Coronavirus: What questions do you have?

cwbullet said:

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.

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May I ask when that planning started? The reason is that we had our first confirmed case in WA (a traveler from China) in late January. After that, our first positive tests were in late February. In that time, the Seattle Flu Study had several cases that they thought looked like COVID, but CDC told them not to give the test because they had no known connections to China. They eventually ignored CDC guidance, found a likely subject, and gave the test anyway. That was how we found out we had community spread. The Life Care deaths started coming in at about the same time.

I'm not an epidemiologist, but that certainly looks like CDC had their head in the sand for a solid month. I would be glad to be wrong. One also can't help but notice the during the critical early days of the epidemic, senior leadership was saying that it was no big deal and would blow over soon.

Finally, I disagree regarding having the resources to fight this early. The $150B to implement testing on the SKM is a drop in the bucket compared to the $2T in relief we just authorized. Sure, there's some hindsight in there, but everybody knew this was going to be massive in late January, where was the actual action? [edit] We also have a massive biotech industry in this country, which doesn't seem to have been mobilized to aid in testing until quite recently.

BABAR said:

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.)

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Social distancing works but it will still be a pandemic. An epidemic is a disease affecting many persons at the same time and spreading from person to person in a locality where the disease is not permanently prevalent. It is usually not as widespread as a pandemic. It has little to do with the speed of a spread.

Social distancing will only prevent infection if it is 100% performed. Look at Walmart today and you will that is not happening. In practice, you are right: the goal is to slow the spread and allow hospitals time between ventilator usage.

boatgeek said:

May I ask when that planning started? The reason is that we had our first confirmed case in WA (a traveler from China) in late January. After that, our first positive tests were in late February. In that time, the Seattle Flu Study had several cases that they thought looked like COVID, but CDC told them not to give the test because they had no known connections to China. They eventually ignored CDC guidance, found a likely subject, and gave the test anyway. That was how we found out we had community spread. The Life Care deaths started coming in at about the same time.

I'm not an epidemiologist, but that certainly looks like CDC had their head in the sand for a solid month. I would be glad to be wrong. One also can't help but notice the during the critical early days of the epidemic, senior leadership was saying that it was no big deal and would blow over soon.

Finally, I disagree regarding having the resources to fight this early. The $150B to implement testing on the SKM is a drop in the bucket compared to the $2T in relief we just authorized. Sure, there's some hindsight in there, but everybody knew this was going to be massive in late January, where was the actual action? [edit] We also have a massive biotech industry in this country, which doesn't seem to have been mobilized to aid in testing until quite recently.

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I can't speak for the West Coast. The CDC started the Incident Management System the first week in January. They were slow at first, but the planning was deliberate. In GA, they started planning locally in February. We met as a group in early March. We had significant difficulty getting people to accept the reality that it was coming. Litterally, my medical center could do less than 30 tests a day. In February, we double that. Now, I can theoretically do 3000 a day (1500 in reality). Now, I would run out of supplies quickly at that rate.

I would agree that many leaders on both sides of the isle ignored the risk. I am not sure if they were trying to calm or ignoring. Personally, I knew it could be a risk, but we really did not know how bad till Italy. We have a model, now it is time to ride the wave and see what the American Model delivers.

Does UV light disinfection work on this virus?
Still wondering if I should disinfect my mail and paper since I obviously cannot wash them with soap and water.
BTW how long does this virus last on paper? I thought I read somewhere that it was a few hours but I may be wrong.

kuririn said:

Does UV light disinfection work on this virus?
Still wondering if I should disinfect my mail and paper since I obviously cannot wash them with soap and water.

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On the news yesterday they recommended leaving packages and envelopes outside of living spaces in the house for 24 hours.
UV-C does work.

Steve Shannon said:

On the news yesterday they recommended leaving packages and envelopes outside of living spaces in the house for 24 hours.
UV-C does work.

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I have been spraying all mail and packages with disinfectant for over two weeks.

Speaknoevil said:

I have been spraying all mail and packages with disinfectant for over two weeks.

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You probably have wasted a LOT of disinfectant and have very soggy mail and packages now.

Maybe only spray them for a couple of seconds instead?

Got a question for you , Chuck.

In an earlier post you mentioned you didn't think packages were worth wiping down.

Went grocery shopping today (e-cart where they do the shopping and bagging for you and wheel the cart out to your waiting car, they also load them into your trunk) and brought all the bags into the garage. I couldn't quite bring myself to simply carry the groceries into the house and put them in the fridge or on the shelf so I wiped everything down with disinfectant wipes, then carried them into the house and let everything air dry before storage.

Is this something that I should be doing?

