Medical Discussion of Coronavirus

[xraygoggles]

The data that I looked at regarding deaths from the CDC still shows an overall downward trend, albeit with some aberrant days with a spike. I believe the marked increase in cases is due to increased testing.

??

This is false. Look at any of the numerous charts on any reputable website or any national organization following the trends.

You do realize deaths lag few weeks behind hospitalizations, which lag few weeks behind confirmed positives, right?

[K82]

Agree about the purpose of the initial lockdowns - was to prevent potential bed shortages in hospitals.

However, it does seem like this second part of the 1st wave is akin to having many NYC outbreaks throughout the US, mainly in the South and West. That may lead to multiple states with hospital shortages, but I guess we will find out in a few weeks or so, when all the young asymptomatic people start infecting their parents and colleagues, leading to increasing hospitalizations and eventual deaths. Hopefully not.

But if I had to guess, I don't think the US will be able to maintain control over the virus until there is strong leadership from the federal govt or a vaccine. (although with the rampant anti-vaxxers in social media, even that may not turn out favorably).

What do you mean "strong leadership from the federal govt"? Do you think we need to shut down again?

[K82]

??

This is false. Look at any of the numerous charts on any reputable website or any national organization following the trends.

You do realize deaths lag few weeks behind hospitalizations, which lag few weeks behind confirmed positives, right?

Yes, I realize that. Where are you seeing deaths rising? The charts I have seen shows them on a general downward trajectory. Its not a straight line with every day seeing fewer than the day before, but the trend is down. I just looked at a graph that showed June 26 and June 30 were higher, but otherwise the deaths are trending down. We are more than 14 days after the start of all the riots and protesting and Trumps rally but there hasn't been a spike of deaths yet. It may be coming and maybe things will get worse but I don't see the data to support that yet.

Here is the site I just looked at:

https://www.nbcnews.com/health/health-news/coronavirus-deaths-united-states-each-day-2020-n1177936

[billy]

had a response ready to go re: ex of weak leadership and strong leadership during this crisis, but also dont want to go back to politics in this post--> we covered it around page 40 something and came close to having the thread closed. But strong leadership doesn't mean nation wide shut down now, at least not to me. It does mean a coherent, science based response that is data driven and not politically driven.

[G]

Yes, I realize that. Where are you seeing deaths rising? The charts I have seen shows them on a general downward trajectory. Its not a straight line with every day seeing fewer than the day before, but the trend is down. I just looked at a graph that showed June 26 and June 30 were higher, but otherwise the deaths are trending down. We are more than 14 days after the start of all the riots and protesting and Trumps rally but there hasn't been a spike of deaths yet. It may be coming and maybe things will get worse but I don't see the data to support that yet.

Here is the site I just looked at:

https://www.nbcnews.com/health/health-news/coronavirus-deaths-united-states-each-day-2020-n1177936

Well, notwithstanding that you forgot to comment on the glaring falsehood of "I believe the marked increase in cases is due to increased testing"...I'm looking at my county data. It is interesting. Stay at home order ended end of May. 7-day moving average inflected sharply upwards 3 weeks later (unfortunately, I don't have easily accessible positivity rate data). So far the deaths and patients in hospital have been steadily rising without a concomitant upward inflection point. That is why the next couple of weeks will be interesting....

Based on the positivity data showing an upswing in the second half of June, why would you expect to see current data showing a spike in deaths? That makes about as much sense as looking today for a spike in the birth rate from the home quarantine order!

[xraygoggles]

What do you mean "strong leadership from the federal govt"? Do you think we need to shut down again?

No, that's not what I mean. And as G said above, I don't want to make it political, let's keep this related to health/medical aspects.

I just meant that it would be much wiser to have a single point of leadership which doles out factual, scientific, proven recommendations, than this haphazard way of doing it state-by-state, where governors are limited in what they can and can't say based on re-election prospects...

How can anyone objectively say that the way the US is handling the virus right now, piecemeal, state by state, is the best way to do it?

[StarTrekDoc]

I'm in WI. Radiology.

A situation we observed early on with this made me wonder about how virulent the disease really is. We had a group of locals go on a Nile River cruise in Egypt and someone on the ship had Covid. 12 people in one of our local communites came down with it early on. They came home and were going about their usual daily activities until they became symptomatic. We thought we were going to see a huge surge related to this since there weren't many cases in WI at that time and these people were going about their usual daily activities. What surprised us was that no one in these folks families came down with it even though they lived with them for days. I know there are incidents out there with a large number of people in a bar getting it from someone, but this early unfolding made me wonder whether shutting everything down over this was the right thing to do.

You can use that philosophy for any vaccine regimen too. You didn't see it....so wonder if it's worth it. Do we really need mmr or polio since we haven't experienced it for so long....right?

Consider WI lucky for the most part. There were early clusters but the wide scale shutdown was nec and effective to putting out the fire as we simply didn't know where it was AND had very short supply lines that were disrupted.

