harrierdoc said:

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Something to think about -

if all of this "social distancing" was really important, where would you think the very first area should be to implement this? Think of a location that people are in close quarters, don't practice hygiene very well, and the population isn't isolated, like in boot camp...

K-12 schools.

Sure, these kids may not get really sick from this, like the majority of us, but they are going back home to their families, many with pregnant mothers, or going to see grandparents or other family members.

If we, as a society, were serious about this, we would stop all schools. But, can you imagine the outcry from the people that have to have their kids in school for work? What about money for the school districts? I guess you could just close schools now for a month or 2, then go to school over summer. More outcry.

So, the fact that our leaders aren't willing to do this simple step tells me that all this hand ringing is nothing more than fear and legal posturing, rather than good population medicine.

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As communities across the country begin to see confirmed cases, you will see exactly that: more and more closed schools.

My discussions with my family have been that I think it is likely that both of our kids' schools will be closed within the next month, and we don't even have a confirmed case in our county yet. But that's where things are headed IMO.

DTP02 said:

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aggierogue said:

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Also don't understand why the CDC says "CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19."

They clearly don't fully understand how it's transmitted, but they advise against wearing a mask. Why? Seems like there's only an upside, and no downside.

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A big part of them saying that is to prevent a shortage of masks for people who really need it, such as people who are sick (to help prevent spreading) and people who work in healthcare and are constantly exposed.

The other part is that studies have shown that having a mask on your face can increase the number of times you touch your face and have the undesired impact of making it more likely that you are bringing the virus closer to your mouth and eyes. The gain in wearing a mask that might catch some airborne droplets would thus by offset by the increased risk of additional touches to your face to adjust the mask, subconsciously scratch at the elastic, etc.

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If one or both of those is true, they should explain it imo, so people have enough information to make their own decisions.

Thank you for the thread, doc. Great information and service for the community.

I have a couple of bits of information I've been unable to find. Perhaps you might be able to give so e insight.

1. The average rate of hospitalization for symptomatic patients under 60.

2. The average length of hospitalization for patients who develop serious or critical illness.

God Bless and stay strong.

I am pretty sure it was some Harvard Dr that talked about that Princess? cruise ship that was quarantined.

His claim was that ship was the best testing environment so far. Those people were stuck in there with people who had the virus and they know only one person brought it on. I don't think he talked about the ability to spread specifically, but if it was airborne, wouldn't practically everyone on that ship gotten the virus? Or at least one section (maybe they did).

Harkrider 93 said:

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I am pretty sure it was some Harvard Dr that talked about that Princess? cruise ship that was quarantined.

His claim was that ship was the best testing environment so far. Those people were stuck in there with people who had the virus and they know only one person brought it on. I don't think he talked about the ability to spread specifically, but if it was airborne, wouldn't practically everyone on that ship gotten the virus? Or at least one section (maybe they did).

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He did. I quoted him. He specifically said the transmission is remarkable from sharing air with others in a room.

aggierogue said:

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DTP02 said:

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aggierogue said:

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Also don't understand why the CDC says "CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19."

They clearly don't fully understand how it's transmitted, but they advise against wearing a mask. Why? Seems like there's only an upside, and no downside.

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A big part of them saying that is to prevent a shortage of masks for people who really need it, such as people who are sick (to help prevent spreading) and people who work in healthcare and are constantly exposed.

The other part is that studies have shown that having a mask on your face can increase the number of times you touch your face and have the undesired impact of making it more likely that you are bringing the virus closer to your mouth and eyes. The gain in wearing a mask that might catch some airborne droplets would thus by offset by the increased risk of additional touches to your face to adjust the mask, subconsciously scratch at the elastic, etc.

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If one or both of those is true, they should explain it imo, so people have enough information to make their own decisions.

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It is true. It is also true that masks can serve as a fomite...

(noun: fomite - objects or materials which are likely to carry infection, such as clothes, utensils, and furniture.)

especially if used repetitively and handled incorrectly. They may help reduce risk somewhat (although data on this is lacking) when used correctly, but used inappropriately they may actually increase risk of disease transmission.

yes, they will wait 2 months until school is almost out anyway.

no big decision to be made there. If the science suggested that we were at a major risk, and social distancing was indeed helpful, then we should do this NOW. But, no way it will ever happen.

Norton_12 said:

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Best Resource I've found so far to clear things up.
Joe Rogan Experience w/ Infectious Disease Epidemiology Expert

This Podcast has featured big time guests.

