Wuhan Coronavirus Resource Thread

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chola
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Re: Wuhan Coronavirus Resource Thread

Postby chola » 01 Apr 2020 16:49

This is a pretty harrowing response. But herd immunity might an advantage for any military that has it over ones that don't?

The Navy is composed of mostly healthy young people. The idea is the death rate would be very low.

https://www.stripes.com/news/pacific/herd-immunity-could-keep-coronavirus-afflicted-carriers-in-the-fight-former-navy-captain-says-1.624433


TOKYO — The Navy should encourage herd immunity for crews on aircraft carriers in the western Pacific, rather than quarantine sailors ashore who need to be ready for action in the South China Sea, a defense expert and former Navy warship captain said Wednesday.

The San Diego-based USS Theodore Roosevelt aircraft carrier, which has been operating in the western Pacific, diverted to Guam last week after sailors aboard tested positive for coronavirus.

Their commander, Capt. Brett Crozier, wrote to Navy leaders Monday asking that sailors be quarantined and isolated ashore. The virus has sickened 150 to 200 sailors on the ship
...


That was in response to this:
https://www.sfchronicle.com/bayarea/article/Exclusive-Captain-of-aircraft-carrier-with-15167883.php
The captain of a nuclear aircraft carrier with more than 100 sailors infected with the coronavirus pleaded Monday with U.S. Navy officials for resources to allow isolation of his entire crew and avoid possible deaths in a situation he described as quickly deteriorating.

The unusual plea from Capt. Brett Crozier, a Santa Rosa native, came in a letter obtained exclusively by The Chronicle and confirmed by a senior officer on board the aircraft carrier Theodore Roosevelt, which has been docked in Guam following a COVID-19 outbreak among the crew of more than 4,000 less than a week ago.

“This will require a political solution but it is the right thing to do,” Crozier wrote. “We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset — our Sailors.”


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Re: Wuhan Coronavirus Resource Thread

Postby rgosain » 01 Apr 2020 17:01

Chola if the readiness of the USN in the WPacific is being compromised and degraded by this virus then the PRC without firing a shot, have degraded the preparedness and the ability of the USN to to operate in that theatre. The habit of the PRC of nurturing these viruses, and then letting them loose on the world in order to exploit the ensuing chaos, should be considered a failure of deterrrence. Instead what we have are the media and academia soft soaping the PRC.
Last edited by rgosain on 01 Apr 2020 17:08, edited 1 time in total.

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Re: Wuhan Coronavirus Resource Thread

Postby rgosain » 01 Apr 2020 17:07

del

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Re: Wuhan Coronavirus Resource Thread

Postby sajo » 01 Apr 2020 17:12

DrRatnadip wrote:Getting test for COVID in private hospitals is easier now as private labs are involved.. time lag between sample collection and getting actual report is considerable though.. I ordered test of three pts since last week.. Got reports after 2 days..
Many senior physicians and pulmonologists I met recently are very happy with GOI efforts exept unavailability of PPE kits.. I summerized opinions of people working in areas affected with pandemic..
1)Though they expect more cases in coming days nobody expects too many deaths in India..
2) Indians appear immune against severe form of disease.. Endemic arboviral infections gives cross immunity against other RNA viruses.. Almost universal BCG immunization is also positive factor
3) Our physicians and ICU staff is well trained in managing viral ARDS due to routine management of swine flu and other similar forms of ARDS
4) This infection has overall improved general understanding about handwashing, social distancing in public. This will decrease incidence of other transmittable diseases in India.
5) Expenditure towards health sector will hopefully increase as we significantly lag behind developed nations in this regard.
6) Many expect COVID 19 will become endemic disease in India.

These are general opinions of people working in COVID affected area I gathered during daily interaction..


Sir, first of all thanks your family for being a frontline combatant for this pandemic. Regarding PPE, are private hospitals not carrying any stocks of their own which can be utilized?
Also, despite claims of it being otherwise, the newspapers carry reports of COVID19 deaths in people who have no history of travel or contact with anyone who had here. Eg : The Erandwane guy who passed away in Deenanath or the Anganwadi sewika who is intubated at Bharati. So is Pune already in the community transmission phase?

