Wuhan Coronavirus Resource Thread

Sicanta · Post by **Sicanta** » 09 Mar 2020 14:57

Yet to be peer reviewed

https://swarajyamag.com/insta/new-study ... ak-0f-872c

Vikas · Post by **Vikas** » 09 Mar 2020 15:55

Even if Virus goes away due to rising temperatures, what are the odds it will come back with Vengeance next winters or once decimated, The virus will not be as effective as it is today ?

SandeepA · Post by **SandeepA** » 09 Mar 2020 17:28

Vikas wrote:Even if Virus goes away due to rising temperatures, what are the odds it will come back with Vengeance next winters or once decimated, The virus will not be as effective as it is today ?

...and how long before it mutates to be tolerant to higher temperatures? These kind of studies are usually a load of BS with no basis in the nature and dynamics of virus evolution. For all you know the Flu may have started in only one part of the world and mutated to live and thrive as a global phenomenon.

Mort Walker · Post by **Mort Walker** » 09 Mar 2020 19:13

nam wrote:There needs to be a better way to screen for the virsus. Checking for just temperature is frankly a foolish way to doing it.

The virus does not become active for 14 days, people easily move out of the airport spreading it all around.

All one has to do is to visit one of these airports and you are infected. Hell even if use one of the Metro/bus/train that goes to the airport, you could be infected.

You don't even have to travel outside of the country. Travel should be banned and every passenger coming in should be quarantined. Letting them go, becoz they don't have temperature is nonsense.

Like the flu, those have a temperature are the ones who are the most contagious. I think GoI is handling this quite well. We will see in the next week how many cases go up as temperatures rise in India.

The larger question is that world needs to question the crazy Chinese diet of eating exotic animals that live in close proximity of humans. Who knows what sort of virus comes out of China next year.

chola · Post by **chola** » 09 Mar 2020 19:47

^^^ Nothing more scary than a bunch of goddam primitives with a modern infrastructure. The world need to continue the travel embargo on Cheen that is now in place. Their international flights are down 95%. Keep it in place until those savages become vegetarians.

vinod · Post by **vinod** » 09 Mar 2020 19:53

GOI should introduce a compulsory check for all international passengers who arrived in India. They should visit a local hospital after 5 days but before 7 days. Whether there are symptoms or not, they should visit a hospital to get checked by a qualified doctor. No excuses!
The doctor can update a database that they have checked the person with this passport etc. If they don't attend, the police should be sent to their given address.

ManSingh · Post by **ManSingh** » 09 Mar 2020 20:27

vinod wrote:GOI should introduce a compulsory check for all international passengers who arrived in India. They should visit a local hospital after 5 days but before 7 days. Whether there are symptoms or not, they should visit a hospital to get checked by a qualified doctor. No excuses!
The doctor can update a database that they have checked the person with this passport etc. If they don't attend, the police should be sent to their given address.

GOI is doing better than what you are suggesting. A cousin returned from Italy last week. He was tested at the airport. After a few days a medical team visited his house in a rural village for another round of testing.

Forcing an infected person to visit a hospital increases the chance of spreading the infection during the visit.

Sicanta · Post by **Sicanta** » 09 Mar 2020 21:07

It professional returning from USA tests positive in bengaluru.

Amber G. · Post by **Amber G.** » 09 Mar 2020 21:20

nam wrote:There needs to be a better way to screen for the virsus. Checking for just temperature is frankly a foolish way to doing it.

Like Mort said, IMO this is VERY effective and can practically be done with IF scanners - without causing trouble to all.
Besides "knowing" its COVID or some other virus is not important - you take the same kind of precautions.

The virus does not become active for 14 days, people easily move out of the airport spreading it all around.

Right to be cautious but panic is bad. Most likely (as in 99+% of the time) casual contact is not going to spread it. Even if one gets infected and test positive most cases (as 80+%) are quite mild - elder people and other vulnerable have to be more careful, but for most stay home and rest, if it just a fever.

All one has to do is to visit one of these airports and you are infected. Hell even if use one of the Metro/bus/train that goes to the airport, you could be infected.

