Totally recalled

"Spanfeller is a twat" (theaspiringengineer) 03/21/2020 at 13:44 • Filed to: None

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Indefinite turns to definite when it ends.

Two weeks ago, things in Spain looked under control, despite the growing number of cases in Castille and Madrid. However, suspension of businesses began nine or so days ago, which coincided with the end of our lease on the apartment .

We couldn’t go back to Galicia, my grandparents are twice over in risk groups, and the parts of my family that live in the country where I am now... again... started getting very nervous about us. So, around seven days ago we came back to Mexico City .

As we boarded the flight , Prime Minister Sanchez announced the temporary suspension of freedom of movement through the authorization granted by the Spanish Congress . Despite the efforts of the Spanish government, today they have the second-highest number of active cases in the world.

We’ve been practicing isolation, save for the exposures in the airports, for around eleven days now. Although none of us have symptoms, we will continue being alone, in our home for at least another seven days. Traveling during a pandemic is regrettably irresponsible but given the circumstances, it was the best thing we could do and we’re extremely conscious of the danger we pose to those unexposed right now.

Causally browsing oppo in the last few days has been heartwrenching. I truly feel for those who have seen their income and job stability challenged, and I hope that your families are safe and that none of you fall seriously ill, or ill at all, to COVID-19.

To many of us, the world might still look normal. But through patience and prevention, we might be able to come out of this pandemic with the fewest personal tragedies and national disgraces possible.

DipodomysDeserti > Spanfeller is a twat 03/21/2020 at 14:25

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My sister is a nurse and she just sent me the presentation she was given based on the data collected from a hospital in China. I’ll post it up here shortly. Nothing about the disease itself seems all that alarming. Of the people that presented symptoms bad enough to go to the hospital, 80% of them were mild and recovered fine. Biggest takeaway is that it doesn’t seem to cause symptoms in a whole bunch of people, so they spread it around without knowing. According to the hospital’s data it is much less infectious than something like measles .

Their biggest concerns now are people rushing hospitals because of all the fear mongering, thus overwhelming them (most are already over capacity). There’s a lot deadlier things that more people have (like heart disease) that still need to be treated.

As we actually start testing people, the rates of infection are going to skyrocket, and people are going to continue to freak out. My sister said they had a lot of flu cases over this season that tested negative for flu. She thinks this has been going around longer than people think.

I will say I’m enjoying the improved air quality. Keep your heads people, we’ve handled much worse than this with much less panic.

VincentMalamute-Kim > DipodomysDeserti 03/21/2020 at 15:15

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As you say, the majority of cases are going to be like the flu and recover fine. But i t is more infectious with higher mortality than the flu. It has more severe cases than we have ICU beds and ventilators for. Those are the cases who would have lived with ICU and vent care and are going to die. Hence ‘flattening the curve’.

re:” There’s a lot deadlier things that more people have (like heart disease)“

Mortality rate from this is about the same as the mortality rate from a heart attack.

You’re absolutely right, panic less. The panic is starting to get me down. I’m going to start decreasing my internet. So you’re on the unlucky end of my last pedanticism. But it needs to be taken seriously.

https://www.wired.com/story/coronavirus-interview-larry-brilliant-smallpox-epidemiologist/?utm_source=pocket-newtab

A nice link from an Oppo:

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

Stay safe especially your sister. Since you mention healthcare credentials, mine is an M.D. from the University of Illinois.

Spanfeller is a twat > DipodomysDeserti 03/21/2020 at 15:28

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I encourage that only the necessary precautions are taken. I’m sorry if my post sounds alarmist; I did not try to convey alarm, just what has happened to us in the last two weeks.

I’m glad you’re wanting to share the information with us.

DipodomysDeserti > VincentMalamute-Kim 03/21/2020 at 15:45

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Since I have you here, on the diagnosis presentation my sister received the R0 is listed as 2.2-2.95. That doesn’t seem like something overly concerning based on how many hospitalization lead to severe cases (19% on her slides). I know that’s more of a public health or epidemiology question, I’m guessing there must be a shit ton of infections that are asymptomatic, and that’s why there’s such a concern about it taking off like wildfire.

