What do I need to know about coronavirus?

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Fox800 said:
Reputable source please.
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Fox800 said:
Reputable source please.
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CNBC
www.cnbc.com

WHO says coronavirus death rate is 3.4% globally, higher than previously thought

World health officials say the death rate for COVID-19 is 3.4% globally, higher than previous estimates of about 2%.
www.cnbc.com www.cnbc.com

NY Times
www.nytimes.com

Cruise Ship Held Off California Becomes New Focus of Concern (Published 2020)

A cruise liner bound for San Francisco from Hawaii is believed to be linked to two coronavirus cases, one of them fatal. More cases were found in a number of states, including Texas and New Jersey.
www.nytimes.com www.nytimes.com

WHO

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NYEMMED said:
CNBC
www.cnbc.com

WHO says coronavirus death rate is 3.4% globally, higher than previously thought

World health officials say the death rate for COVID-19 is 3.4% globally, higher than previous estimates of about 2%.
www.cnbc.com www.cnbc.com

NY Times
www.nytimes.com

Cruise Ship Held Off California Becomes New Focus of Concern (Published 2020)

A cruise liner bound for San Francisco from Hawaii is believed to be linked to two coronavirus cases, one of them fatal. More cases were found in a number of states, including Texas and New Jersey.
www.nytimes.com www.nytimes.com

WHO

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Better yet a real-time mapping of the confirmed cases and deaths.

3199 deaths with 93,166 confirmed cases = 3.4%

who-covid.jpg
 
There are several questions for all of us in the ED to consider:

  1. Are we changing our triage process to capture moderately sick patients with flu-like or cold-like symptoms? Are we increasing our sensitivity by working up more patients with specific vital signs?
  2. Are we preparing for increased "worried well" patients coming into our doors and gumming up our flow? Are we prepared to change our triage process before they hit the ED so that the mildly symptomatic folks have a quick MSE and told to go home?
 
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I'm a big believer in gathering all the evidence before spending $billions and making massive structural changes.

Because of the mildness of this virus in most people, they (rightly) don't need to seek medical care and go unrecorded. We are also dealing with the preponderance of data from China, which has a relatively backwards public health system and healthcare system in general. Typically outbreaks in countries like this lead to higher death rates due to lack of treatment and disorganized response. China was slow to respond to it as they politically didn't want embarrassment.

Korea is probably a better representation of true numbers since it has a functional healthcare system, and more reliable reporting. As of March 1st they had 5600 case with 20 death or about 0.35% death rate.

Those are probably more realistic numbers, and certainly not anything to be terrified of, or to cause a public health crisis.

At the end of the day we shouldn't be worried about a virus that kills 80 + year old patients with co-morbidities. Otherwise we should probably ban Xarelto too....
 
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VA Hopeful Dr said:
Did you mean to include rabies in the easily transmittable category and if so am I missing something?
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You know, this spurred me into more research, and all I can find is what happens when you're bitten by the rabid animal. It's clear that a bite (which, in itself, can be unnoticed) isn't even required. A scratch can do it, and there was a case in NJ of inhaled rabies due to bat guano. I can't find the minimal infectious dose. However, prolonged exposure isn't needed, and using Hansen's disease, for example, at one end, rabies is definitely on the very other end.

Or, are you saying, if exposed to a rabid animal, it is very difficult to transmit? Because, if you are, that is news to me, and you need to expand your answer. I'm not speaking of low rates, or successful treatment with Rabavert and RIG.
 
WilcoWorld said:
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.
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True dat, but, I think his statement was more vague than it could have been. The transmission isn't difficult.
 
Apollyon said:
You know, this spurred me into more research, and all I can find is what happens when you're bitten by the rabid animal. It's clear that a bite (which, in itself, can be unnoticed) isn't even required. A scratch can do it, and there was a case in NJ of inhaled rabies due to bat guano. I can't find the minimal infectious dose. However, prolonged exposure isn't needed, and using Hansen's disease, for example, at one end, rabies is definitely on the very other end.

