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Coronavirus Pandemic

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5 minutes ago, Jimmy Skinner said:

From horrible personal experience, I know that there is a huge difference between using a facemask with oxygen and being intubated and having the ventilator do all the work. Once that happens, you are unlikely to ever get off.  I question the need for tons more ventilators if the chance of ever getting off one is so poor anyway. 

Each case is different. An elderly smoker with comorbidities is less likely to wean than a young healthy athlete. The key is always to wean asat.

Edited by Frmr CLEder

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15 minutes ago, Toddguy said:

Regardless the death rate from people who need to be ventilated from COVID-19 is horrific/will horrific and if the general public realized this there would be many more panicked people worried not only about the availability of ventilators but the very negative prognosis that comes along with someone requiring one to begin with. 

 

Yes I agree completely. I think what I was trying to get at (unsuccessfully) was that people with ARDS who need ventilators survive at a much higher rate than what we are seeing with COVID-19.

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I also have a graph of total cases, but I don't find that very useful overall, and especially not at this point, since the data for the last 12 days is still listed as "Preliminary" on the ODH website.

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There's a lot I still don't really understand, but I'm really hoping that Ohio is doing this right and that the outbreak here will be much smaller than other parts of the country. My mom can't get this. Like, she seriously can't. And she still has to go to work ("essential"). Hell, no one can. I'm 32 and I question if I'd be able to pull through, honestly. Many young people dying as well.

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11 minutes ago, jam40jeff said:

hospitalizations.png

deaths.png

 

Is that Ohio?


"Life is 10% what happens to you and 90% how you respond." -- Coach Lou Holtz

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2 minutes ago, KJP said:

 

Is that Ohio?

 

Yes.  Sorry, I should have specified.

 

Also, I'll get out ahead of this question...

 

I know that yesterday the deaths in Ohio were reported as 29.  However, today ODH has updated their data such that yesterday's total is listed as 28, and the 29th death has now been assigned to today (March 30).  I'm not sure why they did this, but I am keeping my data in sync with the official ODH website data even as they modify it.

Edited by jam40jeff

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One thing I don't understand is how a breakout ends. Like....let's assume we "flatten the curve" effectively in Ohio. At the bottom of the curve there are still people with the virus. What happens when one of those people unknowingly spreads it to somewhere where there wasn't a big outbreak. Would that just start the whole process over again?

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3 minutes ago, Zyrokai said:

One thing I don't understand is how a breakout ends. Like....let's assume we "flatten the curve" effectively in Ohio. At the bottom of the curve there are still people with the virus. What happens when one of those people unknowingly spreads it to somewhere where there wasn't a big outbreak. Would that just start the whole process over again?

 

 

no one knows how it ends. i believe flatten the curve is just to keep illness and death down until we understand the disease better and there are immunizations.

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4 minutes ago, Zyrokai said:

One thing I don't understand is how a breakout ends. Like....let's assume we "flatten the curve" effectively in Ohio. At the bottom of the curve there are still people with the virus. What happens when one of those people unknowingly spreads it to somewhere where there wasn't a big outbreak. Would that just start the whole process over again?

 

a) herded immunity - enough people have antibodies that the risk is very low

b) vaccine becomes widely available

c) we start letting everyone who has recovered back to work, in "nonessential" businesses especially.


Very Stable Genius

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1 minute ago, DarkandStormy said:

 

a) herded immunity - enough people have antibodies that the risk is very low

b) vaccine becomes widely available

c) we start letting everyone who has recovered back to work, in "nonessential" businesses especially.

 

Pretty much the only options.  As more people recover from the illness, and assuming that the predictions of 2-3 years of future immunity are correct, the spread will be more difficult as the people who already had it will be "stoppers" who now can't contribute to the spread.  I believe I have seen where 60% is considered a sufficient number to be able to effectively control a disease through herd immunity.  As for (c), that will require serum testing for antibodies.  I believe NY has approved that.  I wonder when that will become widespread.

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28 minutes ago, Zyrokai said:

One thing I don't understand is how a breakout ends. Like....let's assume we "flatten the curve" effectively in Ohio. At the bottom of the curve there are still people with the virus. What happens when one of those people unknowingly spreads it to somewhere where there wasn't a big outbreak. Would that just start the whole process over again?

As previously mentioned this will occur in waves, with each wave managed to be less severe than the previous wave. This will get us to "herd immunity."  Its the slow way to get there, taking more time, but less catastrophic.

 

Italy is an example of explosive, massive and catastrophic exposure. Once over however their population will have been mostly exposed and have acquired herd immunity. They will be done with it.

 

SARS-COV-2 antibody tests (IgA, IgM) are in development. Device manufacturers and reference labs need expedited FDA approvals.

Edited by Frmr CLEder

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actually and unfortunately i have read having it does not mean it helps you with immunity from getting it again in the future. 

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33 minutes ago, jam40jeff said:

I know that yesterday the deaths in Ohio were reported as 29.  However, today ODH has updated their data such that yesterday's total is listed as 28, and the 29th death has now been assigned to today (March 30).  I'm not sure why they did this, but I am keeping my data in sync with the official ODH website data even as they modify it.

