Warning to All MLW Members - Fear and the Cronavirus

OftenWrong · March 11, 2020

Naming the virus has become a topic of contention in the media. Yes we know it as Coronavirus (all one word), and the much scarier sounding COVID-19 (all capital letters). But more socially relevant names are being floated on social networks:
- Chinese Virus
- Wuhan Virus
Both of which have drawn criticism by the left, ironically labelled as 'racism'. I guess some people are invested in the Chinese stocks, then.

Someone at work suggested "Stupid bat soup eating bastards virus". I thought it was a little rude, but a pretty good one.
You may have your own.

Dougie93 · March 11, 2020

6 minutes ago, OftenWrong said:

You may have your own.

Covfefe-19

SpankyMcFarland · March 11, 2020

Here’s an interesting article from the Lancet:

Quote

What do these comparisons with influenza A and SARS imply for the COVID-19 epidemic and its control? First, we think that the epidemic in any given country will initially spread more slowly than is typical for a new influenza A strain. COVID-19 had a doubling time in China of about 4–5 days in the early phases.Second, the COVID-19 epidemic could be more drawn out than seasonal influenza A, which has relevance for its potential economic impact. Third, the effect of seasons on transmission of COVID-19 is unknown; however, with an R0 of 2–3, the warm months of summer in the northern hemisphere might not necessarily reduce transmission below the value of unity as they do for influenza A, which typically has an R0 of around 1·1–1·5. Closely linked to these factors and their epidemiological determinants is the impact of different mitigation policies on the course of the COVID-19 epidemic...

...No vaccine or effective antiviral drug is likely to be available soon. Vaccine development is underway, but the key issues are not if a vaccine can be developed but where phase 3 trials will be done and who will manufacture vaccine at scale. The number of cases of COVID-19 are falling quickly in China, ⁴but a site for phase 3 vaccine trials needs to be in a location where there is ongoing transmission of the disease. Manufacturing at scale requires one or more of the big vaccine manufacturers to take up the challenge and work closely with the biotechnology companies who are developing vaccine candidates. This process will take time and we are probably a least 1 year to 18 months away from substantial vaccine production.

So what is left at present for mitigation is voluntary plus mandated quarantine, stopping mass gatherings, closure of educational institutes or places of work where infection has been identified, and isolation of households, towns, or cities. Some of the lessons from analyses of influenza A apply for COVID-19, but there are also differences. Social distancing measures reduce the value of the effective reproduction number R. With an early epidemic value of R₀ of 2·5, social distancing would have to reduce transmission by about 60% or less, if the intrinsic transmission potential declines in the warm summer months in the northern hemisphere. This reduction is a big ask, but it did happen in China.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/fulltext

OftenWrong · March 11, 2020

1 hour ago, Dougie93 said:

Covfefe-19

Right, Trump's secret code word. So this was all just another setup.

Dougie93 · March 11, 2020

2 hours ago, OftenWrong said:

Right, Trump's secret code word. So this was all just another setup.

Screen-Shot-2020-03-09-at-4.46.18-PM.png

Argus · March 11, 2020

Maybe we should be taking this a lot more seriously. Maybe we should listen to stories coming out of Italian hospitals overwhelmed with this virus, and their warning to other doctors that 10% of people who catch it will need intensive care.

"And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us. Cases are multiplying, they arrive at a rate of 15-20 admissions per day all for the same reason.

The results of the swabs now come one after the other: positive, positive, positive. Suddenly the ER is collapsing.

Reasons for entry are always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.

Some are already to be intubated and go to intensive care. For others it's too late... Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care beds that did not exist before.

"The staff are exhausted. I saw new levels of tiredness on faces despite the already exhausting workloads they had. I saw the solidarity among all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?"

Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can't save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny."

There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols.

https://www.thelocal.it/20200311/hospitals-are-overwhelmed-italian-doctors-describe-the-struggle-of-fighting-the-coronavirus-outbreak

Argus · March 11, 2020

The British Chancellor of the Exchequer has just announced an emergency $54 billion package to combat the virus and its impact on the economy.

Justin Trudeau just announced a $1 billion package for the same reason....

https://www.bbc.com/news/uk-politics-51835306

Edited March 11, 2020 by Argus

Goddess · March 11, 2020

This was shared today by my smart NP friend.