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 17:18

https://m.timesofindia.com/city/pune/si ... 922140.cms

Many congratulations to courageous efforts by ICU team.. They have used combination anti viral/ anti malarial and anti biotic medications to treat ARDS.. Doctors aren't waiting for all sort of studies and relying on their clinical judgement and experience is good thing.. I was sick of one group publishing xyz drug is effective which was next day refused by other expert group finding faults in previous study.. Though peer reviwed scientific studies are important i believe treating physician is best judge regarding what drugs to be administered to perticular patient..

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Re: Wuhan Coronavirus Resource Thread

Postby sajo » 01 Apr 2020 17:21

DrRatnadip wrote:https://m.timesofindia.com/city/pune/sinhagad-road-woman-punes-first-critical-covid-19-patient-taken-off-ventilator-to-go-home-in-a-week/articleshow/74922140.cms

Many congratulations to courageous efforts by ICU team.. They have used combination anti viral/ anti malarial and anti biotic medications to treat ARDS.. Doctors aren't waiting for all sort of studies and relying on their clinical judgement and experience is good thing.. I was sick of one group publishing xyz drug is effective which was next day refused by other expert group finding faults in previous study.. Though peer reviwed scientific studies are important i believe treating physician is best judge regarding what drugs to be administered to perticular patient..



Thats great news! Her details (name etc) including the names of the Doctor who treated her initially were circulated in Social media which I personally found distressing, like names of wanted people are being circulated.

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 01 Apr 2020 17:23

DrRatnadip wrote:1)Though they expect more cases in coming days nobody expects too many deaths in India..
2) Indians appear immune against severe form of disease.. Endemic arboviral infections gives cross immunity against other RNA viruses.. Almost universal BCG immunization is also positive factor
3) Our physicians and ICU staff is well trained in managing viral ARDS due to routine management of swine flu and other similar forms of ARDS
4) This infection has overall improved general understanding about handwashing, social distancing in public. This will decrease incidence of other transmittable diseases in India.
5) Expenditure towards health sector will hopefully increase as we significantly lag behind developed nations in this regard.
6) Many expect COVID 19 will become endemic disease in India.



Wonderful news, Doctor saar! Can number 2 allow India to loosen up social distancing sooner rather than later and get the economy running again? (In the US, they've just added 30 more days.)

Much thanks for the info on the ground!

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 17:25

[/quote] Sir, first of all thanks your family for being a frontline combatant for this pandemic. Regarding PPE, are private hospitals not carrying any stocks of their own which can be utilized?
Also, despite claims of it being otherwise, the newspapers carry reports of COVID19 deaths in people who have no history of travel or contact with anyone who had here. Eg : The Erandwane guy who passed away in Deenanath or the Anganwadi sewika who is intubated at Bharati. So is Pune already in the community transmission phase?[/quote]

Private hospitals have stocks of PPE.. Its just not enough.. It is not available in market..
Lockdown was fairly early in pune and I dont think we are in community transmission phase yet..

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 17:45

chola wrote:
DrRatnadip wrote:1)Though they expect more cases in coming days nobody expects too many deaths in India..
2) Indians appear immune against severe form of disease.. Endemic arboviral infections gives cross immunity against other RNA viruses.. Almost universal BCG immunization is also positive factor
3) Our physicians and ICU staff is well trained in managing viral ARDS due to routine management of swine flu and other similar forms of ARDS
4) This infection has overall improved general understanding about handwashing, social distancing in public. This will decrease incidence of other transmittable diseases in India.
5) Expenditure towards health sector will hopefully increase as we significantly lag behind developed nations in this regard.
6) Many expect COVID 19 will become endemic disease in India.



Wonderful news, Doctor saar! Can number 2 allow India to loosen up social distancing sooner rather than later and get the economy running again? (In the US, they've just added 30 more days.)

Much thanks for the info on the ground!


I dont think it will be good idea to loosen up lockdown so early especially after seeing nizamuddin incident .. I think we must find ways to
1) increase isolation period in high risk groups ex elderly and those with known co morbidities
2) slowly allowing low risk groups i.e. young healthy individuals to resume routine activities .
If we can achieve this then we will get herd immunity without much sacrifice
Locking up Total population for extended periods will be counter productive.. But selective isolation of high risk groups is practically very difficult... Hope experienced members here can come with some suggestions..

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 01 Apr 2020 17:57

DrRatnadip wrote:
chola wrote:

Wonderful news, Doctor saar! Can number 2 allow India to loosen up social distancing sooner rather than later and get the economy running again? (In the US, they've just added 30 more days.)

