Coronavirus in the US

i posted this on the there thread but thought I would update this one as well:

I had mentioned last week that my mother’s cousin lives in a senior independent high rise in New Orleans with 140 residents. At that time there were 8 positives, 5 hospitalized, and one death. The building is called Lambeth House

Update: there are now 12 confirmed cases, all from independent living, 8 hospitalized, and a death this week.
https://www.nola.com/news/coronavirus/article_6f97c47a-67ca-11ea-8127-9f78c954102f.html
https://www.nola.com/news/coronavirus/article_47690e94-67db-11ea-98ec-07f79e840dac.html

It’s a real dilemma. In middle class districts, kids already have school-issued Chromebooks and white collar parents who are working remotely from home already, so these kids will probably be fine. By closing all the schools, we are throwing a certain population and set of priorities (child safety for some kids, education) under the bus for the benefit of another segment of the population (elderly, immunocompromised) and priority (the adequate functioning of the healthcare system). I am glad that I am not responsible for making the call on these tradeoffs. I can only hope that the right decision was made in retrospect.

Has anyone seen reports or studies on the percentage of ICU level patients who survive? Does the supportive care work in most cases?

Yes, tradeoffs. I wonder how long it will be before those questions are asked given the economic devastation to so many people.

We have a lot of grandparents raising school age children due to the opiod epidemic - so it’s very important here to make sure they are able to continue to do so. Or we will not only be dealing with ICU capacity issues, but the additional challenge of re-homing these children again.

https://www.beaconjournal.com/news/20190227/increasing-number-of-ohio-children-going-to-foster-care-because-of-parental-drug-abuse

Venting patients is considered supportive care, as is delivering O2 by nasal cannula and IV fluid hydration. There are not yet any other interventions that have shown consistent success in treating COVID-19 patients. Steroids, anti-inflammatories and anti-viral medications haven’t shown any efficacy in changing or moderating the course of the disease.

The level of supportive care required by patients in ICU does correlate with mortality. The higher the level of support required, the less likely the patient is to survive.

https://jamanetwork.com/journals/jama/fullarticle/2762996

Additionally physicians in Seattle are reporting it’s taking an unusually long time to wean this vented patients who do survive off their ventilators–10 days or more.

Children under 18 can ride the city’s bus lines for free. Several specially scheduled city buses will take children to school sites to pick up breakfast and lunch.

@TatinG I have read that about 50-60% of patients who end up on ventilators survive in general (not COVID-19 specific).

Thank you, @doschicos , for the Tobias Jones essay which was particularly meaningful to me.

I’ve been wanting bring up a difficult issue which has been on my mind due to elderly family members. It’s an intensely personal issue, and I do not want to start any kind of debate. I’m wondering whether the higher percentages of deaths in Italy have something to do with the comparative lack of DNR/DNI there.

This research study compares the DNR/death process in six European countries: https://www.ncbi.nlm.nih.gov/m/pubmed/16625128/

I have read that DNR is not common in Italy, and not legally recognized. Here is a research article about EOL (end of life) care in Italy: https://www.researchgate.net/publication/41761035_End-of-life_care_is_still_a_challenge_for_Italy

I have also read that even in places where DNR is legally recognized, the compliance of families, nurses and doctors with the patient’s wishes is not always high. (It’s apparently very high in Sweden, for example.)

It is possible that the need to try to save everyone contributed to the severe shortage of ICU care, physicians, ventilators etc. in Italy. I don’t have any easy answers because end-of-life care decisions are complicated and agonizing. I know some doctors in our area are asking about the wisdom of sending patients from nursing homes to the hospital during this crisis if they have a DNR/DNI. There would be less pressure on the hospitals and fewer agonizing choices if patients who definitely do not want CPR, intubation etc. could stay where they are. That is assuming there is good palliative care where they are. There may not be, and I know visiting nurses have been shut down in our area.

Edited to add that this article helped me understand the complications of DNR vs DNI, the consideration of being on a ventilator temporarily vs long-term, and the question of quality of life after treatment: https://www.wbur.org/commonhealth/2017/10/30/end-of-life-dnr-code-status

Thanks to everyone contributing to this informative thread which is helping me process the pandemic we are living through. Also, thanks @AlmostThere2018 for your kind words about DH!

NYS predictions (from Cuomo conference):

NYS currently has:
53,000 hospital beds
3,000 ICU beds
(That’s total, not what’s available)

hospitalization rate 15%-19%

Expert projections:
peak in 45 days
55,000 - 110,000 hospital beds
18,600 - 37,200 ICU beds

Do the math

Thanks. Is there a site that shows numbers tested?

New York governor: We cannot do this without help from the federal government
New York Gov. Andrew Cuomo said the state “cannot do this on our own.”

He added: “I am telling you this [New York state] government cannot meet this crisis without the resources … of the federal government.”

He said he spoke to President Trump today who said he is “ready and willing to help…especially on the hospital capacity issue.”

