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  #51  
Old 03-20-2020, 09:48 AM
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I've been wondering about this. How different are CPAPs from ventilators? Because we've got a shipload of those in every suburb. Would a CPAP not serve the same purpose of maintaining gas interchange in a COVID-19 patient? I suppose we'd have to set it to a higher pressure, but they all have the option to be set to different strengths, right?
I have a BPAP that will stop pressure when you put back-pressure on it. If you're too weak to do that then it would have to be a device that moves air in both direction. I'm assuming a ventilator does this. This would leave us with people who are somewhere in between who would benefit from a BPAP. The advantage would be a machine that forces air (and medical oxygen) into the lungs.
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Old 03-20-2020, 10:20 AM
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Now that's something I haven't even heard discussed. Do we know where ventilators are normally manufactured? Is it ... China? How long does it take to manufacture a ventilator anyway?
Washington Post: ď More lifesaving ventilators are available. Hospitals canít afford them.Ē

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  #53  
Old 03-20-2020, 11:13 AM
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The rate limiter for ventilator management is more likely staff one (respiratory therapists, nurses, and physicians) than an equipment one.
  #54  
Old 03-20-2020, 11:30 AM
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That depends on the place; there is a relative shortage of ventilators in Canada if needs skyrocket. One person can program more than one ventilator, but not everyone has respiratory therapy or emergency care knowledge.
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Old 03-20-2020, 12:20 PM
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No doubt. My statement was based on this 2015 modeling exercise.
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... The number of available critical care physicians was the most constraining key component at the conventional capacity level, limiting the maximum number of ventilated patients to 18,900. The number of available critical care and intermediate care beds was the constraining key component at the contingency capacity level, limiting the maximum number of ventilated patients to 52,400. At the crisis capacity level, the number of available respiratory therapists was the key constraining component, limiting the maximum number of ventilated patients to 135,000. (Table 2) This assessment showed that even if bed capacity and some staff capacity could be expanded by including general ward beds and employing the services of noncritical care physicians and nurses, U.S. ventilation capacity would still be limited by the number of trained respiratory therapists at the crisis capacity level. ...
Current US supplies per the NYT:
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Hospitals in the United States have roughly 160,000 ventilators. There are a further 12,700 in the National Strategic Stockpile, a cache of medical supplies maintained by the federal government to respond to national emergencies.
Maybe staffing has increased since 2015 but I doubt that was the directionality. About 172K ventilators available is significantly more than crisis level staffing (assuming full staff, none out sick or no child care) capacity of 135K.

Of course more is better as it is impossible to 100% efficiently utilize the resources available.
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Old 03-20-2020, 12:42 PM
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During wartime, factories were retooled to pump out aviation parts and required supplies. Some factories have offered to do this for ventilators. At this stage, the ventilator manufacturers may be trying to balance profits and goodwill - but much of the manufacture is done in China. The Canadian government seems to be doing its best to avoid estimating how many are needed - since no one knows and it does not want to buy and store many more than necessary, if it can buy them at all with so much international demand.

Iím sure the modeling exercise is relevant and valid. But Iím less sure that the scope of recent events was envisioned. Itís nice to see pharmacists and breweries pumping out hand sanitizer. But soap probably still works better.

Staffing issues could become very relevant.
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  #57  
Old 03-20-2020, 01:03 PM
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Of course, as you know, a sick patient would likely need IVs, medicines, fluids, intubation or setup for possible intubation, a calibrated oxygen supply, monitors which can measure vitals and oxygen, catheterization, frequent turning, a clean environment, precautions to avoid contaminating staff, frequent blood work, ECGs, central lines, nutrition, family support, bathing or disinfection, addressing comorbid conditions, etc., etc.

The staff are needed. For the people likely to get ill or suffer consequences from being ill (including problems caused by treatment), the problem is a lot more difficult than a shortage of ventilators and RTs.
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Old 03-21-2020, 05:15 PM
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Those are very well written articles.

I don’t know how good your local hospitals are about sharing staff and supplies. In Canada, this raises some issues. The numbers are worse if staff or supplies are needed in different locations, which is inevitable. Sure, there will be more cases in bigger cities - but I would guesstimate the efficiency of distribution to be less than 75 percent? Perhaps lower for staff than equipment? I am too unfamiliar with the American system to be able to make a reasonable guess.

In Canada, some smaller hospitals are running low on masks and reusing them. The government has just bought over ten million N95s and hopefully with distribute them at full speed. One concern, of course, is initial waves and the “worried well” arrive at ERs before later waves of greater acuity.