Much thanks for the info on the ground!


I dont think it will be good idea to loosen up lockdown so early especially after seeing nizamuddin incident .. I think we must find ways to
1) increase isolation period in high risk groups ex elderly and those with known co morbidities
2) slowly allowing low risk groups i.e. young healthy individuals to resume routine activities .
If we can achieve this then we will get herd immunity without much sacrifice
Locking up Total population for extended periods will be counter productive.. But selective isolation of high risk groups is practically very difficult... Hope experienced members here can come with some suggestions..


Understood, Doctor. I was thinking after the current 21 days we can loosen quicker than later. And hopefully not add more days of confinement like in the West.

I totally agreed with you on both 1) and 2). Allow the low risk groups to resume activities while isolating the high risk ones.

I most agreed with you that extended periods of total isolation is counterproductive. There are too many in society that needs to work to survive. Eventually, they'll need to come out and find work to survive. 21 days is already a lifetime of hardship for many. More than that and I worry greatly.

If there is a built-in immunity then the GOI should take that into account. From a medical POV, is there any reasonable way to test the immunity theory and get a firm enough answer to allow government policy to be based on it, Sir?

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Re: Wuhan Coronavirus Resource Thread

Postby madhu » 01 Apr 2020 18:20

DrRatnadip sir,
whats your opinion about use of splitter for ventilator? i see that FDA has approved it for COVID19 patients. The reason i am asking is my friend owns a small 3D printer. thought of creating one and test.
i had floated this idea in my company when they asked for ideas. however one of the guy sent me a link that objects use of one ventilator to multiple people. here is the link.
the problem being a mechanical engineer i have no idea about that standard and what are the requirement that i need to comply with.

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Re: Wuhan Coronavirus Resource Thread

Postby vijayk » 01 Apr 2020 18:51

Is it possible to give BCG booster shots for senior citizens?

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Re: Wuhan Coronavirus Resource Thread

Postby sajo » 01 Apr 2020 18:57

vijayk wrote:Is it possible to give BCG booster shots for senior citizens?


This was the exact query I had. Dr. Google tells me it has varied efficacy but dosage is mentioned. Maybe just not routine.


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Re: Wuhan Coronavirus Resource Thread

Postby brar_w » 01 Apr 2020 19:03

chola wrote:This is a pretty harrowing response. But herd immunity might an advantage for any military that has it over ones that don't?

The Navy is composed of mostly healthy young people. The idea is the death rate would be very low.


Chola if the readiness of the USN in the WPacific is being compromised and degraded by this virus then the PRC without firing a shot, have degraded the preparedness and the ability of the USN to to operate in that theatre.


The Chinese Navy had its impacted vessels as well and their own readiness would also have likely suffered on account of the nation grappling with the virus for the last 2.5 months. The same will be with the USN. They've actually maintained a fair bit of ops tempo and did a FONOPS and at sea (in that theater) weapon launches just a few weeks ago.If there is a need they'll have to fight sick but the real problem, reading between the lines, is that the civilian demand in the US is consuming most of the resources like test kits, PPE, and other infrastructure and the fact that the USN is deployed worldwide at multiple bases so its not like the force is concentrated on a few ships in a few bases in the US. This will be a pretty big challenge to confront particularly in that theater, particularly given the fact that Trump fired the last Secretary of the Navy and a new one hasn't yet been fully confirmed. I expect Japan and South Korea to help out with this.

chola wrote:(In the US, they've just added 30 more days.)


The IHME model which Drs. Birx and Fauci are currently using, and Trump referenced yesterday, as a base case, assumes that the US stays in a 100% lockdown through end of May. We aren't even at a 100% lockdown currently so I don't see how they'll completely rip that band aid off by end of April as they currently claim. Would be interesting to study the impact of all this on divorce rates.
Last edited by brar_w on 01 Apr 2020 19:32, edited 2 times in total.

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 01 Apr 2020 19:16

^^^ Brar ji, true on the chini navy being clobbered as well. Worse since they had to deal with even longer.

