Who will survive this and be here in 6 months ?
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I'd like to see some support for that statement.
Sure over here it's natural that typical triage processes tend to treat the younger crowd of gun shot wounds stabbings and nail-gun shootings before coughs, snot noses and falls. OTOH I watched and/or participated in old foks with possible strokes and heart attacks going to the front of the queue
Sure over here it's natural that typical triage processes tend to treat the younger crowd of gun shot wounds stabbings and nail-gun shootings before coughs, snot noses and falls. OTOH I watched and/or participated in old foks with possible strokes and heart attacks going to the front of the queue
In Italy now, there are not enough ICU beds to go around. So what do you do? Who do you treat and who do you leave to possibly die?
In the first decades of AIDS, before effective treatments were developed, the CFR was 100%, with a significant symptom free infectious period. The only thing that saved us was that it was slow, and in communities where it was not slow (gay men, sub saharan Africa), it has indeed been a near doomsday scenario.
It doesn't really matter how quickly it kills once it has revealed itself, just that it spreads well while it is undetected and it kills lots of people.
Covid 19 spreads well while it is undetected, but appears to have a short symptom free infectious period, making short term isolation a viable preventative measure.
While Covid 19 is relatively harmless to young people, it is very dangerous for older people.
It's most of the way to the nightmare scenario I've described, and it's only luck that it doesn't kill say 20% or 90% of all infected, within say six months...
(How do we know it doesn't?)
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I was caught in the thick of it during SARS (as were many others on here). We were scanned, measured, etc and were just short of having a thermometer shoved up our bums during all our airport movements. Panic set in with the media, but most of us lesser mortals who needed to get on with things just heeded the advice, took the necessary precautions as best as one could, and lived to tell the tale.
To put this reaper into perspective. The current death toll from coronavirus currently stands at 5830 over a 1.5 month period. The average annual death toll from tobacco stands at 8 million (https://www.who.int/news-room/fact-s...detail/tobacco).
Many industries have been hit extremely hard due to the sudden panic by the general public from hearing of some new threat, a panic further induced from the self interest groups like finance and the media, a panic that solves absolutely nothing when sound advice to deal with the problem is already available.
Perhaps you're being too greedy in hoarding your own supply of the stuff....
To put this reaper into perspective. The current death toll from coronavirus currently stands at 5830 over a 1.5 month period. The average annual death toll from tobacco stands at 8 million (https://www.who.int/news-room/fact-s...detail/tobacco).
Many industries have been hit extremely hard due to the sudden panic by the general public from hearing of some new threat, a panic further induced from the self interest groups like finance and the media, a panic that solves absolutely nothing when sound advice to deal with the problem is already available.
Can I have one bucket of sand please.
733driver,
Not sure I follow your reasoning on the numbers! Lets say you have 100 units of people (actual numbers don't matter) and the known infection rate is 60%, therefore 60 units of people will be infected. Lets say the mortality rate is 5% of those KNOWN to be infected, so therefore 3 units of people will die. Now if the ACTUAL infection rate is 100% (40 units who are infected but do not test +ve) the same number of units will die (i.e. 3 units), but instead of the mortality rate being 5%, it will be 3%, BUT THE SAME NUMBER OF PEOPLE WILL DIE!
The only thing that changes in your scenario is the % numbers, actual dead, no change!
Not sure I follow your reasoning on the numbers! Lets say you have 100 units of people (actual numbers don't matter) and the known infection rate is 60%, therefore 60 units of people will be infected. Lets say the mortality rate is 5% of those KNOWN to be infected, so therefore 3 units of people will die. Now if the ACTUAL infection rate is 100% (40 units who are infected but do not test +ve) the same number of units will die (i.e. 3 units), but instead of the mortality rate being 5%, it will be 3%, BUT THE SAME NUMBER OF PEOPLE WILL DIE!
The only thing that changes in your scenario is the % numbers, actual dead, no change!
