[AGL] What's the death rate for us? Read on. Do the math.
Charles Loving
lovingigor at gmail.com
Mon Mar 16 16:52:02 EDT 2020
Mask of the Red Death by Poe 1842. We are not there yet.
On Mon, Mar 16, 2020 at 12:46 PM J. David Moriaty <moriaty at sbcglobal.net>
wrote:
> Friend of mine is a medical professional, says this is one of his trusted
> sources—sort of a digest of actual medical journals.
>
>
>
> This is your daily JournalFeed.
> View this email in your browser
> <https://us3.campaign-archive.com/?e=df48a27992&u=827fa052009e49f904cc3c386&id=2db64b23a8>
> [image: JournalFeed]
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=4968b0860b&e=df48a27992>
> COVID-19 | Spoon-Feed Version
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=914031d937&e=df48a27992>*Mar
> 16, 2020 01:00 am*
>
> *Updated March 16, 2020*
>
> Written by Clay Smith
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=3de6c67779&e=df48a27992>
> Spoon Feed
>
> This post compiles the most authoritative answers to your questions about
> COVID-19 all in one place.
> Why does this matter?
>
> COVID-19 is considered a global pandemic
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=ad5a770cb7&e=df48a27992>.
> In the U.S. alone, there are 330 million people
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f5526e1401&e=df48a27992>.
> Estimates are that 60-70% of the population will become infected. That’s
> between 160 million and 214 million infected in the U.S., of which an
> estimated 200,000 to 1.7 million may die
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=01ebd46bb8&e=df48a27992>.
> The U.S. has only 924,000 staffed beds
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=c0be9079c2&e=df48a27992>.
> These numbers assume no mitigation strategies and may be better than
> expected. This is a very important topic.
> COVID-19 - Authoritative Answers In One Place
>
> We have previously written about COVID-19 in a broad overview
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=56b1f848ac&e=df48a27992> and
> a deep dive on the clinical presentation.
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=a1f72e4a61&e=df48a27992> This
> post is a quick way to find the most reliable sources of information to
> answer your clinical questions about COVID-19. If you see something that
> should be added, please help me and leave a comment or use the website’s contact
> form
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=53bfe46738&e=df48a27992> to
> let me know.
> Basic Science
>
> *Where can I learn about the coronavirus, SARS-CoV-2, that causes the
> disease COVID-19?*
>
> -
>
> This article in Nature takes a deep dive into the basic science of
> coronaviruses
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f145b059b7&e=df48a27992>.
> Free full text.
> -
>
> Mark Denison, MD, Vanderbilt Pediatric Infectious Disease, has been
> researching coronaviruses for almost 30 years. See this treasure trove
> of publications from the Denison Lab
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=7e7b2fcf8a&e=df48a27992>
> .
> -
>
> For more on taxonomy and where SARS-CoV-2 fits among other
> coronaviruses, see this from Nature Microbiology
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=5e60c44556&e=df48a27992>.
> Free full text.
>
> Epidemiology
>
> *What is the incubation period?*
>
> -
>
> It is 2-14 days
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=293f2f0a8e&e=df48a27992> (CDC);
> median 4-5 days.
>
> *How is COVID-19 spread?*
>
> -
>
> Respiratory droplets
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=d62f4c5fa4&e=df48a27992>
> (CDC)
> -
>
> SARS and MERS can live on surfaces for days
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=1139e7aa27&e=df48a27992>.
> SARS-CoV-2 is likely to behave similarly.
> -
>
> Here is a list of EPA-approved disinfectants with activity against
> SARS-CoV-2
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=47a9d445a6&e=df48a27992>
> .
>
> *If I am infected, can I get infected again?*
>
> -
>
> We don’t know yet
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=1ba55d7ad2&e=df48a27992>
> .
> -
>
> If other coronaviruses are any indication, immunity wains and
> reinfection is common.