I have not followed the chini mil side as much since the Wuhan virus but I do recall reading two month ago that the their new carrier was undergoing quarantine. This new carrier was very active until then tooling around the SCS and the Taiwan Strait wringing out its new crew. The thing had not moved from its berth in Dalian for months now the last I checked.
https://mobile.twitter.com/PLANavyNews/status/1244291802686844936

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 19:31

madhu wrote:DrRatnadip sir,
whats your opinion about use of splitter for ventilator? i see that FDA has approved it for COVID19 patients. The reason i am asking is my friend owns a small 3D printer. thought of creating one and test.
i had floated this idea in my company when they asked for ideas. however one of the guy sent me a link that objects use of one ventilator to multiple people. here is the link.
the problem being a mechanical engineer i have no idea about that standard and what are the requirement that i need to comply with.

I have never used splitters.. But obvious problems are
1) The air will go to more compliant lung...
2)the one who is away in circuiy will get less fio2 bt less removal of co2
3)Theorotical risk of mixing two virus strain ..which may pose threat..if spreads
4) risk of cross infection of other pathogen should be There

It may be a solution in desperate times but if one pt has better chance of survival venti should be given to that pt..

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Re: Wuhan Coronavirus Resource Thread

Postby pgbhat » 01 Apr 2020 19:40

https://twitter.com/epigiri/status/1245112071135649794
To be successful in tackling #covid19india,
@tarunb20
we urge for review of containment measures by the PM
@PMOIndia
of each state. We propose a syndromic approach as the way forward for containment measures. We plead to use #techn…https://lnkd.in/eUnQFXi

Our next challenge is the containment of Covid-19. India’s inability to effectively detect and isolate cases hinders this process. Instead, we need what we call syndromic approach. Consider every case having fever, cough, tiredness or difficulty in breathing as that of Covid-19. This can, with or without testing, limit the virus’ spread.

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 19:48

pgbhat wrote:https://twitter.com/epigiri/status/1245112071135649794
To be successful in tackling #covid19india,
@tarunb20
we urge for review of containment measures by the PM
@PMOIndia
of each state. We propose a syndromic approach as the way forward for containment measures. We plead to use #techn…https://lnkd.in/eUnQFXi

Our next challenge is the containment of Covid-19. India’s inability to effectively detect and isolate cases hinders this process. Instead, we need what we call syndromic approach. Consider every case having fever, cough, tiredness or difficulty in breathing as that of Covid-19. This can, with or without testing, limit the virus’ spread.


There are so many patients cough , fever ,tiredness.. Considering everybody as COVID 19 will consume significant efforts, money and manpower.. Labs have to test other diseases too .. We have to treat other patients too.. Giving too much attention to COVID will increase morbidity and mortality due to other causes including TB , non communicable diseases and even hunger..

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Re: Wuhan Coronavirus Resource Thread

Postby pgbhat » 01 Apr 2020 20:07

DrRatnadip wrote:
pgbhat wrote:https://twitter.com/epigiri/status/1245112071135649794



There are so many patients cough , fever ,tiredness.. Considering everybody as COVID 19 will consume significant efforts, money and manpower.. Labs have to test other diseases too .. We have to treat other patients too.. Giving too much attention to COVID will increase morbidity and mortality due to other causes including TB , non communicable diseases and even hunger..


Doctor,
Given our population how would this work out? Does this mean people have to suck it up with social distancing and reach out to government hospitals in case their condition worsens? Otherwise home quarantine? Also is this not a great time to bring in reforms in government hospitals and encourage a move towards "public" insurance model instead of mostly "private" insurance model? Public health and private hospitals do not seem to go along well.

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Re: Wuhan Coronavirus Resource Thread

Postby kvraghav » 01 Apr 2020 20:14

https://www.deccanchronicle.com/nation/current-affairs/010420/tamil-nadu-refuses-cross-bordering-of-unsold-milk-from-kerala-due-to-c.html
Looks like Kerala do not have the milk processing unit in the state owned milk federation and neither any private players doing this. They are dependent on Tamil Nadu for this. Is this state administration doing anything other than schools till 10th standard and propaganda?

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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 01 Apr 2020 20:27

Interesting article:

https://www.nature.com/articles/s41392-020-0148-4

Questions to doctors:

* What is this LYM% number?
* Can this be boosted through treatment?
* If so, is it going to help, i.e., is it likely to be the cause of the severe disease, or is it more like a symptom?