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Long time lurker, first time poster. I'm a consultant anaesthetist with some aeromed experience. I also work with a pilot delivering human factors training in healthcare. I have therefore got some experience of hw you think, not a lot, but some.
Most people in healthcare are extremely worried about this. We are no doing a lot of sim training in doffing and donning of our personal protective equipment and practising practical procedures whilst fully PPEd. There is unprecedented planning. there are still pockets of complacency but I have never seen anything like this in my career (over 15 years since medical school). I was at a major london hospital for 7/7. I saw how quickly we created space but that was 1000 people injured. This is on a scale unheard of in modern times. This is an order of magnitude more serious. And it is a tidal wave rather than a big bang. It is ging to be 3-4 months of work like nothing I have ever seen before.
for the vast majority of you this will be nothing more than the flu. And those who say 'it's just flu' will feel vindicated. But for a significant minority this is going to be a teminal event. Mostly those over 75. We are tripling our ICU capacity, and even that seems optimistic. 60-70 beds for a population of 400-500k. Those that stay on ICU will do so for weeks. Assuming we can turn the ICU over twice in 2 months that means we can accommodate about 140 patients. 4000-5000 infections. So even tripling ICU capacity we can afford for about 1% of the population to get infected. China flew in thousands of doctors and built icu only hospitals. That's how they dealt with it. If we allow this to surge and we suddenly get 10000 cases in our catchment area, we are potentially looking for 500-1000 ICU beds. Even in Hubei it only got to 0.1% of the population. It seems very odd to me to let this run through the population
I think this has been handled very badly by the government. They have lacked clarity and resolve and let panic set in. As pointed out above, there are large areas of deprivation in the UK and they will suffer on two fronts the first being that they will struggle to self isolate based on hand to mouth weekly wages or gig economy 'self emplyment'. and the second is that we know deprivation is a poor prognosis for health outcomes anyway.
I think the travel bans are not helpful, they are leaving large numbers of people stranded all over the world but I do think that social distancing and shutting down of congregations of people across the world is sensible. The hospitality, travel and recreation sectors will suffer. The best thing they can do is make it as easy as possible for people to rebook and retain the goodwill of the customers who through no fault of their own have has to cancel.
We were all looking at Brexit as the economic disaster and this black swan flew in out of nowhere.
I have no understanding of 99.9% of what you all do ion here, but I do love reading your dissections of incidents. 99% of you will hopefully have little experience of ICU, but I a extremely fearful that many many people are about to get familiar with it.
Stay safe, stay sensible, encourage your elderly friends and relatives to stay at home, check on them by phone / skype. Deliver stuff to them if you can. Wash your hands.
Most people in healthcare are extremely worried about this. We are no doing a lot of sim training in doffing and donning of our personal protective equipment and practising practical procedures whilst fully PPEd. There is unprecedented planning. there are still pockets of complacency but I have never seen anything like this in my career (over 15 years since medical school). I was at a major london hospital for 7/7. I saw how quickly we created space but that was 1000 people injured. This is on a scale unheard of in modern times. This is an order of magnitude more serious. And it is a tidal wave rather than a big bang. It is ging to be 3-4 months of work like nothing I have ever seen before.
for the vast majority of you this will be nothing more than the flu. And those who say 'it's just flu' will feel vindicated. But for a significant minority this is going to be a teminal event. Mostly those over 75. We are tripling our ICU capacity, and even that seems optimistic. 60-70 beds for a population of 400-500k. Those that stay on ICU will do so for weeks. Assuming we can turn the ICU over twice in 2 months that means we can accommodate about 140 patients. 4000-5000 infections. So even tripling ICU capacity we can afford for about 1% of the population to get infected. China flew in thousands of doctors and built icu only hospitals. That's how they dealt with it. If we allow this to surge and we suddenly get 10000 cases in our catchment area, we are potentially looking for 500-1000 ICU beds. Even in Hubei it only got to 0.1% of the population. It seems very odd to me to let this run through the population
I think this has been handled very badly by the government. They have lacked clarity and resolve and let panic set in. As pointed out above, there are large areas of deprivation in the UK and they will suffer on two fronts the first being that they will struggle to self isolate based on hand to mouth weekly wages or gig economy 'self emplyment'. and the second is that we know deprivation is a poor prognosis for health outcomes anyway.