NO. just a visit or causal contact does not imply that you will get infected. Even if your hands touched a virus coated place in the bus/metro/train If you wash your hands -- and not touch your eyes, face etc - you will be okay. Washing hands happens to be simple yet very effective way - not only from COVID-19 but all other virus.

sudarshan · Post by **sudarshan** » 09 Mar 2020 21:23

SandeepA wrote: ...and how long before it mutates to be tolerant to higher temperatures? These kind of studies are usually a load of BS with no basis in the nature and dynamics of virus evolution. For all you know the Flu may have started in only one part of the world and mutated to live and thrive as a global phenomenon.

There are some things that biological organisms haven't yet mutated to tolerate. Like bleach - are we worried that if we keep using bleach and alcohol sanitizers, the virus will mutate to thrive on those? It's theoretically possible, but hasn't happened over tens or even hundreds of years that we know of. Likewise - are viruses going to evolve to be tolerant of being roasted? The water is going to evaporate, there is nothing the virus can do to survive without water. If so, humans can also evolve to not need water, and then we can all thrive in the desert!

The virus infection mechanism is that its hard outer shell melts in the warm environment of the host's body. If the outside temperature is similar to the temperature of the host's body, the virus coat is going to melt there, but without a host to survive in. So it becomes unlikely (not impossible) that the virus will find a host before it dies.

SriKumar wrote:So, here's my attempt. It was difficult to rhyme with Wuhan managed to get something (one caveat: I deliberately avoided injecting any levity in the verse, given the gravity of the situation).

A virus from a Wuhan meat shop
Decided to take a world-wide hop
First it spread through Hubei
And continued on its cruel way
To spread round the globe non-stop.

(Mods to indulge a second one:)
Said a noxious virus in Wuhan
Maybe its time to go to Iran
But once it got going
It showed no signs of slowing
And went way past till it hit Milan.

I think you cheated by rhyming with other place names

. But I got to give it to you, that was pretty creative. If I had medals to hand around, I'd give you one. But I think we better stop this before the admins hand us something

.

VKumar · Post by **VKumar** » 09 Mar 2020 21:27

Expect that all foreigners may be stopped from visiting India.

Amber G. · Post by **Amber G.** » 09 Mar 2020 21:28

ManSingh wrote:

GOI is doing better than what you are suggesting. A cousin returned from Italy last week. He was tested at the airport. After a few days a medical team visited his house in a rural village for another round of testing.

Forcing an infected person to visit a hospital increases the chance of spreading the infection during the visit.

Thanks for posting this.. Yes, the advice here is if you have symptoms don't go to hospital , call your doctor etc.. most likely they will tell you to rest etc. .. Many insurance (in US) will reimburse you with this "tele visit"...

Some countries in the world now do not require you to go to a crowded place to do testing ..you drop in the sample and result comes via email.

sudarshan · Post by **sudarshan** » 09 Mar 2020 21:29

Amber G. wrote:
The virus does not become active for 14 days, people easily move out of the airport spreading it all around.
Right to be cautious but panic is bad. Most likely (as in 99+% of the time) casual contact is not going to spread it. Even if one gets infected and test positive most cases (as 80+%) are quite mild - elder people and other vulnerable have to be more careful, but for most stay home and rest, if it just a fever.

All one has to do is to visit one of these airports and you are infected. Hell even if use one of the Metro/bus/train that goes to the airport, you could be infected.
NO. just a visit or causal contact does not imply that you will get infected. Even if your hands touched a virus coated place in the bus/metro/train If you wash your hands -- and not touch your eyes, face etc - you will be okay. Washing hands happens to be simple yet very effective way - not only from COVID-19 but all other virus.