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 20:39

pgbhat wrote:
DrRatnadip wrote:
There are so many patients cough , fever ,tiredness.. Considering everybody as COVID 19 will consume significant efforts, money and manpower.. Labs have to test other diseases too .. We have to treat other patients too.. Giving too much attention to COVID will increase morbidity and mortality due to other causes including TB , non communicable diseases and even hunger..


Doctor,
Given our population how would this work out? Does this mean people have to suck it up with social distancing and reach out to government hospitals in case their condition worsens? Otherwise home quarantine? Also is this not a great time to bring in reforms in government hospitals and encourage a move towards "public" insurance model instead of mostly "private" insurance model? Public health and private hospitals do not seem to go along well.

I dont exactly know sir.. what I know is testing millions of patients for COVID if they have such trivial and common complaints is very costly.. and patients will need repeated testing as they may become positive after test..
Gradual withdrawal of quarantine with releasing least susceptible young population (fortunately we have it abundant)
in community and keeping away elderly population from public places is one solution.. But this need total public support and education especially second part.. I have seen many elderly pts in OPD boasting that they are not scared of death and all.. Poor families where elderlies can not be separated can be given temporary shelters.. But again this in mammoth task..

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Re: Wuhan Coronavirus Resource Thread

Postby Arun.prabhu » 01 Apr 2020 20:42

The focus on the tests is pretty hard to understand when up to 60% of the infected show no symptoms and do not qualify for the tests. Better to ignore the tests - which serve no purpose than to highlight the fear in people's hearts at this time - and to start focusing on treating symptoms, keeping patients alive and getting production of necessary medical equipments, drugs and accessories in order.

DrRatnadip wrote:
pgbhat wrote:
Doctor,
Given our population how would this work out? Does this mean people have to suck it up with social distancing and reach out to government hospitals in case their condition worsens? Otherwise home quarantine? Also is this not a great time to bring in reforms in government hospitals and encourage a move towards "public" insurance model instead of mostly "private" insurance model? Public health and private hospitals do not seem to go along well.

I dont exactly know sir.. what I know is testing millions of patients for COVID if they have such trivial and common complaints is very costly.. and patients will need repeated testing as they may become positive after test..
Gradual withdrawal of quarantine with releasing least susceptible young population (fortunately we have it abundant)
in community and keeping away elderly population from public places is one solution.. But this need total public support and education especially second part.. I have seen many elderly pts in OPD boasting that they are not scared of death and all.. Poor families where elderlies can not be separated can be given temporary shelters.. But again this in mammoth task..

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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 01 Apr 2020 20:43

DrRatnadip wrote:I have seen many elderly pts in OPD boasting that they are not scared of death and all..


If they are Hindus, ask them if they're ok with facing their next life with the consequences of having passed on the disease to some other vulnerable person, and they will fall in line pretty quickly.

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Re: Wuhan Coronavirus Resource Thread

Postby pgbhat » 01 Apr 2020 20:44

DrRatnadip wrote:I dont exactly know sir.. what I know is testing millions of patients for COVID if they have such trivial and common complaints is very costly.. and patients will need repeated testing as they may become positive after test..
Gradual withdrawal of quarantine with releasing least susceptible young population (fortunately we have it abundant)
in community and keeping away elderly population from public places is one solution.. But this need total public support and education especially second part.. I have seen many elderly pts in OPD boasting that they are not scared of death and all.. Poor families where elderlies can not be separated can be given temporary shelters.. But again this in mammoth task..


Hmm just wondering on scalable strategy.. does having antibody testing help here to mitigate the spread in some form and reduce retesting using RT-PCR?
Last edited by pgbhat on 01 Apr 2020 20:49, edited 1 time in total.

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 20:46

sudarshan wrote:Interesting article:

https://www.nature.com/articles/s41392-020-0148-4

Questions to doctors:

* What is this LYM% number?
* Can this be boosted through treatment?
* If so, is it going to help, i.e., is it likely to be the cause of the severe disease, or is it more like a symptom?

Lymphocyte percentage.. Its percent of lymphocytes (type of white blood cell) in total white blood cells.. Lymphocytes are primary responders against viral infection and some other infections like TB..so their count is expected to rise when body is trying to get rid of viral infection.. lymphopenia is decreased count and it may indicate increased destruction of them by viral load or overall bone marrow supression .. It is omnious sign often seen in rapidly detoriating patients..
There is no use of boosting them..

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 01 Apr 2020 20:49

sudarshan wrote:
DrRatnadip wrote:I have seen many elderly pts in OPD boasting that they are not scared of death and all..


