What do I need to know about coronavirus?

[Frazier]

Masks Prevent You From Infecting Others With Coronavirus, But May Not Protect You From Being Infected

Wearing a mask helps prevent transmission of COVID-19.

www.forbes.com

It's a good point... If wearing a mask makes you touch your face more, then it works against the principle of wearing one to serve as reminder to not touch your face.

I agree with that scenario.

That's the point made in 2 sentences by the doc quoted. The rest of the lengthy article reads as a pop journalist opinion piece.

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[Janders]

My favorite line from the WHO paper--

1. Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

 

[thegenius]

My theory is that this type of coronavirus could easily have been here all along and no one has bothered to, cared to, or had a means to test for it. But now, since it has a name, and has caused a large amount of deaths in a huge, densely populated country with poor health care, plus media panic, it's gaining attention. Just think about it. Prior to two months ago, if someone shows up in your ED with a pneumonia, you do a CXR, it shows pneumonia, you treat them with antibiotics. Many are bacterial, some are viral. You can never know for certain, which is which. You may culture them if admitted. Some of the bacterial ones with grow an organism, but not all will. You wouldn't order any tests to determine which type of virus might be causing their pneumonia, if viral. And unless you get a positive bacterial culture, which not all bacterial pneumonias will give you, you can't be certain it's not from a viral pneumonia. The only test for viral pneumonia you'd order, might be a flu swab. But of the numerous viruses that cause pneumonia, you'd never test for any of them. The vast majority will get better, while (but not because) you're giving your antibiotics. A small percentage will get worse, develop ARDS and die. That's just a fact, whether it's coronavirus or one of the others. Out of a thousand rhinovirus, adenovirus, influenza virus, parainfluenza, RSV and coronavirus cases, the vast majority never get very ill. A tiny percentage get pneumonia. And only a tiny percentage with the viral pneumonia, get ARDS, hypoxic and die. It's always been that way.

People have been getting cases of viral pneumonia all along, and dying (albeit a very small percentage) all along, and it never makes news or even gets diagnoses other than "culture negative pneumonia." But now that this has a name, a test, and a worldwide media whipping the public into a 24/7 frenzy, people are paying attention. Whether or not COVID-19 has been here all along, causing 0.1-2% of it's hosts to die, is only a thought exercise. But it's 100% certain, that viruses that do the same exact have been here spreading among us, all along, just without the mass hysteria and media panic.

Oh, and wash your hands.

Without question people die of viral pneumonia, and we never test for them. Invariably if you are sick enough to go into the ICU, possibly vented for pneumonia my guess is you'll probably get a respiratory viral swab done that not only tests for influenza, but like 15 other species of viruses (adenovirus, norovirus, parainfluenza, coxsackie, coronavirus, rhinovirus, da da da...as you mentioned above).

The only thing that makes me think it's a new species is that we have been testing for coronavirus for years and they don't pick up on this particular COVID-19. In that sense it's new. Who knows if it just mutated 3 months ago, 1 year ago, or maybe it's been circulating among us for 50 years.

But yes, the thin line between panic and caution. People so easily go towards panic. I'm almost certain this will end up being not all that deadly. Perhaps even less so than the flu. As with all infectious disease outbreaks, mortality is high in the early counting because all we know about are those DEAD and VERY ILL. Once we test for COVID-19 with the same consistency as influenza, I'm willing to bet a significant amount of money the mortality rate drops significantly.

 

[thegenius]

Good article on "How Does the Coronavirus Compare to the Flu" by the NYT. (despite the link coming from MSN)

How Does the Coronavirus Compare With the Flu?

 

[Birdstrike]

Without question people die of viral pneumonia, and we never test for them. Invariably if you are sick enough to go into the ICU, possibly vented for pneumonia my guess is you'll probably get a respiratory viral swab done that not only tests for influenza, but like 15 other species of viruses (adenovirus, norovirus, parainfluenza, coxsackie, coronavirus, rhinovirus, da da da...as you mentioned above).

The COVID-19 death rate is likely much, MUCH lower than the 1-2% we're estimating. The fact that we're finding cases of community spread coronavirus sprinkled around the country, suggests that whoever's got it (probably a huge number of people) aren't getting sick enough to end up dead or dying in the ICU to generate a fancy CDC viral sub-type culture. If you saw someone 4 months ago and you did a viral culture, you couldn't possibly have tested for a coronavirus sub-type existed in the thousands, but that no one knew existed yet, even if there were thousands of them presenting as "colds."

