Coronavirus

[Daniel in SD]

If it works in Sweden, it can work here, right?

I'm fascinated by Sweden. Here's what the chief epidemiologist recently said:

Tegnell: We are doing two major investigations. We may have those results this week or a bit later in May. We know from modeling and some data we have already – these data are a little uncertain – that we probably had a transmission peak in Stockholm a couple of weeks ago, which means that we are probably hitting the peak of infections right about now. We think that up to 25% of people in Stockholm have been exposed to coronavirus and are possibly immune. A recent survey from one of our hospitals in Stockholm found that 27% of staff there are immune. We think that most of those are immune from transmission in society, not the workplace. We could reach herd immunity in Stockholm within a matter of weeks.

It sounds like they're looking at the change in new cases and fitting it to a model? I don't think that's going work very well, it would be very sensitive to the changing R0 over time. You might think that the rate of spread is slowing due to herd immunity when it could just be changing because people are changing their behavior. I'm a little bit skeptical that the staff of a hospital in Stockholm is a representative sample to say the least. I can't find any information on that study.
Coronavirus: Sweden's Anders Tegnell stands by unorthodox strategy

 

[SageBrush]

I've overlaid a graph of daily percent change. You can see how falling below a 10% growth coincides with the peak.

That does not mean squat.
Think of the epidemic in waves. Pre SAH is one wave; SAH is the second; Post SAH will be another

 

[FoverM]

GA one of the "chunky" states in terms of daily deaths:

Obviously, a single day below 10% is meaningless. Maybe seven days below 10% would be useful as a marker. That would put the peak somewhere around 04/18.

I routinely work with data that's this bad or worse ... but I have data for the complete event. We don't know what's off to the right of this chart yet.

 

[RandomJohnny]

Contrary to popular opinion, vaccines are not big money makers for the companies that make them, and in many cases they actually only break-even because of government subsidies.

LOL

 

[AlanSubie4Life]

NY is clearly past the peak of daily deaths:

View attachment 536768

I've overlaid a graph of daily percent change. You can see how falling below a 10% growth coincides with the peak.

Note: NY's data is well behaved. States with smaller numbers can be very chunky, so you may see 5% one day and then 15% the next.

One thing to keep in mind for NYC and NYS is because of the overall prevalence being 15-25% (maybe), they are getting significant help from the herd. They might be able to get away easily with R of 1.2 or so in some areas. Since they are on pause, they are likely seeing relatively rapid decay due to a combination of these factors. I would not expect other locations to drop off so quickly unless they are better at getting R down somehow.


Other locations (generally everywhere else outside the general vicinity of NY/NJ/CT) are much lower prevalence. So one reason they won’t see as rapid a case falloff is likely that lack of a herd effect. That being said, you have to remember that the cost to New York City of this marginal benefit was (will be...) losing 0.25% of their population. And it will only allow them to reopen a little bit sooner (assuming they have robust test/trace/isolate in place in addition to masks/distancing) due to their more rapid case decay to manageable levels. They cannot just open up - they will have to have those other measures in place first, and should be practicing using them right now. Otherwise cases will explode again, albeit slightly less explosively than the first time.

 

[omgwtfbyobbq]

You NEVER want to be put on one of these. They are far far far worse than being on a ventilator. Just google "ECMO complications".

Are there any forms of life support that don't have more complications than whatever the next step down is? I feel like more/greater complications with more invasive life support systems is just a side effect of how ill the patient is.

I think it's fairly safe to say that, you, as a neurotypical individual, would never want to be put on "X", but there's a lot of variation in neuro-biology we've barely scratched the surface of.

 

[bkp_duke]

Are there any forms of life support that don't have more complications than whatever the next step down is? I feel like more/greater complications with more invasive life support systems is just a side effect of how ill the patient is.

I think it's fairly safe to say that, you, as a neurotypical individual, would never want to be put on "X", but there's a lot of variation in neuro-biology we've barely scratched the surface of.

It's a moot point. Even the highest level trauma centers and tertiary care facilities only have 1-4 of these machines. And they require a specially trained team with someone being IN ROOM 24/7 to take care of the machines and watch the patient. One week on one of these is like 150-200k in hospital charges

 

[cucubits]

Looks like in Texas more value is put on businesses than human lives. The "beloved" governor will allow most businesses to open (with lower occupancy) this Friday.

IMO this is a very bad move, texans are definitely not known as the most disciplined bunch so I expect things to get worse fast...

 

[SageBrush]

I feel like more/greater complications with more invasive life support systems is just a side effect of how ill the patient is.

Not even close.
The general relationship of mortality with length of invasive care reflects nosocomial complications.