Our mistake is we opened too quickly for a quick buck and recovery. We laid out an opening plan and essentially void it the next day. The only states that have been doing it right based in medical evidence are the likes of Hawaii Alaska and at the edge..new york.

At no time did primary care here close down. We transitioned to telehealth but stayed open even for in person visits. We did defer care...even delayed it due to dear, which we had to educate aggressively to minimize it. Mammograms were done.

The only real delay was screening Colo for a short time due to ppe constraints. Was there probably a cva or mi completed at home due to the fear factor? I wouldnt doubt it especially during the early weeks. But once was got stabilized the true emergency visits recovered nicely without the Ed as my primary care visits clogging the system

[K82]

No, that's not what I mean. And as G said above, I don't want to make it political, let's keep this related to health/medical aspects.

I just meant that it would be much wiser to have a single point of leadership which doles out factual, scientific, proven recommendations, than this haphazard way of doing it state-by-state, where governors are limited in what they can and can't say based on re-election prospects...

How can anyone objectively say that the way the US is handling the virus right now, piecemeal, state by state, is the best way to do it?

I'm not sure the Federal Govt has the constitutional authority to make mandates like that over the states. Also, every state is very different in regard to population densities, healthcare resources etc. It can't be a one size fits all.

I agree that this shouldn't be a political discussion but that cats out of the bag. This disease is the most politically charged health care issue I have ever seen and people are kidding themselves if they don't think that the policies and actions related to this thing are largely politically motivated rather than based on sound science. And that includes how the media is reported on this whole thing. They were trumpeting the daily deaths when that was the most horrendous, now they are reporting daily new cases as if that's equivalent to daily deaths. Its a very different thing. As I stated before , the daily deaths are trending down despite the marked increase in daily new cases. Why would that be? Some options include an increase number of tests done, less virulent virus or better treatment options, younger pts contracting it, to name a few.

[K82]

Well, notwithstanding that you forgot to comment on the glaring falsehood of "I believe the marked increase in cases is due to increased testing"...I'm looking at my county data. It is interesting. Stay at home order ended end of May. 7-day moving average inflected sharply upwards 3 weeks later (unfortunately, I don't have easily accessible positivity rate data). So far the deaths and patients in hospital have been steadily rising without a concomitant upward inflection point. That is why the next couple of weeks will be interesting....

Based on the positivity data showing an upswing in the second half of June, why would you expect to see current data showing a spike in deaths? That makes about as much sense as looking today for a spike in the birth rate from the home quarantine order!

Deaths occur roughly 14 days +/- after symptoms begin, correct? Looking at the stats for WI, we opened back up for business in early May. There was also an outcry from many about the in person voting allowed throughout the state on April 7. Many experts predicted a huge swell in the deaths from Covid related to these things. It hasn't happened. Here is a graph of our cases from our Dept of Health:

https://www.dhs.wisconsin.gov/covid-19/data.htm

There were a couple days of spikes at the end of May with around 20 people per day dying but other than that its a consistent slow downward trend. If all the hysteria is correct wouldn't we be seeing a steady upward daily death number?

I don't understand your statement that a spike in deaths well after 14 days after increasing exposure is the same as a rise in birth rates from the home quarantine. Are you saying that more time is needed to see if the daily deaths increase? It seems to me that it should be occurring by now.

I'm also not sure why you believe it to be a "glaring falsehood" that the increasing number of positive cases is related to increased testing that's being done. Why does this not make sense to you?

[K82]

You can use that philosophy for any vaccine regimen too. You didn't see it....so wonder if it's worth it. Do we really need mmr or polio since we haven't experienced it for so long....right?

Consider WI lucky for the most part. There were early clusters but the wide scale shutdown was nec and effective to putting out the fire as we simply didn't know where it was AND had very short supply lines that were disrupted.

Our mistake is we opened too quickly for a quick buck and recovery. We laid out an opening plan and essentially void it the next day. The only states that have been doing it right based in medical evidence are the likes of Hawaii Alaska and at the edge..new york.

At no time did primary care here close down. We transitioned to telehealth but stayed open even for in person visits. We did defer care...even delayed it due to dear, which we had to educate aggressively to minimize it. Mammograms were done.

The only real delay was screening Colo for a short time due to ppe constraints. Was there probably a cva or mi completed at home due to the fear factor? I wouldnt doubt it especially during the early weeks. But once was got stabilized the true emergency visits recovered nicely without the Ed as my primary care visits clogging the system

I'm certainly not saying the whole thing is a hoax. I'm just saying that from my experience in my community it didn't spread like wildfire like we expected it to. I disagree with you that we opened too quickly, I don't think we opened soon enough. As more data comes in there are those who have stated that we probably shouldn't have shut down at all. I don't know what would have been the best course but I think that Docs can lose sight of collateral damage to our country by shutting down like we did that may well have been worse for us than just staying open and dealing with this thing. I may be wrong but so far the data I've presented supports my contentions.

