Governor Cuomo just held a very clueful presser. He “gets it”.
One polish point.
He talks about the need to have the Army Corps of Engineers convert buildings to hospitals.
While that may yet be needed, I think there’s a quicker first step. Set up our existing mobile military hospitals.
https://en.wikipedia.org/wiki/Combat_support_hospital
Facility
The size of a combat support hospital is not limited, since tents can be chained together; it will typically deploy with between 44 and 248 hospital beds, with 44 beds being most common (ATP 4.02-5 Casualty Care, May 2013) For patient care the CSH is climate-controlled, and has pharmacy, laboratory, X-Ray (often including a CT Scanner) and dental capabilities (ATP 4-02.5 Casualty Care, May 2013). It provides its own power from generators.The great operational advantage of the deployable medical systems (DEPMEDS) facility is the use of single or double expanding ISO containers or units to create hard-sided, air conditioned, sterile operating rooms and intensive care facilities, which can produce surgical outcomes similar to that seen in fixed facility hospitals, and do so in an austere environment.
[…]
List of combat support hospitals
Current
10th Combat Support Hospital (10th CSH) (Fort Carson, Colorado)
14th Combat Support Hospital (14th CSH) (Fort Benning, Georgia)
21st Combat Support Hospital (21st CSH) (Fort Hood, Texas)
28th Combat Support Hospital (28th CSH) (Fort Bragg, North Carolina)
31st Combat Support Hospital (31st CSH) (Fort Bliss, Texas)
47th Combat Support Hospital (47th CSH) (Fort Lewis, Washington)
86th Combat Support Hospital (86th CSH) (Fort Campbell, Kentucky)
115th Combat Support Hospital (115th CSH) (Fort Polk, Louisiana)
Reserves / National Guard
228th Combat Support Hospital (228th CSH) (Fort Sam Houston, Texas)
256th Combat Support Hospital (256th CSH) (Twinsburg, Ohio)
75th Combat Support Hospital (75th CSH) (Tuscaloosa, Alabama)
325th Combat Support Hospital (325th CSH) (Independence, Missouri)
328th Combat Support Hospital (328th CSH) (Fort Douglas, Utah)
349th Combat Support Hospital (349th CSH) (Bell, California)
345th Combat Support Hospital (345th CSH) (Jacksonville, FL)
352nd Combat Support Hospital (352nd CSH) (Camp Parks, California)
396th Combat Support Hospital (396th CSH) (Vancouver, Washington)
399th Combat Support Hospital (399th CSH) (Fort Devens, Massachusetts)
405th Combat Support Hospital (405th CSH) (Worcester, Massachusetts)
452nd Combat Support Hospital (452nd CSH) (Milwaukee, Wisconsin)
801st Combat Support Hospital (801st CSH) (Fort Sheridan, Illinois)
865th Combat Support Hospital (865th CSH) (Utica, New York)
Overseas
121st Combat Support Hospital (121st CSH) (Camp Humphreys, Pyeongtaek, South Korea)
212th Combat Support Hospital (212th CSH) (Rhine Ordnance Barracks, Germany)
94th Combat Support Hospital (94th CSH), North Little Rock, Arkansas
Sure, have them convert appropriate existing buildings too. But set up one of these on the sports field while you convert the dorm to a hospital… It will be up faster, and still there for overflow when your conversion fills up later. His own National Guard can start setting up his own, now.
Musings from the Chiefio 
ISO containers are suprisingly adaptable and as they are ISO everyone knows the sizes to build to. In the Falklands there were ISO cities. Now decades later building facilities from the ISO containers is a thriving industry:
https://isospaces.com/case_study/hope-gardens/
http://www.world-camps.com/expandablecontainers.php (note already set up for CV-19 use)
Any local authority should assess these for use in the current emergency.
@Ian W:
The US Military is converting to something like that (from tents), see “DEPMEDS” in the quote from wiki. But your comment made me wonder if a commercial unit existed:
https://blu-med.com/expandable-hospital-containers/
Looks like Cuomo needs to start thinking “INSIDE the box”! :’)
http://www.world-camps.com/medicalcontainers.php
So maybe open that check book, Guv, and order up a few dozen for your State Emergency Response unit…
If you had not pointed out the difference, I would have assumed that was what Sonny was talking about.
The biggest problem with these units is that they need them yesterday and they should have been funded and ordered a year ago to have them available today. Democratic Governors such a Cuomo want the Feds to give him a blank check to do this, If he calls up the State Guard units, medical facilities that he can command, he has to pay for them. If Trump orders them up the feds have to pay the bill.
Meanwhile, from the Seattle area:
” A fully self-contained tent with flooring and heat will be used as an isolation and recovery location on the county-owned parking lot at 13620 Eastgate Way in Bellevue. The area will have 24/7 onsite security and health services staff, and will be available in about a week.”
This is super interesting. Breakdown of Diamond Princess infections by age.
percent infected increases markedly with age. <10% of under 50s were infected. 20% of over 50s up to 80 and 25% of over 80s. Maybe younger people were just shrugging the infection off without tests ever returning a positive result. Otherwise why would there be 2x % of older people getting infected.
https://cmmid.github.io/topics/covid19/severity/diamond_cruise_cfr_estimates.html
World really needs to get some good data on exactly how many people are likely to get infected – that will inform a lot of huge policy decisions.
@Foyle:
My guess would be Vit-D status. As you get older, you make less of it from the same sun exposure. Then, who is most likely to spend 4 hours in the outdoor pool top deck, and who in the hot tub below decks? Or at the bar? Who sits on the shaded deck chair with a blanket and hat? Who runs around shirtless in cutoffs?