I think the travel bans are not helpful, they are leaving large numbers of people stranded all over the world but I do think that social distancing and shutting down of congregations of people across the world is sensible. The hospitality, travel and recreation sectors will suffer. The best thing they can do is make it as easy as possible for people to rebook and retain the goodwill of the customers who through no fault of their own have has to cancel.
We were all looking at Brexit as the economic disaster and this black swan flew in out of nowhere.
I have no understanding of 99.9% of what you all do ion here, but I do love reading your dissections of incidents. 99% of you will hopefully have little experience of ICU, but I a extremely fearful that many many people are about to get familiar with it.
Stay safe, stay sensible, encourage your elderly friends and relatives to stay at home, check on them by phone / skype. Deliver stuff to them if you can. Wash your hands.
As much remains unknown about the virus, cases of reinfection have health experts worried that the illness could remain dormant after an apparent recovery.
“Once you have the infection, it could remain dormant with minimal symptoms,” Philip Tierno Jr., professor of microbiology and pathology at New York University, told Reuters.
“And then you can get an exacerbation if it finds its way into the lungs,” he said.
Last edited by nonsense; 15th Mar 2020 at 19:52.
dr_tbd
Great post, couldn't agree more.
Don't know if you've seen it already but a data science prof at UCL in london has been publishing some good data on progression rates in various countries to show what could be coming in the near future for those just starting to see in country transmissions e.g. UK is about 14 days behind Italy. He's not a epidemic expert but the data appears robust and the analysis seems logical to me.
Worth checking it out - COVID 19 Growth Rate
Just returned to the UK after 4 weeks in OZ, symptom free but me and my wife are self isolating for 2 weeks as it feels the right thing to do.
This too shall pass....
Great post, couldn't agree more.
Don't know if you've seen it already but a data science prof at UCL in london has been publishing some good data on progression rates in various countries to show what could be coming in the near future for those just starting to see in country transmissions e.g. UK is about 14 days behind Italy. He's not a epidemic expert but the data appears robust and the analysis seems logical to me.
Worth checking it out - COVID 19 Growth Rate
Just returned to the UK after 4 weeks in OZ, symptom free but me and my wife are self isolating for 2 weeks as it feels the right thing to do.
This too shall pass....
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dr_tbd ; Respect , for a first post . Thanks for sharing your views on this .
There is middle ground between : this a just the flu , it will pass , ( which unfortunately I still hear around me ) and putting yourself in full quarantine . It is called social distancing , which is what I believe everyone should do asap.
Of course countries whose population is disciplined by nature or by force will do better than Latin-based open cultures ( e.g Italy, Spain ,France etc.. ) but at one point or another we have all to get our act together.
There is middle ground between : this a just the flu , it will pass , ( which unfortunately I still hear around me ) and putting yourself in full quarantine . It is called social distancing , which is what I believe everyone should do asap.
Of course countries whose population is disciplined by nature or by force will do better than Latin-based open cultures ( e.g Italy, Spain ,France etc.. ) but at one point or another we have all to get our act together.
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First Class post, Doc! (From a lowly Instructor).
Rumour that the UK may enforce over 70s to self-isolate for up to 4 months in order to protect ICU beds for younger cases. And for the Army to guard Hospitals and Supermarkets.
Rumour that the UK may enforce over 70s to self-isolate for up to 4 months in order to protect ICU beds for younger cases. And for the Army to guard Hospitals and Supermarkets.
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dr_tbd
Great post, couldn't agree more.
Don't know if you've seen it already but a data science prof at UCL in london has been publishing some good data on progression rates in various countries to show what could be coming in the near future for those just starting to see in country transmissions e.g. UK is about 14 days behind Italy. He's not a epidemic expert but the data appears robust and the analysis seems logical to me.
