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

I got this on a WeChat group I'm in. All Chinese. Is it bollocks?


“Hey guys. Passing along a message from my friend at Stanford.

FYI

[From a friend at the Stanford hospital board. This is their feedback on Corona virus: The new Coronavirus may not show sign of infection for many days. How can one know if he/she is infected? By the time they have fever and/or cough and go to the hospital, the lung is usually 50% Fibrosis and it's too late...Taiwan experts provide a simple self-check that we can do every morning. Take a deep breath and hold your breath for more than 10 seconds. If you complete it successfully without coughing, without discomfort, stiffness or tightness, etc., it proves there is no Fibrosis in the lungs, basically indicates no infection. In critical time, please self-check every morning in an environment with clean air.
Serious excellent advice by Japanese doctors treating COVID-19 cases: Everyone should ensure your mouth & throat are moist, never dry. Take a few sips of water every 15 minutes at least. Why? Even if the virus gets into your mouth, drinking water or other liquids will wash them down through your throat and into the stomach. Once there, your stomach acid will kill all the virus. If you don’t drink enough water more regularly, the virus can enter your windpipe and into the lungs. That's very dangerous. Please send and share this with family and friends. Take care everyone and may the world recover from this Coronavirus soon. Please forward to your kids and friends.]”
 
Could someone explain how does self isolation exactly? What happens if you live with other people? Or if you live alone and need supplies?
 
kps88 said:
Could someone explain how does self isolation exactly? What happens if you live with other people? Or if you live alone and need supplies?
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You stay at home as much as possible. If you live with others then stay apart from them as much as possible. Clean surfaces after use it you share eating and bathroom areas. If possible have someone deliver goods, leaving them outside for you. Basically do what you can but know that not everyone has the resources to go full hermit.
 
Grinner said:
I got this on a WeChat group I'm in. All Chinese. Is it bollocks?


“Hey guys. Passing along a message from my friend at Stanford.

FYI

[From a friend at the Stanford hospital board. This is their feedback on Corona virus: The new Coronavirus may not show sign of infection for many days. How can one know if he/she is infected? By the time they have fever and/or cough and go to the hospital, the lung is usually 50% Fibrosis and it's too late...Taiwan experts provide a simple self-check that we can do every morning. Take a deep breath and hold your breath for more than 10 seconds. If you complete it successfully without coughing, without discomfort, stiffness or tightness, etc., it proves there is no Fibrosis in the lungs, basically indicates no infection. In critical time, please self-check every morning in an environment with clean air.
Serious excellent advice by Japanese doctors treating COVID-19 cases: Everyone should ensure your mouth & throat are moist, never dry. Take a few sips of water every 15 minutes at least. Why? Even if the virus gets into your mouth, drinking water or other liquids will wash them down through your throat and into the stomach. Once there, your stomach acid will kill all the virus. If you don’t drink enough water more regularly, the virus can enter your windpipe and into the lungs. That's very dangerous. Please send and share this with family and friends. Take care everyone and may the world recover from this Coronavirus soon. Please forward to your kids and friends.]”
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Heard a variation off it about drinking hot water to stop the incubation in your throat
 
There are more confirmed infections in Norway than in the UK. That's crazy.
 
I've come around to the idea that we will all probably get it and most of us end up being fine. It's just a glorified flu after all. The real danger will be that if people already started to freak out and empty supermarket stocks and fight over toilet paper while we're at the beginning of it, who is to say how people will react when we're a little further along the curve as predicted. Maybe we will see some riots in London again.
 
It’s getting scary here. Predictably our population isn’t prepared to deal with it and people are only concerned with themselves with zero regard to others, so we have a jeweler in my parents town who had symptoms but concealed the fact that his son returned from Italy and his wife who was a school teacher and kept going to work despite symptoms. It’s a 40k town, it’s going to get pretty bad very soon I imagine considering circumstances. My parents are both 65 this year and my grandmas are 88 and 95 so I’m really concerned now.
 
Vidic_In_Moscow said:
I've come around to the idea that we will all probably get it and most of us end up being fine. It's just a glorified flu after all. The real danger will be that if people already started to freak out and empty supermarket stocks and fight over toilet paper while we're at the beginning of it, who is to say how people will react when we're a little further along the curve as predicted. Maybe we will see some riots in London again.
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Flu ridden Cockneys rampaging through the Streets of London. Id almost pay to see it :)
 
Working from home tomorrow as a test - then other colleagues are doing it on Friday and Monday. Those of us who work on iMac's have been issued MacBook Pro's so we are able to work from home.

