CORONA Main Coronavirus thread

Trivium Pursuit

Has No Life - Lives on TB
There isn't a lot of study on this with Covid-19 but they did have some studies for SARS. I would imagine the pathology would be the same.

What was found was that it was what I would call "shock kidneys". With this virus you get a progressive shortness of breath over the first week to 10 days of symptoms (average, some earlier--some later). As PO2 (the blood gas value--for home use lets talk about it as the pulse-ox reading) drops, less oxygen is able to cross the damaged alveoli into the blood. This causes hypoxia. The lack of oxygen begins to damage all of the organs. It is made worse by the body's attempts to shunt blood flow to the heart and brain as they are the most sensitive to hypoxia. The liver, kidneys, bowels, etc. become ischemic. Without oxygen the body reverts to the production of lactic acid for its energy need instead of aerobic respiration. Blood pH drops, the patient becomes acidotic and without correction will die.

Often times at this point steroids may be a last-ditch effort to help. We would be pushing IV fluids, pressors like epinephrine or dopamine to keep blood pressure up to protect the organs. The patient would be definitely intubated or, if needed and available, placed on ECMO.

Now, lets focus on the kidney problem. When it doesn't get enough oxygen the cells in the renal tubules begin to die. These cells are what line the nephron and help to control the excretion of waste and reabsorbtion of things you don't want to lose. They will die and sluough off into the urine. This is called Acute Tubular Necrosis. A good marker for this is urine output. If it falls below about 400ml in a 24hr period the patient will need dialysis. Because the cells are dead/dying/sloughing off protein--something your body wants to readsorb--spills out into the urine. This is a tell tell sign of damage to the kidney. It can take several weeks for the kidneys to begin to heal and there will likely be some degree of permanent impairment from the injury. In SARS the involvment was a HUGE marker in the severity of the disease. Of those that got an acute kidney injury 92% died vs. 8% who died without kidney injury. Thus it is important to keep the organs well perfused to improve survival. IV fluids for blood pressure, supplemental oxygen for hypoxemia are critical supportive measures.
Thank you, once again, for a thorough, progressive and systemic look at an issue that will be faced by many. It would appear that supplemental oxygen might be a good thing to have on hand where possible. Would the standard banana bag of the ED be helpful here, at least as a palliative?
 

northern watch

TB Fanatic
Coronavirus Outbreak Slams Iran's Embattled Economy; Demand from Beijing, one of Tehran's last crude-oil customers, drops amid chaos of health crisis

Thursday, February 13, 2020, 6:34 PM ET
By Benoit Faucon in London and Gordon Lubold in Washington
Wall Street Journal

Iran's crude-oil sales have been battered by a sudden downturn in demand from its last big trading partner, China, following the deadly coronavirus outbreak, U.S. and Iranian officials said, a blow that lands as the Islamic Republic faces the risk of an economic collapse.

In addition to declining oil sales, turmoil in China also is disrupting the supply of spare parts and cheap goods Tehran needs for its factories and bazaars.

"The Iranian economy is already in bad shape," said Ali Amirliravi, a Tehran-based commodities trader. "Now the coronavirus is hurting trade between Iran and China."

The outbreak since mid-January has mushroomed into an epidemic , killing more than 1,000 people and halting businesses such as refineries and manufacturing plants across the country.

The slowdown at an industrial powerhouse once known for its insatiable appetite for raw materials has rippled far and wide, from Vietnamese coffee growers to Midwest hog farmers . It has even forced Saudi Arabia, the world's top oil exporter, to lobby Russia to join collective crude-production cuts.

Iran says it hasn't recorded any cases, but the nation is among the most vulnerable economies world-wide to the crisis faced by China, its most important economic ally.

In 2018, Beijing defied the Trump administration's decision to quit an international nuclear pact and reinstate sanctions against Iran. China is now the last major buyer of Iranian oil, the Islamic Republic's most lucrative commodity.

China bought 300,000 barrels a day of Iranian oil in 2019, according to the International Energy Agency , an oil-consumers' body, although that is half the level it has purchased in the past. A spokeswoman for Iran's oil ministry said she had no information on Iran's oil exports as the data isn't public.

Current and former Iranian oil officials say Chinese purchases of Iranian oil have declined further since the outbreak, with refineries in China reducing their operations as workforces stayed at home and the government restricted transit and travel in the country. U.S. officials said they couldn't specify the decline.

