Coronavirus: What questions do you have?

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Speaknoevil

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New data released in the news. A small isolated population of over 600 was brought into a controlled environment and tested for COVID. All were asymptomatic and 8 tested positive for COVID. They were separated into two cohorts: COVID and Non-COVID. The groups were separated by physical barriers (distance) and had separate facilities. No chance of contamination. After 14 days of strict quarantine, both groups were retested. Over 150 tested positive for COVID on the second test.

I cannot explain the results and it has me guessing but I am 100% certain this did not magically transport into the population. I have to think that the false-negative rate is so high that a few slipped through.
I hate to say it, but this is scary familiar to the account the lady, former CDC scientist, and anti-vaxers prediction. She felt that COVID-19 and it's immediate appearance worldwide could not have happened from human-to-human contact, but instead from a "dirty" flu vaccine administered globally sometime in the last 18 to 24 months.
 

Bill S

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I hate to say it, but this is scary familiar to the account the lady, former CDC scientist, and anti-vaxers prediction. She felt that COVID-19 and it's immediate appearance worldwide could not have happened from human-to-human contact, but instead from a "dirty" flu vaccine administered globally sometime in the last 18 to 24 months.
Now that is a unsettling thought if true.
 

cwbullet

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I hate to say it, but this is scary familiar to the account the lady, former CDC scientist, and anti-vaxers prediction. She felt that COVID-19 and it's immediate appearance worldwide could not have happened from human-to-human contact, but instead from a "dirty" flu vaccine administered globally sometime in the last 18 to 24 months.
That is absolutely not true and she is a whack-a-doodle. The flu vaccine for this year has been confirmed to not contain Coronavirus. The CDC debunk this the day ti appears on the conspiracy websites. She is an employee that is an axe to grind with Dr. Fauci. Although, I am not a fan of Dr,. Fauci, she is coo-coo for Cocoa Puffs.


Most importantly, none of these 600 were given the flu vaccine yet.
 

Speaknoevil

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That is absolutely not true and she is a whack-a-doodle. The flu vaccine for this year has been confirmed to not contain Coronavirus. The CDC debunk this the day ti appears on the conspiracy websites. She is an employee that is an axe to grind with Dr. Fauci. Although, I am not a fan of Dr,. Fauci, she is coo-coo for Cocoa Puffs.


Most importantly, none of these 600 were given the flu vaccine yet.
Good to know.
 

dhbarr

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Now that is a unsettling thought if true.
So is the sun turning to cheese, but I don't have to worry about that either.

Apparently Oklahoma will just stop reporting state level numbers as accurately at the same time as opening up substantially, so that's actually something I do have concern with.


Are there any other states that are pretending counting body locations is a privacy issue?
 

NateB

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New data released in the news. A small isolated population of over 600 was brought into a controlled environment and tested for COVID. All were asymptomatic and 8 tested positive for COVID. They were separated into two cohorts: COVID and Non-COVID. The groups were separated by physical barriers (distance) and had separate facilities. No chance of contamination. After 14 days of strict quarantine, both groups were retested. Over 150 tested positive for COVID on the second test.

I cannot explain the results and it has me guessing but I am 100% certain this did not magically transport into the population. I have to think that the false-negative rate is so high that a few slipped through.
How many of those who retested positive developed symptoms? Did anyone require hospitalization within that group?

This suggests that the tests are unreliable and/or the virus has a lower chance of an infected person developing severe symptoms.
 

cwbullet

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That is absolutely not true and she is a whack-a-doodle. The flu vaccine for this year has been confirmed to not contain Coronavirus. The CDC debunk this the day ti appears on the conspiracy websites. She is an employee that is an axe to grind with Dr. Fauci. Although, I am not a fan of Dr,. Fauci, she is coo-coo for Cocoa Puffs.
How many of those who retested positive developed symptoms? Did anyone require hospitalization within that group?

This suggests that the tests are unreliable and/or the virus has a lower chance of an infected person developing severe symptoms.
Only a dozen or so ever developed any symptoms and zero were admitted. The test results show why you should not test the asymptomatic.
 

afadeev

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Are there any other states that are pretending counting body locations is a privacy issue?
FL has been one. In addition to faux-privacy claims, they've been reclassifying FL deaths to other states (like NY/NJ) of the deceased had a legal residency elsewhere. Legally plausible, but medically and practically misleading.

You can still get a pretty accurate daily update on new infections and deaths, by state, from the following source. One disclaimer - their "day" definition seems to coincide with GMT:
 

ksaves2

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Only a dozen or so ever developed any symptoms and zero were admitted. The test results show why you should not test the asymptomatic.
Had a pre-op surgery test come back positive in an asymptomatic person. Was going to have out patient ESI (epidural steroid injections). False positive? Don't know. Procedure cancelled. If indeed one can carry and spread virus without symptoms that is a scary proposition. Person is in isolation at home and still asymptomatic. Kurt
 

cwbullet

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Had a pre-op surgery test come back positive in an asymptomatic person. Was going to have out patient ESI (epidural steroid injections). False positive? Don't know. Procedure cancelled. If indeed one can carry and spread virus without symptoms that is a scary proposition. Person is in isolation at home and still asymptomatic. Kurt
False positives are rare. Less than 1% if the labs is run correctly. In very rare labs does it go above 1%. False negatives are higher 20-40% - probably 30%.
 