Crossing my fingers that the number of identified cases is the tip of the iceberg and that milder cases reflect a milder strain. Since too much is unknown, one must prepare for other scenarios.
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  #59  
Old 03-21-2020, 05:39 PM
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Yeah I am not so sure that U.S. hospitals would do so well re-allocating resources either. A small plus to the consolidation of healthcare into large hospital systems though is a small bit better of a chance to re-allocate less inefficiently within the systems anyway.

More often it isn't the resources that get moved but the patients.

Your unknown/prepare comment made me think that the OP's comment in this thread is right on the money for the whole pandemic!
Quote:
I can understand the urgent need to make sure nobody underestimates this, but I feel like knowingly presenting false information as fact to achieve this is reckless, especially from doctors. I wish she had just said “we simply don’t have enough data to know the risk, so we need to treat it as high risk until we have more data”
  #60  
Old 03-21-2020, 06:17 PM
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Of course, as you know, a sick patient would likely need IVs, medicines, fluids, intubation or setup for possible intubation, a calibrated oxygen supply, monitors which can measure vitals and oxygen, catheterization, frequent turning, a clean environment, precautions to avoid contaminating staff, frequent blood work, ECGs, central lines, nutrition, family support, bathing or disinfection, addressing comorbid conditions, etc., etc.

The staff are needed. For the people likely to get ill or suffer consequences from being ill (including problems caused by treatment), the problem is a lot more difficult than a shortage of ventilators and RTs.
I think this illustrates the key factor in this crisis. Coronavirus may be with us forever but the crisis is due to the amount that's happening right now. Our health care system doesn't have the capacity to handle a hundred thousand people all having this disease in the same week. People who would recover if they could be treated are going to die because there won't be enough treatment available for everyone.

A few years from now, if a hundred people are sick with coronavirus every week, it'll be just another health problem for our healthcare system to handle alongside all of the others.
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Old 03-21-2020, 07:15 PM
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Those are very well written articles.

I don’t know how good your local hospitals are about sharing staff and supplies. In Canada, this raises some issues. The numbers are worse if staff or supplies are needed in different locations, which is inevitable. Sure, there will be more cases in bigger cities - but I would guesstimate the efficiency of distribution to be less than 75 percent? Perhaps lower for staff than equipment? I am too unfamiliar with the American system to be able to make a reasonable guess.

In Canada, some smaller hospitals are running low on masks and reusing them. The government has just bought over ten million N95s and hopefully with distribute them at full speed. One concern, of course, is initial waves and the “worried well” arrive at ERs before later waves of greater acuity.
I had to go to Emergency at Joseph Brant Hospital in Burlington yesterday, for a matter unrelated to COVID-19. I was dreading it - I figured worried-well and everyone with a sniffle would be there.

There was... no one. Well, there was exactly one person in the waiting room, and a small handful of patients in the examining rooms. Staff far outnumbered the customers. I do not in my whole life remember an ER being so underused. I was swept in, thoroughly examined, had my blood taken and tested, a full ECG, and sent on my way in an hour, including check-in, administration, the works.

It was actually sort of encouraging. If there ever is a wave of patients truly needing help, it'll take people NOT going just because they have a mild fewer and a sore throat to ensure the resources are free.
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Last edited by RickJay; 03-21-2020 at 07:18 PM.
  #62  
Old 03-21-2020, 09:58 PM
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Yes. Coronavirus will be with us forever but within a couple of years, we will all be immunized and immune.
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Old 03-21-2020, 10:57 PM
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You would hope, but the more people are infected, the more likely that it splits into different strains and becomes something like seasonal flu, where you can get a vaccine for one strain but need to do that basically every year.
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Old 03-22-2020, 10:41 AM
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Iíve heard from a few people that folks are finally using the ER for emergencies. I donít think RickJayís experience was unique.

SARS has been studied for 17 years. We donít have a vaccine for SARS or other mutating viruses. The RNA mechanisms and mutation make vaccines quite challenging. Hopefully, our best minds and new money come up with something.

Perhaps things would be easier if the government had more clearly messaged: ďBecause so much is unknown, we are treating this seriously. We are acquiring more data to guide us. Until we can ascertain the risk, we ask everyone to follow these guidelines and will relax them as soon as it is safe to do so.Ē

Unfortunately, a measured approach with less disruption would require much more widespread testing than is available in Canada with strict isolation of positive cases. The media would have to strike a less fearful tone. And given the situation in some places, would not be without controversy. All things considered, I think the Canadian government has tried hard to strike a balance. But it wonít be easy to back off from tough measures, will set precedents, and wonít be inexpensive. There is much to be said for maintaining normalcy and one hopes the right lessons are learned for how this can be improved.
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  #65  
Old 03-22-2020, 10:53 AM
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I hope it does split into strains and the more lethal ones die out (The other ones can too). I hope a yearly vaccine shot is soon available, as with the flu. Coronavirus was discovered in the 60s and started to get well researched after SARS but clearly will be a stronger focus now.

