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  • Originally posted by ChicSkiier View Post
    Very busy in the ICUs in AZ (from Navajo Nation to Phoenix and Tucson from COVID. Started seeing late 30, 40, and 50 yr olds intubated and with severe ARDS. Overflow in ER expected which is actually not a good thing for many reasons.
    I'm very curious.

    Those under sixty (or fifty), how many truly had no underlying conditions: DM or HTN (even unrecognized), BMI>30, moderate asthma, smokers? If CDC to be believed, the mortality for truly healthy under 50 appears to be as low as 0.005%. of course by age forty probably 60% of Americans have at least one such condition.

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    • Originally posted by Max Power View Post
      This is the million dollar question. Just like a cold or STD or anything else, you can be free and clear one day and then be a carrier or symptomatic by the end of the week. Viruses have been around billions of years while we've been here probably not even one million for good reason.

      All of the antibody tests of pregnant women, general public, health care workers, etc basically continue to say ppl having or being recovered from Covid is 8-10x as likely as initially reported since so many have minor or no symptoms. If they say we are at 2.5mil cases, we probably have 20mil+ past or present ones in reality, but you can't test every single person. This is not a shocker when this is what happens with all other known Corona or similar cold/flu viruses also. It is very likely your wife, any health worker, anyone who has taken public transport or shopped in stores, or even any social or interpersonal job person (so basically anyone) may have had it and didn't know it. This was the case for me: only found out through a university antibody study I'd volunteered for; I never had symptoms aside from the minor stuffy nose or aches you get every winter or get from lack of sleep for a night or two... nothing I'd even consider getting treated or tested or missing work for.

      ...In the long term, all we really need to do for Covid is mask up the golden oldies and the weak/immunocomp (as they should be doing in winters anyways)... and we mask+test some workers too. The only people who probably need to be tested regularly are people regular in contact with Covid (front line medical), people with physical touch jobs (athletics, salon, etc), and people working with very vulnerable (NH, ECF, SNF, rehab, etc workers). But what is "regularly"? It is not that it's very dangerous to those workers, but we obviously want to catch it early so they don't superspreader it without even knowing.

      Test kits won't be scarce forever, but there is still no easy way to protocol it. I have no idea if my dentist or surgeon doing a procedure today caught HIV last night or if my barber just caught TB on a flight back from the Caribbean. Once there is a semi-effective vaccine or people get bored with the Covid headlines, common sense will prevail. You could test health and other workers every week and make them wear N95 masks forever and cause brain damage with the CO2 levels, but I think just wearing paper masks in high risk and N95s for known/suspected cases the way we do for TB/MRSA/flu/etc will work. For testing, maybe every 10-30 days (based on facility Covid rate and worker job situation... more for ICU/ER/lab, less for specialists and athletes and police, etc) will probably be the long term consensus... sorta like pornstars?
      Human-ape common ancestor around 6 million years ago so we've been around at least that long, you could say.
      Last edited by FIREshrink; 06-27-2020, 08:15 AM.

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      • Originally posted by FIREshrink View Post

        I'm very curious.

        Those under sixty (or fifty), how many truly had no underlying conditions: DM or HTN (even unrecognized), BMI>30, moderate asthma, smokers? If CDC to be believed, the mortality for truly healthy under 50 appears to be as low as 0.005%. of course by age forty probably 60% of Americans have at least one such condition.
        From the charts I reviewed on Covid pts that I was called on: usually saw one risk factor at least: overweight/obese, prediabetic or diabetic (sx: dka and cough), HTN, or smoker, for example. Saw as young as 22 and up. Some reported unknown exposure. Some with ill family member. I did not review all covid pt charts so this is just on pts I was called on. Definitely more pts >50 but now seeing younger pts. The peak incidence in AZ is yet to come.

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        • Originally posted by FIREshrink View Post

          I'm very curious.

          Those under sixty (or fifty), how many truly had no underlying conditions: DM or HTN (even unrecognized), BMI>30, moderate asthma, smokers? If CDC to be believed, the mortality for truly healthy under 50 appears to be as low as 0.005%. of course by age forty probably 60% of Americans have at least one such condition.
          bmi >40 was top risk factor for those under 50 in my experience back in April. I'd expect similar from the rest of the country. At one point they actually thought smokers somehow were protected from the worst outcomes of COVID. Not sure if that still holds. There was unfortunately the rare truly previously healthy 30 yr olds who died too, but they were a rare cohort.

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          • Originally posted by burritos View Post
            Is anyone noticing utpicks/surges in their ICU's and hospitals. News is making surges sound apocalyptic. That's their job of course. Not sure if that jives with reality.
            Yes.
            Bars closed. Restaurants back to 50%. Between the healthcare, mayor, County Judge, and governor we have “messaging” problems regarding covid-19 and politics. Who would have guessed that!
            https://www.houstonchronicle.com/new...e-15366386.php

            Statements, clarifications and publicity plots. Covid-19 itself is spreading, but they have prohibited electives and really upped the caution factors. ICU space has entered what I call “protected status”. It’s not currently a capacity danger, but it could get there. The population has been advised to cut the crap, limit your activities to needed ones. Not the time to go out for amusement.
            The ironic thing is the demographics are different.
            My daughter can do “electives” outside of the County line. First inclination, move them all. Wiser choice was made. The ones that can truly wait, are being pushed back.
            Coincidently, the word is 15 physicians are being laid off. Not related to the current increase. Seems like a 10%-15% downsizing.
            The numbers have substantially ramped up.