I really don't think it will be long before people are just told to work from home if they are able to. Alphabet, Google's parent company, has just told it's North American staff to all work from home:

https://www.bbc.co.uk/news/technology-51828782

Google's parent company Alphabet has asked its North American staff to work from home to reduce the potential spread of the coronavirus. Last week the tech giant sent a memo to staff recommending that employees in Washington state work from home.

It has now expanded that request to all of its almost 100,000 workers across 11 office in the US and Canada.

Alphabet is the latest company to make such an announcement as US coronavirus cases have risen to almost 1,000.

"Out of an abundance of caution, and for the protection of Alphabet and the broader community, we now recommend you work from home if your role allows," Chris Rackow, Google's vice president of global security, wrote in an email to workers.

Alphabet said its offices in North America will remain open for those whose jobs require them to come in.
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EDIT - am based in Canary Wharf - so a few companies around here have already had positive tests for the Miley.
 
swooshboy said:
Working from home tomorrow as a test - then other colleagues are doing it on Friday and Monday. Those of us who work on iMac's have been issued MacBook Pro's so we are able to work from home.

I really don't think it will be long before people are just told to work from home if they are able to. Alphabet, Google's parent company, has just told it's North American staff to all work from home:

https://www.bbc.co.uk/news/technology-51828782



EDIT - am based in Canary Wharf - so a few companies around here have already had positive tests for the Miley.
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:drool:
 
This is doing the rounds on medical whatsapp groups. Seems legit to me.

Best summary yet. Do read all the way to end.
DO READ THIS. BEST SUMMARY YET.

This is from an anonymous intensivist in Washington state caring for covid patients. PROB A WEEK OLD.
_________________________________
“We've been told not to share info, but we are all doing it anyway.
Since COVID is now deemed endemic in the XXXX area, and to quote a reliable source, the rest of the country is just "lagging behind," thought I'd share some relevant details, including from CDC teleconference today for COVID providers.
- as we all assumed, it has been in community spread locally for weeks. We have seen idiopathic ARDS cases since early/mid-Feb. Retrospective testing is being done where possible. - the numbers presented in media do not reflect actual cases, obvs. Testing here only started 2/28. Our first CONFIRMED death was 2/23.
=XXX State Lab can only run 26kits/day, though they are ramping up quickly. Despite strict criteria for testing, there is a 3d backlog at this time.
- Negative Resp Path PCR is required before SARS2 test will be accepted. We have been running out of RP PCRs. This is unheard of, especially as most admitted resp pts get one during flu/cold season (mostly for approp iso, since RSV is contact). Goddess bless the local Children's hospital for sending us 60 the other night. Your hospital should begin stocking up on RP PCRs now. Our Public Health dept does not expect SARS2 tests to be ample enough to d/c the neg RP PCR requirement.
- on a related note, county lab no longer runs tests from pts not sick enough to be admitted, since dz is now endemic. Expect this will be the case elsewhere soon.
- as of today, we have 21 pts and 11 deaths since 2/28. Not including the postmortem retrospective dx of pts who died with idiopathic ARDS the prior week. Of note, Harborview had an idiopath ARDS death 2/26. There will be more retrospective dx. - our mortality rate is skewed up (and in some cases, down) because many of our pts come from the LCCK SNF (Lifecare Care Center of Kirkland) & are elderly and severely chronically medically ill - the sort of pts who die of rhinovirus. Many of these patients' families are opting for comfort care, as many are DNI. We have 3 such on the floor on comfort care now. Of note, those 3 pts have what would be considered mild infxn in a different cohort.
- we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen. - media (including NYT) are mentioning "efforts to contain the outbreak" at the SNF.
I'm sure you are all aware, but the US has been past containment since January, and the SNF cases aren't an "outbreak" they're a cluster. - thus far many pts have contacts there (esp visiting family members), but also at a local HD center and a car dealership. Others have zero identifiable contacts at all, though I suspect many have Costco-horde connections, heh. - fortunately Evergreen has capability to turn all or half of any ward into a neg pressure zone
Currently, all of ICU is for critically ill COVIDs, all of XXX floor medsurg for stable COVIDs and EOL care, half of PCU, half of ER. New resp-sx pts Pulmonary Clinic offshoot is open.
- in XXXX, CDC is no longer imposing home quarantine on providers who were wearing only droplet iso PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery on these pts in the week prior to testing starting. Because that resulted in our Stroke Center hospital no longer being able to admit LVOs or any kind of bleed. And decimated 10% of our Hospitalists, 3 of the 6 Night docs, and a PCCM. Plus it's now endemic. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne iso PPE for aerosol-generating procedures in ANY pt in whom you suspect COVID, just to prevent the mass quarantines.
- we ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs, which is not the manufacturer's recommendation. Not surprised on N95s as we use mostly CAPRs anyway, but still. Supplies are en route, but your facility may wish to stock up now, esp if you expect each staff member and room to have its own PAPR/CAPR.
- terminal cleans (inc UV light) for ER COVID rooms are taking forever, Enviro Services is overwhelmed. Bad as pts are stuck coughing in the waiting room. Rec planning now for Enviro upstaffing, or having a plan for sick pts to wait in their cars (that is not legal here, sadly).