Worth checking it out - COVID 19 Growth Rate
Great post, couldn't agree more.
Don't know if you've seen it already but a data science prof at UCL in london has been publishing some good data on progression rates in various countries to show what could be coming in the near future for those just starting to see in country transmissions e.g. UK is about 14 days behind Italy. He's not a epidemic expert but the data appears robust and the analysis seems logical to me.
Worth checking it out - COVID 19 Growth Rate
For example testing is widely available in germany for example, in some regions including drive-in-testing for everybody who wants to get tested. Which explains, to a point the, number of cases which might be much closer to the real number of total cases than in countries where testing is limited or not available at large scale. This afternoon the number of confirmed cases stands at 5072 with 10 confirmed covid-19 deaths in germany, whereas the latest number for the UK (which is from yesterday morning) stands at 1140 cases and 21 deaths. There is clearly a huge divide there in the ratio between deaths and cases. Of course, if you want to spread misinformation you could now say that you are much more likely to get covid-19 in germany, but are much more likely to die from it in the UK. Both is simply not true at all, as both health systems work very differently and react very differently to the crisis, both in testing, public and political reaction and of course publicly available information.
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>Why the young were so vulnerable is seemingly still a mystery.
I used to believe the second theory. Which led me to expect that covid-19 didn't involve "cytokine storms" as it hit the oldest hardest. Turns out that
this isn't the case, and "cytokine storms" seem to be heavily involved in cov-19 deaths.
Weeks ago I looked up some Spanish flu references and happened across a plausible-sounding theory that the elderly were protected by lingering immunity
from an earlier flu epidemic. Similar strains hadn't occurred for some time, hence the young didn't have this partial immunity.
Article
https://www.medicalnewstoday.com/articles/276060
Why was 1918 flu pandemic so deadly? Research offers new clue
Paper abstract
https://www.pnas.org/content/111/22/8107.short
Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus
Paper pdf
https://www.pnas.org/content/pnas/111/22/8107.full.pdf
Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus
One theory you already suggest - debilitation by gassing (or trench life in general).
Another I've seen is that the particular 1918 strain induced immune-system "storms" that themselves caused body damage - a healthy young immune system could actually be a liability. cf: https://en.wikipedia.org/wiki/Cytokine_release_syndrome
These weren't really recognized and studied until transplants (and immune reactions to them) became common more than half a century later.
Another I've seen is that the particular 1918 strain induced immune-system "storms" that themselves caused body damage - a healthy young immune system could actually be a liability. cf: https://en.wikipedia.org/wiki/Cytokine_release_syndrome
These weren't really recognized and studied until transplants (and immune reactions to them) became common more than half a century later.
this isn't the case, and "cytokine storms" seem to be heavily involved in cov-19 deaths.
Weeks ago I looked up some Spanish flu references and happened across a plausible-sounding theory that the elderly were protected by lingering immunity
from an earlier flu epidemic. Similar strains hadn't occurred for some time, hence the young didn't have this partial immunity.
Article
https://www.medicalnewstoday.com/articles/276060
Why was 1918 flu pandemic so deadly? Research offers new clue
Paper abstract
https://www.pnas.org/content/111/22/8107.short
Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus
Paper pdf
https://www.pnas.org/content/pnas/111/22/8107.full.pdf
Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus
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dr_tbd ; Respect , for a first post . Thanks for sharing your views on this .
There is middle ground between : this a just the flu , it will pass , ( which unfortunately I still hear around me ) and putting yourself in full quarantine . It is called social distancing , which is what I believe everyone should do asap.
Of course countries whose population is disciplined by nature or by force will do better than Latin-based open cultures ( e.g Italy, Spain ,France etc.. ) but at one point or another we have all to get our act together.
There is middle ground between : this a just the flu , it will pass , ( which unfortunately I still hear around me ) and putting yourself in full quarantine . It is called social distancing , which is what I believe everyone should do asap.