Or, are you saying, if exposed to a rabid animal, it is very difficult to transmit? Because, if you are, that is news to me, and you need to expand your answer. I'm not speaking of low rates, or successful treatment with Rabavert and RIG.
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Right, so you think bite/scratch/guano cave is easily transmissible?

Because when I hear that something's easily transmissible that's not what I think.
 
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sylvanthus said:
Anyone want to predict how long it takes for the masses to freak the f out and come to the ED en masse for coronavirus fears/testing?
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I took a long drive this afternoon and was listening to NFL Radio on Sirius. There was an ad from Sirius "Doctor Radio" (I didn't know such a thing exists) with an EM physician telling people that if you think you have the coronavirus to stay home, stay in bed, and drink lots of fluid. There is no need to go to the hospital unless you feel critically ill or have been warned that you specifically have a medical condition that requires more aggressive care.

I didn't pay much attention to the ad until I saw this thread. But it was interesting that they had an ad that basically said DON"T GO TO THE ED!

The only problem was that they were advertising on NFL Radio. That is probably the one population group that you need to say GO TO THE ED! At least if you go with my interactions with middle age and older, midwestern, German, farmers and factory workers.
 
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Vandalia said:
I took a long drive this afternoon and was listening to NFL Radio on Sirius. There was an ad from Sirius "Doctor Radio" (I didn't know such a thing exists) with an EM physician telling people that if you think you have the coronavirus to stay home, stay in bed, and drink lots of fluid. There is no need to go to the hospital unless you feel critically ill or have been warned that you specifically have a medical condition that requires more aggressive care.

I didn't pay much attention to the ad until I saw this thread. But it was interesting that they had an ad that basically said DON"T GO TO THE ED!

The only problem was that they were advertising on NFL Radio. That is probably the one population group that you need to say GO TO THE ED! At least if you go with my interactions with middle age and older, midwestern, German, farmers and factory workers.
Click to expand...

Wow, reasonable advice on NFL radio. I'm impressed.
 
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VA Hopeful Dr said:
Right, so you think bite/scratch/guano cave is easily transmissible?

Because when I hear that something's easily transmissible that's not what I think.
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I don't know why you sound so combative. If you get bitten by a rabid bat or dog (literal thousands of cases/deaths yearly in India), it's easily transmissible. Again, if you mean something else, you really have to explain, because I'm still not sure what you mean.
 
Apollyon said:
I don't know why you sound so combative. If you get bitten by a rabid bat or dog (literal thousands of cases/deaths yearly in India), it's easily transmissible. Again, if you mean something else, you really have to explain, because I'm still not sure what you mean.
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Because you're reading too much into this? I'm not trying to be combative.

When I hear that something is easily transmissible, to me that means that its easy to transmit. The other infections you mentioned mostly fall into the category: varicella - aerosolized or contact with vesicles, herpes - same skin route, dengue/viral encephalitis - mosquito bites which are pretty much universal.

Rabies needs either a mammal bite (reasonably rare most places) or inhaling a decent amount of guano. Now yes its easier to transmit than leprosy, but pretty much everything is.
 
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traxus said:
There are several questions for all of us in the ED to consider:

  1. Are we changing our triage process to capture moderately sick patients with flu-like or cold-like symptoms? Are we increasing our sensitivity by working up more patients with specific vital signs?
  2. Are we preparing for increased "worried well" patients coming into our doors and gumming up our flow? Are we prepared to change our triage process before they hit the ED so that the mildly symptomatic folks have a quick MSE and told to go home?
Click to expand...

The worried well (especially those that are infected!) are going to be a HUGE issue in the coming weeks. It won't be possible to isolate suspected cases once you get more than a handful in a day, and it'll end up using up all the PPE we have (which we'll need for the hordes of dying gomers). Honestly, I think our best option would be to set up a nurse/registration desk outside the front door to screen out any patients w/ resp symptoms and place them all in a tent in the parking lot (excepting severe cases w/ hypoxia or other need for hospitalization).