>
> *What is the case fatality rate for COVID-19?*
>
> -
>
> It depends on the age of the patient.
> -
>
> There was 0% mortality in children 0-9 years and 14.8% mortality over
> age 80. It was a little worse than seasonal influenza in those aged 10 - 39
> years, with case fatality rate of 0.2%. But case fatality steadily rose
> with age over ≥40.
> -
>
> Case fatality among healthcare providers was 0.3%.
> -
>
> This came from the China CDC
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=666809af9c&e=df48a27992>,
> which loads *very slowly*. Here is a PDF version
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=11ad509022&e=df48a27992> you
> can rapidly download. Citation credit: The Novel Coronavirus Pneumonia
> Emergency Response Epidemiology Team. The Epidemiological Characteristics
> of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China,
> 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.
>
> *How do I protect myself as a healthcare provider?*
>
> -
>
> See this guidance from the CDC
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=76f20a3897&e=df48a27992>.
> Wear a surgical mask, gown (if possible), eye protection, and gloves.
> -
>
> If intubating or doing a procedure that creates aerosols, an N-95 mask
> is recommended
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=e89fefc070&e=df48a27992>
> .
>
> *What are general ways to protect myself and my family?*
>
> -
>
> The basics make a big difference
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=c20f22ca48&e=df48a27992>
> (CDC).
> -
>
> Keys: Handwashing (or hand sanitizer with 60% alcohol); social
> distance (6 feet); don’t touch eyes, nose, or mouth; avoid close contact
> with sick people (obviously meant for a non-healthcare audience); stay home
> if sick; cover coughs and sneezes; wear a facemask if sick; disinfect
> high-touch surfaces like counters, doorknobs, etc.
>
> *Who is at higher risk from infection with COVID-19?*
>
> -
>
> Older patients and those with comorbidities are at greatest risk
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=5b3c3e59c3&e=df48a27992>
> .
> -
>
> Comorbidities may include diabetes, heart disease, receiving
> immunosuppressive medications, chronic lung disease, chronic kidney disease.
> -
>
> It is unknown if COVID-19 is more dangerous in pregnancy. The WHO
> stated, “pregnant women do not appear to be at higher risk
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=232a8d5d91&e=df48a27992> of
> severe disease. In an investigation of 147 pregnant women (64 confirmed, 82
> suspected and 1 asymptomatic), 8% had severe disease and 1% were critical.”
> The CDC has an entire section devoted to pregnancy and breastfeeding
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=2322792423&e=df48a27992>
> .
>
> *How widespread is the disease, COVID-19?*
>
> -
>
> The best map is from Johns Hopkins
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f563db5bff&e=df48a27992>
> .
> -
>
> The WHO map
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=55efda2ed7&e=df48a27992> is
> here.
> -
>
> The New York Times
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=9f6293854f&e=df48a27992> has
> a frequently updated map as does the CDC
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=7203484ef6&e=df48a27992>
> .
>
> *What are the best sites to keep informed about this emerging pandemic?*
>
> -
>
> CDC
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=1180cdc8a4&e=df48a27992>
> | WHO
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=08876a378d&e=df48a27992>
> | NEJM
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=6b6fecf077&e=df48a27992>
> | Lancet
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=154e06e644&e=df48a27992>
> | BMJ
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=01f88a32f7&e=df48a27992>
> | JAMA
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=47ce181adf&e=df48a27992>
> | UpToDate
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=125702aca1&e=df48a27992>
>
> Clinical Pearls
>
> *What is the clinical presentation?*
>
> -
>
> Acute cough is common.
> -
>
> Fever on initial presentation was noted in 44% of patients and in
> almost 90% during hospitalization at some point. “Fever” was defined as an
> axillary temperature ≥ 37.5°C in this large Chinese case series
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=ba75991602&e=df48a27992>
> .
> -
>
> Some patients had fatigue, headache, myalgia, sore throat, or
> shortness of breath. (NEJM).