By way of a physician friend in the USA who shared and I also wanted to share.

By Dr Erica Kaye...

I am hearing frequent expressions of disbelief about the seriousness of COVID19 (novel coronavirus). On social media and in real life, it seems like lots of people think that the pandemic is a “hoax” or a “political game” or “media-driven fear mongering.”

I am a physician and not an epidemiologist, and these are my own opinions informed by close review of rapidly evolving primary data sources.

I am a pragmatist. I believe data. In general, panic is rarely necessary or productive. Preparedness, on the other hand, is essential. We don’t yet know what the impact of COVID19 will be on our population. As we gather more information over the coming weeks, it’s possible that we will discover that the situation in the U.S. is well controlled. We may find that our healthcare system is more than adequate to handle acute increases in patient volumes.

I understand why people are frustrated with media reports of the pandemic. Stockpiling supplies will probably not be helpful. Misinformed anxiety can be harmful to individuals and communities. But as we collect more information over the next few weeks, it is equally unsafe for people to casually discount the gravity of this situation. At this moment, we have increasing reports from other countries suggesting that COVID19 is causing harm beyond the average flu season; we don’t have data yet to reassure us that these trends will be different in the U.S. Clear-headed assessment of the available primary data consolidated by the WHO, in conjunction with first-hand stories from our colleagues on the ground, should be sufficient to incentivize our communities to be proactive instead of reactive.

I participate in multiple private online forums of physicians who are working to share real-time information about prevention and treatment of COVID19. Over the last 48 hours, we are seeing extremely worrisome first-hand reports from physician colleagues in Italy. They do not have sufficient ventilators for all of the patients who require mechanical respiratory support. They are facing excruciating decisions about which lives to attempt to save. Many critically ill patients are older than 60; however, there also are previously healthy 30 and 40 year olds on ventilators and dying. They are unable to staff hospitals due to substantial numbers of infected healthcare personnel.

The first cases of COVID19 were reported in Italy at the beginning of February, and the sentinel cases that are believed to have triggered widespread contagion occurred around February 21. This means that regions of the country went from a handful of cases to a volume that exceeded the capacity of their healthcare infrastructure in approximately 2.5 to 5 weeks. We need to be mindful of this information, and we need to do our best to learn from the experiences of our colleagues in other countries.

I’ve also seen many people commenting that the pandemic is a political weapon. I think it is important to acknowledge that politics are involved, particularly in the context of delayed testing and censorship of information for public consumption. Last week, a mandate was passed requiring that formal messaging from epidemiology and infectious disease experts at the CDC go through the White House before being released to the public. Leadership is calling the virus a “hoax,” and misinformation is circulating. In this time of public anxiety, it is essential that we strive to elevate and center the voices of scientists, researchers, epidemiologists, and healthcare providers, all of whom are advocating for our country to consider proactive approaches to mitigate the potential impact of the virus.

Unfortunately, at the moment, it is very difficult to assess the situation in the U.S. Genomic sequencing of viral strains in Washington state suggest that COVID19 is already endemic (i.e., spreading within communities). Yet we have very few official cases of novel coronavirus documented in the U.S. – simply because we are not conducting widespread or systematic testing for it.

Weeks ago, the U.S. declined to use the COVID19 testing kits that the WHO offered. These are the same kits that have been used successfully to test hundreds of thousands of people across Europe and Asia. Instead, the U.S. opted create its own kits and then disseminated kits with faulty controls. We have still not recovered from these oversights. It remains extremely difficult for healthcare providers to obtain COVID19 tests for patients in most regions of the U.S. One week ago, the CDC removed data on “total numbers tested” from its website, so we can no longer track how far behind U.S. testing is, compared to other countries. As recently as today, I continue to hear reports that local health departments do not have capacity to provide tests for patients with classic symptoms and high-risk travel histories. Despite promises that COVID19 testing would become readily accessible by yesterday, physicians across all of my networks continue to report inability to access tests.