There is also just a general fading of immunity with age. A small innoculating dose that a 20 something fights off in 3 days with no symptoms can turn to serious disease by day 5 in an old person of compromised immunity. You see this in any nursing home.
Foyle,
As you say “super interesting”.
There seems to be well documented comorbidity in fatal outcomes in the elderly.
If I recall correctly there was an autopsy study from the USA 2 or 3 years ago that suggested 60% of those autopsied were being treated for things they did not have.
There is some suggestion that Aspirin losing its trademark contributed to the high death rate from the Spanish Flu. There is also suggestion that the Iranian medical community prefers using steroids to treat Covid19 symptoms. There are also some that suggest the Italian preference is for using NSAIDs.
What if it is not the underlying diseases that lead to fatal outcomes?
Could it be the underlying medications that firstly predispose one to more symptoms or more severe symptoms, and then secondly to fatal outcomes?
In the UK, hotels are currently almost-empty, so the idea there is to use hotels as temporary hospitals if it becomes necessary. The rooms and beds are there, so just needs the equipment added. Seems a better alternative to building new hospitals since it also means that the hotels won’t go bust. Maybe the big problem there is that they’ll need more nurses and doctors to run those temporary hospitals, but that applies whatever route you choose. Hotels might be less efficient as regards number of staff needed, though.
@Tony, Doctors like most “trained professionals” are just practicing what they know which is very little. Real craftsmen tailor their approach to the job.
Chinese doctors tried everything they could think of to limit bad outcomes and learn a few things worked to improve outcomes. They learned that mega doses of Vitamin C worked well. Treatment with Chloroquine worked. We know that Fever is the body’s way to burn out a Virus attack, NSAIDs and steroids are the medical professions “go to” treatment to reduce fever so a poor treatment for a viral infection. The Chinese found that many “go to” for treatments seemed to make matters worse.
For myself, I’m leaning to Vitamin C and D as prophylactic and Mega doses C as home treatment for any viral infection as well as “sweat” treatment to elevate body temperatures.
@Tony Hansen:
Fever is one of our immunity tools to kill virus and bacteria.
Supression of fever feels better, but compromises your immune response.
Steroidal anti-inflammatory drugs and NSAIDs (Aspirin, ibuprofen, etc.) reduce fever.
Covid-19 needs a stong immune response to stop it becoming a serious debilitating infection.
Therefore steroidal and Non-Steroidal Anti-Inflammatory Drugs make Covid-19 worse.
That’s the chain of logic that binds those stories all together, in any case…
@Simon:
While reasonable to use hotels, especially as they already have running water, power, and sanitation facilities: THE Big place with “issues” is the air handling system. Big highrise hotels best suited to conversion are likely to have central A/C and heating / ventilation. They do not have HEPA Filters and sterilization. “Make-up air” (really, fresh air) is usually set to about 10% to keep HVAC costs low. The other 90% comes from the inside of the building and gets recycled (I.e. spread all over the building).
You can open the make-up air dampers, but can’t set recycle to zero. (At least on buildings I’ve managed). With some work, HEPA filtration could be added, and UV Sterilzers installed. Lead time? Availability?
That’s why I was saying to set up the military field hospital in the parking lot, quad, sports ground, whatever… while doing the building conversion. Right now, you either recycle the whole building (like Diamond Princess disease incubator), ramp up make-up air like crazy (whole building positive pressure spewing a fountain of virus from every seam), or retrofit with HEPA & UV & air flow control for negative pressure in rooms.
One other possible:
Leave the hotel without air sterilizers and just declare it all Red Zone and use the field hospital as your green zone. Decontaminate in the space between them. The field hospital also includes facilities for things like emergency surgery and such, so eliminates those ambulance runs. Essentially treat it as a small real hospital with an attached red zone infectious ward.
Best descriptions I have seen of the test kit fiasco, Democrat laws and Trump:
https://threadreaderapp.com/thread/1238650034238836739.html
AND
This goes with the above:
“November 9, 2016 report by NPR station WABE-FM in Atlanta where the CDC is headquartered headlined an article on CDC employees’ reaction to Trump’s victory: “Atlanta CDC Employees Express Anxiety Over Trump’s Win”.
The WABE article details a somber, depressing, tearful, binge eating reaction by CDC staff:”
SOURCE:
*https://www.thegatewaypundit.com/2020/02/flashback-cdc-workers-were-crying-in-the-hallways-when-trump-was-elected-president/
Do I think these people would deliberately try to sabotage President Trump if they could, even if it meant people died?
They certainly were not interested in disease prevention under Obama!
Obama’s illegals bring disease to America’s children
Tuberculosis: The Deadly Disease of Political Correctness
The Viral and Deadly Diseases of Legal and Illegal Immigration
OR under Bush…
2004 LEPROSY, HEPATITIS AND TUBERCULOSIS RISING FAST IN UNITED STATES
https://newswithviews.com/Wooldridge/frosty9.htm
Cuomandius
I met a traveler from an antique land
Who said: a rusting column, overgrown
Stands on a hillside. With it, close at hand
Half sunk, a long and curving shaft lies prone
Though crumpled and corroded by the rain
Its sculptor’s purpose still is plain to see
A giant windmill, spinning to entrain
From tortured gearing, electricity
And on the pedestal these words appear
“My name is Cuomandius, King of kings
Look on my works, deniers, and despair”
Nothing beside remains, round the decay
Of that colossal wreck, the meadows fair
And forests breathing life stretch far away
Youngsters immune systems are more responsive to novel threats than older people’s because just about everything is novel to them, and in general they are healthier.
