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2020 Dumpster Fire (Enter at your own risk)

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3 hours ago, SiouxVolley said:

Hydroxychloroquine and arizothromicin approved in France after 78 out of 80 people improved.  https://www.thegatewaypundit.com/2020/03/france-sanctions-chloroquine-after-78-of-80-patients-completely-recover-from-covid-19-within-five-days/

 

We have seen no benefit from this combination in critically ill patients.  Many colleagues at nearby hospitals are noting the same.  The cytokine storm present in critically ill patients is too much for anything that this combo is likely to touch.  We're transitioning to use hydroxychloroquine for med surg level patients (patients requiring admission but who are not critically ill) in the hopes that it provides more benefit at that level.

 

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I have no idea about this as far as factual, just found it interesting. 

I don’t know this person, but saw this a week or so ago:

 

 

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Almost 4000 ND residents have been tested. Current positive testing rate is 2.8% of those 3909 tested. Let's say that rate TRIPLES across the entire state of our roughly 760000 residents. That tripled rate means 63900 ND residents will be infected when it's all said and done. At a death rate 1.5% ND will have around 960 deaths statewide. If by chance is hovers around 3% from here on out......340 deaths.

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This is a refreshing thread. Nice to be able to read about the facts with (mostly) no mention of Tr*mp or D*mocrats or R*publicans or el*ctions. Here is an interesting look at what Italy has gotten right and wrong.

Quote

There is no time to waste, given the exponential progression of the virus. As the head of the Italian Protezione Civile put it, “The virus is faster than our bureaucracy.”

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19 minutes ago, Oxbow6 said:

Almost 4000 ND residents have been tested. Current positive testing rate is 2.8% of those 3909 tested. Let's say that rate TRIPLES across the entire state of our roughly 760000 residents. That tripled rate means 63900 ND residents will be infected when it's all said and done. At a death rate 1.5% ND will have around 960 deaths statewide. If by chance is hovers around 3% from here on out......340 deaths.

I do not trust the sample size enough yet to extrapolate to the entire population. 4000 ND residents tested is only %0.53 of the total population. It could be better or it could be worse. The math works out under the assumption that we are at peak covid spread in ND or that testing negative will follow linearly on the way up. Based on the available data, I can't make an assumption if we are at peak spread in ND yet, or if we are still on our way there. Likely, it will take a few weeks for us to have a more reasonable picture/ predictable outcome for our state. Thankfully I think we are going to be one of the last to get hit and the first to be done and recover. 

 

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17 minutes ago, dynato said:

I do not trust the sample size enough yet to extrapolate to the entire population. 4000 ND residents tested is only %0.53 of the total population. It could be better or it could be worse. The math works out under the assumption that we are at peak covid spread in ND or that testing negative will follow linearly on the way up. Based on the available data, I can't make an assumption if we are at peak spread in ND yet, or if we are still on our way there. Likely, it will take a few weeks for us to have a more reasonable picture/ predictable outcome for our state. Thankfully I think we are going to be one of the last to get hit and the first to be done and recover. 

 

Aren't all the current models used by the experts using some assumptions? The answer is yes. The models are trying to extrapolate and forecast over 330M.

I'd be shocked if the positive testing confirmation rate in ND winds up being roughly 8.5% across the board when this is over. 

I know even at that total % extrapolated out it doesn't fit the "sky's falling" narrative for which I apologise.

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Posted (edited)

Wow.......June 10.

Screenshot_20200330-202432.png

Edited by UNDBIZ
Removal of politics

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7 hours ago, SIOUXFAN97 said:

probably but it seems like laws are being trampled on left and right....you would think that if you bought a chevy yesterday from "Sally Smith" at Rydell's and you now see 33 year old Sally Smith tested positive for the Rona maybe don't go to work or gma's?

When patients are diagnosed, this is a reportable disease. The patient with Covid-19 is interviewed and a list of contacts is collected and the contacts are contacted. Absolutely no reason for public to get names. It would be a HIPPA violation. 

