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Covid II: Medical Info and Implications


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7 hours ago, RevTestament said:

Ooohh!  Warm water.  That's the one I need.

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https://www.economist.com/graphic-detail/2020/10/31/italian-towns-hit-hardest-by-covid-19-are-doing-better-now

"Some experts have advised letting the young and healthy get covid-19, in order to approach such herd immunity. European data suggest this goal remains distant: within countries, the regions with the most cases in the spring also tend to have the biggest outbreaks now. Yet broad averages can obscure local variation. And new Italian data show that the worst-hit places do now enjoy some degree of immunity."

"Social distancing has also slowed the virus. According to Google, Lombards moved around 24% less in July than in January, the steepest drop in Italy. But this decline has been similar in all of Lombardy. That leaves immunity as the best explanation for differences in case counts within the region.

These data do not prove the case for seeking herd immunity. Without a vaccine, the cost of gaining even mild resistance is grim. No national study has found a share of people with antibodies even one-third as high as the 24% seen in Bergamo in July. And Europe’s highest national excess death rate, in Spain, is just a fifth of Bergamo’s.

Yet for beleaguered Bergamasques, the data are good news. Sero surveys show that antibodies there are not only common, but especially so among the old and health-care workers, who need them most."

 

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"No serious adverse cardiac events were reported. The most common side effects were gastrointestinal. Conclusion--Hydroxychloroquine use in outpatients reduces the incidence of the composite outcome of COVID-19 infection, hospitalization, and death. Serious adverse events were not reported and cardiac arrhythmia was rare."

https://www.medrxiv.org/content/10.1101/2020.09.30.20204693v1

"293 nursing-home residents at high-risk were also included in the

patient mix. In these individuals, HCQ use for pos t-exposure prophylaxis reduced the risk of

developing PCR-confirmed COVID-19, by half: relative risk 0.49 (95%CI 0.21 to 1.17)

 

Edited by bsjkki
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Pogi, have you any info on level of compliance to mask mandates in Utah at this point?  For some reason I missed when high transmission counties (almost all of them now) became mask required. It has been a complicated couple of weeks for me, this isn’t the only thing that slipped by me. 
 

From what I just read, if compliance becomes high we could turn the surging around in two weeks or so. I am wondering if that is wishful thinking. 
 

I have had to ask a few people to put their masks on before I entered their business or they entered my home, but everyone has been very agreeable, even thanking me.  There is a bit different feel about it, it seems to me...though that might be just my increase in leaving my home recently. 

Edited by Calm
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Excellent and short interview on conditions at the UoU Hospital (worst issue staffing, 100-110 iCU beds out of 111 in use, her opinion is staff not really available even if more beds are added in the state as they are exhausted and at limits already):

https://www.wbur.org/hereandnow/2020/10/26/utah-coronavirus-surge
 

UoU has apparently the largest geographical footprint in the country for a critical care facility, the rural facilities can’t handle the cases and send them there...so even if there is room in rural facilities, doesn’t mean much.

Pogi, please correct me if I have misunderstood or anyone else who listens to this. 

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About staffing issues and implications:

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According to state data, Utah’s ICUs have been about 75% occupied in recent days. But that number can be misleading. “It gives a false sense of security," Bell explained, “because ... we can’t operate to the max.”

Not only do staffing levels shift over time, but also different patients require different levels of time and attention. And coronavirus patients, who made up about 20% of ICU patients last week, can be particularly time intensive to care for, said Dr. Lindsay Leither, director of Intermountain Medical Center’s respiratory ICU.

 

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“A lot of our COVID patients tend to be really sick and they do tend to stay in the ICU longer,” Leither said in an online news briefing. And, she added, there’s a heightened “busyness” in coronavirus units. “Nurses, all the different therapists that are there, in and out of patients' rooms all day long, putting on and off their [personal protective equipment] and cleaning it.”

Meanwhile, as ICU beds become more scarce, the logistics of moving patients around takes more and more time and effort.

 

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“It can be very hard when we’re moving patients out and in throughout the day nonstop, and you’re telling nurses, ‘OK, I know you’ve already had three different patients today but we have more coming and we need to get more out,’ ” said Dani Beebe, a nurse in an Intermountain Medical Center ICU. "It’s constant.”

Just arranging the transfers adds to the workload.

 

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"Every one of those calls takes time, whether it’s for somebody having a heart attack down in Delta or whether it’s for somebody who needs COVID care at [Intermountain Medical Center] or a child that has a complex congenital disease down in Utah County that needs to go to Primary Children’s [Hospital]. It does take time away from direct patient care,” said Dr. Mark Ott, medical director for Intermountain Medical Center.