Another interesting observation is that there are fewer asymptomatic younger patients and at about 50 years of age the ratio of asymptomatic to symptomatic cases reverses. It’s also as if the immune systems of those over the age of 50 don’t recognize the virus as a threat.
Very Interesting on the old age suceptibility to infection. It makes sense, but was not expecting it to be so extreme, as elderly often get fewer colds flus. ( Exposed less?) Active used immune systems better?
Currently 34 percent of the diamond princess infected are still sick. ( 233) Only 15 are in critical. This has not changed in many days. These infections must average 25 plus days old. That is a long time to have a non serious flu like viral infection. Pretty soon they best start recovering, or we may see many move to serious critical.
Gail, I am saving your posts now as some of my liberal family will blame all on President Trump.
I saw this guy Stephen C. Redd taking press questions. He was terrible.
Literally hardly one clear answer. 2016 Obama appointee. Beyond that I know nothing.
At any rate if you ever do a bullet point summary, I will definitely save it, share it etc…
When you look at all the efforts of the CDC over the last 4 months you could conclude that they were purposefully trying to force a vast increase in their funding and power by creating a crises situation.
The reaction of officials over the last 4 days is far in excess of what is needed or justified. I am 74 and expect to survive this virus, I might even have it now for all I know, by my figures I would think that there are over 2,000 people in California have been infected. Only wide spread testing will tell and it will be another week before that can begin to take place…pg
Trying to find the study where 60% of those autopsied were treated for diseases they did not have, I found the number of autopsies have decreased since the 1970s…
And I ound this:
How Vaccines Can Damage Your Brain:
Vaccines, Depression and Neurodegeneration After Age 50: Another Reason to Avoid the Recommended Vaccines
By Russell L. Blaylock, M.D.
http://whale.to/b/blaylock.html
(Has a long list of references)
It goes along with “Vaccine-induced enhancement of susceptibility to SARS-CoV has been documented.”
Evaluation of Antibody-Dependent Enhancement of SARS-CoV Infection in Rhesus Macaques Immunized with an Inactivated SARS-CoV
p.g.sharrow says: 17 March 2020 at 12:29 am
“When you look at all the efforts of the CDC over the last 4 months you could conclude that they were purposefully trying to force a vast increase in their funding and power by creating a crises situation.”
@p.g. – Right on! Preach it brother! You have it exactly right.
This new strain of coronavirus really is serious stuff only because us geezers have immunity of some degree or other to coronaviruses 1 through 18, but… Ta Da! this is number 19.
OK. We don’t have any historical built-up immunity. We 60+ can get it and we will be hit hard. Everyone dies from something or other.
But not everyone 60+ gets it and dies. The data I’m seeing says if you’re 90+, kiss your @$$ goodbye. If you’re 80 to 90, make sure your will is up to date. If you are 60 to 80, better hope all that exposure and recovery from all the terrible viruses we faced and overcame give us a little help here… and we have good genes and good vitamin backup.
Just like the military, the CDC is fighting the last
warvirus, not the current one. It’s a typical, common, garden-variety government friggen’ bureaucracy, fer cryin’ out loud!Though I’m at increased risk – 65+, Type II diabetes, and I have a ponytail ;o) – I don’t fear this new, and it is a new variant, viral outbreak. I expect to get it this year or next and I will survive it or I won’t.
The gubmint be damned!!!
.
.
.
P.S. to you, p.g. – My mother-in-law is 86 years old and is gradually succumbing to dementia. We are keeping her in her home to lessen her exposure to WuFlu, but she watches the news and then understands why we’re keeping her there- only at that moment – but then can’t remember why she is stuck at home and there is no point going shopping…….. can’t remember who our Governor is or who the President is but can still process that this is version of coronavirus that is a serious viral threat to her… oh my!… but then can’t recall why we won’t take her anywhere.
Sad, but it happens. (She’s right smack in the middle of needing professional care for dementia vs. independence… that difficult place.)
Keep well. You’re still firing on all eight cylinders (Yes. You. Are!), but this is a new coronavirus to which no one has immunity, so it could take any one of us ‘elders’ here on the Chiefio blog, and that sucks.
Meanwhile, I’ll go fishing at every opportunity that the weather allows to make sure I’m socially isolated.
Yeeeeeee HAW! `I promised those little red worms I’d take them fishing. I don’t renege on my promises…. poor little blighters.
:o)
@HR; my mother is 96 and still living somewhat independent near my youngest sister. She nearly succumbed to pneumonia last spring, not sure why she got it, then after a few days of hospitalization recovered. Good thing sister and her son can check up on the lady every day. I once met all 4 of her grand parents and they all made it into their 90s. Good farm stock!
Catchin up on your fishin is a great way to spend your time, I used to do that a lot when I was young, After fishing commercially in Alaska I lost all fun in catching fish and so quit. Even tried fishing without the catching, just wet a line and drank beer, still no fun, Now I leave the fishing to others and just drink beer on rare occasions with the right people.
Really hate losing Larry, he was quite a resource of knowledge and information in this group but, we seem to be growing in contributors, that is good, but following conversations is getting more difficult with the increased traffic here. We will have to keep each other entertained for the next month, specially our host as he and his wife is in real lock down…pg
Latest from epidemic modelling group at imperial college. Very dark conclusions. Even best mitigation approaches will at best see hospitals overwhelmed by 8x on way to achieving herd immunity, and that (incredibly expensive) suppression until vaccination is really only viable choice to avoid 2-3% of population dying this year.