No Iranian crude cargoes have been discharged in China since Jan 24, contrasting with average weekly arrivals previously, according to data from international commodities-data provider Kpler.

The setback comes as Iran, which just commemorated 41 years of existence as an Islamic republic, is the most economically vulnerable it has been in decades.

The United Nations estimates the country's gross domestic product is set to contract 2.7% this year, the third year of recession, as it faces triple-digit inflation rates.

The economic crisis forced the government to drastically cut fuel subsidies, triggering deadly riots in November.

Until now, China has provided a rare buffer against further turmoil. Last year, Beijing traded $23 billion of goods with Tehran, almost two-thirds of which were commodities sold to the Asian powerhouse, according to its General Administration of Customs.

Beyond crude oil, the lockdowns in China are jeopardizing some of Tehran's other business opportunities, including a giant oil-field investment in Western Iran and spare parts sold by Beijing for Iran's car factories, Iranian businessmen said.

Tehran has been forced to interrupt flights to and from China. The chairman of the Iran-China Chamber of Commerce, Majidreza Hariri, warned on January 25 against travel to the Asian nation.

Mr. Hariri said at the time there was no impact on bilateral trade. Foreign Minister Javad Zarif has expressed solidarity with China in Mandarin-language tweets. But on the ground, Iranian businessmen say the coronavirus outbreak is hurting business.

A distributor of electric consumer goods said production at refrigerator factory in southeastern Iran had been impeded by the shutdown of a fan maker in Wuhan—the epicenter of the epidemic in China. Iran started to produce its own refrigerators after sanctions stopped Asian brands from selling there, but it is now struggling to find replacement fans in Turkey, the distributor said.

Mohammad Parsa, a former director at the Tehran chamber of commerce, said the outbreak had also disrupted arrivals of cheap household goods and automotive spare parts.

The economic paralysis in China also is hurting prospects of Chinese investments in Iran. Until mid-January, China's state-run energy giant China Petroleum and Chemical Corp ., or Sinopec, had continued talks to invest $3 billion for more development of an Iranian oil field, an adviser to the project said.

But these conversations have been halted as Chinese executives are banned from traveling from China and into Iran and activity more broadly comes to a standstill, the adviser said. Sinopec didn't return a request for comment.

U.S. officials said any purchases of Iranian oil fund the regime's foreign interference activities and its missile-development programs. "Any Chinese company importing Iranian oil at any time is engaging in sanctionable conduct and risks being sanctioned directly as a result," a senior administration official said on Thursday.

Some Iranian businessmen see rare silver linings amid the turmoil.

Mr. Amirliravi said he has received orders from China for the delivery of one million face masks a day. The businessman said he can't deliver them because Iran has banned such exports in case of an outbreak there. But for others, "There is the black market."

Write to Benoit Faucon at benoit.faucon@wsj.com and Gordon Lubold at Gordon.Lubold@wsj.com


Coronavirus Outbreak Slams Iran’s Embattled Economy
 

jward

passin' thru
so all I really want to know is: of those who catch this, how many are ending up serious/critical?
Anything out there pointing to a reliable answer to this?
 

CarolynA

Veteran Member
This afternoon I watched a National Geographic channel show called "How the World Ends". It was released in 2017 and this episode was on, you guessed it, pandemics! Holy crap! It talked about SARS, Spanish Flu, etc and then covered the fact that we would have a big pandemic someday. And here we are. It was spooky to say the least. If you get a chance to watch it please do.
 

rondaben

Veteran Member
Thank you, once again, for a thorough, progressive and systemic look at an issue that will be faced by many. It would appear that supplemental oxygen might be a good thing to have on hand where possible. Would the standard banana bag of the ED be helpful here, at least as a palliative?

