SARS CoV-2 coronavirus / Covid-19 (No tin foil hat silliness please)

In Sweden we’re being hit hard by the second wave now.

Interesringly though, none of the patients in our Covid unit are showing any signs of multi organ failure. During the spring we had many cases that presented with lung disease and circulatory failure/renal failure etc, but the second wave has only been isolated lung disease, even those coming from home that we’ve admitted straight to the ICU.
 
Anustart89 said:
In Sweden we’re being hit hard by the second wave now.

Interesringly though, none of the patients in our Covid unit are showing any signs of multi organ failure. During the spring we had many cases that presented with lung disease and circulatory failure/renal failure etc, but the second wave has only been isolated lung disease, even those coming from home that we’ve admitted straight to the ICU.
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Is this because we're better at handling the virus in it's earlier stages of symptomatic of something else?
 
Beans said:
Have you heard about the MATH+ Protocol created by the Frontline Covid 19 Critical Care Alliance? They're a group of experts with 2,000 papers between them, their Dr. Kory had testified on behalf of the group to the Senate months ago about the benefits of steroids which was adopted more widely, and just testified about recent studies showing remarkable results with ivermectin and standard care.

In his testimony he mentioned a Dr. Hector Carvallo in Argentina heading their coronavirus response, who used ivermectin nasal sprays as a prophylaxis for 800 healthcare workers and 0 got ill, while 400 that weren't treated had 237 healthcare workers getting sick.

Here's a link to their protocol and a 10 minute excerpt from the testimony of him begging the FDA to look at their presentation of the new data. Apologies it's a Fox feed, but it's just a live feed without commentary.

https://www.evms.edu/media/evms_pub...cine/EVMS_Critical_Care_COVID-19_Protocol.pdf

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Very interesting! Will have a gander at this later on- thanks!

zing said:
https://in.news.yahoo.com/mucormycosis-fungal-infection-mortality-rate-165958750.html
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I think we've mainly seen Aspergillus infections, but I have heard Mucormycosis is getting more annual findings in the UK in recent years.
We do a blood test called Procalcitonin which gives a good indicator of how likely someone with COVID will suffer a septic response. If it's above a certain number, we've seen evidence to say that starting an unwell COVID patient (who is requiring hospital admission) on antibiotics is beneficial.
If we're seeing more of these cases, we may have to do more regular fungal blood tests after they've seemingly recovered from their initial bout of requiring oxygen supplementation; or (less likely) start people on anti-fungals and antibiotics prematurely before the blood test result is returned.

I think it entering peak Winter soon will make this all the more complicated. We'll be seeing infective bouts of COPD and typical community acquired pneumonias. Unfortunately, COVID will have to be the diagnosis to rule out first. I'm sure it happens in most hospitals now, but once a patient is deemed requiring admission from our Emergency Department - they get swabbed and only once that swab is returned with a result will they be moved to a "red" ward (COVID) or a "green" ward (non-COVID). We're already seeing patients waiting +18 hours in an uncomfortable hospital A&E bed depending on what time the swab is sent off - and that's not even mentioning the inevitable of patients getting a result back but can't be moved because there is no bed space in the hospital.

Logistically, if the influx of typical winter pressure patients present to A&E, then I can't even comprehend how fecked some hospitals are going to be given that there will be the addition of COVID cases who may unfortunately be mixing with the non-COVID patients in the assessment bays.
 
Hernandez - BFA said:
I think it entering peak Winter soon will make this all the more complicated. We'll be seeing infective bouts of COPD and typical community acquired pneumonias. Unfortunately, COVID will have to be the diagnosis to rule out first. I'm sure it happens in most hospitals now, but once a patient is deemed requiring admission from our Emergency Department - they get swabbed and only once that swab is returned with a result will they be moved to a "red" ward (COVID) or a "green" ward (non-COVID). We're already seeing patients waiting +18 hours in an uncomfortable hospital A&E bed depending on what time the swab is sent off - and that's not even mentioning the inevitable of patients getting a result back but can't be moved because there is no bed space in the hospital.

