Cont: 2019-nCoV / Corona virus Pt 3

[Marcus]

1 mask a day per person = 10's of billions of masks manufactured a week.

3M is currently producing 100 million N95's a month. not enough to meet total demand but it is making a dent in the needs of medical personnel.

 

[pipelineaudio]

3 days of 100+ case increases in my state. Deaths starting.

Our shelter order is falling apart, people out everywhere.

Learn from our mistakes

Where are you?

 

[Delphic Oracle]

Where are you?

Missouri, U.S.

 

[Planigale]

So an irritant to me. The clever people here might have a solution for. We have four bedded bays, all the patients are covid positive. Anything that goes in is contaminated and stays in or is binned unless it can be cleaned. (Or has to be able to be bagged before going in, be removed from the bag afterwards and be able to be surface cleaned.) So if I go into round on the patients or the nurses are in doing observations, we want to go in see all the patients then go out rather than going in and out after seeing each patient and having to use four sets of PPE rather than one set. The difficulty is that the notes and obs charts can't come in, how do we reliably document our findings? Currently observations are written on a scrap of paper, stuck to the inside of the window so that someone outside or yourself can later transcribe them into the charts. I see a patient then go to the door and dictate my exam notes / plans to someone who writes them in the notes after I see each patient.

Is there a better solution? It has to be cheap and quickly available. Walkie talkies aren't approved for use near medical equipment, and are a bit expensive, and may be poor in confidentiality. We are looking to get white boards so we can hold up messages to people outside e.g. 'need a 40% oxygen mask', rather than relying on scrap paper.

 

[Ulf Nereng]

A dictaphone app on a phone that stays in the room, perhaps? You'd record all the information on it and then relay it to another phone that is outside the room before leaving. Maybe one of you have an old phone you don't use anymore.

ETA: Another thought; on the assumption that there are schools in the neighborhood that are now closed... these might have equipment that you could commandeer (or ask nicely for!), like whiteboards, overhead projectors, loudspeakers, etc. Maybe ask someone there to conjure up a solution for it.

 

[Blue Mountain]

Is there a better solution? It has to be cheap and quickly available. Walkie talkies aren't approved for use near medical equipment, and are a bit expensive, and may be poor in confidentiality. We are looking to get white boards so we can hold up messages to people outside e.g. 'need a 40% oxygen mask', rather than relying on scrap paper.

The way I see it, the only way to get information out of the room without relying on potentially contaminated physical media is by using something on the electromagnetic spectrum. We're taking radio waves (walkie-talkie, already rejected as a method), WiFi (but computers are expensive and hard to disinfect), sound waves (shouting through the closed door, with a risk of reception errors [listener misunderstanding what was said],) visible light, or Hawking radiation from a black hole (which are in short supply and take a long time to transfer information.) The idea of writing notes on scrap paper or whiteboard falls into the "visible light" category.

Are the notes to be put on the charts consistent enough that one could create a paper form with a bunch of checkboxes and/or fill-in boxes? The form goes into the room, the doctor or nurse puts the needed information into the boxes and ticks appropriate checkboxes, then tapes that to the window.

If such a form is possible, I'd recommend putting all the fill-in boxes down the left or right-hand side so they can be quickly scanned and transcribed. The people on the outside could take a picture of the completed form with a smartphone and take that back to the station for transcription. If the emergency goes on long enough, it may be possible to develop and app that would do much of the transcription for you.

 

[Planigale]

The way I see it, the only way to get information out of the room without relying on potentially contaminated physical media is by using something on the electromagnetic spectrum. We're taking radio waves (walkie-talkie, already rejected as a method), WiFi (but computers are expensive and hard to disinfect), sound waves (shouting through the closed door, with a risk of reception errors [listener misunderstanding what was said],) visible light, or Hawking radiation from a black hole (which are in short supply and take a long time to transfer information.) The idea of writing notes on scrap paper or whiteboard falls into the "visible light" category.

Are the notes to be put on the charts consistent enough that one could create a paper form with a bunch of checkboxes and/or fill-in boxes? The form goes into the room, the doctor or nurse puts the needed information into the boxes and ticks appropriate checkboxes, then tapes that to the window.

