COVID-19

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lpm
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Re: Wuhan Coronavirus

Post by lpm » Tue Feb 04, 2020 12:51 pm

How far does oxygen, paracetamol and a drip take you?

In other words, how many people with flu/pneumonia/coronavirus are saved if there's zero medical treatment other than basic stuff a nurse can deliver?

In a pandemic, due to lack of resources and incompetent government a lot of countries will only be able to do the basics. I'm thinking of the UK here. I would hope Johnson & Co could ensure enough oxygen gets to patients in a pandemic, but anything beyond that would be a stretch.
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Re: Wuhan Coronavirus

Post by Brightonian » Tue Feb 04, 2020 1:50 pm

Does this graph (via Wikipedia) indicating that the number of cases is tailing off, or is it too early to say?
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Re: Wuhan Coronavirus

Post by bob sterman » Tue Feb 04, 2020 1:57 pm

lpm wrote:
Tue Feb 04, 2020 12:51 pm
How far does oxygen, paracetamol and a drip take you?

In other words, how many people with flu/pneumonia/coronavirus are saved if there's zero medical treatment other than basic stuff a nurse can deliver?

In a pandemic, due to lack of resources and incompetent government a lot of countries will only be able to do the basics. I'm thinking of the UK here. I would hope Johnson & Co could ensure enough oxygen gets to patients in a pandemic, but anything beyond that would be a stretch.
Quick question - regarding oxygen - for anyone with hospital knowledge. In most hospitals these days oxygen is centrally piped to a fixed number of outlets. Portable cylinders are used a bit but not in large numbers.

So, in the UK, if we wanted to treated large numbers of patients outside of existing wards - would sufficient portable cylinders even exist now?

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Re: Wuhan Coronavirus

Post by Woodchopper » Tue Feb 04, 2020 2:16 pm

In addition to bottled gas, there are also portable oxygen concentrators which take in air, remove some of the nitrogen, and deliver an oxygen rich mixture to the patient via a mask. At least they don't need to be refilled.

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Re: Wuhan Coronavirus

Post by Nero » Tue Feb 04, 2020 2:42 pm


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Re: Wuhan Coronavirus

Post by Gfamily » Tue Feb 04, 2020 3:54 pm

Woodchopper wrote:
Tue Feb 04, 2020 2:16 pm
In addition to bottled gas, there are also portable oxygen concentrators which take in air, remove some of the nitrogen, and deliver an oxygen rich mixture to the patient via a mask. At least they don't need to be refilled.
Dad had one of those for his last year or so with lung cancer.

For those interested in the process:
It pumps air at high pressure into a chamber containing zeolite, which adsorbs Oxygen molecules. The pressure is then released and a third stage at lower pressure releases the molecules from the zeolite, which allows the user to get an enriched O2 content.
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Re: Wuhan Coronavirus

Post by mikeh » Tue Feb 04, 2020 4:41 pm

lpm wrote:
Tue Feb 04, 2020 12:51 pm
How far does oxygen, paracetamol and a drip take you?

In other words, how many people with flu/pneumonia/coronavirus are saved if there's zero medical treatment other than basic stuff a nurse can deliver?

In a pandemic, due to lack of resources and incompetent government a lot of countries will only be able to do the basics. I'm thinking of the UK here. I would hope Johnson & Co could ensure enough oxygen gets to patients in a pandemic, but anything beyond that would be a stretch.
Not sure there'll be any particularly good data to support any hypothesis but some initial thoughts whilst I am bored on a train.
Not the UK but looking at community pneumonia and data from this report.
- Suggests that mortality rate from (all causes of) community-acquired pneumonia in Africa varies massively from 1-50%. In most of these cases, I'd guess a doctor would not be easily accessible - either none at all, or in a hospital that is poorly-resourced and there's a small number of massively stressed medics trying to look after far too many people.
- hospitalised pneumonia cases have mortality rate of 7% (which is actually similar to high-income countries)
- this will include a lot of bacterial pneumonias, which seem to have a higher mortality
- but, turns out a lot of what we thought were bacterial pneumonias are in fact viral pneumonia, with more RSV (respiratory syncytial virus) cases that we thought, so suggest these numbers here are reasonably yardsticks at least to start with
- current death rate is approx 2-3% coronavirus, almost all of them in China, a high-income well-resourced country but one where health facilities in some areas are going to be stretched to the limit right now.

