Coronavirus in the US

[momo2x2018]

Sorry, the other threads are too long and I did not want this to get lost in the shuffle:

Attributed to James Robb, a pathologist formerly at UC San Diego.

Subject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic

Dear Colleagues,

As some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.

The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.

Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:

1. NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.

2. Use ONLY your knuckle to touch light switches. elevator buttons, etc… Lift the gasoline dispenser with a paper towel or use a disposable glove.

3. Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.

4. Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.

5. Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.

6. Keep a bottle of sanitizer available at each of your home’s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.

7. If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

What I have stocked in preparation for the pandemic spread to the US:

1. Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
   Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

2. Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you - it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth - it is only to keep you from touching your nose or mouth.

3. Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.

4. Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.
I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us!

Jim
James Robb, MD FCAP

[doschicos]

@Creekland

This was shown to me yesterday (probably paraphrased as my memory isn’t that good):

If you drank from a garden hose when you were young, you’re immune to the coronavirus.

Source: Facebook medical

(Have to admit I thought it was cute and wondered if anyone else wanted a chuckle. It means I’m safe! ;))

Well if that, making mudpies, and walking around barefoot all summer on a farm provides protection, I’m good.

[skieurope]

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[aMacMom]

@skieurope I’m glad I saw that when it was on it’s own because I can’t keep up with this thread!

@momo2x2018 Do you have a link? Many good tips (such as buying zinc lozenges and nitrate gloves now in case of a pandemic) that I hadn’t thought of/seen suggested.

Edit to say that I just saw @skieurope pinned it. That’s the perfect way to handle it. Thanks!

[katliamom]

@Tigerle

They need testing, testing, testing. A drive through swabbing area like in the UK, go back home, drink tea, don’t go anywhere until we come back to you. Not “decide for yourself how ill you are”. It doesn’t matter with corona!

Tigerle, there’s some grim comfort that your “northern European” country’s response is as messed up as our American one… It sounds like only England and South Korea managed to set up an extensive testing program.

** added, as per doschicos’ post Italy and China also are/have tested extensively (so as not to spread misinformation.)

[skieurope]

Further discussion here:
http://talk.collegeconfidential.com/parent-cafe/2171687-coronavirus-in-the-us.html#latest

[doschicos]

@bluebayou

@Cardinal_Fang

How should we have reacted better? What should we be doing different now?

TESTING! CDC decided not to use the WHO test, and then bungled making our own test, wasting weeks. Doctors were begging for their patients to be tested, but were refused. Meanwhile the disease was spreading undetected in the community. This was culpable incompetence.

per article:

**It remains to be seen what effect the delay in producing a working test will have on the health of Americans. **If the United States dodges the rapidly spreading outbreaks now seen in Iran and South Korea, the impact will be negligible. But if it emerges that the disease is already circulating undetected in communities across the country, health officials will have missed a valuable chance to lessen the harm.

https://www.propublica.org/article/cdc-coronavirus-covid-19-test

You neglect the part where a test can always be improved upon. Get a test out there - which is eventually what the govt has decided to do with letting some high quality local labs create their own. That doesn’t mean one stops looking for improvement. CDC is still going to create their own while aiming for the highest quality. I find your logic unconvincing. The article is worth reading because it does speak to the many issues with the lack of timely tests by the CDC. Those parts weren’t quoted.

[doschicos]

@katliamom

Tigerle, there’s some grim comfort that your “northern European” country’s response is as messed up as our American one… It sounds like only England and South Korea managed to set up an extensive testing program.

Italy and China have both tested extensively. Italy was over 13K as of a day or two ago and China was over 300K awhile back.

[Marilyn]

@HImom , very sorry for your loss. Could you have the funeral venue post a few signs, and have the officiant make an announcement at the start and end of the service? Something to the effect, “Due to health concerns, we request that you provide sympathy and comfort with words instead of handshakes and kisses.” A couple of prominently displayed Purell stations (if possible) would reinforce the concept. Agree with wearing light gloves, and perhaps have someone posted to shield your mother (and you) to keep others from ignoring the request. Or have a place to sit with a small table in front of you to curtail approaches.

[Cardinal_Fang]

• Was designing their own test ‘incompetence’? Maybe, but where is the proof that CDC did not design a much higher efficacy test, and longer term it was worth the delay?

The proof is already forthcoming, and will increase soon, as we diagnose people who would not have caught the disease if we had separated the people they caught it from.

[3SailAway]

Lots of interesting data in the WHO report from China. I hope our systems and scientists are well funded to collect the data they need to do analysis here and learn for the next pandemic.

The following might be useful for those wondering how long people are going to be sick when they get the virus:

Using available preliminary data, the median time from onset to clinical recovery for mild cases is approximately 2 weeks and is 3-6 weeks for patients with severe or critical disease. Preliminary data suggests that the time period from onset to the development of severe disease, including hypoxia, is 1 week. Among patients who have died, the time from symptom onset to outcome ranges from 2-8 weeks.