Of course countries whose population is disciplined by nature or by force will do better than Latin-based open cultures ( e.g Italy, Spain ,France etc.. ) but at one point or another we have all to get our act together.
What I do see as a potential hole is that we have now started prime seasonal allergy season and given the awareness of Covid, the number of people headed for medical help not knowing is going to increase which could provide an unanticipated vector.
Denti
Agree, but it's very hard to get any info on the level of testing being done in each country and the way the test group is being selected.
The exemplar for testing is South Korea who have one of the lowest growth rates of all the "early in country transmission" countries and do roughly 10,000 tests a day and quarantine anyone who tests positive (until recently the TOTAL test count for the US was just over 11,000).
About a year after this all settles there will be some great papers on the things we should have spotted in the data early on but didn't. Right now we're instrument flying on a partial panel at best....
The UCL site was the first one I'd seen that showed some level of "like for like" analysis across countries. Learning should be "If you are N days behind Italy on the curve use those N days aggressively and wisely".
Much as I love my personal freedom I think history is going to show that benign dictatorship is a better model for dealing with pandemics then free market forces...
IMHO - others will have a different take on all this.
Agree, but it's very hard to get any info on the level of testing being done in each country and the way the test group is being selected.
The exemplar for testing is South Korea who have one of the lowest growth rates of all the "early in country transmission" countries and do roughly 10,000 tests a day and quarantine anyone who tests positive (until recently the TOTAL test count for the US was just over 11,000).
About a year after this all settles there will be some great papers on the things we should have spotted in the data early on but didn't. Right now we're instrument flying on a partial panel at best....
The UCL site was the first one I'd seen that showed some level of "like for like" analysis across countries. Learning should be "If you are N days behind Italy on the curve use those N days aggressively and wisely".
Much as I love my personal freedom I think history is going to show that benign dictatorship is a better model for dealing with pandemics then free market forces...
IMHO - others will have a different take on all this.
Well this is all very interesting and I certainly have my own views on what may transpire but I thought this thread was supposed to be about which airlines were going to go to the wall?
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FYSA, there is a bogus site replicating the JHU map with malware included. See below:Alert Synopsis From HHS.gov:
A malicious website pretending to be the live map for Coronavirus COVID-19
Global Cases by Johns Hopkins University is circulating on the internet
waiting for unwitting internet users to visit the website
(corona-virus-map[dot]com). Visiting the website infects the user with the
AZORult trojan, an information stealing program which can exfiltrate a
variety of sensitive data. It is likely being spread via infected email
attachments, malicious online advertisements, and social engineering.
Furthermore, anyone searching the internet for a Coronavirus map could
unwittingly navigate to this malicious website.
A malicious website pretending to be the live map for Coronavirus COVID-19
Global Cases by Johns Hopkins University is circulating on the internet
waiting for unwitting internet users to visit the website
(corona-virus-map[dot]com). Visiting the website infects the user with the
AZORult trojan, an information stealing program which can exfiltrate a
variety of sensitive data. It is likely being spread via infected email
attachments, malicious online advertisements, and social engineering.
Furthermore, anyone searching the internet for a Coronavirus map could
unwittingly navigate to this malicious website.
My opinion only, but IMHO the only guys making money out of commercial aviation in the next 12 months will be some cargo operations and those renting parking space for unused aircraft (and they'll be wanting cash in advance). I hope I'm wrong BTW, I really do, but I don't think I will be....
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to get back to the topic :
That is about what I was afraid of , never expected it would be so fast though ..
. it says lay off s will last " until conditions for commercial aviation improved." but reading this thread so far , if may take months .
COPENHAGEN/STOCKHOLM (Reuters) - Airline SAS (SAS.ST) said it will temporarily halt most of its flights from Monday until conditions for commercial aviation improved.
Travel restrictions and falling demand due to the coronavirus have hammered airlines around the world, forcing them to reduce flights and lay off staff to stay afloat.