If such a form is possible, I'd recommend putting all the fill-in boxes down the left or right-hand side so they can be quickly scanned and transcribed. The people on the outside could take a picture of the completed form with a smartphone and take that back to the station for transcription. If the emergency goes on long enough, it may be possible to develop and app that would do much of the transcription for you.

This is probably what we will do. We created a standard assessment form over the weekend we can have one copy in the room complete it stick it to the window then transcribe into a duplicate form.

 

[Planigale]

A dictaphone app on a phone that stays in the room, perhaps? You'd record all the information on it and then relay it to another phone that is outside the room before leaving. Maybe one of you have an old phone you don't use anymore.

Yes we had though about an old phone and blue tooth connecting it. But that calls for an awful lot of old phones! There are lots of four bedded bays, the single rooms are less of an issue.

 

[Klimax]

1 mask a day per person = 10's of billions of masks manufactured a week.

Not all masks are single-use and some kill virus outright.
(Example: from Czech company https://shop.respilon.com/respiratory-protection/respimask-vk-virus-killer--adult-/)

 

[Myriad]

So an irritant to me. The clever people here might have a solution for. We have four bedded bays, all the patients are covid positive. Anything that goes in is contaminated and stays in or is binned unless it can be cleaned. (Or has to be able to be bagged before going in, be removed from the bag afterwards and be able to be surface cleaned.) So if I go into round on the patients or the nurses are in doing observations, we want to go in see all the patients then go out rather than going in and out after seeing each patient and having to use four sets of PPE rather than one set. The difficulty is that the notes and obs charts can't come in, how do we reliably document our findings? Currently observations are written on a scrap of paper, stuck to the inside of the window so that someone outside or yourself can later transcribe them into the charts. I see a patient then go to the door and dictate my exam notes / plans to someone who writes them in the notes after I see each patient.

Is there a better solution? It has to be cheap and quickly available. Walkie talkies aren't approved for use near medical equipment, and are a bit expensive, and may be poor in confidentiality. We are looking to get white boards so we can hold up messages to people outside e.g. 'need a 40% oxygen mask', rather than relying on scrap paper.

How about a wired intercom? The outside portion could be a wired headset (plug it into a jack outside the room), for patient privacy.

Might not be available off the shelf as one product. Is there anyone there (a home theater hobbyist, maybe) who can throw together a system like that out of off the shelf components?

 

[Ivor the Engineer]

Not all masks are single-use and some kill virus outright.
(Example: from Czech company https://shop.respilon.com/respiratory-protection/respimask-vk-virus-killer--adult-/)

A bargain at only 78 euros.

 

[lomiller]

If someone else has posted this before my apologies.

I am puzzled by the figures I see for infection rates and death rates in different countries.

Looking at Italy and Spain: Both have similar infection rates per 1mil population and similar deaths per 1mil population whereas the USA and Germany are dramatically less.

For example with a total number of infections of 120,500 the USA has had just over 2,000 deaths whereas Italy with total infections of 92,500 has had total deaths of just over 10,000.

Now some of this can be explained I suppose by the time the infections happened. The longer the infection has been present in the body the greater chance of death for example. Another reason could be better medical help in the USA. I would be skeptical about this but have little to no knowledge of it.

The rate of spread of the virus in the different countries is puzzling also. Why did it spread so rapidly in Spain and Italy but not so quickly in Germany. Different social practices and more diligent observation of social distancing perhaps or what?

In addition to testing mentioned yesterday, another thing to remember is that you can't really use active cases to calculate death rates, at least not directly. Active cases are people who could still die of could still survive. Among cases that have been closed, the US has a higher percentage of fatalities than Spain but lower than Italy.

 

[Skeptic Ginger]

Nature disagrees.

That's an opinion blog, not a scientific paper.

I didn't say it provides no resistance to smallpox. I said I hadn't heard that.

As for the mutation occurring previously, the distribution of the CCR5 deletion suggests otherwise. It exists in a small percentage of Europeans. It wasn't found in Africa which surely had plenty of smallpox.