Logistically, if the influx of typical winter pressure patients present to A&E, then I can't even comprehend how fecked some hospitals are going to be given that there will be the addition of COVID cases who may unfortunately be mixing with the non-COVID patients in the assessment bays.
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That's one of the really scary things about the high case numbers. It raises the spectre of hospital acquired transmission again - especially if there are delays in testing.

Just out of curiosity. I know that these 30 minute tests are viewed as inadequate, but couldn't they be run while the "real" PCR test results were awaited? Even if they only get 50% of the cases, that's still better than nothing - especially if the theory that they probably show the (currently) most infectious people is correct.
 
jojojo said:
That's one of the really scary things about the high case numbers. It raises the spectre of hospital acquired transmission again - especially if there are delays in testing.

Just out of curiosity. I know that these 30 minute tests are viewed as inadequate, but couldn't they be run while the "real" PCR test results were awaited? Even if they only get 50% of the cases, that's still better than nothing - especially if the theory that they probably show the (currently) most infectious people is correct.
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I think the risk outweighs the benefit. As you said, they aren't particularly sensitive tests the "rapid" ones. If it comes up as a false negative, and then they get moved up to a clean ward then the shit hits the fan. I know the real PCR tests aren't 100% accurate but its only thing to truly go off.

I think the very difficult thing is that most Emergency Departments are split into "?COVID" areas and areas that include patients who don't come in with COVID symptoms, like chest pain, abdominal pain or a fracture.

The issue lies is that within the ?COVID areas, you'll get the bog standard patient with a bacterial pneumonia and actually isn't COVID, next door to a bed (to be fair separated by a wall) with a COVID patient. Unfortunately, they can present initially the same way and really the risk of the non-COVID patient getting COVID goes up.

Likewise, a man with chest pain in the non-COVID area may be COVID + but is asymptomatic, and his bed is next door to a guy who doesn't have COVID (separated by a curtain).

A lot of waffle there - but basically I think it's practically impossible to completely eradicate hospital-acquired COVID. Minimising it is definitely achievable but unless you get everyone's COVID status before they enter the A&E reception, then it's impossible.

Hence why a vaccine and proof that they've had it goes a long way.
 
Hernandez - BFA said:
I think the risk outweighs the benefit. As you said, they aren't particularly sensitive tests the "rapid" ones. If it comes up as a false negative, and then they get moved up to a clean ward then the shit hits the fan. I know the real PCR tests aren't 100% accurate but its only thing to truly go off.
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I must admit I was thinking of using them the opposite way round - to start pulling (some of) the positive ones away from mixed/non-covid areas into covid streams. Interesting to read how that admissions process is being handled, thanks for taking the time to explain what's happening.
 
Hernandez - BFA said:
I think the risk outweighs the benefit. As you said, they aren't particularly sensitive tests the "rapid" ones. If it comes up as a false negative, and then they get moved up to a clean ward then the shit hits the fan. I know the real PCR tests aren't 100% accurate but its only thing to truly go off.

I think the very difficult thing is that most Emergency Departments are split into "?COVID" areas and areas that include patients who don't come in with COVID symptoms, like chest pain, abdominal pain or a fracture.

The issue lies is that within the ?COVID areas, you'll get the bog standard patient with a bacterial pneumonia and actually isn't COVID, next door to a bed (to be fair separated by a wall) with a COVID patient. Unfortunately, they can present initially the same way and really the risk of the non-COVID patient getting COVID goes up.

Likewise, a man with chest pain in the non-COVID area may be COVID + but is asymptomatic, and his bed is next door to a guy who doesn't have COVID (separated by a curtain).

A lot of waffle there - but basically I think it's practically impossible to completely eradicate hospital-acquired COVID. Minimising it is definitely achievable but unless you get everyone's COVID status before they enter the A&E reception, then it's impossible.

Hence why a vaccine and proof that they've had it goes a long way.
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They definitely shouldn’t be used to rule out covid but couldn’t they be used to screen for and isolate the really infectious cases a little bit quicker? Could maybe do a quick screening test for every patient (and relative!) at the door of A&E, with results available by the time they hit triage. Obviously any cases with any kind of clinical suspicion would need a negative PCR before you rule out covid.
 
