All things Chinese CoronaVirus

[njbill]

Don’t know about other parks, but Fairmont Park in Philadelphia is over 14 square miles while Central Park in New York is a little over one square mile in size.

[RedFromMI]

Interesting note from Josh Marshall at TalkingPointsMemo about treatment for COVID-19 when on a ventilator:

Possible Developments in the Treatment of Acute COVID-19

https://talkingpointsmemo.com/edblog/po ... e-covid-19

Basically, one particular physician (New York City emergency and critical care physician Cameron Kyle-Sidell) has noted that he thinks the standard protocols they are using for treating CV is not right.

He said that what he is seeing in his ICU does not look like pneumonia but rather oxygen deprivation (hypoxia). Thus the treatment shouldn’t be focused on high pressure for someone whose lungs aren’t able to function but rather more effective additional oxygen. Critically, he argued the high pressure ventilation might be damaging the lungs. He also said his impressions were based both on his ICU work over the previous two weeks and conversations with other clinicians around the country.

Marshall:

For all those reasons I was intrigued but didn’t write anything up on it, though I was eager to hear from other clinicians who might be evaluate what he was saying. I’m writing about it now because of this article I saw in Medscape, a publication for clinicians and researchers (you need to sign up for access but it’s free). Yesterday Dr. John Whyte, chief medical officer at WebMD, published an interview with Kyle-Sidell discussing his ICU observations. The Medcape article notes that the American Journal of Respiratory and Critical Care and Intensive Care Medicine are publishing, respectively, a letter and an editorial by Dr. Luciano Gattinoni of the University of Gottingen who makes a similar set of observations and recommendations to those in Kyle-Sidell’s videos. Gattinoni’s findings were based on his and his colleagues clinical experience in Germany as well as discussions with doctors in northern Italy.

From Medcape …

In the editorial, Dr. Gattinoni and his colleagues explained further that ventilator settings should be based on physiological findings — with different respiratory treatment based on disease phenotype rather than using standard protocols.

“This, of course, is a conceptual model, but based on the observations we have this far, I don’t know of any model which is better,” he said in an interview.

Anecdotal evidence is increasingly demonstrating that this proposed physiological approach is associated with much lower mortality rates among COVID-19 patients, he said.

While not willing to name the hospitals at this time, he said that one center in Europe has had a 0% mortality rate among COVID-19 patients in the intensive care unit when using this approach, compared with a 60% mortality rate at a nearby hospital using a protocol-driven approach.

By no means is this conclusive (read the rest of the article and look at the doctor's videos to see more) but it does show how smart physicians can make improvements on the fly that could be quite beneficial...

[holmes435]

Don’t know about other parks, but Fairmont Park in Philadelphia is over 14 square miles while Central Park in New York is a little over one square mile in size.

Hey, I've played lacrosse there!

While I looked at Haverford during my college search, I hadn't realized until a visit a few years ago just how many colleges and universities and prep schools are on Lincoln Hwy / 30. Was wild driving down the first time and seeing one after the other.

[jhu72]

Interesting note from Josh Marshall at TalkingPointsMemo about treatment for COVID-19 when on a ventilator:

Possible Developments in the Treatment of Acute COVID-19

https://talkingpointsmemo.com/edblog/po ... e-covid-19

Basically, one particular physician (New York City emergency and critical care physician Cameron Kyle-Sidell) has noted that he thinks the standard protocols they are using for treating CV is not right.

He said that what he is seeing in his ICU does not look like pneumonia but rather oxygen deprivation (hypoxia). Thus the treatment shouldn’t be focused on high pressure for someone whose lungs aren’t able to function but rather more effective additional oxygen. Critically, he argued the high pressure ventilation might be damaging the lungs. He also said his impressions were based both on his ICU work over the previous two weeks and conversations with other clinicians around the country.

