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Posts Tagged ‘Covid epidemic’

This graphic is from McGill U. in Canada. 2 meters is 6.5 feet.

 

By Paul Goldfinger, MD.  Edior@Blogfinger.net

Everyday there are more and more sources of information about the epidemic including those that are not medical.  I have heard from my cousin Bobby–a realtor,  Bed, Bath, and Beyond; a political news source, and a local Assemblywoman.  Of course, there are many expert sources as well such as Cornell Medical School, American Medical Association, CDC, etc.

But some doctors may not be helpful such as a group of doctors at the University of Washington who are predicting  numbers of Corona deaths. That is not science, and such information should be reserved for the health authorities and not the public.

Ideally, all public information should be evidence based, but as you know, for example, doctors are using an antimalarial drug to treat serious Corona cases without having any controlled trials.

They argue that these are desperate times and we can’t wait for those studies.  When Dr. Anthony Fauci, the NIH face of expertise in D.C., was asked by a reporter if he would take that or other unproven drugs if he were infected, he replied that he would only consider an unapproved COVID-19 drug if it were part of a scientific controlled trial.

It is tempting to repeat something you hear, but I suggest you pay attention only to authoritative sources such as CDC.gov.

Today we have some powerful quotes from healthcare professionals courtesy of the McGill Office for Science and Society in Montreal.  Thank you to them for these samples:

 An ER doctor in Montreal:   “Please disseminate this message to everyone that you know: to those young and old and those in-between that are underestimating the gravity of this situation. This is NOT the time to hang out, to chill and to party together because then it is YOU that is propagating the rapid spread of this potentially deadly virus. The death of MANY will then be on YOUR shoulders. And why? Because you couldn’t just stay on your damn couch.”    (This doctor took some needed time outdoors to ride bikes with her family when she discovered many “clusters” of people disobeying the 2 meter rule.  (2 meters is 6.5 feet)

A Harvard gastroenterologist:  “I am always trying to find a positive spin on everything and I am optimistic that this will change healthcare forever for the better. Performing telephone interviews with patients or video virtual encounters are helping keep us to communicate with patients and prevent them from feeling abandoned. The overwhelmingly positive response from the patients is making the continued work worthwhile.”

From a scientist from the National Research Council  discussing vaccines:

“In conclusion, there are several steps involved in developing a vaccine before the final step of testing, which is clearly the most critical part of the process. Health practitioners need not only ensure efficacy, but also safety. In addition to general safety considerations, vaccines against a virus have an additional complication. Unfortunately, instead of blocking, some virus-specific antibodies can enhance the entry of the virus, and in some cases the replication of the virus. These can therefore enhance rather than limit the infection and must be eliminated.

“Therefore, yes it may seem that it is taking forever to get a vaccine, but considering all that needs to be done, and done successfully, a year or so is really not that long.”

Dentist in Montreal:  “Dentistry and physical distancing are mutually exclusive. We get very up close and personal with patients as we are literally working inside of mouths. Unlike many other occupations, ours cannot be performed remotely. It is imperative to treat emergencies in the safest possible conditions so as not to endanger the health of patients and caregivers. Of particular concern are treatments in which bio-aerosols are produced, namely when employing handpieces, air-water syringes, and ultrasonic cleaners.”

(PG: My NJ dentist first said “only emergencies” and then said, “We are totally closed.”  Not every dental office is equipped to work on patients with Covid-19 or threats of infection. If you have a dental emergency, call your local health authorities for a referral.)

Pennsylvania internist who takes care of Corona cases:  “…but certain procedures or processes can increase the risk of aerosolizing infectious particles that aren’t filtered by a simple mask. Examples include during intubation, or even when the patient is on noninvasive ventilators.

“The general population who are not in direct and close contact with COVID-19 patients definitely do not need a respirator mask such as the N95 in the US.  So if you happen to have stocked up on some, consider donating them to your local hospital. We are running short.”

(PG:   This doctor sometimes wears regular masks for “regular patients,”  but for the COVID cases she uses a respiratory N-95 mask and she wears the same mask for 8-12 hours. This is probably OK, but supplies of masks are still short. She also doesn’t wear those space suits that you see on TV.  She wears a gown, shoe covers, gloves, hat and appropriate mask. She volunteered to be the Corona doctor for the 12 cases in her hospital.)

This doctor and so many of them like her are so brave.   And their exposure creates  potential risk for their families. They need to be appreciated by all of us.

 

 

 

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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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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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