Thank you ma'am, for mitigating the panic and dishing out sensible advice. Yes, we all need to be careful, this is a bad one to come down with, but there are simple prevention measures. What scares me is that many people are so careless or indifferent, not even washing hands after visiting the restroom. Not to mention that health official you posted about, hosting a press conference about prevention measures, while happily thumbing away at the pages of her document after wetting her fingers with her tongue! I also abhor this practice of licking stamps, I've never done it that way, always found some tap or other water source to wet the stamps down before sticking on the envelope. I think the Indian way is eminently sensible, avoid spreading your saliva around, especially when eating, no casual contact of your "dirty" plate with clean food, etc.

sooraj · Post by **sooraj** » 09 Mar 2020 21:38

Karnataka's first COVID-19 case: US returnee showed symptoms only 4 days after reaching Bengaluru

A 40-year-old techie has tested positive for coronavirus and has been admitted in Rajiv Gandhi Institute of Chest Diseases. His wife and daughter have also been admitted as they are symptomatic, Minister of Medical Education, Sudhakar, revealed at a press conference on Monday.

He was tested twice in the NIV lab of RGICD.

“He is doing well and is not in a serious condition requiring ventilator or any such thing. We are giving him treatment,” said Minister Sudhakar.

After reaching from the USA on March 1, he continued to attend work. His colleague who stayed with him during the trip is also asymptomatic and has been admitted in RGICD.

His driver, driver’s wife and two kids are asymptomatic and have been home quarantined.

2666 primary and secondary contacts of the people he worked with, interacted and travelled with are being traced. 60 of them travelled with him on the flight.

“He developed symptoms 4 days after he arrived and self-reported to a private hospital. A sample was taken on March 5 after which he was shifted to RGICD on March 8. Another sample was taken and test done then and that too tested positive,” said Health Commissioner, Pankaj Kumar Pandey.

He travelled from Austin to New York on February 28, from New York to Dubai on February 29 and reached Bengaluru on March 1.

The school where his daughter is studying in Whitefield has been shut for all grades up to 12th standard. She is 13 to 14 years old.

8 cases in total are admitted in RGICD on Monday.

KLNMurthy · Post by **KLNMurthy** » 09 Mar 2020 21:48

VKumar wrote:Expect that all foreigners may be stopped from visiting India.

(Sorry for OT)

Hope India can use the same efficient pattern of interdiction, control and neutralization against the BIF virus.

sooraj · Post by **sooraj** » 09 Mar 2020 21:54

Govt asks CAPF to expand quarantine facility amid coronavirus scare in India

The government has directed the Central Armed Police Forces (CAPF) to prepare quarantine facilities with a bed capacity to admit over 5,400 people to deal with cases of coronavirus across the country, officials said on Monday.

These forces, comprising the Central Reserve Police Force, the Border Security Force, the Central Industrial Security Force, the Indo-Tibetan Border Police, the Sashastra Seema Bal and the National Security Guard, have also been asked to create 75 isolation wards as part of preparations to combat possible large-scale outbreak of the virus.

Officials told PTI that the Union home ministry has asked these forces to create a total of 5,440-bed capacity at 37 locations in the country.

“The aim is to build capacity. These forces have also been asked to earmark and depute their respective teams of doctors, paramedics and sanitation officials who will man these quarantine facilities,” a senior home ministry officer said.

The Indo-Tibetan Border Police (ITBP) force, which is already running such a quarantine centre in Delhi’s Chhawla area, has also been asked to prepare training modules for specialist trainers of these forces.

ITBP experts will hold workshops and prepare online modules for these forces to make them understand the management and other medical protocols to run a quarantine centre for coronavirus affected people, officials said.

ramana · Post by **ramana** » 09 Mar 2020 22:03

nam wrote:There needs to be a better way to screen for the virsus. Checking for just temperature is frankly a foolish way to doing it.

The virus does not become active for 14 days, people easily move out of the airport spreading it all around.

All one has to do is to visit one of these airports and you are infected. Hell even if use one of the Metro/bus/train that goes to the airport, you could be infected.

You don't even have to travel outside of the country. Travel should be banned and every passenger coming in should be quarantined. Letting them go, becoz they don't have temperature is nonsense.

Lat Thursday, SHQ had a meeting with client. Client so no visitor meetings due to COVID-19. Didn't even come to lobby.

Then the visitors moved to Petes Coffee shop nearby as the sales team manager did not want to waste opportunity for BS.

