Coronavirus (COVID-19) Outbreak

[Azeem]

Will he take it on the chin first 

[Dr. Gonzo]

On 08/03/2020 at 01:20, Harvsky said:

If you're going to lock somewhere down it might be best not to tell people in advance. Wonder if any carriers got out in the evacuation rush last night. 

Basically what happened in Wuhan.

[RandoEFC+]

Some very worrying stories coming out of Italy about hospitals. Sounds like a lot of younger people who initially self isolated thinking they could sit this thing out like the flu are now flooding to hospitals with fevers and respiratory problems which are already full to the brim with "high risk" elderly patients.

Also seems things are moving a lot more quickly in many European countries, relative to the population, than it ever did in China...

[nudge]

14 minutes ago, RandoEFC said:

Some very worrying stories coming out of Italy about hospitals. Sounds like a lot of younger people who initially self isolated thinking they could sit this thing out like the flu are now flooding to hospitals with fevers and respiratory problems which are already full to the brim with "high risk" elderly patients.

Also seems things are moving a lot more quickly in many European countries, relative to the population, than it ever did in China...

I thought this was a very harrowing read. A testimony of Daniele Macchini, a doctor at the Humanitas Gavazzeni Clinics. 

His original post: 

 

The original transcript in Italian press: https://bergamo.corriere.it/notizie/cronaca/20_marzo_07/coronavirus-bergamo-medico-humanitas-facebook-situazione-drammatica-altro-che-normale-influenza-4fdf6866-6088-11ea-8d61-438e0a276fc4.shtml

And here's the translation (spoiler tags because it's long):

 

 «In one of the non-stop e-mails that I receive from my hospital administration on a more than daily basis, there was a paragraph on "how to be responsible on social media", with some recommendations that we all can agree on. After thinking for a long time if and what to write about what's happening here, I felt that silence was not responsible. I will therefore try to convey to lay-people, those who are more distant from our reality, what we are experiencing in Bergamo during these Covid-19 pandemic days. I understand the need not to panic, but when the message of the danger of what is happening is not out, and I still see people ignoring the recommendations and people who gather together complaining that they cannot go to the gym or play soccer tournaments, I shiver. I also understand the economic damage and I am also worried about that. After this epidemic, it will be hard to start over.

Still, beside the fact that we are also devastating our national health system from an economic point of view, I want to point out that the public health damage that is going to invest the country is more important and I find it nothing short of "chilling" that new quarantine areas requested by the Region has not yet been established for the municipalities of Alzano Lombardo and Nembro (I would like to clarify that this is purely personal opinion). I myself looked with some amazement at the reorganization of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly "emptied", elective activities interrupted, intensive care unit freed to create as many beds as possible. Containers arriving in front of the emergency room to create diversified routes and avoid infections. All this rapid transformation brought in the hallways of the hospital an atmosphere of surreal silence and emptiness that we did not understand, waiting for a war that had yet to begin and that many (including me) were not so sure would never come with such ferocity (I open a parenthesis: all this was done in the shadows, and without publicity, while several newspapers had the courage to say that private health care was not doing anything).

I still remember my night shift a week ago spent without any rest, waiting for a call from the microbiology department. I was waiting for the results of a swab taken from the first suspect case in our hospital, thinking about what consequences it would have for us and the hospital. If I think about it, my agitation for one possible case seems almost ridiculous and unjustified, now that I have seen what is happening. Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded and battles are uninterrupted day and night. One after the other, these unfortunate people come to the emergency room. They have far from the complications of a flu. Let's stop saying it's a bad flu. In my two years working in Bergamo, I have learned that the people here do not come to the emergency room for no reason. They did well this time too. They followed all the recommendations given: a week or ten days at home with a fever without going out to prevent contagion, but now they can't take it anymore. They don't breathe enough, they need oxygen. Drug therapies for this virus are few.

The course mainly depends on our organism. We can only support it when it can't take it anymore. It is mainly hoped that our body will eradicate the virus on its own, let's face it. Antiviral therapies are experimental on this virus and we learn its behavior day after day. Staying at home until the symptoms worsen does not change the prognosis of the disease. Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sicks, of different colors depending on the department they belong to, are now all red and instead of the surgical procedure, there is the diagnosis, which is always the same: bilateral interstitial pneumonia. Now, tell me which flu virus causes such a rapid tragedy.