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39 minutes ago, Oxbow6 said:

Aren't all the current models used by the experts using some assumptions? The answer is yes. The models are trying to extrapolate and forecast over 330M.

I'd be shocked if the positive testing confirmation rate in ND winds up being roughly 8.5% across the board when this is over. 

I know even at that total % extrapolated out it doesn't fit the "sky's falling" narrative for which I apologise.

I never said I did not agree with your math/numbers. Your numbers are not unrealistic. There is not a narrative here. Giving someone the full details on the assumptions made to come to your conclusion is not taking away from your narrative. It helps keeps the reader informed and let the come to their own conclusion. Ultimately, your methodology to reach the low end is just as valid as someones methodology to predict the higher end. Experts use more predictive models that people have worked on for years that have been validated as feasible in the medical research community. They still need to be challenged, which we are obviously doing on both ends of the spectrum. Both sides have merit that can't be disproven until this is over.

We can run numbers all day, but it won't change what is happening. Running the numbers on the flu and relate covid: 34 million Americans had the flu last year, for a total death toll of 33,000, or 0.1% of infected. Covid has an established death rate that is nearly 5 to 15 times more than the flu for this first go around. Assuming that covid spreads just as well and fast as the flu - the traditional virus, that would mean a total death toll of 165,000 to 500,000 in the USA. This can be considered conservative, as covid both seems to spread faster and isnt contained to spreading in specific seasons. With the shelters in place, the goal is to keep it on the lower end of whatever the theoretical range is.

What this means in relation to north dakota: 152 flu deaths last year can translate to 1520 to 1800 covid deaths, placing it at the #1 cause of death in the state. The final death rate for covid would still only be 0.2% of the entire ND population. 

https://www.cdc.gov/nchs/pressroom/sosmap/flu_pneumonia_mortality/flu_pneumonia.htm

The scary sky is falling stat would be the recovered patients vs death statistic. ~160K registered cases in the USA. There has been only ~8000 resolved outcomes. 5000/8000 (62.5%) recovered, 3000/8000 (37.5%) died. Using small sample sizes means in this case means you are 37.5% likely to die if you get corona. CDC states these outcome stats are likely 2 weeks behind, which makes them unusable for now.

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2 hours ago, keikla said:

We have seen no benefit from this combination in critically ill patients.  Many colleagues at nearby hospitals are noting the same.  The cytokine storm present in critically ill patients is too much for anything that this combo is likely to touch.  We're transitioning to use hydroxychloroquine for med surg level patients (patients requiring admission but who are not critically ill) in the hopes that it provides more benefit at that level.

 

Does your hospital have access to Leronlimab?  Shows promise against HIV. It will be hot topic over next few days. Have you seen anyone use corticosteroids?  Have you many (if any ) patients requiring ventilators recover?  Thanks for you great work and thanks for sharing. I’m passing the comments of your experience up our chain of command. Greatly appreciated. Hang in there and take care of yourself. 

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24 minutes ago, dynato said:

I never said I did not agree with your math/numbers. Your numbers are not unrealistic. There is not a narrative here. Giving someone the full details on the assumptions made to come to your conclusion is not taking away from your narrative. It helps keeps the reader informed and let the come to their own conclusion. Ultimately, your methodology to reach the low end is just as valid as someones methodology to predict the higher end. Experts use more predictive models that people have worked on for years that have been validated as feasible in the medical research community. They still need to be challenged, which we are obviously doing on both ends of the spectrum. Both sides have merit that can't be disproven until this is over.

We can run numbers all day, but it won't change what is happening. Running the numbers on the flu and relate covid: 34 million Americans had the flu last year, for a total death toll of 33,000, or 0.1% of infected. Covid has an established death rate that is nearly 5 to 15 times more than the flu for this first go around. Assuming that covid spreads just as well and fast as the flu - the traditional virus, that would mean a total death toll of 165,000 to 500,000 in the USA. This can be considered conservative, as covid both seems to spread faster and isnt contained to spreading in specific seasons. With the shelters in place, the goal is to keep it on the lower end of whatever the theoretical range is.