Why does this matter? Because identification of cases of COVID19 is a strategy for slowing the spread. It is also important to better understand the denominator in the U.S., so that we can make better predictions regarding morbidity and mortality rates for our population. Currently, we are relying on rapidly accumulating data from multiple countries 4-8 weeks ahead of the U.S., which suggest that the morbidity and mortality of COVID19 exceeds that of the worst flu season. Data on COVID19 properties (e.g., incubation rate, unchecked R0, etc) suggest that it is on track to infect 40-70% of world’s population by December, and we don’t yet know how many will die as a result. Current estimates suggest that 1 out of every 50 people infected may die (although these numbers may change as denominators increase). In comparison, the seasonal flu infects a significantly lower percentage of the world’s population, and flu generally kills 1 out of every 2000 people it infects. These numbers will likely continue to evolve; at the moment, however, expert epidemiologists are projecting a “best case scenario” of ~5x worse than flu and a “worst case scenario” of 50x worse.

At this time, infectious disease experts believe that the U.S. has missed the opportunity for containment by multiple weeks. To be fair, it may have never been possible to contain, even with excellent surveillance strategies. But there is still an opportunity to “flatten the curve.” This means that, even if we cannot decrease the number of people who get infected, we can try to slow down the rate of spread of infection. This matters profoundly, because if large numbers of sick patients show up at our local healthcare systems at the same time, it will significantly strain the system in a way that can be difficult for healthcare providers to handle. And this can have a direct impact on patient outcomes: data from China suggest a 0.5% mortality in the setting of strict quarantine and adequate resources, and a 3-5% mortality in the context of depleted resources.

It also is not just about having enough ventilators to support patients with COVID19. It is about having enough resources and staff to take care of patients with heart attacks, strokes, acute appendicitis, and other urgent medical needs. If our local hospital systems become overwhelmed, then we are likely to see patients die from treatable pathophysiology, simply because the volume of patients exceeds the hospital’s capacity.

Conversely – if we decrease the rate of infection across the community, then we have an opportunity to lessen the burden on limited hospital resources and staff. The way to do this is through social distancing. This means that, as much as possible, everyone tries his or her best to avoid large public gatherings where a single infected individual could easily spread the virus to dozens of other people.

Social distancing requires an attitude of altruism. Sure, you might think: “approximately 80% of people who get this virus basically have a mild cold. Everyone is being ridiculous, and I’m not going to disrupt my life over this.” But we have increasing crowd-shared data from other countries that up to 20% of people who present for testing may require hospitalization, 5-10% may require ICU level support, and 2-4% of people may die. Some of these critically ill patients are young and previously healthy. Extrapolating from these data, my own risk of dying as a relatively healthy woman in my late 30s appears to be approximately 1/300 or 1/400, depending on the source (although possibly higher in the setting of direct patient care exposures). I don’t know about you, but I think these odds justify proactive efforts. Even if you are not elderly, you should take it seriously. And even if you mistrust the COVID19 mortality rate – if the volume of patients seeking medical care exceeds the capacity of healthcare system, then you and your family are at risk. If you have a loved one who might need medical attention for any reason in the next 8-12 weeks, you should care deeply about flattening the curve. Skip the big party. Avoid the shopping mall. Reschedule doctor visits unless you are ill and need medical attention. Limit travel unless it is essential.

I wrote this summary in an effort to help synthesize available data. My goal is not to scare people – statistically, most people who read this will be perfectly fine. I hope that we will see a slowing of cases in the coming weeks as the weather warms. Maybe the patterns that we are seeing in Europe and more recently out of Washington state will be outliers. But I also think that our country's response thus far has been largely reactive, as opposed to proactive. Everyone is awaiting centralized instructions with regulations for social distancing – and I anticipate that government-mandated closures of large gatherings will be forthcoming in the next few weeks. But I worry that these directives may arrive several weeks too late to meaningfully flatten the curve and lessen the impact on the healthcare system.

As people gather information over the next few weeks to ascertain how this pandemic unfolds in our communities, I think it is important for each of us to be proactive in as many ways as possible. I believe that we need to start prioritizing social distancing sooner rather than later. Whenever safe and possible, please consider avoiding large celebrations. Please consider postponing social, in-person gatherings or converting to online forums in the coming days and weeks.

Please help your first responders and healthcare workers, who will likely be on the front lines soon. Encourage your friends and family to practice social distancing and to strictly follow quarantines if/when enacted. Please help your community flatten the curve.

Iceni warrior · March 11, 2020

14 hours ago, Dougie93 said:

Covfefe-19

I see what you did there.