And so, if anyone wants to apply some pragmatic guesswork, thinking about current death rate of coronavirus and the deaths mostly but not exclusively being in people who are more likely to present with a severe pneumonia, and in the absence of doctors and clever machines that go bing - then your starter for ten, take it over from here.

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Re: Wuhan Coronavirus

Post by nefibach » Tue Feb 04, 2020 5:46 pm

Woodchopper wrote:
Tue Feb 04, 2020 2:16 pm
In addition to bottled gas, there are also portable oxygen concentrators which take in air, remove some of the nitrogen, and deliver an oxygen rich mixture to the patient via a mask. At least they don't need to be refilled.
This is actually really useful information for me, for reasons entirely unrelated to this thread. Thank you.

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Re: Wuhan Coronavirus

Post by nefibach » Tue Feb 04, 2020 5:48 pm

Stat News goes through a couple of possible scenarios for how this might play out. Tl;dr is that it either turns into something like the common cold, or something more like seasonal flu. Take your pick.

https://www.statnews.com/2020/02/04/two ... contained/

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Re: Wuhan Coronavirus

Post by AMS » Tue Feb 04, 2020 9:45 pm

Stephanie wrote:
Tue Feb 04, 2020 9:02 am
A twitter thread summarising the preprints on biorxiv about Coronavirus https://twitter.com/HorsingJig/status/1 ... 35718?s=19
Interesting that some of the protease inhibitors developed for HIV therapy are able to block the coronavirus protease too - that's kind of handy, especially if healthcare systems around the world have stocks already. I wonder how easily the manufacturers can ramp up production.

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Re: Wuhan Coronavirus

Post by Martin_B » Tue Feb 04, 2020 11:50 pm

Brightonian wrote:
Tue Feb 04, 2020 1:50 pm
Does this graph (via Wikipedia) indicating that the number of cases is tailing off, or is it too early to say?
Image
Is that just the quarantine working?
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Re: Wuhan Coronavirus

Post by jimbob » Wed Feb 05, 2020 8:16 am

Interesting article on modeling the epidemic

https://pursuit.unimelb.edu.au/articles ... oronavirus

If the time to death from diagnosis is longer, then that raises the fatality rate a lot.

The article mentions 14 days as a first estimate.
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Re: Wuhan Coronavirus

Post by raven » Wed Feb 05, 2020 11:55 am

jimbob wrote:If the time to death from diagnosis is longer, then that raises the fatality rate a lot.
I was thinking that might be the case yesterday, when I read that it was taking over a week from the first, usually milder, symptoms to progress to severe respiratory problems. (That's very like getting a cold, and then it progressing to a chest/sinus infection a week later when you think you're geting over it, which has happened to me more than once.)

Of course there might be some lag in reporting deaths too, given the stress hospitals are under in Wuhan. And difficulty getting treatment might be making the death rate worse too.

OTOH, there's probably underreporting of total cases, given a) it can be really mild and b) there may be issues with test kits running out in Wuhan (from this BBC story), which might be why this guy didn't test positive for 10 days. So that may lower fatality rates overall.

I think it's just to early to tell really.

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Re: Wuhan Coronavirus

Post by bob sterman » Wed Feb 05, 2020 12:09 pm

In comparison with SARS - with SARS at the point when 2270 cases had been confirmed – 79 people had died…

https://www.who.int/csr/sars/archive/2003_04_03/en/

With this outbreak at the point when 2014 cases had been confirmed (Jan 26th) – 56 people had died (officially)…

https://www.who.int/docs/default-source ... --ncov.pdf

However, it is notable that unlike for SARS the fatality rate seems much lower outside China. As far as I know - of the 200+ cases outside China there is not yet a case of someone dying following local transmission.

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Re: Wuhan Coronavirus

Post by AMS » Wed Feb 05, 2020 5:35 pm

The difference between China and other countries might be earlier diagnosis. Or maybe that these cases are dotted around far and wide, and so are placing far less stress on healthcare systems.

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Re: Wuhan Coronavirus

Post by AMS » Wed Feb 05, 2020 5:57 pm

Also, different demographic profiles - visitors returning from China in January maybe more likely to be working age, and less likely to have other health conditions, compared to overall population.

And with a fatality rate of single-digit %, 0 out of ~200 might still be within expectations?