> -
>
> GI symptoms were uncommon. Rhinorrhea, conjunctival injection, tonsil
> swelling, and rash were also uncommon.
> -
>
> Around 80% have mild disease. They may be treated at home
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=b01df9adf0&e=df48a27992>
> .
> -
>
> Approximately 14% will develop severe disease
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=971d8ab91d&e=df48a27992> requiring
> hospitalization, and 5% will need critical care
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=70c52e6a0c&e=df48a27992>
> (JAMA).
> -
>
> 83% of hospitalized patients with pneumonia had lymphocytopenia,
> <1,100. About one-third of these patients had leukopenia and
> thrombocytopenia.
> -
>
> Over half of early presenters (in the first 2 days) may have no CT
> changes
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=dbba92f6c9&e=df48a27992>.
> However, most hospitalized patients with pneumonia from COVID-19 develop
> bilateral consolidation and ground glass opacities. See these images
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f22a171b08&e=df48a27992> (AJR).
> The American College of Radiology
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=9e09bacaa7&e=df48a27992> does
> not recommend CT be used to screen for COVID-19.
>
> *Which patients should be tested for possible COVID-19?*
>
> -
>
> The CDC recommendations are found here
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=88af2c4ad5&e=df48a27992>.
> These are evolving over time.
> -
>
> Patients who have symptoms and are hospitalized, those with
> comorbidities, and healthcare workers should be prioritized.
>
> *How do I test for it?*
>
> -
>
> This is what you need to know
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=fb090d5910&e=df48a27992> from
> the CDC. We use universal viral transport medium and FLOQSwabs in my
> facility.
> -
>
> If collecting a specimen, you need to watch this 41 second video
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=00f68d84dc&e=df48a27992> on
> proper nasopharyngeal sampling technique.
>
> *What lab test is done to test for SARS-CoV-2?*
>
> -
>
> It is a Real-Time RT-PCR test.
> -
>
> Here are all the details
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=04949d6fed&e=df48a27992>
> .
>
> *How is COVID-19 treated?*
>
> -
>
> There are no drugs approved for use yet.
> -
>
> The CDC recommends avoiding corticosteroids if possible.
> -
>
> Trials of remdesivir
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=b23c5db3af&e=df48a27992> are
> underway.
> -
>
> For now, it is supportive care.
>
> *How long do infected patients remain infectious?*
>
> -
>
> According to the WHO-China Joint Mission on Coronavirus Disease 2019
> (COVID-19)
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=e445dadbfc&e=df48a27992>,
> “ virus can initially be detected in upper respiratory samples 1-2 days
> prior to symptom onset and persist for 7-12 days in moderate cases and up
> to 2 weeks in severe cases.”
>
> *What should healthcare workers do if they are exposed to patients with
> confirmed COVID-19?*
>
> -
>
> It depends on the risk of the exposure.
> -
>
> See this CDC guidance
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=a8f7f1cc55&e=df48a27992>
> .
>
> *What should healthcare workers do if they develop symptoms?*
>
> -
>
> You should be tested
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=0c1ea6b83a&e=df48a27992>
> (CDC).
>
> *When should healthcare workers return to work if they test positive for
> COVID-19?*
>
> -
>
> This must be determined by your employer on a case-by-case basis at
> this point.
>
> *How should EMS handle confirmed or potential cases of COVID-19?*
>
> -
>
> Here are recommendations for EMS
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=0fbc4124a9&e=df48a27992> related
> to COVID-19.
>
> *Will there be a vaccine for COVID-19?*
>
> -
>
> It will likely be a while
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f411565f94&e=df48a27992>
> .
> -
>
> But phase 1 trials may begin has early as April.
>
>
> *What additional questions would you like to see answered here?*
>
> Please contact us
> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=bdc2e383b6&e=df48a27992>.
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> <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=25e6e5fd7f&e=df48a27992>
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--
Charlie Loving
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