COVID-19 Outbreak (Update: More than 2.9M cases and 132,313 deaths in US) (25 Viewers)

[nolastyle]

My sister-in-law is a nurse practitioner specializing in dialysis, but she isn't on the clinical side anymore, she works with a renal medicine NGO in Washington (DC).

In their weekly conference calls, their medical executives talk regularly about how Covid-19 likely damages organs outside of the primary respiratory system disease . . . and that there's still so much unknown about the pathology of this infection. All the more reason to avoid getting infected by it.

Same idea:

https://www.washingtonpost.com/health/2020/05/10/coronavirus-attacks-body-symptoms/?arc404=true

Look to the past to define the future. Very, very similar to the SARS virus of 2004, also a strain of coronavirus. A predominantly respiratory disease that viciously attacks other body systems as it worsens, causing a cascade of organ failure and, eventually, death. From way back:

Severe acute respiratory syndrome (SARS) is an acute infectious disease that spreads mainly via the respiratory route. A distinct coronavirus (SARS‐CoV) has been identified as the aetiological agent of SARS. Recently, a metallopeptidase named angiotensin‐converting enzyme 2 (ACE2) has been identified as the functional receptor for SARS‐CoV. Although ACE2 mRNA is known to be present in virtually all organs, its protein expression is largely unknown. Since identifying the possible route of infection has major implications for understanding the pathogenesis and future treatment strategies for SARS, the present study investigated the localization of ACE2 protein in various human organs (oral and nasal mucosa, nasopharynx, lung, stomach, small intestine, colon, skin, lymph nodes, thymus, bone marrow, spleen, liver, kidney, and brain). The most remarkable finding was the surface expression of ACE2 protein on lung alveolar epithelial cells and enterocytes of the small intestine. Furthermore, ACE2 was present in arterial and venous endothelial cells and arterial smooth muscle cells in all organs studied. In conclusion, ACE2 is abundantly present in humans in the epithelia of the lung and small intestine, which might provide possible routes of entry for the SARS‐CoV. This epithelial expression, together with the presence of ACE2 in vascular endothelium, also provides a first step in understanding the pathogenesis of the main SARS disease manifestations.

Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis

Severe acute respiratory syndrome (SARS) is an acute infectious disease that spreads mainly via the respiratory route. A distinct coronavirus (SARS‐CoV) has been identified as the aetiological agent of SARS. Recently, a metallopeptidase named ...

www.ncbi.nlm.nih.gov

 

[faceman]

Wow, I just made up my own conspiracy theory! And it's only slightly more idiotic than some of the demented ones I have heard about.
Feel free to add your own ridiculous conspiracy theory here: ______________________

This one is making the rounds on social media- "If you got the flu shot in the last ten years, you will test positive for Covid 19

 

[superchuck500]

Look to the past to define the future. Very, very similar to the SARS virus of 2004, also a strain of coronavirus. A predominantly respiratory disease that viciously attacks other body systems as it worsens, causing a cascade of organ failure and, eventually, death. From way back:

Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis

Severe acute respiratory syndrome (SARS) is an acute infectious disease that spreads mainly via the respiratory route. A distinct coronavirus (SARS‐CoV) has been identified as the aetiological agent of SARS. Recently, a metallopeptidase named ...

www.ncbi.nlm.nih.gov

A "first step" indeed, but as the experts quoted in the Wash Post article note, SARS (and MERS) infected a tiny fraction of what SARS2 has infected - and both SARS and MERS infections brought fatal respiratory manifestations in a much higher percentage of those infected . . . so we never really had the opportunity to study broader impact on the body and its systems.

 

[travelingsaintsfan]

Here's Alabama's new case chart (you have to toggle it to the right twice). With 7-day average being the most often cited metric, Alabama's trajectory is still very upward. It would be truly puzzling if that trajectory wasn't significantly steeper in three weeks.

ArcGIS Dashboards

ArcGIS Dashboards

alpublichealth.maps.arcgis.com

The problem is everywhere cannot be ruled the same. Here in Baldwin County there has only been 5 deaths out of 222 cases. Plus the increase of cases has to do with the increasing of testing. There are new testing locations coming out all the time.

 

[Optimus Prime]

Just as a reminder...in Battlestar Galactica, the top 14 died on Caprica, resulting in the Secretary of Education becoming President. The result wasn't so bad.

Something tells me Betsy DeVos is no Laura Roslin

 

[Saint_Ward]

@Saint_Ward Do you know how they figure out the "Target Range" for percent positive for laboratory testing on the Florida Dashboard website?

No. I think they just want less than 10% of people coming for testing to be positive. At least, that's what made sense to me when they were only testing symptomatic people.

If suddenly you see a spike in positive results as a percentage of the total with respiratory issues, then you have an issue.

 

[sammymvpknight]

No. I think they just want less than 10% of people coming for testing to be positive. At least, that's what made sense to me when they were only testing symptomatic people.

If suddenly you see a spike in positive results as a percentage of the total with respiratory issues, then you have an issue.

It's a confusing benchmark. I guess that they want to have 90% negatives to ensure that you getting a significant majority of positives. But at least in my region, we use to ONLY test patients with symptoms, and more recently have branched out to testing patients with exposure. So naturally, the percent positive rate will be lower. I'm just not sure that its incredibly valuable information, because that information can be deduced from the other stats. What I feel would be much more valuable is to have a goal for ED visitations. There should be a way to calculate the number of ED beds, providers, etc...and use that as a MAX capacity...then you can get the number of COVID related ED visits and be able to see "percentage of COVID cases per average capacity". It wouldn't be a perfect stat (because people do go to the ED for reasons other than COVID...the majority actually do)...but it would probably the most use single data point on the website.