Because that's the difference (now I get a little technical): in classical flu, besides that it infects much less population over several months, cases are complicated less frequently: only when the virus has destroyed the protective barriers of our airways and as such it allows bacteria (which normally resident in the upper airways) to invade the bronchi and lungs, causing a more serious disease. Covid 19 causes a banal flu in many young people, but in many elderly people (and not only) a real SARS because it invades the alveoli of the lungs directly, and it infects them making them unable to perform their function. The resulting respiratory failure is often serious and after a few days of hospitalization, the simple oxygen that can be administered in a ward may not be enough. Sorry, but to me, as a doctor, it's not reassuring that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least a pill for high blood pressure or diabetes.

I can also assure you that when you see young people who end up intubated in the ICU, pronated or worse, in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the lungs to hopefully heal), all this confidence for your young age goes away. And while there are still people on social media who boast of not being afraid by ignoring the recommendations, protesting that their normal lifestyle habits have "temporarily" halted, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.

The cases multiply, up to a rate of 15-20 hospitalizations a day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing. Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the to use to emergency room EHR and a few minutes later I'm already downstairs, next to the warriors on the war front. The screen of the PC with the chief complaint is always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency etc ... Exams, radiology always with the same sentence: bilateral interstitial pneumonia. All needs to be hospitalized. Some already needs to be intubated, and goes to the ICU. For others, however, it is late. ICU is full, and when ICUs are full, more are created. Each ventilator is like gold: those in the operating rooms that have now suspended their non-urgent activity are used and the OR become a an ICU that did not exist before. I found it amazing, or at least I can speak for Humanitas Gavazzeni (where I work), how it was possible to put in place in such a short time a deployment and a reorganization of resources so finely designed to prepare for a disaster of this magnitude. And every reorganization of beds, wards, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more. Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted. The staff is exhausted. I saw fatigue on faces that didn't know what it was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?" or "leave that admission to me, i will take care of it." Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal an already marked destiny. There are no more shifts, schedules.

Social life is suspended for us. I have been separated for a few months, and I assure you that I have always done my best to constantly see my son even on the day after a night shift, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have voluntarily not seen neither my son nor my family members for fear of infecting them and in turn infecting an elderly grandmother or relatives with other health problems. I'm happy with some photos of my son that I look at between tears and a few video calls. So you should be patient too, you can't go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem just an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only to indispensable things. Do not go en masse to make stocks in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are infected. You can go there without a rush. Maybe if you have a normal mask (even those that are used to do certain manual work), put it on. Don't look for ffp2 or ffp3. Those should serve us and we are beginning to struggle to find them. By now we have had to optimize their use only in certain circumstances, as the WHO recently recommended in view of their almost ubiquitous running low. Oh yes, thanks to the shortage of certain protection devices, many colleagues and I are certainly exposed despite all the other means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues also have infected relatives and some of their family members are already struggling between life and death. We are where your fears could make you stay away. Try to make sure you stay away.

Tell your family members who are elderly or with other illnesses to stay indoors. Bring him the groceries please. We have no alternative. It's our job. Indeed what I do these days is not really the job I'm used to, but I do it anyway and I will like it as long as it responds to the same principles: try to make some sick people feel better and heal, or even just alleviate the suffering and the pain to those who unfortunately cannot heal. I don't spend a lot of words about the people who define us heroes these days and who until yesterday were ready to insult and report us. Both will return to insult and report as soon as everything is over. People forget everything quickly. And we're not even heroes these days. It's our job. We risked something bad every day before: when we put our hands in a belly full of someone's blood we don't even know if they have HIV or hepatitis C; when we do it even though we know they have HIV or hepatitis C; when we stick ourselves during an operation on a patient with HIV and take the drugs that make us vomit all day long for a month. When we read with anguish the results of the blood tests after an accidental needlestick, hoping not to be infected. We simply earn our living with something that gives us emotions. It doesn't matter if they are beautiful or ugly, we just take them home. In the end we only try to make ourselves useful for everyone. Now try to do it too, though: with our actions we influence the life and death of a few dozen people. You with yours, many more. Please share and share the message. We need to spread the word to prevent what is happening here from happening all over Italy.» 

[Dr. Gonzo]

4 minutes ago, RandoEFC said:

Some very worrying stories coming out of Italy about hospitals. Sounds like a lot of younger people who initially self isolated thinking they could sit this thing out like the flu are now flooding to hospitals with fevers and respiratory problems which are already full to the brim with "high risk" elderly patients.