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            • Does influenza disproporionately impact the obese as much as covid? Are there any other acute viral infections which do that?

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              • I just don't get the endgame for this virus. Vaccine? Herd immunity? Will people actually physically distance and wear masks?

                We squandered the lockdown and didn't prepare sufficient testing, tracking, and masking policies to reopen. Clinicians even resist masking at my hospital!! If this courses through our population (and I don't see how it won't unless we drastically ramp up prevention and isolation) and 60-80% of Americans get this in the next year, that's .60 x 340 mm x .005= ICUs and morgues are overrun and over a million dead with major societal disruption.

                What, exactly, is our plan? We aren't an island, we aren't used to having our civil liberties restricted (I'm not saying we should be), but letting this run rampant would presumably crush to many vital systems; it's more than the death toll. What comes next?

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                • By the time vaccine has been developed and validated we'll probably be already close to herd immunity levels. Just my guess. I think vaccine is unlikely to provide durable immunity.

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                  • I have talked with many elderly couples who have resigned themselves to hole up in their home until vaccine.

                    I imagine by the time a vaccine is ready there will only be a few pockets of people left who need it. Depending on if the disease provides lasting immunity

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                    • I am personally prepared to hole up until there’s a vaccine. I haven’t been near another human other than my isolating household since March 9. Unfortunately I am losing my ability to isolate. My wife feels a need to see her dying father, and my 12 grader may have school in September. So I guess I toss the dice and hope that at 62 and reasonably healthy, I’ll survive. No other choice at this point.
                      My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

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                      • Agreed with above.
                        But the strain on the hospital system, food system and general infrastructure will be huge during this process; how are we addressing that? Increasing hospitalizations by 50% and death rates by a similar amount will cause a ton of disruption. How can we mitigate this, since people resist masks, distancing, and hand-washing?

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                        • Those at risk (I question whether we really know that) will choose to give up leisure activities.
                          Some won’t. This may be a situation of attrition. The only thing I know is to survive the majority of the population needs their health and earn a living. Competing interests, but both are required.
                          The government has taken the position of picking “winners and losers”. That is not going to be acceptable very long. Unfortunately some people make a living in the leisure activity space. The words have been so unreliable, influenced by points of view that are presented as facts but really preferences.
                          Fact: 4000 ICU beds with vents can be setup and fully staffed in a week.
                          Fact: The official healthcare experts have lost credibility. Boy crying wolf has sunk in to the public. The honorable Dr. Fauci intentionally misleading saying the public doesn’t need masks.
                          The MedCenter releasing a statement saying “almost out of ICU beds! Then walking it back in 18 hours saying “Oh by the way we can double capacity easily” What we meant was ....
                          Lowering the curve was and is spreading out the number of serious cases.
                          Not one community is currently at capacity. Maybe it’s equilibrium. No one has made public logistical plans for shifting resources.
                          The election politics will continue to the detriment of needed nonpartisan healthcare advice.
                          The economy will continue opening because earning a living isn’t “elective”. Temporary halts will work, but even those will be met with increasing disregard. Now tell me again why the surge in younger demographics?
                          Hotspots will have to be dealt with. That’s reality.
                          It is coming down to individual choice on minimizing exposure.

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                          • Originally posted by snowcanyon View Post
                            Agreed with above.
                            But the strain on the hospital system, food system and general infrastructure will be huge during this process; how are we addressing that? Increasing hospitalizations by 50% and death rates by a similar amount will cause a ton of disruption. How can we mitigate this, since people resist masks, distancing, and hand-washing?
                            You’re just now realizing that the country has a problem?

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                            • Originally posted by snowcanyon View Post
                              Agreed with above.
                              But the strain on the hospital system, food system and general infrastructure will be huge during this process; how are we addressing that? Increasing hospitalizations by 50% and death rates by a similar amount will cause a ton of disruption. How can we mitigate this, since people resist masks, distancing, and hand-washing?
                              I suspect masking and hand washing are the only way forward to minimize all the harms. For this to be widely accepted, we'll need really consistent messaging from politicians, athletes, musicians, social media stars, etc. Leverage social influence to make masks cool and desirable and it can happen. I'm guessing this would probably work best as a national standard. Otherwise we're heading for more unnecessary pain in one form or another

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                              • Originally posted by PedsCCM View Post

                                I suspect masking and hand washing are the only way forward to minimize all the harms. For this to be widely accepted, we'll need really consistent messaging from politicians, athletes, musicians, social media stars, etc. Leverage social influence to make masks cool and desirable and it can happen. I'm guessing this would probably work best as a national standard. Otherwise we're heading for more unnecessary pain in one form or another
                                I think it's probably too late for all that to happen.

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