There have been several people in USA now, that got the virus from community spread, i.e. from someone that hadn't gone to China, who got it from someone in USA, who got it from someone in USA and so on. There may have been thousands of cases in USA prior to two months ago, and we may not have known it, because no one knew the virus sub-type existed yet. If so, your death rate isn't 1 USA death / 100 known US cases, or 1%. It would would be much lower, if the denominator is a far greater number than we know.

Some of us may have even already had this thing and not even known it.

 

[Birdstrike]

Next up: People are going to start testing for coronavirus in the millions, and it's going to unjustifiably create a panic-generating spike in positive cases, not due to new and rapidly spreading infections, but simply by them finding the thousands of pre-existing cases we didn't know were spreading around, causing mostly benign colds and "flu-like" viral illnesses. Wait for it. It'll be in the news in about a week and it won't be a sign of The End of Days, but if fact the opposite. They'll be finding the virus was benign enough (99.9% of the time) to be spreading around without us even knowing it all along.

 

[Porfirio]

The summer can’t come fast enough... I miss warm weather and sunshine.

 

[Listen2Savage]

My theory is that this type of coronavirus could easily have been here all along and no one has bothered to, cared to, or had a means to test for it. But now, since it has a name, and has caused a large amount of deaths in a huge, densely populated country with poor health care, plus media panic, it's gaining attention. Just think about it. Prior to two months ago, if someone shows up in your ED with a pneumonia, you do a CXR, it shows pneumonia, you treat them with antibiotics. Many are bacterial, some are viral. You can never know for certain, which is which. You may culture them if admitted. Some of the bacterial ones with grow an organism, but not all will. You wouldn't order any tests to determine which type of virus might be causing their pneumonia, if viral. And unless you get a positive bacterial culture, which not all bacterial pneumonias will give you, you can't be certain it's not from a viral pneumonia. The only test for viral pneumonia you'd order, might be a flu swab. But of the numerous viruses that cause pneumonia, you'd never test for any of them. The vast majority will get better, while (but not because) you're giving your antibiotics. A small percentage will get worse, develop ARDS and die. That's just a fact, whether it's coronavirus or one of the others. Out of a thousand rhinovirus, adenovirus, influenza virus, parainfluenza, RSV and coronavirus cases, the vast majority never get very ill. A tiny percentage get pneumonia. And only a tiny percentage with the viral pneumonia, get ARDS, hypoxic and die. It's always been that way.

People have been getting cases of viral pneumonia all along, and dying (albeit a very small percentage) all along, and it never makes news or even gets diagnoses other than "culture negative pneumonia." But now that this has a name, a test, and a worldwide media whipping the public into a 24/7 frenzy, people are paying attention. Whether or not COVID-19 has been here all along, causing 0.1-2% of it's hosts to die, is only a thought exercise. But it's 100% certain, that viruses that do the same exact have been here spreading among us, all along, just without the mass hysteria and media panic.

Oh, and wash your hands.

I would be pretty pissed if I was one of these quarantined people

stay in a cruise ship stateroom for 2 weeks bc you might have been exposed to a cold... wtf

am I missing something?

 

[Lubeckd]

As a pharmacist what kind of meds do I need to order? what are the treatment for current guidelines? what do you think will run out in supplies first? in terms of food and medicine?

 

[MechEDoc]

As a pharmacist what kind of meds do I need to order? what are the treatment for current guidelines? what do you think will run out in supplies first? in terms of food and medicine?

Z-pack in bulk (Z-pallets!), General Tso's Chicken and Taco Bell (people get hungry in quarantine and would like a nice last meal), and lots of prednisone! Seems like every URI where I am gets a z-pack and steroids.

In all seriousness, probably Haldol and Ativan to deal with kung-flu mania that we'll be seeing in personality disorder patients.

 

[Lubeckd]

Z-pack in bulk (Z-pallets!), General Tso's Chicken and Taco Bell (people get hungry in quarantine and would like a nice last meal), and lots of prednisone! Seems like every URI where I am gets a z-pack and steroids.

In all seriousness, probably Haldol and Ativan to deal with kung-flu mania that we'll be seeing in personality disorder patients.

I check a medical journal on prednisone to calm the lungs down. It says its not a good treatment, because the body cant fight the virus off.
not sure

 

[MechEDoc]

I check a medical journal on prednisone to calm the lungs down. It says its not a good treatment, because the body cant fight the virus off.
not sure

Are you sure? How about a low magnesium diet followed by high dose Azithromycin + Zofran? I like to titrate to QTc > 550 for fastest resolution of the disease.

