Coronavirus: What questions do you have?

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Those who suffer from obesity are at increased risk for diabetes, hypertension, kidney failure, liver failure, and heart failure.

The volume of adipose tissue itself takes up space even inside the chest.

The volume in the abdomen makes diaphragmatic movement more difficult.

Think of a severe viral infection that compromises 50% of lung capacity. In someone who starts at 100%, they may do fine, they have a full 50% reserve

For those who have one or more of the above, you can see how they aren’t starting at the same “100%”.

True. It takes quite a bit of Obesity to get to 50%.
 
I am having my morning Joe after a little walk through the neighborhood. I am thinking of today's work while listening to Joe Diffie. I might start the day off the same way until this terrible crisis is over. Today's song is: "Is it cold outside"....." or is it just you".

Yesterday, our drive through COVID tent decided to try to fly away. Today, I have to find a more permanent structure.
 
I am having my morning Joe after a little walk through the neighborhood. I am thinking of today's work while listening to Joe Diffie. I might start the day off the same way until this terrible crisis is over. Today's song is: "Is it cold outside"....." or is it just you".

Yesterday, our drive through COVID tent decided to try to fly away. Today, I have to find a more permanent structure.
Music is often a great aid in times of stress. Thanks again for your help Chuck.
 
I need to listed to more. I found it very therapeutic this am. Hopefully some of the $20 I spent on iTunes goes to his family.

I was in a store for supplies and heard the muzak lyrics "I got the rockin pneumonia and the boogie woogie flu." Couldn't help it, I just cracked up. For some reason people were looking at me a little weird.
 
I did have a question about my handling of supplies. Went grocery shopping today. I plan to leave the groceries in the garage for a couple of days, there is a fridge out there for the cool stuff, before bringing them into the house. I made sure I sanitized before coming in the house and then did a good soap wash. Do you think this is an adequate plan for now? We live in a county that has about 35 confirmed cases which to me means there are probably 400 or so. When this peaks in three or four weeks I don't plan to be out at all. Yes, both my wife and I are in a high mortality group.
 
I would like to echo PatD's question. I was wondering if I should be concerned about the items I bring in from outside like groceries and packaging, the mail, the newspaper. Should I be disinfecting these? Whenever I go out now to get supplies I wear gloves and discard them before stepping back into the car. Includes picking up groceries, pumping gas, using the ATM, etc.
I wash produce anyway, but should I be disinfecting cans and packages that food comes in?
Paper goods (mail, newspaper) too? What is the best method?
I am the sole caregiver for my 97 yr old father.
 
I did have a question about my handling of supplies. Went grocery shopping today. I plan to leave the groceries in the garage for a couple of days, there is a fridge out there for the cool stuff, before bringing them into the house. I made sure I sanitized before coming in the house and then did a good soap wash. Do you think this is an adequate plan for now? We live in a county that has about 35 confirmed cases which to me means there are probably 400 or so. When this peaks in three or four weeks I don't plan to be out at all. Yes, both my wife and I are in a high mortality group.

I think these are relatively low risk, but wash your hands when dealing with the products. For god sake, don't like them or rum your eyes or pick your nose after touching.

I would like to echo PatD's question. I was wondering if I should be concerned about the items I bring in from outside like groceries and packaging, the mail, the newspaper. Should I be disinfecting these? Whenever I go out now to get supplies I wear gloves and discard them before stepping back into the car. Includes picking up groceries, pumping gas, using the ATM, etc.
I wash produce anyway, but should I be disinfecting cans and packages that food comes in?
Paper goods (mail, newspaper) too? What is the best method?
I am the sole caregiver for my 97 yr old father.

Same as above.
 
Is there an age breakdown somewhere for fatalities based on US data? I found a breakdown on worldometers but it was old data from ex-US sources.

There's an age breakdown of both confirmed cases and deaths for Washington here: https://www.doh.wa.gov/Emergencies/Coronavirus I don't know of one for all of the US, but it may be available somewhere. This is probably reasonably representative for national figures, too.
 
I am having my morning Joe after a little walk through the neighborhood. I am thinking of today's work while listening to Joe Diffie. I might start the day off the same way until this terrible crisis is over. Today's song is: "Is it cold outside"....." or is it just you".

Yesterday, our drive through COVID tent decided to try to fly away. Today, I have to find a more permanent structure.
Yeah, a shame about Joe Diffie.
 
I think these are relatively low risk, but wash your hands when dealing with the products. For god sake, don't like them or rum your eyes or pick your nose after touching.



Same as above.
Basically the question was about a reasonable time to isolate supplies, sorry if I wasn't clear. I am aware that viable viruses decrease on surfaces over time. Although you are a "grunt in the trenches" right now I really appreciate you giving your rest time to us so we have your perspective on any newer information that is available. Thank you.

Edit: WOW was that a serious run on sentence. Sorry, couldn't help myself. My english teacher in high school always said I could do better. I think I have proven her wrong multiple times. :)
 
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I really enjoyed the CBS special last night live with Garth Brook and Trisha Yearwood. They did it for the medical workers, military, and first responders that are working hard every day.