You’re the MD, but my sister (cardio nurse) was telling me that she would still be much more concerned about an MI patient, as they have something like a 14% mortality rate. 

DipodomysDeserti > Spanfeller is a twat 03/21/2020 at 15:47

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I didn’t think you were. Just trying to put things in perspective.

RallyDarkstrike - Fan of 2-cyl FIATs, Eastern Bloc & Kei cars > Spanfeller is a twat 03/21/2020 at 15:56

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Well said friend....things are relatively normal here in Canada in the sense that we only have 1000 or so cases country-wide, but the government is really cracking down on everything ‘early’ to prevent the ridiculous spread everybody is seeing in Italy, Spain and the US...hopefully things will start to calm down everywhere :(

Stay safe mate...

VincentMalamute-Kim > DipodomysDeserti 03/21/2020 at 16:08

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The over 80 COVID-19 crowd has about the exact same mortality rate as that MI. Based on current info. And worse if you’re in Italy because of the exact reason I give that this should be taken seriously - Italy’s ICU/vent capacity is overwhelmed. And yeah, that’s Italy for you we all think. Your sister should have first hand knowledge of this - US capacity isn’t much better. My hospital gets overwhelmed every winter from flu patients. This is why we have to do the drastic steps.

My car friend is an ENT surgeon. A few weeks ago, he bought an old US Army “ICU-in-a-suitcase” which includes a ventilator. He will maintain his wife (really bad lungs/heart ) on the vent in his bedroom if needed. He knows there’s a chance there won’t be a vent for her if it comes down to it. And keeps her away from hospital bugs (nosocomial infections ).

You’re absolutely right - w e don’t currently know the denominator (asymptomatic infected and the so mild I don’t think it’s worth mentioning infected) . There’s likely a lot of those. It’s going to be a while, maybe a year or more before we have accurate numbers and therefore real statistics like the rate of severe cases and deaths. We just don’t know right now.

Our numbers are bad since the US wasn’t prepared for testing. S. Korea probably has the most accurate numbers right now and they’ve got much lower mortality rates than China, Italy, probably exactly for the reason you give. If we ever know asymptomatic and minimally symptomatic numbers, I’m sure the severe case rate and mortality rates are going to be much lower than we currently know. But still worse than the flu.

Your message of don’t panic is very good. I got the sense, possibly wrong, that you were also throwing in “It’s not serious” with that.

oh, that R0 is very concerning. I’d have to look it up but the R0 for the flu is like half that, I think. Thank you very much for listening to this and responding politely.

VincentMalamute-Kim > Spanfeller is a twat 03/21/2020 at 16:10

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I found your post interesting. What’s happening in Mexico doesn’t make the front pages in the US. No news so then I think no COVID in Mexico. I am interested because I have a friend in Mexico DF.

VincentMalamute-Kim > DipodomysDeserti 03/21/2020 at 16:20

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That doesn’t seem like something overly concerning based on how many hospitalization lead to severe cases (19% on her slides)

oh, the following is if we don’t do anything or if it’s not drastic enough - it’s somewhere in the second link I gave earlier. Given that those R0's indicate it’s much more infectious than the flu, that 19% could be tens of millions (hundreds?) of patients. Most definitions of “severe” for COVID means ICU/vent care. Since we have like 100,000 vents (again, I think), those could be millions of deaths that could have been prevented.

Again, worst case if we don’t take any measures. And state governors have been stepping up.

Don’t panic but those numbers (R0 2.3-2.95, 19% severe cases ) actually do warrant severe measures. If you or I get it, we’re almost certainly going to be fine. Hopefully cold symptoms but possibly flu like symptoms. Unlikely but still higher mortality for us young’uns than the flu.

Nom De Plume > Spanfeller is a twat 03/21/2020 at 16:31

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We’ve been practicing isolation, save for the exposures in the airports, for around eleven days now. Although none of us have symptoms, we will continue being alone, in our home for at least another seven days.

That point in the conversation you realize standing applause.gif has too many people too close together to insert into a reply.

Very responsible of you young man.  