Also seems things are moving a lot more quickly in many European countries, relative to the population, than it ever did in China...

China imposed loads of restrictions relatively quickly. It was on the 31st of January when I got that notice from my work about the 5 restrictions the Chinese government put in place to prevent the spread of the virus: (restriction of "free travel" in big cities and certain regions; extending the Lunar New Year Holiday; forbidding more than 40 people at offices, factories, and warehouses; employees facing health inspection upon arrival to work; public transportation restrictions). That's just 8 days after this thread was started. Granted, Wuhan's a massive city compared to many cities in Europe so it's understandable China would take a drastic response - imagine if this disease had started in London (I think Wuhan's got more people than London); we'd expect a drastic response as well.

I've heard from a someone who works at a company that's a client of ours that I met last year on my trip to Beijing, Harbin, Tianjin... he works in a regional office in Zhengzhou (in central China) that reports to the Beijing office I went to. Someone in his community (which I think when he says that, he means the tower he lives in - but I'm not sure) tested positive for coronavirus. In Zhengzhou they've imposed pretty severe restrictions on buildings where someone has tested positive for coronavirus. Since early February, his community (which again, I think means his building - but I'm not 100%, I'm not sure if there's just a mistranslation or not... but it sounds like he's talking about his building). Each family living in the building gets 1 pass for leaving their home between the hours of 11AM-3PM. So they can buy things, like food and shite like that. So his wife and his daughter, for over a month, haven't left the house in over a month. He told me he's lucky, because he lives on the first floor so he has a fairly large patio/balcony and that's how his wife and his kid get to experience going outdoors. He says there's other people in his building that other than the people with the pass to leave the house haven't left their homes or experienced fresh air for over a month.

He's not been to his office since he's been put in this lockdown, but it seems like most people in China right now are working from home (granted, I know there's about 5 people in Beijing that still work from the office). But I know Beijing isn't undergoing the same sorts of restrictions that we're seeing in other parts of China.

China's an authoritarian country, so it can easily impose restrictions like this without getting too much push back from the general public. Whereas in Europe, I think it's harder to tell people not to do certain things without expecting them to just completely ignore what they've been asked. But really really harsh restrictions like that are probably fairly effective at stopping the spread of the virus. I've seen Italy's done that now, but I do question whether or not us Europeans can stomach the same kind of restrictions China would impose.

[Machado]

It's only getting worse in Italy. In 4 days they went from aprox. 800 new cases, to 1000, to 1400, to 1800.

[El Profesor]

11 hours ago, Stan said:

Was gonna come in here and say that humans are naturally selfish to some extent but, despite that, maybe people had the virus but just didn't know, weren't aware or weren't diagnosed with it? So didn't know to self-isolate? Bound to be some cases like that, no? Like they might have it but not to a serious, debilitating level so they'll just carry on as normal without knowing they've contracted it. And before you know it they've passed it on... 

 

One thing I find interesting is that asians seem to take restriction measures a lot more serious than westerners.

Granted, there was that korean lady that went to the church but for the most part, the impression I have is that westerners seem to have a much harder in following rules that curb their individual autonomy. I´ve just read about two italians trying to go to Spain for vacation and also about a rave that took place in Milan recently. 

 

 

 

https://www.bbc.com/future/article/20170118-how-east-and-west-think-in-profoundly-different-ways

[Panflute]

4 hours ago, Azeem said:

Isolation is the most effective method. If you have enough contact, you will get it no matter how hygienic your are take pre-emptive steps and minimizing outside time.

I can't exactly isolate myself from my mother if she relies on me for groceries and a bunch of other tasks, though.

[Mel81x+]

12 minutes ago, El Profesor said:

One thing I find interesting is that asians seem to take restriction measures a lot more serious than westerners.

Granted, there was that korean lady that went to the church but for the most part, the impression I have is that westerners seem to have a much harder in following rules that curb their individual autonomy. I´ve just read about two italians trying to go to Spain for vacation and also about a rave that took place in Milan recently. 

https://www.bbc.com/future/article/20170118-how-east-and-west-think-in-profoundly-different-ways

Think it has a bit to do with authoritarian schooling as well. 

How are things in Brazil right now? The last I read an older gentleman who was traveling from Italy made it safe home and then contracted the virus.

