outbreak! (ebola, sars, coronavirus, etc)

(the number of deaths per 1,000 people is more than 6 times worse for Sweden as it is Norway, so can't merely be that they're twice as big)

I watched Outbreak the other week, it was lol and actually distracted me from the current situation.

I have a friend who lives in Sweden and was working in Denmark and there was a stark difference between the two.

Anti-lockdown protests in Berlin, which seem to be coming mostly from the left and stupid hippies.

https://www.dailymail.co.uk/news/article-8257013/Germany-police-arrest-100-protesters-Berlin-demonstrating-against-lockdown-measures.html

(xpost) Among 10,000 Hollywood contrivances--the stuff Contagion stays clear of for the most part--the most ludicrous is how, once they get the host back to Cedar City--they've got the treatment within 15 minutes.

I read that the original script had the president recommending household disinfectants as a cure, but the general feeling was that they had to draw the line somewhere.

w/r/t how out of touch the president is regarding the death toll (reminder, these are first wave projections through Aug 1, 2020):

“It looks like we’ll be at about a 60,000 mark, which is 40,000 less than the lowest number thought of,” Trump said during a news briefing on Sunday, April 19, adding the next day that “the low number was supposed to be 100,000 people. We could end up at 50 to 60 [thousand].”

4 days later (4/23), the USA death toll surpassed 50k. It will surpass 60k next week, with more than 3 months remaining until 8/1.

he was referring to the Washington Institute's model that, at the time, estimated 60k deaths. but like the typical idiot he is, he didn't realize it's just a model, and one that's drawn significant criticism. it's since bumped up to 67k deaths, but even that's hard to square with the 2k deaths per day that are still occurring.

it will still be lower than if there was no action, but 100,000 looking a lot more likely. hopefully I'm wrong.

hard to imagine with the slate of state re-openings it's going to stay on the "low side"

well, if all other states open up prematurely, then yeah, that number will definitely skyrocket.

And we are probably undercounting deaths by a significant amount

Most certainly.

Also the consequences of state reopenings won't stay confined inside those states, as the borders are porous (I can cross three state lines on a 20-minute drive). This will muddle the data.

ban states IMO

(US politics post, sorry) the sad part is, those "uncounted" deaths are never going to count to trump or his voters. what's that you say, there was some model that said that the number of deaths is higher than the official count? you're telling me the blue states are trying to make trump bad by counting deaths that aren't even real, based on a model? etc. the only deaths that will "count" to any of them are the obvious confirmed ones, and they'll probably cite the lowest estimates of those too

IMO make them visit the cemetary and look at the exhumed corpse of every dead person, maybe that will satisfy them

oh who am I kidding

"there's no evidence this person isn't still alive...look, they twitched!"

"this person was obviously killed by a gunshot wound or cancer or something like that"

"this is a crisis actor in an induced vegetative state, and I claim my $5"

they would never lie about such a thing...

In late August 2018, almost a year after the hurricane, the Milken Institute School of Public Health at George Washington University published their results. They estimated 2,658–3,290 additional people died in the six months after the hurricane over the expected background rate, after accounting for emigration from the island.[6] As result, the official death toll was updated from the initial 64 to an estimated 2,975 by the Governor of Puerto Rico.[216][208]

In September 2018, President Trump disputed the revised death toll. Writing on Twitter, Trump claimed that "3000 people did not die in the two hurricanes that hit Puerto Rico", but that the Democrats had inflated the official death toll to "make me look as bad as possible". Trump provided no evidence to support his claims.[230]

https://pbs.twimg.com/media/EWi9UUSWsAImuGR?format=jpg
https://pbs.twimg.com/media/EWi99LBWsAYvK9o?format=jpg

Even worse with those graphs that include the official Covid-19 death stats as a third line

It's good that those excess deaths mostly seem to be dropping in the most recent week... right?

https://nymag.com/intelligencer/amp/2020/04/we-still-dont-know-how-the-coronavirus-is-killing-us.html

by one measure 88 percent of New York patients put on ventilators, for whom an outcome as known, had died. In China, the figure was 86 percent

Ned shared this on FB. Scary as hell. I was worried about running out of ventilators but now I'm beginning to wonder if we're killing people with them.

well those are the people who are the sickest. it’s a last resort.

very good article though. very weird about the blood clotting.