Spanfeller is a twat > VincentMalamute-Kim 03/21/2020 at 16:33

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The government is thus far trying to follow up personally on every case, we’ve done very few tests and numbers are very hard to come by.. Officially we have 203 cases and three deceased; both had underlying conditions per the government.

Half measures are set to begin this monday (reduced capacity in businesses, no schools, etc) but some states already started taking more serious steps. Jalisco’s governor literally asked people to stay in their homes for the following days. The government created a 7B dollar fund for economic recovery, and they claim they’re preparing a humanitarian deployment of the army (known as DN-III-E).

Many doctors are saying that everything has been postponed for a month; non essential surgeries and appointments.

The government expects 250,000 cases in the next twelve weeks; of which around 70k will require hospitalization, of which 5000 will require ICU treatment. Mexico’s public healthcare system has around 140,000 beds, but we only have six thousand respirators country-wide, so there is a very real possibility that we will be overwhelmed.

TheRealBicycleBuck > Spanfeller is a twat 03/21/2020 at 16:36

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Meanwhile, my neighbors are having a party.

DipodomysDeserti > VincentMalamute-Kim 03/21/2020 at 16:46

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No, definitely take it seriously, but put it in perspective. A problem we have is that the general public doesn’t take health seriously, so they don’t really know what that means.     I travelled a lot last fall, and saw people not washing their hands every time I used an airport restroom, the most obvious place to wash your hands. Even now, we have retail stores telling people no t to wear masks because of the optics.

High death rate rate among people over eighty. Something to be aware of, especially if you are elderly or have elderly family members or are a healthcare professional. My grandmother is over eighty and we are all staying away from her, staying contact and getting supplies fo r her.

However, the general public will look at that and apply it to everyone, freak out, and not taking into account that the life expectancy in the US is 78.69 years.

We should always be health conscious around our elderly and have special provisions set up for them. This is nothing new.

In other words don’t treat this like one of the seasonal flus ( that we know how to treat), but also don’t act like it is 1918 and this is the Spanish Flu (that killed healthy people in a much worse way).

This might finally force us to rethink our healthcare infrastructure which is an absolute joke. I have friends that quit being MDs in order to sell medical equipment, and have student’s whose parents are in healthcare corporate admin. Based on how much money these people make, there is no reason we should be in a constant state of overload. Of course they’ll just try to cut your and my sister’s pay in order to make due.

Full disclosure I have a health sciences degree but decided to go a different route. Now I’m in grad school studying environmental resource management kicking myself that I didn’t just go to med school (I had the grades) back when med school tuition cost less than what I’m paying now.

Godspeed.

VincentMalamute-Kim > Spanfeller is a twat 03/21/2020 at 17:25

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It sounds like most countries including the US then - insufficient testing and just now starting to take it seriously.

VincentMalamute-Kim > DipodomysDeserti 03/21/2020 at 17:29

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I would say you’re better off not having gone the med school route. For me the pay made it worth it for a while. Then it wasn’t. The field has changed.

I may be more susceptible to feeling that way since medicine was one way when I started whereas new docs won’t know any other way.  T herefore will be happy with it.

Thank you for being a reasonable and rational person.

VincentMalamute-Kim > RallyDarkstrike - Fan of 2-cyl FIATs, Eastern Bloc & Kei cars 03/21/2020 at 17:30

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You’re saying Canada is more rational than the US?  /s

DipodomysDeserti > VincentMalamute-Kim 03/21/2020 at 18:02

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Her slides differentiated between mild (81%) , severe (14%) and critical (5%) , with critical needing respirators. I was going to post it, but it has a MD’s personal email on a slide.

I don’t like to get into number and totals. They often times require pretty complicated algorithms, as you have to account for how many of those critical patients were sick enough that they were going to die anyways, among a host of other factors. I’ll leave that for the stat guys.

The biggest risk with this thing seems to be that so many people don’t have symptoms. You get the flu and you feel like shit and stay home. This thing you may feel fine and keep your regular routine.

Spanfeller is a twat > VincentMalamute-Kim 03/21/2020 at 18:28

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I don’t think we’re taking it seriously yet... The biggest issue by far is that the Mexican economy is a free for all, and there’s very little indication that the government will do anything remotely helpful, so people continue working just hoping they don’t catch it .

