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Author Topic: COVID-19 | science, damage limitation, NO POLITICS  (Read 86402 times)

Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #200 on: March 30, 2020, 11:48:09 am »

Alan, I can only speak for what I'm told in the Dutch context. Urgent care is being given to other patients. Yesterday e.g. a heart transplant was performed in a Dutch Hospital, and other ICU care was administered to those who need it.

Planned operations may be postponed for a week or so until it becomes clearer that the ICU capacity will be available (the Covid-19 reproduction rate in the Netherlands seems to have dropped to 1.0 or less), but the Covid-19 patients take up beds that would otherwise have been empty, or they take up the additional beds that were, and still are being created specifically for them (we expect another peak in 1 week time). We also move patients around in the country to make space for the locally anticipated needs, and we even exchange space with our neighboring countries (especially Germany has a large spare ICU capacity).
But elective surgery is down.  I spoke to my nephew who's a researcher and surgical anesthesiologist in Boston's Massachusetts General Hospital.  Operations are down two-thirds.  Research has stopped completely. He's home right now with his wife who's a radiologist there.  So a lot less regular medical things are happening.  Obviously things can;t stay at the same level with all the extra requirements caused by Covid-19.

John Camp

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #201 on: March 30, 2020, 11:53:01 am »

Interesting, although alarming, new insights are emerging.

In the current ICU capacity planning in my country, an average period of 10 days in ICU per patient was used for some capacity planning models. However, the actual minimum period that people with Covid-19 have to remain in ICU's turns out to be more like 21 days, effectively halving the available capacity. <snip>


I see New York has been working on a system to share one ventilator between two patients. How, I don't know.
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Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #202 on: March 30, 2020, 11:54:01 am »

In Portugal, hospitals are set up with covid and nocovid areas. All non-urgent medical treatments are post-poned. In the last few days two trends have emerged:

- infections in home care houses for older people, many private, and that have done very little to be prepared... ending up with both staff and residents infected.

- 800+ medical staff infected.

Next up are prisons.

All of the above could have been prevented with proper and timely planning and preparation. It ispathetic to see the minister of Health saying that the numbers of how many residents exist in caring homes is "not clear".

My 97 year old mother-in-law is in an assisted living residence close by.  They shut it down for all visitors including my wife, her mother.  Further up in New Jersey, a similar home had many deaths as the virus broke out there.  So old age facilities are taken strong measures to protect the residents.  They all have to eat in their rooms and not in the common dining room.  It must be very tough on many of these people as they're isolated from friends and family.

Manoli

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #203 on: March 30, 2020, 12:04:53 pm »

I see New York has been working on a system to share one ventilator between two patients. How, I don't know.

Shorter stints, alternating between the two.
I've heard this in the EU, not just NYC. Hard to separate fact from fiction.

TV reports that Mercedes F1/ have designed a simpler design ventilator. Simpler both to manufacture and operate. Not verified and no further details AFAIK.
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LesPalenik

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #204 on: March 30, 2020, 12:05:39 pm »

But elective surgery is down.  I spoke to my nephew who's a researcher and surgical anesthesiologist in Boston's Massachusetts General Hospital.  Operations are down two-thirds.  Research has stopped completely. He's home right now with his wife who's a radiologist there.  So a lot less regular medical things are happening.  Obviously things can;t stay at the same level with all the extra requirements caused by Covid-19.

Here in Ontario, many doctors, dentists, and physiotherapists cancelled the appointments and won't schedule any new appointments until mid summer or fall. That's under the assumption, that the virus situation will soon improve.
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Bart_van_der_Wolf

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #205 on: March 30, 2020, 12:12:46 pm »

But elective surgery is down.  I spoke to my nephew who's a researcher and surgical anesthesiologist in Boston's Massachusetts General Hospital.  Operations are down two-thirds.[...]

That's most likely to create a buffer for the unknown number of patients.

We also experience some strange trends, like a reduction of Emergency admissions. Fewer people are going to the hospital. Maybe the Social Distancing also creates fewer accidents?
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Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #206 on: March 30, 2020, 12:16:52 pm »

That's most likely to create a buffer for the unknown number of patients.