Wouldn't be my first choice, but I don't know that it would hurt you. Good question.
 

jward

passin' thru
Briefs
Expert Recommendations for US and Global Preparedness for COVID-19
The Center for Global Development
February 13, 2020
Download PDF


https://twitter.com/PneumoniaWuhan

The novel coronavirus outbreak that emerged in late 2019 has infected tens of thousands in China, community transmission is feared in other countries, and containment looks increasingly unlikely. The world is woefully unready for a scenario in which China-like conditions emerge in multiple other countries. The US, in particular, should not assume it is immune to a major domestic outbreak. While the prevention and control measures in numerous countries may delay the outbreak’s spread, they are unlikely to prevent it. Efforts are underway to develop medical countermeasures, but these are unlikely to be ready for widespread use for at least one to two years; meanwhile, the virus has shown in China that it can grow from introduction to a sizable outbreak in just weeks.

Related Content

Coronavirus and Low-Income Countries: Ready to Respond?
There is an urgent but closing window to prepare for large-scale spread of the disease in the US and elsewhere. This paper recommends actions to address pressing gaps in US and global preparedness in the event that COVID-19 cannot be contained and sustained human-to-human transmission occurs beyond China. These recommendations are critical both for this outbreak and for future epidemic threats. The paper draws on consultations over the past two weeks involving experts from the Center for Global Development, the Georgetown Center for Global Health Science and Security, the Nuclear Threat Initiative|Bio, the University of Nebraska Medical Center’s College of Public Health, and In-Q-Tel/B.Next.

Recommendations for Action
  • Develop policy guidance for mitigating outbreaks when the normal health system becomes overwhelmed. The US government should outline contingency plans for mitigating mass-scale domestic transmission of the virus and for providing mass-scale isolation and treatment. As the US updates its national pandemic planning, it should also develop clear mechanisms for distributed care, including home diagnosis and isolation, and clear guidance and options to local authorities for social distancing measures. Federal and state health authorities should review the crisis thresholds at which these measures would be triggered. In the interim, federal officials should provide regularly updated guidance on best practices for social distancing measures. The US National Academies of Medicine could also convene medical technology companies to recommend investments to improve home isolation and care during a major epidemic or pandemic.

  • Scale up support to frontline health workers. In any novel outbreak, frontline health workers bear the greatest risks. In China, reports portray shocking levels of infections among health facility staff, as workers struggle to maintain services amid a growing wave of cases. A comparably sized outbreak in the US might play out similarly; the US health system has limited surge capacity and inadequate support for outbreak readiness. In the immediate term, urgent measures must be taken to ready frontline health workers to safely manage a surge in cases. This must include training and guidance on screening, case management, and infection prevention protocols. It must also address crisis care guidance for health facilities on managing limitations on bed availability and critical supplies. Importantly, this guidance and support should focus not only on hospitals, but also on smaller clinics and urgent care centers where people with COVID-19 symptoms may initially present. The government should also act to address the financial burden that a surge in cases would also pose, as health systems would be forced to increase staffing, hours, personnel risk mitigation, and other measures outside normal budgeted services.

  • Pursue additional manufacturing capability and reinforce the existing supply chain for personal protective equipment (PPE) and other critical medical supplies. The US should urgently review its PPE supply chain—for domestic and international use—to determine availability of basic PPE during a respiratory epidemic of COVID-19. The US should urgently develop and publicly communicate plans for PPE distribution within the US and globally. It should also develop options for addressing PPE shortfalls, including scaling up PPE manufacturing, and parameters for reuse in crisis conditions. At a global level, the World Health Organization (WHO) should lead and publish a review of vulnerabilities in the global supply of PPE and explore urgent new mechanisms for global sharing and distribution of limited PPE stores. These analyses should also include other critical medical supplies and equipment that could face shortfalls in a pandemic scenario.


  • Communicate regularly to the public through trusted experts. Fear, panic, and mis/disinformation will exacerbate preparedness gaps and cost lives. The US should continue to communicate outbreak information to the American public through scientifically credible communicators. The recent practice of communicating through knowledgeable senior HHS, CDC, and NIH officials has been positive and should be maintained. These officials should regularly update the public on planning for COVID-19 spread in the US and globally.

  • Increase and sustain domestic and global preparedness investments. US pandemic preparedness planning at a federal level waxes and wanes in the absence of a crisis. With the expiration of the 2015 Ebola funding for hospital preparedness, the US must create a more sustainable financing model for hospital epidemic preparedness, as well as preparedness within broader health systems and among urgent care facilities and walk-in clinics. Importantly, the approach used on Ebola—designating a small number of highly capable reference facilities—would be insufficient to meet needs of a more widespread domestic outbreak of COVID-19. Guidance and mechanisms for supplying surge capacity in crisis situations also remains a gap. Funding to enhance public health preparedness for major outbreaks is also inadequate, and needs sustained ongoing support. Meanwhile, at state and local levels, the executive branch should support governors and mayors to develop and exercise preparedness plans for COVID-19 and other emerging pandemic risks.