RallyDarkstrike - Fan of 2-cyl FIATs, Eastern Bloc & Kei cars > VincentMalamute-Kim 03/21/2020 at 18:35

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Well, more rational than your current incredibly sketchy government, at any rate! :(

VincentMalamute-Kim > DipodomysDeserti 03/21/2020 at 19:20

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It really doesn’t matter that much what her speci fic numbers say. All of t he numbers are early.

VincentMalamute-Kim > Spanfeller is a twat 03/21/2020 at 19:21

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I hope it all turns out OK and that we really have over-reacted.

DipodomysDeserti > VincentMalamute-Kim 03/21/2020 at 21:10

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Her presentation was from a Chinese doctor working at a hospital in Beijing, but I agree their just there to give an idea of what to expect if you handle things how they did. Ours will most assuredly be different.

Chan - Mid-engine with cabin fever > Spanfeller is a twat 03/21/2020 at 21:45

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Best wishes to you and your family. Stay safe and urge your elderly relatives not to take unnecessary risks, especially in Europe where cities are more densely populated.

Here in California we clearly saw what happened when New York waited too long to lock down the whole state. So we ended up “going home” in stages starting last Monday with the San Francisco Bay Area. The National Guard is prepping and Hummers have been seen on the streets, although officially not on duty yet.

We’re hoping that the community stays glued together, especially with the hate and division that has been on the rise these few years.

We’re all in uncharted territory...with the 24/7 online culture, people are really afraid of what will happen to thei r jobs when normal life is basically put on pause.

Chan - Mid-engine with cabin fever > DipodomysDeserti 03/21/2020 at 21:49

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The US healthcare system is not prepared for this because it is almost entirely for-profit. That means they will maximise profit at a scale of operations that barely covers normal life. There is very little preparation or capacity for a sudden epidemic.

I live in one of, if not the most affluent areas in the US, and our local hospitals are short on supplies and equipment. My friends who are doctors in the country’s best hospitals, are scared of running out of masks and gowns—the most basic items when dealing with contagious diseases.

Hospitals are PLEADING for donations.  In the Silicon Valley.

‘Murica, freedom, something like that.

DipodomysDeserti > Chan - Mid-engine with cabin fever 03/21/2020 at 22:09

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You have the freedom to make an insane amount of money and set yourself at the expense of your fellow man if it all goes tits up. Freedom isn’t free...

it costs a buck ‘0 five.

Spanfeller is a twat > TheRealBicycleBuck 03/22/2020 at 12:30

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That’s pretty irresponsible...

I wonder if they know.

TheRealBicycleBuck > Spanfeller is a twat 03/22/2020 at 12:32

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They just moved in a few months ago. Considering the other irresponsible things they’ve done, I wouldn’t be surprised if they knew and just didn’t care.

Rusty Vandura - www.tinyurl.com/keepoppo > DipodomysDeserti 03/22/2020 at 15:10

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FWIW, I think you struck just the right tone here. FWIW also, I appreciate the effort.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 15:14

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Is pendanticism a word? Pendantricy ?

I am metering my inter ne t as well. I pay attention when someone who goes symptomatic grants an interview at tells us what they’re experiencing. My wife, I am concerned about. Chest colds always settle and take days or weeks to clear out; she’s getting over one now.

The media always should be taken as 80% speculation to fill column inches.

We are taking precautions.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 15:17

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And thank you very much for your input here. Oppo is priceless. It’s the only social media I bother with.

What is MI?

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 15:19

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This is exactly what I have been saying. I will let someone write “I told you so” with a Sharpie across my chest if that turns out to be the case, but I’m not Sharpie shopping yet.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 15:34

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Sorry, I try to avoid medical jargon. It spills out sometimes. Myocardial Infarct. And med people tend to use the diagnosis to refer to patients. Like “the MI in room 201" instead of “Mr. Vandura in room 201".

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 15:36

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Good pedanti try there !

