Coronavirus:

[Rufus T. Firefly]

I have been limiting my contact with other people and NO hand shaking. Too many people apparently out of toilet paper.

I would not be shaking hands with folks that are out of toilet paper............

But how would you know? I suppose there would be a stain of sorts. ???

Ask Hondo. He apparently has a detection system,

[Rufus T. Firefly]

If you do not have a need to be out in public, stay out of the public sphere for the next 2-4 weeks as much as possible. Just good public health policy at this point. Hopefully there will be some positive news about anti-viral drugs in the next few weeks or month, but there's no guarantee.

Hard to think that might happen - terribly lucky, or terribly premature.....

With any luck, the advent of warm weather will also work in our favor in the coming weeks.

I'd be wary of hanging any hats on the hopes of warm weather being a factor - have to look at what's happening in Singapore and Australia. And then expect a resurgence with this in the Fall.

[Neil]

It's all relative.

There are over 30 clinical trials of drugs that show in vitro activity against the virus, which has shown good correlation in clinical settings with clinical activity, so I'm optimistic that some of these drugs will have activity. Anyway, you just need the drug to modify the course of infection, reduce infectivity, not necessarily have 100% effectiveness. That could cut the death rate by 50-90% if it pans out. Unlike cancer drugs, anti-microbial drugs have a much better correlation between activity in the test tube/petri plate and in the patient.

All respiratory viruses known to us have seasonal peaks in the winter and seasonal nadirs in the summer, so it seems likely the same will happen with this coronavirus, although there are obviously no guarantees. The infection rate in tropical or warmer areas has thus far been much less than in colder climates, which is also typical of respiratory viruses. We're talking relative risks, not absolute. If the epidemic slows down by 40-50% when ambient temperatures rise, that will greatly ease the problem for our ICUs and health care systems.

We'll know soon enough whether either possibility pans out. Meanwhile, public health measures to avoid transmission have a good chance of having an effect, and other than under-reaction by the Feds, are well underway. Non-essential personnel should be working from home, even for medical centers. When I'm off clinical service, I expect to be staying home, at least for a few weeks, but that decision hasn't yet been made. Everyone not involved in direct patient care should be working from home for a while. People not involved in actually producing goods or services directly should be staying home in areas with community spread. Trump's personal ideas are idiocy, by and large, as expected, and represent his fantasies about what public health measures are in the main. The virus is already here, so suspending all air travel by non-US citizens makes no scientific sense and will be economically unnecessarily damaging. This policy reflects his xenophobia and scientific illiteracy, not the opinions of his scientific and clinical advisers, I very much suspect.

[Rufus T. Firefly]

When I'm off clinical service, I expect to be staying home, at least for a few weeks, but that decision hasn't yet been made. Everyone not involved in direct patient care should be working from home for a while. People not involved in actually producing goods or services directly should be staying home in areas with community spread.

UVA med has already directed all of its staff to avoid gatherings of more than 25, less if they are not known associates, and to stay home otherwise.

I'll probably forego hitting my office on campus next week; work in the home office entirely. Hit the library yesterday....grocery store....

Trump's personal ideas are idiocy, by and large, as expected, and represent his fantasies about what public health measures are in the main. The virus is already here, so suspending all air travel by non-US citizens makes no scientific sense and will be economically unnecessarily damaging. This policy reflects his xenophobia and scientific illiteracy, not the opinions of his scientific and clinical advisers, I very much suspect.

Ludicrous stuff last night; irrational and based in foolishness. More bizarre behavior at today's press.....really have to begin to wonder about his mental state.

[HONDO74]

I would not be shaking hands with folks that are out of toilet paper............

But how would you know? I suppose there would be a stain of sorts. ???

Ask Hondo. He apparently has a detection system,

If you believe that I have some other goodies I can sell you.

[HONDO74]

If you listened to Chinese state-run media, you'd think President Trump went to China and released vials of COVID-19 on groups of unsuspecting men, women and children.

Beijing has been bending over backward trying to convince the world that the United States is the real culprit behind the quickly spreading virus that's already claimed more than 4,600 lives across the globe.

It's a high-stakes strategy for the Asian nation fighting to keep its superpower status amid a national lockdown and palpable anger over claims that Wuhan, China, the epicenter of the coronavirus, at first covered it up, triggering a worldwide health and economic crisis.