We also experience some strange trends, like a reduction of Emergency admissions. Fewer people are going to the hospital. Maybe the Social Distancing also creates fewer accidents?
Also, who wants to go to a hospital where everyone is infected with the virus?  Hospitals are dangerous places under normal conditions. 

Alan Goldhammer

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #207 on: March 30, 2020, 01:39:13 pm »

Race to find COVID-19 treatments accelerates
Full article: https://science.sciencemag.org/content/367/6485/1412.full
I've been tracking all the clinical trials and drug development world wide.  For more on chloroquine/hydroxychloroquine see:  https://blogs.sciencemag.org/pipeline/archives/2020/03/29/more-on-cloroquine-azithromycin-and-on-dr-raoult    Immune serum for patients who have recovered is a nice approach but from what I have read, one person can yield only enough to treat two others.  This is why humanized monoclonal antibodies are desperately needed.  they can be produced at large scale.  Lopinavir/ritonovir have already come up negative in two Chinese trials though there are still some more ongoing.  I have not seen results from remdesivir.  There is a bunch of other stuff going on and Johnson & Johnson just announced their vaccine plans today.  They will begin trials in April and are building up capacity to produce a billion doses by sometime next year. 
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Alan Goldhammer

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #208 on: March 30, 2020, 01:45:59 pm »


TV reports that Mercedes F1/ have designed a simpler design ventilator. Simpler both to manufacture and operate. Not verified and no further details AFAIK.
The US had a contract several years ago for a streamlined model and through a variety of screw ups the project was halted.  https://www.nytimes.com/2020/03/29/business/coronavirus-us-ventilator-shortage.html
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armand

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #209 on: March 30, 2020, 02:56:32 pm »

I see New York has been working on a system to share one ventilator between two patients. How, I don't know.

While it can be done in extreme cases, it should be reserved for the extreme cases only if you hope to get another vent available soon. It was done this way in Las Vegas after the shooting, but those were simpler cases from a lung pathology point of view. Otherwise it's a recipe for disaster.
The professional societies came up with a joint statement against it: https://www.asahq.org/about-asa/newsroom/news-releases/2020/03/joint-statement-on-multiple-patients-per-ventilator

John Camp

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #210 on: March 30, 2020, 03:57:03 pm »

The US had a contract several years ago for a streamlined model and through a variety of screw ups the project was halted.  https://www.nytimes.com/2020/03/29/business/coronavirus-us-ventilator-shortage.html

Supposedly the UK's Dyson vacuum cleaner company designed a ventilator in ten days and plans to quickly manufacture 15,000 of them.  I have no further comment on that particular plan...8-)

https://futurism.com/the-byte/vaccuum-maker-dyson-designed-ventilator
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Slobodan Blagojevic

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #211 on: March 30, 2020, 04:43:17 pm »

https://medium.com/@noahhaber/flatten-the-curve-of-armchair-epidemiology-9aa8cf92d652

Flatten the Curve of Armchair Epidemiology
Vet your sources or more people will be deluded


Quote
Everyone has seen messages telling you we must “act today or people will die,” COVID-19 is basically just the flu, and/or that “flattening the curve is a deadly delusion.” These often have numbers, charts, citations, retroactively edited titles (“taksies backsies”), and data “science.”
Unfortunately, all of the above are signs of DKE-19, a highly contagious illness threatening the response against COVID-19. We must act today to flatten the curve of armchair epidemiology, or we will all be in peril.
What is DKE-19?
Dunning-Kruger Effect (DKE) is a phenomenon where people lack the ability to understand their lack of ability.

Alan Goldhammer

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #212 on: March 30, 2020, 05:52:49 pm »

https://medium.com/@noahhaber/flatten-the-curve-of-armchair-epidemiology-9aa8cf92d652

Flatten the Curve of Armchair Epidemiology
Vet your sources or more people will be deluded


Why did you post this here, when the thread title says science and no politics.  This post and the referenced article should have been posted on the other COVID-19 thread.  You should respect the wishes of the OP.
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Bart_van_der_Wolf

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #213 on: March 30, 2020, 05:56:46 pm »

Why did you post this here, when the thread title says science and no politics.  This post and the referenced article should have been posted on the other COVID-19 thread.  You should respect the wishes of the OP.

