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Archive for the ‘COVID-19 virus updates’ Category

AP

Asbury Park. Boardwalk shut, but beaches still open, however practice distancing. This Paul Goldfinger photo is not recent but may be predictive when NJ case numbers get worse in April. ©

 

Paul Goldfinger MD.   Blogfinger.net

a.  Projections from Rutgers suggest a 60,000 bed shortage in April in NJ. They say that it could worsen without “strict” distancing.  Interestingly they mention “a moderate level of distancing” which can make matters worse. We have to be “strict” and many engage in compromises.

I have seen that in action where people make exceptions to the grouping rules and the distance rules of 6 feet, or certainly nothing less than 4 feet, but that is a compromise.

If you get too close, you could get infected droplets in your mouth, nose or eyes due to sneezing and coughing, but also from hands touching live drops and then touching your face, and even from someone with the virus just breathing on you at close range.

b. As of today in NJ  6,876 cases and 81 dead.   The startling thing about these deaths is that they can evolve very quickly from what presents as a minor problem, and the mechanism is not only life threatening respiratory insufficiency, but also unexpected cardiac arrest.

c. The NJ Governor is hoping that banks will allow reprieves for mortgage payments, eg 90 days. In New York, Gov. Cuomo has already mandated that.

d.  The second home issue is still alive.  This is from the APP:

“Many permanent residents (and a few mayors) are urging second home owners to stay away. Never mind if they stock their car before they leave and agree to follow all the virus guidelines once they arrive. The second homeowners argued that this was still a free country and they had a right to use their homes — and they pay a lot of taxes all year round. Some locals defended them.”

This is a debate worth having because it is about freedoms that may be stifled during Corona, and the issues can trigger fundamental disagreements about our liberties.

 

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Paul Goldfinger,  Editor@Blogfinger. net

Ft. Myers, Fla.    3/22/20.

I stopped by Publix at 7:50 AM this morning hoping to dash inside, while keeping 10 foot distances, to get some paper toweling and, if I were really lucky, some toilet paper.   I’m not one of those people who are filling up their closets with toilet paper, but to grab a few more rolls while I’m in the neighborhood…You know, the Europeans have long called Americans barbarians for using toilet paper instead of bidets, but that would bi another story.

But I found a line of people outside, dutifully standing 10 feet apart while chatting amiably. So, I thought, “What the heck” and I got on line. Then the door opened, and the line surged forward, and once inside the doors of the lobby, the line collapsed into people close together.  The ranks quickly broke as people claimed a cart.

The guy in front of me began to swiftly wipe off his cart handle with a wipe.  Then he turned to me and offered to wipe my handle.  (How can I describe this any better?).  So he did and we moved forward.  I  stayed behind him.  I could hear an employee at the front of the line offering one bottle of hand sanitizer to each person, but when I got there, about 2 minutes after arrival, they were all gone.

As I entered the store I thought I would follow the people to paper goods, but they all scattered in different directions.   As I headed in the paper goods direction, I noticed that nobody had toilet paper or paper towels in their carts.  Then I got to the aisle and found out that those shelves were empty.

So I grabbed a pack of (substandard) everything bagels and went to checkout thinking, “I just exposed myself to Corona and all I got were 6 bagels…what a deal!” The checkout lady told me to get on line again tomorrow, but come earlier.  I’m thinking, “No way!”

I went back to my car and rubbed some of Eileen’s famous homemade hand sanitizer on my hands and then drove to Walgreen’s to pick up a prescription. There was one car in the lot—excellent! …and as I got out, the window rolled down and a woman said, “They don’t open till 10.”  Oh!   So I went home to continue my isolation.

It turns out that the use of toilet paper has not increased in America since the virus hit.   It’s just the hoarding that’s the problem. The paper industry is increasing its output.  According to the NY Times, sewer lines across the country are becoming blocked due to flushing of paper towels and disinfectant wipes.  And, I am told, even “flushable” tush wipes can be problematic..

And,if you think you can get this stuff, including hand sanitizers, on line, you won’t have much success.  You might be able to order items in short supply, but with delivery in April.

And the Times also reports that Fed Ex, UPS and other large delivery services are being challenged by sicknesses among their employees all the while the demand for online deliveries is exploding.  Maybe those fast deliveries will be challenged.

Also, there are new categories emerging of hard to get items including bottled water.

Another side effect is when your spouse spends a good part of her isolation time reading God knows what on her phone.

There is a new and important source of Corona information for New Jerseyans:    COVID19.NJ.GOV/

We might also note that the demand for news and the multiplication of news sources is extraordinary, but it can also make you crazy figuring out what to pay attention to.

Stay tuned to Blogfinger for all the news that’s not fit to print, but is OK on the Internet.

 

 

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The COVID-19 virus as seen by an NIH electron microscope. Its reality is deceptively almost beautiful.