[Mpache]

So I got permission to go cover the Dallas Cup for my website. This damn Coronavirus is cancelling everything though. @nudge in a youth tournament, what are the chances it gets cancelled? Would it be 2 weeks before? Since people will have to buy flights and whatnot.

I'm not sure when the best time to buy flight tickets if at all.

[El Profesor]

5 minutes ago, Mel81x said:

Think it has a bit to do with authoritarian schooling as well. 

How are things in Brazil right now? The last I read an older gentleman who was traveling from Italy made it safe home and then contracted the virus.

 

 25 confirmed cases and no deaths so far. It´s still summer here, so the real test will be from April on, especially in south, where temperatures are lower.

[nudge]

10 minutes ago, El Profesor said:

 

One thing I find interesting is that asians seem to take restriction measures a lot more serious than westerners.

Granted, there was that korean lady that went to the church but for the most part, the impression I have is that westerners seem to have a much harder in following rules that curb their individual autonomy. I´ve just read about two italians trying to go to Spain for vacation and also about a rave that took place in Milan recently. 

 

 

 

https://www.bbc.com/future/article/20170118-how-east-and-west-think-in-profoundly-different-ways

I agree with the general idea of western societies tending to lean more towards individualism and eastern cultures towards collectivism (to a certain degree) - but I'd say it has been changing pretty fast in recent years and I personally wouldn't generalise too much.

As an example related to this: just yesterday 80 Thai workers returning from South Korea were supposed to be escorted to a naval base for screening and quarantine but escaped the airport in Bangkok instead and are now being searched for.

[nudge]

6 minutes ago, Inti Brian said:

So I got permission to go cover the Dallas Cup for my website. This damn Coronavirus is cancelling everything though. @nudge in a youth tournament, what are the chances it gets cancelled? Would it be 2 weeks before? Since people will have to buy flights and whatnot.

I'm not sure when the best time to buy flight tickets if at all.

I have no idea - but I think it's fair to say that things can change suddenly without any proper warning in advance so it's pretty impossible to tell...

[Mpache]

13 minutes ago, nudge said:

I have no idea - but I think it's fair to say that things can change suddenly without any proper warning in advance so it's pretty impossible to tell...

Ughh, thats frustrating. Thanks.

[nudge]

Breaking: ALL Italy to be placed on lockdown; just announced by the Italian Prime Minister and coming into effect on Tuesday morning.

[RandoEFC+]

What concerns me is that most other Western countries are about 2-3 weeks behind Italy in this process. Without wanting to be a massive scaremonger, maybe it's time countries like us, Germany and France took more extreme measures early on instead of waiting for hundreds to die and thousands more to get infected before going to these extents.

Just got to hope other countries are getting hit less hard than Italy rather than the same but 2 weeks later.

[Mpache]

Looking at Italy now makes it interesting how it shifted from China to Italy themselves. 44 new cases in China but more than 1700 in Italy. Spain is getting along those lines too. 

[RandoEFC+]

I worry for the US as well. Trump really doesn't seem to have a clue how to handle the situation. 

[Dr. Gonzo]

4 minutes ago, Inti Brian said:

Looking at Italy now makes it interesting how it shifted from China to Italy themselves. 44 new cases in China but more than 1700 in Italy. Spain is getting along those lines too. 

What's shifted? The rate at which it's spreading?

Again, it's probably because China very quickly took more extreme measures to contain the virus (although I think extending the Lunar New Year holiday led to loads of people traveling and spreading the virus) - and because they had to, considering how it's China and Wuhan, a city of 10m +, isn't really considered to be that big of a city. But they've been taking containment of the virus very seriously since the first week of the outbreak reaching international news (shame they didn't take it more seriously in December, when that doctor warned the government & was silenced - RIP guy who tried to warn us about the disease).

There's a lot of ways where you could argue Italy's response may have made things worse. Taking people's temperatures when they arrived at airports created a false sense of security, because so many people carried and spread the infection while they weren't showing symptoms. Banning flights from China was a bit weird, because what they should have really been doing is banning people who'd recently been to affected areas like Wuhan - many Chinese people found their way into Italy after the China air travel ban by just changing flights elsewhere in the EU and then ending up in Italy. And Italy didn't have a shared protocol for how to deal with the virus at first - so different areas were doing different things to stop the spread to different regions in Italy. Now the government is stating that a universal protocol needs to be followed.

