Coronavirus: What questions do you have?

[cwbullet]

Back to work after a much needed day off. Today we practice our bed expansion and try to stress the staff and system. We will find out if all 24 ventilators work. If we get the other 14 vents, we will add them to the circuits.

I hear a lot of folks staying there are not enough ventilators. That is selling the problem short. There are not enough ventilators in the US but there are also not enough circuits and supplies to keep them running. We ordered enough and some extra vents early. We will see.

 

[cwbullet]

Email question: How does COVID-19 compare with Influenza?

Not too well. First and foremost, Influenza is not one illness. It is a family of viruses. Even in the family of Influenza A, there are multiple forms of viruses.

The 1917 Flu Epidemic killed millions (17-50). It infected over 1/4 of the world's population. Humans had nearly zero immunity to it. COVID is in a similar situation because we have nearly zero immunity. Years of flu vaccines have given us some immunity to even the most novel of cases of flu like H1N1 of 2009.

Death rate: COVID 2.3% vs Flu 0.1%. I am not sure this is a comparable stat. It is like comparing an F150 to a Tesla. Once again, COVID is Novel and we have nearly no immunity. Spanish Flu was 3.4-10%. You can quickly see that novel or new is not a good thing when it comes to viruses.

Transmission: R0 values compare viruses and indicate how many people will catch the bug from someone who is ill. This year's Flu: 1.3 vs COVID 2-3. The comparison is fair but looks at the facts. This is like comparing two people shot with a gun and saying one weapon is deadlier than the other based on wound characteristics but you gave one guy a bulletproof vest. The vest is the vaccine many of us received this year which gave protection of 40-50%.

Some protection is better than none. If I had to catch one, I would choose the Flu - this year. 1917, not so much. Talk to me again next year when we have an immunization.

 

[Mushtang]

Chuck,

Like you, I'm here in Georgia and I know you're familiar with the pollen season we get and how that can make someone cough for weeks.

Is there an easy way to tell the difference between the Covid cough when I'm not showing any other symptoms (fever, tiredness, etc) and a pollen cough?

It seems like a stupid question that there's no way for you to answer, I see that, but I'm hoping there's something I don't know that you'll be able to point out like, if you're also coughing up a lot of phlegm then it's definitely not pollen (or that definitely IS just pollen), or something like that. I'm hoping there's something about a covid patient's cough that may be a clue.

I know I sound paranoid but that's because I am. A couple of weeks ago I had a high fever and my wife and I started to worry, but the next day it was gone and I haven't had a fever since. So things like that make me worry a little until I realize they're not Covid.

 

[cwbullet]

Question by PM: How accurate are the tests for COVID?

There are false positive and negative rates for some the tests that are anywhere from 1% to 17%. It depends on the test and technique. It is really complicated.

Particularly, a 17% false negative rate creates a lot of concern. That means up to 17% of patients would be sent home with a positive result but being told they are negative. A false positive is less concerning because they should be isolated. That means out of 100, 17 patient could be sent home. If they infect 2 patients each, that would result in 34 new infections. That is overly simplistic but illustrates the problem. This is one reason why force testing with PCRs is not a great means for testing large numbers of folks.

 

[cwbullet]

Chuck,

Like you, I'm here in Georgia and I know you're familiar with the pollen season we get and how that can make someone cough for weeks.

Is there an easy way to tell the difference between the Covid cough when I'm not showing any other symptoms (fever, tiredness, etc) and a pollen cough?

It seems like a stupid question that there's no way for you to answer, I see that, but I'm hoping there's something I don't know that you'll be able to point out like, if you're also coughing up a lot of phlegm then it's definitely not pollen (or that definitely IS just pollen), or something like that. I'm hoping there's something about a covid patient's cough that may be a clue.

I know I sound paranoid but that's because I am. A couple of weeks ago I had a high fever and my wife and I started to worry, but the next day it was gone and I haven't had a fever since. So things like that make me worry a little until I realize they're not Covid.