Marshall:

For all those reasons I was intrigued but didn’t write anything up on it, though I was eager to hear from other clinicians who might be evaluate what he was saying. I’m writing about it now because of this article I saw in Medscape, a publication for clinicians and researchers (you need to sign up for access but it’s free). Yesterday Dr. John Whyte, chief medical officer at WebMD, published an interview with Kyle-Sidell discussing his ICU observations. The Medcape article notes that the American Journal of Respiratory and Critical Care and Intensive Care Medicine are publishing, respectively, a letter and an editorial by Dr. Luciano Gattinoni of the University of Gottingen who makes a similar set of observations and recommendations to those in Kyle-Sidell’s videos. Gattinoni’s findings were based on his and his colleagues clinical experience in Germany as well as discussions with doctors in northern Italy.

From Medcape …

In the editorial, Dr. Gattinoni and his colleagues explained further that ventilator settings should be based on physiological findings — with different respiratory treatment based on disease phenotype rather than using standard protocols.

“This, of course, is a conceptual model, but based on the observations we have this far, I don’t know of any model which is better,” he said in an interview.

Anecdotal evidence is increasingly demonstrating that this proposed physiological approach is associated with much lower mortality rates among COVID-19 patients, he said.

While not willing to name the hospitals at this time, he said that one center in Europe has had a 0% mortality rate among COVID-19 patients in the intensive care unit when using this approach, compared with a 60% mortality rate at a nearby hospital using a protocol-driven approach.

By no means is this conclusive (read the rest of the article and look at the doctor's videos to see more) but it does show how smart physicians can make improvements on the fly that could be quite beneficial...

Interesting observation.

[calourie]

https://covid19.healthdata.org/united-states-of-america

Another interesting interactive site with numbers both worldwide and national brought to you by the non-hoaxy Institute for Health Metrics and Evaluation at the University of Washington. They project the numbers for the disease going forward for the time being through the 1st of August. Under the United States heading there are state by state projections, and they provide a very sound basis for determining what the experts project the infected and mortal numbers will be on a national and state by state basis, given current (and every couple of days) updated data. At this moment for the US as a whole they project peak medical resource use to happen on April 15, with US deaths peaking at around 3200 per day a day later. Overall they estimate 81,000 US deaths.
These numbers assume maximum personal distancing on the part of the public, and make no assumptions regarding the efficacy of a possible "miracle" cure such as Hydroxy or any other drug which may turn out to be effective. In the event one proves to be so, the IHME will adjust their projections accordingly. The numbers presented provide a very effective basis for comparing what this group of experts expects and what actually ends up unfolding. They are not intended to be "the sky is falling" fodder.

[jhu72]

The past 24 hours have been the most deadly - 1930 deaths (GMT 24 hour period) to date. 12800 deaths counted to date.

[Jim Malone]

30 an hour around me. Up from 26 on Friday.

The flu numbers are massive compared to COVID-19, yet the flu did not jam up hospitals and morgues the way the coronavirus is as well as expenditure of healthcare protective equipment and required medical equipment.

The past 24 hours have been the most deadly - 1930 deaths (GMT 24 hour period) to date. 12800 deaths counted to date.

[ggait]

Those UW projections were the more optimistic ones that CDC Director Redfield was talking about today. 82k deaths vs. the 100-240k coming from Fauci and Birks.

Redfield's spin (below) on the UW projections seems pretty misleading/Trumpian though.

First, UW's model has a range of deaths from 49-136k. So it is not just 82k.

Second, both UW and Fauci/Birks projections assume social distancing stays in place.

Third, the UW projections haven't dropped all that much. Their base case has been under 100k for quite some time.

A more responsible spin would have been "if we seriously commit to keeping up the social distancing until the end of May, we may be able to keep the death toll under 100k. Which is less than what some of the models had previously been predicting.


“If we just social distance, we will see this virus and this outbreak basically decline, decline, decline. And I think that's what you're seeing,” said Robert Redfield, the Director of the Centers for Disease Control. “I think you're going to see the numbers are, in fact, going to be much less than what would have been predicted by the models,” he said.

[jhu72]

Deaths are doubling every 5 days now. Death curve is no where near flat. By mid-month we will be at 30K deaths and still likely rising. The rate has slowed slightly since April 1.