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 15:38

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My daughters always said I overthink things.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 15:39

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I’m already irritated at the possibility (small) that these drastic measures will prevent a disaster and then afterwards idiots will say “see, this wasn’t as bad as the flu! All this effort was for nothing!”

Stock up on Sharpies though.

VincentMalamute-Kim > RallyDarkstrike - Fan of 2-cyl FIATs, Eastern Bloc & Kei cars 03/22/2020 at 15:39

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You’re being awfully nice calling it “incredibly sketchy”.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 15:47

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So  many idiots. It’s sort of like, what do we want, lots of cadavers or four more years of a certain politician? We are out of sorts.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 15:49

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Here’s a question for you, if you don’t mind: what about home made masks? We have nurses in the immediate family and among our very closest friends who are encouraging us to make them. Essentially two layers of tightly woven cotton, pleated, and fitting like a typical paper surgical mask. Capability of inserting an extra layer in between for added filtration, such as vacuum cleaner filter or  cotton jersey material. What are your thoughts on any of that?

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 16:04

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We’re definitely getting out of my wheelhouse. My info is only from what I read. The virus is like .1 micron. N95 masks filter down to like .2-.3 micron. HEPA filters down to like .3 microns. Cotton and other fibers are worse obviously. But they’ll stop aerosols which are large.

And the fibers will take out some of the virus that impacts them. And will impede virus flow. All stuff that helps. If you’re a high risk individual or going into high risk places like your nurse who has nothing else available, definitely do it.

Everything in medicine is statistics. Reduce the risk, likelihood, etc. Which is why N95 masks work. So the homemade stuff will help too.

From what I read, what I’m currently doing is hand washing thoroughly after coming home and not touching my face (trying anyway). But I’m low risk - I live alone and the stereotypical introvert.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 16:21

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That’s great input. I like to take in information from a variety of sources, throw out the hysteria — or skip it in the first place — and let the information coalesce into a picture that makes sense.

You’re an MD? 

RallyDarkstrike - Fan of 2-cyl FIATs, Eastern Bloc & Kei cars > VincentMalamute-Kim 03/22/2020 at 16:36

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I agree, I was being lenient....but I don’t like upsetting people and there are, sadly, people out there that support Trump and his cronies, so I was trying to keep some restraint as to not upset the table.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 16:39

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My wife is 58 and prone to having chest colds that get in there and take a long time to get rid of. She doesn’t get them often, but when she does, it’s yucky. She’s getting over one now, as a matter of fact. Is that the sort of thing that ought to be especially concerning with regard to COVID?

VincentMalamute-Kim > RallyDarkstrike - Fan of 2-cyl FIATs, Eastern Bloc & Kei cars 03/22/2020 at 16:57

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I violently hate Trump but I’m not confrontational so I do that too.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 17:04

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Yes. I’m an MD. My specialty (I’m a radiologist) is on the frontlines of diagnosing COVID-19 in hospitalized patients with CT scans. (people not ill enough to be hospitalized are diagnosed by symptoms and testing (RT-PCR for COVID-19)). Were I still working.

The rad techs are the ones on the actual frontlines exposed to the patients while taking the CT scans. I would be safely locked away in my office in front of banks of monitors.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 17:09

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With that history, your wife “could” have some lung damage from childhood perhaps that makes her prone. I would treat her as belonging to a higher risk category.

A car buddy is an ENT surgeon. His wife is absolutely high risk. B ad heart and lungs (pulmonary hypertension ) . He just bought an Army surplus “ICU-in-a-suitcase” off of eBay . He will put her on the ventilator in his  bedroom if it comes down to it.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 17:58

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It is concerning to me. How much did he pay for that Ebay item?

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 17:59

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You are not working now? Retired?

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 19:09

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This is it: https://www.gearfuse.com/icu-in-a-suitcase-for-critical-conditions/

From 2008 with Dept of Defense financial support. Built to fit NATO stretchers. Company appears to have canned the unit. I don’t know why. $1000 for the unit, another few hundred for the power supply which was missing, and rig up his own power supply cable.