This could be useful for people wondering about preexisting conditions (note that CFR is crude fatality rate):

Mortality increases with age, with the highest mortality among people over 80 years of age (CFR 21.9%). The CFR is higher among males compared to females (4.7% vs. 2.8%). By occupation, patients who reported being retirees had the highest CFR at 8.9%. While patients who reported no comorbid conditions had a CFR of 1.4%, patients with comorbid conditions had much higher rates: 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.

The report also details recommendations for the rest of the world based on what worked to achieve relative containment in China.

[Nrdsb4]

@conmama

@doschicos , I had no idea the flu vaccine had such a low resistance rate. That is unsettling. We think we are protected, but not so well. I often wonder out of the thousands who die every year from the flu, how many were vaccinated.

Being vaccinated against the flu significantly lowers the morbidity and mortality rate of people who still end up getting sick with the flu. In other words, getting the vaccine may not protect you completely from getting the flu, but it will possibly keep you from having to be hospitalized or from dying.

[Cardinal_Fang]

But if it emerges that the disease is already circulating undetected in communities across the country, health officials will have missed a valuable chance to lessen the harm.

If the disease is circulating in communities? We already know it is circulating in Washington. Every couple of hours we get another report of another US person somewhere who has the disease but didn’t go overseas. We know it’s circulating.

[Nrdsb4]

@Tigerle

@doschicos, agree that being vaccinated doesn’t make it impossible I’m having the flu, but having decades of flu shots under my belt (including swine flu!) it’s highly unlikely there is anything around I do not have at least some immunity against. Also, I had the real flu almost 30 years ago (before I started getting the flu shots religiously) and it doesn’t creep up on you over a week of the hardest skiing you’ve ever done (learning to be an aide to a beginning monoskier) the way this cold did - it knocks you flat on your back within 30 minutes! I’m hanging out here with a mildly scratchy throat, a mild sniffle, some grumpiness and (of today) no temperature, still doing food and laundry. Maybe this is how flu manifests in someone with my specific immunity status, but I doubt it. Could be any of the four types of Coronavirus that have caused common colds forever - or it could be covid 19.

Daughter is very grumpy, with mild temperature. Husband is grumpy, but no temperature (he’s perfectly capable of being grumpy and well, LOL). Boys are fine so far. Having spent the week in a tiny hotel suite and a day in the car, there Is no point whatsoever in separating ourselves now.

It feels completely odd to contemplate whether we should self isolate as a family for 14 days.

@tkoparent, advice is the following triage: if there has been no exposure to a known patient and no travel to high risk areas in Italy (our situation), you’re to self monitor your health, stay home only when unwell, and wash hands. No self isolation for 14 days, no testing even if you ask for it (as I found out this morning), assume it’s the flu, phone your GP to discuss, come into hospital only if starting to feel very ill.

Known exposure or travel to high risk area, you’re to self isolate for 14 days and self monitor your own health. Arrange testing via your GP only if symptoms develop, and come into hospital only if starting to feel very ill.

When I ask around, EVERYONE tells me someone in their family is ill with something, and I am being alarmist. If everyone who is fine on Monday goes back to school or work, and it turns out we are spreaders though, I will feel completely irresponsible.

How come it’s completely up to us what to do about our symptoms during a pandemic?!

I am assuming the triage criteria I have outlined work to save up resources during the containment phase. Most experts think Europe is beyond that, and we are in the community spread phase. I wish they’d focused on building up testing capability. Maybe they have, and it’s still not enough they can afford to do community spread testing.

Of course everyone has “a temperature,” so I know you mean fever. When you say “mild temperature,” what exactly do you mean? If you have a fever, it generally indicates that you are contagious with something, whether it is flu or some other malady. You should always stay home and avoid contact with others while febrile.

In the US, a “fever” usually means 100.4 degrees F or higher. But you might be considered to have a “mild fever” at under that temperature if it is higher than your norm.

[bluebayou]

@doschicos

@bluebayou

@Cardinal_Fang

How should we have reacted better? What should we be doing different now?

TESTING! CDC decided not to use the WHO test, and then bungled making our own test, wasting weeks. Doctors were begging for their patients to be tested, but were refused. Meanwhile the disease was spreading undetected in the community. This was culpable incompetence.

per article:

**It remains to be seen what effect the delay in producing a working test will have on the health of Americans. **If the United States dodges the rapidly spreading outbreaks now seen in Iran and South Korea, the impact will be negligible. But if it emerges that the disease is already circulating undetected in communities across the country, health officials will have missed a valuable chance to lessen the harm.

https://www.propublica.org/article/cdc-coronavirus-covid-19-test

You neglect the part where a test can always be improved upon. Get a test out there - which is eventually what the govt has decided to do with letting some high quality local labs create their own. That doesn’t mean one stops looking for improvement. CDC is still going to create their own while aiming for the highest quality. I find your logic unconvincing. The article is worth reading because it does speak to the many issues with the lack of timely tests by the CDC. Those parts weren’t quoted.