If they are Hindus, ask them if they're ok with facing their next life with the consequences of having passed on the disease to some other vulnerable person, and they will fall in line pretty quickly.

Indian Doctors can scare anybody..Nothing to worry on this front.. :D

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Re: Wuhan Coronavirus Resource Thread

Postby sudarshan » 01 Apr 2020 21:08

DrRatnadip wrote:
sudarshan wrote:Interesting article:

https://www.nature.com/articles/s41392-020-0148-4

Questions to doctors:

* What is this LYM% number?
* Can this be boosted through treatment?
* If so, is it going to help, i.e., is it likely to be the cause of the severe disease, or is it more like a symptom?

Lymphocyte percentage.. Its percent of lymphocytes (type of white blood cell) in total white blood cells.. Lymphocytes are primary responders against viral infection and some other infections like TB..so their count is expected to rise when body is trying to get rid of viral infection.. lymphopenia is decreased count and it may indicate increased destruction of them by viral load or overall bone marrow supression .. It is omnious sign often seen in rapidly detoriating patients..
There is no use of boosting them..


Thanks for the response. At least it should be useful to predict who needs intensive treatment, then.

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Re: Wuhan Coronavirus Resource Thread

Postby Karan M » 01 Apr 2020 21:23

brar_w wrote:
Karan M wrote:Even for a quarantine facility, the above is not ideal. The point of quarantine is to quarantine you from others who are at risk due to you, and also quarantine you from them. The point is to not get symptomatic Covid at all.



This is an overflow set up for non acute positive COVID 19 patients. This could be patients who test positive, are hospitalized at one point or another from it or any other complication but have not yet deteriorated to a point where they need higher level of care or those who can be shifted down from an ICU or a step down facility. These types of overflow facilities are not going to be treated as either shared spaces for COVID 19 and non COVID 19 patients or as just pure quarantine facilities where the homeless can go (regardless of their COVID 19 diagnosis) to to comply with a stay at home restrictions. Those naturally would have to be designed differently. They are building these across America using the National Guard and the military field hospital and logistical equipment. Others have built similar set ups as well.Patients will be sent from the hospital to these facilities to make room in the hospital for more critical patients, or in some cases positive patients may directly be moved here if they don't have another place to go and/or are at an elevated risk for hospitalization. What Assam has done is in line what others around the world have done in response to the same anticipated issue of positive patients saturating hospital beds.

New York's Javits Center is similarly built using the same equipment from the NG but they've added a screen but it too will be used just for positive non-acute cases. The US Army Corps of engineers is building more technical capability, such as negative pressure rooms more akin to an ICU, in hotel rooms student dorms in the University systems in some of the impacted cities. But that is a 7-10 day or longer process given the legal and logistical work required.

https://youtu.be/csfCKuy5HH8?t=26


Javits convention center in NYC -

Image

London and other major cities are building these as well and it will be needed when the hospitals begin to get flooded with + COVID19 patients across the spectrum of symptoms.


All these work only in so far some sort of herd immunity is sought to be created which ignores the fact that there may be multiple strains of viruses floating around and reinfection is very much possible. The screen wont work against micro-droplets being circulated by ventilation. Masks can work only insofar they don't become vectors for reinfection but will themselves be in short supply.

The basic issue is infrastructural not whether the above sort of setup in any country is an ideal approach, its clearly not. In fact individual quarantining may be even better using their own resources but as many people have shown, they lack the societal courtesy to do the right thing and hence such measures.

Karan M
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Re: Wuhan Coronavirus Resource Thread

Postby Karan M » 01 Apr 2020 21:27

Every bloody country had this happen. Every other country. Including India whose sold-out journos most of them wont even report this. Simple example - ordered a few masks off of Amazon, the seller was a whole sale retailer, there was clearly no shortage of supply. A week later reports emerged of chinese teams in delhi and elsewhere doing mass purchase, overnight the entire supply of the higher end N95 masks from MNC vendors was gone. Only items left were desi-vendors whose supplies got taken out post our desi guys panicking and purchasing.

The Chinese behavior during this entire crisis has been akin to locusts. Many didnt just mass-purchase out of necessity but to resell back for a profit. This is what's being discovered in Europe.