Click to access Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
I’m prepared to bet that Imperial College has it wrong and that it is way high in its numbers. As Willis writes in WUWT today out of 3700 people on the Diamond Princess only 700 tested positive and so far 7 have died. The UK can expect hundreds and the US low thousands of deaths. Of course if I’m wrong you can come here and take me up on my bet. But I may not be here..
If it bleeds, it leads. Media has every incentive to overhype the worst case scenario, yet never properly does an error analysis and propagation such that the proper uncertainty levels do *not* get published. Chicken Little, meet the Boy who cried “Wolf” too many times.
Given the way these things go, the areas where they were the least well prepared and made the most mistakes will be hit the hardest. The areas where the opposite is true will be the least affected. There will be areas that will *not* be affected at all. Flyover country is the place you ought to be ;p.
How long was the Diamond Princess in semi quarantine? Less then a month with about 8 doubling events.
( Not Good)
Most of that time supposed isolation in seperate rooms, small groups only out, keeping seperate.
So a poorly done quarantine, perhaps analogous to treating this like a common flu.
Fully one third of the passengers are not recovered. Mean illness time of those passengers is at least one month, a reasonable WAG of 5 weeks.
15 are serious / critical. The other 218 are still sick! I will wait to see how many of the serious/critical recover, and which way the 218, still sick after 5 weeks go, before coming to any mortality number.
Perhaps most important here, all received excellent medical care and the final CFR could be 3 to 5 percent.
That and only a month of spreading, and then true quarantine stopped the spread in its tracks. The lesson here is true quarantine works, and this virus has a very high R naught.
Just my perspective.
More on chloroquine / hydroxychlorquine. Usually used as an anti-Malarial. If you were in ‘Nam, you took it. Generic. Widely available. Links follow. Cheers –
– AG
https://www.powerlineblog.com/archives/2020/03/what-price-chloroquine.php
https://docs.google.com/document/d/e/2PACX-1vTi-g18ftNZUMRAj2SwRPodtscFio7bJ7GdNgbJAGbdfF67WuRJB3ZsidgpidB2eocFHAVjIL-7deJ7/pub
Speaking of buildings to make into hospitals…Fort Hood built a new hospital not long ago. I wonder what they’re doing with the old hospital?
Just sayin’…
@agirmarc; thanks for those links. The more I look at the government actions the more I think that Government officials are deliberately making this as bad as they can or they are amazingly STUPID !
@P.G.:
Or BOTH!
Can they be Both? From what I can see, 1 chloroquine per week as a prophylaxis, for a month or 2 would do the trick even if only the older half of the population received it,
Damn! third time I’ve had to clear the satellite dish we have 3 inches of very wet Sierra Cement on the ground and still coming down, March has become a lion.
Yeah, snow on Mt. Hamilton down here too. Cold air off the mountains has yardtime cold even at noon.
Global Warming my ass.
Fla. Gov. Ron DeSantis ordered bars & nightclubs closed for 30 days, eff. 5 p.m. today (FM 96.5 report). Rather amazing that a guv. of tourism-dependent Florida had the audacity/courage to do this on such a commercially important day, known to devout Christians as the Feast of St. Patrick. Closure does not apply to fast-food and other restaurants, altho’ take-out and delivery is officially encouraged by the guv.
Not commercially good for my local families-owned brew-pub, which still must pay electricity for cooling to lager their beers & ales in our current over-80°F premature heat wave. Anyone know how much financial compensation is provided by eliminating staff wages and lighting for the duration.
Foyle: “Latest from epidemic modelling group at imperial college.”
Interesting paper. Here is an idea I will throw out there to anybody who can run with it (and run it by their ethics board).
Instead of letting all the young’uns get infected naturally, as the UK proposes, do it in a controlled experiment. Ask for young healthy volunteers willing to go into isolation for several weeks. Promise them unlimited internet, great food, and let them have any exercise equipment they want, any musical instruments, etc. Then expose them to infected patients in a controlled manner, controlling how they get infected and the dose. Ranging from being near the patient, shaking hands with them, talking with them, touching things they have touched, and so on. Then monitor them.
As a result we should know more about how people get infected and we add a few to the herd immunity numbers. Depending on the results, the deliberate infection process could be stepped up or cancelled altogether.
I think we are getting ahead of ourselves here. Do not attribute to malice what can be easily explained by stupidity.
That government wants to grow is a given, But I think they are making this bigger out of stupidity, not malice.
I still cannot find any statistical review on survival rate of anyone who goes to an intubation state (ventilator use). The statistics certainly don’t look good for anyone who reaches the severe/critical stage with this virus.
Closed cases have moved up to 9% not good results.
https://www.worldometers.info/coronavirus/
@Ossqss:
In one of the earlier threadx I repeated s statistic from one of the mrdical videos: that, of the 20% who are severly ill, something like 1/3? go to ICU, and of the ICU patients, 15% die. So 15% of 20% is 3% which is close to the observed mortality rate in the data available (W.H.O. has it at 3.4%) so it passes a reasonableness test / cross check.
@EM, it still does not answer my question on Intubation effectiveness.
Either way, the current data we actually have on closed cases is not following that 3% path to date and has gone up not down over the last week. The current data also shows a 6% severe critical state (currently at 107k active cases), not the 20% we got from the old china statistics. Sure, I get Italy has impacted those numbers as 23% of their population is 65+ in age, but the data is still the data we have available, and not speculative and continues to produce similar numbers with much larger counts than existed even a week ago. CFR is at 9% at this point, not 3. Just sayin, I hope it changes with the +2 week lag we have involved overall.