What this means in relation to north dakota: 152 flu deaths last year can translate to 1520 to 1800 covid deaths, placing it at the #1 cause of death in the state. The final death rate for covid would still only be 0.2% of the entire ND population. 

https://www.cdc.gov/nchs/pressroom/sosmap/flu_pneumonia_mortality/flu_pneumonia.htm

The scary sky is falling stat would be the recovered patients vs death statistic. ~160K registered cases in the USA. There has been only ~8000 resolved outcomes. 5000/8000 (62.5%) recovered, 3000/8000 (37.5%) died. Using small sample sizes means in this case means you are 37.5% likely to die if you get corona. CDC states these outcome stats are likely 2 weeks behind, which makes them unusable for now.

Dr. Birx has stated outside of the NY area the positive confirmation rate nation wide is slightly below 8%. 

BTW I thought anything flu to COVID comparisons were apples to oranges according to many here???

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6 minutes ago, iramurphy said:

Does your hospital have access to Leronlimab?  Shows promise against HIV. It will be hot topic over next few days. Have you seen anyone use corticosteroids?  Have you many (if any ) patients requiring ventilators recover?  Thanks for you great work and thanks for sharing. I’m passing the comments of your experience up our chain of command. Greatly appreciated. Hang in there and take care of yourself. 

I doubt it, but we are trying to get actemra.  It is being approved on a case by case basis by the manufacturer for covid use.  We hope it will help with the massive cytokine release in critical patients.  We are starting to trial steroids a bit, but don't have enough data to report back.

We have had some ventilator patients that we were successfully able to extubate, mostly the young and healthy who you didn't expect to be intubated in the first place.  Many others have not been so fortunate.

One thing we've noticed is the use of paralytics.  For those who aren't familiar, vented patients may or may not need a paralytic agent.  It depends on the patient's ability to sync with the vent.  We're seeing that many vented covid patients are requiring paralytics for much longer and at much higher doses than what we would see for the normal vented population.  It's higher than we would normally even see for ARDS patients.  

My hospital has flipped like 8 or 9 units from their original intended purpose (i.e a post-op rehab unit to covid med surg) in the past week and a half.  We have more than doubled our ICU capacity and still have those beds filled.  Our census goes up by 20% every day, mostly for covid, many critical.  Today we added some beds to a small gym and some more to a small kitchen area.  This is not sustainable. 

Some nearby hospitals have started to ask families of all covid patients about DNR status, because the resources are not there to save those who code.  I wouldn't be surprised if we have that discussion in the next couple days.

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34 minutes ago, iramurphy said:

Does your hospital have access to Leronlimab?  Shows promise against HIV. It will be hot topic over next few days.

I have seen data that Hydroxychloroquine and arizothromicin aren't a miracle cure and dont work on severe cases (But are the only FDA approved drugs to treat Coronavirus?). They usually work best when caught early and virus hasn't vastly spread.

For the other cases...

Quote

Two coronavirus patients in New York City are off ventilators and out of intensive care after they received an experimental drug to treat HIV and breast cancer.

Quote

The drug, leronlimab, is delivered by injection twice in the abdomen, the Daily Mail reported.

Of seven critically ill patients who received the drug in New York, two were removed from ventilators and two showed significant improvement.

https://nypost.com/2020/03/28/coronavirus-patients-taken-off-ventilators-after-getting-experimental-hiv-drug/amp/?utm_source=twitter_sitebuttons&utm_medium=site buttons&utm_campaign=site buttons&__twitter_impression=true

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8 minutes ago, keikla said:

I doubt it, but we are trying to get actemra.  It is being approved on a case by case basis by the manufacturer for covid use.  We hope it will help with the massive cytokine release in critical patients.  We are starting to trial steroids a bit, but don't have enough data to report back.