Dougie93 · March 11, 2020

9 minutes ago, Iceni warrior said:

I see what you did there.

taxme · March 11, 2020

19 hours ago, SpankyMcFarland said:

To Newfoundland and Labrador? Unlikely. We desperately need new people at the moment. At this rate, I could be the last man standing here.

We do not need millions more new immigrants brought into Canada. We need to encourage and give incentives to our own people to have more children. The tax dollars that our dear leader politicians blow by bringing in millions more new immigrants, legal and illegal so called refugees, and eventually allow those immigrants/refugees to be able to bring in their old parents is costing the Canadian taxpayer's hundreds of billions of their tax dollars every year trying to feed, clothe, and house pretty much all of them.

The people of Newfoundland and Labrador are very lucky that they are living on an island in the middle of the Atlantic Ocean otherwise they would probably have been swamped already by all those new immigrants coming to Canada. The people of Newfoundland have their own Newfie kind of culture that is very unique in Canada. Too flood it with dozens of new cultures would ruin that Newfie culture in time. It seems like I am the last man standing here when it comes to discussing immigration.

taxme · March 11, 2020

18 hours ago, OftenWrong said:

Maybe we should invest more in the men who are here. I mean those who are laying around, and those young men who are looking for a future.

Those men are not being allowed to become men anymore. Those men are now getting constantly bombarded by the promotion of the gay lifestyle, feminism, and some who like to call themselves a feminist. Thanks to liberalism and socialism they have both been a curse on men, and they have pretty much reduced men to want to act more like women and children just from my observations of what I have noticed these past few decades.

taxme · March 11, 2020

16 hours ago, SpankyMcFarland said:

Here’s an interesting article from the Lancet:

How did Italy end up with so many deaths from this virus, and nowhere else on earth, other than of course in China where it all started? I am starting to believe that there is more to this than what we are being led to believe and told. Being of a conspiratorial type of guy, who likes to question everything, I am starting to believe that there is something more to this picture that is being painted for us all.

Why have not all airplane flights all over the world be cancelled? After all, what a better way to spread this virus than by people flying on planes. It seems that everything from concerts, sports events, and other assorted gatherings of a different type are being pretty much all shut down because of this virus but yet planes are still allowed to fly? Why are planes still being allowed to fly but having a sports event played outside in the open are being cancelled? What think you, Spanky boy? Have an answer for this?

eyeball · March 12, 2020

On 3/10/2020 at 7:04 PM, OftenWrong said:

Naming the virus has become a topic of contention in the media. Yes we know it as Coronavirus (all one word), and the much scarier sounding COVID-19 (all capital letters). But more socially relevant names are being floated on social networks:
- Chinese Virus
- Wuhan Virus
Both of which have drawn criticism by the left, ironically labelled as 'racism'. I guess some people are invested in the Chinese stocks, then.

Someone at work suggested "Stupid bat soup eating bastards virus". I thought it was a little rude, but a pretty good one.
You may have your own.

If I heard anyone spewing this bullshit around my grandkids they'd have a nice big face full of me to deal with.

A disease that selects for right-wing conservatism is what the world really needs.

And just to be clear the right- wing isn't a race but it's definitely the bane of our species existence.

eyeball · March 12, 2020

12 hours ago, Argus said:

The British Chancellor of the Exchequer has just announced an emergency $54 billion package to combat the virus and its impact on the economy.

Justin Trudeau just announced a $1 billion package for the same reason....

https://www.bbc.com/news/uk-politics-51835306

This pandemic could trigger calls for the sort of socioeconomic action that will undoubtedly be described as socialist verging on communist. Never mind stimulus to ease the stock market's pain wait until ordinary people's mortgage payments and unpayed bills start piling up.

Michael Hardner · March 12, 2020

21 minutes ago, eyeball said:

...sekects for right-wing conservatism is what the world really needs.

And just to be clear the right- wing isn't a race but it's definitely the bane of our species existence.

You'll have to settle for one that targets their demographic only. Of course that includes you and me, but hey take the bad with the good...

OftenWrong · March 12, 2020

24 minutes ago, eyeball said:

If I heard anyone spewing this bullshit around my grandkids they'd have a nice big face full of me to deal with.

A disease that selects for right-wing conservatism is what the world really needs.