One bright young lady says "just returned from Spain and its not like I am infected or contagious!!!"
SHQ just got up and left.
Today sent a nasty email to the young lady and the sales mgr for not informing about the Spain trip before the meeting and to tell her if the person gets develops fever etc.

People are treating it like a flu and being blase about it.
My friend flew from Chennai, Dubai, Seattle, Chicago. No masks or screening or asking questions any where.
He off course had his mask and sanitizer all the time.

sudeepj · Post by **sudeepj** » 09 Mar 2020 22:05

ManSingh wrote:
vinod wrote:GOI should introduce a compulsory check for all international passengers who arrived in India. They should visit a local hospital after 5 days but before 7 days. Whether there are symptoms or not, they should visit a hospital to get checked by a qualified doctor. No excuses!
The doctor can update a database that they have checked the person with this passport etc. If they don't attend, the police should be sent to their given address.
GOI is doing better than what you are suggesting. A cousin returned from Italy last week. He was tested at the airport. After a few days a medical team visited his house in a rural village for another round of testing.

Forcing an infected person to visit a hospital increases the chance of spreading the infection during the visit.

This is really encouraging. For a change, the Govt. of India under Modi ji appears to be performing better than the govts. in richer and more advanced western countires! Kudos!

ramana · Post by **ramana** » 09 Mar 2020 22:06

The Bengluru techi could have picked it up in Dubai.

Krita · Post by **Krita** » 09 Mar 2020 22:13

Not related to Coronavirus.
About London patient who was suffering from both AIDS and Lymphoma. A Bone marrow transplant from the donor has cured him. The donor carried a mutation called Delta -32 which inhibits HIV infection.
https://www.nytimes.com/2020/03/09/heal ... llejo.html
Certain ethinicities will be naturally resistant to Coronavirus as well?

vijayk · Post by **vijayk** » 09 Mar 2020 22:28

Desktop Dashboard

https://gisanddata.maps.arcgis.com/apps ... 7b48e9ecf6

Mobile Dashboard
https://www.arcgis.com/apps/opsdashboar ... 62e5c06e61

Amber G. · Post by **Amber G.** » 09 Mar 2020 22:55

BSR Murthy wrote:
Hope he will be fine soon. The testing process could be much better.

Thanks. She is my daughter-in-law. Yes testing process/red tape is *much* worse than any of us could imagine. In last few years this US administration has made the whole thing worse than any other modern country.
There are Korean companies, (and German companies..and Chinese companies) which are making hundreds of thousands of kits per day, and have testing ability to tests 10,000+ tests every day .. here we are .. where even doctors/nurses do not fit in their "testing guidelines". Hope things change soon..(waiting for new guide lines)
(Interestingly, US person from Austin can get tested in Benglaru ...)

Amber G. · Post by **Amber G.** » 09 Mar 2020 22:56

ramana wrote:The Bengluru techi could have picked it up in Dubai.

More likely from Texas - the area is "home" where some are quarantined.

saip · Post by **saip** » 09 Mar 2020 23:01

I bought my tickets to India (for 3/25) for a three week trip. The airline is not yet allowing change or cancellations without penalty. I am more concerned about not being allowed back (middle of April) by Trump admin from India.

Amber G. · Post by **Amber G.** » 09 Mar 2020 23:19

Meanwhile 127 new cases in Germany 1167 total

Coronavirus has been in Germany since Wednesday last week. Our priority now is to slow its spread. The slower the virus spreads, the better the healthcare system can cope.” Health Minister Jens Spahn said on Sunday adding “Consider also what in your daily life is so important that you can’t do without it for the next three months, whether that’s an evening clubbing, a family birthday or a club meeting

rsingh · Post by **rsingh** » 09 Mar 2020 23:24

Amber G. wrote:
BSR Murthy wrote:
Hope he will be fine soon. The testing process could be much better.
Thanks. She is my daughter-in-law. Yes testing process/red tape is *much* worse than any of us could imagine. In last few years this US administration has made the whole thing worse than any other modern country.
There are Korean companies, (and German companies..and Chinese companies) which are making hundreds of thousands of kits per day, and have testing ability to tests 10,000+ tests every day .. here we are .. where even doctors/nurses do not fit in their "testing guidelines". Hope things change soon..(waiting for new guide lines)
(Interestingly, US person from Austin can get tested in Benglaru ...)

