General / Off-Topic The safest place

[Morbad]

The NIAID has revised down the predicted death toll for the US to ~60k. Hopefully that turns out to be the case.

Herd immunity isn’t a realistic goal, even when you are an optimist like me.

Herd immunity, achieved one way or another, is really the only way a viral pandemic ends.

Inducing herd immunity by doing nothing early on is definitely a silly strategy though.

It is far, far worse than that. The .66% mortality is provided hospital care is available to all those who need it. If that is done, 'only' .66% will die. But if you infect 60% of the norwegians in a year, that means 3 million will be infected, of which 300,000 will need to be hospitalized for an average of ~23 days. If you spread them out perfectly evenly you can have 16 'loads' of patients (365/23). That means that for the next year every single day almost 19,750 COVID beds will be taken. On average, Norway has 3,600 normal hospital beds non-occupied and a total of 800 ventilators. Worse, it is quite possible that those who were infected are not always immune, especially the milder cases. Best of luck.

I think we're going to see much lower than a .66% final mortality rate, with treatment, in the end, both due to infection likely being more widespread than reported and improvements in treatment procedures as we learn about the progress of COVID-19.

The oft repeated points about why mitigations are imposed are spot on though...can't treat everyone if everyone gets it at nearly the same time and health services have marginal surplus capacity.

And I agree with that, to a point.

However there are those of us who still have to work (and volunteer) to keep the country ticking over need to go to work, and some of us are in minimum wage/low paying jobs.

When I have to step back onto the deck of a ship to deliver aid where its needed, I'll be working. Even now because I've always worked for the good of society, I'm out on in the village ready to deliver goods to and check up on those whom are vulnerable.

TL/DR: I didn't like the sneering down the nose idea of Patrick's post that somehow those of us wanting to continue to work for the good of all don't have our Human dignity or pride, when it's us ensuring that the electricity is on so Patrick can spam badly formed 'English speaking west bad' prose.

Oh there is definitely work that needs to be done and some work that is all the more necessary during a pandemic. I'd never get in the way of this and I encourage anyone willing and able to perform such labor without exposing others to undue risk to do so...and to charge as much as they can get away with for their time.

Personally, I don't think people should have to actively work for the good of society; I think good systems reward those who do, and refrain from penalizing people for stepping back if they'd be getting in the way. The idea of work for it's own sake, or to pad financial abstractions like market indices, has never jived with me.

We could have another run on the banks without any more pretend money to prop them up.

Good. Half of them should have been rendered defunct in the last crisis.

Covid-19 is disproportionately taking black lives

Hundreds of years of racism has delivered poor health and economic outcomes for black people, making them more vulnerable in the pandemic.

www.vox.com

Detroit it taking it pretty hard, with a disproportionate volume of casualties among the black population.
One simple reason for increased infection is the use of public transport being higher by the poorest people. But there might be a biochemical reason too.

ACE-inhibitor drugs are well known to be less effective in this subset of patients.

ACE inhibitors in African Americans with hypertension associated with worse outcomes as compared to other antihypertensives | BMJ Evidence-Based Medicine

SARS Cov2 virus binds to the ACE2 protein as its receptor.
One pathway around ACE inhibition is having plenty of ACE2. Maybe the same reason the virus is more deadly here.

Edit:
Crap.
What happens on the African continent then? I hope I am wrong about the biochem.

The powers that be don't care about black people and they care about the African continent even less.

 

[jasonbarron]

Again: anecdotes. You can support any random nonsense with cherry-picked anecdotes. Number of ICU beds have been more than doubled in the Netherlands and they are packed.That isn't normal. You can't put the entire national healthcare system at 200% of capacity with some devious accounting. Despite all measurements the number of people dying above the normal weekly average is more than all other causes combined. You don't get that by writing the wrong diagnosis on some form.

People are dying. They are real. Pretending otherwise is not just incredibly stupid, it is needlessly cruel.

Do I really have to keep sharing the stories where Dr Birx and Professor Ricciardi in Italy say that that is EXACTLY what they're doing and that it isn't "anecdotal" at all? That doesn't mean that the theory is iron clad, but if a guy with your brain power can't at least admit to catching even a whiff of bull being handed out by the powers that be then I honestly don't know how to critique that in a way that would be acceptable to the forum rules.