 

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That all means operating at 100% capacity is generally unrealistic, Bell said. “If you’re a manager of an ICU, you might say, ‘We really can only open three more beds this afternoon,’ even if [the normal ICU capacity] says ‘six.'"

https://www.sltrib.com/news/2020/10/25/with-coronavirus-cases/

Edited by Calm
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Info on Utah hospital beds:

https://www.ahd.com/states/hospital_UT.html

Total ICU beds are about 500, which means UoU carries 1/5 of them. 
 

13 hospitals have over 100 total beds, only IHC in Murray is over 500 as well at 502, a couple in the 300s. So UoU is our biggest hospital by far, and with 1/5 of their beds ICU the one most focused on critical care. 
 

With staffing in the state down 20-30%, this is a major crisis. 
 

From Trib:

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We’re down 20% to 30%. Hundreds and hundreds of nurses are not able to work as they were [before] because of their own disease or infection in the family, or they’re moms and dads with school issues,” Bell said. “Some are worn out, some are on leave because they’ve been doing this for seven months.”

 

Edited by Calm
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There are 317 people currently hospitalized with COVID-19 in Utah, including 123 in intensive care units across the state. About 69% of all ICU beds in Utah are occupied as of Thursday, while about 55% of non-ICU beds are filled, state data shows.

https://www.ksl.com/article/50039872/a-very-difficult-time-herbert-provides-update-as-1837-more-covid-19-cases-10-deaths-reported-thursday

For now it looks like the breaking point is staff. 

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Mask study from the CDC. 
https://wwwnc.cdc.gov/eid/article/26/10/20-0948_article

Conclusions

The filtration, effectiveness, fit, and performance of cloth masks are inferior to those of medical masks and respirators. Cloth mask use should not be mandated for healthcare workers, who should as a priority be provided proper respiratory protection. Cloth masks are a more suitable option for community use when medical masks are unavailable. Protection provided by cloth masks may be improved by selecting appropriate material, increasing the number of mask layers, and using those with a design that provides filtration and fit. Cloth masks should be washed daily and after high-exposure use by using soap and water or other appropriate methods.

Edited by bsjkki
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37 minutes ago, Rain said:

I remember hearing that about New York as well.   

Utah and other places sent healthcare workers to help. Not really an option now  

 

 

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10 hours ago, Calm said:

Pogi, have you any info on level of compliance to mask mandates in Utah at this point?  For some reason I missed when high transmission counties (almost all of them now) became mask required. It has been a complicated couple of weeks for me, this isn’t the only thing that slipped by me. 
 

From what I just read, if compliance becomes high we could turn the surging around in two weeks or so. I am wondering if that is wishful thinking. 
 

I have had to ask a few people to put their masks on before I entered their business or they entered my home, but everyone has been very agreeable, even thanking me.  There is a bit different feel about it, it seems to me...though that might be just my increase in leaving my home recently. 

I haven't heard anything about compliance in Utah.  I think it is pretty good in public places, for the most part.  If it is anything like my family, it is terrible with extended family gatherings.  I won't attend anymore unless masks are worn.  

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13 minutes ago, pogi said:

won't attend anymore unless masks are worn.  

Everyone knows already I am walking out today of the memorial if it turns out anyone ignores it. I am going to feel like an idiot and likely tick off my husband, but I am doing it.  Time to get ready. Bed is too sweet as always when I want to move. 
 

All singing is recorded, eating is limited to grabbing cream puffs or eclairs on the way out. No masks off except perhaps speakers with the podium cleaned with bleach in between. 
 

We got a large room so as to Social distance. 

Edited by Calm
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7 minutes ago, Calm said:

Everyone knows already I am walking out today of the memorial if it turns out anyone ignores it. I am going to feel like an idiot and likely tick off my husband, but I am doing it.  Time to get ready. Bed is too sweet as always when I want to move. 

I'm sure the attendees are going to be asked to wear them beforehand. But it's a possibility that some ignore it. My former neighbor happened to have grown up near my BIL and in the summer they had a memorial for his mom in a tent setting outside near the cemetery. Well there is my neighbor and friend without her mask throughout it. We did take ours off to eat at the luncheon held outside too. But it's kinda bad when we were asked to wear masks, and she didn't. We play pickle ball occasionally and she is an anti masker and a huge supporter of you know who.

I hope they all wear them so that you can be there for the full time Calm. You got this!! 