2 minutes ago, RandoEFC said:

I worry for the US as well. Trump really doesn't seem to have a clue how to handle the situation. 

Honestly the worst person I'd want in charge of a health crisis is Trump. The man can't form a fucking coherent sentence, yet I'm supposed to trust he's going to see this crisis through. A close second person I wouldn't want would be Mike Pence based off his handling of AIDS in Indiana (he caused an AIDS epidemic in his home state).

I especially worry that it'll clear up as temperatures rise in our hemisphere in late Spring/Summer. And people will forget all about it. And then like the Spanish Flu, there will be a second wave once temperatures start to cool. And that second wave will be much more devastating than the first if it follows the trend of the Spanish flu.

But that's just paranoia.

Having said that, the paranoia's got me assuming everyone I see is a disease ridden fucker that needs to get the fuck away from me. So wash your hands everyone & don't touch your face.

[Mpache]

Just now, Dr. Gonzo said:

What's shifted? The rate at which it's spreading?

Again, it's probably because China very quickly took more extreme measures to contain the virus (although I think extending the Lunar New Year holiday led to loads of people traveling and spreading the virus) - and because they had to, considering how it's China and Wuhan, a city of 10m +, isn't really considered to be that big of a city. But they've been taking containment of the virus very seriously since the first week of the outbreak reaching international news (shame they didn't take it more seriously in December, when that doctor warned the government & was silenced - RIP guy who tried to warn us about the disease).

There's a lot of ways where you could argue Italy's response may have made things worse. Taking people's temperatures when they arrived at airports created a false sense of security, because so many people carried and spread the infection while they weren't showing symptoms. Banning flights from China was a bit weird, because what they should have really been doing is banning people who'd recently been to affected areas like Wuhan - many Chinese people found their way into Italy after the China air travel ban by just changing flights elsewhere in the EU and then ending up in Italy. And Italy didn't have a shared protocol for how to deal with the virus at first - so different areas were doing different things to stop the spread to different regions in Italy. Now the government is stating that a universal protocol needs to be followed.

I meant that you'd believe that the virus started in Italy if you just got out of a rock right now, but we all know it originated in Wuhan.

[Dr. Gonzo]

Just now, Inti Brian said:

I meant that you'd believe that the virus started in Italy if you just got out of a rock right now, but we all know it originated in Wuhan.

Yeah unless you looked at the total number of confirmed cases and then saw that China's number blows Italy well the fuck out of the water 

[RandoEFC+]

I'm in the mindset now that you can't be too careful. It feels like it won't be long until a pandemic is declared. Still no cases on the island yet but it is surely only a matter of time and I dread to think how poorly a health system designed to serve 80000 people will cope with a significant influx of this virus.

[Honey Honey]

23 minutes ago, RandoEFC said:

I'm in the mindset now that you can't be too careful. It feels like it won't be long until a pandemic is declared. Still no cases on the island yet but it is surely only a matter of time and I dread to think how poorly a health system designed to serve 80000 people will cope with a significant influx of this virus.

I don't think there will be a health care system. From what I understand what has happened in Lombardy and Wuhan is hospitals become solely for intensive care and everyone else is booted out.

[RandoEFC+]

19 minutes ago, Harvsky said:

I don't think there will be a health care system. From what I understand what has happened in Lombardy and Wuhan is hospitals become solely for intensive care and everyone else is booted out.

We frequently have to helicopter people over to Liverpool for certain types of intensive care under normal circumstances. We simply don't have the facilities over here to handle an outbreak of any magnitude and I can't see that sending people to Merseyside is going to be much of an option if their ICUs get anything like as bad from local cases as what's happened in Italy.

[Carnivore Chris]

1 hour ago, RandoEFC said:

We frequently have to helicopter people over to Liverpool for certain types of intensive care under normal circumstances. We simply don't have the facilities over here to handle an outbreak of any magnitude and I can't see that sending people to Merseyside is going to be much of an option if their ICUs get anything like as bad from local cases as what's happened in Italy.

A week before I went to Barcelona there had been 3 cases in the whole of Spain, I've come back and there is now well over 1,000. Then you come back to England and BANG there are 100s and that will end up in the 1,000s before long just like has been the case in Germany, France and Spain within the space of a few weeks.

Scary shit, but it was inevitable.