 

I wonder if that's just a small blip because of a lack of testing in some areas, or perhaps a true flattening of the curve. Interestingly, Kentucky has seen fewer newer cases over the past three days. Both Kentucky and Ohio have been more proactive and stringent on the regulations than other states, such as Tennessee, where it's spreading like wildfire.

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18 minutes ago, Zyrokai said:

One thing I don't understand is how a breakout ends. Like....let's assume we "flatten the curve" effectively in Ohio. At the bottom of the curve there are still people with the virus. What happens when one of those people unknowingly spreads it to somewhere where there wasn't a big outbreak. Would that just start the whole process over again?

 

I would look at South Korea for an example of how to flatten the initial curve and then reopen society. Large events remain cancelled and most companies are requiring or encouraging employees to work from home, but there are no shelter-in-place orders and I believe most business closures have been lifted. They have adequate testing available and have put basic precautions in place to reduce the spread. For example, anyone getting on a bus is required to have a mask, and if they aren't wearing one, the driver gives them one. There are also hand sanitizer dispensers at both the front and back doors.

 

 

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3 minutes ago, mrnyc said:

actually and unfortunately i have read having it does not mean it helps you with immunity from getting it again in the future. 

 

We don't know for sure because the virus is new and scientists haven't had a chance to study it in depth, but from what I have heard, most scientists believe you will gain immunity to the virus once you get it. The biggest risk is that if the virus start to mutate, we could end up with multiple strains passing through the population, and we don't really know if immunity to one strain will protect you from other strains.

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2 minutes ago, taestell said:

 

We don't know for sure because the virus is new and scientists haven't had a chance to study it in depth, but from what I have heard, most scientists believe you will gain immunity to the virus once you get it. The biggest risk is that if the virus start to mutate, we could end up with multiple strains passing through the population, and we don't really know if immunity to one strain will protect you from other strains.

 

I have also read that they believe the mutations have been very minimal and that immunity likely will last for at least a couple years.

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20 minutes ago, taestell said:

 

I would look at South Korea for an example of how to flatten the initial curve and then reopen society. Large events remain cancelled and most companies are requiring or encouraging employees to work from home, but there are no shelter-in-place orders and I believe most business closures have been lifted. They have adequate testing available and have put basic precautions in place to reduce the spread. For example, anyone getting on a bus is required to have a mask, and if they aren't wearing one, the driver gives them one. There are also hand sanitizer dispensers at both the front and back doors.

 

 

Have they nailed it or does this represent the first of several waves of managed infection?  I would say it's probably the latter.

 

We dont know how much of their population has already been infected and as we already know, confirmed cases is misleading and only represents a fraction of the total number of infected.

Edited by Frmr CLEder

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7 minutes ago, seicer said:

 

I wonder if that's just a small blip because of a lack of testing in some areas, or perhaps a true flattening of the curve. Interestingly, Kentucky has seen fewer newer cases over the past three days. Both Kentucky and Ohio have been more proactive and stringent on the regulations than other states, such as Tennessee, where it's spreading like wildfire.

 

Did you mean to quote something else?  The blurb you referenced was about the number of deaths in Ohio, not the number of cases.

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1 minute ago, Frmr CLEder said:

Have they nailed it or is this the first of several waves of infection?

 

We dont know how much of their population has already been infected.

 

The question is, after the first wave is over, can we start to slowly reopen society while keeping heightened sanitary practices in place (mask wearing, social distancing, avoiding large gatherings, increased hand washing, increased cleanliness) and avoid a second wave? So far, Korea has shown that it is possible, but of course, it will take time before we know if they are able to completely avoid a second wave. Maybe they will eventually get a second wave but it will be much smaller than other countries because they keep these measures in place.

 

Unfortunately, I think that when the first wave is over in America, we are much more likely to revert to our old ways -- people not washing their hands enough, going into work even though they feel sick, starting to forget the social distancing guidelines -- and that's going to set us up for a very big second wave.

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Except for Italy, we should resign ourselves to the fact that this will be with us for a while and until a therapeutic and/or vaccine is a available, our lives will be very different.

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15 minutes ago, DarkandStormy said:

 

a) herded immunity - enough people have antibodies that the risk is very low

b) vaccine becomes widely available

c) we start letting everyone who has recovered back to work, in "nonessential" businesses especially.

 

Exactly:

 

The way I picture this (I was one class from a math minor with my economics degree, so I am dumb at math but generally understand basic things), is the curve being flattened doesn't mean there won't be a large "aggregate" number of people who contract coronavirus. It only means it happens over a longer period of time, so the "sum total" of people receiving is the same as it would be otherwise.

 

Now, that would make survival rates higher overall because the hospital system could take care of people as they need to and not be overrun with delays in care.

 

Overtime, let's say in October (before a vaccine still), that in Ohio let's say that 30% of people have had the virus and shed it (survived) and thus have immunity. Well, that will really tamp down on the spread (for example currently around say 2.5 R0 to a 1.5 R0) and thus the waves won't be as high. That is basically the premise of it (I know my numbers aren't correct I am just spitballing things).

