Medical Discussion of Coronavirus

[Cubicle]

I don't see how you can come up with a vaccine when you can't even say if people who got the disease once can get it again.

This has been on my mind all day. This will pause me from taking the vaccine; show me how it lasts when the real infection doesn't provide future immunity.

[Dont_know_mind]

It looks like the US is advertly or inadvertently going towards a path of herd immunity. I can’t see a way that contract tracing resources would be vaguely possible with the current case numbers. The only option to turn things around would be a very hard lockdown for a month or 2 but this seems unlikely in the current political climate.

The medium term economic effects then would hinge around 1. Is herd immunity possible with this type of virus 2. What is the rate of long term medical sequelae if any from the virus (eg. ACE receptor vasculitis type effects).

[billy]

i think we missed the opportunity for a real hard lockdown in march/april, like some countries in europe did. We were not in a real strict lockdown. Half---'d measures obviously didnt work, and no way the public will stand for a harder lockdown than our previous stay at home edicts. That's what makes this even more frustrating when we continue to argue about masks, which should allow parts of the US to further relax "lockdown" measures if the public buys into the idea. But even that wont help stop spread significantly unless everyone is wearing one (in closed spaces or in close proximity to those outside your immediate family, not saying wear it in your car alone). Sorta like vaccinating only 10% of a population wont work against infections for a particular disease. And the people not wearing masks are more likely to be the ones refusing to social distance in places. Frustrating to watch.

[FIREshrink]

A whole group of my family members in Texas got tested, it was all a complete mess. Results took days to come back; some got both positive and negative test result letters; inconclusive test results; no contact tracing; no follow up phone calls; conflicting text messages. And of several awaiting test results, only one fully quarantined until results came back.

Is it any wonder our epidemic is out of control? Our country is the laughingstock of the developed world. Well, they would be laughing if it wasn't just so sad.

[G]

The whole idea of contact tracing-- with 1) no quarantine and 2) such widespread disease --is nonsense (at least to this simple pit doc).

I had a kid yesterday who came back positive. In the last couple weeks, they had taken a flight and two road trips to one large city and another road trip to another state to a popular park. Good luck tracing that one, especially when the 7d average is approaching 100 cases/day in my county.

In other news, 1/5 of my patients yesterday were in ER for Rona problems and I admitted 2 more to the hospital.

I am relieved to be told that coronavirus is so benign.

[Dont_know_mind]

I’m beginning to doubt the popular narrative that there can’t be another lockdown.

If you look at it globally, there are some states that are doing a second lockdown with second waves of only 200 cases per million population.

The problem with reality is that it’s like a rock. You can pretend it’s not there. If it’s a little rock, that’s not a problem. If it’s a big rock, you’ll keep tripping over it.

With the virus we seem to come back to 3 rocks:
1. Exponential spread
2. strict lockdown is effective in reducing active cases
3. Society has difficulty accepting the consequences of it ripping through.

I had thought it would be contained, there would be some more stimulus and it would be ok. Now I wonder if a second lockdown is inevitable and further hash up. This makes me slightly less optimistic about risk assets than last week.

Not to be alarmist, but if you are still knee deep in first wave, 3 months in and second wave or whatever you want to call it comes along, does that mean you get chest deep or neck deep ?

[fatlittlepig]

I’m beginning to doubt the popular narrative that there can’t be another lockdown.

If you look at it globally, there are some states that are doing a second lockdown with second waves of only 200 cases per million population.

The problem with reality is that it’s like a rock. You can pretend it’s not there. If it’s a little rock, that’s not a problem. If it’s a big rock, you’ll keep tripping over it.

With the virus we seem to come back to 3 rocks:
1. Exponential spread
2. strict lockdown is effective in reducing active cases
3. Society has difficulty accepting the consequences of it ripping through.

I had thought it would be contained, there would be some more stimulus and it would be ok. Now I wonder if a second lockdown is inevitable and further hash up. This makes me slightly less optimistic about risk assets than last week.

Not to be alarmist, but if you are still knee deep in first wave, 3 months in and second wave or whatever you want to call it comes along, does that mean you get chest deep or neck deep ?

I don’t seem another lock down coming as it seems to be spreading through the younger age groups and therefore we haven’t seen a commensurate increase in death rates.