  • Address urgent vulnerabilities in the developing world. A virus that can strain a health system like China’s will pose enormous challenges to health systems in poor and underdeveloped countries. As Ebola outbreaks have demonstrated, infection prevention is weak, and frontline health workers in the developing world are at particular risk. The US should partner with other donors, philanthropies, and the WHO to reinforce pandemic preparedness and infection prevention and control readiness in the developing world, both urgently for the current outbreak and through longer-term health security investments.

  • Support coordinated international action. The COVID-19 outbreak is rapidly becoming an international coordination challenge. While the WHO declaration of a Public Health Emergency of International Concern was intended to align international engagement and investments, it has not prevented countries from imposing sweeping travel restrictions despite WHO advice to the contrary. The political and diplomatic challenges around this outbreak will only become more fraught in the weeks ahead. The UN Secretary-General and the WHO Director-General should jointly convene a special UN Security Council meeting to harmonize international action on the outbreak, and consider setting up a standing coordination and leadership platform for high-consequence biological events, such as those with the potential to overwhelm national governments, within the Office of the UN Secretary-General.

  • Support research and innovative technologies. As with any emerging disease, a tremendous amount of knowledge must be generated to understand the nature of the virus; develop, test, and manufacture medical countermeasures; and determine the evolving epidemiology, best practices for clinical care, and the impact on populations, economies, and security. Likewise, technological innovations hold the potential to support the response to COVID-19 and future major pandemics. Technologies like digital health platforms, rapid point of care diagnostics, and population-level data tools are achievable and could prove important to the response. The US should support collaborative research and innovation, integrating professionals from academia, the private sector, and government to develop and validate knowledge to mitigate the outbreak. This should include pursuit of regulatory, logistic, and broad platform and manufacturing innovation to accelerate bringing solutions into timely use.

  • Amplify diagnostic capacity. Diagnostic capacity for COVID-19 in the US remains limited, with samples going to centralized CDC and state public health labs and at times taking several days to convey results. These turnaround times burden frontline hospitals that must isolate patients for extended periods while awaiting results. Volumes remain limited even with CDC distribution of its emergency use authorized test kits. Efforts are needed to scale up testing capacity, including through accelerating investments in rapid point-of-care testing.

  • Develop new partnerships to distribute and dispense medical countermeasures for COVID-19 now, before they come online. Last-mile dispensing of medical countermeasures has not been solved in the US. While there has been progress in major cities, the US should urgently assess its plans, staffing, and partnerships with the private sector for administering and dispensing medical countermeasures for COVID-19 once they come online. These plans should account for a variety of circumstances, including vaccine hesitancy; hard-to-reach communities; protection of healthcare workers and others administering, delivering, or dispensing medical countermeasures; and other disruptions that could impede medical countermeasure delivery, dispensing, or administration.


Related Topics:
Global Health, Outbreak Preparedness, Infectious Diseases, Migration, Displacement, and Humanitarian Policy, Humanitarian Assistance

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posted for fair use
 

northern watch

TB Fanatic
Jonathan Cheng‏Verified account @JChengWSJ 56m56 minutes ago

Daily industrial output figures illustrate the slow return to business. Steel transaction volume one day this week was 23% lower than the same day last year, while coal consumption by power producers was 39.6% below the year-earlier level on the same day.
 

night driver

ESFP adrift in INTJ sea
REF: Comments on the DMAT being dispatched and spun up for MIRAMAR.

DMATs are in no way STRATEGIC entities, They won't be involved in Strategic investigations or anything like that,

DMATs are muddy boots on the ground, dirty handed treatment people. USUALLY, first-pass meatball save-the-patient surgeries with later save the limb and other interventions. USUALLY, they are staging for transport to tertiary care facilities a LONG way away.

For THIS they become the tertiary facility which can be incinerated and destroyed after it does its job of treating the nCoV/COVAD-19 patients.