[calourie]

Those UW projections were the more optimistic ones that CDC Director Redfield was talking about today. 82k deaths vs. the 100-240k coming from Fauci and Birks.

Redfield's spin (below) on the UW projections seems pretty misleading/Trumpian though.

First, UW's model has a range of deaths from 49-136k. So it is not just 82k.

Second, both UW and Fauci/Birks projections assume social distancing stays in place.

Third, the UW projections haven't dropped all that much. Their base case has been under 100k for quite some time.

A more responsible spin would have been "if we seriously commit to keeping up the social distancing until the end of May, we may be able to keep the death toll under 100k. Which is less than what some of the models had previously been predicting.


“If we just social distance, we will see this virus and this outbreak basically decline, decline, decline. And I think that's what you're seeing,” said Robert Redfield, the Director of the Centers for Disease Control. “I think you're going to see the numbers are, in fact, going to be much less than what would have been predicted by the models,” he said.

The more interesting numbers for me, ggait, are the April 16 peak with 3200 deaths. That's nine days away and will be able to be assessed as to if it is anywhere close to reality or not. I'll be amazed if the numbers can be honed anywhere near that closely, but it will be informative to follow what happens over the next two weeks. I thoroughly expect some intriguing fluctuations, particularly from a state by state stand point.

[youthathletics]

Interesting how CDC uses death counts solely based on a positive for cv19, when there may be other circumstances.

Which goes back to earlier discussions...how can we be certain it is CV 19 that was cause of death?

[Typical Lax Dad]

Interesting how CDC uses death counts solely based on a positive for cv19, when there may be other circumstances.

Which goes back to earlier discussions...how can we be certain it is CV 19 that was cause of death?

We can't be.

[wgdsr]

Interesting note from Josh Marshall at TalkingPointsMemo about treatment for COVID-19 when on a ventilator:

Possible Developments in the Treatment of Acute COVID-19

https://talkingpointsmemo.com/edblog/po ... e-covid-19

Basically, one particular physician (New York City emergency and critical care physician Cameron Kyle-Sidell) has noted that he thinks the standard protocols they are using for treating CV is not right.

He said that what he is seeing in his ICU does not look like pneumonia but rather oxygen deprivation (hypoxia). Thus the treatment shouldn’t be focused on high pressure for someone whose lungs aren’t able to function but rather more effective additional oxygen. Critically, he argued the high pressure ventilation might be damaging the lungs. He also said his impressions were based both on his ICU work over the previous two weeks and conversations with other clinicians around the country.

Marshall:

For all those reasons I was intrigued but didn’t write anything up on it, though I was eager to hear from other clinicians who might be evaluate what he was saying. I’m writing about it now because of this article I saw in Medscape, a publication for clinicians and researchers (you need to sign up for access but it’s free). Yesterday Dr. John Whyte, chief medical officer at WebMD, published an interview with Kyle-Sidell discussing his ICU observations. The Medcape article notes that the American Journal of Respiratory and Critical Care and Intensive Care Medicine are publishing, respectively, a letter and an editorial by Dr. Luciano Gattinoni of the University of Gottingen who makes a similar set of observations and recommendations to those in Kyle-Sidell’s videos. Gattinoni’s findings were based on his and his colleagues clinical experience in Germany as well as discussions with doctors in northern Italy.

From Medcape …

In the editorial, Dr. Gattinoni and his colleagues explained further that ventilator settings should be based on physiological findings — with different respiratory treatment based on disease phenotype rather than using standard protocols.

“This, of course, is a conceptual model, but based on the observations we have this far, I don’t know of any model which is better,” he said in an interview.

Anecdotal evidence is increasingly demonstrating that this proposed physiological approach is associated with much lower mortality rates among COVID-19 patients, he said.

While not willing to name the hospitals at this time, he said that one center in Europe has had a 0% mortality rate among COVID-19 patients in the intensive care unit when using this approach, compared with a 60% mortality rate at a nearby hospital using a protocol-driven approach.

By no means is this conclusive (read the rest of the article and look at the doctor's videos to see more) but it does show how smart physicians can make improvements on the fly that could be quite beneficial...