Both my child bride and I are geezerly in terms of years on earth, she is immune-compromised from rheumatoid arthritis medications and is at the tail end of her plaquinel treatment due to shortages. Her side of the family usually makes it into their mid to upper 70's while my side usually lives into their high 80's and 90's (feisty and cantankerous).

Thanks!

Mushtang said:

You probably have wasted a LOT of disinfectant and have very soggy mail and packages now.

Maybe only spray them for a couple of seconds instead?

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Ha!

o1d_dude said:

Got a question for you , Chuck.

In an earlier post you mentioned you didn't think packages were worth wiping down.

Went grocery shopping today (e-cart where they do the shopping and bagging for you and wheel the cart out to your waiting car, they also load them into your trunk) and brought all the bags into the garage. I couldn't quite bring myself to simply carry the groceries into the house and put them in the fridge or on the shelf so I wiped everything down with disinfectant wipes, then carried them into the house and let everything air dry before storage.

Is this something that I should be doing?

Both my child bride and I are geezerly in terms of years on earth, she is immune-compromised from rheumatoid arthritis medications and is at the tail end of her plaquinel treatment due to shortages. Her side of the family usually makes it into their mid to upper 70's while my side usually lives into their high 80's and 90's (feisty and cantankerous).

Thanks!

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The Surgeon General just discussed this issue and how he treats "his" groceries. He leaves them out for several hours if not perishable, and washes all the fresh.

o1d_dude said:

I wiped everything down with disinfectant wipes, then carried them into the house and let everything air dry before storage.

Is this something that I should be doing?

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If it makes you feel safer, keep doing it. There is not a lot of research to back doing it. For the average person, I would say it is not needed. Your wife has a risk/risks. It might be worth the peace of mind.

I am changing my stance a little. Plastic and glass can hold the virus longer. A quick wipe is probably worth the effort. I do not do it. Boxes and paper are less likely to hold the virus alive for long periods, so I am not sure they are worth the effort. That being said, I would not go from sorting your mail to eating or picking your nose without washing your hands.

What do I do? I work in the health care industry. I never wear my work clothes home and I shower when I come in the house.

Titan II said:

The Surgeon General just discussed this issue and how he treats "his" groceries. He leaves them out for several hours if not perishable, and washes all the fresh.

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It won't hurt anything but I am not sure the research is there to back it up. I would say there is plenty of research to argue against doing that with meat or dairy.

cwbullet said:

Reinhard said:

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.

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

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Chuck,
You are over-focusing on the treatment angle (perfectly reasonable in your position), but missing the broader epidemic control measures.

Without effective identification, tracing and isolation of the asymptomatic carriers, the only way this pandemic ends is when human-to-human transmission of the virus decreases, owing to acquired population immunity, or development of a vaccine. In other words, until a viable vaccine is identified, mass produced, and distributed (12+ months from now), we have two simple choices:

1. Controlled spread: manage hospital overload via social distancing and economic slow-down, then wait the virus out until 40-70% of the population will have been infected and recovered.
   • Aka “reactive mode". Time to conclusion - indefinite.
2. Containment and eradication: massive and rapid implementation of testing, tracing, quarantining of infected and their contacts, and aggressive nation-wide containment measures. Aka South Korean approach.
   • The goal here is to reduce the risk of community transmission by isolating infected patients and their contacts, even before they show symptoms (via ubiquitous testing); to prevent casual and household transmission.

https://www.theguardian.com/commentisfree/2020/mar/20/south-korea-rapid-intrusive-measures-covid-19
https://www.sciencemag.org/news/202...sharply-south-korea-whats-secret-its-success#
https://www.who.int/emergencies/diseases/managing-epidemics-interactive.pdf

cwbullet said:

It is much easier to test a population that is 1/6 of ours (excluding those that are not citizens). [...]We are doing most of what SK is doing. It will make an impact over time.

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No, it would not be that much harder in a country 6x SK's population, since we have 20x the resources (GDP ratio).
No, we are not doing most of what SK has been doing. There is no centralized effort to test, trace, and quarantine infected population. There is an inconsistent attempt to voluntarily semi-quarantine everyone, that's it.
Yes, we are lacking national-level mobilization of effort, funding, policy, and resources. Any state-specific efforts will get undermined by nearby states that don't share the same policies, beliefs, or priorities.

Until that changes, the only viable option is #1 - reactive mode. That's the only thing we have. You are an expert on it, and we appreciate your efforts, and sharing your experience and advise.

However, economic pressures are already building to call it off as soon as possible, to restart the economy.... along with re-accelerated virus transmission.

https://www.sciencemag.org/news/2020/04/united-states-leads-coronavirus-cases-not-pandemic-response

a

And meanwhile, Florida governor has declared places of worship essential businesses able to hold services.