 

[travelingsaintsfan]

Wasn't one of the main reasons for shutting everything down was to not overload the hospitals? In locations that this is not an issue they are opening back up. If you are afraid you may get sick stay inside. If you are not get out and about, but be responsible. Businesses need to also be responsible for themselves and their customers. Everyone needs to make their own decisions and not be controlled by a blanket decision. Depending on where we go we may or may not wear our masks. We will still use hand sanitizer and wash our hands.

 

[superchuck500]

 

[bonnjer]

Mythbusters did an episode on this one time.

 

[Arathrael]

Some updates from the UK. The Office of National Statistics released a bulletin yesterday on their Infection Survey Pilot. This is a study intending to provide estimates of how many people have COVID-19 at a given point in time.

The early estimate is that 0.24% of England are positive for COVID-19, with around 136,000 currently infected.

Caveats are that's an early estimate, the data involved in this sample came from self-administered throat and nose swabs with an unknown false-positive/negative rate, and there's no profiling there (i.e. we don't know what proportion of that estimated 136,000 have recently been infected, and what proportion might have had it and recovered but still be testing positive). There are also blood samples being taken to determine what proportion of the population has antibodies to COVID-19, but they haven't published results from that. The first regular release of results is due on the 14th, so it'll be interesting to see that.

Also, today, our government has published their plan (pdf) outlining their recovery strategy. It mentions in there that the number of patients in hospital in the UK is 'under 13,500 as of 4 May', and that '27% of NHS critical care beds in the UK were occupied by a COVID-19 patient on 4 May - compared to 51% on 10 April'. (Note those figures are for the UK, not just England, although ~85% of the population of the UK is in England).

At a crude measure, that would indicate around 8.5% of those currently infected being hospitalised.

There's also a report on the first reported 8250 patients critically ill with COVID-19 (pdf) published by ICNARC (intensive care national audit & research centre) on 8th May. You can also get a table of the underlying data, linked from here: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports

That goes into a lot of detail about the demographics of those being admitted (sex, age, ethnicity, medical history), and outcomes. If I get a chance I might come back to that in a bit, but if someone else wants to take a look, please do, there's some interesting data in there that's worth highlighting (71.3% male, 91.7% of those admitted previously able to live without assistance in daily activities...).

But in terms of how many people are currently in critical care, it indicates that around 2,107 were last reported as still receiving critical care, which, in line with the figures above, would indicate a crude rate of roughly ~15% of those hospitalised, or ~1.3% of those currently infected.

Those estimates are broadly in line with those earlier in the thread, so on the face of it, that would appear to indicate that there is not a huge quantity (millions) of people who've silently had it without knowing as some have suggested and we would have a very long road ahead of us in terms of building up natural immunity in the population (assuming that's viable otherwise). But again, it's an early release of data, so I'll keep an eye on it as they publish more.

The UK government plan isn't great by the way, and has led to a lot of confusion. They've switched from a 'stay home' message to a 'stay alert' message, although the devolved nations (Wales, Scotland, Northern Ireland) aren't following that. On the one hand, they seem to be saying it's very serious and we can't significantly lift restrictions yet, and at the same time, they seem to think that lifting some restrictions (allowing people to meet individual people from other households outside, exercise outside as much as you like, encouraging some more businesses to resume activity) will somehow lower the rate of infection and allow some primary school years to resume in three weeks. Mmm.

 

[Saint_Ward]

It's a confusing benchmark. I guess that they want to have 90% negatives to ensure that you getting a significant majority of positives. But at least in my region, we use to ONLY test patients with symptoms, and more recently have branched out to testing patients with exposure. So naturally, the percent positive rate will be lower. I'm just not sure that its incredibly valuable information, because that information can be deduced from the other stats. What I feel would be much more valuable is to have a goal for ED visitations. There should be a way to calculate the number of ED beds, providers, etc...and use that as a MAX capacity...then you can get the number of COVID related ED visits and be able to see "percentage of COVID cases per average capacity". It wouldn't be a perfect stat (because people do go to the ED for reasons other than COVID...the majority actually do)...but it would probably the most use single data point on the website.

Florida is charting all of that. I think other than new cases, the CDC / Admin posting other requirements they could meet. I know the Governor and our health department head were both talking about it. I just opted to unplug a bit this weekend.

 

[bonnjer]

My sister-in-law is a nurse practitioner specializing in dialysis, but she isn't on the clinical side anymore, she works with a renal medicine NGO in Washington (DC).

In their weekly conference calls, their medical executives talk regularly about how Covid-19 likely damages organs outside of the primary respiratory system disease . . . and that there's still so much unknown about the pathology of this infection. All the more reason to avoid getting infected by it.

Same idea:

https://www.washingtonpost.com/health/2020/05/10/coronavirus-attacks-body-symptoms/?arc404=true

I know I'm not the only one who finds all of this fascinating. To think that there are all these other coronaviruses out there and they don't really do much to us, but this one.....it just keeps on coming up with more and more ways that it damages us. To paraphrase a famous line, "Of all the coronaviruses in all the organisms in all the world, this one makes the jump to us."

 

[Saint_Ward]

@sammymvpknight take a look.



This goes to their Taskforce report. Probably worth a good read.

https://www.flgov.com/wp-content/uploads/covid19/Taskforce%20Report.pdf

 

[St. Widge]

Out of curiosity, why would you think being outside would have you safe?

I don't want to speak for L.C., but we know that UV rays kills the virus so the idea was that if you are outside in sunshine the sun's UV rays would kill the virus before it can infect someone else.