SAS said on Sunday it would temporary lay off up to 10,000 employees, or 90% of the airline’s total workforce.
“Demand for flights into, out of, and within Scandinavia has more or less disappeared,” chief executive Rickard Gustafson told a press briefing on Sunday.
“We have to adapt to current circumstances and starting tomorrow, Monday, we will temporary pause a large part of our operations and we will heavily reduce the number of flights in our entire network,” he added.
SAS said it would as far as possible maintain some flights within the next few days to enable people to return home.
Travel restrictions and falling demand due to the coronavirus have hammered airlines around the world, forcing them to reduce flights and lay off staff to stay afloat.
SAS said on Sunday it would temporary lay off up to 10,000 employees, or 90% of the airline’s total workforce.
“Demand for flights into, out of, and within Scandinavia has more or less disappeared,” chief executive Rickard Gustafson told a press briefing on Sunday.
“We have to adapt to current circumstances and starting tomorrow, Monday, we will temporary pause a large part of our operations and we will heavily reduce the number of flights in our entire network,” he added.
SAS said it would as far as possible maintain some flights within the next few days to enable people to return home.
. it says lay off s will last " until conditions for commercial aviation improved." but reading this thread so far , if may take months .
FYSA, there is a bogus site replicating the JHU map with malware included. See below:Alert Synopsis From HHS.gov:
A malicious website pretending to be the live map for Coronavirus COVID-19
Global Cases by Johns Hopkins University is circulating on the internet
waiting for unwitting internet users to visit the website
(corona-virus-map[dot]com). Visiting the website infects the user with the
AZORult trojan, an information stealing program which can exfiltrate a
variety of sensitive data. It is likely being spread via infected email
attachments, malicious online advertisements, and social engineering.
Furthermore, anyone searching the internet for a Coronavirus map could
unwittingly navigate to this malicious website.
A malicious website pretending to be the live map for Coronavirus COVID-19
Global Cases by Johns Hopkins University is circulating on the internet
waiting for unwitting internet users to visit the website
(corona-virus-map[dot]com). Visiting the website infects the user with the
AZORult trojan, an information stealing program which can exfiltrate a
variety of sensitive data. It is likely being spread via infected email
attachments, malicious online advertisements, and social engineering.
Furthermore, anyone searching the internet for a Coronavirus map could
unwittingly navigate to this malicious website.
Denti
Agree, but it's very hard to get any info on the level of testing being done in each country and the way the test group is being selected.
The exemplar for testing is South Korea who have one of the lowest growth rates of all the "early in country transmission" countries and do roughly 10,000 tests a day and quarantine anyone who tests positive (until recently the TOTAL test count for the US was just over 11,000).
About a year after this all settles there will be some great papers on the things we should have spotted in the data early on but didn't. Right now we're instrument flying on a partial panel at best....
The UCL site was the first one I'd seen that showed some level of "like for like" analysis across countries. Learning should be "If you are N days behind Italy on the curve use those N days aggressively and wisely".
Much as I love my personal freedom I think history is going to show that benign dictatorship is a better model for dealing with pandemics then free market forces...
IMHO - others will have a different take on all this.
Agree, but it's very hard to get any info on the level of testing being done in each country and the way the test group is being selected.
The exemplar for testing is South Korea who have one of the lowest growth rates of all the "early in country transmission" countries and do roughly 10,000 tests a day and quarantine anyone who tests positive (until recently the TOTAL test count for the US was just over 11,000).
About a year after this all settles there will be some great papers on the things we should have spotted in the data early on but didn't. Right now we're instrument flying on a partial panel at best....
The UCL site was the first one I'd seen that showed some level of "like for like" analysis across countries. Learning should be "If you are N days behind Italy on the curve use those N days aggressively and wisely".
Much as I love my personal freedom I think history is going to show that benign dictatorship is a better model for dealing with pandemics then free market forces...
IMHO - others will have a different take on all this.