Today is my mandatory day off that will be spent working from home to catch up on evaluations and awards.

I will close today's message with a story of a medical facility in which nearly 3 dozen health care workers were potentially exposed by a single patient that came in for a non-COVID patient that spiked a fever and became a COVID patient. They will all sweat out time waiting for symptoms and test results to return. It is a testament to the number of medical professionals that touch each patient every day and the risks they take.
 
Basically the question was about a reasonable time to isolate supplies, sorry if I wasn't clear. I am aware that viable viruses decrease on surfaces over time. Although you are a "grunt in the trenches" right now I really appreciate you giving your rest time to us so we have your perspective on any newer information that is available. Thank you.

Edit: WOW was that a serious run on sentence. Sorry, couldn't help myself. My english teacher in high school always said I could do better. I think I have proven her wrong multiple times. :)

You are correct. The virus does decrease over time. I do not think you need to Lysol or bleach packages. Just open packages and throw away the boxes. I have made it a habit to wash my hands and bath more frequently.
 
Chuck thanks for this thread.

Here’s a question - one of the arguments I have seen online is that this virus is far less deadly than commonly stated because the testing rate is still very low and many mild cases are going undetected. Ok, that could be. But earlier you said that at least at your location many of those tested came back negative. That has been the same in our town, with about 10% of those tested coming up positive.

Looking forward to your reply. Have a good day man.
 
Chuck thanks for this thread.

Here’s a question - one of the arguments I have seen online is that this virus is far less deadly than commonly stated because the testing rate is still very low and many mild cases are going undetected. Ok, that could be. But earlier you said that at least at your location many of those tested came back negative. That has been the same in our town, with about 10% of those tested coming up positive.

Looking forward to your reply. Have a good day man.

Early on, the testing criteria created a sort of bias because we only test those that are high risk. Unless we do a randomized antibody screen to see had been exposed, it will be impossible to determine how widespread infections are. You need to test a population of asymptomatic folks. We are not doing that.

The cheap rapid tests determine exposure but not an infection. They are great to look at population studies.
 
The cheap rapid tests determine exposure but not an infection. They are great to look at population studies.
Just read an excellent article by Frank Jordans of the AP in my morning paper which addresses that. The Germans developed a test in mid January and have been doing swift and extensive testing of their population. That is why their death rate seems so low: their denominator (# of confirmed cases) is much higher than other countries because they are finding asymptomatic carriers. So their death rate is lower.
South Korea is also testing extensively and they have flattened their curve.
Seems like early and extensive testing would have been the solution.
 
Just read an excellent article by Frank Jordans of the AP in my morning paper which addresses that. The Germans developed a test in mid January and have been doing swift and extensive testing of their population. That is why their death rate seems so low: their denominator (# of confirmed cases) is much higher than other countries because they are finding asymptomatic carriers. So their death rate is lower.
South Korea is also testing extensively and they have flattened their curve.
Seems like early and extensive testing would have been the solution.

How does testing flatten the curve? How does testing lower the death rate?

How do you determine who to test?
 
How does testing flatten the curve? How does testing lower the death rate?

How do you determine who to test?

Extensive testing of asymptomatic people lowers the death rate (deaths/confirmed case) because the denominator of confirmed cases becomes much larger.

S Korea flattened the curve by aggressively testing all known contacts of people who tested positive, isolating those who test positive regardless of symptoms, then wash, rinse, repeat. They had their first confirmed case the same day the US did, but have gotten new infections under control. They will reopen schools this week.

[edit] Testing alone doesn't get to Korea-like performance. You have to follow up with the other public health steps of isolation and tracking contacts.
 
Extensive testing of asymptomatic people lowers the death rate (deaths/confirmed case) because the denominator of confirmed cases becomes much larger.

S Korea flattened the curve by aggressively testing all known contacts of people who tested positive, isolating those who test positive regardless of symptoms, then wash, rinse, repeat. They had their first confirmed case the same day the US did, but have gotten new infections under control. They will reopen schools this week.

[edit] Testing alone doesn't get to Korea-like performance. You have to follow up with the other public health steps of isolation and tracking contacts.

Sort of. Sure, we can fluff out numbers with asymptomatic carriers. The problem is antibodies is they do not mean infectious and most of the testing is done on large populations is antibody testing. Actually, antibodies indicate immunity. They would not even be counted in the denominator.

Saying testing flattened the curve sells the efforts of Singapore and South Korea very short. They has a huge enforcement effort to monitor compliance with home isolation and public health.
 
We're having huge issues with compliance to the existing regulations. Too many people think their 'freedom' outweighs the common good. I don't think the Korean solution is viable on our scale and in our culture.
 
So why isn't the US emulating the South Korean and Singapore models?

We're having huge issues with compliance to the existing regulations. Too many people think their 'freedom' outweighs the common good. I don't think the Korean solution is viable on our scale and in our culture.