 

How many would deny the invisible terror of COVID-19 and rent a room here or anywhere else? This is Ft. Myers, Fla. 3/20/20.

By Paul Goldfinger, MD

 

As long as man has had religion, there have been debates about whether there is a god. And that debate has always revolved around whether one can believe in something that cannot be seen.  In ancient times the weather or fate or life itself was, for some, indirect evidence of a god.  But not everyone accepted that argument.

In modern times we have no problem accepting the invisible reality of a child’s voice materializing in a cell phone, or the ability to watch a video on our phone or computer or TV.  We can turn on a light without seeing electricity.  And we can watch a live press conference from the Oval Office thanks to the invisible Wi-Fi.

The COVID-19 virus cannot be seen with the naked eye, but it is quite vivid under the gaze of an electron microscope.  But does everyone agree that this terror, invisible to the naked eye, actually exists?

Now we have an epidemic–a situation where an invisible force can terrorize us, make us sick, ruin our lives or even kill us.

But the concept of an invisible terror is not new.  All of us have known since childhood that if we have a cold, we shouldn’t cough in someone’s face. During the Black Plague, no one knew about microorganisms, but we came to accept the invisible germ concept when vaccinations stopped polio and smallpox.

Yet, despite thousands of deaths already from this world-wide epidemic, there are some who cannot believe what they cannot see. Yesterday, on the news, we heard some interviews with college kids on spring break.  They were not going to deny the promised pleasures of spring break “partying.”   One said, “We have been planning this trip to Miami for months, so we are not going home.”  This college student is denying the existence of the invisible threat that threatens her life and many people around her.

And there is a rising risk of this virus among the young who have been thought of being at low risk.

That is why government, to some extent, has to force or strongly urge public health principles on all of us, despite our traditional American value of liberty.    In China, they sent the army to Wuhan and shut down the entire city, and if you didn’t accept their mandates, then you would pay a very tangible price.

For the most part we don’t force people to accept the latest invisible terror restrictions, but in some places, for example in California ‘s Orange County or Colorado, the law has forcibly isolated some towns.  Telluride, a famous Colorado ski resort, now has mandatory closing of all ski facilities and all restaurants.  So, in a growing number of places, whether you can see the virus or not, you will be told what to do for the sake of everyone’s safety.  And public pressure at the local level is another means of urging cooperation.

In America we object to public health laws that might be enforced by police or military (martial law) and that would have to be a last resort.

Some people think that the fuss is just contrived intimidation created by the media*, but the evidence of this incredibly real and life threatening invisible terror is confirmed by highly reputable sources such as the National Institutes of Health, the CDC (Communicable Disease Center) and the World Health Organization.

But more than kids on Spring Break, there are many folks who, at some level, do not believe in the risk.  They make jokes, go wherever they like, and rub shoulders with groups of friends or relatives. It seems that there is a level of disbelief on the part of many.

Where I am in Florida, a senior community of about 500 small homes, a meeting of the Co-op was called for about 100 people to be held in a smallish community room.  They said that anyone who has health issues should not attend, but everyone else could come.   I publicly called them out on their Facebook page saying that having that meeting was a “mistake” and threatened those in attendance. I even put my MD after my name.

I was pilloried on that page by many citizens  for being critical of management while only one person thanked me for the health information.

I’m afraid that the invisible terror is still misunderstood by many.  A few days later, somehow, people began to wake up, and now you can see very few even taking a walk or riding a bike.  It’s like a ghost town.

The invisible terror is opposed only when everyone does what the public health experts are recommending, and those recommendations may very well become even more stringent and uniform across the country.

We can be somewhat reassured by recalling one tangible victory over invisible terrors when we look at the HIV  (viral) epidemic.  In the beginning those who acquired HIV stood a large chance of evolving into full blown AIDS, a fatal disease.   Now, being positive for HIV can be compatible with a normal life and little risk of AIDS and transmission thanks to new medications which have turned HIV into a chronic condition, with the invisible terror suppressed by modern science, and most of the credit goes to American genius.

* See comment #3 below for some additional information about a possible “media hoax.”

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Florida farmers market. Vendors have cancelled, and shoppers are few. Most are buying produce and practicing social distancing. Paul Goldfinger photo. ©. March 20, 2020. Click to enlarge.

 

Today’s NY Times describes a young lawyer who got a “cold” and then quickly evolved into being in an ICU, in isolation, and on a ventilator.  His COVID test was positive.  His family has no clear idea as to how he acquired the infection. His wife and child are OK.

I have seen only one person wearing a mask here. (Ft. Myers, Florida southwest). Is this person trying to avoid infection, or is she ill and doesn’t want to spread the virus?

CDC says, “If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.”

If the woman above is sick, she should not be out and about.

And  when should individuals be tested?  This issue has not been settled even as tests become more available. And opinions vary around the world.   In the case of the ICU lawyer, his wife and child have not been tested.