Cuomo, who has traded barbs on Twitter with Trump over the past couple days, said “I said to the President… I put my hand out in partnership. I want to work together 100%.”

He continued, “I want your help. I need your help.”

He said Trump responded that he wants to work together and he believed the President was “100% sincere” in saying that.

On the White House coronavirus response team, Cuomo said they have been “on it. They’ve been responsive.” CNN

New York governor says “it’s possible we will be doing more dramatic closings” of businesses

New York Gov. Andrew Cuomo said “it’s possible we will be doing more dramatic closings” on top of closing bars, restaurants, and schools to reduce the spread of the coronavirus.

He added that those orders won’t be happening today. He said it might mean they have to “continue to close down things — such as businesses.”

“We’re not there yet — but I’m telling you we have to get down on that rate of spread,” Cuomo said.

Cuomo said he’s talking to other governors about ideas for what can be closed. He said “whatever we come up with will be statewide rules” for New York. He said he’s “hopeful” that can be done with “surrounding states.” CNN

New York governor: We have “no plan whatsoever” to quarantine New York City

New York Gov. Andrew Cuomo said there are no plans to quarantine New York City, despite rumors and fears.

“We hear New York City is going to quarantine itself — that is not true,” Cuomo said at a news conference, adding that cities would need to get state approval to make such orders.

“We have no interest whatsoever — and no plan whatsoever — to quarantine any city,” he said.
Earlier today, New York City Mayor Bill de Blasio said he is “absolutely considering” ordering the city’s residents to shelter in place during the coronavirus pandemic.

“Right now we have taken a series of steps to reduce the number of people who are circulating around,” he said. “But we’re going to look at all other options, and it could get to that for sure.” CNN

why is the peak in 45 days if we’ve already spread it so much (testing is behind) and now are heavily practicing social distancing? I would think peak in 21 days? What do i know.

The hardest thing for me is how my poor senior daughter won’t have any of her ‘senior spring’. Prom, sports, will all be cancelled, i’m sure. Her friends on social media are still out and about, while I’ve forced lockdown.

Praying non of my family members get sick, some of whom are immuno compromisted. I, myself, can suck it up in my nice house and quiet neighborhood for a month. I’m sad for the kids and afraid for the grandparents.

Miami is closing all non-essential business due to coronavirus outbreak

The City of Miami, Florida, has issued an order on Tuesday mandating all entertainment and non-essential business establishments to close until further notice due to increased cases of community transmission in Florida, according to a news release from the city.

The order which goes into effect at 11:59 p.m. ET on Tuesday, March 17, applies to all alcohol service establishments that do not serve food, including bars, nightclubs and lounges.

Dine-in restaurants may sell food for takeout, delivery, and drive-thru on a two-hour basis.

Entertainment venues including movie theaters, gyms and fitness centers are also impacted by the new order. CNN

Israel tells people to avoid leaving their homes and public transportation
From CNN’s Michael Schwartz and Oren Liebermann

Israel’s Ministry of Health has instructed people to avoid leaving the home unless absolutely necessary and to avoid public transportation entirely if possible.

The new instructions bring Israel one step closer to a full lockdown to stop the spread of coronavirus, though Prime Minister Benjamin Netanyahu has not yet enforced such stringent limitations.

The new instructions also encourage Israelis not to travel to meet with family members but instead to catch up over the phone or through video calls.

“These are not simple instructions,” said Ministry of Health Director-General Moshe Bar Siman Tov in a video posted on Twitter with the latest instructions. “We ask you to reduce as much as possible the number of times you leave your home. It is possible that anywhere you go, there could be someone who is sick [with coronavirus] who could infect you. It is possible that you are sick and you still don’t know, and you could infect someone else.”

“We may be about to enter a difficult period with the coronavirus. Our ability to succeed depends on your conduct and ours.”

President Reuven Rivlin urged Israelis to heed the latest instructions for the health of the country.

“We must not turn these days into leisure days,” he said in a video statement, continuing, “I hear that our beaches and our hiking trails are bursting. The danger is real! Let me ask you again to follow the instructions with regard to distancing, and to refrain from gatherings. This is a real danger.”

[ I’ve heard people mention going on hikes or walks in more remote areas. As my young adult son reminded me, rural areas have already been facing a health care crisis with lack of doctors and hospital beds even before COVID-19. Don’t risk bringing the virus to them by being in their communities. ]

I assume you need to count on some spread even with the current rules. It also takes a while for the illness to get serious enough to require hospitalization and ICU. China still shows 3.2K people in critical conditions.

My son teaches in a very remote town with no cases and just three roads connecting it to the outside world. I am surprised his town and towns like it don’t keep people out (except truck drivers bringing in food and necessary supplies).

Has anyone heard of any towns doing this?