@Ossqss:
I thought all the ICU patients were on ventilator. No? Or maybe I’m assuming things about intubation vs other kinds of ventilation…
Italy has summarily graduated this years M.D. class, skipping final exams, to add 10,000 doctors to the pool. They have hit the wall on beds and staff. Even their crematorium is overloaded. That’s got to make the numbers worse.
All of Europe is blowing up:
So 3500+ new cases per day and 345 dead per day…
ICU stats are exactly what’s missing EM. We have no clue as to who is on a ventilator for pulmonary issues and who is having Kidney or cardiac issues with the scenario/data at hand at this point. It is relevant to the picture. Everything is pretty much blowing up now, not just the EU.
We added almost 2,000 cases so far today in the USA. That is nearly a 1/3 increase in one day. I am told doubling time is 4 days or less at this point for the foreseeable future, dependent upon testing output.
News from Germany. They have discovered new symptoms of catching the virus — you lose your sense of smell and taste. 2/3 of the cases have this and it lasts several days (n=100)
https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/virologe-hendrik-streeck-ueber-corona-neue-symptome-entdeckt-16681450.html
Defence Secretary Esper said on Fox News interview that The National Guard was activated in 18 States. They will be deploying field hospitals as needed, when needed. Also having Army Engineers working with New York on hotel to hospital conversions.
Has anybody else noticed th odd data on the worldometer page on COV19?
The really odd one is the “active Cases” column, the numbers are way too high.
Is it the case that all those thousands are still active or is it that worlometers are not notified when someone is given the all clear.
The other stat that doesn’t look right is the last column for cases per million population, in particular Switzerland looks way too low compared to the other countries.
Do not forget that the peak doubling time itself has a variable time span. We do know that the peak doubling time will *not* last forever. These things show a mathematical relationship that is a double exponential, not a single one. The USA is on the upswing part of the curve, sure; yet it will top out. As the numbers of infected grow, the numbers of yet to be infected must decline, since the total number is relatively fixed. Thus a logistic/Gompert’s curve will be what the numbers will look like, in the end.
Here, only the largest metro areas have been affected, with metro Birmingham being the worst one with about 2/3rds of the cases. Birmingham is only 150 miles/3 hours west of Atlanta, and about the same southwest of Chattanooga, TN and south of Nashville, TN. The other 4 big metro areas, Mobile, Huntsville, Montgomery and Tuscaloosa, together have about 1/3rd of the total number of cases. There are no cases, yet, in the smaller urban areas or the rural ones; though any severe cases from there would be sent to Birmingham or one of the other larger, teaching hospitals. Birmingham does have the big teaching hospital (with Mobile, Huntsville and Tuscaloosa also having smaller teaching hospitals) and generally good ones.
Disclosure: I have worked for the University of Alabama Hospital pathology lab system in the past, now named UAB Hospital Pathology Labs. The cholesterol lab was in a building a block away from the virology lab. The hematology lab was in another building and closer to the virology lab. When I was there, I often passed by the virology lab. I live on the outskirts of Metro Birmingham, which ends at the river about 10 miles away from me. My children and grandchildren all live in Metro Birmingham and I have a daughter that works for the UAB Hospital system. My angioplasties were all done at the newest hospital in Metro Birmingham, Grandview Medical.
AC, I think the active cases is correct.
This is a difficult bug you get over.
It is also a good example of why the CFR starts at 0 and lags the exponential, slowly arching up as cases mature. So reports of like CFR may be premature. For instance…
DIAMOND PRINCESS
How long was the Diamond Princess in semi quarantine? Less then a month with about 8 doubling events.
( Not Good)
Most of that time supposed isolation in seperate rooms, small groups only out, keeping seperate.
So a poorly done quarantine, perhaps analogous to treating this like a common flu.
Fully one third of the infected passengers are not recovered. Mean illness time of those passengers is at least one month, a reasonable WAG of 5 weeks.
14 are serious / critical. The other 218 are still sick! I will wait to see how many of the serious/critical recover, and which way the 218, still sick after 5 weeks go, before coming to any mortality number.
Perhaps most important here, all received excellent medical care and the final CFR could be 3 to 5 percent.
That and only a month of spreading, and then true quarantine stopped the spread in its tracks. The lesson here is true quarantine works, and this virus has a very high R naught.
Still sick, or not testing negative but otherwise symptom-free? There just isn’t enough data.
Oh, a reminder. Not everyone in an ICU is on a respirator. Intensive care means intensive monitoring and support. Only sometimes will that mean a respirator. Folks post-op that needed intubation and folk that get intubated during cardiopulmonary resuscitation do go on respirators. Others, that don’t need that kind of intensive support, won’t get it. Supplemental oxygen can be supplied by other means. In other words, plenty of people with pneumonia will just be given spirometers and oxygen via nasal cannula as long as the peripheral pulse oximetry reading is about 90%, since they don’t need mechanical assistance.
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext
As of Feb 27, 2020, coronavirus disease 2019 (COVID-19) has affected 47 countries and territories around the world.1 Xiaobo Yang and colleagues2 described 52 of 710 patients with confirmed COVID-19 admitted to an intensive care unit (ICU) in Wuhan, China. 29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.2
Jonathan Chun-Hei Cheung and colleagues3 do not recommend use of a high-flow nasal cannula or non-invasive ventilation until the patient has viral clearance. Supporting the recommendation of the authors, I would like to add some points in relation to the use of high-flow nasal oxygen therapy and non-invasive ventilation in patients with COVID-19 infection:
END QUOTED TEXT.
So looks like 22 out of 710 needed intubation, and of the 29 started on other ventilation, only 7 did NOT progress to intubation… if I’m reading that right. And 86% of the intubated died anyway.