Also interesting is that the power supply connectors were 12 pin units with 4 wires for positive and 4 wires for negative and 1 white wire.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 19:11

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yeah, retired two years ago and moved to Colorado. I was telling DipodomysDeserti that medicine had changed since when I started.  No longer any fun.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 19:21

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Well, there aren’t any of those on Ebay now... I am concerned about my wife being at risk . Just an ordinary chest cold and it sounds like someone’s shoveled gravel into her chest. We’re taking all of the precautions...

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 19:39

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oh no, you need some degree of training to be able to ventilate a patient. Although ventilator support could be as simple as CPAP (lots of people have those machines for use at home when they sleep ) to as invasive as being intubated.

I couldn’t manage a ventilator. That’s what respiratory therapists do in the hospital under the direction of intensivists (docs who specialize in ICU care ). Some clinical specialties like my friend can do that.

If your wife needs something as simple as CPAP, she needs to be in the hospital. I only mentioned my friend because it was so extreme in the DIY stuff we do here that it became funny to me.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/22/2020 at 19:45

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I sleep with a CPAP. My concern is that she’ll need care that the hospital cannot provide. I guess if it comes to that, I’ll bring her home and strap the CPAP to her face.

I definitely got that we were talking about extreme DIY / Dr. MacGyver stuff there.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/22/2020 at 20:02

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Take reasonable precautions and most likely we’ll all be fine including your wife. No, it doesn’t hurt to think of worst case like my friend. Good luck.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/23/2020 at 13:40

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Wall of text but very nice review of what we know so far. From an Infectious Disease academic which should be more reliable than most other sources.  Your questions about masks are in the first paragraph .

Dr. Otto Yang, Infectious Disease, UCLA:



I’ve seen so much misinformation making the rounds, and increasing panic, so I thought I’d share my thoughts in follow-up to my earlier posts. The situation is continuing to evolve, but overall nothing has changed drastically from my prior posts.



Transmission and protecting yourself.



All RELIABLE data to date still indicate that the virus is carried in respiratory droplets from infected persons who cough/sneeze and NOT aerosol. What this means is that the virus doesn’t float through the air and you don’t get infected by breathing the same air as an infected person. To get infected, a person has to cough forcefully in your face so that droplets land directly on susceptible cells in your eyes, nose, or mouth. Alternatively, the droplets with virus land on a surface, you touch that surface, and you touch your face. This means that unless you are directly in close contact with an infected person, no mask is necessary (e.g. walking in public places where you are several feet away from others). If you’re in a crowded area face to face with others, a regular mask may be appropriate (with eyewear). The mask isn’t acting as a filter; it is acting as a shield against droplets. So that also means an N95 is not needed. It is no more useful as a shield than a regular mask. One thing that HAS changed since my last posts is that authorities are relaxing about healthcare professionals wearing N95 masks. The Canadian CDC, for example, is requiring only normal masks in hospitals (unless the patient is getting a high-risk procedure that generates a lot of aerosols) and normal isolation rooms without negative airflow. Our own CDC, as well as local public health authorities, are also considering downgrading their current isolation protocols. There are reassuring reports, such as two airplane passengers with COVID-19 on a 15-hour flight who did not transmit to anyone on the plane. Bottom line: You don’t need an N95, and you don’t even need a regular mask. You might consider a regular mask if you will be in very crowded areas especially around international travelers and if you are at higher risk for serious illness.



Who is at risk for serious illness?



The data are clear that age is a major factor. Mortality takes off rapidly starting around age 40-50. Still, as I discussed earlier, current mortality estimates appear to be quite high, and true mortality is probably much lower due to the underdiagnosis of mild cases. Best guess now is that overall 80% of people have mild illness not requiring hospitalization. About 5% will have a very severe illness. This is overall; again age is a huge factor. No children under 10 have died according to a large case series from China (with the caveat that their reports are not always reliable). What will the final overall mortality rate be? It seems highly likely that it will be south of 1% (versus the current media reports of >3%). Perhaps 0.5% or less? We’ll see. But it’s not like the 1918 Spanish flu that had a mortality that some estimated to be as high as 10%. Besides masks, handwashing and surface decontamination are absolutely essential. It’s not clear how long the virus lives on a surface, although people are citing very detailed exact numbers.... We don’t know, but it’s moot. Who cares? Treat every surface like it could have a virus. Again, bleach or Lysol-type wipes and sprays are extremely