Ahh the reality check. In Hollywood films we see NSA guards shout "lets go" 10 times a minute, taking complete control of situation. Communication control ( obsession with control), setting up quarantine zone within minutes. In reality they leg behind India and Bangladesh. Simple testing kit is not available.

g.sarkar · Post by **g.sarkar** » 09 Mar 2020 23:54

https://www.aljazeera.com/news/2020/03/ ... 26110.html
Iran releases 70,000 prisoners as toll rises: Live updates
Iran and Italy report more coronavirus cases, new countries confirm infections amid signs outbreak in China is slowing.
by Kate Mayberry , Virginia Pietromarchi & Usaid Siddiqui, Monday, March 9
Iran temporarily released about 70,000 prisoners because of the coronavirus contagion, as the death toll rose by 43 new fatalities to 237.
In Italy, where some 16 million people in Lombardy and other parts of the north are now under quarantine, there were 133 deaths reported, bringing the total to 366. More than 7,000 people in the country have been confirmed to have the virus.
But the latest figures from China and South Korea suggest the virus might be slowing in Northeast Asia.
More than 3,800 people have died worldwide from coronavirus and there are more than 110,000 infections, according to the World Health Organization.
.....
Gautam

Rishi_Tri · Post by **Rishi_Tri** » 09 Mar 2020 23:56

sudarshan wrote:
Amber G. wrote:
NO. just a visit or causal contact does not imply that you will get infected. Even if your hands touched a virus coated place in the bus/metro/train If you wash your hands -- and not touch your eyes, face etc - you will be okay. Washing hands happens to be simple yet very effective way - not only from COVID-19 but all other virus.
Thank you ma'am, for mitigating the panic and dishing out sensible advice. Yes, we all need to be careful, this is a bad one to come down with, but there are simple prevention measures. What scares me is that many people are so careless or indifferent, not even washing hands after visiting the restroom.

Edited your quotes.

I am aghast at how many times the Restroom thing happens. I was shocked initially but then see that the Joe sees it as part and parcel of his being. Totally yuck.

Rishi_Tri · Post by **Rishi_Tri** » 10 Mar 2020 00:08

vinod wrote:GOI should introduce a compulsory check for all international passengers who arrived in India. They should visit a local hospital after 5 days but before 7 days. Whether there are symptoms or not, they should visit a hospital to get checked by a qualified doctor. No excuses!
The doctor can update a database that they have checked the person with this passport etc. If they don't attend, the police should be sent to their given address.

India introduced compulsory check for all passengers arriving in India more than a week ago. Checks on passengers from China, Japan, Korea, Singapore, Thailand, Malaysia have been on for last one and half months. Italy was added about two weeks ago.

For passengers from 12 countries - China, Japan, Korea, Italy, Iran, Nepal, Thailand, Malaysia, Singapore, Vietnam, Indonesia, Hong Kong - there are separate off-boarding facility, screening facility, immigration facility, and carousel facility. They are not allowed to mix with other passengers.

More than 450,000 passengers had been screened till a few weeks ago. I am sure this must have gone up to million by now.

GOI site - http://prasarbharati.gov.in/ - is good source of information through the online channels of AIR and DD.

Vamsee · Post by **Vamsee** » 10 Mar 2020 00:09

@Reuters
Death toll in Italy from coronavirus rises to 463 with total number of cases rising to 9,172

Mort Walker · Post by **Mort Walker** » 10 Mar 2020 00:53

Amber G. wrote:
ramana wrote:The Bengluru techi could have picked it up in Dubai.
More likely from Texas - the area is "home" where some are quarantined.

The CDC released a person by mistake in late February who tested negative, but then came back and tested positive. They were being quarantined at Lackland AFB in San Antonio.