 

[jasonbarron]

Covid-19 is disproportionately taking black lives

Hundreds of years of racism has delivered poor health and economic outcomes for black people, making them more vulnerable in the pandemic.

www.vox.com

Detroit it taking it pretty hard, with a disproportionate volume of casualties among the black population.
One simple reason for increased infection is the use of public transport being higher by the poorest people. But there might be a biochemical reason too.

ACE-inhibitor drugs are well known to be less effective in this subset of patients.

ACE inhibitors in African Americans with hypertension associated with worse outcomes as compared to other antihypertensives | BMJ Evidence-Based Medicine

SARS Cov2 virus binds to the ACE2 protein as its receptor.
One pathway around ACE inhibition is having plenty of ACE2. Maybe the same reason the virus is more deadly here.

Edit:
Crap.
What happens on the African continent then? I hope I am wrong about the biochem.

Am I the only person who's noticed that according to Worldometer the covid mortality rates are almost nonexistent once you leave the parameters of western civ? There are some exceptions of course, but far and away this seems to be first world problem. I'd be genuinely curious what all of you forum neuro scientists and various experts of sciency things made of that.

 

[Northpin]

Again: anecdotes. You can support any random nonsense with cherry-picked anecdotes. Number of ICU beds have been more than doubled in the Netherlands and they are packed.That isn't normal. You can't put the entire national healthcare system at 200% of capacity with some devious accounting. Despite all measurements the number of people dying above the normal weekly average is more than all other causes combined. You don't get that by writing the wrong diagnosis on some form.

People are dying. They are real. Pretending otherwise is not just incredibly stupid, it is needlessly cruel.

yea, right.
officially reported anecdotes.

Anyway, i'm only advocating realistic reporting. Someone dead because Covid-19 is a correct reporting (pneumonia, septic shock or whatever deadly complication might result directly from Covid-19)
Someone that died for whatever reason not directly related to Covid-19, while being infected with Sars-Cov-2, should not be reported as a Covid-19 case, like the unfortunate terminal cancer patient (he was not the only case, but being the first reported death media was all over this story).

It was also mentioned in the media that accurate reporting is one of the reasons the number of reported Covid deaths in Germany is lower than anywhere else

So yes, people are dying - no one is denying this.
But no one should deny the media appetite for sensationalism and the fact that local authorities might over-report to attract more resources (laudable scope, but the means not so much)

 

[Robin of Spiritwood]

New York City Paramedics Called to Coronavirus DOA Cases Describe ‘Horror Show’

Paramedics used to saving lives now risk their own on coronavirus patients dying by the hundreds at home.

www.thedailybeast.com

The NYC paramedics deserve a special mention. At a rate of 175 deaths more per day at homes, these workers are having battlefield levels of contact with the casualties, and are now forced to truncate resusitations so that they can accomodate the volume.

NYC stats may have to be adjusted up by 10% or so to account for the home deaths that are undiagnosed.

 

[Ralph Vargr]

A few numbers that may show why the herd immunity approach isn’t politically viable.

To obtain herd immunity, 60-80% of a population needs to be immune.
Best estimate so far on Covid-19 mortality rate is 0.66%
Because I’m an optimist, I will use 60% and 0.5%.

In 1 million people, we need 600,000 infected. Of these, 3000 will die.
I Norway with 5 million people, that means 15,000 dead.
In a normal year, 41,000 people die. That is over 35% Increase. Some of the 15,000 would have died anyway, but 30% over a normal year does not look good.

Those 15,000 Norwegians would be 900,000 Americans or 4.2 million Chinese.

Herd immunity isn’t a realistic goal, even when you are an optimist like me.

What's a few megadeaths between friends?

 

[Morbad]

NYC stats may have to be adjusted up by 10% or so to account for the home deaths that are undiagnosed.

Do antibody tests work on compost heaps that were formerly people?

 

[sewerratuk]

So fine - put yourself on the line and let everyone else stay at home.

