Coronavirus Tidbits #44 5/6/20

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Announcements:

First, there is now a Resources Page here for the most commonly asked questions I’m getting.

Tidbits will likely be a bit shorter and a little less frequent for the next little bit. I have been immersed in it and I need to spend a little more time on self-care, which for me means seeing the spring flowers emerge and digging in the dirt.

Happy to continue to answer your questions/concerns as best I can, so don’t be shy about that.

 

NEW Post on Kawasaki, kids, and COVID-19. The latest weird syndrome.

with pics of what to watch out for.

News 

Trump plans to disband the COVID task force

Trump will stop counting fatalities once the Task Force ends. “The numbers just got too big, once we passed 60,000.” This is a homeland security response in 3 key failures: ignoring the intelligence; inability to execute for the states; and refusal to respect the dead ~ ~ ~

Marked decline in cancer screenings d/t COVID19

Routine #cancer screenings have plummeted during the #COVID19 pandemic, medical record data show Breast & cervical cancer screenings down by 94%. Colon cancer screenings down by 86% https://statnews.com/2020/05/04/cancer-screenings-drop-coronavirus-pandemic-epic/…

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Russians are falling from windows again…

Three physicians have “accidentally” fallen and been critically injured; two have now died. Each had complained about working conditions. ~7% of the fatalities have thus far been among health care workers, and they complain about lack of PPE.

https://www.washingtonpost.com/world/europe/three-russian-doctors-have-fallen-from-hospital-windows-in-two-weeks-amid-reports-of-dire-conditions/2020/05/06/c3ca73f4-8f88-11ea-a9c0-73b93422d691_story.html

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Diagnostics:

still an incredible, negligent lack of testing.

Drugs:

Good news about Remdesivir:

Dr. Francisco Marty reports (on Twitter, not yet published) experience w almost 200 patients. Key points:

Like #treatment for any severe infectious disease (meningitis, Gram-negative bacteremia, influenza pneumonia, etc), earlier is always better. #COVID19 is no different. #Remdesivir stops #SARS-CoV2 replication, but won’t heal the lung injury.  And the lung injury in #COVID19 is nasty and slow to heal, slower that any pneumonic process he recalls  When to use #remdesivir? Use it early in severe #COVID19 disease, anyone with an abnormal chest X-ray that drops to SpO2 <94%: limit the lung injury, get patients home in 2-4 days, not 2 to 4 weeks.  And I would not play number games in terms of age, comorbidities, immunosuppression. If they are sick enough to be in the hospital with #COVID19, sick enough to treat. We see responses in all patient groups, young & old, cancer & transplant, earlier is better.  Patients who end up in the #ICU on mechanical ventilation with #COVID19 likely benefit too. The lung damage is already advanced and takes time to heal, no different that other #lung infections  And yes, several patients who we treated early in their severe #COVID19 disease were able to go home without completing 5 days of #remdesivir. No one has come back yet with recrudescent disease.  The risk of #hepatotoxicity with #remdesivir is real, 3% of patients needing discontinuation. The risk for acute #kidney injury is due to the #cyclodextrine used to solubilize #remdesivir.

 

Devices:

Epidemiology/Infection control:

Excess Deaths – How to know when to reopen?

Good points by Jeremy Faust and Carlos del Rio:

https://threadreaderapp.com/thread/1257473206736359425.html

see also WaPo https://www.washingtonpost.com/opinions/2020/05/04/metric-that-could-tell-us-when-its-safe-reemerge/

 

 

 

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More on disaster of early reopening:

Two to four of every 10,000 US adults may need hospitalization and intensive care unit (ICU) resources during the COVID-19 pandemic, if events similar to those in Wuhan, China, unfold here, according to a study published today in JAMA Network Open.

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Texas Gov Abbott’s sleazy move

As @GovAbbott reopens the state in the midst of a rising infection and death rate, leaked audio from a call with Texas Legislators reveals that he knows reopening puts more Texans at risk.

Ohio’s Gov DeWine tries to rival Abbott

@GovMikeDeWine announces $775M in Ohio budget cuts, with most coming to Medicaid, K-12 education and higher education. The state is not spending a dime (yet) from its $2.7 billion “Rainy Day Fund.”