Mort Walker · Post by **Mort Walker** » 10 Mar 2020 00:55

saip wrote:I bought my tickets to India (for 3/25) for a three week trip. The airline is not yet allowing change or cancellations without penalty. I am more concerned about not being allowed back (middle of April) by Trump admin from India.

Certain areas like the Bay Area of California have more cases than all of India. I would try to contact GoI consulate to see what guidance they give.

rajkumar · Post by **rajkumar** » 10 Mar 2020 01:02

Saip, the real joker in the pack is the Trump administration..we really can't say with any certainty what the administrations actions are going to be

nam · Post by **nam** » 10 Mar 2020 01:35

sooraj wrote:Karnataka's first COVID-19 case: US returnee showed symptoms only 4 days after reaching Bengaluru

It is not good to create panic, however this case proves the futile pratice of sending people home when they don't have temperature.

Now his workplace, his child school, probably his home area is completely disrupted.

I'd he was quarantined all of this disruption would have been prevented.

ramana · Post by **ramana** » 10 Mar 2020 01:44

Mort Walker wrote:
saip wrote:I bought my tickets to India (for 3/25) for a three week trip. The airline is not yet allowing change or cancellations without penalty. I am more concerned about not being allowed back (middle of April) by Trump admin from India.
Certain areas like the Bay Area of California have more cases than all of India. I would try to contact GoI consulate to see what guidance they give.

Saip, If you don't have to go don't go. You might catch something and no point in blaming govts.

My friends cancelled a cruise near Australia and the flight to get there passes through Asia.

SD has issued advisory on cruises.
Many ports no allowing disembarkation.

ramana · Post by **ramana** » 10 Mar 2020 01:46

BTW GOI has travelers fill out a form about places visited.
Bay Area and Northern Califronia is a COVID19 area.
So you might not be out of the airport in India.

ramana · Post by **ramana** » 10 Mar 2020 01:58

chetak wrote:Coronavirus: Kerala family that landed from Italy hid vital information to slip through the system

09th March 2020

KOCHI: The way the family from Venice slipped through the screening system at the Kochi Airport has come as a jolt to the Health Department and spoiled the hard-earned reputation of the state as the most secure place in the country to guard against the spread of the deadly coronavirus.

But the authorities have put the blame squarely on the Ranni family for concealing vital information including the fact they arrived from Italy, which now has the second-largest COVID-19 infected cases after China, when they landed at the Kochi airport.

N K Kuttappan, DMO, Ernakulam said the family has acted “irresponsibly” to evade the screening by hiding important points in the declaration form.

“As the form filling is compulsory for passengers to come out of the airport, the Ranni family has submitted the form without informing the officials that they are coming from Italy. Since they claimed they had no symptoms, they were not screened either,” he said.

A CIAL official has clarified that lack of stamping in the passport from the European Union (EU) countries was another reason for the three-member family comprising a 24-year-old youth and his parents aged 55 and 53 respectively.

I saw that Immigration asks which flight you arrived on and not where are you coming from and list all flights.
Second when we visited Rome two years back they stamped the passport.
So the EU not stamping passport could be oversight or bogus.

The DMO is not taking responsibility for any failures on the govt's part.

ramana · Post by **ramana** » 10 Mar 2020 01:59

AmberG, Where in Northern California?
Placer County has issues.

Primus · Post by **Primus** » 10 Mar 2020 02:17

saip wrote:I bought my tickets to India (for 3/25) for a three week trip. The airline is not yet allowing change or cancellations without penalty. I am more concerned about not being allowed back (middle of April) by Trump admin from India.

With a very heavy heart we canceled our trip too. Took the decision today. Our airline is most likely not going to refund anything. We had already pre-paid for the travel arrangements within India and also for the big party we are hosting.

The reason is precisely as above, we may get stuck not being allowed back in or worse, put in quarantine with people who are really sick and then catch it from them. We are also told that people in Delhi have started avoiding malls, movie halls and even wedding parties.

The next few months are going to be very trying for everyone.

BSR Murthy · Post by **BSR Murthy** » 10 Mar 2020 03:00

Sharing from a physician colleague:

From an ID conference in California

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 <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.

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.