In addition to the cultural/scale issues, you have to start the Korean model early. You can handle the kind of testing and lockdown needed if you come down on it like a ton of bricks at the first case. Even then, there was one patient who massively spread the virus (see here). We could have started the Korean model when they did at the end of January with known cases in the single digits, but you couldn't hope to do it now. Why we didn't emulate the Korean model then? We (collectively and senior politicians) didn't take it seriously enough to put the effort, political capital, and money into the project.
 
So why isn't the US emulating the South Korean and Singapore models?

Cost. I have not run the model for South Korea (SKM) and cost but a similar model to the SKM which provided even higher success would cost over 150 billion in just testing within the United States and that assumes we could bring down the cost to 50%. That is not even accounting for the cost of equipment and swaps. Our country is way to massive for PCR testing link many of the countries tested all their population.
 
In addition to the cultural/scale issues, you have to start the Korean model early. You can handle the kind of testing and lockdown needed if you come down on it like a ton of bricks at the first case. Even then, there was one patient who massively spread the virus (see here). We could have started the Korean model when they did at the end of January with known cases in the single digits, but you couldn't hope to do it now. Why we didn't emulate the Korean model then? We (collectively and senior politicians) didn't take it seriously enough to put the effort, political capital, and money into the project.

Not necessarily. I was a part of the planning. We started early. Once we knew the scale of this thing, we started planning and quickly acknowledged that we did not have the facilities and the US is way to massive and rural to implement the SKM. The US was trying to slow down the virus to get the better screening. It is right now coming online and it was expedited. Much of the politicians were either trying to capitalize on a tragedy or calming the public to avoid panic. In general, I wish our public and politicians would start listening to experts and stay indoors for a few weeks.
 
How does testing flatten the curve? How does testing lower the death rate?

How do you determine who to test?
Based on increased testing, more asymptomatic carriers can be found and put in isolation. Especially those working in essential sectors will otherwise show up for work.
So ideally everybody with a remote chance of being infected would be tested, plus some random folks to get an idea about the number of asymptomatic carriers. Currently, this is not feasible because not enough tests are available, so they need to be used in a more focused way.

Cost. I have not run the model for South Korea (SKM) and cost but a similar model to the SKM which provided even higher success would cost over 150 billion in just testing within the United States and that assumes we could bring down the cost to 50%. That is not even accounting for the cost of equipment and swaps. Our country is way to massive for PCR testing link many of the countries tested all their population.

The US is 6 times more populous than SK. Based on your 150 billion at 50% cost reduction, this would imply that SK has already spent around 50 billion testing. Are you sure this is correct?

Edit:
Just checked. The difference between the US and SK is actually not that big.
US: 3,782 tests per million people (unofficial)
SK: 8,349 tests per million people
https://en.wikipedia.org/wiki/COVID-19_testing

Reinhard
 
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Extensive testing of asymptomatic people lowers the death rate (deaths/confirmed case) because the denominator of confirmed cases becomes much larger..
Yup, “denominator management.” First learned that term from my boss at Hill AFB. One of the first rules of bean counting!

Perhaps on the good side (???), if there are a lot of asymptomatic cases then a significant number of people are getting exposed, getting infected, and clearing the virus without getting sick. So maybe the true morbidity and mortality aren’t as high as some published numbers. Still a horrendous pandemic, doesn’t mean we can relax any of the current rules. But even a 1% mortality in our country means 3.27 MILLION deaths in U.S., 76 MILLION worldwide if everybody eventually gets exposed. But 1% of SYMPTOMATIC cases is a lot smaller number if many people (perhaps hopefully most) are ASymptomatic.

My question, does maximally effective social distancing turn this from a pandemic to an endemic? Difference being a pandemic sweeps through, infects EVERYBODY in weeks to months, overwhelms medical system with those who need hospital and sometimes ventilator care, vs endemic which still gets to EVERYBODY but spreads it out over many months to a couple of years (or until vaccine is developed, tested, mass produced, AND deployed). The endemic scenario keeps the hospitals from being overwhelmed, but spreads the misery over a much longer time span. Also, under the endemic (or pandemic) scenario, can those who have HAD the virus and recovered return to work as usual?

Until a vaccine comes out, isn’t it likely that at least 70% or more of us will EVENTUALLY get exposed to this virus? Social distancing spreads out the infections in time but doesn’t ultimately prevent it? (barring the international space station.)
 
Based on increased testing, more asymptomatic carriers can be found and put in isolation. Especially those working in essential sectors will otherwise show up for work.

You should not need a test to tell you to stay at home if you have a cold.

I was not referring to the SKM with the monetary estimates.

The limitation is not tests or test kits. These things are like copiers. You have paper, a guy to push the button, a page to copy, a copier, and toner. Any of those items are short, you cannot make copies. The additional problem is that most of the copiers can only do like 60-1500 tests a day. Even if you could afford to test 50% of the population at a 50% savings, it would take 120 days to test them with maintenance time. That is assuming every state has 10 machines which most do not.

It is much easier to test a population that is 1/6 of ours (excluding those that are not citizens). The problem is not as simple as the new or public make it.

We are doing most of what SK is doing. It will make an impact over time.
 
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