COVID-19 Tracking

86salmon

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A majority of patients with covid are NOT intubated because of a little cough. In fact, most covid positive patients are sent home if at all possible and told to quarantine there. Patients that are intubated are spiraling into respiratory failure. In noncovid patients there are cases where non invasive measures may be used to avoid it. A bridge such has a high flow cannula or BiPAP/CPAP are normally used for this purpose. These bridges are not contraindicated in covid patients because of a cough. It's because those modalities are aerosol generating. Nebulized treatments are also contraindicated in favor of inhalers for this same reason. The helmet CPAP seen in pictures from Italian ICU also mitigate the leakage of aerosol but are not FDA approved, so they are not in use in the US.

I'm not going to go into the strategies for mechanical ventilation of a covid patient here, but they require aggressive settings and vigilant monitoring due to the dangerously high pressures exerted on the lungs.

@Gruber The high acuity and speed in which covid patients can reach a very sick state is what makes covid so dangerous
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MaxPower

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Here's the thing. Yes, this is a virus. The flu is a virus so there are similarities. Where things differ is that COVID-19 has an expotentially higher death rate. That certainly is frightening and a real not "manufactured" health crisis.

Check this link:
https://www.businessinsider.com/coronavirus-compared-seasonal-flu-in-the-us-death-rates-2020-3
The mortality rate is a bit of a moving target, because we have no idea how many people have been infected - particularly here in the US. We know the number of confirmed cases, but given the lack of testing, it's likely thousands more are carrying the virus. Even in New York - the hardest-hit state - residents can't get tested without an order from a physician. And even then, they only have the capacity to test a subset of those individuals, prioritizing symptomatic individuals in high-risk groups (and those who have been in direct contact with confirmed cases).

So, no one knows the true mortality rate. However, even factoring in the likely high numbers of undiagnosed mild & asymptomatic infections, it's apparent that the COVID-19 mortality rate is going to be a lot higher than that of the flu - on the order of ten times more deadly.

It's also apparent that the coronavirus spreads more readily than influenza. R0 of COVID-19 (a measure of the average number of cases generated by a single infected individual) is about double that of the flu (ranges of 2 to 2.5 and 1 to 1.3, respectively). Complicating matters is the fact that so many cases are mild, or even asymptomatic. If these people aren't strictly observing shelter-in-place rules, then they're walking around and shedding viruses all over the place. It's strange to think about it this way, but if the coronavirus caused more uniformly severe symptoms in all (or most) patients, it wouldn't be spreading as quickly. When you're hit with the flu, you typically feel like crap and don't want to go anywhere. You automatically self-isolate.

The mortality figures are of course terrible, but an equally serious concern is the hospitalization rate. Last year, some 35 million Americans were infected with the flu. About 500,000 of those were hospitalized, which works out to ~1.4%. COVID-19 hospitalizations are running around 10% - 20%. China's number was right around 20%; of those, 13.8% were considered serious (patients required oxygen administration) and 6.1% were considered critical (requiring mechanical assistance for breathing). In NYC, there already aren't enough beds for the serious patients, and not enough ventilators for the critical ones. There's a domino effect; this also means no beds for any typical non-corona emergency cases. Resources stretched thin. Burnt-out and/or sick caregivers. It's a mess.

Like I said earlier, it's going to get a lot worse before it gets better.

Sorry for the wall of text, but it makes me absolutely f*@#ing mental when I see people downplaying the severity of the pandemic, or ignoring shelter-in-place rules. Parents throwing birthday parties for their kids. Megachurches in Florida holding regular Sunday services with hundreds of congregants. Actually, the entire state of Florida. I don't know what's going to convince these people to stay at home, other than suffering a personal loss associated with COVID-19. I don't wish that on anyone...but maybe that's what it's going to take. The good news (such as it is) is that social distancing does seem to be an effective means to contain the spread of COVID-19. The tricky part is getting everyone on board.
 

Rickmeister 48

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The mortality rate is a bit of a moving target, because we have no idea how many people have been infected - particularly here in the US. We know the number of confirmed cases, but given the lack of testing, it's likely thousands more are carrying the virus. Even in New York - the hardest-hit state - residents can't get tested without an order from a physician. And even then, they only have the capacity to test a subset of those individuals, prioritizing symptomatic individuals in high-risk groups (and those who have been in direct contact with confirmed cases).

So, no one knows the true mortality rate. However, even factoring in the likely high numbers of undiagnosed mild & asymptomatic infections, it's apparent that the COVID-19 mortality rate is going to be a lot higher than that of the flu - on the order of ten times more deadly.

It's also apparent that the coronavirus spreads more readily than influenza. R0 of COVID-19 (a measure of the average number of cases generated by a single infected individual) is about double that of the flu (ranges of 2 to 2.5 and 1 to 1.3, respectively). Complicating matters is the fact that so many cases are mild, or even asymptomatic. If these people aren't strictly observing shelter-in-place rules, then they're walking around and shedding viruses all over the place. It's strange to think about it this way, but if the coronavirus caused more uniformly severe symptoms in all (or most) patients, it wouldn't be spreading as quickly. When you're hit with the flu, you typically feel like crap and don't want to go anywhere. You automatically self-isolate.

The mortality figures are of course terrible, but an equally serious concern is the hospitalization rate. Last year, some 35 million Americans were infected with the flu. About 500,000 of those were hospitalized, which works out to ~1.4%. COVID-19 hospitalizations are running around 10% - 20%. China's number was right around 20%; of those, 13.8% were considered serious (patients required oxygen administration) and 6.1% were considered critical (requiring mechanical assistance for breathing). In NYC, there already aren't enough beds for the serious patients, and not enough ventilators for the critical ones. There's a domino effect; this also means no beds for any typical non-corona emergency cases. Resources stretched thin. Burnt-out and/or sick caregivers. It's a mess.