effective. Hand sanitizer should have at least 60% alcohol; soap and water are better if you can wash your hands. If stores are sold out, buy rubbing alcohol and mix it with a moisturizer like aloe gel at a ratio of 1 part to 2 parts alcohol (66% alcohol). Should you stop going to public places and events? General rule: If you can control your distance from other people and decontaminate things you have to touch, it’s probably OK. Again, the virus doesn’t float in aerosol. So, if you go to a gym and can wipe stuff down and you can keep a distance from people, that’s probably fine. Going to a punk concert where people are slam dancing... not so much. And again, this has to be weighed with personal risk, including your age. Diabetes, chronic lung disease, and cardiovascular disease are also significant risks for severe disease. Weigh all this in your decision. Also remember, you need to protect those around you, and that is a matter of personal responsibility. You want to protect not only yourself, but everyone you know who may be exposed to you, and weigh that in your risks too.There has been a document “from Stanford” floating around. It demonstrates a dangerous trend, which is mixing true useful information that comes from reliable sources with total nonsense. Washing hands? Yes, absolutely. Gargling with saline? Not useful. Taking deep breaths to see if you have lung fibrosis? Nonsense, that is not even worthy of being on House MD. Drinking water every 15 minutes to wash the virus into your stomach where it is killed by acid? Makes absolutely no sense; once a virus hits a cell it will stick and enter quickly. This is only useful for causing you to pee every 15 minutes. Garlic? Nope. Essential oils? Nope. Bleach? Drinking bleach is a good way to die. Sesame oil? Smells nice but won’t help.



What’s on the horizon for treatment?



Right now, treatment is “supportive care,” which means providing oxygen and breathing artificially if you can’t breathe well enough until your body recovers naturally. The virus causes an inflammatory process in the lungs that impairs their ability to exchange oxygen. If the inflammation gets very bad, your body can develop shock, with low blood pressure and multiple organ failure, which is the common “sepsis” syndrome seen with any overwhelming infection. As for specific treatment, the most promising agent now is a drug that was being developed to treat SARS before it disappeared, called Remdesivir. It blocks an enzyme used by the virus to reproduce its genetic material. A few major medical centers are involved in clinical trials of this drug (I am the principal investigator who has enrolled UCLA in a trial), and the company with this drug (Gilead) has a program to issue the drug as a “compassionate use” agent, i.e. a doctor can request it for desperate cases, although my understanding is that Gilead is being overwhelmed with these requests and it may be hard to get. A big unknown that has not been discussed much in the press is seasonality. The other coronaviruses (including SARS) tend to be most active in fall-winter months and wane dramatically in spring-summer. SARS in fact totally disappeared, never to return (again all expectations and predictions). I doubt this virus will disappear, but we may see a dramatic decline when the weather warms; it’s too early to say if we’ll be this lucky. In the meantime, we all need to take personal responsibility to slow its spread. We won’t stop it, but we may reduce the number of cases and save many lives. Even if in the worst-case scenario we can’t reduce the number of cases, just slowing it down will be very helpful. The problem in Italy now, where there aren’t enough ventilators for patients and they are dying in the hallways, is that too many cases have presented all at once. If we slow it down so that the cases we get are spread out over time, that will prevent our health system from being overwhelmed in that way. It’s like releasing water from a dam; a controlled flow is manageable but a sudden onslaught is not.



Above all, be rational and don’t panic.



We’ll get through this. Hopefully, our CDC will step up and overcome its completely inadequate management of surveillance and testing thus far, and private companies will bring testing online to make up for this egregious shortcoming of CDC leadership.

VincentMalamute-Kim > Rusty Vandura - www.tinyurl.com/keepoppo 03/23/2020 at 14:19

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oh, I don’t know the date on that UCLA post, it’s at least as old as 3.17.20.

Rusty Vandura - www.tinyurl.com/keepoppo > VincentMalamute-Kim 03/23/2020 at 14:34

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Thank you for thinking  of me and sharing this.