+1
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BobShaw

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #214 on: March 30, 2020, 06:23:06 pm »

I spoke to a friend who's in Florida for vacation and had to go to the doctor there.
Wow, you mean people are actually going on holidays in the US?

Here in Australia there is no essential travel.
You are only allowed to go to work (if it is considered essential), the supermarket or a health professional.
Only two people are allowed on the street together.
You are not allowed out of the country or even to another state.
If you are Australian only you can re-enter the country but you are bussed to a hotel for 14 days and have to stay in the room.

There is no elective surgery. Some hospitals are now Covid only and some for other illnesses.
The curve is now going down and we have 4200 cases and 18 dead.
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Slobodan Blagojevic

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #215 on: March 30, 2020, 06:34:39 pm »

Why did you post this here, when the thread title says science and no politics.  This post and the referenced article should have been posted on the other COVID-19 thread.  You should respect the wishes of the OP.

It didn’t occur to me it has anything to do with politics, but rather with human (mis)understanding of the various scientific or media reports about the pandemic.

Alan Goldhammer

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #216 on: March 30, 2020, 07:09:13 pm »

It didn’t occur to me it has anything to do with politics, but rather with human (mis)understanding of the various scientific or media reports about the pandemic.
I understand but in the absence of good testing information, we are in this state of uncertainty.  To your point, this is a very clear presentation:  https://spectator.us/understand-report-figures-covid-deaths/  I'm pretty much in accord with this and think that the ultimate mortality will be higher than seasonal flu, maybe double at highest.  The reason for the 'social distancing' is to keep the hospitals from being overloaded.  I worry that they won't be able to take care of serious non-pandemic stuff like bone fractures, cardiac problems, etc.
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Manoli

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #217 on: March 30, 2020, 07:36:37 pm »

Combined effort  Mercedes F1 and UCL intensive care dept.
high pressure oxygen unit fuels a tight fitting air mask or helmet,
forced air to keep the lungs open and get the air into blood stream.
100 hours to design , 10 days to get approval.

Sorry, just heard/saw this off SKY news, just a snippet  ...
hopefully further details soon in the press
(unit looks no bigger than a large battery pack)
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Manoli

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #218 on: March 30, 2020, 07:51:39 pm »

< Dunning-Kruger Effect (DKE) is a phenomenon where people lack the ability to understand their lack of ability >

Seeing this in various forms, but irrespective this IS a pandemic and it IS a crisis. To focus on per capita data is missing the point and for where we are today is wholly irrelevant.

If comparing prevalence of cancer between countries, you’d adjust per capita,  because it’s not a transmissible disease: it comes from lifestyle, genes, pure chance, so if per-capita rate is higher in A than B, then that’s because of something specific to that country.  Covid spreads from person to person; it’s not like cancer. It’s exogenous.

Generally, these digressions are not informative regarding HOW a country’s dealing with Covid-19.  So all we should be focussed on is the % increase as a measure of expansion (and containment). The rest can come later.

What’s clear is countries that adopted strict social distancing and early bird policies are faring substantially better than those who delayed. See the Australian stats in BobShaw’s post above.
« Last Edit: March 30, 2020, 07:56:01 pm by Manoli »
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armand

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #219 on: March 30, 2020, 08:24:51 pm »

Combined effort  Mercedes F1 and UCL intensive care dept.
high pressure oxygen unit fuels a tight fitting air mask or helmet,
forced air to keep the lungs open and get the air into blood stream.
100 hours to design , 10 days to get approval.

Sorry, just heard/saw this off SKY news, just a snippet  ...
hopefully further details soon in the press
(unit looks no bigger than a large battery pack)

Those are basically CPAP/BiPAP machines, and we do have more of those although even more can't hurt.
The issue that I mentioned earlier is because of the high pressures there is significant aerosolization, and with Covid living up to 3h on air the risk to the people around is very high. This could be done in dedicated negative pressure floors where all patients are Covid positive and the medical personal has adequate protective equipment; it can be done but it's easier said than done. The failure to do both can explain at some extent the high rate of infection within physicians in Italy.
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