[Rufus T. Firefly]

If you listened to Chinese state-run media, you'd think President Trump went to China and released vials of COVID-19 on groups of unsuspecting men, women and children.

You mean he didn't?

[MurphOnMillerAve]

Considering the conversation, herein, up to this point, I thought I would add a real-life experience for me, which has just occurred:

This morning I had scheduled myself for a visit to my urologist. He then sent me to the hospital to which his office is subtended, for a blood test.

I found the procedures they all had in-place interesting and sensible, and something I had anticipated, having seen all the news about the virus.

How I prepared:
I never touched a door knob without using a small paper napkin I had brought ( a pocketful) for the purpose; hand sanitizers were at every turn, and I used them, but did not touch the lever to cause the Purell to be extruded without using a paper-napkin each time, discarding each one immediately after its use on that particular task.

I was cautious not to lean on any counters; to keep my hands off my face ( that took discipline,) and even picked-up the pens that were proferred for signing forms with a napkin, too, even using one when asked to use a pen that only made a mark on a screen, not paper.

And here was my boldest move: when I was seated in the waiting-room of the Lab for the blood-test, a mumbling older female sat across from me, and then, a middle-aged+ man entered the room and sat two sets away from me. So, I said aloud, cheerfully but with obvious purpose, "OK, I'm going to assume none of us has to cough or sneeze, right?" The man replied that he had been sneezing and coughing. I immediately got up and left the room, something I'd never have said or done before all this virus stuff, for an adjacent waiting room. I "apologized" for that to him, sort of.

When I got back in the car, before touching the steering wheel, I immediately used hand-sanitizer we have always kept in the driver's door compartment.

When I got home, I washed my hands up to the elbows, and washed my face, then, and had lunch, which included a couple nectarines and some cantaloupe, all of which I had washed in Palmolive dish-detergent yesterday.

Howz all that grab ya, guyz ?

[Rufus T. Firefly]

Can't hurt. Maybe carry your own pen in the future Who else might be touching your steering wheel?

[rogruth]

I have grand daughter that is a nursing student in a large state university ( not in Georgia ) that was told she and other students must attend hospitalized patients or they will fail. I understand that this is something that must be done by someone. She was told that nurses must be able to handle all cases whenever needed. I also understand this but for a student? I suppose that if done it proves that a student is capable.

[Neil]

Our students in medicine and nursing will not provide care for high risk patients, which makes sense. If things get worse, we may have to ask for volunteers. Right now, we have one positive case out of a few million people, but I'm sure we have lots of undetected or asymptomatic cases. Once testing gets underway, the numbers will go up. Fortunately, our ICUs are not overwhelmed at present.

[Neil]

Just so you know the cavalry may be on the way (fingers crossed):

Remdesivir: A Possible Treatment for 2019 Novel Coronavirus
March 12, 2020 by Mark Abramowicz, M.D. Leave a Comment
A well-known, broad-spectrum, antiviral drug appears to be the best early hope for an effective treatment of COVID-19. It is active in vitro and in animal models against SARS, MERS, and other coronaviruses. Remdesivir is not approved in any country for any use, but it is manufactured by Gilead and was stockpiled for use against Ebola, which is not a coronavirus and against which it was not particularly effective, but the drug appeared to be safe.

Two clinical trials of remdesivir are underway in China, and the National Institute of Allergy and Infectious Disease has begun a randomized controlled trial of the drug in hospitalized adults with a confirmed diagnosis of COVID-19 at the University of Nebraska Medical Center in Omaha. Gilead is apparently willing to consider compassionate use requests for other hospitalized patients with a confirmed diagnosis and significant clinical manifestations. At least one patient, who had visited Wuhan, has been treated with the drug in Washington State. On his 5th day in the hospital, the 9th day of illness, he developed radiographic and clinical signs of severe pneumonia and was treated with IV remdesivir; the next day he became afebrile and his signs and symptoms improved markedly.1 Gilead is ramping up production of the drug.

ML Holshue et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382:929.

[Rufus T. Firefly]

Been following right along with that one.

Hopefully they can get more data.

[Rufus T. Firefly]

Once testing gets underway, the numbers will go up. Fortunately, our ICUs are not overwhelmed at present.

Yup. Hope that the latter does not go up though.

[up148]

The lack of testing kits is extremely disappointing. In the KCMO area we have a huge lack of kits, but the usual warnings from government medical spokespeople.