And just to be clear the right- wing isn't a race but it's definitely the bane of our species existence.

Sorry but your murderous vision for the future is not likely to happen. Diseases generally prefer the unclean and morally degenerate. IE. the left. Maybe if you people bathed a little more frequently we wouldn't have this problem, but nah. That too is not likely to happen. So it appears the virus will do a little cleanup of its own.

Its called theory of evolution, fella, strong will survive. And you'd better get used to it!

Edited March 12, 2020 by OftenWrong

BubberMiley · March 12, 2020

There's a lot to be said for veganism.

SpankyMcFarland · March 12, 2020

On 2/29/2020 at 5:32 PM, ProudConservative said:

Do you think the virus is manmade?

It is not man made. The reality of these Chinese food markets is scary enough.

SpankyMcFarland · March 12, 2020

16 hours ago, Argus said:

The British Chancellor of the Exchequer has just announced an emergency $54 billion package to combat the virus and its impact on the economy.

Justin Trudeau just announced a $1 billion package for the same reason....

https://www.bbc.com/news/uk-politics-51835306

The Brits have really done well in this crisis. BoJo will pick up an unfair proportion of the Brownie points for a well organized national effort but he does have the knack of speaking in a frank yet upbeat and not too partisan fashion that deserves credit - it’s the tone to strike, unlike Trump’s gloomy, xenophobic and hostile foolishness today. This is one time for big spending and I’m surprised JT isn’t going way bigger. I wish Jane Philpott could be brought back as some sort of COVID czar to run this show, despite the recent unpleasantness. She has all the skills for such a challenge. Tony Clement would be a good guy to tap too in some way, as poor old Freeland has enough things on her plate. Clamping down on community transmission in the first few weeks is vital to avoid a plague and that’s where policy is vital. If things go truly pear-shaped, how many ventilators do we have in our vaunted national stockpile and what is their condition? I’m not sure I’d like to be put on one. Scheduled surgery will have to be cancelled, plus cancer surgery which will be more controversial. A lot of patients will have to be sent back to their nuclear or sub-nuclear families, ready or not. We could end up in an African Ebola situation where ‘self-care at home’ is the default model for COVID pneumonia and neighbours just leave food outside the sick person’s hut until it stops being eaten. I have great neighbours so that’s some comfort - if you’ve been to Newfoundland you know what I mean, best people in the world. However, Canada’s geezers could really get culled here. My concern for them has skyrocketed since entering that demographic.

When the dust settles, the global community is going to have to initiate a wee chat with the lads in China about these pandemics and the cost involved. It’s getting to be a habit.

Edited March 12, 2020 by SpankyMcFarland

SpankyMcFarland · March 12, 2020

On a global scale, we have to think more thoroughly about how such viral pandemics start, testing for them, stopping spread, nursing care, ventilators, vaccines and antiviral therapy etc. The response so far this time has been at best disjointed. The world can do better than this.

Edited March 12, 2020 by SpankyMcFarland

eyeball · March 12, 2020

5 hours ago, OftenWrong said:

Sorry but your murderous vision for the future is not likely to happen.

No but I suspect your racist horseshit will continue to flourish, spread, mutate, metastasize...it is what it is, incurable.

eyeball · March 12, 2020

1 hour ago, SpankyMcFarland said:

On a global scale, we have to think more thoroughly about how such viral pandemics start, testing for them, stopping spread, nursing care, ventilators, vaccines and antiviral therapy etc. The response so far this time has been at best disjointed. The world can do better than this.

How when the world is on a such a tight thin economic shoestring? Everything is ordered, manufactured, shipped and sold according to the dictate of some just-in-time strategy that's designed to maximize profit. Having a bunch of stock just sitting there not moving, selling or collecting interest just isn't with the program.

BubberMiley · March 12, 2020

8 hours ago, OftenWrong said:

Its called theory of evolution, fella, strong will survive. And you'd better get used to it!

Don't start panicking and attacking your neighbours. Just wash your hands and it will all be okay.

OftenWrong · March 12, 2020

2 hours ago, eyeball said:

No but I suspect your racist horseshit will continue to flourish, spread, mutate, metastasize...it is what it is, incurable.

It's ok for you to hate right wingers though- because they're not a race, that makes it ok.