Peartree

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False negatives are higher 20-40% - probably 30%.
Which begs the question about the study you mentioned earlier: In that study, when they tested everyone on intake, were they tested once or, I assume, more than once to overcome the possibility of false negatives?

Or, if any statisticians care to weigh in, with a 20-40% probability of a false negative, how many tests would be required to attain a six-sigma confidence level that the entire population was virus free?
 

cwbullet

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Which begs the question about the study you mentioned earlier: In that study, when they tested everyone on intake, were they tested once or, I assume, more than once to overcome the possibility of false negatives?

Or, if any statisticians care to weigh in, with a 20-40% probability of a false negative, how many tests would be required to attain a six-sigma confidence level that the entire population was virus free?
Great question - Not me.
 

afadeev

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Or, if any statisticians care to weigh in, with a 20-40% probability of a false negative, how many tests would be required to attain a six-sigma confidence level that the entire population was virus free?
Perhaps, the following will shed a little additional light on the testing subject.
I reputable local medical practice was offering PCR (acute infection) and Anti-Body IgG/IgM serology tests by Confirm BioSciences.
Explanation of IgG vs. IgM meaning can be found at the following links: https://www.confirmbiosciences.com/...s-testing-types-antibody-igg-igm-pcr-testing/

Since my family went through a bout of bad flue in mid-Feb (before we all started paying attention to this pandemic), I took the AB-test.
The stats below provide the relevant insight into the statistical validity of the results:
IMG_20200527_135815.jpg


The terminology is needlessly folksy.
The translation is as follows:
Sensitivity == true positive rate, or % probability to correctly identify those with the disease.
Specificity == true negative rate, or % probability to correctly identify those without the disease. A test with a higher specificity has a lower type I error rate.


So, for IgG, sensitivity/true positive of 97.2% means that 2.8% of the test results returned false positive.
Also for IgG, specificity/true negative of 100% means 0.0% of the test results returned false negative.

a

P.S.: It's late, so hope I got the explanation straight and sufficiently clear.
 

cwbullet

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Perhaps, the following will shed a little additional light on the testing subject.
I reputable local medical practice was offering PCR (acute infection) and Anti-Body IgG/IgM serology tests by Confirm BioSciences.
Explanation of IgG vs. IgM meaning can be found at the following links: https://www.confirmbiosciences.com/...s-testing-types-antibody-igg-igm-pcr-testing/

Since my family went through a bout of bad flue in mid-Feb (before we all started paying attention to this pandemic), I took the AB-test.
The stats below provide the relevant insight into the statistical validity of the results:
View attachment 419115

The terminology is needlessly folksy.
The translation is as follows:
Sensitivity == true positive rate, or % probability to correctly identify those with the disease.
Specificity == true negative rate, or % probability to correctly identify those without the disease. A test with a higher specificity has a lower type I error rate.


So, for IgG, sensitivity/true positive of 97.2% means that 2.8% of the test results returned false positive.
Also for IgG, specificity/true negative of 100% means 0.0% of the test results returned false negative.

a

P.S.: It's late, so hope I got the explanation straight and sufficiently clear.
Good explanation. What everyone needs to understand is that there are a lot of different AB tests out there and each one had a vide variability in the sensitivity and specificity.
 

cwbullet

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Update: Yesterday had the lightest weekday in 2 weeks. About 300 positive tests. They changed by their report time so that might be an enigma bases on less than 24 hours. Today at 3 will be the determinaction.
 

cwbullet

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Update: Back up to 500-600 per day.

I never would have thought it would be so difficult to get thing back from the hiatus. The complexity of protecting patients, risk adversity, employees that do not feel safe, and where to start reopening had added complexity that I did not plan for. I went to Publix yesterday and it more crowded than expected. Clearly, the public is not afraid.
 

NateB

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The complexity of protecting patients, risk adversity, employees that do not feel safe, and where to start reopening had added complexity that I did not plan for.
On this note, how do you feel about employees wearing N95s during every patient contact? Do you think they would be necessary when treating low risk patient complaint?
 

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If y
On this note, how do you feel about employees wearing N95s during every patient contact? Do you think they would be necessary when treating low risk patient complaint?
If you have enough, I would say it is a good idea.
 

Bill S

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It would be nice if employers could actually get N95s to issue to their employees. My wife is a retail pharmacist, and her company was clearly unprepared. They didn't issue masks and faceshields until early April, and they were the lousy KN-95 masks and cheezy plastic faceshields that had a great big sticker on them saying "this will not prevent you from being infected with an infectious disease.\

As her husband, I'd love to be able to have some N95s or even decent masks to wear so I don't get sick and infect her, removing another healthcare provider from circulation (she is higher risk due to taking immuno-suppressant drugs for psoritic arthritis). All I had was some N100 masks with exhalation valve, but due to various goofs, I didn't replace them after their expiration date and most of them were unusable due to the valve materials degrading. No way can I find and decent masks anywhere.
 