Once it's all done you can get your gunz out and tear it all up to get things back to normal.

And I'll join you.

But right now that isn't the optimal plan as far as I can see - not when you're betting someone else's existence on it.

Believe it or not some of us in the UK class ourselves as fortunate that we are considered essential workers, we want to go out and work and consider furloughing as a seriously negative thing.
Not all of us want to take an extended state paid vacation, for my part it not because I couldn’t afford too, I just think it’s the wrong policy. For others working with me, they don’t want to be furloughed because they can’t afford the short term financial instability and they also have the foresight to see that it will cause long term financial instability for them and everyone else.
But hey, you all just sit on your asses taking that 80% pay from the state thinking everything is cool

 

[Robin of Spiritwood]

Do antibody tests work on compost heaps that were formerly people?

Yes. But I do not know for how long. Antibodies are just proteins, and they will degrade over time.

 

[ianw]

Believe it or not some of us in the UK class ourselves as fortunate that we are considered essential workers, we want to go out and work and consider furloughing as a seriously negative thing.
Not all of us want to take an extended state paid vacation, for my part it not because I couldn’t afford too, I just think it’s the wrong policy. For others working with me, they don’t want to be furloughed because they can’t afford the short term financial instability and they also have the foresight to see that it will cause long term financial instability for them and everyone else.
But hey, you all just sit on your asses taking that 80% pay from the state thinking everything is cool

I'm classed as an essential worker as is my partner. I'm also classed as a higher risk. And I'm not getting 80% from anyone.

I'm impressed that you worked out that furloughing is a seriously negative thing, did you do that all by yourself or did someone help you?

 

[jasonbarron]

Believe it or not some of us in the UK class ourselves as fortunate that we are considered essential workers, we want to go out and work and consider furloughing as a seriously negative thing.
Not all of us want to take an extended state paid vacation, for my part it not because I couldn’t afford too, I just think it’s the wrong policy. For others working with me, they don’t want to be furloughed because they can’t afford the short term financial instability and they also have the foresight to see that it will cause long term financial instability for them and everyone else.
But hey, you all just sit on your asses taking that 80% pay from the state thinking everything is cool

I like the cut of your jib. Respect.

 

[ianw]

yea, right.
officially reported anecdotes.

Anyway, i'm only advocating realistic reporting. Someone dead because Covid-19 is a correct reporting (pneumonia, septic shock or whatever deadly complication might result directly from Covid-19)
Someone that died for whatever reason not directly related to Covid-19, while being infected with Sars-Cov-2, should not be reported as a Covid-19 case, like the unfortunate terminal cancer patient (he was not the only case, but being the first reported death media was all over this story).

It was also mentioned in the media that accurate reporting is one of the reasons the number of reported Covid deaths in Germany is lower than anywhere else

So yes, people are dying - no one is denying this.
But no one should deny the media appetite for sensationalism and the fact that local authorities might over-report to attract more resources (laudable scope, but the means not so much)

Seems fairly simple really. When the person died was coronavirus present and did it put them in ICU? If the answer is no then it's not down to the virus, if it's yes then it was, it doesn't matter about the underlying conditions at the point of death. Everyone is going to die eventually so you might as well say there is no such thing as a cause of death if you're not going to attribute any contributing factors and you want to be really stupid.

Media reporting is obviously sensationalist garbage for the most part just as local authorities angling for resources is expected, just like budgets being used up just before the end of the financial year to avoid them being cut for the following year. None of this is new or surprising.

 

[Robin of Spiritwood]

From Medscape, behind paywall:
US cardiologists cast warnings regarding HOCQ treatment, with some specifics.

This is basic technical stuff we do on a CCU daily, but it is much harder to try in low dependency units with early stage illness, where the treatment is most likely to be effective. Getting ECGs is time consuming, and subjects workers to greater exposure.

Spoiler

"

Hydroxychloroquine and azithromycin have been touted for potential prophylaxis or treatment for COVID-19; both drugs are listed as definite causes of torsade de pointes" and increase in the risk of other arrhythmias and sudden death, the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society said in a joint statement April 8 in Circulation.

