Player To Be Named Later said:

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It isn't just "at risk" folks that end up hospitalized. In our county, steadily 20%* of cases have been bad enough to get admitted.

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*known cases

Granitestate said:

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If you where sitting at the table with the taskforce considering how to reopen, what guidance would you give ? For example would you advocate contact tracing? Participation in contract tracing for access to public transit? Rapid test prior to boarding a flight? Opening of public beaches, parks, golf courses? Mandatory reporting of all positive and negative test results? Reporting icu bed occupancy rate? Number of test administered in geographic area, number of positives, and number of negatives? Etc. None of the above? others?

Thank you in advance. Your input has been extremely helpful.

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Track cases by date tested and not date test results received.

Make doctors give cause of death based on actual cause regardless of Covid symptoms.

Today's update!

https://www.facebook.com/1998386763777604/posts/2672595163023424/?sfnsn=mo

Funny just logged in and everyone is discussing what I wrote about. I will have to go back and read all of your posts!

Great minds think a like! Lol

BiochemAg97 said:

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redline248 said:

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I'm curious what is the opinion of medical professionals in regards to continuing shelter in place here in Texas. Posters on other texags boards are quite insistent it's massive overreaction.

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Not a medical professional, but it appears from all I have heard that we may have flattened the curve. Our hospitals have plenty of capacity because of we stopped all elective surgeries. This has caused a completely different problem than in places like NY. Instead of overwhelming our healthcare system, we have furloughed our healthcare workers.

Additionally, economic dislocation has its own risks, including increase suicides, domestic violence, alcoholism.

However, there is still a lot unknown. So a phased rollback of restrictions makes a lot of sense. We do not want to go too far too fast and end up overwhelming our healthcare system.

So far, we have:
-Allowing curbside to go from "non-essential" businesses makes a lot of sense. It has been allowed in other states and there is no reason to expect it is safer to get takeout food than to get takeout other goods.

-opening state parks. There is no reason to expect a state park is more dangerous than a city park or the sidewalk, if you maintain appropriate precautions.

-expand the definition of allowable surgeries. We have the hospital capacity to space.

All this presumes that we are near a peak and not on the verge of spiking.

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All excellent points, this is almost exactly how I feel! I pretty much said most of the same things tonight.

Kick-R said:

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Scenario 3 only really occurs if at-risk populations are too quick to try and return to normal, no?

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Or we completely ignore hygiene and social distancing. This will cause a huge resurgence in cases.

Player To Be Named Later said:

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It isn't just "at risk" folks that end up hospitalized. In our county, steadily 20% of cases have been bad enough to get admitted.

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That is true of the population we have tested which has mainly been the symptomatic patients. There is a tremendous number of people who have had the disease but were undetected because they were essentially asymptomatic. So if you count them the number is much smaller. But your point is well taken because anyone can end up in the hospital. Young, old risk factors or no risk factors. We are still trying to figure out why some get so much sicker than others.

Granitestate said:

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If you where sitting at the table with the taskforce considering how to reopen, what guidance would you give ? For example would you advocate contact tracing? Participation in contract tracing for access to public transit? Rapid test prior to boarding a flight? Opening of public beaches, parks, golf courses? Mandatory reporting of all positive and negative test results? Reporting icu bed occupancy rate? Number of test administered in geographic area, number of positives, and number of negatives? Etc. None of the above? others?

Thank you in advance. Your input has been extremely helpful.

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I didn't address contact tracing again tonight but I did earlier this week. I think it is a great idea but unfortunately i don't believe enough will participate in the google/apple plan to trace all known positives to make it effective.

Testing before flights is a good idea but boy you are opening up a can of potential problems. People complaining about not being able to fly or threatening litigation over false positive costing them a major deal in another city. As we are now finding out people don't take well to being told no.

Opening of parks, golf courses, beaches are all great ideas and will help the moral of the citizens as depression and anxiety are becoming the next pandemic. I see at least 5 patients a day now with these disorders from losing job, home, savings etc.

COVID-19 is already a reportable disease so all results are reported by the lab.

We have plenty of ICU beds so not really a factor. Currently expected to need 300 and we have 2,259 beds available.

Granitestate said:

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If you where sitting at the table with the taskforce considering how to reopen, what guidance would you give ?
For example would you advocate contact tracing?
Participation in contract tracing for access to public transit?
Rapid test prior to boarding a flight?
Opening of public beaches, parks, golf courses?
Mandatory reporting of all positive and negative test results? Reporting icu bed occupancy rate?
Number of test administered in geographic area, number of positives, and number of negatives? Etc. None of the above? others?