In all seriousness, I don't think pharmacy needs to stock anything special for COVID-19.

 

[NYEMMED]

As a pharmacist what kind of meds do I need to order? what are the treatment for current guidelines? what do you think will run out in supplies first? in terms of food and medicine?

Any medication made in China, stock up the hospital now, there will be shortages of those medications

 

[Lubeckd]

Any medication made in China, stock up the hospital now, there will be shortages of those medications

Any medication made in China, stock up the hospital now, there will be shortages of those medications

china stop production of the masks. I'll do top 200 drugs. And drug production may stop as well. No more food in Italy, china. And toilet paper out in USA

 

[SXMMD]

Z-pack in bulk (Z-pallets!), General Tso's Chicken and Taco Bell (people get hungry in quarantine and would like a nice last meal), and lots of prednisone! Seems like every URI where I am gets a z-pack and steroids.

In all seriousness, probably Haldol and Ativan to deal with kung-flu mania that we'll be seeing in personality disorder patients.

Quick side rant:
"The steroids will make you feel better honey, it's for inflammation!" -Jenny McJ at UC

/endrant

 

[BoardingDoc]

On a side coronavirus note: I enjoyed this earlier today.

 

[turkeyjerky]

Quick side rant:
"The steroids will make you feel better honey, it's for inflammation!" -Jenny McJ at UC

/endrant

WTF is up w/ midlevels and just having to do something? I'm sure it's great for their patient sat scores, but it just screws up things so much (for either the pt or the dept). I see patients every single day w/ mild URI's who are disappointed their cough isn't gone yet, b/c two days ago Jenny McJ or Bradley McD told them the tessalon or prednisone or benadryl or z-pak or essential oils would clear it right up.

A couple of shifts ago a patient came in reporting an allergic rash to acyclovir that had been prescribed for an HSV outbreak. The midlevel wanted to give him a test dose of valacyclovir and hold him in the ER for a few hours (we were full at the time). WTF? I told him to DTMFA

 

[Birdstrike]

Update: U.S. flu deaths are up from 14,000 to 18,000 this season, including 20 deaths among children this week alone.
U.S. coronavirus deaths are currently at 5 adults and 0 children (CDC) out of 300,000,000 Americans.

Maybe we should make a public service announcement to be printed out and posted on every ED door, mail box and light pole: "The only rational response to virus season still, is to wash your hands, get a flu shot and stay home if sick. Buying up the entire supply of beer, bread, smokes, guns & surgical masks in your town: Still, not rational. Stop."

 

[cyanide12345678]

Got called by my dad to start taking vitamin C to boost my immune system -_-

Then he was telling me to send an email to my hospital to give us "special personal protective equipment for Corona virus" -_-

My only concern is my 7 week baby that's home. Once she is 90 days old, I'll feel better. Otherwise, it's just a virus.... So damn over rated. We don't even have a test for this at my hospital, im sure there are 1000s of cases that are mild and undiagnosed just walking around...

 

[Birdstrike]

Got called by my dad to start taking vitamin C to boost my immune system -_-

Then he was telling me to send an email to my hospital to give us "special personal protective equipment for Corona virus" -_-

My only concern is my 7 week baby that's home. Once she is 90 days old, I'll feel better. Otherwise, it's just a virus.... So damn over rated. We don't even have a test for this at my hospital, im sure there are 1000s of cases that are mild and undiagnosed just walking around...

I would be concerned about my 7-week-old baby, too, just because it's normal to be concerned about everything at that age. However, unlike flu, coronavirus has seemed to spare the youngest. I'm not sure anyone knows why that is yet, but it seems to be the case, so far. Hopefully that will continue.

 

[cyanide12345678]

I would be concerned about my 7-week-old baby, too, just because it's normal to be concerned about everything at that age. However, unlike flu, coronavirus has seemed to spare the youngest. I'm not sure anyone knows why that is yet, but it seems to be the case, so far. Hopefully that will continue.

I'm guessing they haven't had that many neonatal cases to have enough data for that age group. Like any virus, neonates are always going to be susceptible i feel.

 

[TooMuchResearch]

I'd be hesitant to buy/use meds produced in China. Unrelated to current pandemic fears.

Any medication made in China, stock up the hospital now, there will be shortages of those medications

 

[Fox800]

Guess I'll be sporting a N95 most of the day as we are overrun by worried well adults that seem to think that 3-4 days of fever, cough, and rhinorrhea is properly treated with a single dose of Aleve before going straight to an emergency department.

 

[NYEMMED]

I'd be hesitant to buy/use meds produced in China. Unrelated to current pandemic fears.