It’s the 6 degrees of separation

Atlanta airport closes two domestic terminal checkpoints due to “declining demand”
From CNN’s Tina Burnside and Amanda Watts

Hartsfield Jackson International Airport has temporarily closed the north and south domestic terminal checkpoints due to “declining demand,” according to airport spokesperson, Elise Durham.

Passengers at the world’s busiest airport are being directed to the Main checkpoint until further notice.

Brooklyn will stop prosecuting “low-level offenses that don’t jeopardize public safety”
From CNN’s Erica Orden

The Brooklyn, New York, district attorney’s office says it will stop prosecuting “low-level offenses that don’t jeopardize public safety.”

Brooklyn district attorney Eric Gonzalez also says he is asking public defenders to tell the office about clients in pre-trial detention who are vulnerable to infection “and who we should consider releasing during this crisis.”

Eric Gonzalez
:heavy_check_mark:
@BrooklynDA
Statement from Brooklyn District Attorney Eric Gonzalez regarding the #coronavirus (#COVID19).

Europe experiencing “critical shortages” of medical supplies, WHO official says
From CNN Health’s Jacqueline Howard

The European region is facing some “critical shortages” in medical supplies, Dr. Hans Henri Kluge, the World Health Organization’s regional director for Europe, said during a media briefing.

“WHO is monitoring the potential risk of a disruption to medicine supplies, focusing on essential medicines critical for primary health care and emergencies, including antibiotics, painkillers, treatments for diabetes, hypertension, HIV, tuberculosis,” Kluge said.

“WHO delivers laboratory equipment, medical devices and personal protective equipment to countries in need. We are aware of some critical shortages and working hand-in-hand with partners like the European Commission and WHO globally and the private industry to tackle this,” Kluge said. “Resources are critical to sustain our effort so that no one is left behind nor at the sidelines.”

Europe has “more reported cases and deaths than the rest of the world combined, apart from China,” Tedros said on Friday. “More cases are now being reported every day than were reported in China at the height of its epidemic.”

New York City mayor says he’s “absolutely considering” a shelter in place order
New York City Mayor Bill de Blasio said he is “absolutely considering” ordering the city’s residents to shelter in place during the coronavirus pandemic.

“Right now we have taken a series of steps to reduce the number of people who are circulating around,” he said. “But we’re going to look at all other options, and it could get to that for sure.”

New York City has already closed schools, ordered restaurants to offer takeout and delivery only and encouraged workers to telecommute if they can.

Nearly seven million people living in a wide swath of Northern California, including Silicon Valley, have been ordered to shelter in place. The order went into effect at midnight Monday.

New Day
:heavy_check_mark:
@NewDay
Mayor Bill de Blasio says he is “absolutely considering” a shelter in place order for New York City residents just like the one instituted in California’s Bay Area on Monday.https://cnn.it/3beohvt

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∆people are still going to groceries and takeout and pharmacies

Doschicos has surely already posted the “ten days ago” made by individuals in Italy

German foreign minister rules out exclusive access to coronavirus vaccine, without mentioning Trump
From CNN’s Nadine Schmidt in Berlin

Germany’s foreign minister Heiko Maas told reporters that “others” would not be allowed to buy German coronavirus research exclusively, without naming US President Donald Trump.

“German researchers are taking a key role in developing medication and vaccines as part of global cooperation networks. We cannot allow a situation where others want to exclusively acquire the result of their research,” Maas said in an interview with Funke media group. The quote was confirmed to CNN by the German Foreign Office.

Over the weekend reports surfaced that Trump had been interested in buying research into a coronavirus vaccine by German biotech company CureVac. The German interior minister called the reports “accurate.”

CureVac denied a report that Trump was trying to lure its scientists to the US in a statement Sunday. It did not deny being in touch with the President or US government, but rejected rumors of an acquisition.

On Monday, Dietmar Hopp, a lead investor in the company, issued a statement saying that it should be available anywhere, also without mentioning Trump. CNN has reached out to Hopp for more information.

Maas said that everyone shares the goal of slowing the spread of the virus and saving lives.

“Every country is trying to protect its citizens as best it can, depending on the situation on the ground, and some countries are even imposing temporary travel restrictions,” he said.

“In the crisis we feel more than ever how much we depend on each other. That is why we need more, not less, cooperation right now.”

Maas added that he had discussed cooperation with colleagues from Canada, South Korea, Brazil and Australia, and will also do so with G7 ministers.

“We’ll only defeat this virus together, not against each other,” he said.

"We support the WHO so that help can be given where it is most needed, including in poorer countries.”

But we should be able to ‘flatten the curve’. I don’t think its feasible to stop life for 2 months. We have to expect that there will be people who will have CV and it will continue to spread until July and we should do social distancing until then but I can’t see how its feasible for us to be on lockdown for 8 full weeks. 2-3 weeks, yes. 8 weeks… UGH.

https://www.businessinsider.com/coronavirus-italy-quarantine-lockdown-video-2020-3