We have had some ventilator patients that we were successfully able to extubate, mostly the young and healthy who you didn't expect to be intubated in the first place.  Many others have not been so fortunate.

One thing we've noticed is the use of paralytics.  For those who aren't familiar, vented patients may or may not need a paralytic agent.  It depends on the patient's ability to sync with the vent.  We're seeing that many vented covid patients are requiring paralytics for much longer and at much higher doses than what we would see for the normal vented population.  It's higher than we would normally even see for ARDS patients.  

My hospital has flipped like 8 or 9 units from their original intended purpose (i.e a post-op rehab unit to covid med surg) in the past week and a half.  We have more than doubled our ICU capacity and still have those beds filled.  Our census goes up by 20% every day, mostly for covid, many critical.  Today we added some beds to a small gym and some more to a small kitchen area.  This is not sustainable. 

Some nearby hospitals have started to ask families of all covid patients about DNR status, because the resources are not there to save those who code.  I wouldn't be surprised if we have that discussion in the next couple days.

I raised the issue with our hospital CEO today. Over 90% of my patients age 80 or older have indicated they wish to be DNR. Unfortunately most haven’t filled out the forms so unless the ER docs or hospitalist read my notes they don’t ask. We all assume patients are full code unless we have documentation to direct us otherwise. The elderly patients have indicated they don’t wish to be intubated but often family members talk them into being full code. I am reviewing the patients code status every day now with regard to COVID-19. Thanks for the info.  

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The mayor of LA doesn't want you to buy fresh produce....outside in fresh air.

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51 minutes ago, Oxbow6 said:

Dr. Birx has stated outside of the NY area the positive confirmation rate nation wide is slightly below 8%. 

BTW I thought anything flu to COVID comparisons were apples to oranges according to many here???

Statements need to be questioned about what they truly mean before taking them as gospel, just like any other statistic out there about covid. There is a lot of stat manipulation out there as you are aware. I would argue positive testing has many too many uncontrollable variables to it to correlate it to anything significant right now. The arguments down the road will be did we test too early and those who were first panic and tested negative got infected later? Did they get tested again? Where are we testing? Did we test too late? Are all tests account for? IS there a time lag between reporting of negative vs positive? Did we test enough people or not enough? Did we test the right people? Should we have been more or less selective about the people we tested? How does the positive test rate correlate to the entire population of infected? Most of these questions will be answered for us a year down the road. 

Many here are correct about comparisons. I brought up the flu because I've seen it attempted to be used as an argument to discredit the severity of Covid. Comparing the current 3,000 some deaths of COVID to the 33,000 deaths of the flu and calling COVID insignificant is a terrible comparison. Comparing raw totals for an incomplete dataset is an invalid argument that people will disregard. Covid is not an established virus with established weekly/yearly totals yet so it cannot be used for a valid comparison based on totals alone. The comparisons that you can draw, that will be respected and not challenged, have to be established variables between the two viruses chosen. In this case I went with the flu vs covid death rate variables, compared them in a ratio, and scaled up to get realistic theoretical totals. 

What is the spread of a virus in our environment? (10% of Americans get the flu in a year). Within reasonable certainty, you can deem that if a standard virus can easily spread to 10% of Americans every year, a virus of with a similar mode of transmission will also spread to a similar total of the population. In this case, COVID is found to be transmitted airborne and also linger on surfaces for long periods of time, giving it a faster rate of transmission from person to person than the typical virus. For transmission of COVID, it appears to be active in any season, making it deadly all year round (for the flu, it is primarily in the fall/winter season). This makes seasonal totals an invalid argument, at least until weekly rates for COVID are established for the duration of the virus/year. However, this supports the argument that COVID has the potential to spread to more than 10% of Americans if we are not cautious. 

Using the above info on the spread, we can use the established death rates of each virus to scale up to get a reasonable estimate. The COVID:Flu death rate ratio is currently 17.3:1 in the USA. It would be justifiable to use this ratio and multiply it by the average amount of Americans typically impacted by a person to person virus to receive a reliable death total estimate (165-500k). With vaccines being made, more sheltering in place, and supporting our hospital infrastructure by whatever is necessary, I'm hopeful we can lower the severity of it down to the level of the common flu by next year. 