Rampy wrote:
anmol wrote:


Chinese propaganda machine has started a new play, i got messages to donate 100 masks for NYC for $270 and all of them are shipped from China. First ship things out and now get your market ready by asking know idiots and buy and donate

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Re: Wuhan Coronavirus Resource Thread

Postby hanumadu » 01 Apr 2020 21:33

http://timesofindia.indiatimes.com/articleshow/74925585.cmsutm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

2,361 evacuated from nizamuddin markaz. 617 showing symptoms are hospitalized while the "rest are home quarantined". Shouldn't they be hospitalized too? They are almost certain to break home quarantine. We only have two more weeks to control the infection or else the lock down has to be extended. In total more than 8000 seems to have attended the 'congregation'. Imagine tracing all of them when they are not even willing to come forward to identify themselves and then their contacts. My blood is boiling at that POS quam.

How did so many people fit in one mosque? Sounds disgusting even to think about it.

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Re: Wuhan Coronavirus Resource Thread

Postby Karan M » 01 Apr 2020 21:36

Suraj wrote:
Karan M wrote:Yes, but you need more spacing and physical separation, so that one individual doesnt infect everyone.

That depends on whether it's a quarantine facility for those who are asymptomatic, or a facility to hold those who are already exhibiting symptoms that need bed-based care.

The picture suggests the latter, which means the lack of physical separation isn't really meaningful. Those who have been potentially affected but are asymptomatic or mildly symptomatic should by procedure stay in isolation in their own homes, rather than being in any sort of environment - with or without 6ft distancing, where they could be contagious.

As such, I don't see much wrong with that picture.


Asymptomatic and mildly symptomatic patients also need to be insulated from each other given the nature of this disease.

https://www.medscape.com/viewarticle/926929
https://www.latimes.com/world-nation/st ... r-outbreak

Otherwise we can have one severely infected guy whose viral load develops even further, infecting others heavily and re-infecting those who would have otherwise got better.

Plus there are concerns of different cv strains which may also cause an issue (I hope not).

I have added a video below of the micro-droplets issue which is a real challenge with these kind of facilities with stagnant air.

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Re: Wuhan Coronavirus Resource Thread

Postby SRoy » 01 Apr 2020 21:37

Lock down is going to get extended, looking at the infection rate for last few days and today.

Karan M
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Re: Wuhan Coronavirus Resource Thread

Postby Karan M » 01 Apr 2020 21:41

hanumadu wrote:http://timesofindia.indiatimes.com/articleshow/74925585.cmsutm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

2,361 evacuated from nizamuddin markaz. 617 showing symptoms are hospitalized while the "rest are home quarantined". Shouldn't they be hospitalized too? They are almost certain to break home quarantine. We only have two more weeks to control the infection or else the lock down has to be extended. In total more than 8000 seems to have attended the 'congregation'. Imagine tracing all of them when they are not even willing to come forward to identify themselves and then their contacts. My blood is boiling at that POS quam.

How did so many people fit in one mosque? Sounds disgusting even to think about it.


This is my biggest concern with these large scale quarantine facilities with people packed right next to each other. Stagnant air supply, p!ss poor hygiene habits (many openly clear their throat), constant coughing (which is a factor of the disease itself) and you are set up for a bad scenario.

Please see this video - I encourage everyone to see it. Even if you have the seasonal flu or cold, seeing this may make you re-evaluate.


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Re: Wuhan Coronavirus Resource Thread

Postby chanakyaa » 01 Apr 2020 21:43

Chinese scientists seeking potential COVID-19 treatment find 'effective' antibodies

A team of Chinese scientists has isolated several antibodies that it says are “extremely effective” at blocking the ability of the new coronavirus to enter cells, which eventually could be helpful in treating or preventing COVID-19...

The group has partnered with a Sino-U.S. biotech firm, Brii Biosciences, in an effort “to advance multiple candidates for prophylactic and therapeutic intervention”, according to a statement by Brii.
...(more)

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Re: Wuhan Coronavirus Resource Thread

Postby Arun.prabhu » 01 Apr 2020 21:44

The govt has to juggle the risk of civil unrest with containment. I wouldn't be so sure.

SRoy wrote:Lock down is going to get extended, looking at the infection rate for last few days and today.