- CLINICAL INFO based on our cases and info from CDC conf call today with other COVID providers in US:
- the Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data very skewed by late and very limited testing, and the number of our elderly pts going to comfort care. - being young & healthy (zero medical problems) does not rule out becoming vented or dead - probably the time course to developing significant lower resp sx is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb). - based on our hospitalized cases (including the not formally diagnosed ones who are obviously COVID - it is quite clinically unique) about 1/3 have mild lower resp sx, need 1-5L NC. 1/3 are sicker, FM or NRB. 1/3 tubed with ARDS. Thus far, everyone is seeing: - nl WBC. Almost always lymphopenic, occasionally poly-predominant but with nl total WBC. Doesn't change, even 10days in. - BAL lymphocytic despite blood lymphopenic (try not to bronch these pts; this data is from pre-testing time when we had several idiopathic ARDS cases) - fevers, often high, may be intermittent; persistently febrile, often for >10d. It isn't the dexmed, it's the SARS2. - low ProCalc; may be useful to check initially for later trending if later concern for VAP etc. - up AST/ALT, sometimes alk phos. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis at admit (150-200) correlates with clinical deterioration and progression to ARDS. LFTs typically begin to bump in 2nd week of clinical course. - mild AKI (Cr <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.
- characteristic CXR always bilateral patchy or reticular infiltrates, sometimes perihilar despite nl EF and volume down at presentation. At time of presentation may be subtle, but always present, even in our pts on chronic high dose steroids. NO effusions. CT is as expected, rarely mild mediastinal LAD, occ small effusions late in course which might be related to volume status/cap leak.
- Note - China is CT'ing everyone, even outpts, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs. Etc. 2 of our pts had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than CXR. - when resp failure occurs, it is RAPID (likely 7-10d out from sx onset, but rapid progression from hospital admit). Common scenario for our pts is, admit 1L NC. Next 12hrs -> NPPV. Next 12-24hrs -> vent/proned/Flolan. - interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you'd notice and say hmmm. - thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate. - given the inevitable rapid progression to ETT once resp decompensation begins, we and other hosps, including Wuhan, are doing early intubation. Facemask is fine, but if needing HFNC or NPPV just tube them. They definitely will need a tube anyway, & no point risking the aerosols. - no MOSF. There's the mild AST/ALT elevation, maybe a small Cr bump, but no florid failure. except cardiomyopathy. - multiple pts here have had nl EF on formal Echo or POCUS at time of admit (or in a couple of cases EF 40ish, chronically). Also nl Tpn from ED. Then they get the horrible resp failure, sans sepsis or shock. Then they turn the corner, off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less, then either VT->VF-> dead or PEA-> asystole in less than a day. Needless to say this is awful for families who had started to have hope. - We have actually had more asystole than VT, other facilities report more VT/VF, but same time course, a few days or a week after admit, around the time they're turning the corner. This occurs on med-surg pts too; one today who is elderly and chronically ill but baseline EF preserved, newly hypoTN overnight, EF<10. Already no escalation, has since passed, So presumably there is a viral CM aspect, which presents later in the course of dz. - of note, no WMAs on Echo, RV preserved, Tpns don't bump. Could be unrelated, but I've never seen anything like it before, esp in a pt who had been HD stable without sepsis.