Is there any indication when the Govt in the UK thinks it will have rolled out the vaccine to the majority of the population? Any timeline?
 
Good article in The Guardian about what happened.
In short most of the Asian countries that controlled it realised what it was, A Virus. The western countries thought it was A Disease.
 
Jacko21 said:
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German posters - I saw news of anti-lockdown protests in Berlin and some other places. I know at least some of the groups involved were left-wing and some were basically the German branch of QAnon.
What is the political split of anti-lockdown people? And, is Berlin worse than other areas?
 
djembatheking said:
Will people behave in Germany and respect restrictions or just ignore them like a lot in the UK ?
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We will probably get the same in NL this week. We've gone from 4k per day to 10k in 2 weeks. It will never work unless you have a proper, harsh, military managed lockdown. People aren't following the rules anymore. They did in the beginning and we got to 0 deaths per day.
 
Stanley Road said:
We will probably get the same in NL this week. We've gone from 4k per day to 10k in 2 weeks. It will never work unless you have a proper, harsh, military managed lockdown. People aren't following the rules anymore. They did in the beginning and we got to 0 deaths per day.
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It is the same here in Wales, apparently the NHS will be pretty much dedicated to covid soon, in South Wales yesterday a man had to wait outside hospital for 19 hours with suspected stroke. I went to get some shopping for my in laws today who haven`t been out since March and saw 2 people that said they have given up and are just carrying on as normal now. My next door neighbour has all sorts in and out of his house all day . It is all or nothing here it seems , just got to look after your own I suppose.
 
djembatheking said:
It is the same here in Wales, apparently the NHS will be pretty much dedicated to covid soon, in South Wales yesterday a man had to wait outside hospital for 19 hours with suspected stroke. I went to get some shopping for my in laws today who haven`t been out since March and saw 2 people that said they have given up and are just carrying on as normal now. My next door neighbour has all sorts in and out of his house all day . It is all or nothing here it seems , just got to look after your own I suppose.
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As Stanley says, with no enforcement you get low levels of compliance, and even those people will get tired of it as time goes on. I honestly think people were more inclined to follow the rules when they were the same everywhere.
 
Penna said:
As Stanley says, with no enforcement you get low levels of compliance, and even those people will get tired of it as time goes on. I honestly think people were more inclined to follow the rules when they were the same everywhere.
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And if they know that everyone else is following them. The high profile rule breakers in govmnt (Cummings, etc) really hurts the ability of the govmnt to try to force more stringent rules. People will be just saying “it’s one rule for them and another for us”.
 
Stack said:
Is there any indication when the Govt in the UK thinks it will have rolled out the vaccine to the majority of the population? Any timeline?
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As usual, it depends.

If the AstraZeneca vaccine manages to do a more convincing job with the data it's got and with whatever it can assemble over the next few weeks - it could get its emergency use approval and start rolling out before the end of January. They think they can ramp up production fast so we might see all the highest risk (over 70s, healthcare workers and the clinically extremely vulnerable) done by early Q2. If we're relying on Pfizer/Moderna it takes the whole of Q1/2 to get there, and that assumes Pfizer/Moderrna don't hit further production issues. Better than nothing, and a massive reduction in the death rates, but still not great.

The other possible gap fillers are Novavax and J&J - if their current Phase 3 trials show the right efficacy/safety. Both of those may be ready for emergency approval late Q1. In theory at least both of those could ramp up production quickly. If those are available then Q2 could see a real increase in availability - probably enough to cover all the NHS priority groups including the over 50s. If that happens then by summer Europe will be a much more normal place - not business as usual perhaps but close.

In other words - fingers crossed for AstraZeneca (revised report!), J&J and/or Novavax.

The BBC has done a nice article at https://www.bbc.co.uk/news/health-55274833 that includes things like the approximate number of people in each priority group.
 
groovyalbert said:
Is this because we're better at handling the virus in it's earlier stages of symptomatic of something else?
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Feels more like it behaves differently this time around, because we're seeing this both in patients who are treated in-hospital who end up admitted to the ICU and patients who come in from their home and need admitting into the ICU right away.