Many meds we use every shift are made in China

 

[wholeheartedly]

Guess I'll be sporting a N95 most of the day as we are overrun by worried well adults that seem to think that 3-4 days of fever, cough, and rhinorrhea is properly treated with a single dose of Aleve before going straight to an emergency department.

Yours try aleve first? damn, ours come in on day one of fever and sore throat. fever being 99.9...

 

[cyanide12345678]

Yours try aleve first? damn, ours come in on day one of fever and sore throat. fever being 99.9...

99.9? Some think 98.8 is a fever -_-

 

[Siggy]

Next up: People are going to start testing for coronavirus in the millions, and it's going to unjustifiably create a panic-generating spike in positive cases, not due to new and rapidly spreading infections, but simply by them finding the thousands of pre-existing cases we didn't know were spreading around, causing mostly benign colds and "flu-like" viral illnesses. Wait for it. It'll be in the news in about a week and it won't be a sign of The End of Days, but if fact the opposite. They'll be finding the virus was benign enough (99.9% of the time) to be spreading around without us even knowing it all along.

Hence why I'm buying Select Medical (owns both Select LTAC and Concentra urgent care) and CVS (who has the minute clinic stock). If you do get ARDS, then by all means, fill up my LTAC beds. All the rest of the worried well? Go to an urgent care and make me some dollars.

 

[NITRAS]

99.9? Some think 98.8 is a fever -_-

It’s is a fever for them. Haven’t you seen House?!!?

 

[rokshana]

https://www.nejm.org/doi/full/10.1056/NEJMe2002387

 

[Janders]

Tip of the iceberg?

China’s cases of Covid-19 are finally declining. A WHO expert explains why.

"It’s all about speed": the most important lessons from China’s Covid-19 response.

www.vox.com

"In Guangdong province, for example, there were 320,000 tests done in people coming to fever clinics, outpatient clinics. And at the peak of the outbreak, 0.47 percent of those tests were positive. People keep saying [the cases are the] tip of the iceberg. But we couldn’t find that. We found there’s a lot of people who are cases, a lot of close contacts — but not a lot of asymptomatic circulation of this virus in the bigger population. And that’s different from flu. In flu, you’ll find this virus right through the child population, right through blood samples of 20 to 40 percent of the population"

 

[TooMuchResearch]

I'm aware.

Many meds we use every shift are made in China

 

[GeneralVeers]

I'm not worried about a disease that preferentially takes out 80-year old unhealthy nursing home patients.

There's a policy they are going to implement at my hospital whereby if a patient is admitted for pneumonia, and the doctor/nurse treats them without wearing PPE (meaning an N-95 mask) then that doctor/nurse has to be quarantined for 14 days. I explained to them that we'd rapidly run out of people available to work.....

I'm not wearing a N-95 mask on my shift all day. I can't breathe in those things, and it's terribly itchy.

 

[TooMuchResearch]

Our group is coming up with contingency plans for physician quarantine.

I'm not worried about a disease that preferentially takes out 80-year old unhealthy nursing home patients.

There's a policy they are going to implement at my hospital whereby if a patient is admitted for pneumonia, and the doctor/nurse treats them without wearing PPE (meaning an N-95 mask) then that doctor/nurse has to be quarantined for 14 days. I explained to them that we'd rapidly run out of people available to work.....

I'm not wearing a N-95 mask on my shift all day. I can't breathe in those things, and it's terribly itchy.

 

[GeneralVeers]

It's astonishing that we are talking about quarantining (non-sick) physicians over the common cold due to hysteria induced by media malpractice.

 

[Fox800]

Yep. We are so short-staffed and using locums docs that if they try to quarantine the EM physicians here the EDs will just close.

 

[MechEDoc]

As a locums doc, how do you think I feel about some clipboard r'**** trying to lock me into a hotel room for two weeks on the road somewhere?

 

[Listen2Savage]

As a locums doc, how do you think I feel about some clipboard r'**** trying to lock me into a hotel room for two weeks on the road somewhere?

lol
can you just say fuggoff jaggoff and dip or what

 

[Xerxes1729]

I'm trying to decide if I should shave my beard so a mask fits better.

 

[rokshana]

I'm an emergency doctor. I expect to get coronavirus | CNN

James Phillips writes that as an emergency physician at an urban hospital in Washington, D.C., this is personal: "I will likely become infected in the next few months. It's just simple math that I have accepted." But there are ways to stop the virus from overwhelming the health care system.

www.cnn.com

I thought this was nicely written...