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10 hours ago, Tacenda said:

I'm sure the attendees are going to be asked to wear them beforehand. But it's a possibility that some ignore it. My former neighbor happened to have grown up near my BIL and in the summer they had a memorial for his mom in a tent setting outside near the cemetery. Well there is my neighbor and friend without her mask throughout it. We did take ours off to eat at the luncheon held outside too. But it's kinda bad when we were asked to wear masks, and she didn't. We play pickle ball occasionally and she is an anti masker and a huge supporter of you know who.

I hope they all wear them so that you can be there for the full time Calm. You got this!! 

They all did.  We gave air hugs too.  It was a beautiful ceremony.  The only issue was it went longer to an hour and a half, so it is possible we could get sick.  I am not stressing about it.

Edited by Calm
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I am not saying we could have achieved this, our culture and country geography is too different, but I think there is good evidence it didn’t have to be the record highs, more than a case a second being added to the list, etc

EDH:

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Taiwan marked 200 days without a locally transmitted infection. On Thursday, Taiwan, with a population of 23.8 million, reached its 200thday without a single locally transmitted case of COVID-19, according to the Guardian. The paper attributed the country’s success to a nationwide coordinated effort that has included two weeks of quarantine for anyone flying into the island and extensive testing and tracing.

 

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A run down of Covid infection scenarios with expected infection rate. Looks well done but take with grain of salt. I am guessing the Patient 0s in these scenarios are patients with at least a moderate to high rate of virus shedding but that is a guess.

 

https://english.elpais.com/society/2020-10-28/a-room-a-bar-and-a-class-how-the-coronavirus-is-spread-through-the-air.html

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While China was the origin, looks like it was Europe that brought it to the world.

https://www.mdpi.com/2076-2607/8/11/1678?fbclid=IwAR1MmPYgs4KXoVc8Br0Z0aJy_0NfMwd_wwKy2T_2nwOMvOz29DoDyLzDNdM

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We confirmed that the phylogeny pinpoints China as the origin of the pandemic with major founders worldwide, mainly during January 2020. However, a single specific East Asian founder underwent massive radiation in Europe and became the main actor of the subsequent spread worldwide during March 2020. This lineage accounts for the great majority of cases detected globally and even spread back to the source in East Asia.

 

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Despite an East Asian source, therefore, the global pandemic was mainly fueled by its expansion across and out of Europe. It seems likely that travel bans established throughout the world in the second half of March helped to decrease the number of intercontinental exchanges, particularly from mainland China, but were less effective between Europe and North America where exchanges in both directions are visible up to April, long after bans were imposed.

 

Edited by Calm
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Here are some more stats for the United States.  These numbers are the most current numbers available.  They are a snapshot in time and do not consider every factor, but do provide some interesting data.

States requiring masks

Avg Cases per million - 25,552

Avg Deaths per million - 719

Avg 14 Day growth rate - 46%

Death Rate - 2.81%

Avg Cases per day per million - 7,843

Avg Deaths per day per million - 97.5

Unemployment - 8.55%

States Not requiring masks

Avg Cases per million - 35,802

Avg Deaths per million - 649

Avg 14 Day growth rate - 44%

Death Rate - 1.81%

Avg Cases per day per million - 8,321

Avg Deaths per day per million - 80.22

Unemployment - 6.05%

 

Of the top ten states in Avg Cases per day per million - 30% Require masks

Of the top ten states in Avg Deaths per day per million - 50% Require masks

Of the top ten states in Avg Cases per million - 40% Require masks

Of the top ten states in Avg Deaths per million - 80% Require masks

Of the top ten states in Unemployment - 100% Require masks

 

Stats for Utah

Avg Cases per day per million  - Ranks 9th worst

Avg Deaths per day per million - Ranks 34th worst or 17th best

Death Rate - Ranks 2nd best

Unemployment - Ranks 7th best

 

For what it's worth

Edited by T-Shirt
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The virus may be mutating to become more contagious. A peer-reviewed study published October 30 in mBio, the journal of the American Society for Microbiology, found that the coronavirus is accumulating genetic mutations, one of which may have made it more contagious. The research identified a mutation, called D614G, which pries open our cells for viral entry. Ilya Finkelstein, PhD, associate professor of molecular biosciences at The University of Texas at Austin and coauthor of the study, told UT News, “The virus is mutating due to a combination of neutral drift — which just means random genetic changes that don’t help or hurt the virus — and pressure from our immune systems.” Study authors say that the investigation, involving more than 5,000 COVID-19 patients in Houston, is the largest peer-reviewed study of SARS-CoV-2 genome sequences in one metropolitan region of the United States to date. During the first wave of the outbreak, 71 percent of the novel coronaviruses identified in patients in Houston had this mutation but that leapt to 99.9 percent during the second wave.

 

 

From EDH

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