(Shakes head in disgust)

Marc_G said:

And meanwhile, Florida governor has declared places of worship essential businesses able to hold services.

(Shakes head in disgust)

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New buzz phrase down here “limited contact”.
What’s odd though, they just arrested a church pastor last week for still holding congregation when there was already a “no groups of more than 10 people” in effect. Beaches were still crowded last weekend. Go figure.

afadeev said:

Chuck,
You are over-focusing on the treatment angle (perfectly reasonable in your position), but missing the broader epidemic control measures.

Without effective identification, tracing and isolation of the asymptomatic carriers, the only way this pandemic ends is when human-to-human transmission of the virus decreases, owing to acquired population immunity, or development of a vaccine. In other words, until a viable vaccine is identified, mass produced, and distributed (12+ months from now), we have two simple choices:

1. Controlled spread: manage hospital overload via social distancing and economic slow-down, then wait the virus out until 40-70% of the population will have been infected and recovered.
   • Aka “reactive mode". Time to conclusion - indefinite.
2. Containment and eradication: massive and rapid implementation of testing, tracing, quarantining of infected and their contacts, and aggressive nation-wide containment measures. Aka South Korean approach.
   • The goal here is to reduce the risk of community transmission by isolating infected patients and their contacts, even before they show symptoms (via ubiquitous testing); to prevent casual and household transmission.

https://www.theguardian.com/commentisfree/2020/mar/20/south-korea-rapid-intrusive-measures-covid-19
https://www.sciencemag.org/news/202...sharply-south-korea-whats-secret-its-success#
https://www.who.int/emergencies/diseases/managing-epidemics-interactive.pdf




No, it would not be that much harder in a country 6x SK's population, since we have 20x the resources (GDP ratio).
No, we are not doing most of what SK has been doing. There is no centralized effort to test, trace, and quarantine infected population. There is an inconsistent attempt to voluntarily semi-quarantine everyone, that's it.
Yes, we are lacking national-level mobilization of effort, funding, policy, and resources. Any state-specific efforts will get undermined by nearby states that don't share the same policies, beliefs, or priorities.

Until that changes, the only viable option is #1 - reactive mode. That's the only thing we have. You are an expert on it, and we appreciate your efforts, and sharing your experience and advise.

However, economic pressures are already building to call it off as soon as possible, to restart the economy.... along with re-accelerated virus transmission.

https://www.sciencemag.org/news/2020/04/united-states-leads-coronavirus-cases-not-pandemic-response

a

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I have said this a thousand times: you cannot compare us to SK. Different culture. Much smaller geography and smaller population. We are close to Russia (population) or China (geography).

You are overlooking the scale of the problem and posting a page from the WHO doe not help your argument. The arrogance of the WHO and lack of transparency from China are most of the problem. I commend your verbose answer, but it shows your true lack of understanding of the true resources required to test even 10% of the United States. I have tested 200 people and that cost $20000 of your hard-earned tax dollars to get less than 10 positives. Even the cheapest antibody testing is gonna cost $25 without supplies. Neither these estimates include the cost of PPE and swabs.

The scale of the problem:
1. Geography - people are too spread out to test them all.
2. The scale of testing - testing for disease is not 5 minutes. It is 4-6 hours. The shorter tests do not inform illness. They test for exposure. You will have to order the other test to confirm infectivity.

The country is too large and we do not have enough equipment to test. Sure, we can do antibody testing (serology). By the way, we ran a new 5-minute serology on 8 positive samples so far and it was incorrect in 1 of 8. Is a 17% misrate worth letting someone walk around infecting others. Hopefully, the Roche is better. For now, I will stick to the 97.5% I am getting on the PCR testing.

Either way, your point is mute because we do nto have a test available to send out to test any mass of folks to screen for the virus. Who knows when testing will be available? I hear the promises, but until deployed to the field, it essentially does not exist.

Marc_G said:

And meanwhile, Florida governor has declared places of worship essential businesses able to hold services.

(Shakes head in disgust)

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I am a man of faith, but do not understand this. Sure, the diety will help you fend off infection, but I am sure what every deity you believe in, gave you brain to avoid the virus.

cwbullet said:

I am a man of faith, but do not understand this. Sure, the diety will help you fend off infection, but I am sure what every deity you believe in, gave you brain to avoid the virus.

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My thought was along the lines of Matthew 4:7. Do not put The Lord your God to the test.

I.e., don’t be an arrogant jackass, and feel like God is required to save you from your recklessness.

Cl(VII) said:

My thought was along the lines of Matthew 4:7. Do not put The Lord your God to the test.

I.e., don’t be an arrogant jackass, and feel like God is required to save you from your recklessness.