But it must have been around for tens of thousands of years before, no? I wonder if anything is different or has changed looking at a long-term viral history. Probably no one knows?
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Old 03-22-2020, 11:02 AM
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1. Once most of the population has been infected, it will have a hard time spreading. People can spread the disease without symptoms, but I suspect that people who are immune to the disease will not spread it. I guess it's like SARS, which I believe still exists but isn't killing very many people.
Not to be pessimistic, just realistic, it is not yet known if victims of the disease become immune, or if they cease to be able to spread it.
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2. There will be a vaccine eventually, and there will be a huge rush to get it to people who need it the most (eg the elderly and health care workers). Unfortunately immunocompromised people get no benefit from this.
Immunocompromised people benefit greatly from herd immunity.
  #67  
Old 03-22-2020, 11:28 AM
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even Christians don't know if this virus called Covid-19 is from God, but if it is from God a whole lot of other things will happen next like earthquakes, famine, wars, nations in turmoil (these promises are in the New Testament)

The Bible also says, "Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."

This virus does not like heat so summer should see it's being less, but I think we will all be back in this same predicament by December 2020
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Old 03-22-2020, 11:42 AM
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Immunocompromised people benefit greatly from herd immunity.
And from vaccines, though they are slightly less effective in that population.


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Old 03-22-2020, 12:57 PM
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I hope it does split into strains and the more lethal ones die out (The other ones can too). I hope a yearly vaccine shot is soon available, as with the flu. Coronavirus was discovered in the 60s and started to get well researched after SARS but clearly will be a stronger focus now.

But it must have been around for tens of thousands of years before, no? I wonder if anything is different or has changed looking at a long-term viral history. Probably no one knows?
Coronaviruses are group of viruses within the family of Coronaviridae. The coronaviruses responsible for the 2002-2004 SARS outbreak, the MERS outbreaks, and the recent COVID-19 outbreak are all of recent zoonotic origin; that is, they have recently been transferred from animals to humans. In fact, most pathogenic viruses and bacteria have a zoonotic origin. CDC: Zoonotic Diseases. This is an essential consequence of animal husbandry and the incautious preparation and consumption of animal products.

It is really difficult to track the genetic history of viruses very far because as they are not living organisms they do not directly transfer or combine genes from one another, and essentially exist due to lateral gene transfer from living organisms. However, in the pre-civilization era although zoonosis could and did occur, serious pathogens simply couldnít travel very far because if they had detrimental effects on hunter-gatherer populations they would simply disable or kill infected groups. The rise of epidemic disease is an artifact of civilization, e.g. living in dense groupings, wide travel and commerce, industrial food processing and distribution, living in enclosed spaces with pathogen-friendly surfaces, et cetera.

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Old 03-22-2020, 01:13 PM
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Iím aware that many betacoronoviridae show so much genetic similarity to animal diseases that their zoonotic origin is relatively clear. But no one was looking at coronaviruses for so long that it would be interesting to know more about their history. As you say, we may not know enough to do that now and it may be impossible. Iíll buy that a severe disease affecting an isolated hunter-gatherer group might well die out after exhausting its hosts. But civilization in the sense of dense populations is at least several thousand years old; the network effects of someone being able to travel almost anywhere and return are perhaps fifty years old. That speaks to contagion, and maybe to zoonosis too.
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  #71  
Old 03-22-2020, 01:40 PM
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VICE News: ďThe Scientific Detectives Tracing Coronavirus

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Old 03-22-2020, 04:06 PM
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I canít say I know much about molecular clock analysis. But Iíve read some articles from virology journals on Google Scholar and itís fascinating they can trace certain zoonotic crosses back to 1890 and before. Who woulda thought?
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Old 03-23-2020, 11:22 AM
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Because Australia has been affected (to a degree similar to Canada), and is in summer, it seems at this stage the effects of heat are smaller than the pressure to spread. Flu goes down in the summer. Coronavirus probably wonít go down too much, but I hope it does.
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  #74  
Old 03-23-2020, 11:58 AM
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Not to be pessimistic, just realistic, it is not yet known if victims of the disease become immune, or if they cease to be able to spread it.
Immunocompromised people benefit greatly from herd immunity.
Has there ever been a virus to which humans do not develop a temporary immunity, at least? Temporary being a minimum of 6 months.

If there are viruses to which humans do not develop immunity, are any of those closely related to corona viruses?

Would the fact that, by and large, this thing isn't reinfecting people in China suggest that immunity is attained, possibly just temporarily? (I know there are some reports of at least 1 reinfection, but my understanding is that is not known if that was a reinfection.)
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