Scientists would like to test everybody in order to follow the progress of the epidemic, but that is not possible. It’s not even possible now to test everyone with mild viral type symptoms or everyone who is vulnerable.  Very ill patients do get tested.

The CDC provides the information below, and even they say that there is “more to learn about the virus transmission.”

We have been wondering about the effectiveness of the NPI’s (non-pharmacologic interventions) which refers to all the social spacing, self isolation, public policies of closing stores, beaches, schools, etc. which we are currently implementing.

Can we hope that this will be totally effective;  well it can’t.   We know that from the 1918-19 horrible influenza pandemic.  And epidemiologists who are now looking at the COVID-19 pandemic say that many will still get infected despite our best efforts with NPI’s.

That is why the pharmaceutical industry is working frantically with the government to come up with some anti-viral drugs that might slow this all down.  A vaccine won’t be ready for a long while.

We have been trying to keep up with all the information, but that would be a full time job, and a depressing and anxiety provoking one at that.

So we will try to highlight bits and pieces and concepts on a daily basis with no pretense that we are doing a comprehensive job.

Instead you might think of us as a sort of beacon shining a small light here and there in the middle of a stormy sea.

 

Blogfinger update:  March 20, 2020.  Paul Goldfinger, MD

Source CDC: 

“COVID-19 is an emerging disease and there is more to learn about its transmission, severity, and how it will take shape in the United State. Everyone can do their part to help plan, prepare, and respond to this emerging public health threat.

  • People are thought to be most contagious when they are most symptomatic (the sickest).
  • Some spread might be possible before people show symptoms; there have been reports of this occurring with this new corona virus, but this is not thought to be the main way the virus spreads.

“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

“How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, spreading continually without stopping.

“The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.

“Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

“Different parts of the country are seeing different levels of COVID-19 activity. The United States nationally is currently in the initiation phases, but states where community spread is occurring are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response.

  • CDC and state and local public health laboratories are testing for the virus that causes COVID-19.
  • More and more states are reporting cases of COVID-19 to CDC.
  • U.S. COVID-19 cases include:
    • Imported cases in travelers
    • Cases among close contacts of a known case
    • Community-acquired cases where the source of the infection is unknown.
  • Three U.S. states are experiencing sustained community spread.

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I know that you all are obtaining plenty of information on this topic.  Here are some perhaps less well known items received from the AMA and from NJ Patch reports:

a.  Blood drives have been curtailed around the country, so there will likely be a blood shortage developing.

b.  If the virus hits full force, there will be bed shortages even if other conditions are not admitted.  Elective surgeries are being cancelled now.    A closed hospital (300 beds) in Camden will be reopened, and a Navy ship will sail into New York City to be turned into a hospital for COVID-19  patients.  Maybe the closed Dover General Hospital will reopen in Morris County.

c. There will be a worrisome respirator shortage.   Respirators are the machines which are hooked up to endotracheal tubes to help victims breathe.  Manufacturers here and abroad cannot make them fast enough. In some instances, decisions may have to be made as to who lives and who dies.

d. Telemedicine, the technology that lets patients engage with their doctors without going to a healthcare facility, will be expanded for Medicare patients.

e.  New Jersey has 427 cases  of COVID-19  so far. 8 have been in Monmouth County. 5 NJ deaths so far.    In the US there has been 4000 cases and 90 deaths.  Overall, of the deaths, 85% were over age 60.  Self testing will soon be a reality.

f.  Schools will likely be shut down all over the country with no plans to reopen for this school year. Any school system that doesn’t comply will be at risk of litigation.

g. There is a small chance of catching the virus from food. Take-out services from restaurants will grow fast.  Have the delivery left at your door and work something out for tipping.

h. As far as social distancing is concerned, the CDC says to avoid close contact and stay at least 6 feet away from others. Reducing human to human contact is the key element in prevention.

i.  From Tap into East Brunswick:

EAST BRUNSWICK, NJ – East Brunswick Mayor Brad Cohen is joined by his fellow doctor-mayor Phillip Kramer of Franklin Township in entreating Governor Phillip Murphy to order a statewide closure of daycare centers for children and adults and to place all of New Jersey on lockdown for the next two weeks to “flatten the curve” in the spread of COVID-19. Cohen also notes that the current closures in East Brunswick exceed those required by the State of New Jersey.

j. News today says that the testing scenario is chaotic across the country due mainly to lack of test components.  But here’s the problem:  No clear guidelines have been issued as to who should be tested.

For example:  A couple live together and are staying home  and keeping their distance from all humans. They go out briefly to get some food.   They are 70 years old and they come down with a “cold” with cough, runny nose, sneezing and low grade fever.

Some say that they should be tested, but why?  They are quarantining themselves, and if the test were done and were positive, what would change?   Nothing!   So why test?

–Paul Goldfinger, MD

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