bcl05

Having a bit of time to prepare doesn't allow us to double the number of ventilators or O2 masks or hospital beds. It does allow us to do the types of social distancing and limitation of contact that might blunt the curve and allow it to stay within our capacity. This is happening, to a degree, but I'm worried if that it may be too little too late. Too early to say. Fingers crossed. If only we had started this on day 1, instead of weeks later, we really could have made a much bigger difference.

That Atlantic article is a must-read. Italy is not some backwater with a primitive health care system. It is very analogous to ours, and we could be facing a similar catastrophe.

My hospital just announced that there will be no in-person meetings of 10+ people unless absolutely necessary. Lots of virtual/teleconference meetings in my future. I wish I had invested in Zoom/gotomeeting/etc.

I certainly hope you're right. I do know that developing a vaccine is challenging, and not easily predictable. People have been working on a HIV vaccine for decades and we are still waiting. Multiple trials have been unsuccessful. These things are hard. It makes the story of the polio/smallpox successes all the more remarkable.

I'm skeptical about a C19 vaccine. The common cold is a big hassle and is a related coronavirus. If that was easily vaccine-able, we would have had it by now. I hope I'm wrong.

My area of medical expertise is not very useful in this kind of emergency. If/when it happens that I need to help with C19 patients, I think my main role will be carrying stuff and doing what I'm told.

My hospital just announced that all medical staff travel is cancelled for the foreseeable future. Both as a deterrence against spread and a readiness plan for when the numbers of cases spike beyond normal capacity. I haven't managed a ventilator or intubated anyone since my first residency, 17 years ago. God help anyone for whom I'm the best choice for that...

I don't know... I think Disney is probably a moderately risky idea. But Star Wars, probably with the shortest lines ever? I would go. Not saying I should, or that its responsible. But the temptation is very understandable.

The spread was inevitable, but the speed of that spread is alterable, and critical. This administration has been an abject failure of leadership and organization in any effort to mitigate this disease. All efforts to limit spread now (school closures, working from home, canceling of big events, etc) are happening - and may have a very beneficial effect - in spite of Trump’s BS about how this is contained and minor. I’m sure he’ll take credit for any “success” anyways. But it will be a lie, just like almost every other thing he says.

If we somehow manage to keep the number of dead americans from this virus to less than the average seasonal flu, that would represent a big success. The social distancing, slowing of travel, closing of schools, etc, would have saved lives. This virus appears, in early data, to be both more infectious and more lethal than the typical seasonal flu. Unchecked, this could kill hundreds of thousands or even millions. It is worth the economic disruption. I very much fear that, in this best case scenario, the stupid among us will see a relatively small final number of dead, assume the whole thing was a hoax or overblown, and not learn any lessons for the inevitable next pandemic or in the value of public health investment. I don't think so. There are a lot of symptomatic and infected patients without pulmonary fibrosis who are still spreading disease. That breath-holding thing is probably a reasonable approximation to see if someone has severe disease, but that's about it.

This is exactly wrong. The goal of quarantine is not really to prevent spread. That is unrealistic at this point. If our government had acted appropriately weeks/months ago, maybe. But not now. The goal should be to slow spread as much as possible, so that the capacity of the health care infrastructure is not exceeded, or at least not by too much. Countries that have instituted strict and aggressive quarantines and controls have achieved this, and have far lower mortality than countries that have reacted too late and too timidly. A modicum of reading would make this clear.

I would say this is a very accurate assessment of the current situation.

No. You're exactly right. And this terrible incompetence is why this is going to be far worse in the US than it should be. More people are going to die because this administration eroded bureaucratic competence, defunded the CDC, prioritized messaging and the stock market, and gaslighted the public rather than actually address the problem in the only way that works.

I know him. Had dinner with him about a year ago. He’s very, very legit.

I would expect that is the case, but I haven not seen any data where the smoking history is included as a variable.

Please, please read this thread.

Not trying to address the spat you two are having, but, here is the primary data: https://www.medrxiv.org/content/10.1101/2020.03.03.20030593v1 This suggests a change in R0 (a standard measure of infectivity) from 3.86 to 0.32 (caveat- big error bars) pre and post intervention. There is a ton of data in there and the article is worth reading.

Well... there are a lot of patients out there with symptoms who are not getting tested. The "criteria" for testing has been extremely narrow and restrictive, and is a significant contributor to the lack of good data currently available for US infections. The data from other countries is currently of a much higher quality, at least according to the experts at my institution. I think the correct amount of worry is somewhere between the two of you...

This is something to talk about. I think it is reasonably possible that 200,000 americans will eventually need ICU care from this, but it is exceedingly unlikely that 200,000 will need it simultaneously. At this point, given how many people are spreading this broadly all over this country, I think it is quite likely that many/most Americans will EVENTUALLY be infected by COVID19. We, as a health care system, despite all the flaws, can likely handle this if the spread is slow and patients come into hospitals in small numbers at a time. If the spread is not controlled, and it grows exponentially, it could easily swamp available resources and people will get far sicker than they need to because of lack of access/bottlenecking of care. We need to reframe discussions about this away from preventing spread to at least slowing spread. A key part of that effort would be broad testing of anyone with suggestive symptoms, and any contacts of known or suspected individuals. Our testing infrastructure is not ready for this. Another key part of controlling this would be an intelligent, organized, rapid, trusted and effective way for the central leaders to mobilize people to change behavior and reduce risk. Our president can't seem to stop lying about this, and is obviously more concerned about the effects on the economy than on the people. Why he can't see the connection between those two is beyond me, other than he is just that stupid. At least we can all wash our hands. Please do so.

That's correct. And that's why school closures are an effective tool in the containment effort.

The government is gaslighting a pandemic. This is so stupid and destructive.

That pass by Backstrom is just ridiculous.

This thread captures what I’m worrying about... and we have a clown in charge.

I'm a doc, and I'm worried about this. I don't think this is ebola, its not a threat to civilization or anything like that. I am worried that if this grows as one would expect (as it did in Wuhan, in Italy, in Iran, etc), the stress on our medical system is going to be severe. Our hospital is typically at 90-95% capacity at all times. If we suddenly have dozens/hundreds/thousands of patients showing up with severe respiratory disease, we are not going to have enough ICU beds to go around. If/when docs/nurses/other hospital staff start getting sick in droves, the challenge is going to be severe. If this grows slowly, over months or years, then our system can likely handle it. We can achieve that with widespread testing, aggressive tracking, and appropriate quarantines. I'm afraid that isn't happening. If this explodes, like it could (not saying for sure it will), we won't be able to provide adequate care for all the sick (not just people with coronavirus). This is all compounded by the stress on the supply chain that is making equipment and medications scarce. There remains a wide range of possible outcomes for this virus in the US. I'm hoping for the best. But, at this point, the chances of a major, rapid outbreak that we are truly not ready for remains high enough that I'm not sleeping very well...