Coronavirus Tidbits #26 4-1-20
News:
New post:
People Can Spread Coronavirus For Up To Three Days Before Having Symptoms
This means we will have to be much more careful to maintain distancing and STAY at HOME. It will also likely lead to a push for the public to wear masks when out.
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nearly a quarter of the city’s emergency medical service workers out sick, according to the Fire Department. In all, 2,800 members of the Fire Department are sidelined, including about 950 of the city’s 4,300 paramedics.
Nearly 16% of the New York Police Department’s uniformed force is off sick, with more than 1,000 officers testing positive for the virus so far.
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NYC is converting *all its public hospitals* in ICU units for COVID-19. “Patients who do not have the virus will be sent to large-scale temporary hospitals or to hotels that are being converted into temporary medical facilities.”
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We’re Betraying Our Doctors and Nurses – “Many of my colleagues are making wills, they’ve sent their families away. People are scared, & rightfully so. We see it every day. We see the Covid people coming in, short of breath and dying right in front of us.” Nick Kristof nails it. Feds fail to provide #PPE, nurses and doctors are fired for speaking out or for wearing their own. Outrageous.
Besides being the moral thing to do, to care for the brave healthcare workers on the front lines, who will care for you if they all die?
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Debra Vasalech Lyons @DebVasalech
I lost my best friend to Covid19 a few hours ago. @DrFrankGabrin was an ER Doctor in NYC. He planned to go back to work when he recovered. It took only five days from the first sign of symptoms. He leaves a husband of less than one year behind. We are devastated. #PPENow
2) Symptoms developed 9 days after he’d been forced to use the same mask for multiple shifts. He was told to self quarantine. He woke up this morning and couldn’t breathe. In less than two hours he was gone. He never made it to a hospital. His husband is sick too. #PPENow 
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Threats against Dr. Fauci have prompted him needing a security detail.
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Strict lockdowns and rapid tests: How poorer countries are bracing for coronavirus
Important perspective on Africa, S. America and other poorer areas by Amy Maxman
Diagnostics:
still nothing new
Drugs:
Vineet Chopra thread: ID Doc at U Michigan: His impressions are that tocilizumab and other IL6 blockers really seem to work – if you give it early enough in the disease…He has not seen any clinical benefit from hydroxychloroquine, but has seen a lot of GI side effects and liver enzymes bumping up. Says: Not sure this has as much of a role in disease care TBH.
There is profound physical weakness during recovery. Those that get better need help with basic ADLs. Yes, even a 30 yr old needs assist to get up and go to the bathroom. Early PT and ambulation is key.
Finally, I have never seen a dz that needs so many of us to come together to deliver care. #COVID19 care needs MDs, RNs, resp therapists, APPs, pharmacists, PT, Social workers, sub specialties and palliative care. It takes a village to fight.
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Hydroxychloroquine (Plaquenil) is being given for prophylaxis for Doctors and contacts of lab confirmed cases is part of a ‘Demonstration Study‘ in India. It will be used in ‘regular people’ only after collating the results. This appears to be a study without informed consent.
Devices:
The federal government has a ventilator stockpile, with one hitch: Thousands do not work. – NYTimes
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See Politics for more on ventilator shortages
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Not suitable for home use x perhaps steam heat using microwave steam bags, designed for disinfecting infant feeding equipment,
Epidemiology/Infection control:
Checking sewage for SARS-CoV-2 might be an early warning system for the presence of virus in a community. Infected people excrete viral RNA in stool. Might be useful in future as a way to look for additional waves; build on #polio sewage surveillance? (Paywalled: Bloomberg)
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Should Everyone Wear A Mask In Public? Maybe—But It’s Complicated Quite the analysis from @tarahaelle on why there is such debate on Masks
“Now, with social distancing, we’re assuming everyone is sick, so it makes sense for the time being that the CDC is considering broadening mask recommendations, not to protect the wearer, but to protect the family members and others in the community.”
If healthcare workers can’t get enough masks, they get sick, and there are fewer of them to take care of people, so fewer people receive care, more disease is spread, and more people die.
Everyone Thinks They’re Right About Masks
“The mask debate is so intense because both the stakes and the uncertainty levels are so high. “We’re trying to build the plane while we’re flying it,” Hanage said. “We’re having to make decisions with quite massive consequences in the absence of secure data. It’s a nightmare for your average cautious public-health professional.”The coronavirus pandemic has moved so quickly that years of social change and academic debate have been compressed into a matter of months. Academic squabbles are informing national policy. Long-standing guidelines are shifting. Within days, an experiment that’s done in a hospital room can affect how people feel about the very air around them, and what they choose to wear on their faces. Masks are a symbol, yes, but not just of conscientiousness. They’re also emblematic of a world that is changing so quickly, no one has time to take a breath.”
Tips, general reading for public:
see Masks links by Tara Haelle and Ed Yong.
Politics:
Re large shipments of American-made respirators and ventilators to be sold to foreign buyers.
“The U.S. government has placed no restrictions on exports of medical supplies while continuing to impose financial penalties on the import of personal protective gear, protective goggles, pulse oximeters, hand sanitizer, and other medical products from China. On March 10 and 12, President Donald Trump temporarily lifted tariffs, in place since 2017, on some of these medical products.
Trump did not declare a national emergency until March 13 and the federal government did not start issuing major federal contracts for the purchase of personal protective equipment, as The Intercept previously reported, until early and mid-March.
The failure of the U.S. to recognize Covid-19 as a serious problem follows years of efforts to dismantle federal programs designed to maintain international disease surveillance. The Trump administration cut 14 employees from the Beijing office of the U.S. Centers for Disease Control and Prevention, and closed U.S. Agency for International Development programs in China working to monitor disease outbreaks over the last two years. In 2018, Trump disbanded the National Security Council office devoted to pandemic preparation.
https://theintercept.com/2020/04/01/coronavirus-medical-supplies-export/
Feel good du jour:
Dolly Parton is making a donation of $1 million to Vanderbilt towards coronavirus research and to encourage people that can afford it to make donations.
Comic relief:
Germany is now advising people to stock up on sausage and cheese. It’s the Wurst Kase Scenario.
Perspective/Poem
Good overview of what SE Asia did so well and how they controlled their coronavirus infections–Testing, Isolation, Contact Tracing, and Quarantine. It is criminally negligent that we have not done widespread testing.
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The U.S. is still in the clambering-into-the-life-raft phase of responding to Covid-19. Dry Land is Far Away. –Worth a read. From Marc Lipsitch…Viruses do not remember they were previously under control and will resurge when restrictions are lifted…With something like Covid-19 there is the first peak, and there’s the whole epidemic.
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A journal of the Plague Year: Week 3. — Jenny Boylan offers a thoughtful, rather lyrical perspective.
Bits of beauty:
One can never have too many bluebells or scilla
2 Comments
Diane McMahon
Just want to thank you for your daily updates Judy – they mean so much to me. I just don’t have the ability to understand this pandemic at the level that you do. And facts are what I am searching for. Thanks for doing that for us – out of the goodness of your heart!
Judy Stone
Thank you for the kind words and encouragement, Diane. Please reach out if you have questions.
Do you remember when we put together the Holocaust Remembrance Day program, we spoke about how one of the things that helped save some of my family’s lives were the acts of kindness and how people helped each other?
That is such an important lesson to remember now, to help us better survive this nightmare.
We each have different ways of being able to help our communities–this newsletter and answering questions is what I can do best as a contribution. Others are delivering food, or taking care of patients, or…whatever.
Thanks again, Diane.