Looks to me like the folks in ICU on ventilation ought to be given whatever possible drug treatments are proposed as possible and learn fast by trial what is better than 86% dead.
@EM, interesting info. Some of the reference cases in that paper also provided some interesting data points.
Considering the global closed case CFR is back in double digits as of this afternoon and active serious/critical is back to 6%, changes would be expected moving forward. The US stats have yet to catch up as the CFR data is very different currently. The officials did reference to expect a large spike in case reporting over the next several days and into next week with new higher volume test processing methods having come online. That fact compounded by a soon to arrive stimulous/bailout package will provide a clear exit path for many hourly employees and employers.
https://www.worldometers.info/coronavirus/country/us/
The reaction is truly insane to shut down the economy over a virus with an effect no worse than the normal flu.
https://www.cdc.gov/flu/weekly/index.htm
“CDC estimates that so far this season there have been at least 36 million flu illnesses, 370,000 hospitalizations and 22,000 deaths from flu.”
Some random thoughts on the insanity:
The US so far lists about 100 deaths to this new virus, about 30 out of one long term nursing home in Washington state. High death rates to the normal flu in these types of units are common.
If a person dies of the run of the mill flu virus, and tests positive for the new virus as present, the new virus may be counted in the death numbers. How many of the elderly are counted against the new virus simply as being tested as “present”?
As the numbers of infected without symptoms or only mild reactions are high and unknown, but are known to be much higher than infected with major symptoms , the published death rates showing an order of magnitude higher rate for this new virus than the normal flu are complete junk and way over blown.
The madnesses of crowds and bureaucrats need to expand their power and budgets are a match made in hell.
@Ed Forbes:
Using flu mortality total vs Covid-19 fatality to date is foolish.
Flu is nearing the end of the season and most folks have been exposed. It typically kills about 0.1% and mostly only the very ill.
Covid-19 is just barely getting started. Nobody has resistance so it will rip through most of the population if ignored. Lethality with aggressive treatment in S.Korea is 1% or ten times the flu. In other places lethality ranges from 3.5% to 9%, or up to 90 times the flu.
If you do not stop spreading by a hard lock down (“shutting down the economy”) at the very best case, about 200 million get infected in the USA and 2 million of them die. This isn’t speculation, it is math plus facts. If you do not aggressively treat (and we are not) that becomes 6 to 12 million dead. This, too, is not speculation. Doctors in both China and Italy stated their crematoria could not keep up with the dead. WHEN you overrun your medical facilities (which will happen if you do not stop spreading) that rises to about 30 million dead. We know that as we know how many only survive with medical intervention. See Italy and Spain, today, as examples in progess of medical system collapse just starting. In italy, increasing numbers of younger patients without comorbidities are showing up needing hospital care. It isn’t just old sick folks going down hard.
But worse: it isn’t the dead that are all that matters. Folks who get sick and recover are left with a variety of damages. Limited beathing capacity (“out of breath after a short walk”), kidney damage, testicular lesions and sterility, and more. Then, the non-critical hospitalized get to spend weeks in the hospital in misery.
This is going to be a global math test. Those who understand exponential growth and case fatality rate will get it. Those who think linearly, and only in the present will not.
Ed; there is a reasonable likelihood of 10000x increase in number of infected and 100000x number of dead. React early and extremely or your country is screwed.
EM, what Ed Forbes also does not appear to get is that there are 4 Flu viruses with all those cases and deaths.
COVID19 is on top of all those cases and deaths, it really is good that the Flu season is coming to an end, if COVID19 had started when the Flu season started the health systems would be overcome very quickly indeed.
Also don’t forget once the health system is overloaded all the IC cases like Flu, stokes, heart attacks, accident cases etc also die for lack care facilities.
Re the Swiss cases per million data, it has now been corrected at 355.
Worldmeter today:
Note Italy was just a few hundred cases a couple of weeks ago. Now they are adding over 4000 cases per day, exponentially growing, 475 died in the last day, also exponentially growing. As their medical facilities clog up, that will start being a bigger exponent. Close on their heels is Spain with Germany and France headed that way too. Only now, deep in the AwShit moment, have they started closing borders and isolating folks.
You either shut down the Daily Germ Exchanges (“the economy”) for a few weeks to exterminate this bug, or those numbers grow to about 40 million cases in Italy, and hundreds of thosands best case, to 6 million dead worst case. We can see what the reality is in Italy, we need not wait for it to get that bad here before catching clue. (You either catch clue early, or reality beats you with the ClueStick until enlightened…)
The population permeation/reach factor is significantly higher with Covid-19. Considering the mild symptom percentage and asymptomatic factor for transmission, it gets to much more of the population than regular flu does IMH observation. I have always pondered how they can calculate the RO when they do not really know the naught real numbers.
Things like R naught, while the epidemic is active, are guessed and modelled. Sadly, neither a proper error analysis and propagation nor a proper uncertainty propagation, is ever, seemingly, ever on the guesses/models. After the event is over, tighter guesses are made from the data at hand, which will also be subject to uncertainty. History, though, can guide you. Having experienced natural measles going through a school, shutting it down when everyone is sick, gives you a clue about the upper bound. The common cold (here rhino viruses only) gives you a lower bound.
A little more food for thought Ed. Please explain why you think China destroyed their economy over 80 thousand infections and a few thousand deaths. Do you think the released videos and testimonials were faked?
And please explain why numerous national medical systems are being overwhelmed with relatively low numbers.
“You either catch clue early, or reality beats you with the ClueStick until enlightened”
Unfortunately some observers see only catastrophe avoided, then direct anger at the very policies that saved a greater catastrophe. Kind of like a man walking up without an arm getting furious at the doctor, saying “look, I am fine, why did you remove my arm?”