They start Corona, talk a little about other infectious diseases and come back around at the end.

BIo: Michael Osterholm is an internationally recognized expert in infectious disease epidemiology. He is Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, a professor in the Technological Leadership Institute, College of Science and Engineering, and an adjunct professor in the Medical School, all at the University of Minnesota.

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I saw that two days ago...very good interview. Rogan actually has some good interviews, which surprised me. I am not a huge fan of his but he has good guests. This interview is long but the beginning is pretty informative for those that don't want to watch the whole thing

harrierdoc said:

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yes, they will wait 2 months until school is almost out anyway.

no big decision to be made there. If the science suggested that we were at a major risk, and social distancing was indeed helpful, then we should do this NOW. But, no way it will ever happen.

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I think you're looking at this wrong.

Much more likely that they will wait until it hits their local community and then cancel school. That's going to play out all across the country.

This thing impacts us locally and is best dealt with locally based on the local conditions at the time. What going on in Seattle is very different right now than what's going on in small town Kansas.

Hey Dr. Rev,

I have a question about the mortality rate of COVID-19 and the Flu. Both are bad for the elderly and those with underlying medical conditions, but which one is more deadly for those that are considered at high risk? I know the normal Flu has kills tens of thousands of people per year. But there has only been a couple thousand deaths world wide out of maybe 120,000 total cases. I just have a hard time seeing this being deadlier than the normal flu. I understand that it is 10-15x more infectious than the flu and if it gets out of hand, it could create a real problem. I'm no expert by any means, I'm just a dude trying to wrap my head around this.

I am 25 and have crohns and psoriatic arthritis. Am I supposed to stop taking my suppressants?

Kydero said:

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Why was the swine flu, which also was a pandemic, not treated as seriously as Covid-19?

Universities didn't close, athletic events weren't cancelled.

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Probably has to due with the long incubation period. Period are contagious even though they dont know they are sick for alot longer than most other things. This is the source of the scare to me.

bh93 said:

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"Chest CT?" On a pregnant pt? Umm is that medically necessary?

That's ~7 mSv vs .1 mSv for a chest x-ray.

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It's a risk/benefit calculation any time imaging is performed on pregnant patients. The potentially deleterious effects on the fetus are largely restricted to the first trimester, which is also when the patient can easily be shielded for the exam. This is not even an issue in an immediately life-threatening situation.

Quote:

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But there has only been a couple thousand deaths world wide out of maybe 120,000 total cases.

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4,700 deaths with 128,000 cases.... this thing isn't even warmed up yet.

doctorAg13 said:

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bh93 said:

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"Chest CT?" On a pregnant pt? Umm is that medically necessary?

That's ~7 mSv vs .1 mSv for a chest x-ray.

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It's a risk/benefit calculation any time imaging is performed on pregnant patients. The potentially deleterious effects on the fetus are largely restricted to the first trimester, which is also when the patient can easily be shielded for the exam. This is not even an issue in an immediately life-threatening situation.

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It just seems overkill with the CT when the recommended max dose is 1 mSv over the term of the pregnancy and shielding is essentially pointless due to the vast amount of radiation the fetus receives is due to the scatter inside the mother.

It was one part that caught my attention and curiosity. Always ask questions.


Thank you for your response.

But once it is in the community, given the variable presentation, you've waited too long to keep people separated.

We are a social animal. We will always find ways to get together. I don't think there is any way to really affect this, or any other viral pathogen that is in the community. I think it's better to try to come up with a vaccine, and just let the virus spread through the population until then. Otherwise, we are just trying to put a small band-aid on a huge laceration.

Teens and college kids aren't going to stop hooking up and swapping bodily fluids because they may get a cold. Heck, they do it knowing they can get STD's that can affect them for life.

I am 46 years old. I take an immunosuppressant called remicade every 10 weeks for my ulcerative colitis. Been in Remission for 12-13 years. Last injection was early February. I'm also in great shape and train extremely hard mostly with barbells and I weigh about 214, low body fat (humble brag). I get that I'm "at risk" and I handle all things I have been doing for years that way. Wash hands, don't share food, avoid hands to face etc.

Given my level of physical fitness, do I still count as "at risk" and what is your advice on how to proceed, if anything? I currently am the head trainer at a local gym as well. So avoiding the gym is not an option b/c of work. Oh and the gains. Gotta make my gains.

harrierdoc said:

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But once it is in the community, given the variable presentation, you've waited too long to keep people separated.