Once we have suspected country-wide community transmission (10 days or so from now?) we'll need to change our case definition and stop swabbing people. We'll need to stop accommodating people who "just want to know if I have it" and tell them to gtfo. We need people on local newscasts saying to stop w/ the usual "seek healthcare early" BS and tell people to stay home and self-isolate. Honestly, as far as I can tell, the cat's outta the bag at this point.

Another issue: how are we going to deal with being shortstaffed when we start catching it? It's one thing to make up for a handful people being out in a triple coverage department, but losing 1 doc out of 6 at a single coverage shop makes for a local catastrophe. Are we really going to continue to hold people out just for exposure?
 
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turkeyjerky said:
The worried well (especially those that are infected!) are going to be a HUGE issue in the coming weeks. It won't be possible to isolate suspected cases once you get more than a handful in a day, and it'll end up using up all the PPE we have (which we'll need for the hordes of dying gomers). Honestly, I think our best option would be to set up a nurse/registration desk outside the front door to screen out any patients w/ resp symptoms and place them all in a tent in the parking lot (excepting severe cases w/ hypoxia or other need for hospitalization).

Once we have suspected country-wide community transmission (10 days or so from now?) we'll need to change our case definition and stop swabbing people. We'll need to stop accommodating people who "just want to know if I have it" and tell them to gtfo. We need people on local newscasts saying to stop w/ the usual "seek healthcare early" BS and tell people to stay home and self-isolate. Honestly, as far as I can tell, the cat's outta the bag at this point.

Another issue: how are we going to deal with being shortstaffed when we start catching it? It's one thing to make up for a handful people being out in a triple coverage department, but losing 1 doc out of 6 at a single coverage shop makes for a local catastrophe. Are we really going to continue to hold people out just for exposure?
Click to expand...

All great points, that haven't been adequately addressed. It's complete nonsense considering the mildness of the symptoms in the vast majority of people and the LOW death rate (again look at Korea).
 
turkeyjerky said:
Another issue: how are we going to deal with being shortstaffed when we start catching it? It's one thing to make up for a handful people being out in a triple coverage department, but losing 1 doc out of 6 at a single coverage shop makes for a local catastrophe. Are we really going to continue to hold people out just for exposure?
Click to expand...

Maybe hospitals will keep ER's open for only 18 hrs a day, not 24. Are there any laws against this?
 
First case here today, recent international travel. 70s in ICU.
 
Here's something.
Don't do this for a training exercise and then have it filmed.

FAU people.
 
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Dr.McNinja said:
Here's something.
Don't do this for a training exercise and then have it filmed.

FAU people.
Click to expand...


I am embarrassed for those residents.

What kind of program leadership lets something like this go on?

HH
 
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VA Hopeful Dr said:
Rabies needs either a mammal bite (reasonably rare most places) or inhaling a decent amount of guano. Now yes its easier to transmit than leprosy, but pretty much everything is.
Click to expand...
99% of human rabies cases come from bites from rabid dogs. Where are those? India. There are thousands of cases there every year. Here in the US, it's less than 50. We have Rabavert and RIG. We also vaccinate animals; in my town, it's required for dogs (I don't know if that is a town ordinance, or state, but it's required for a town dog license). Rabies and tetanus are the only two things against which you can immunize after infection. That's not transmission here, that's incidence. You get bit by a rabid dog, it's very likely in India, and you are very likely going to die from it, there, unfortunately. That's my end of it.
 
Dr.McNinja said:
Here's something.
Don't do this for a training exercise and then have it filmed.

FAU people.
Click to expand...


Oof.

Kind of irresponsible on the part of their leadership whipping up fears of a horror movie style outbreak. Especially given the FAU patient population is almost entirely the easily terrified snowbird retirees RustedFox likes to rant about.
 