Treatment -
- Remdesivir might work, some hosps have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, pts improve much more rapidly than expected in usual ARDS.
- Recommended course is 10d, but due to scarcity all hosps have stopped it when pt clinically out of the woods - none have continued >5d. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting then rapidly back to normal - suggests not a primary toxic hepatitis.
- unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID pts. Also CrCl>30, which is fine. CDC is working with Gilead to get LFT reqs changed now that we know this is a mild viral hepatitis.
-currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin can't remember where.

- steroids are up in the air. In China usual clinical practice for all ARDS is high dose methylpred. Thus, ALL of their pts have had high dose methylpred. Some question whether this practice increases mortality.
- it is likely that it increases seconday VAP/HAP. China has had a high rate of drug resistant GNR HAP/VAP and fungal pna in these pts, with resulting increases mortality. We have seen none, even in the earlier pts who were vented for >10d before being bronched (prior to test availability, again it is not a great idea to bronch these pts now).
- unclear whether VAP-prevention strategies are also different, but wouldn't think so?
- Hong Kong is currently running an uncontrolled trial of HC 100IV Q8.
- general consensus here (in US among docs who have cared for COVID pts) is that steroids will do more harm than good, unless needed for other indications.
- many of our pts have COPD on ICS. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far pts are tolerating that, no major issues with ventilating them that can't be managed with vent changes. We also have quite a few on AE-COPD/asthma doses of methylpred, so will be interesting to see how they do.

That's all I got for now. Will be skipping the next 2 CDC COVID calls as working Nights, but will call in again next week and keep you all posted.

Please share info but preferably with no direct attribution as I need to remain employed
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Full of jargon but you’ll get the jist of it. CM = cardiomyopathy, which I’m hearing about more and more. The virus seems to be directly cardiotoxic in the very unwell and that’s what kills them rather than ARDS.

Also confirms what we’re hearing from Italy. Being old/frail makes you more likely to end up in hospital but being young, fit, healthy is no guarantee that you won’t end up on a ventilator or dead.
 
Vidic_In_Moscow said:
I've come around to the idea that we will all probably get it and most of us end up being fine. It's just a glorified flu after all. The real danger will be that if people already started to freak out and empty supermarket stocks and fight over toilet paper while we're at the beginning of it, who is to say how people will react when we're a little further along the curve as predicted. Maybe we will see some riots in London again.
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The problem is that, in the coming weeks and months, if you're one of the unlucky one-in-seven who requires hospital treatment when you get it, you'll likely find that there are no available hospital beds, no equipment and no doctors or nurses to look after you.
 
Pogue Mahone said:
This is doing the rounds on medical whatsapp groups. Seems legit to me.



Full of jargon but you’ll get the jist of it. CM = cardiomyopathy, which I’m hearing about more and more. The virus seems to be directly cardiotoxic in the very unwell and that’s what kills them rather than ARDS.

Also confirms what we’re hearing from Italy. Being old/frail makes you more likely to end up in hospital but being young, fit, healthy is no guarantee that you won’t end up on a ventilator or dead.
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Great. feckin great.
 
SirAF said:
277 infected in Norway now, up 87 from yesterday. Minister of Health says that we are now «entering a new phase» and there will be more restrictions.
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Hope you're keeping safe mate.

If Scotland end up playing Norway in the Euro playoff, do you think it will be moved to behind closed doors? People here are having a hard time deciding if it's worth purchasing tickets and travelling over.
 
Vidic_In_Moscow said:
I've come around to the idea that we will all probably get it and most of us end up being fine. It's just a glorified flu after all. The real danger will be that if people already started to freak out and empty supermarket stocks and fight over toilet paper while we're at the beginning of it, who is to say how people will react when we're a little further along the curve as predicted. Maybe we will see some riots in London again.
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The infection rate is much worse
 
Someone my mum knows is in Rome and allowed back so long as they self isolate. Seems kinda negligent as it’s unlikely them and their family will for a whole 2 weeks.

Also, I can feel a sniffle coming on and am meant to be meeting my mate’s new baby on Friday. Probably going to have to give it a miss just in case, which sounds ridiculous but I suppose it’s right.
 