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Update:
Today, I get to focus on reopening our clinics and hospital to some routine care. It will be a slow ramp-up maintaining social distancing. I am thinking of template management to ensure time is an ally to maintain social distancing. I also have to figure out how to use the AB test. We might use it to screen our most exposed staff and move out from there.
 

cwbullet

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It would be nice if employers could actually get N95s to issue to their employees. My wife is a retail pharmacist, and her company was clearly unprepared. They didn't issue masks and faceshields until early April, and they were the lousy KN-95 masks and cheezy plastic faceshields that had a great big sticker on them saying "this will not prevent you from being infected with an infectious disease.\

As her husband, I'd love to be able to have some N95s or even decent masks to wear so I don't get sick and infect her, removing another healthcare provider from circulation (she is higher risk due to taking immuno-suppressant drugs for psoritic arthritis). All I had was some N100 masks with exhalation valve, but due to various goofs, I didn't replace them after their expiration date and most of them were unusable due to the valve materials degrading. No way can I find and decent masks anywhere.
In a pharmacy, I would suggest sneeze guards over N95s. We are setting up bank teller like barriers to avoid exposure. Our pharmacists all wear cloth masks and have a barrier.

Our pharmacies only do scrips by the drive-through from a tent currently. Zero face to face. When we finally reopen the pharmacy, we will have to figure a way to space refills. 1500-3000 patients a week and we cannot use our 100+ chair because it would a nightmare to prevent spread. We are being forced to think about buying a drive-through building for refills.
 

Bill S

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Cwbullet,
My wife does have a large plexiglass sneeze guard in place. But the moronic customers can't hear her through it, so they pull down their masks and lean their face under it to yell questions at her. She has had several tirades at them saying why would you want to infect me? I can't serve you if you get me sick and put me in the hospital, etc. Absolute idiots.
 

NateB

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It would be nice if employers could actually get N95s to issue to their employees.
We have enough disposable N-95s for "extended use" meaning we wear them for 12 hours of patient contact, until they are soiled, or until we can't breathe through them. Floor staff get one per 12 hour shift, but at least get a new one each day. They also have us some cotton masks that are more comfortable.

For us, the N-95s are very hot. When you add a long sleeve and long pant Nomex suit and a helmet to the mix it gets hard on our bodies. We have AC in the ship, but it just takes the edge off of the heat. One day this week it was 90 inside and outside and we had our hands full with our case. When you are already sweating through your clothes, any restriction to your breathing feels 10x worse.

I was given a p100 respirator today to try. The manufacturer was able to get us a case for our crews. Hopefully the exhalation valve makes breathing cooler. They aren't rates for medical use by any means, but I feel safe enough with it.

PSX_20200605_082913.jpg
 

cwbullet

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We have enough disposable N-95s for "extended use" meaning we wear them for 12 hours of patient contact, until they are soiled, or until we can't breathe through them. Floor staff get one per 12 hour shift, but at least get a new one each day. They also have us some cotton masks that are more comfortable.

For us, the N-95s are very hot. When you add a long sleeve and long pant Nomex suit and a helmet to the mix it gets hard on our bodies. We have AC in the ship, but it just takes the edge off of the heat. One day this week it was 90 inside and outside and we had our hands full with our case. When you are already sweating through your clothes, any restriction to your breathing feels 10x worse.

I was given a p100 respirator today to try. The manufacturer was able to get us a case for our crews. Hopefully the exhalation valve makes breathing cooler. They aren't rates for medical use by any means, but I feel safe enough with it.

View attachment 419403
For high rick clinical use the p-100 or PAPR is really the way to go. Guys are 3D printing PAPRs.
 

NateB

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For high rick clinical use the p-100 or PAPR is really the way to go. Guys are 3D printing PAPRs.
The truck crews are using PAPRs on medium and high risk patients. They like them better than wearing masks too. The hoods won't work with our helmets, so that option was out. We tried a device called Halo Clean Space. It is like a PAPR with a BiPAP mask and a self contained positive pressure blower that sits behind your neck. It works with the helmet, but we weren't able to communicate with each other.

Our pilots were able to get full face p100 masks that clip into the helmet with no vision restriction and a microphone that plugs into our ICS system. We couldn't get enough for the whole crew. The supply chain is still a big problem. Right now important equipment is either backordered or being confiscated by FEMA.
 

ksaves2

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How about a Corona virion riding on the back of a rocket in full plume? Kurt
 

BABAR

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Only a dozen or so ever developed any symptoms and zero were admitted. The test results show why you should not test the asymptomatic.
Babar’s first rule of medicine
“It is hard to make an asymptomatic patient better.”

Corollary to Babar’s first rule if medicine
“It is amazingly easy to make an asymptomatic patient worse.”
 
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BABAR

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How about a Corona virion riding on the back of a rocket in full plume? Kurt
We already have one flying on the nose

 
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