Apollyon said:
99% of human rabies cases come from bites from rabid dogs. Where are those? India. There are thousands of cases there every year. Here in the US, it's less than 50. We have Rabavert and RIG. We also vaccinate animals; in my town, it's required for dogs (I don't know if that is a town ordinance, or state, but it's required for a town dog license). Rabies and tetanus are the only two things against which you can immunize after infection. That's not transmission here, that's incidence. You get bit by a rabid dog, it's very likely in India, and you are very likely going to die from it, there, unfortunately. That's my end of it.
Click to expand...
So because India has lots of rabies its easily transmissible?
 
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VA Hopeful Dr said:
So because India has lots of rabies its easily transmissible?
Click to expand...
Yes. It's in the saliva. Dog bite breaks the skin. Rabid dog. I don't have solid numbers, but, I know it's high enough to be in the thousands of cases. That's a question for which I don't know the answer: bitten by a rabid dog. What is the chance you don't get rabies? I don't know, but, my guess is highly unlikely.
 
GeneralVeers said:
All great points, that haven't been adequately addressed. It's complete nonsense considering the mildness of the symptoms in the vast majority of people and the LOW death rate (again look at Korea).
Click to expand...
Korea's mortality rate is an huge outlier compared to most other countries dealing with this. The WHO continues to revise the average mortality worldwide upwards, even while Korea's stays low. There are a few possible explanations for why they are getting such a low mortality rate compared to everyone else:

1) The first is that there just aren't that many cases, and there aren't that many cases because Korea been testing REALLY aggressively and quarantining their positive cases. They have already tested 140,000 people. Compare that with the US where we have only successfully managed to screen a few thousand people despite already having multiple sites with documented community transmission. It may be that this aggressive approach has limited the virus to the young and middle aged travelers who tend to spread it from abroad but who seem to die pretty rarely, and has kept it away from the elderly who are driving the mortality statistics.

2) The second possible reason is that they are the only government, so far, to standardize a protocol of treating high risk patients with antivirals (see below), even if they aren't actually in the ICU yet. China has been pioneering this but Korea is the first to protocolize it.



Finaly Korea's massive nationwide testing has pretty much confirmed that there aren't a ton of asymptomatic cases walking around out there. The mortality rate really is way, way higher than the mortality rate from flu.
 
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Perrotfish said:
Korea's mortality rate is an huge outlier compared to most other countries dealing with this. The WHO continues to revise the average mortality worldwide upwards, even while Korea's stays low. There are a few possible explanations for why they are getting such a low mortality rate compared to everyone else:

1) The first is that there just aren't that many cases, and there aren't that many cases because Korea been testing REALLY aggressively and quarantining their positive cases. They have already tested 140,000 people. Compare that with the US where we have only successfully managed to screen a few thousand people despite already having multiple sites with documented community transmission. It may be that this aggressive approach has limited the virus to the young and middle aged travelers who tend to spread it from abroad but who seem to die pretty rarely, and has kept it away from the elderly who are driving the mortality statistics.

2) The second possible reason is that they are the only government, so far, to standardize a protocol of treating high risk patients with antivirals (see below), even if they aren't actually in the ICU yet. China has been pioneering this but Korea is the first to protocolize it.



Finaly Korea's massive nationwide testing has pretty much confirmed that there aren't a ton of asymptomatic cases walking around out there. The mortality rate really is way, way higher than the mortality rate from flu.
Click to expand...


Idk 0.8% mortality rate, assuming they catch everybody, sounds pretty reasonable to me. You think that the people inflicted are preferentially the young/middle aged and not the elderly.... why exactly?

Does coronavirus now cause.... seizures? And zombie-like activity? Will they be coming off buses and come running at the hospital like the zombies from I Am Legend?
 
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Hamhock said:
I am embarrassed for those residents.

What kind of program leadership lets something like this go on?

HH
Click to expand...

Yikes, that's incredibly embarrassing. It's a really new program but you think they'd know better. My program would never do nonsense like this.
 
evilbooyaa said:
Idk 0.8% mortality rate, assuming they catch everybody, sounds pretty reasonable to me. You think that the people inflicted are preferentially the young/middle aged and not the elderly.... why exactly?
Click to expand...

There's no need to speculate, you can find the data here.