A good physician uses history to make the difference but it is a challenge in some. Itching can be a way to weed our allergies but even that is different form patient to patient. A good clinician and use a physical exam to identify allergies. The picture is slightly different.

 

[davel]

...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.

Chuck, what is the lastest thoughts on what portion of the population would need to have immunity or have been vaccinated for 'Herd Immunity' to be effective? I thing I heard 80-90% but that was a while ago.

 

[cwbullet]

It depends on the vaccine and virus. 70 percent is the quoted number.

 

[ThirstyBarbarian]

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

(Shakes head in disgust)

I'd say the ones that are "businesses" are not also "essential".

Stay at home! Stream your services online! My mom is missing her church services and the other church activities she is used to being part of. It's very sad, and it's hard for her. But she is coping with it.

 

[cwbullet]

I'd say the ones that are "businesses" are not also "essential".

Stay at home! Stream your services online! My mom is missing her church services and the other church activities she is used to being part of. It's very sad, and it's hard for her. But she is coping with it.

Essential is rather vague.

 

[ThirstyBarbarian]

There is no good reason for congregations to be congregating. Pastors like that Florida nut job who gather a thousand people in one place for services are really putting the “perish” in the parish.

Churches can do many good things without all gathering together in one place. They can hold services online, they can be a lifeline for their vulnerable members, they can raise money for relief, they can be trusted leaders and spread accurate information, and they can do many other things. But they should not be holding in-person services.

 

[Blast it Tom!]

Thirsty, I am with you - good line, too! To be sure, they weren't gathering as usual- they kept spacing and had taken other measures for sanitation and so on, but in my opinion not enough. This isn't a church-state issue, for crying out loud, it's a public health temporary safety measure. My wife is related to that sheriff, though we haven't fully tracked down how, but he bears an uncanny resemblance to her uncle and to a little less degree, her dad. He didn't want to do what he had to do there.

And I agree as well, and it's happening, that the church is out there in all the ways that you are saying. It's the least we can do.

 

[NateB]

Deleted.

 

[cwbullet]

In my opinion, "christians" who think the church building is essential to worship and spread the word of God have missed the point of the Scriptures. Actions speak louder than religious words. Listen to the service on the radio and grab groceries for your neighbor who shouldn't be out. A simple kind action will put your mind in a better place with God than reciting the same songs over and over again.

I would recommend we end the discussion on religion. The occasional comment is ok, but this might spiral.

 

[NateB]

I would recommend we end the discussion on religion. The occasional comment is ok, but this might spiral.

Understood, removed my comment.

 

[cwbullet]

Understood, removed my comment.

It was ok, I was being careful since we get a lot complaint on that topic.

 

[Greg Furtman]

Chuck, I have a question. When I go into town I wear a surgical mask (I know it is not the best thing to wear but I figure it is better than nothing) and nitrile gloves. When I get back in my car I take the mask off & strip the gloves & throw them on the passenger floor. Am I correct that if I let them set for a week that they would be safe to use again?

 

[Sooner Boomer]

What are the flu numbers like this year?

 

[cwbullet]

Chuck, I have a question. When I go into town I wear a surgical mask (I know it is not the best thing to wear but I figure it is better than nothing) and nitrile gloves. When I get back in my car I take the mask off & strip the gloves & throw them on the passenger floor. Am I correct that if I let them set for a week that they would be safe to use again?

My opinion on masks is changing. I still think true surgical masks and medical N95 should be used by medical providers. The N95 is a respirator that should be properly sized to work correctly. The mask on you is best used to protect others from your breath and saliva. Many fabrics will work.

As for gloves, I do not wear them and do not know the utility for non-medical folks wearing them.

 

[kuririn]

As for gloves, I do not wear them and do not know the utility for non-medical folks wearing them.

Chuck, I wear them when I go out to get groceries, pump gas, use the ATM, whatever. Wouldn't they prevent transfer of the virus from contaminated surfaces to your hands? I do my business, then toss the gloves before I reenter the car. Seems like it's easier and more practical than washing my hands every ten minutes.