 

Then, once a vaccine is developed, the percentage of people that have immunity may be 50% and the virus is just circulating throughout the country in small waves here and there. Then, everyone gets the vaccine who hasn't been exposed to the virus and thus we develop herd immunity.

 

After this, it will become like the flu.

 

This will forever change our healthcare system. What was once the baseline of ICU beds and nurses, etc. will be a new, higher baseline to deal with the coronavirus on top of the flu every year. I don't see how this could possibly "die out" like SARS, it will probably always be in circulation one way or another.

 

Something interesting about the 1918 flu pandemic was that older people were surviving much better than younger folks. They had found that there was some immunity back in the 1880's from a different strain of H1N1 that protected a lot of people. For the younger generation, they never experienced this strain and it was a very tough strain of H1N1.

 

We should have some type of immunity to this coronavirus for the rest of our lives and there won't be another pandemic like this unless it is a completely different strain. God we only hope a respiratory Ebola or HIV like virus doesn't strike, that would be truly horrific, too. 

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^ A vaccine is way off. Even with influenza (A and/or B) its an educated guess, based upon circulating strains in the different hemispheres, in preparation for the upcoming season. The vaccine needs to be developed, technology transferred, scaled-up and manufactured, after completion of the clinicals.

 

Best opportunity near term is an antiviral therapeutic. Remdesivir is the furthest along in development and just received expanded access approval. Theoretically if it is safe and effective, in addition to alleviating symptoms, it could also reduce viral shedding, so patients become less contagious.  We'll have to wait and see. Preliminary results are due in April.

 

https://www.statnews.com/pharmalot/2020/03/13/gilead-coronavirus-covid19-clinical-trials/

 

Edited by Frmr CLEder

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^It would be interesting to get these numbers based on numbers per capita per age group. I don't have a way to conceptualize what percentage of Ohioans are 80+, 40-49, etc. If there was a way to break up the age groups by equal quintiles or something, so 20% of the Ohio population is between certain ages, and they make up X% of hospitalizations. Not directly asking you to do this, but I think it would be the easiest way to really understand how the disease is affecting different age groups.

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^ Understand how the disease is affecting "confirmed cases" in different age groups. 

Remember the limitations to the data. There's some inherent bias in the data.

 

Edited by Frmr CLEder

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20 minutes ago, ryanlammi said:

^It would be interesting to get these numbers based on numbers per capita per age group. I don't have a way to conceptualize what percentage of Ohioans are 80+, 40-49, etc. If there was a way to break up the age groups by equal quintiles or something, so 20% of the Ohio population is between certain ages, and they make up X% of hospitalizations. Not directly asking you to do this, but I think it would be the easiest way to really understand how the disease is affecting different age groups.

 

 

age.png

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33 minutes ago, ryanlammi said:

^It would be interesting to get these numbers based on numbers per capita per age group. I don't have a way to conceptualize what percentage of Ohioans are 80+, 40-49, etc. If there was a way to break up the age groups by equal quintiles or something, so 20% of the Ohio population is between certain ages, and they make up X% of hospitalizations. Not directly asking you to do this, but I think it would be the easiest way to really understand how the disease is affecting different age groups.

 

The output would only be somewhat useful as not everyone is tested. Many with symptoms are told to stay home and self isolate.  If you are 60 years old AND symptomatic and don't have HIV or lung or other specific issues, Cleveland Clinic says you are NOT a preferred candidate for testing.  

 

https://my.clevelandclinic.org/landing/preparing-for-coronavirus#testing-tab

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1 minute ago, Pugu said:

 

The output would only be somewhat useful as not everyone is tested. Many with symptoms are told to stay home and self isolate.  If you are 60 years old AND symptomatic and don't have HIV or lung or other specific issues, Cleveland Clinic says you are NOT a preferred candidate for testing.  

 

https://my.clevelandclinic.org/landing/preparing-for-coronavirus#testing-tab

 

I think his point was that it's more helpful than just the raw numbers.  Both the raw and per capita stats have the same flaws, but at least per capita does give you a little more insight by normalizing the raw numbers by population.  But yes, I agree that you can assume the cases per capita would likely be much more even across all age ranges if everyone was tested.  Hospitalizations and deaths are a much better measure in this regard.

Edited by jam40jeff

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1 hour ago, taestell said:

 

I would look at South Korea for an example of how to flatten the initial curve and then reopen society. Large events remain cancelled and most companies are requiring or encouraging employees to work from home, but there are no shelter-in-place orders and I believe most business closures have been lifted. They have adequate testing available and have put basic precautions in place to reduce the spread. For example, anyone getting on a bus is required to have a mask, and if they aren't wearing one, the driver gives them one. There are also hand sanitizer dispensers at both the front and back doors.

 

 

South Korea has 1 border, with North Korea.  Less than 1/6th the population of the US.  Yes they did a nice job reacting & containing, but so many variables in terms of international travel, exposure, local contamination, etc etc etc

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