Sorry, its not “my logic”, it’s CDC’s. The Agency chose not ‘get a test out there’ for (hopefully) the right medical reasons. None of us know what they are. (Perhaps the tests ‘out there’ had a bunch of false negatives? Or, perhaps it is gross incompetence, or somewhere in between?)

But none of us were in that situation room when the decision was made (by our best and brightest?) to wait and make a test.

And until actual facts come out, I see no reason to be critical of our top career medical and infectious disease specialists at CDC and NIH. Without scientific facts to the contrary, I’m willing to give them the benefit of the doubt that they are doing their professional best in extremely difficult situation.

[doschicos]

@bluebayou Mistakes happen. I get that. They created some bad tests. Good leadership is often judged by what happens after the mistake. They could have chosen several routes, one of them being the route they ultimately chose. Just earlier rather than wasting precious time. I guess you are more generous than I am. I see nothing wrong with pointing out issues and shortcomings. There have definitely been issues and shortcomings and not just with the test creation. I guess we’ll disagree.

ETA: PLENTY of their peers are judging them as well. People with more knowledge than you and me.

[maya54]

Friend who is epidemiologist said Pandemic scenarios that her group has studied and modeled haven’t really ever looked at virus with incredibly mild/no symptoms for large percentage of population with high (2 percent plus death rate) in some. She’s thinks this makes the work on this especially hard.

[bluebayou]

@doschicos

@bluebayou Mistakes happen. I get that. They created some bad tests. Good leadership is often judged by what happens after the mistake. They could have chosen several routes, one of them being the route they ultimately chose. Just earlier rather than wasting precious time. I guess you are more generous than I am. I see nothing wrong with pointing out issues and shortcomings. There have definitely been issues and shortcomings and not just with the test creation. I guess we’ll disagree.

I actually agree with nearly all of your post, dos, my only caveat is the effect of the testing “mistake”, which at this point we don’t know. As the propublica article notes, “It remains to be seen…”

And that continues to be my point.

(Releasing ill folks early bcos they had a false negative test could be worse than not testing them at all and keeping them in quarantine for a few more days.)

[Tigerle]

@Nrdsb4 , I have been taught to use “temperature” (short for “elevated temperature” of course) for anything above 99.5 F, but below 100.4 F (37.5 C - 38 C). For instance, doctors here will vaccinate anyone with an elevated temperature below 100.4 F, but not above (cause that’s a “fever”). I agree it’s somewhat arbitrary, no idea if there are international guidelines on this or anything.

I have a mildly elevated temperature tonight, but not a “fever”. Still it’s a symptom, and I’ll stay home tomorrow. Daughter is feeling fine again, no more grumpiness and temperature below 99.5 F, so no symptoms, and according to the health ministry advice her school circulated a few hours ago, she is to go to school.

The criteria are exceedingly narrow - if you haven’t been to Lodi province in Lombardy or Vo province in Veneto (or parts of China or Iran of course), you are advised to consider any symptoms seasonal flu or garden variety cold. Stay home if you have them, go to work or school if you don’t.

I have an appointment with son’s physiotherapist tomorrow. I phoned her to ask whether she was fine with being driven by me (her daughter has impaired lung function). She was philosophical about it - “this is going down whatever we do tomorrow.”

[doschicos]

GERMANY - Number of cases in Germany almost doubles in one day. 63 new cases for a total of 129.

“Nine of Germany’s 16 states now have cases of COVID-19, with Frankfurt, Hamburg and Bremen among the cities reporting their first infections…Almost half of the cases, 74 in total, have been confirmed in North Rhine-Westphalia, which is Germany’s most populous state. Bavaria has the next highest number of confirmed cases, with 23, followed by Baden-Württemberg with 15.” (Guardian)

FRANCE - 30 new cases reaching 130 total. 116 people are in hospital – nine of them in a serious condition – and 12 people recovered, 2 dies.

“New cases include two children, a one-year-old and a five-year-old, who have been hospitalized in Strasbourg along with their 27-year-old mother who also tested positive. Their condition has been described as not worrying.” (Guardian)

UK - 1st reported case in Scotland. 13 new cases today, largest daily increase, for a total of 36.

United postpones new pilot class and warns of additional flight cuts

A 23-person class of pilots that was supposed to start training this week has been postponed. (CNBC)

Major scientists’ group cancels one of world’s top science conferences

"The American Physical Society is canceling its annual meeting, one of the world’s biggest international scientific conferences with 10,000 people expected to attend, just a day before it was supposed to begin.

From the organization’s website:

“Due to rapidly escalating health concerns relating to the spread of the coronavirus disease (Covid-19), the 2020 APS March Meeting in Denver, Colorado, has been canceled. Please do not travel to Denver to attend the March Meeting.”" (CNBC)