Thank you in advance. Your input has been extremely helpful.

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1) CDC and local health departments are doing contact tracing already. But it is a challenge at this point because of the number of cases and the time involved in figuring out who you may have been in contact with. The Apple/Google thing is all about making that task easier so it scales while doing their best to protect privacy. Voluntary reporting of illness to the system means it won't be perfect. I imagine people will also be able to disable the feature on their phone, and some will do it. It will have gaps. This isn't about being perfect and eradicating the disease by isolation and quarantine, it is about controlling the spread and keeping the effective R(t) close to 1 or less. Hopefully voluntary works well enough, because the alternative is forced reporting or a more invasive option... plenty of companies already know everywhere you went and they could just mine that data for contact tracing on a non-voluntary basis.

2) public transit is hard. Maintaining social distancing and cleaning while operating is an extreme challenge. Public transit in Texas sucks and a lot of people don't use it. That is helpful in this situation, but others rely on it, and they also tend to be people who can't work from home. Can you reasonably track who gets on/off where so you can do contact tracing without the technology solution? Can you add employees who ride along and disinfect seats as people get on and off? I just don't have a good answer although temperatures may be better than nothing.

3) rapid testing before flights creates a throughput challenge. Yes, the test takes 15 minutes or less, but the machine only does one at a time. You need banks of machines just to screen one flight. Plus the trained staff to properly take a swab. Taking temps may be a more workable but less perfect alternative. Yes, there are asymptomatic carriers who could slip past temp screening, but we are looking to limit spread because we can't eliminate it. Also, taking temps could be done with IR cameras as people walk through security without stopping everyone for a swipe across the forehead or something. People will continue to be wary of flying for a while, and temps creates a bigger false positive issue. I could also see that businessman with the big deal he needs to get to popping a couple Tylenol before going to the airport so he can pass the screening, so there is a false negative there too.

4) opening outdoor spaces is good. Sunlight is a great disinfectant and being outdoors can be good for mental and physical health. People will need to maintain social distancing.

5) positive tests are already reported to health departments (that is how we get the daily counts) and I know the data on ICU bed use and even general bed use is available, just not something that is widely spread to the public. I'm against forced disclosure of identities of infected people, but notifying people they were exposed to someone who was infected is important.

6) basing things on the absolute numbers of tests or as a percent of population doesn't make sense. There are different levels of testing needs at different points on the curve. Keeping the % positives of the conducted tests below some threshold or declining makes sense. You also have to factor in how you change the criteria for who gets tested. If you are getting 10% positives from the people with symptoms one week and the next week you broaden testing criteria to include a lot of asymptomatic people, you would expect the % to drop, it that could mask an increase in the symptomatic cases. So, as we broaden the criteria for testing, we have to at least look at what the results would have been for the subset that fit the prior criteria. Rapid tests are nice, we the longer tests at a large lab are capable of much higher throughput. Reasonable turn around times (2-3 days at most) and availability to test anyone with symptoms and tests for contact tracing would be good to have. Ideally, you could do rapid tests for people presenting symptoms and the 4 hr tests sent off to a lab for contact tracing.

Masks... I view this as similar to the "no liquids over 4 oz" rule on the plane. Maybe it doesn't help all that much, but it will give people confidence to go out. And yes, catch those virus filled droplets of the guy coughing in the store has some benefit, but unless there is a significant % of the population infected in your area, for most of us, the odds of you being close to someone is low, especially if we continue to practice social distancing. By significant I mean ~0.1%-1%.

Companies must take steps to protect employees. Maybe that includes wearing mask. It likely includes keeping track of who came to work each day and depending on the size of the workspace dividing up the space and keep staff in individual zones so one sick person doesn't infect everyone. That spacial division doesn't work for retail, but can in an office/manufacturing setting. For retail maybe you separate the staff by time... this group of employees only works together and never works with that group of employees. Shutting the whole place down because everyone is in quarantine because one person got sick isn't good for business. Also, step up the cleaning and disinfecting.


Better training/education on mask use!!!! It isn't doing much good if you take it off to talk on the phone or it only covers your mouth and not your nose. Same with gloves. Gloves spread germs around by contact just like hands. They need to be changed. And be honest, what is more likely to happen... wash/sanitize your hands or change your gloves.

