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Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away

InkaUtexas

By InkaUtexas
in Cloak Room

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Uncle Boobs
Uncle Boobs

Against my better judgment and several beers deep, I have taken you up on this, potentially ending my streak of totally worthless posts. I have done 3 and 7 day averages only on the Worldometer data. 

Brisketexan
Brisketexan

Daughter’s home. A little PTSD, we’re picking up Whataburger to help.

Coelenterate Fuccboi
Coelenterate Fuccboi

Just try and imagine GreenspointTexas being the person to intubate you as you fight for your life against COVID-19. You’re laying there gasping for air while he chastises you for all the things you li

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conVINCEd

conVINCEd 21469

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5 minutes ago, TexasBeta said:

From one of my fraternity brothers whose a doc here in town. Friends with the doc who posted. Now I don’t know what they hey this all means but thought I’d share


Stephen VanRoekel posted this to share...

Good COVID-19 update from our ID folks!
3/8/2020

Notes from the front lines:

I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.
2. Co-infection rate with other respiratory viruses like Influenza or RSV is 3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.
4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.
5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.
6. If our local MCHD lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation. Presumably, this would only affect inpatients though since we (CHOMP) have decided not to collect specimens ordered by outpatient physicians.
7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.
8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.
9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.
10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.
11. Sutter and other larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.
12. Health Departments (CDPH and OCHD) state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in San Jose area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.

Feel free to share. All PUIs in Monterey Country so far have been negative.

Martha.

Martha L. Blum, MD, PhD
Medical Director, Infection Prevention and Antimicrobial Stewardship
(831) 333-3040
(831) 886-3639 fax
martha.blum@montagemedicalgroup.org
cid:image003.jpg@01D219B0.5285BAC0

I’m sure Martha appreciates you posting her contact info.

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B00M

B00M 6463

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30 minutes ago, bolverk said:

Macron has just ordered all schools from daycare on up to university closed until further notice in France starting Monday.

30% of their nurses just became stay at home moms or had to find daily baby sitters if their #s are like ours.

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InkaUtexas

InkaUtexas 26093

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17 minutes ago, Constant said:

My wife, who is a teacher in Mansfield ISD, received an email stating district leadership is meeting tomorrow with Tarrant County Public Health to devise a plan moving forward. Should get ahead of it and just close schools for the foreseeable future. Thousands of students and staff locked in rooms together doesn’t sound like a recipe for flattening the curve. 

yep. I am fucking amazed at how the school here is handling it. 

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Tailgate

Tailgate 3023

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17 minutes ago, Constant said:

My wife, who is a teacher in Mansfield ISD, received an email stating district leadership is meeting tomorrow with Tarrant County Public Health to devise a plan moving forward. Should get ahead of it and just close schools for the foreseeable future. Thousands of students and staff locked in rooms together doesn’t sound like a recipe for flattening the curve. 

This needs to happen. I think I read on this board or somewhere else that Italy regrets not doing it sooner. The kids may have no symptoms but go home and give it to mom and dad....grandparents.

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Thetexashammer

Thetexashammer 1062

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5 hours ago, closetojumping said:

So Sweden has stopped testing for the most part. I assume a healthy chunk of other countries opted for this route as well. I'm not trying to rain on the "what the fuck are we doing, why aren't we testing, the fucking feds are clowns!" parade for that part of the mob, but as many others have suggested on this thread for weeks (not me), large scale testing may not make a whole lot of sense if this shit is really widespread already. I don't know. I don't really understand that part of the outcry once it was established that we, and others, did very little in the beginning of the outbreak.

Link to the Swedish article that your browser should be able to translate: https://www.dn.se/sthlm/farre-kommer-att-provtas-for-coronaviruset-i-stockholm/

At some point, if you have a fever and cough, a test is irrelevant, you go quarantine yourself. That's not to say you shouldn't get a test, since you need to know if you are immuneish, but as a social practical matter the testing is kind of moot. The tests themselves aren't perfect either. They miss people who have COVID, and they test positive for some who don't have it. 

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Pancho

Pancho 44986

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NCAA Spring Sports

Division I Championships

The NCAA administers 90 championships in 24 sports for its member institutions. Each championship is run by a committee of coaches and administrators from NCAA member schools who are experts in their sport.

 
 
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Red Five

Red Five 40887

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I cancelled my trip to Port A next week. When I called the homeaway people, I asked if it was too late to cancel my reservation. "Oh no, you can still cancel."

"Oh yeah? That's good."

"You can't get any of your money refunded though".

"Then why the hell would I give a shit if I can cancel or not?"

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NoName

NoName 16397

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2 minutes ago, Pato del Muerto said:

If they grant an extra year of eligibility to seniors, that’s going to play havoc on scholarship limits and recruiting, especially for the 2021 classes. 

can't imagine they do anything like this

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Js1

Js1 85563

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4 minutes ago, Pato del Muerto said:

If they grant an extra year of eligibility to seniors, that’s going to play havoc on scholarship limits and recruiting, especially for the 2021 classes. 

Couldn't they just mandate you don't count all returning super seniors against the limit?  It would just be a 1 year reprieve.

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Digdogger

Digdogger 1344

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8 minutes ago, Pancho said:

NCAA Spring Sports

Division I Championships

The NCAA administers 90 championships in 24 sports for its member institutions. Each championship is run by a committee of coaches and administrators from NCAA member schools who are experts in their sport.

 
 

Looks like the rodeo is still a go, thankfully

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dingleberryswitzer

dingleberryswitzer 2724

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4 minutes ago, Pato del Muerto said:

If they grant an extra year of eligibility to seniors, that’s going to play havoc on scholarship limits and recruiting, especially for the 2021 classes. 

 

2 minutes ago, NoName said:

can't imagine they do anything like this

For basketball no, but has track and baseball finished more than a quarter of their season?  Everyone could be in line for a redshirt.

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Foosters

Foosters 17885

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10 minutes ago, InkaUtexas said:

yep. I am fucking amazed at how the school here is handling it. 

I'm in Los Angeles and the lack of any response whatsoever is staggering. All LAUSD has done is cancel sporting events. I work in the criminal justice system where I am in frequent contact with the homeless and the incarcerated. We're basically being told to be careful and that they are working on getting hand sanitizer to us. Otherwise, business as usual.

There are going to be a lot of people in positions of power who will have a lot of explaining to do when this is all said and done.

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