spicemaster said:
We just got 1 confirmed case in my county out here in west tx:picard:




Better early than later. I imagine there are gonna be more isolated and less populated areas really facing their biggest issues way off time with the rest of the country and because of it, they'll be fending for themselves.


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Darwin23]
    #26564002 - 03/28/20 07:16 PM (3 years, 10 months ago)

A lot of people fly into Midland Tx mainly from Houston


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: koods] * 1
    #26564005 - 03/28/20 07:18 PM (3 years, 10 months ago)

Quote:

koods said:
Quote:

audiophoenix said:
I think this is fascinating.

Big brother contestants learning about covid-19 for the first time and being updated.

This is bullshit reality TV but it's still interesting to see people isolated from the world learn about how crazy things can get so quickly.








Thats good TV





The one time Big Brother is actually interesting.


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Offlineaudiophoenix
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Asante] * 2
    #26564043 - 03/28/20 07:38 PM (3 years, 10 months ago)

Yup lol. Never even watched an episode


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: audiophoenix]
    #26564062 - 03/28/20 07:46 PM (3 years, 10 months ago)

Went out to buy a truck today and all I saw down I-75 where people with New York, New Jersey, and Connecticut tags.. Quarantines not going to work if you tell people before you enact it... We're screwed


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Ovoidhunter] * 4
    #26564090 - 03/28/20 08:06 PM (3 years, 10 months ago)

Forwarded memo

From an MD in NOLA:
"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.

2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
Diagnostic

CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.



Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.

Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.


A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.
An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.
Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.


Disposition

I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment

Supportive
worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol.
Get the dosing of Precedex and Nimbex back in your heads.
One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

Also, “pink eye” also called “red eyes” was actually the first diagnostic finding notes on the Washington home patients that were Covid-19 positive

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.”







note that this doctor says hydroxychloroquine doesnt seem to be effective


Edited by morrowasted (03/28/20 08:19 PM)


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: koods] * 1
    #26564103 - 03/28/20 08:14 PM (3 years, 10 months ago)

So the new case count growth in the US is starting to slow. I don’t know if this is real or we have started to reach the limits of our ability to test. Getting 20,000 new cases a day probably required upwards of 200,000 tests. I just don’t think we have the labor resources to run too many more tests until the automated systems are up and running. I certainly think that the new case count will become more and more inaccurate as we get further into it.



The death count will probably continue on its current trajectory for at least a week. If the decline in case count growth is real, we will see that in the death count. If it’s not, the death count will not be affected by our ability to test. As hospitals become saturated, the growth rate of deaths could even increase.

I went back and looked at the rate of increase of deaths and it’s been pretty consistent around 25% per day.

I calculated these numbers based on our current situation and an daily increase of 25% I think the next 7-10 days is set in stone, after that we shall see if our social distancing reduces the outcomes at 15 days and beyond.



I stopped at 15 days because I think things start to get very unpredictable beyond 7-10 days, but if you’re curious at our current rate we will have 1.6 million deaths 30 days from now


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NotSheekle said
“if I believed she was 16 I would become unattracted to her”


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: morrowasted] * 3
    #26564104 - 03/28/20 08:17 PM (3 years, 10 months ago)

Thread from nursing Group:

"Any RNs experiencing COVID symptoms? If so, how did it start?"

Replies:

1) Dry cough for 2 weeks. Then in the same day, ha, sore throat, and runny nose. Next day major decrease in smell and taste, nausea, decreased appetite, stomach ache, fatigue, weakness, and body aches. No fever. Low temp actually 97.3. Oh and freezing cold.

2) High temp, then soar throat, then sporadic cough and fatigue. I was sent straight home from work with high temp to self isolate for 7 days and still not been tested!

3) Sore throat, diarrhea, chest pain and pressure, shortness of breath, dizziness, fatigue, chills.

4) I currently have it and my only symptom is complete loss of smell.

5) headache, body aches, dizziness and slight sore throat. I have not have fever except one low grade temp. Night sweats are killing me. Not able to sleep well.

6) Severe Body aches, chills, horrible sore throat, and loss of voice.

7) It started with dizziness, fatigue and bodyaches. Now I have cough, chest tightness and 1 day of n/v/d with abd cramping. No fever, sob.

8) Sore throat, headaches, muscle aches, fatigue, slight shortness of breath, no fever



Seems fever should not be included with the criteria for testing


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: koods] * 2
    #26564105 - 03/28/20 08:18 PM (3 years, 10 months ago)

Morrow that is an extremely grave report. I think this really could be as bad as could be immagined with almost the entire population getting infected and a CFR of 2%. 6 million dead in the US alone.


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NotSheekle said
“if I believed she was 16 I would become unattracted to her”


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: koods] * 5
    #26564108 - 03/28/20 08:21 PM (3 years, 10 months ago)

Quote:

koods said:
Morrow that is an extremely grave report. I think this really could be as bad as could be immagined with almost the entire population getting infected and a CFR of 2%. 6 million dead in the US alone.



I'm already starting the grieving process for my high comorbidity family members tbqhwy. I just really really hope it doesn't get my parents. They are in good health for their age- never smoked or drank, decent BMI, no serious surgical/medical history.