Plenty of 20 something year olds who are doing fine to bring the rate down, high female to male ratio which brings it down as well. That may be a reflection of the church membership which makes up almost half of these cases.
 
turkeyjerky said:
The worried well (especially those that are infected!) are going to be a HUGE issue in the coming weeks. It won't be possible to isolate suspected cases once you get more than a handful in a day, and it'll end up using up all the PPE we have (which we'll need for the hordes of dying gomers). Honestly, I think our best option would be to set up a nurse/registration desk outside the front door to screen out any patients w/ resp symptoms and place them all in a tent in the parking lot (excepting severe cases w/ hypoxia or other need for hospitalization).
Click to expand...

The issue then becomes whether we are performing a MSE on every single patient and slowing down every part of the triage / in-take process or eschewing EMTALA and telling those with mild symptoms and no vital sign derangement to go home. I am concerned that we do not have the staff or resources to document every encounter while trying to find not only the sick covid-19 patients but also all the other emergencies that will be hitting our doors.

turkeyjerky said:
Another issue: how are we going to deal with being shortstaffed when we start catching it? It's one thing to make up for a handful people being out in a triple coverage department, but losing 1 doc out of 6 at a single coverage shop makes for a local catastrophe. Are we really going to continue to hold people out just for exposure?
Click to expand...

I for one will not be quarantined within the facility and forced to work more hours than I want to or is even safe. We can't quarantine every single clinician, nurse, tech or housekeeping staff otherwise might as well close the ED doors. This is going to become a cluster and quickly so if they will mandate this approach.
 
Apollyon said:
99% of human rabies cases come from bites from rabid dogs. Where are those? India. There are thousands of cases there every year. Here in the US, it's less than 50. We have Rabavert and RIG. We also vaccinate animals; in my town, it's required for dogs (I don't know if that is a town ordinance, or state, but it's required for a town dog license). Rabies and tetanus are the only two things against which you can immunize after infection. That's not transmission here, that's incidence. You get bit by a rabid dog, it's very likely in India, and you are very likely going to die from it, there, unfortunately. That's my end of it.
Click to expand...

I stopped giving rabies shots for dog bites. There are some docs who still do it. According to the CDC there are something like 50 or so US cases TOTAL of rabies over the past 20 years. No dog transmissions from dogs in the US. Most of these people who get it are either people from other countries who come here, or people who get bit by raccoons or bats.
 
thegenius said:
I stopped giving rabies shots for dog bites. There are some docs who still do it. According to the CDC there are something like 50 or so US cases TOTAL of rabies over the past 20 years. No dog transmissions from dogs in the US. Most of these people who get it are either people from other countries who come here, or people who get bit by raccoons or bats.
Click to expand...

But giving rabies shots, and making them come back every few days for the series is a patient satisfier! #dosomethinganything
 
emcrit.org

Management of COVID-19 patients admitted to stepdown or ICU

CONTENTS Rapid Reference 🚀 Initial tests to guide management Chest CT findings Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib...
emcrit.org emcrit.org

Josh Farkas doesn't get enough credit. Damn, he creates some great content.

HH
 
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Looks like there will be widespread business and school closures over the next few weeks.
 
alpinism said:
Looks like there will be widespread business and school closures over the next few weeks.
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SXSW closed in Austin. Just completely shut down the entire festival.
THE Johns Hopkins U is not allowing spectators at their D3 basketball games.
 
thegenius said:
I stopped giving rabies shots for dog bites. There are some docs who still do it. According to the CDC there are something like 50 or so US cases TOTAL of rabies over the past 20 years. No dog transmissions from dogs in the US. Most of these people who get it are either people from other countries who come here, or people who get bit by raccoons or bats.
Click to expand...

if the biting dog is known there is no reason to rabies vaccinate the bitten person. Strictly confine the biting dog, if still normal in ten days no chance that the dog was rabid. If you got bit by a stray dog no way to monitor it then would vaccinate.
Just a pet peeve from a veterinarian.



 
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Cancelling SXSW is a big deal. Much of the spring touring industry revolves around it.
 
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