Going to start (another) thread on Corona Virus....
#1
....this one is going to bring over good stuff from the GuLp place.....

First:

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Date: March 11, 2020 at 18:29:53 EDT
Subject: Latest on COVID-19 from UCSF's top infection disease researchers

With -- help I was able to arrange a discussion yesterday on COVID-19 with USCF’s top researchers in infectious disease. Here are the notes. I bolded some of the more notable comments from the researchers.

UC San Francisco is either the #1 or #2 hospital in California depending on which survey you read. It is the 4th largest medical research center in the US, based on research grants.

————

University of California, San Francisco BioHub Panel on COVID-19
March 10, 2020

Panelists
Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic.
Emily Crawford: COVID task force director. Focused on diagnostics
Cristina Tato: Rapid Response Director. Immunologist.
Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist.
Chaz Langelier: UCSF Infectious Disease doc

What’s below are essentially direct quotes from the panelists. I bracketed the few things that are not quotes.

Top takeaways
At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US.
Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.
How many in the community already have the virus? No one knows.
We are moving from containment to care.
We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.
40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
[We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.]
The fatality rate is in the range of 10X flu.
This assumes no drug is found effective and made available.
The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%. [See chart by age Signe found online, attached at bottom.]
Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
I can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year.

What should we do now? What are you doing for your family?
Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
How long does the virus last?
On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this
The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based.
Avoid concerts, movies, crowded places.
We have cancelled business travel.
Do the basic hygiene, eg hand washing and avoiding touching face.
Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing.
Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
We would say “Anyone over 60 stay at home unless it’s critical”. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in.
Three routes of infection
Hand to mouth / face
Aerosol transmission
Fecal oral route
"You have been weighed on the scales and found wanting"
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#2
Next (actually continuation of the last, but it was too long as it was).

What if someone is sick?
If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on.
If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis.
If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines. [More I found online.]
Why is the fatality rate much higher for older adults?
Your immune system declines past age 50
Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults.
Risk of pneumonia is higher in older adults.

What about testing to know if someone has COVID-19?
Bottom line, there is not enough testing capacity to be broadly useful. Here’s why.
Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating”.
A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives.
The PCR test requires kits with reagents and requires clinical labs to process the kits.
While the kits are becoming available, the lab capacity is not growing.
The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation.
Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon.
UCSF and UCBerkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified.
Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.

How well is society preparing for the impact?
Local hospitals are adding capacity as we speak. UCSF’s Parnassus campus has erected “triage tents” in a parking lot. They have converted a ward to “negative pressure” which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility.
If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected.
School closures are one the biggest societal impacts. We need to be thoughtful before we close schools. If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services.
Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found.
What will we do to handle behavior changes that can last for months?
Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.

[Dr. DeRisi had to leave the meeting for a call with the governor’s office. When he returned we asked what the call covered.] The epidemiological models the state is using to track and trigger action. The state is planning at what point they will take certain actions. ie what will trigger an order to cease any gatherings of over 1000 people.

Where do you find reliable news?
The John Hopkins Center for Health Security site. Which posts daily updates. The site says you can sign up to receive a daily newsletter on COVID-19 by email. 
[i]The New York Times is good on scientific accuracy.


Observations on China

Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots.
[/i]
"You have been weighed on the scales and found wanting"
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#3
And, to me, this one was MOST informative:
Fwd: Covid 19. From Stanford Hospital Board Member - Sounds like great info and advice for us and loved ones.

Good practical advice.

I have this from a friend of mine who’s brother is on the Stanford hospital board. This is their feedback for now on Corona virus: The new Coronavirus may not show sign of infection for many days.

How can one know if he/she is infected? By the time they have fever and/or cough and go to the hospital, the lung is usually 50% Fibrosis and it's too late. Taiwan experts provide a simple self-check that we can do every morning.

Take a deep breath and hold your breath for more than 10 seconds. If you complete it successfully without coughing, without discomfort, stiffness or tightness, etc., it proves there is no Fibrosis in the lungs, basically indicates no infection. In critical time, please self-check every morning in an environment with clean air. Serious excellent advice by Japanese doctors treating COVID-19 cases:

Everyone should ensure your mouth & throat are moist, never dry. Take a few sips of water every 15 minutes at least. Why? Even if the virus gets into your mouth, drinking water or other liquids will wash them down through your throat and into the stomach. Once there, your stomach acid will kill all the virus. If you don't drink enough water more regularly, the virus can enter your windpipe and into the lungs. That's very dangerous.

1. If you have a runny nose and sputum, you have a common cold

2. Coronavirus pneumonia is a dry cough with no runny nose.

3. This new virus is not heat-resistant and will be killed by a temperature of just 26/27 degrees. It hates the Sun.

4. If someone sneezes with it, it takes about 10 feet before it drops to the ground and is no longer airborne.

5. If it drops on a metal surface it will live for at least 12 hours - so if you come into contact with any metal surface - wash your hands as soon as you can with a bacterial soap.

6. On fabric it can survive for 6-12 hours. normal laundry detergent will kill it.

7. Drinking warm water is effective for all viruses. Try not to drink liquids with ice.

8. Wash your hands frequently as the virus can only live on your hands for 5-10 minutes, but - a lot can happen during that time - you can rub your eyes, pick your nose unwittingly and so on.

9. You should also gargle as a prevention. A simple solution of salt in warm water will suffice.

10. Can't emphasis enough - drink plenty of water!

THE SYMPTOMS

1. It will first infect the throat, so you'll have a sore throat lasting 3/4 days

2. The virus then blends into a nasal fluid that enters the trachea and then the lungs, causing pneumonia. This takes about 5/6 days further.

3. With the pneumonia comes high fever and difficulty in breathing.

4. The nasal congestion is not like the normal kind. You feel like you're drowning.

It's imperative you then seek immediate attention.

SPREAD THE WORD - PLEASE SHARE."
"You have been weighed on the scales and found wanting"
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#4
This was not from the OP, but another poster:

Just bringing over everything I think is relevant....

"Forgot to mention: The 1% fatality rate is a huge LIE or delusional.
The current Concluded Cases Chart's graph has flattened out for a week now at a steady 6%. So the REAL fatality rate is 6%. (Me:  Not sure how accurate that is!)
Based on a 70% infection rate of the US populace, the total US mortality will be almost 14 million. I surmise, that half or more of them will be 65 or over.
So... The undertaker industry and Social Sec. will be happy. Florida and Arizona house prices are likely to drop."
"You have been weighed on the scales and found wanting"
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#5
This is good information and sober advice, except perhaps for the one "internet rumor" post about how easy it is to kill the COVID-19 virus. All of us old fogies need to practice "social distancing" for self preservation. While kids are not usually seriously affected by COVID-19, they are going to be the primary vectors for spreading the disease.
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#6
(03-12-2020, 07:01 PM)Michele B Wrote: This was not from the OP, but another poster:

Just bringing over everything I think is relevant....

"Forgot to mention: The 1% fatality rate is a huge LIE or delusional.
The current Concluded Cases Chart's graph has flattened out for a week now at a steady 6%. So the REAL fatality rate is 6%. (Me:  Not sure how accurate that is!)
Based on a 70% infection rate of the US populace, the total US mortality will be almost 14 million. I surmise, that half or more of them will be 65 or over.
So... The undertaker industry and Social Sec. will be happy. Florida and Arizona house prices are likely to drop."
The person that posted that originally is so full of it the only industry happy right now are the shovel makers...

41 deaths out of 1600+ infected is 2.5%...
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