We're doing some things better this time around though, mainly in terms of anticoagulation and consistent proning of patients.
 
jojojo said:
I must admit I was thinking of using them the opposite way round - to start pulling (some of) the positive ones away from mixed/non-covid areas into covid streams. Interesting to read how that admissions process is being handled, thanks for taking the time to explain what's happening.
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Pogue Mahone said:
They definitely shouldn’t be used to rule out covid but couldn’t they be used to screen for and isolate the really infectious cases a little bit quicker? Could maybe do a quick screening test for every patient (and relative!) at the door of A&E, with results available by the time they hit triage. Obviously any cases with any kind of clinical suspicion would need a negative PCR before you rule out covid.
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I see what you mean. To be honest, even the rapid tests take ~2 hours or so (at least that’s the quickest that I’m aware of). Still a long time to wait before triage.

Fair points though - could very well be onto something.
 
Rudie said:
A lot of people like this journalist from the Daily Mail seem confused as to how they're getting the virus, also about the rules they're breaking...

https://www.dailymail.co.uk/health/...oment-got-infected-Covid.html#article-9046351

Now I know the Daily Mail reporters aren't the brightest but is she openly admitting to breaking Covid rules by not isolating?
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Journalists aside, I’m constantly shocked by how few people can get their heads around an incubation period. Her and her kid tested negative because they were tested too soon. They almost certainly had the same dose as her ex, just took a few more days for their viral load to increase to a level where they would get a positive test. It’s incredible how seemingly smart people (and I’m including my friends in this) think a negative test means they’ve no virus in their system.
 
jojojo said:
As usual, it depends.

If the AstraZeneca vaccine manages to do a more convincing job with the data it's got and with whatever it can assemble over the next few weeks - it could get its emergency use approval and start rolling out before the end of January. They think they can ramp up production fast so we might see all the highest risk (over 70s, healthcare workers and the clinically extremely vulnerable) done by early Q2. If we're relying on Pfizer/Moderna it takes the whole of Q1/2 to get there, and that assumes Pfizer/Moderrna don't hit further production issues. Better than nothing, and a massive reduction in the death rates, but still not great.

The other possible gap fillers are Novavax and J&J - if their current Phase 3 trials show the right efficacy/safety. Both of those may be ready for emergency approval late Q1. In theory at least both of those could ramp up production quickly. If those are available then Q2 could see a real increase in availability - probably enough to cover all the NHS priority groups including the over 50s. If that happens then by summer Europe will be a much more normal place - not business as usual perhaps but close.

In other words - fingers crossed for AstraZeneca (revised report!), J&J and/or Novavax.

The BBC has done a nice article at https://www.bbc.co.uk/news/health-55274833 that includes things like the approximate number of people in each priority group.
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Australia is still planning for a March start. They are hinting that this is because we are being more rigorous with the approvals process but I think it is likely that there is just no hurry as we ordered the Oxford and UQ vaccines first but were a bit late to the party for the other orders. My suspicion is that we won't get deliver of the Pfizer vaccine until Q1 - the only approved vaccine we have ordered. We have the ability to make 4m doses of the Oxford vaccine per month but that doesn't help until the issues with the data are resolved so as to allow approval.

The bottom line is that the Feds botched things yet again. Without the states acting with authority we would be awash with covid most likely.
 
utdalltheway said:
The high profile rule breakers in govmnt (Cummings, etc)
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Yeah we had a high profile minister, Minister of Justice, get married during lockdown, had tons of guests, no social distancing and it was all on film. What Justice is that for us plebs? As usual with high profile rule breakers he apologized and that apparently makes it ok. These people need to be fired, if i break the rules at work then i certainly would be.
 
djembatheking said:
Will people behave in Germany and respect restrictions or just ignore them like a lot in the UK ?
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Yes I think they will. I think over the last weeks and months, too many Germans were too relaxed and the rules were handled rather lax (myself inluded).
I think the message has resounded. Monday and Thursday could be bad (before on Wednesday non-essentential shops close)
Then there will be nothing to do, aside from work and grocery shopping
And at least in my region, authorities seem intended to control the rules more sctrictly and visiblier. (was at my girlfriend over the weekend and she drove me home, she got over the 8pm curfew on the way home and the streets are empty and police are setting up checkpoints on major streets.
But right before 8pm, there was rather normal sunday evening traffic. So my guess many people were coming back from private visits and friends. Not good for the numbers in the next two weeks. Peak Covid deaths and numbers should hit Germay right between Christmas/New Years Day/First two weeks of 2021.
 