Like I said earlier, it's going to get a lot worse before it gets better.

Sorry for the wall of text, but it makes me absolutely f*@#ing mental when I see people downplaying the severity of the pandemic, or ignoring shelter-in-place rules. Parents throwing birthday parties for their kids. Megachurches in Florida holding regular Sunday services with hundreds of congregants. Actually, the entire state of Florida. I don't know what's going to convince these people to stay at home, other than suffering a personal loss associated with COVID-19. I don't wish that on anyone...but maybe that's what it's going to take. The good news (such as it is) is that social distancing does seem to be an effective means to contain the spread of COVID-19. The tricky part is getting everyone on board.
I totally agree with you about these people not taking this seriously.
I'm gonna say this bluntly, and I'm sad that it's the truth, but this situation is proving just how many people are stupid and don't really care about anyone but themselves.
 

charleswrivers

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Well... looking at the numbers... we typically have 7500 death/day in the US. Looks like we're around 700 deaths from COVID-19 for the day... so we're on your way to having raised our national death rate by about 10%... if you assume that the people dying from COVID-19 weren't planning on dying today.

Over 10% surges in new cases and nearly 20% in deaths compared to the previous day... we're getting beat up and it's really just starting to pick up. I fear it's going to be a tough stretch of weeks ahead because there's probably untold 100,000s/millions that are carriers w/o any symptoms yet... may may never have any. Just hope they're staying at home.
 


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Heeeeyyyyyyyyy!!

Oh who am I kidding. I’m screwed. Im diabetic, too.
Help me understand. From a Floridian's/resident's perspective: what the hell is DeSantis doing? My understanding is that there's still no state-wide stay-at-home order in place. Is he unaware of the high concentration of at-risk elderly residents? Does he not believe in the severity of the virus? I don't get it.
 
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stevessvt

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Help me understand. From a Floridian's resident's perspective: what the hell is DeSantis doing? My understanding is that there's still no state-wide stay-at-home order in place. Is he unaware of the high concentration of at-risk elderly residents? Does he not believe in the severity of the virus? I don't get it.
Nope. No mandatory stay at home. He’s leaving it to the individual counties. Here in Palm Beach county it’s not mandatory. But down south it is. Only time I go out though is to food shop. Still gotta eat. TBH I’m not sure what he’s thinking either.
 

86salmon

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South Carolina only just enacted a stay at home order. The cities of Charleston and Columbia already had their own orders in place, yet the governor and state attorney general tried to rescind them because he felt they were circumventing his authority... :banghead:
 

86salmon

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Nope. No mandatory stay at home. He’s leaving it to the individual counties. Here in Palm Beach county it’s not mandatory. But down south it is. Only time I go out though is to food shop. Still gotta eat. TBH I’m not sure what he’s thinking either.
He's following Trump's playbook on this
 

Gruber

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Also, coronavirus is brand new to humanity. We have no immunity to it. The flu in it’s many different forms, has been around forever. We have some degree of immunity to it, and we have vaccinations for it.
That's the same fallacy that has been repeated in the media even by people who should know better because they are in the health care business, and should understand what "immunity" means. Still, some "experts" kept repeating this cliché (now less frequently, as they apparently started to see the obvious nonsense of such statements when most people don't even get sick, or barely have a cold). If "we" had no immunity, 100% of infected people would die. A virus of this sort, if unopposed by the immune system, would replicate, take over, and kill everyone. The reason why most respiratory illnesses in most people eventually just go away is nothing else but the work of the immune system. We obviously have immunity even to new pathogens, and this one is not even entirely new.
 


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He's following Trump's playbook on this
Sad to see. At the current rate, several states without mandatory statewide shelter-in-place declaration will replace the current top five soon (except NY). No, leaving the decision up to each county doesn’t work.

Honda Civic 10th gen COVID-19 Tracking AE1620A1-B1A5-40C4-9954-3F602702860D
 

Gruber

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The high acuity and speed in which covid patients can reach a very sick state is what makes covid so dangerous
This is very true, and is one of the reasons why they don't wait too long with the decision. The condition can turn very grave in half an hour. But this doesn't mean that if only all seriously ill could be put on ventilator on time, they would be saved.
 

86salmon

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This is very true, and is one of the reasons why they don't wait too long with the decision. The condition can turn very grave in half an hour. But this doesn't mean that if only all seriously ill could be put on ventilator on time, they would be saved.

What's the alternative? ARDS already has a 25% mortality rate using ARDSnet protocols. Covid induced respiratory failure rates are yet to be determined and we are still tweaking our treatment strategies. That doesn't mean we shouldn't try and to help every patient that needs it. People do get extubated. Those that recover tend to spend 11-21 days on the vent though, so we need all the vents we can get and as many healthy doctor's and respiratory therapists we can get to manage them
 

86salmon

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Sad to see. At the current rate, several states without mandatory statewide shelter-in-place declaration will replace the current top five soon (except NY). No, leaving the decision up to each county doesn’t work.
Leaving it to each individual state doesn't seem to be working that well either. The alternative, federal mandate, is scarier considering the decisions made so far
 

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Well, the fact is that according to WHO, "lower respiratory infections" are the third or fourth cause of death in the world, causing around 3 million deaths every year. In low-income countries they are the No 1. cause of death. So, since the beginning of the century, some 50+ million people died of "lower respiratory infections" without big headlines, and all the famous and celebrated pandemics like SARS-COV, MERS-COV, swine flu, ebola, etc. combined were only a tiny fraction of this number.
https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
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