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Re: Wuhan Coronavirus Resource Thread

Postby brar_w » 01 Apr 2020 21:45

Karan M wrote:All these work only in so far some sort of herd immunity is sought to be created which ignores the fact that there may be multiple strains of viruses floating around and reinfection is very much possible. The screen wont work against micro-droplets being circulated by ventilation. Masks can work only insofar they don't become vectors for reinfection but will themselves be in short supply.


This is the only option for 99.9% of the areas where you expect an apex within 7, 10 or 14 days. Hence cities all around the world, with advise from their health officials, are doing exactly this. You have to buy or build hundreds if not thousands (or tens of thousands) of ventilators and then build make shift ICU like capacity while also on boarding retired healthcare professionals to provide the service. Then you have to stratify the hospitalized population based on acuity and triage them appropriately. This is an excellent way to do that.

If this wasn't being done here, it would have been done in hospitals which are even less adequately prepared to handle it (lining up cots in hallways and other common space). It is unfortunate, but in order to minimize the number of deaths you have no other option..be it London, Paris, New York, or Wuhan. Higher level resources have to go to creating capacity to support higher acuity patients who have a higher likelihood of dying without an intervention. Very sad..but that's all that can be done in such short notice while also prioritizing other resources. Better than sending them home to die.
Last edited by brar_w on 01 Apr 2020 21:51, edited 3 times in total.

nam
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Re: Wuhan Coronavirus Resource Thread

Postby nam » 01 Apr 2020 21:46

SRoy wrote:Lock down is going to get extended, looking at the infection rate for last few days and today.


We don't know yet. It has just been 7 days.

The good thing is the increase in the infection rate is after 7 days from the lockdown.

We will know early next week. However GoI might extend it for another 7 days.

Karan M
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Re: Wuhan Coronavirus Resource Thread

Postby Karan M » 01 Apr 2020 21:52

brar w wrote:This is the only option for 99.9% of the areas where you expect an apex within 7, 10 or 14 days. Hence cities all around the world, with advise from their health officials, are doing exactly this. You have to buy or build hundreds if not thousands (or tens of thousands) of ventilators and then build make shift ICU like capacity while also on boarding retired healthcare professionals to provide the service. Then you have to stratify the hospitalized population based on acuity and triage them appropriately. This is an excellent way to do that.

If this wasn't being done here, it would have been done in hospitals which are even less adequately prepared to handle it (lining up cots in hallways and other common space). It is unfortunate, but in order to minimize the number of deaths you have no other option..be it London, Paris, New York, or Wuhan. Higher level resources have to go to creating capacity to support higher acuity patients who have a higher likelihood of dying without an intervention. Very sad..but that's all that can be done in such short notice while also prioritizing other resources. Better than sending them home to die.


I think one thing which hasnt been adequately explored is using unoccupied flats and real-estate for the mildly symptomatic/asymptomatic patients and their mass quarantine.

In India at least, there are countless apartments where you can via Govt decree, take them over for a period of time, and set them up for relatively spacious quarantine. You don't need ventilators and ICU like capacity for the above category of asymptomatic or mildly-symptomatic patients - you need individual rooms and (hopefully) restrooms but at least by giving them individual rooms with open ventilation, you automatically reduce the viral load which is aerosolized/ via micro-droplets. If they use a common restroom, again, that can have a mandate for constant sanitization and then ventilation before usage by anyone else. This is anyday better than 1000 beds next to each other.

This is safe for them and safe for society.

You can follow the tent approach for negative pressure in large football field size stadiums for the highly infected patients who already have a very high viral load - if you can't fit the existing infrastructure to the standardized layout in commercial housing which has its panels already laid in and too many open spaces/vents which can't be managed. Then you move to individual tents for the high risk patients with the worst symptoms. Again centralization in one area allows you to centralize vs distributing 10 beds in each hospital, pool resources, trained personnel.

Here, you can pool the ventilators, the staff with the best PPE, the monitoring, ventilators etc.
In most countries, the general wards don't even have a negative pressure environment. Many hospitals run off a centralized AC which though anti-virus scrubbers are claimed, their efficacy isn't going to be tested at such short notice.
Put up separate beds in an ICU, you risk all the patients.
The above is an easier option but for the fact these tents and other gear are also usually meant for CBRN type scenarios and not easily available. I won't be surprised if US vendors have shifted even their production to China.
In India, CBRN gear is made locally, but capacities are of the order of 1000's per day, not millions (given the Indian population size, if the need to scale up capacity hasn't stil been realized..).


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