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1 hour ago, Cratter said:

The mayor of LA doesn't want you to buy fresh produce....outside in fresh air.

Is it still safe to poop on the sidewalks?

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7 hours ago, Cratter said:

The mayor of LA doesn't want you to buy fresh produce....outside in fresh air.

I imagine this decision is more about the crowding of the markets and not about the inability to buy fresh produce.

In other parts of the world that have a lower infection and death rate, the farmer's markets are still open because people are actually heeding the two-meters distance suggestion.

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It appears Italy's number of positive tests is sitting steady about 21 days after implementing their lockdown. Their number of deaths is still rising though because of the lag between action and results.

Hopefully, in the coming weeks their numbers of deaths will start declining as well.

Currently, the U.S. is seeing the number of deaths double every three days. If that rate continues for the 21 days that it has taken for most countries following a lockdown, that's 385,000 deaths in the U.S. by April 21. However, at this point many states have not implemented lockdown measures and some places are still openly allowing large groups of people to gather.

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2 hours ago, southpaw said:

It appears Italy's number of positive tests is sitting steady about 21 days after implementing their lockdown. Their number of deaths is still rising though because of the lag between action and results.

Hopefully, in the coming weeks their numbers of deaths will start declining as well.

Currently, the U.S. is seeing the number of deaths double every three days. If that rate continues for the 21 days that it has taken for most countries following a lockdown, that's 385,000 deaths in the U.S. by April 21. However, at this point many states have not implemented lockdown measures and some places are still openly allowing large groups of people to gather.

Walz still good for his 74K during that timeframe? He needs 73390 more in 3 weeks. 

4+ months into this outbreak worldwide and we are a zero short of your number in this country's death total by 4/21. 

Maybe I just need to jump into the Fauci camp of 1.6-2.2M worst case scenario US deaths and just go about my own business but by that time, over the course of 18 months or so, what are any of us going to have to come back to society wise? If this country is in lockdown until June 1 or beyond I have not heard one economic expert say we'll recover from that to pre-corona.

BTW way front page of the Fargo Forum this morning........headline "Study predicts 171 ND virus deaths" and somewhere real journalists and reporters like Chuck Todd and Jim Acosta are dodging dead bodies falling from the sky.

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7 hours ago, dynato said:

Using the above info on the spread, we can use the established death rates of each virus to scale up to get a reasonable estimate. The COVID:Flu death rate ratio is currently 17.3:1 in the USA. It would be justifiable to use this ratio and multiply it by the average amount of Americans typically impacted by a person to person virus to receive a reliable death total estimate (165-500k). With vaccines being made, more sheltering in place, and supporting our hospital infrastructure by whatever is necessary, I'm hopeful we can lower the severity of it down to the level of the common flu by next year. 

Lot of good information but that was a lot to read this early in the morning.

Regardless of how you or I see this.....what are you implying bases on the bolded part for this country to get back to some normalcy? When can we sit and eat in a restaurant? No kids in an actual school building next academic year? When can I watch my daughter participate any of the HS activities she's involved in? When can any of us sit in a church service? When can we go to the gym? When can we go visit family in an assisted living facility or nursing home? Basically when do we get back to living???

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12 minutes ago, Oxbow6 said:

Walz still good for his 74K during that timeframe? He needs 73390 more in 3 weeks. 

4+ months into this outbreak worldwide and we are a zero short of your number in this country's death total by 4/21. 

Maybe I just need to jump into the Fauci camp of 1.6-2.2M worst case scenario US deaths and just go about my own business but by that time, over the course of 18 months or so, what are any of us going to have to come back to society wise? If this country is in lockdown until June 1 or beyond I have not heard one economic expert say we'll recover from that to pre-corona.

Mods:

Where are the facts or does 'no political' not apply here.

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