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I like that one - Especially your version.

I just looked up the Roche test. It is a PCR test also. We have a Panther. It does more tests than we can perform in 24 hours.

https://www.healthpolicy-watch.org/...ting-not-possible-says-roche-industry-leader/

I am not sure I buy the 4128 tests a day. They must have the TOM Brady of lab techs. The Panther quotes 3000 a day and can crank out about 850 with two shifts 5 days a week. The problem is you can't staff one to run 24/7.

Cl(VII) said:

My thought was along the lines of Matthew 4:7. Do not put The Lord your God to the test.

I.e., don’t be an arrogant jackass, and feel like God is required to save you from your recklessness.

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It has dwindled down in recent years, but even 10 years ago we routinely treated snakebite victims from a local church.

Email Question: What we are doing like South Korea?

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I am not privy to what every state is doing. In GA and in the military, we are following the Korea Playbook (South Korea). I helped every hospital set up drive-through COVID/FLU clinics in tents and RVs. We test based on the CDC and military guidelines. They are pretty easy algorithms. Currently, we are testing symptomatic patients and those with exposures. We put them on isolation / self-quarantine based on risk level. The criteria are identical to South Korea. If they are high risk or positive, public health does a trace to look for other exposures. All exposures are isolated until symptoms appear, then testing occurs. If they are symptom-free at 14 days, they are released from isolation.

Email question: Why can't we just test everyone?

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This is a common question. First, it is cost-prohibitive right now. Also, there is not enough equipment and testers. Lastly, the most accurate time to test is when you are symptomatic and actively shedding (producing) the virus in your nose and throat. You can have a false positive tets for days after you clear the infection as you shed virus, but the most accurate test to test for prior infection is antibodies. These tests are approved by the FDA and will be available in a few weeks (? quantity).

NateB said:

It has dwindled down in recent years, but even 10 years ago we routinely treated snakebite victims from a local church.

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That happens a lot in SW West Virginia.

NateB said:

It has dwindled down in recent years, but even 10 years ago we routinely treated snakebite victims from a local church.

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I’m from an area that had (may still have) some of the snake handling churches...never really got that one, but I don’t have to get someone else’s faith. At least a snake bite has few societal impacts beyond the person and their treatment.

cwbullet said:

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

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I should clarify this which I did to an email question. Locally, we are following the Korean playbook. Clearly, NY, WA, and SF did not.

cwbullet said:

Thank you. I really needed that. After 14-18 hours a day for the last 7 days, I am starting to get pretty fatigued. If you see a medical professional - thank them. This is what we trained to do, but the circumstances are tough and the decisions are even rougher.

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@cwbullet Thank You for what you are doing! People like you do not get the credit they deserve.

Winston said:

Here's what's going to happen with sheltering in place to "flatten the curve":

Loop until 70% have had it and recovered:
1. Shelter - destroy economy further
2. Come out of shelter - virus returns

We can destroy our economy and end up with similar results to what would happen if we didn't destroy our economy. 85-90% of people who have it are not hospitalized and many don't even realize they have had it. Ventilators? 95+% of people in China who went on ventilators died anyway. For the more elderly population of the Diamond Princess, 7 of 700 have died.

Require quarantine of only the most vulnerable and protect them to the maximum extent possible. Everyone else proceeds as normal with MUCH improved hygiene to flatten the curve while keeping the economy going. Once possible, there should be MASSIVE single-blood-droplet pin prick rapid result testing for COVID-19 antibodies (that test already exists). Maybe even give a card to those who have had it and recovered so they can return to work and keep the economy going.

Israel is doing this:

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It has been said many times in many threads, you cannot stop how many people get infected, but you can slow the spread, prevent the overloading of the healthcare system, and save lives by social distancing, and if necessary complete quarantine. The economy will recover. Saving lives is what matters in a situation like this. Life is more valuable than a bank account.

P.S. Never trust data from China.

Marc_G said:

And meanwhile, Florida governor has declared places of worship essential businesses able to hold services.

(Shakes head in disgust)

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The central tenet of most religions can be distilled to 'Don't be selfish'. I was a Hare Krishna for a while; that was Krishna's purpose on Earth.

I studied Comparative Religion. I was also an OR and ER nurse for twelve years. God can be found everywhere. He/She/It/They can be found in your garden, in your home, in your hospital, in your cafe. Anywhere you are.

Not self-isolating is selfish.

Sorry if I'm out of line.

Cape Byron said:

Not self-isolating is selfish.

Sorry if I'm out of line.

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Concur 100%. A local Applebees made the national news for having groups drinking in close proximity. Not only were they selfish, they are responsible and just plain stupid.