Not sure what else you think in is that article that contradicts what I said.

The mutation is not completely fool proof. Cases of homozygous carriers that have become infected with HIV have been reported. These few exceptions have dissuaded health officials from fully supporting genetic tests over ethical concerns

This is opinion. I don't think that's what happened. We didn't want people with 2 copies of the mutation to believe they were immune and therefore ignore precautions. Research on the mechanism of resistance certainly wasn't ignored because the resistance wasn't complete.

 

[Skeptic Ginger]

Okay, a couple of points here:

1. "known to spread through air"?

My understanding is that this is in very limited circumstances when the virus can become aerosolized, such as certain medical procedures. Otherwise it is mostly passed through droplets, is it not? If I misunderstand, or am wrong on this, could you please provide a link to this.

The evidence is it is more airborne that previously claimed. Premature guidelines before the evidence was in led to this misbelief in limited aerosol spread.

It's still not clear. How did 30+ members of a meeting of 54 get infected? Did they all touch contaminated hands or doorknobs, or did it spread across the table? We don't know. That public health officials continue to repeat this mantra of minimal airborne spread when the evidence suggests otherwise and there is not clear and convincing evidence of minimal airborne spread is going to go down in history as another great blunder.

2. "masks are useless"

I am very doubtful of this despite having seen it claimed very often. In one of the podcasts that pipelineaudio posted TWiV, the expert (with covid-19) who is being interviewed mentions studies that show mask wearing reduces transmission of the virus (I believe there are also studies showing this is true in things like flu which are also passed on in droplets more than as an airborne virus). He explains how in China mask-wearing is almost ubiquitous now and suggests that the lack of mask-wearing (among other things) are one of the reasons is could be spreading so fast in the US (and other places).

Do you have some evidence for saying masks are useless other than an assumption that if it passes through the air the masks cannot have any effect?

Masks are not useless. They provide partial but not complete protection. And theoretically if everyone wore them we would prevent much of the spread has been downplayed in this country in the effort to conserve PPE for health care workers.

That's fine to protect first-line workers. And in this case, sadly if public health guideline were for everyone to wear masks people would hoard them unnecessarily.

I hope eventually when there are sufficient mask supplies it is recommended everyone wear them to prevent spread from infected people to uninfected people.

 

[Skeptic Ginger]

Single data point/anecdote: Karen tested negative for influenza. For some reason, same clinic did not test me.

That moves the bar toward COVID, but there are false negative flu tests for multiple reasons.

So maybe 50:50? Until antibody tests can look for past infection, you won't know with any certainty.

 

[Skeptic Ginger]

Regarding my linking to an article saying coronavirus may have been circulating in the US earlier than we thought, and that my wife and I possibly may have had it...



Well, at least I appreciate your certainty - and brevity!

Our local walk-in clinic, where we got diagnosed with bronchitis and sinusitis and prescribed meds, said they were swamped with cases like ours that were not the flu*, but differed from the common cold in symptoms, severity and duration. The local Walmart’s shelves were out of several brands of cough syrup.

Anyway, since no one back then was tested for coronavirus, I just don’t see any evidence that would validate your certainty, and at least circumstantial evidence that something different was circulating, at least here in E Tennessee.

*I mentioned my wife’s test for the flu came back negative. A week later they did not test me, though my symptoms mirrored hers, albeit behind by about a week. My thought is they had enough negative tests for flu that the working assumption became that this was something else going around.

That is very suggestive anecdotal evidence.

Here in WA where it was proved to have been circulating for weeks before it was recognized supports your suspicion. The way it was shown was to find the first case, in our state that was a person exposed in China that was hospitalized here and compare that virus genome to a recent infection. There was a genetic marker showing the newer cases stemmed from the first case.

Were there any cases or quarantined persons in your area early on?

And it still can't be ruled out it wasn't something else altogether. There are several candidate pathogens like parainfluenza.

 

[Skeptic Ginger]

Oh, by the way, a mask is only good for a short time. I learned the hard way that repeated use causes germs to build up and they get to be a source of infection. And strictly speaking, the masks should be changed each time a doctor goes from one possible infected patient to the other.