VeevaVee said:
Someone my mum knows is in Rome and allowed back so long as they self isolate. Seems kinda negligent as it’s unlikely them and their family will for a whole 2 weeks.

Also, I can feel a sniffle coming on and am meant to be meeting my mate’s new baby on Friday. Probably going to have to give it a miss just in case, which sounds ridiculous but I suppose it’s right.
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The whole country is just a raft of negligence at the moment. I'm convinced their plan involves everyone getting it.

College here just had a student return from Italy displaying symptoms and they've been told to self isolate. The College though remains open until the test results come back because

We have taken advice from Public Health England who have advised that until an individual receives a COVID-19 diagnosis the college should remain open with all its community following the advice and guidance published by Public Health England and Department for Education.
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Did Nadine Dorries self isolate when she started showing symptoms btw? Did she bollocks. She started feeling ill on Thursday, attended a surgery with constituents on Friday and also various cabinet meetings. They're contradicting their own advice it seems and only isolating themselves when the test results come back. This is for a test that you can't even get unless you've been to a hotspot or been in close promiximity to someone who has and you are showing symptoms. It would be laughable if it wasn't so tragic.
 
People that constantly post "Its a glorified flu" should be banned on the grounds of spreading misinformation detrimental to public health.
 
Got turned around and asked to work from home. I really hope the supermarket shelves aren't raided out. My fridge is empty.
 
Italy has 10,000 cases and 631 deaths.

A 6.3% cfr is scary. I always though that Europe/America would be worse affected than the developing world. We have older, more obese populations despite the better medical resources.
 
The Firestarter said:
People that constantly post "Its a glorified flu" should be banned on the grounds of spreading misinformation detrimental to public health.
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Indeed. Seasonal flu doesn't send 14% of people who get it to the hospital (and 8% to the ICU). It also doesn't kill otherwise healthy people in their 20s and 30s.
 
I ordered a months supply of my prescriptions this morning which means with what I have left from my last order I won’t have to go into the pharmacy for 6 weeks or so. I’d be snookered If it had to close as I’m on heart and blood meds

On a side note, popped into Aldi and the bog roll aisle was empty of all the 9 and 12 packs, only a couple of 4 packs left
 
VeevaVee said:
Someone my mum knows is in Rome and allowed back so long as they self isolate. Seems kinda negligent as it’s unlikely them and their family will for a whole 2 weeks.

Also, I can feel a sniffle coming on and am meant to be meeting my mate’s new baby on Friday. Probably going to have to give it a miss just in case, which sounds ridiculous but I suppose it’s right.
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You should be missing it anyway if you feel a sniffle if its just a new born, no?
 
VeevaVee said:
Also, I can feel a sniffle coming on and am meant to be meeting my mate’s new baby on Friday. Probably going to have to give it a miss just in case, which sounds ridiculous but I suppose it’s right.
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This is where it gets difficult to judge. I'm 44, when I was a kid I had asthma but grew out of it. I always have an inhaler handy but months and sometimes years pass between uses. Usually when I get a cold it ends up on my chest and in 2016 I actually had pneumonia which antibiotics cleared up pretty quick. This has been the pattern my whole adult life and I live with it. My chest is my weak link so while I'm not one to panic, I am viewing the situation in a weird light.

I had a mild cold two weeks ago and over the last 48 hours it has once again ended up on my chest so I'm wheezing a bit and coughing a bit, but only a little bit. Nothing stopping me working or walking the dog or anything. Half of me thinks this is normal, because it is, but half of me thinks I should be self isolating but it feels ridiculous. I know what I should do but it seems stupid.
 
Wednesday at Stoke said:
Got turned around and asked to work from home. I really hope the supermarket shelves aren't raided out. My fridge is empty.
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My last sortie (yesterday) revealed that there was plenty of everything except bog roll, pasta and hand-sanitiser. Fridge stuff is gonna be fine, beans'll be the next thing to go.
 
Feeling a bit under the weather. Have had a cold for the last 4 weeks. Woke up this morning heavier breathing than usual but inconsistent breathing patterns. Having to take deep breaths, almost like somebody is sitting on my chest. A bit of a cough coming on. Last few weeks when I've hit the gym I've noticed I've been getting out of breath quicker when doing cardio but I just put this down to half a stone I put on over Christmas so I'm not sure if this means anything.
 
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