Interesting observation.

i've seen dozens of chest xrays in the last month and basically just see ribs. how can those and all indications not be caught by more than a few people?

weird. i have high confidence medical science will figure it out. question is they're on the clock and trying to learn on the fly in truncated time.

[Trinity]

https://porter.house.gov/uploadedfiles/ ... but_us.pdf

Rep Katie Porter’s report on our readiness.

[njbill]

Interesting how CDC uses death counts solely based on a positive for cv19, when there may be other circumstances.

Which goes back to earlier discussions...how can we be certain it is CV 19 that was cause of death?

We can't be.

Of course the statistics won’t be 100% accurate. Death statistics never are. Everybody probably has a personal story where they know the cause of death on a death certificate wasn’t accurate. But it is the information we have. In terms of COVID-19, the death numbers could be too high or too low (cause was actually COVID-19 but the patient was never tested). We simply don’t know at this point. Maybe there will be a way to clean up some of the inaccuracies down the road.

[njbill]

John Prine has died. Very sad news.

https://www.yahoo.com/entertainment/joh ... 01061.html

[kramerica.inc]

Time for a vodka and ginger ale.

RIP John Prine.

https://www.google.com/amp/s/www.rollin ... 53684/amp/

John, you were that guy that everyone felt like you were their friend, even though you’d never met.

When I get to heaven, I'm gonna shake God's hand
Thank him for more blessings than one man can stand
Then I'm gonna get a guitar and start a rock-n-roll band
Check into a swell hotel; ain't the afterlife grand?
And then I'm gonna get a cocktail: vodka and ginger ale
Yeah, I'm gonna smoke a cigarette that's nine miles long
I'm gonna kiss that pretty girl on the tilt-a-whirl
'Cause this old man is goin' to town
Then as God as my witness, I'm gettin' back into showbusiness
I'm gonna open up a nightclub called "The Tree of Forgiveness"
And forgive everybody ever done me any harm
Well, I might even invite a few choice critics, those syph'litic parasitics
Buy 'em a pint of [?] and smother 'em with my charm
'Cause then I'm gonna get a cocktail: vodka and ginger ale
Yeah I'm gonna smoke a cigarette that's nine miles long
I'm gonna kiss that pretty girl on the tilt-a-whirl
Yeah this old man is goin' to town
Yeah when I get to heaven, I'm gonna take that wristwatch off my arm
What are you gonna do with time after you've bought the farm?
And them I'm gonna go find my mom and dad, and good old brother Doug
Well I bet him and cousin Jackie are still cuttin' up a rug
I wanna see all my mama's sisters, 'cause that's where all the love starts
I miss 'em all like crazy, bless their little hearts
And I always will remember these words my daddy said
He said, "Buddy, when you're dead, you're a dead pecker-head"
I hope to prove him wrong, that is, when I get to heaven
'Cause I'm gonna have a cocktail: vodka and ginger ale
Yeah I'm gonna smoke a cigarette that's nine miles long
I'm gonna kiss that pretty girl on the tilt-a-whirl
Yeah this old man is goin' to town
Yeah this old man is goin' to town

https://open.spotify.com/track/5O0h2Fq8 ... wMwA_COzAQ

[jhu72]

Usual suspects acting stupidly.

[Typical Lax Dad]

Interesting how CDC uses death counts solely based on a positive for cv19, when there may be other circumstances.

Which goes back to earlier discussions...how can we be certain it is CV 19 that was cause of death?

We can't be.

Of course the statistics won’t be 100% accurate. Death statistics never are. Everybody probably has a personal story where they know the cause of death on a death certificate wasn’t accurate. But it is the information we have. In terms of COVID-19, the death numbers could be too high or too low (cause was actually COVID-19 but the patient was never tested). We simply don’t know at this point. Maybe there will be a way to clean up some of the inaccuracies down the road.

I believe a death under count is more likely than a death over count.

https://www.cnn.com/2020/04/06/health/c ... index.html

[Laxgunea]

Usual suspects acting stupidly.

Possible Darwin Award winners?