What do y’all think about the idea of the younger docs being the ones to be on the front line triaging!

 

[southerndoc]

This may be a common cold, but the implications of its severity are real.

R0 for influenza is 1.3, R0 for coronavirus is 2.4-2.7. Influenza infects 1 billion per year worldwide. Implication with COVID-19? Probably looking at possibly 2-3 billion people infected worldwide.

Mortality rate for influenza is around 0.1%. Mortality rate for COVID-19 has been around 2-3% (1.4% in the NEJM article) (15% age >80, 8% 70-79, 3.5% 60-69, 1.3% 50-59, much less for younger individuals). Implication? With 2 billion people infected worldwide and the NEJM 1.4% mortality rate, 28 million people will die if this becomes a pandemic. 3 billion infected will result in around 42 million deaths. The 1918 influenza pandemic (Spanish flu) killed 50 million people with an estimated 500 million infected worldwide.

This may not be the most deadly disease, but it still has major potential to be a deadly pandemic.

 

[thegenius]

The mortality rate will be vastly lower than 2% when it's all said and done. it's 2% now that we are counting, and we are counting probably most if not all mortality cases of COVID-19. The number infected? It's many many times more than what we know now.

That's what I think.

 

[thegenius]

The mortality rate will be vastly lower than 2% when it's all said and done. it's 2% now that we are counting, and we are counting probably most if not all mortality cases of COVID-19. The number infected? It's many many times more than what we know now.

That's what I think.

That being said....I just read this 1 minute later:

KIRKLAND, Wash. — As three more deaths in the United States were linked to the coronavirus Tuesday, World Health Organization officials warned the virus could be far more dangerous than the flu, with a mortality rate of 3.4%.

Coronavirus deaths in US increase; official warns of many more cases



We do know that the more deadly a virus is, the harder it is to infect.

 

[Apollyon]

We do know that the more deadly a virus is, the harder it is to infect.

Ever heard of Ebola, or Marburg, or canarypox, or monkeypox, or Tanapox, or smallpox?

 

[wholeheartedly]

The mortality rate will be vastly lower than 2% when it's all said and done. it's 2% now that we are counting, and we are counting probably most if not all mortality cases of COVID-19. The number infected? It's many many times more than what we know now.

That's what I think.

Normally I'd agree with you, but the WHO team that went to China noted some intersting data.

"A critical unknown is how many mild or asymptomatic cases occur. If large numbers of infections are below the radar, that complicates attempts to isolate infectious people and slow spread of the virus. But on the positive side, if the virus causes few, if any, symptoms in many infected people, the current estimated case fatality rate is too high. (The report says that rate varies greatly, from 5.8% in Wuhan, whose health system was overwhelmed, to 0.7% in other regions.)

To get at this question, the report notes that so-called fever clinics in Guangdong province screened approximately 320,000 people for COVID-19 and only found 0.14% of them to be positive. “That was really interesting, because we were hoping and maybe expecting to see a large burden of mild and asymptomatic cases,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “That piece of data suggests that’s not happening, which would imply that the case fatality risk might be more or less as we currently have.” But Guangdong province was not a heavily affected area, so it is not clear whether the same holds in Hubei province, which was the hardest hit, Rivers cautions."

Science | AAAS

www.sciencemag.org

 

[thegenius]

Ever heard of Ebola, or Marburg, or canarypox, or monkeypox, or Tanapox, or smallpox?

I've heard of ParrotPox, and Orangutan-tangggg!-Pox

 

[Apollyon]

I've heard of ParrotPox, and Orangutan-tangggg!-Pox

Oh, you!

But, honestly, in addition, herpes virus, varicella, rabies, dengue, all the encephalitis viruses - easily to very easily transmittable.

 

[WilcoWorld]

Oh, you!

But, honestly, in addition, herpes virus, varicella, rabies, dengue, all the encephalitis viruses - easily to very easily transmittable.

I think his point is that viruses with high mortality don't spread as much as those with lower mortality, because it's easier to transmit your infection when you're up walkin' around then when you're layin' underground.

 

[VA Hopeful Dr]

Oh, you!

But, honestly, in addition, herpes virus, varicella, rabies, dengue, all the encephalitis viruses - easily to very easily transmittable.

Did you mean to include rabies in the easily transmittable category and if so am I missing something?

 

[NYEMMED]

Mortality rate has increased.
14% mortality for those over 80
3.4% mortality globally

 

[Fox800]

Mortality rate has increased.
14% mortality for those over 80
3.4% mortality globally

Reputable source please.