The statement came amid ongoing promotion by the Trump administration of hydroxychloroquine, in particular, for COVID-19 despite lack of strong data.

In addition to underlying cardiovascular disease, "seriously ill patients often have comorbidities that can increase risk of serious arrhythmias," including hypokalemia, hypomagnesemia, fever, and systemic inflammation, the groups said.

They recommended withholding the drugs in patients with baseline QT prolongation (e.g., QTc of at least 500 msec) or with known congenital long QT syndrome; monitoring cardiac rhythm and QT interval and withdrawing hydroxychloroquine and azithromycin if QTc exceeds 500 msec; correcting hypokalemia to levels greater than 4 mEq/L and hypomagnesemia to more than 2 mg/dL; and avoiding other QTc-prolonging agents when possible.

The groups noted that, "in patients critically ill with COVID-19 infection, frequent caregiver contact may need to be minimized, so optimal electrocardiographic interval and rhythm monitoring may not be possible." There is also a possible compounding arrhythmic effect when hydroxychloroquine and azithromycin are used together, but that has not been studied.

There's a known risk of torsade de pointes with chloroquine and a possible risk with the antiviral HIV combination drug lopinavir-ritonavir, two other candidates for COVID-19 treatment. Hydroxychloroquine and chloroquine, both antimalarials, might help prevent or treat infection by interfering with angiotensin-converting enzyme 2 receptors, which the COVID-19 virus uses for cell entry, the groups said.

It is not an easy question to answer without study data. We all want the treatment to work. But we shouldn't be pushed to make medical choices( for or against) by political imperatives, from any source.

 

[ianw]

From Medscape, behind paywall:
US cardiologists cast warnings regarding HOCQ treatment, with some specifics.

Spoiler

"

So hypothetically speaking - it would be a good idea for someone with AF to avoid this treatment?

Asking for a friend.

 

[metatheurgist]

On a side note,the brainless begin to fantasize as "the end" of quarantine approaches.

-In Europe, UEFA wants to end the Champions League competition in June or July,behind closed doors, but the final open to the public.

-In local news, in the Canary Islands, the island's hoteliers association writes a letter to the president of the Spanish football league, offering them to end league games in the islands' stadiums, as there are few infections and to give a way out.

How do these people think that we will stop getting the virus if there is no reliable vaccine or medicine?
I think we are not going to learn anything from this.

People be morons.

 

[jasonbarron]

If the disease is as deadly as they say and you catch it and are circling the drain, are you going to worry about your arrhythmia or are you going to clutch at a possible lifeline?

 

[jasonbarron]

On a side note,the brainless begin to fantasize as "the end" of quarantine approaches.

-In Europe, UEFA wants to end the Champions League competition in June or July,behind closed doors, but the final open to the public.

-In local news, in the Canary Islands, the island's hoteliers association writes a letter to the president of the Spanish football league, offering them to end league games in the islands' stadiums, as there are few infections and to give a way out.

How do these people think that we will stop getting the virus if there is no reliable vaccine or medicine?
I think we are not going to learn anything from this.

There's no vaccine in sight and the virus probably isn't going to magically go away. Out of curiosity, how long do you (or anyone else for that matter) think they can hide from it by quarantining? There are some such as Morbad who suggest that if we "just wait longer" things will be "better" but that seems pretty foolish and naive to me; this isn't going to get "better" for months, if not years.

 

[ianw]

If the disease is as deadly as they say and you catch it and are circling the drain, are you going to worry about your arrhythmia or are you going to clutch at a possible lifeline?

In that situation, lifeline all the way.

But then it's not as deadly as you say they say it is for most people. Except for some.

Dunno about you but if someone offers me a 1 in a 1000 chance to die v a 999 in a 1000 chance to be a squillioanaire I'd rather pass and go down the pub for a beer.

 

[jasonbarron]

But then it's not as deadly as you say they say it is for most people. Except for some.

Let me know when you're done being cute, ok? I don't have all the answers, I just know something isn't adding up. If you can't handle the fact that I'm not as eager to guzzle the koolaid as you are than I can't help you with that.

 

[Ian Phillips]

This is getting rather tetchy.
Please remember to be civil to each other. Thanks.