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Rudie said:
A lot of people like this journalist from the Daily Mail seem confused as to how they're getting the virus, also about the rules they're breaking...

https://www.dailymail.co.uk/health/...oment-got-infected-Covid.html#article-9046351

Now I know the Daily Mail reporters aren't the brightest but is she openly admitting to breaking Covid rules by not isolating?
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What a bunch of numpties. It's extremely obvious in all of those cases where they likely caught it - you know the badly ventilated indoor places where no one is wearing masks.
 
Rudie said:
A lot of people like this journalist from the Daily Mail seem confused as to how they're getting the virus, also about the rules they're breaking...

https://www.dailymail.co.uk/health/...oment-got-infected-Covid.html#article-9046351

Now I know the Daily Mail reporters aren't the brightest but is she openly admitting to breaking Covid rules by not isolating?
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Father gets covid while looking after son. Days later sends kid to the mother. Mother and son later test positive for covid.

Sounds like a x-file to me.
 
Irwin99 said:
I don't think the second one really ended. I expected the numbers to come down a bit more than they did.
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The case numbers were definitely on a downward curve. Now they are going up again. I only mention it because I thought there would be discussion about it on this brilliant thread. It looks like the fall was due to the lockdown and the rise is due to the end of the lockdown to me.
 
giggs-beckham said:
The case numbers were definitely on a downward curve. Now they are going up again. I only mention it because I thought there would be discussion about it on this brilliant thread. It looks like the fall was due to the lockdown and the rise is due to the end of the lockdown to me.
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Yeah I don't think anyone doubted that cases would start to rise again after people went back out to the shops, pubs and started meeting up with mates in other homes. What we learned from the lockdown is the only way we could keep on top of things during winter was to keep them closed. During summer we could open them back up with people spending enough time outdoors, but going from one potential transmission hotspot onto another and then into someone's home just isn't manageable, along with people washing their hands less, making less effort to avoid crowds etc. At this rate it'd be very surprising if we're not in a much worse place in January than we were in November. I still think it's ludicrous we had to re-open shops pre-Christmas to "save them", when it's obvious that the usual 10% drop in sales post-Christmas combined with the virus restrictions will kill them off much quicker in January.
 
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Here in Essex the numbers have rocketed despite being really low pre-lockdown. Evidently people have just decided to ignore the rules throughout lockdown.

It's obvious on the weekends when we go for a long walk and see all the extra cars parked that people are just visiting each other anyway.
 
Brwned said:
Yeah I don't think anyone doubted that cases would start to rise again after people went back out to the shops, pubs and started meeting up with mates in other homes. What we learned from the lockdown is the only way we could keep on top of things during winter was to keep them closed. During summer we could open them back up with people spending enough time outdoors, but going from one potential transmission hotspot onto another and then into someone's home just isn't manageable, along with people washing their hands less, making less effort to avoid crowds etc. At this rate it'd be very surprising if we're not in a much worse place in January than we were in November. I still think it's ludicrous we had to re-open shops pre-Christmas to "save them", when it's obvious that the usual 10% drop in sales post-Christmas combined with the virus restrictions will kill them off much quicker in January.
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This, plus keeping in mind places like London are tier 2, and with this weather, no chance in hell restaurants/bars are going to be having any windows or doors open for airflow. Hence why I think warmer countries are still faring better.
 
Cases have come down in the north and north west but have risen in London and south east of England and Wales. Inevitable numbers would be back up as it spreads around other regions. North west along with the always low south west are the two lowest regions now.
 
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London & South East look to be in a significant upwards trajectory, I don't know why they're not pushing them into tier 3 already.
 
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