Foreign bodies get infected
Blood run through tubes clots

 

[dhanson865]

AK74R23 460sv GIF | Gfycat

Austrian Supermarket

 

[NikolaACDC]

Thankfully, no.
I've been a physician for 35 years and I cannot remember a single physician who advocated tobacco abuse. That includes those physicians who smoked. The latter were during my medical school days. Those smoking physicians went away pretty quickly, and I cannot think of a single physician in the last 25 years who abuses tobacco.
If the tobacco industry influenced physicians it was short lived.

Yeah, one would have to be pretty old to remember
Throwback Thursday: When Doctors Prescribed 'Healthy' Cigarette Brands

 

[NikolaACDC]

It's anti-science BS.
...

A couple of studies seem to show an effect.
And that's why they'll do trials in France at least
Does nicotine help against the new coronavirus? | DW | 27.04.2020

 

[jbcarioca]

Here's a screencap of the counties containing the most deaths as of 04/26:

View attachment 536710

The usual suspects (high population counties) are in there. How concentrated are the deaths? The Top 20 counties have 61% of the deaths but only make up 12% of the US population.

Actually there is error in the data presentation.
New York County= Manhattan (slight discrepancy being a tiny park of The Bronx)
Kings County= Brooklyn
Queens County=Queens
Richmond County=Staten Island
All four of those counties would be on the list.
FWIW, Boroughs of NYC roughly equate to Counties but there are elected officials for all three entities.
One can look this up on the NYS or NYC website.

 

[omgwtfbyobbq]

It's a moot point. Even the highest level trauma centers and tertiary care facilities only have 1-4 of these machines. And they require a specially trained team with someone being IN ROOM 24/7 to take care of the machines and watch the patient. One week on one of these is like 150-200k in hospital charges

I feel like I missed something. Are you saying it's moot because they're uncommon, or because of something else?

 

[omgwtfbyobbq]

Not even close.
The general relationship of mortality with length of invasive care reflects nosocomial complications.

Foreign bodies get infected
Blood run through tubes clots

I can see complications getting a function of the life support device being used and the duration of use, but how are they not a function of patient condition?

 

[AlanSubie4Life]

It's a moot point. Even the highest level trauma centers and tertiary care facilities only have 1-4 of these machines. And they require a specially trained team with someone being IN ROOM 24/7 to take care of the machines and watch the patient. One week on one of these is like 150-200k in hospital charges

Also, according to his wife at least, complications (presumably ischemia) from the cannula used for the ECMO machine resulted in the loss of Nick Cordero's leg. Presumably the ECMO was necessary for maintenance of life, but still...

So it's not really a panacea to say the least.

Broadway Actor Nick Cordero Gets Temporary Pacemaker – Update – Deadline

Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment | Critical Care | Full Text

 

[Daniel in SD]

I feel like I missed something. Are you saying it's moot because they're uncommon, or because of something else?

It's moot because if we keep the number of cases low enough that everyone who needs an ECMO machine can get one that means we've contained the epidemic. In other words the maximum number of lives that could be saved by all the ECMO machines in the country is insignificant.
Good NYT story about a 49 year old healthy man who recovered from COVID-19 with the help of an ECMO machine. He spent 18 days on the machine.
32 Days on a Ventilator: One Covid Patient’s Fight to Breathe Again
Another good article on ECMO: https://www.washingtonpost.com/outlook/2020/04/14/coronavirus-heart-lung-bypass/
Another article from 2019: End-of-life decisions, questions: ECMO can be part of life support
Apparently there are only 264 hospitals in the US with ECMO machines.

 

[SageBrush]

I can see complications getting a function of the life support device being used and the duration of use, but how are they not a function of patient condition?

They are ... indirectly.
The worse the condition, the longer the person stays on invasive measures.
The longer they are on invasive measures, the greater the risk of nosocomial complications.

It is easy to see in e.g. young people after head trauma in vegetative states:
No catheters or tubes -- they live a long time with good nursing care in a LTC facility
Tracheostomy but no foley catheter: recurrent nosocomial pneumonia a couple times a year
Intubation and Foley cather: die in the acute care hospital

 

[SageBrush]

Yeah, one would have to be pretty old to remember
Throwback Thursday: When Doctors Prescribed 'Healthy' Cigarette Brands

Your link says

To allay fears, tobacco brands hired throat “doctors” (that is, models dressed in white coats) to explain that dust, germs or a lack of menthol were to blame, not the cigs themselves.

 

[bkp_duke]

I feel like I missed something. Are you saying it's moot because they're uncommon, or because of something else?

They are uncommon and just the use of one has VERY HIGH rates of complication.

I'm sure some facilities will use them, because:
1) they are available to them
2) they can drive revenue for the hospital in a time when elective procedures don't exist

But honestly, as a physician, I would have to think twice about being put on one of these. I might just tell them to pull the plug and let me die first.