 

[Sparky]

Chuck - my 80 year old aunt assumed I was making masks since I sew. She asked for at least one or more as she thinks it will soon be required by everyone going out.

So, I've seen patterns for them all over Facebook and places.
1. Is two layers of regular quilter type cottons fine for 'casual' use.
2. I've hear that using two different fabrics to make sure the same side it outside each time.
3. Ties are easier to live with than elastic over the ears.

So, should I follow those rules, as I will make her and a couple of other family members some.

What else should I know or do?

 

[cwbullet]

Chuck - my 80 year old aunt assumed I was making masks since I sew. She asked for at least one or more as she thinks it will soon be required by everyone going out.

So, I've seen patterns for them all over Facebook and places.
1. Is two layers of regular quilter type cottons fine for 'casual' use.
2. I've hear that using two different fabrics to make sure the same side it outside each time.
3. Ties are easier to live with than elastic over the ears.

So, should I follow those rules, as I will make her and a couple of other family members some.

What else should I know or do?

3 layers of cotton make a pretty good mask. I am wearing a cotton one at work when not in patient care.

 

[Sparky]

Thanks Chuck, I'll make them 3 layers deep. Guess I'll be doing that some this weekend.

 

[cwbullet]

Chuck, I wear them when I go out to get groceries, pump gas, use the ATM, whatever. Wouldn't they prevent transfer of the virus from contaminated surfaces to your hands? I do my business, then toss the gloves before I reenter the car. Seems like it's easier and more practical than washing my hands every ten minutes.

I guess so if you maintain good sterile technique. Most non-medical folks I see contaminate the gloves and themselves.

 

[cwbullet]

I guess so if you maintain good sterile technique. Most non-medical folks I see contaminate the gloves and themselves.

I did a study in medical school on this topic and used a black light to show how much non-trained folks contaminate themselves. It was hilarious.

 

[Speaknoevil]

I did a study in medical school on this topic and used a black light to show how much non-trained folks contaminate themselves. It was hilarious.

Did it start something like this...

 

[o1d_dude]

Although I am sometimes ... many times ... alright, most times ... a wiseass and sarcastic (ask Thirsty, we fly together) I truly hope we all get through this unscathed or affected as minimally as possible.

Stay safe out there.

PS. I don’t shake hands, I wash them frequently, and I keep my distance from everyone, so here’s a virtual High Five for you all.

 

[cwbullet]

Not sure we will return to hand shaking.

 

[PXR5]

Yeah, I think handshakes might be over with.

 

[boatgeek]

Chuck - my 80 year old aunt assumed I was making masks since I sew. She asked for at least one or more as she thinks it will soon be required by everyone going out.

So, I've seen patterns for them all over Facebook and places.
1. Is two layers of regular quilter type cottons fine for 'casual' use.
2. I've hear that using two different fabrics to make sure the same side it outside each time.
3. Ties are easier to live with than elastic over the ears.

So, should I follow those rules, as I will make her and a couple of other family members some.

What else should I know or do?

Our family has turned out 30 masks, on the Deaconess design (PM me if you need a link, but it's a square pleated mask). They're pretty straightforward and easy to make, though the elastic ones are quite a bit faster than ties. You can make them fit much better if you add wire to the nose. Wire ties for garden use work really nicely, and I just found 100-packs of the right gauge and length (~8") at our local Ace. One thing I saw but haven't made is a headband with buttons to hold the elastic. Apparently, come nurses near us have been requesting those to make the elastic ones more comfortable. Finally, there's differing opinions on fabrics. Some people like softer fabrics like flannel for the nicer feel on the face, but others want something cooler.

 

[Sparky]

@boatgeek Thank you for that information. I am liking this pattern I found as it gives sizes for teens, children and adults. And can be either elastic or stretch ties.

https://www.madeeveryday.com/fabric-face-mask-free-pattern/