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: morrowasted] * 2
    #26564143 - 03/28/20 08:37 PM (3 years, 10 months ago)

https://techstartups.com/2020/03/27/breaking-tolicizumab-shown-effective-hydroxychloroquine-treating-coronavirus-patients-doctors-say/


BREAKING: Tolicizumab (Actemra) shown to be more effective than hydroxychloroquine in treating coronavirus patients, Italian doctors say



Quote:

according to doctors treating coronovirus patients in Italy, Tolicizumab, a drug used to treat moderate to severe rheumatoid arthritis, has been shown to be more effective than hydroxychloroquine. Tolicizumab is so effective that the FDA gives green lights to Phase III Tocilizumab Trial for COVID-19 pneumonia. In a related report, Italian doctors said that a 101-year-old Italian man who survived the 1918 Spanish flu pandemic and World War II, recovered from COVID-19.

In another report, scientists claim Tocilizumab has been shown to help cure 95 percent of critically ill coronavirus patients in China. Tocilizumab, which is marketed as Actemra, is taken by patients with rheumatoid arthritis to reduce  inflammation. Chinese doctors gave it to 20 patients during the peak of of coronavirus epidemic. Nineteen of the patients were discharged within 14 days despite being critically ill. Actemra has now been approved for use in China and for trials in the US

In response to a question from another doctor on hydroxychloroquine, Dr. Giusppe Galati, an Italian doctor, said in a tweet: “Dear @DrLuizSilva1 despite the large noise on social media. Here in Flag of Italy they are trying several combinations of antiviral included the combination HCQ + azithro. Infectivologist refer little benefit. The unique drug which is causing impressive improvement is #Tolicizumab.”

Tocilizumab, also known as atlizumab, is an immunosuppressive drug, mainly for the treatment of rheumatoid arthritis (RA) and systemic juvenile idiopathic arthritis, a severe form of arthritis in children. It is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R).





https://twitter.com/GiuseppeGalati_/status/1241002165189181440

sounds like a bunch of hearsay but if it's true that IL-6 is a major factor in patient mortality then...

that other doctor said
Quote:


An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.



The cytokine storm is what causes pts to progress from ARDS to systemic inflammatory response syndrome to septic shock to multisystem organ failure. so it seems like a reasonable approach

:strokebeard:


Edited by morrowasted (03/28/20 08:44 PM)


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: morrowasted] * 2
    #26564155 - 03/28/20 08:42 PM (3 years, 10 months ago)

Quote:

Tocilizumab, also known as atlizumab, is an immunosuppressive drug, mainly for the treatment of rheumatoid arthritis (RA) and systemic juvenile idiopathic arthritis, a severe form of arthritis in children. It is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is implicated in the pathogenesis of many diseases




Hard to produce in quantity.

But:

Quote:

Coronavirus disease 2019 (COVID-19)

China's National Health Commission included the use of tocilizumab in guidelines to treat coronavirus disease 2019 (COVID-19) patients.[32] In March 2020, China approved tocilizumab for the treatment of inflammation in patients with the coronavirus SARS-CoV-2. As of March 2020, there is no evidence whether this treatment is effective.[33] Chinese health officials say that only 21 patients have been asked to use this medicine.[34]

On 11 March 2020 Italian physician Paolo Ascierto reported that tocilizumab appeared to be effective in three severe cases of COVID-19 in Italy.[35] On 14 March 2020 three of the six treated patients in Naples had shown signs of improvement prompting the Italian Pharmacological Agency (AIFA) to expand testing in 5 other hospitals.[36] Roche and the WHO are each launching separate trials for its use in severe COVID-19 cases.[37]

On 26 March 2020, Guglielmo Gianotti, executive director of surgery at the Cremona hospital said: "The only drug that we've seen that is showing the slightest bit of benefit to COVID-19 patients is the immunosuppressive drug Tocilizumab, which is mainly used for the treatment of rheumatoid arthritis. It's being trialled at the Pascale Cancer Institute in Naples with very encouraging results." [38]




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Edited by Asante (03/28/20 08:44 PM)


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Asante]
    #26564161 - 03/28/20 08:44 PM (3 years, 10 months ago)

This is jacked. I hope there will be a decline but if not....well I've already got everything in place to stay home for at least a month or 2 if necisarry. And in the meantime I ordered 3 volumes of college course books to learn japanese.


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: morrowasted] * 3
    #26564164 - 03/28/20 08:46 PM (3 years, 10 months ago)

They should be evaluating Angiopoietin 1 and Angiopoietin 2 levels in patient plasma. The ratio of Ang2/1 often defines the magnitude of underlying inflammation as well as how leaky/dyfunctional the microvasculature has become. Combined, these measures are often prognostic in ARDS, MODS, AKI and SIRS.


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"What appears impenetrable to us does exist, manifesting itself in the deepest wisdom and the most radiant beauty" Einstein

"The conservatives of 70 years ago would be outraged at what has come to pass. It embodies everything they took up arms for to defeat"Asante


:kratom:


Edited by pslyke (03/28/20 08:50 PM)


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: Asante]
    #26564167 - 03/28/20 08:47 PM (3 years, 10 months ago)



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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: spirit_shadow]
    #26564168 - 03/28/20 08:47 PM (3 years, 10 months ago)

Ive been crying for the past week :shrug:

gotta b genetic would be looking for snp's in the ded bois if i was a smart guy


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - Unreal Numbers [Re: cannabinated]
    #26564172 - 03/28/20 08:50 PM (3 years, 10 months ago)

Quote:

cannabinated said:
Ive been crying for the past week :shrug:

gotta b genetic would be looking for snp's in the ded bois if i was a smart guy



even if we find out what those genes are we still have to develop vaccines and treatments for those people and in the meantime we have to figure out the biomarkers that predict various complications and treat accordingly


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