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Re: Wuhan Coronavirus

Post by mikeh » Wed Feb 05, 2020 7:01 pm

This was highlighted by a Scrutable overlord earlier today. Some excellent journalism from everyone's favourite periodical


mail.JPG
mail.JPG (152.56 KiB) Viewed 4005 times

From
https://twitter.com/hannahchrstina/stat ... 4240062464

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Re: Wuhan Coronavirus

Post by nefibach » Thu Feb 06, 2020 12:21 am

Some interesting links:

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Re: Wuhan Coronavirus

Post by nefibach » Thu Feb 06, 2020 12:28 am

3,700 people on a Japanese cruise ship have been quarantined for 14 days after 10 people fell ill with 2019-nCoV. Only 300 have been tested so far. 3,600 people on a second cruise ship docked in Hong Kong are also being tested.

https://www.bbc.co.uk/news/world-asia-51381594

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Re: Wuhan Coronavirus

Post by EllyCat » Thu Feb 06, 2020 7:02 am

Infection documented in a newborn baby now. The beeb article (https://www.bbc.co.uk/news/world-asia-china-51395655) suggests that the Coronavirus seems to be far less common in children. Anyone got any guesses why, or know some phrases I can google to start with?

To be honest, I’m more surprised that it’s taken this long for the first infected newborn to be identified - there’s an awful lot of bodily fluid involved in birth, even if the virus can’t cross the placenta. Surely it’s more likely that babies aren’t normally testing positive this early, rather than babies are somehow not catching it?

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Re: Wuhan Coronavirus

Post by bob sterman » Thu Feb 06, 2020 7:30 am

EllyCat wrote:
Thu Feb 06, 2020 7:02 am
Infection documented in a newborn baby now. The beeb article (https://www.bbc.co.uk/news/world-asia-china-51395655) suggests that the Coronavirus seems to be far less common in children. Anyone got any guesses why, or know some phrases I can google to start with?
For SARS mortality was also really low in children compared to other age groups so perhaps there are some papers on why this was the case back then? Similar reasons could apply.

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Re: Wuhan Coronavirus

Post by jimbob » Thu Feb 06, 2020 7:55 am

https://www.taiwannews.com.tw/en/news/3871594

Is this a reputable source?


late Saturday evening (Feb. 1), Tencent, on its webpage titled "Epidemic Situation Tracker," showed confirmed cases of novel coronavirus (2019nCoV) in China as standing at 154,023, 10 times the official figure at the time. It listed the number of suspected cases as 79,808, four times the official figure.
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Re: Wuhan Coronavirus

Post by lpm » Thu Feb 06, 2020 8:13 am

Wouldn't expect so, no. Partly because there are no reputable sources, not even the govt ones. Highly unlikely any 3rd party is doing anything other than modelling estimates.
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Re: Wuhan Coronavirus

Post by OneOffDave » Thu Feb 06, 2020 9:43 am

bob sterman wrote:
Tue Feb 04, 2020 1:57 pm

Quick question - regarding oxygen - for anyone with hospital knowledge. In most hospitals these days oxygen is centrally piped to a fixed number of outlets. Portable cylinders are used a bit but not in large numbers.

So, in the UK, if we wanted to treated large numbers of patients outside of existing wards - would sufficient portable cylinders even exist now?
In the national strategic stockpile there are oxygen distribution systems designed for use in field hospitals that are intended to be set up after a mass casualty incident. These could be mobilised if required to treat large numbers in a non-hospital setting. These use a similar approach to the piped systems in hospitals and use liquid oxygen as the source rather than cylinders of compressed gas. They can also act as a manifold for a bank of T-sized cylinders

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Re: Wuhan Coronavirus

Post by bob sterman » Thu Feb 06, 2020 12:03 pm

OneOffDave wrote:
Thu Feb 06, 2020 9:43 am
In the national strategic stockpile there are oxygen distribution systems designed for use in field hospitals that are intended to be set up after a mass casualty incident. These could be mobilised if required to treat large numbers in a non-hospital setting. These use a similar approach to the piped systems in hospitals and use liquid oxygen as the source rather than cylinders of compressed gas. They can also act as a manifold for a bank of T-sized cylinders
Excellent. In the event of a serious outbreak here, a network of local supportive care centres (e.g. fluids and O2) for people with more manageable symptoms might be an important way to keep hospitals clear for the most serious cases.

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