I got a lot of masks before they ran out. A box full. But I will use a cut-up old bedsheet with rubber bands and wash it frequently. For a clear face shield, one can use the overhead projector transparent sheets and some tape. For gloves I know people are using plastics bags with rubber bands to keep them on.

A very important issue is taking off the PPE. That is where medical staff are getting infected. A friend of ours is tasked with visiting confirmed cases here in South Africa in order to do tracing. I have given her a lot of advice.

I will be making my own ventilator here at home. I am very inventive and have all the stock (mostly wood and plastic) and the tools to do so. It should not take long. It will not have ball bearings and the latest electronics but it should work for at least 30 days.

You might find this of some use:

N95 Filtering Facepiece Respirator Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination and Reuse

 

[Dr.Sid]

In addition to testing mentioned yesterday, another thing to remember is that you can't really use active cases to calculate death rates, at least not directly. Active cases are people who could still die of could still survive. Among cases that have been closed, the US has a higher percentage of fatalities than Spain but lower than Italy.

You also have to take into account number of test being made, and methodology used. Some countries with large number of cases were doing quite well actually, like South Korea.
Especially in the beginning, the cases curve is mostly about how good you are at testing.
Deaths are much better metric, but even that's not perfect. First, US is still only starting. Deaths lag 1-2 weeks behind infections. Second only people previously tested positive and then dying are considered as 'deaths from coronavirus'. Most countries do not test corpses. So this number is affected by the same issues as the confirmed cases.
In other words .. all those numbers are just for rough orientation. You can't compare 2 vastly different countries.
If you want to know how bad it is, look into hospitals. If they have patients in the hallways, it's bad. If their morgue is full, it's bad.

 

[Sherkeu]

Why Bats Make Such Good Viral Hosts (TheScientist May 2018)

What has puzzled researchers for a long time is why bats don’t appear to get sick from their unusually high microbial loads. The question has been nagging Peng Zhou, a virologist at China’s Wuhan Institute of Virology, for more than a decade, ever since he took part in a survey of bat populations in southern China. Zhou and his colleagues were looking for the strain of the SARS coronavirus responsible for the 2003 outbreak that sickened more than 8,000 people worldwide and killed nearly 800. “We started to think, why bats?” he says.
...
Despite STING’s (STimulator of INterferon Genes) role in viral responses, Zhou believes that the mutation may be conserved in bats for a different reason, one related to another aspect of bats’ livelihood. Fragments of the bats’ own DNA can also be released into their cells’ cytoplasm as a byproduct of the strenuous effort bats make during flight, Zhou says. This has led him to the hypothesis that the mutation originally provided an evolutionary advantage to bats by preventing their immune systems from boiling over every time the animals fly.

...[Zhengli] Shi is aware of these gaps. “We hope to get the full picture in, I don’t know, 10 years or maybe 20 years,” she says.
Zhou, meanwhile, likes to turn the problem on its head. Rather than thinking that bats “tolerate” so many viruses, he suggests that it’s more appropriate to think of the viruses choosing their hosts. His research shows how bats’ immune systems have built an ideal home for viruses to thrive for a long time without killing their hosts, he says. “Think about it. . . [The bat] immune system is just perfect for viruses.”

In November 2019, Zhou had been recruiting for 1 or 2 post docs to help with research in Wuhan on bats/humans/corona viruses. Doesn't seem he had time to get the new talent as the ad is still there.

 

[Skeptic Ginger]

What in the world are you talking about? What does Trump have to do with the quick spread of the virus in NYC?

He failed to recognize the risk and act prophylactically.

CNN: Washington Post: US intelligence warned Trump in January and February as he dismissed coronavirus threat

He had dismantled much of the response team, not refilled supplies. Was more worried about funding his wall and scapegoating brown people and Muslims.

He downplayed the risk and made stupid 'magical gestures' like banning Chinese but not Americans from China, and much later banned flights from the EU but not the UK (later changed). All the while lack of careful monitoring allowed international flights from all over the world to pass through NY igniting a firestorm.

That's what incompetrump did.