outbreak! (ebola, sars, coronavirus, etc)

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

probably similar reasons to you

I don’t think I’m smart! I’m obviously very stupid, for instance I keep talking to you

you know, instead of taking the bait, you could have taken the hint.

I don’t have anything else going on

Some
Posts
Were
Blocked

sanpaku please just stop posting that stuff man

Aimless, I'm pretty familiar with the story (and overselling) of D over the past 2 decades (it's why a prescribed bottle languished in the freezer). Association studies of low D status found links with just about every chronic disease, but low D status is also just a marker of being too ill/old to go outside, and supplementation randomized controlled trials have been mostly disappointing, with a small effect seen when 56 RCTs were pooled looking at all-cause mortality.

Still, we're in this for the next 18 months, and so far there aren't any proven pharmaceutical interventions. Early hydroxychloroqine trials were well publicised, but there's been disappointing reports this week with remdesivir, favipiravir, and lopinavir–ritonavir. Not that the good scientists aren't throwing the spaghetti at the wall. 915 trials registered with WHO, and some are weird. But its nice to have hope that something will work. And it's fun to read papers.

Overselling the D is a rite of passage

that's what she said

He said that he believed that stricter lockdowns "only serve to flatten the curve and flattening the curve doesn't mean that cases disappear -- they are just moved in time."

"And as long as the healthcare system reasonably can cope with and give good care to the ones that need care, it's not clear that having the cases later in time is better."

Right now, Sweden's hospitals aren't overrun like the US's, but not sure what it would take for that to happen either

https://edition.cnn.com/2020/04/28/europe/sweden-coronavirus-lockdown-strategy-intl/index.html

it's not clear that having the cases later in time is better

This is the weak point in his reasoning. Even if no cure or vaccine become available, the cumulative experience of treating covid-19 patients will over time lead to a convergence upon the best possible treatment options for the best possible outcomes.

Seems we're about 2 weeks away from a major med journal publishing a large randomized trial on convalescent plasma. That could have saved tens of thousands worldwide, and I have confidence it will as SOP. Avoiding mechanical ventilation as long as possible with high flow nasal canulas and proning may have similar benefits.

If some pandemic lumbers towards becoming endemic, its better to be among the second and later waves.

It feels very strange to post this on the day of the USA's 4th highest death toll, but it appears that we are post-peak of the first wave here in the states.

So much for the Sunshine Law: #Florida medical examiners were releasing #coronavirus death data, which showed a higher number than the official state tally. The state made them stop. https://t.co/XsvyTM1xcO via @kmcgrory & @rwoolington

— Craig Pittman (@craigtimes) April 29, 2020

deaths per day def seem to be on the decline particularly in NY

ten times (or more) the reported cases

The new serological data, which is provisional, suggests that coronavirus infections greatly outnumber confirmed covid-19 cases, potentially by a factor of 10 or more. Many people experience mild symptoms or none at all, and never get the standard diagnostic test with a swab up the nose, so they’re missed in the official covid-19 case counts.

https://www.washingtonpost.com/health/antibody-tests-support-whats-been-obvious-covid-19-is-much-more-lethal-than-flu/2020/04/28/2fc215d8-87f7-11ea-ac8a-fe9b8088e101_story.html