[fatlittlepig]

I don’t see any more lockdowns coming. We have as a country decided on a permissive infection strategy. Wuhan recently had another small outbreak, China tested like 6 million people in a matter of days, also recently in Beijing the same thing. They aren’t messing around, we have decided to take another approach. I’ve been seeing covid patients, I’ve been tested a grand total of zero times. It is what it is.

[PedsCCM]

I don’t seem another lock down coming as it seems to be spreading through the younger age groups and therefore we haven’t seen a commensurate increase in death rates.

Do we really think the virus has changed? Or that our elderly are now well protected by ...? I find those much less likely than 18-40 year olds are the least concerned about the virus and most likely to expose themselves in bars, parties, etc, thus are the canaries telling us that the virus is still present and actively spreading. I also am extremely skeptical that the disease will stay in that group given we have zero evidence of that being true in any country at any time since this has started. Rhetoric along these lines strikes me as extremely hopeful but unlikely. My predictions:

1. Hospitalization increases will continue to follow new case spikes by 2-3 weeks
2. Mortality rates will continue to follow hospitalization rates by 3-4 weeks
3. Masking works. Higher % mask use will allow greater freedom of economic and social interactions while maintaining manageable levels of transmission
4. Some states will need to shut down public indoor gatherings - restaurants, bars, gyms, larger meetings, churches, +/- retail

[Hank]

Let’s please keep the discussion focused on the medical aspect of Covid-19, not politics.

This is a really useful thread. We don’t want to see it go off the rails.

[G]

I don’t see any more lockdowns coming. We have as a country decided on a permissive infection strategy. Wuhan recently had another small outbreak, China tested like 6 million people in a matter of days, also recently in Beijing the same thing. They aren’t messing around, we have decided to take another approach. I’ve been seeing covid patients, I’ve been tested a grand total of zero times. It is what it is.

It will be interesting to see what happens.

Yesterday the two big hospitals in my town were on divert because one was full/closed to everything and in the other medics couldn't offload their patients due to ER saturation.

[Bdoc]

Random update: NYC area here. personally no covid patients for almost 2 months(only the IgG positive ones from previous infection who remain swab positive for months later). Had my first covid patient in 2 months the other day with active symptoms. Travel from California. My guess is that entire plane is going to have it and start a new NYC spread. Here we go again....travel is still very risky IMO. Just a PSA bc I myself am getting more lax and the threat is still real.

[fatlittlepig]

Do we really think the virus has changed? Or that our elderly are now well protected by ...? I find those much less likely than 18-40 year olds are the least concerned about the virus and most likely to expose themselves in bars, parties, etc, thus are the canaries telling us that the virus is still present and actively spreading. I also am extremely skeptical that the disease will stay in that group given we have zero evidence of that being true in any country at any time since this has started. Rhetoric along these lines strikes me as extremely hopeful but unlikely. My predictions:

1. Hospitalization increases will continue to follow new case spikes by 2-3 weeks
2. Mortality rates will continue to follow hospitalization rates by 3-4 weeks
3. Masking works. Higher % mask use will allow greater freedom of economic and social interactions while maintaining manageable levels of transmission
4. Some states will need to shut down public indoor gatherings - restaurants, bars, gyms, larger meetings, churches, +/- retail

im not disagreeing with you. All I’m saying is that as more younger people are infected, our death rates will decrease because the denominator increases and the death rate approaches the true infection fatality rate for the virus.

[Hatton]

My entire extended local family has been exposed to COVID. My ex-sister-in-law has tested positive. She has a fever, aches, o2 90-95%. Short of breath on the phone. Her significant other since she divorced my brother just died of pancreatic cancer. His family had been coming over to her house unmasked. My brother, his 3 daughters, and 3 grandchildren all exposed by this event. I would have gone but it was my birthday and some friends were taking me to lunch. My ex SIL has asthma, diabetes, and is obese so I am not optimistic at all. I remain healthy. Waiting to hear on the rest of my family.

[PedsCCM]

im not disagreeing with you. All I’m saying is that as more younger people are infected, our death rates will decrease because the denominator increases and the death rate approaches the true infection fatality rate for the virus.

I think I agree, but "rate" is kind of a fuzzy term. Case fatality rate should keep going down but I would guess that the absolute deaths/day rate will go up pretty dramatically over the next 6 weeks - at least if my theory holds up. It would be really helpful and solid evidence that something may have changed if this doesn't happen.