So that nobody in the Miramar area has to unbuild a hospital like they did in Dallas.
 

jward

passin' thru
well guess this is why we don't see cases out of africa- looks like zimbabwe is now also able to test- :eek:
Global Biodefense Retweeted



Helen Branswell
@HelenBranswell

10h

#Covid19: Update on testing capacity in Africa. At the beginning of Feb. only Senegal & South Africa had labs that could test for the new virus. More can now (green) but the countries that can't still outnumber them. Countries in white are in a diff WHO region. source:
@WHOAFRO
View: https://twitter.com/HelenBranswell/status/1228008892145131520?s=20
 

northern watch

TB Fanatic
Jonathan Cheng‏Verified account @JChengWSJ 1h1 hour ago

A shortage of supply renders traditional stimulus measures powerless to address the problems China is facing. “If companies aren’t open, and workers are hundreds of miles from workplaces, lower interest rates and fiscal spending won’t do much good."
 

jward

passin' thru
REF: Comments on the DMAT being dispatched and spun up for MIRAMAR.

DMATs are in no way STRATEGIC entities, They won't be involved in Strategic investigations or anything like that,

DMATs are muddy boots on the ground, dirty handed treatment people. USUALLY, first-pass meatball save-the-patient surgeries with later save the limb and other interventions. USUALLY, they are staging for transport to tertiary care facilities a LONG way away.

For THIS they become the tertiary facility which can be incinerated and destroyed after it does its job of treating the nCoV/COVAD-19 patients.

So that nobody in the Miramar area has to unbuild a hospital like they did in Dallas.

do they have a closet full of vents to take with, perhaps? :: crossin' fingers ::
 

LoupGarou

Ancient Fuzzball
SOMEONE is being REAL proactive!!

These Units take a LOT of bubbling under work on a weekly and monthly basis to be ready to MOVE OUT!!! at the drop of a hat.
FEW folks not involved understand what it takes. Even the medical staff in the TO&E for that unit won't FULLY understand unless they are working in a tertiary responsibility for logistics.

NOT a REAL surprise ( I suspect there are 10 others getting a hint to go through their prepacks to make sure nobody went in and rat****ed the gear for one or two things they HAD to have SOMEWHERE other than in the storage warehouse or hangar.

PRAYERS to everyone playing NDMS games right NOW.

I was about to post that everybody with a spare scanner might want to program in not only their local EMS frequencies, but also both the NIFOG list, as well as the FEMA/NDMS lists. Since they are VHF and above, if you hear activity on those frequencies, it means that they are "in the area" (within 50-70 miles)...

NIFOG easy to program in list (not all of the frequencies in use, but the main ones):

FEMA/NDMS/MERS and USAR:

Just listening to your local EMS frequencies will tell a lot once things get thicker.

Loup
 

rondaben

Veteran Member
I can live with that .... well, 80% chance I could, anyway lol.

Ok, well, that is ideal distribution. If the total infected those that are more critical will not get vents, those needing a bed in a hospital will be at home and so forth. Thats when the mortality rate would go up.

CDC strategy is to slow it down so that the case load won't swap the system. I wish them luck.
 

jward

passin' thru
I hadn't run across this before, it is interesting... hopefully

Kai Kupferschmidt
@kakape

·
11h

Important from
@DrMikeRyan
: In places incl. Singapore, China and Hong Kong, 1000s of samples of people who aren't suspected of having #COVID19 being tested as part of normal winter respiratory disease surveillance. “At the moment, we're just not seeing COVID activity in these."




----------------------------------------
Kai Kupferschmidt

@kakape

·
11h

“That would give an indication that the iceberg may not be that great. That's not a guarantee. But this idea that this iceberg is absolutely massive and in some way we're only detecting one or two or 5 percent, this is all based on modeling” #COVID19
View: https://twitter.com/kakape/status/1227997502986739715?s=20
 

jward

passin' thru
Ok, well, that is ideal distribution. If the total infected those that are more critical will not get vents, those needing a bed in a hospital will be at home and so forth. Thats when the mortality rate would go up.

CDC strategy is to slow it down so that the case load won't swap the system. I wish them luck.

Seems about the only tool we have right now... it's the swamping and bottle necks that scare me: people can rise to amazing heights, when needed. but ya simply can't pull vents outta yer arse.
 

Hogwrench

Senior Member
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