E.M.Smith [said] 18 March 2020 at 3:07 am [GMT] [*]:
I thought all the ICU patients were on ventilator. No? Or maybe I’m assuming things about intubation vs other kinds of ventilation.
“No?” One can be admitted from the Emergency Dept. to the ICU without intubation, with just a face-mask (and later nasal cannula) of wall-supplied O2, as a family member learned very unexpectedly very recently. Altho’ his ICU room might have been equipped differently had he been admitted primarily for a respiratory problem instead of his heart attack, on top of chronically low blood-oxygen capacity (thus that patient’s insistence on being supplied with an O2 cylinder before attempting exit from his home to an ambulance stretcher). Somewhere during that adventure on O2, cautious hospital staff tested him for numerous respiratory infections, and tentatively posted his private room as “respiratory protection required” [**]. So for the 1st 24 hrs. or so, all staff, even if entering only long enough to replace trash bags, donned the one-piece combo breathing mask with clear-plastic face-shield [♢]. That lasted until the infection-screening tests, which all were negative, cleared the concern about potential respiratory infections, and allowed the sign to be removed. That might have been when he was taken off the O2. After that, only a few staff wore masks inside the room.
I got the impression that what made the room part of the ICU was that the staff-to-patient ratio at that floor’s nursing center is much higher than for ordinary rooms. There was nothing that appeared special to this layman about the 1 room I saw in this ICU; this one was private (with a door and bonus curtain), and pretty much the same as nonICU rooms I’ve seen elsewhere in the same shiny new North Tower. Maybe this is to simplify rapid reconfiguration of hospital floors to facilitate the changes needed for to treat patient loads for varying illnesses. So the room I saw contained a bed that superficially looked like their ordinary equipment, but seemed to be intended to be overly challenging for patients to escape, with side-rails always up (and no controls within a curious patient’s reach), and staff forbidding climbing out of the bed, anyhow. The room has a private bathroom including a shower, which staff forbids even the most ambulatory patients from using, even those familiar with how to safely wheel a transfusion tree-with-pump [⌁] to a hallway bathroom. ICU patients were instead humbled to use bed pans (despite their contents surprisingly not being sampled for a lab) and the handle-equipped plastic bottles known as urinals, the latter for measurement of excreted fluids.
——-
Note *: <https://chiefio.wordpress.com/2020/03/15/instant-hospitals/#comment-126732>.
Note **: Well, hey-yell!. “Cdquarles” beat me to it (“18 March 2020 at 3:08 pm” GMT), even tho’ I’d drafted my posting before he posted it.
Note ♢: I suppose I should have tried to photograph one of those combo masks for the record (e.g., for posting here), but I supposed that photographing staff wearing the masks might violate their privacy rights, and it was unlikely that they’d let me handle one.
Note ⌁: On wall-plug disconnection or other power loss, uninterrupted automatic switch-over to 6–8 hours battery back-up. Which makes it easy for the patient to forget to reconnect it to his wall socket.
Madness
shutting down the economy will not stop total infection.
Everything is based on “slowing the curve”, with total infections being about the same. Just taking a bit longer to reach the same total.
Nothing in the numbers suggest hospital requirements vastly exceeding normal flu requirements such that deploying MASH units and emergency private construction could not handle the excess.
The Chinese panicked with the first numbers. They can be excused as they were first, but there is no justification for the US to panic with the updated numbers now available. The Chinese likely now wish they been more restrained, but again, they can be excused as being first.
As the issue comes down to excess deaths, mainly in the 65+ in poor health group, how many millions of $ per “excess” death in this group does the US want to spend by shutting down the economy? Yes, one must, and the world does, put a value on life and life expectancy.
So for further discussion, put a $ amount per excess death over and above what would be expected from full hospitals and deployed MASH units.
Full disclosure. I am a member of the 65+ group, but in reasonable good health and condition. Reading the mortality stats, I consider myself to be at low to moderate risk of death to either the flu or the new virus.
So just perusing the released information from various sources today (including an interview I caught on Tuckers show tonight who stated a 100% positive result on a 40 person sample) indicates the announcement from the FDA tomorrow will probably be the approved use of old time Malaria drugs as we have discussed. The market will go ballistic and up. That is my lone prognostication for the evening :-)
Ed,
You refused to address any of the points raised, ignored the exponential growth, don’t care about the existence proof of Italy, and Spain in progress, and continue fixated only on deaths, ignoring the massive damage to the survivors and our medical system (including the eventual death of about 10% of Doctors snd Nurses (experiencd in other countries when PPE had issues)).
Given that, I can only assume you do not wish to think about anything contrary to your preconceived notions , nor “do the math”. Given that, I’ve no reason to continue explaining it to you. Best of luck with that.
E M I’m noticing that there is the same problem here as JoNova has on her blog.
A complete refusal by some commentators to accept the basic facts of this new disease and how it is spread.
I find it curious that when the issue is climate change, most here & on JoNova recognise that the Climate zealots are blinded to the facts by their ideology. But now that we have a global pandemic, ideology again prevents folks accepting the facts.
The Eco-Nazi, CAGW, CC (insert crisis, cataclysm, whatever for the second C after Climate) and other crowds have been salivating on the possibility of seeing their Misanthropic vision come to some fruition. Just sayin, what exactly is the basic end result of that type of oppressive agenda in the end? Think about it.
The Defense Production Act signed today has far more reaching elements than I originally thought. I think of it as Huge, very soon. That kinda slipped by my radar earlier, because of a toilet paper discussion. Go Figure.