We are a social animal. We will always find ways to get together. I don't think there is any way to really affect this, or any other viral pathogen that is in the community. I think it's better to try to come up with a vaccine, and just let the virus spread through the population until then. Otherwise, we are just trying to put a small band-aid on a huge laceration.

Teens and college kids aren't going to stop hooking up and swapping bodily fluids because they may get a cold. Heck, they do it knowing they can get STD's that can affect them for life.

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The goal isn't to prevent the virus from spreading. That'd be nice, in theory, but isn't realistic. The virus is going to spread and it's almost certainly going to hit just about every community and a huge chunk of the world's population is going to be infected at some point.

The goal is to slow down the spread by taking judicious measures, so that the healthcare system doesn't get overwhelmed to the point that mortality increases due to the inability to treat all the seriously ill patients.

The question is where do the local officials draw the line on what is a judicious measure. To me, they should plan and then act only after it's hit their community. That's the balance between acting too soon, and thus likely accomplishing only prolonging the economic hardship, and acting too late and risking overloading healthcare.

An exception to this philosophy is that preemptive action should be used for high-risk places like nursing homes.

But that's the local government response (which is more important to each of us than the fed government response, although people only talk about the feds). We all need to do our own part by practicing good hygiene in terms of hand washing, coughing, and being aware of what surfaces we touch.

Reveille said:

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As for vaccine one has been developed right here in Texas already. It is currently being tested on dogs, but as to when it will be available to the general public who knows. It will have to be proven to be effective and safe in dogs. After that they will start human testing. All of these things take time and it is anyone's guess as to when it will be done. Normally this is a 5+ year process. Trump wants it done within 18 months which sounded extremely optimistic at the time. But now, I suspect everything will be expedited and it could be available in a little of over a year. Maybe even sooner because the usual liberal roadblocks are not being vocal about stopping it right now.

There are also at least 8 other companies working on vaccines that I know of probably way more than that. All of these are racing to get a working vaccine to the world as soon as possible.

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I don't understand this. If the virus is so bad that we have to shut down society I would think there would be a way to fast track this vaccine. 18 months seems like a long time.

Also, if our health care system is so broken that getting a large number of people sick at once will break it then I get it, do what has to be done to flatten the curve. Then, once we get past the crisis fix the damn system so that we are prepared for the next pandemic. As bad as this one is, it could be so much worse, we need to be prepared for a true worst case pandemic.

Just wanted to clarify that I am not directing this at Reveille. I appreciate you taking the time to provide information, just frustrated that the wealthiest, most scientifically capable country in the world seems so ill-prepared to deal with an issue that everyone knew would eventually happen and that could have been much worse.

Is there any data on smokers and this virus? I know china's population are massive smokers. I wonder if there is any correlation. Id assume there are risk factors here. Anyone know if Italy is a big smoking community?

maroonbeansnrice said:

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26 of the total 39 deaths at present in the USA were at a nursing home on the west coast. Will we ever find out what happened there? Very strange. I'm guessing the patients had private or semi-private rooms. Even if they have communal areas it seems; the facility would have to be severely under-staffed (a sick employee(s) would almost have to go to every room coughing/sneezing on each and every patient), and/or have some kind of extremely unsanitary practice for this to have spread as rapidly and thoroughly as it did.

It seems like what happened there would be extremely important information to have as it pertains to the spread of this virus.

What are your thoughts on this?

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There are many scenarios in nursing homes that could facilitate the spread of a virus very quickly. Gatherings for movies, common meal times, or other social events that are regular occurrences in those places could have provided an easy path to expose many people at once. Alternatively it could have been an employee with a job that brought them room to room to check on people, empty trash, deliver meds, etc..

We know that this virus likely spreads via respiratory droplets. Formation of those aren't restricted to just coughing and sneezing. People expel them through normal breathing, talking, laughing, etc.. So any social caretaker that was making the rounds could have systematically exposed many people in a short time.

One of the major issues in containing this virus is that many people have asymptomatic or relatively mild symptoms, and may not even realize they're sick. So it's likely the source of the exposure at these places never knew they were contagious.

Yukon Cornelius said:

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Is there any data on smokers and this virus? I know china's population are massive smokers. I wonder if there is any correlation. Id assume there are risk factors here. Anyone know if Italy is a big smoking community?

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The only anecdotal pieces of evidence I've seen are that the death rate in China is much higher among males, and smoking is much more prevalent among males. Doesn't mean smoking explains the difference in death rate completely, but it's likely a factor since this is primarily a respiratory disease.