 

“The Arizona Department of Health Services told a team of university experts working on COVID-19 modeling to “pause” its work, an email from a department leader shows.”

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COVID-19 Outbreak Associated with Air Conditioning in Restaurant

in Guangzhou, China, involved 3 family clusters. The airflow direction was consistent with droplet transmission. To prevent the spread of the virus in restaurants, we recommend increasing the distance between tables and improving ventilation.

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Court: Miami jail can’t be forced to give inmates soap, tests during coronavirus outbreak

Decision from Judge William Pryor and Judge Elizabeth Branch, two of Trump’s appointees.

Metro West is where 163 inmates have tested positive for COVID-19, the illness caused by the novel coronavirus. In all three Miami jails, about 340 inmates have tested positive in the cramped quarters where social distancing is challenging. One has died.

https://www.miamiherald.com/news/local/crime/article242522116.html

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Why would you want to transfer prisoners from DC to Appalachia?

see also my LTE below, in politics section

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

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The Lincoln Project has a biting new ad, which prompted a 3 am Twitter meltdown:

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Kiss the Postal Service–and election–goodbye.

Top Republican fundraiser and Trump ally, Louis DeJoy, named postmaster general, giving president new influence over Postal Service. ~ ~ ~

Ousted @BARDA  head @RickABright‘s whistle blower complaint

says he was removed from the critical agency’s top job because he raised concerns about the Trump administration’s handling of the #Covid19 response & about nepotism. He brought receipts. ~ ~ ~ My reader commentary: excerpts re our health department’s lack of transparency, our clueless local officials, and plan to transfer prisoners from DC to our rural region.

Don’t rush back to business as usual

  • May 1, 2020

The World Health Organization and U.S. National Institutes of Health studied past pandemics and recommend the following guidelines for communications about pandemics: planning, trust, transparency, announcing early and listening.

Our country’s response has long blown past “planning” and “announcing early.” However, it is not too late for “trust,” “transparency” and “listening.”

There is no better place for our elected and appointed officials to use these guidelines than at the local level…

The lack of transparency by the Allegany County Health Department (ACHD) and our local officials is one of the most frustrating and counterproductive approaches they could take. Transparency and honesty are the basic foundations of trust and gaining cooperation from the public or coworkers.

…They could report racial demographics and institutional cases, but choose not to. Comprehensive reporting of the number of COVID-19 positive cases in our region, regardless of county of residence, would increase general public understanding of risk to area residents, especially workers in essential services…

Why wouldn’t the health department want transparency about risks to local residents? Is the Bureau of Prisons required to report cases to the health department? How many local folks have requested, but been denied, testing?

Some rural legislators and businesses are pushing Gov. Hogan to reopen rural areas of the State. Note that the Western Maryland lawmaker chose to be unnamed. Why?

…Allegany County’s preparedness to handle coronavirus is “extremely low” — almost rock bottom — at 2 of 100, according to Stat news with Applied XL and the Center on Rural Innovation.

Not that we didn’t know that, but it is still stunning to see it quantified like this.

It is unconscionable to bring a Bureau of Prisons COVID-19 operation to a region underserved by health care. Allegany and Garrett have an older, more vulnerable population than most areas of the state.

COVID-19 tests miss 30% of people who are infected. At least 40% of people who are infecting others are asymptomatic.

Until there is widespread testing, our local numbers are going down, and we have the ability to do contact tracing, it would be negligent to go back to business as usual.

Feel good du jour:

Comic relief:

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Perspective

Excellent, experienced perspective from WHO’s Mike Ryan:

“The lessons I’ve learned after so many Ebola outbreaks in my career: Be fast.
Have no regrets.
You must be the first mover.
The virus will always get you if you don’t move quickly.”  “If you need to be right before you move, you will never win.” “Perfection is the enemy of the good when it comes to emergency management.

Speed trumps perfection…

The problem in society at the moment…everyone is afraid of the consequence of error.

The greatest error is not to move…to be paralyzed by the fear of failure.” 

Bits of beauty:

 

Love from Maine – Mary Baudo

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