Reveille said:

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Granitestate said:

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If you where sitting at the table with the taskforce considering how to reopen, what guidance would you give ? For example would you advocate contact tracing? Participation in contract tracing for access to public transit? Rapid test prior to boarding a flight? Opening of public beaches, parks, golf courses? Mandatory reporting of all positive and negative test results? Reporting icu bed occupancy rate? Number of test administered in geographic area, number of positives, and number of negatives? Etc. None of the above? others?

Thank you in advance. Your input has been extremely helpful.

---

I didn't address contact tracing again tonight but I did earlier this week. I think it is a great idea but unfortunately i don't believe enough will participate in the google/apple plan to trace all known positives to make it effective.

Testing before flights is a good idea but boy you are opening up a can of potential problems. People complaining about not being able to fly or threatening litigation over false positive costing them a major deal in another city. As we are now finding out people don't take well to being told no.

Opening of parks, golf courses, beaches are all great ideas and will help the moral of the citizens as depression and anxiety are becoming the next pandemic. I see at least 5 patients a day now with these disorders from losing job, home, savings etc.

COVID-19 is already a reportable disease so all results are reported by the lab.

We have plenty of ICU beds so not really a factor. Currently expected to need 300 and we have 2,259 beds available.

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Mental health is going to be a big problem. It is sad you are seeing so many patients with those issues already, although it is good they are seeking help. It is worse that there will be many more that don't seek help.

We need to continue to push for better mental health care in this country, both from availability and getting people comfortable with seeking help when they need it. Of course, we still have plenty of people who put of physicals healthcare because "that pain isn't that big of a deal".

Today's update!

https://www.facebook.com/1998386763777604/posts/2673430499606557/?sfnsn=mo

Great stuff as always, doc....can't thank you enough for the updates each night!

A finger what?

In October 2019 husband and wife friends of mime had returned from Italy. She is in her 50s. Avid tennis player and in good health. The next day she was sick and admitted to a hospital in Boston. Low grade fever, double pneumonia, kidneys failings, very weak, no sense of taste or smell. Hospital had no idea what they were dealing with. My buddy called and told me what was going on. CDC, DHS, DoS had no travel restrictions posted. I suggested they have her tested for NDM-1 which came back negative. Within a couple of days she felt better and was released. She is doing fine now. Her doc called and asked her to get tested for antibodies which most likely will be negative. I will advise of the results. Fascinating stuff.

Today's update!

https://www.facebook.com/1998386763777604/posts/2674299759519631/?sfnsn=mo

Thanks again Doc for taking time out of your busy schedule each day to post updates!

Aggie4 said:

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my daughter returned from a trip from China mid January, and 6 days later my wife came down with fever that escalated during the night to the point she was drenched wet and she had respiratory issues( hard time breathing). She tested negative for the flu and was never tested for Covid. The doctor treated her with steroid shot and an inhaler thinking it was Bronchitis. This lasted 6 days and she was not getting better, so she went to a medical SPA and got an IV consisting of Vitamins but mostly Vit C and Zinc..also got a COQ10 shot. She was almost 100% that night and well the next day.

This past Saturday we went to Arcpoint Labs to get the antibody test, which they receive from Shanghai, and our test were negative.

I'm assuming those test have a high percentage of inaccuracy, so maybe it was a false negative. Is there a better test out there?

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There are a lot of things that cause respiratory illness. Typically, during flu season we see about 10% positive cases early in flu season, peaking at about 30-40% positives at the peak and then falling back down to 10% by the end and then we stop testing for the flu. So, your wife could have had something else. A typical respiratory illness panel test for about 20 viruses in addition to several bacteria and a fungus. Those are rarely run for your everyday go home and take tamiflu case and mostly only done when you are admitted to the hospital.

Also, the rapid flu test that you get while you wait in the Doc's office is generally terrible at false negatives. Generally it is about 50% of the negatives are false, but in some situations it can be as high as 90% of negatives are false, so she could have had a the flu and the test provided a false negative.

As for antibody tests from China, there have been some major problems with those. A lot of unscrupulous types in China selling fraudulent tests, which is pretty much par for the course for China anyway. Stories of counterfeit pharma and biological material from China would be a whole new thread. I'm sure there are some legit tests from China, but it is hard to tell what is a good test and what is a bad test just knowing it is from China.

Today's update!

https://www.facebook.com/1998386763777604/posts/2675162356100038/?sfnsn=mo