Yes but if you count patients on ventilators whose cases are unresolved it becomes something like 20%, and people on ventilators are taking a long time to resolve. That figure is only counting people who are recovered or dead.

aka “by one measure”

this article from a few weeks ago is about doctors pushing back against ventilator use

https://time.com/5818547/ventilators-coronavirus/

xp

Are we really saying most people ventilated in China in February are still alive and still on ventilators?

Le Monde is reporting today a mortality rate of 30% to 40% among French patients who need advanced life-support for the virus (meaning ventilation, generally), as opposed to the 10% that's been reported by the ministry of health until now.

that article is fascinating, frustrating and terrifying. I'm actually even more worried about my husband getting it despite him probably being technically healthy. this has been published too in the UK about children getting ill

https://www.theguardian.com/world/2020/apr/27/nhs-warns-of-rise-in-children-with-new-illness-that-may-be-linked-to-coronavirus?CMP=Share_AndroidApp_Copy_to_clipboard

It barely seems possible that this is all one virus - the N.Y. article touches on the likelihood of varying stains.

xp I was referring to the NY article there

fucking hell.

two terrifying articles

😦

The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head. Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.

jesus

kind of wish I didn't read this article so early in the day

what the fuck

*makes note to re-up blood pressure medication*

*makes note to stop caning wine and coffee and never go outside again*

At UChicago Medicine they're opting for high-flow nasal cannulas over ventilators, and claiming 'truly remarkable' success. See also Sharon Begley's piece for STAT.

Should be noted that in the Brigham and Women's Hospital's Covid protocols, which heavily influence standard of care in the US, they recommend avoiding high-flow nasal cannulas due to the potential of increasing aerosol risk for HCWs.

“The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%..."

This is exactly the sort of thing that one hoped to see at this stage, where different treatment strategies are being sorted out according to less and more effectiveness, through empiricism and communication within the medical community. But the most effective strategy by far will continue to be slowing the rate of transmission from the infected to the uninfected.

Week over week numbers dropped in Austin, TX. Stay at home order only goes to May 8 so far. Lots of rumblings about things starting to open soon. Don't know what to make of it. I think end of May seems more realistic, but people may not have the patience for that.

~2 month lockdowns were successful in places like Hubei, or where social distancing compliance was high like South Korea. But testing nationwide in the US has plateaued at ~150k tests/day through all of April, and I haven't seen mass hiring of tens of thousands for training to do test sample collection or contact tracing. And I don't think we can just lay it all in the lap of current public health and social workers: one estimate I've seen is 300k with some training in contact tracing would be required for the US to reopen.

if only there were 300k people looking for work and training!

But testing nationwide in the US has plateaued at ~150k tests/day through all of April

https://i.imgur.com/5LXVRd2.jpg

it did plateau, but seems to be picking up over the week.

xp: There should have been big grants to states explicitly for this in the first coronavirus relief bill, with CDC providing guidelines, training curriculum, and advisors. With a few exceptions, it feels like our political system has lost the ability to be proactive.

Should be noted that in the Brigham and Women's Hospital's Covid protocols, which heavily influence standard of care in the US, they recommend avoiding high-flow nasal cannulas due to the potential of increasing aerosol risk for HCWs.

Since I've been doing a lot of research on this, it's true the aerosol risk is high but it can be reduced with proper use of PPEs and negative pressure rooms. At one hospital I talked to that used this method (high flow nasal cannulas + proning), the majority of their covid patients admitted into ICU survived without intubation, with only one death and no transmission to HCWs so far.

(Most of my contributions didn't make it but it was for this story on ventilators.)

Preprint so usual caveats, but this paper has some crazy numbers. Patterns of Covid-19 Mortality and Vitamin D: An Indonesian Study. 16 out of 388 with normal D status died, only 28 out of 392 with insufficient/deficient D status survived. That could have a lot to do with socioeconomic status in Indonesia, but on the assumption it's meaningful... My immediate thought was that this could be a major factor in why African-Americans have a high fatality rate, as most have low vitamin D status (high latitude + melanin means little UVB induced 25(OH)D synthesis in skin).

I'm probably okay as I've Mediterranean skin and spend 30 mins at noon walking with bare arms/legs. But it did motivate me to find an old bottle of 5000 IU D3.

crazy numbers, like all extraordinary claims, need very close scrutiny

.... yeah

Sanpaku why is it that you think you’re smart