“If you have a book, You have TP”
Ossqss 2020>
I just got back from Walmart…
Aralen Phosphate
https://www.goodrx.com/chloroquine-phosphate?form=tablet&dosage=500mg&quantity=30&label_override=chloroquine%20phosphate
E.M.,
Off topic but interesting. A 40+ earthquake swarm just west of Salt Lake City in the last 12 hours. Started with a 5.7 quake eleven kM deep.
Sean Hannity (radio) has mentioned today the possibility that in return for financial help to cruise lines, our experienced dealmaking Pres. Trump might insist on converting some of their ships to floating hospitals.
That could be comparable to the national interest in converting ships of the old-line Cunard and White Star passenger-transport system to troop carriers, not only for World War II, but also for the U.K.-Argentina War over the Falkland Is. I don’t know what are the relative capacities of old-line ships, e.g., Queen Elizabeth II, v.s. the astonishingly tall Carnival, Norwegian, or Princess ships [×]. With more people getting a clue about the risks of cruise vacations while CoV-19 spreads, the reduced or undone cruise bookings should keep temporary ship conversions to hospital ships from being much of a corporate hardship.
Meanwhile, an existing Navy hospital ship, equpped with approx. 1000 beds, is being dispatched to the New York harbor.
Ooops!
——-
Note ×: I’m amazed that there seems to be no danger of those tall modern cruise ships keeling over broadside if they lose power. Corrections to my late-night attempt at nautical terminology are welcome.
@Sera, you found that at your local Walmart?
@Ossqss:
I think if is prescription in the USA and OTC in central Americs.
@Conpugator:
If turned too sharp or broadside seas and wind, they can capsize, but the giant hunks of iron down low tend to balast the fluffy rooms up top.
Conversion to hospital ships makes sense, but the same air handling issues exist.
Ought to be fairly easy to retrofit UV and HEPA.
Hmmm…
I wonder if wide use of OTC chloroquine as anti malarial, in central and south America, is why their cases have stayed low?
Chloroquine as a prophylactic, to use or not to use?
If Chloroquine, let’s call it CQ, is a good treatment for the seriously ill along with short-supply anitvirals, we should use it as a treatment. But it is also claimed (rumoured to proven, on a scale you must decide for yourself) to be an effective prophylactic. Take it for five days and you won’t get Coronavirus for a fortnight..
This is the UK situation, where CQ does not require a script, it’s usually behind the counter at the pharmacy.
A while ago here I criticised the NHS for being slow to consider this option. It seems I was wrong, so let me build a few bits of evidence and rumour into this wild surmise.
Bits:
The NHS is said to have put CQ on a no-export list.
The pharmacies who normally supply it are out of stock.
Folks who post on WUWT have tried to get the MSM to report the CQ claims without success, although it is widely reported on the net.
There’s a report of a planned UK trial putting 10,000 front-line health workers on CQ prophylaxis.
Surmise:
The authorities know all about it but there isn’t enough for everybody, and maybe the risks outlined by some commenters below are a factor too.
The stocks have been called in and pooled. There’s enough right now for the NHS workers trial.
Production is being ramped up. Reports are Bayer in the US and a company in the Netherlands are rushing it into production.
When there is enough there will be a staged rollout. Old, pre-existing to get it first, then all essential workers then the general public.
Nobody wants to talk about it publicly for fear of riots of people down the totem pole of priorities wanting the drug. Maybe the MSM is being gagged, maybe they don’t want to mention it until they can frame it as a government error or omission.
IF we can get widespread prophylactic use of CQ we can restart the economy. The first countries to do that will gain the maximum benefit.
And we won’t get malaria, of course.
The release of a non-prescribed drug for alternative purposes is easier here, we don’t have a FDA, we have a committee which cares mostly about cost vs efficacy.
IF we can restart the economy, we can’t afford not to
@Ossqss:
You need a prescription- I’m older and have a cool GP. GP also said not to take for the heck of it
because there can be side effects- wait for symptoms.
People are hoarding toilet paper but not medicines. Yet.
Rhoda, I am with you, although the Daily Mail on line has been pushing for Quinine based medicines as well as antiviralsto be tried for COPID19.
If it works and is already cleared for other deseases without major adverse side effects they must start using it.
Only if it has bad side effects for immune compromised patients should they take care, those that the studies say have recovered are over 60.
It is very good news, that is being ignored by the government, which if announced would bring some anxiety relief against all the gloom & doom.
Rhoda, Sounds about right to me.
Something else to think about with the 60+ crowd, who are taking the proverbial sack, is multiple medication/supplement interactions. Still, it is worth a try, especially in severe cases.
Remember, things like grapefruit are known to cause issues in some people with some medications via altered metabolism/absorption.
Yeah, drug interaction can be bizarre and catastrophic. Even M.D.s can get it wrong. MIL was put on drugs known to cause confusion especially when mixed, then evaluated for mixed dementia… New M.D. took her off all meds (about a half dozen) then figured out what was her and what drugs.
It’s been commonly known for years that if you are taking medicine you should hold the grapefruit.
https://www.drugs.com/article/grapefruit-drug-interactions.html
It’s also well known that older folks are harder hit by many diseases, not just the current virus.
Doubtless there are many reasons for that, including weak immune systems.
Now I learn that pain killers can suppress the immune system — and we all know that old folks have lots of aches and pains. I have to dig more, but pills to reduce pains and anti-inflammatories may not be good for the immune system, and not opioids either.
https://www.foxnews.com/health/dont-use-ibuprofen-coronavirus-symptoms
links to
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext
“We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.”