[fatlittlepig]

Deaths occur roughly 14 days +/- after symptoms begin, correct? Looking at the stats for WI, we opened back up for business in early May. There was also an outcry from many about the in person voting allowed throughout the state on April 7. Many experts predicted a huge swell in the deaths from Covid related to these things. It hasn't happened. Here is a graph of our cases from our Dept of Health:

https://www.dhs.wisconsin.gov/covid-19/data.htm

There were a couple days of spikes at the end of May with around 20 people per day dying but other than that its a consistent slow downward trend. If all the hysteria is correct wouldn't we be seeing a steady upward daily death number?

I don't understand your statement that a spike in deaths well after 14 days after increasing exposure is the same as a rise in birth rates from the home quarantine. Are you saying that more time is needed to see if the daily deaths increase? It seems to me that it should be occurring by now.

I'm also not sure why you believe it to be a "glaring falsehood" that the increasing number of positive cases is related to increased testing that's being done. Why does this not make sense to you?

Increased testing alone doesn’t explain the rise in cases because the rate of positive tests is increasing. That’s pretty basic.

[G]

Deaths occur roughly 14 days +/- after symptoms begin, correct? Looking at the stats for WI, we opened back up for business in early May. There was also an outcry from many about the in person voting allowed throughout the state on April 7. Many experts predicted a huge swell in the deaths from Covid related to these things. It hasn't happened. Here is a graph of our cases from our Dept of Health:

https://www.dhs.wisconsin.gov/covid-19/data.htm

There were a couple days of spikes at the end of May with around 20 people per day dying but other than that its a consistent slow downward trend. If all the hysteria is correct wouldn't we be seeing a steady upward daily death number?

I don't understand your statement that a spike in deaths well after 14 days after increasing exposure is the same as a rise in birth rates from the home quarantine. Are you saying that more time is needed to see if the daily deaths increase? It seems to me that it should be occurring by now.

I'm also not sure why you believe it to be a "glaring falsehood" that the increasing number of positive cases is related to increased testing that's being done. Why does this not make sense to you?

1) yes
2) because it is false. this is actually an easy one to look up-- don't just believe the leader of the coronavirus task force or his boss or the echo chamber of partisan news.

I will assume you looked at the data on the link that you included. 2 weeks ago the 7 day moving average of positive cases started an upward trend. eyeballing the two week data, it appears that the positivity rate is also going up in WI just like it is nationwide.

for the record, I'm in the category in favor of opening up; I'm just weary of the lies, misinformation, and opinions presented as facts. again, in a couple more weeks, it will be interesting to see what the hospitalization numbers looks like-- good for WI that it is going down so far--my county is up 30% in 4 weeks.

once again, the mortality data in a couple more weeks will be very interesting to see. it would be great if the positive cases reflect younger people getting the disease and not dying and hopefully getting immunity in the process.

[xraygoggles]

I'm certainly not saying the whole thing is a hoax. I'm just saying that from my experience in my community it didn't spread like wildfire like we expected it to. I disagree with you that we opened too quickly, I don't think we opened soon enough. As more data comes in there are those who have stated that we probably shouldn't have shut down at all. I don't know what would have been the best course but I think that Docs can lose sight of collateral damage to our country by shutting down like we did that may well have been worse for us than just staying open and dealing with this thing. I may be wrong but so far the data I've presented supports my contentions.

Here is data taken directly from The COVID Tracking Project.

There is a clear trendline of worsening cases and spread throughout the US, with the exception of the Northeast. It's not just more testing.

[fatlittlepig]

I think NYC and surrounding areas that are enjoying a lull in covid will get hit again eventually when they open up. From what I read they were not remotely close to herd immunity so they’ll get hit again. I don’t think the virus is stoppable short of super aggressive testing and/or lockdown.

[Jaqen Haghar MD]

Lately, I’ve been seeing a dozen cases per day in the ED. I’m averaging one admit every other day. We are still operating at reduced staffing due to a lack of patients overall. We were told the end of days was coming 4 weeks ago after completely reopening, but it hasn’t materialized. (though the news coverage says otherwise). Now I’m told just wait a few more weeks and it will be here.

We saw our 1st major cluster of confirmed cases at the end of February. We were only testing the elderly and those with high risk travel then. I was seeing six of them per shift and admitting them all, hypoxic, elderly and ill.

Now it seems to be the walking well. We are now testing everybody. I’m sure we are seeing more Infection cases and we are definitely testing much, much more per day, so we are capturing the others that we didn’t test before.

I’m just hoping we are building herd immunity, which I believe is the only real way out of this.

When people go out, you see more infections. You can wait inside for 5 years, and I believe the result will be the same when you finally get out.

Our government response and the media coverage appears to be 100% political at this time. We have transitioned to a no cost, no infection strategy. This is of course unrealistic.

It’s just a guess, but I predict this all lasts 2 years. With a big 2nd wave in the fall when schools reopen and windows close.