Sunday, March 15, 2020

Treating At Home

Reviewing Our Situation,

​I first had good enough information about the novel coronavirus to post some details and projections in Year Of The Rat Fink, 1/25/20  ​
That information was fleshed out to it's present form by 1/28/20 post, Viral Valentine  ​

 ​Viral spread has been keeping up with basic predictions of epidemiological models, and the US is set to have a worse time of this than Italy, though Wuhan had it worst of all. Each of us lives in a community, and some are reacting better than others. I have been pleased that Austin has reacted a little ahead of what I expected. 
 At People's Community Clinic, I have been forwarding information and discussing it with other doctors for over a month. Tomorrow morning we set up our new respiratory evaluation protocol, having already had a change in screening and flow for this whole past week. We could not test until Wednesday, though, with a 4 day turn-around, so... I expect a lot of news in Austin tomorrow, and further restrictions. I will know the whole community is on-board when the strip-clubs shut. Really.​
 My eldest daughter, Holly Day MD is a hospitalist in Internal Medicine at a major Texas hospital. 
Thursday she volunteered to take all of the suspected "COVID-cases" on her hospital service. All arrangements are haphazard so far, and she has been forbidden to treat even sicker patients empirically with safe, and available medicines, until tests come back, which the San Antonio Health Dept. only runs Monday through Friday.
Holly is working very hard and long, is a patient person, voted "most compassionate" for all 3 years of her residency program. The obstructionism of the hospital bureaucracy, with injunctions against any patient care until given permission, with no mechanism or expertise to create permission, is a Catch-22 for her and for every patient with this virus, getting sicker, while awaiting a test result.
 This is "normal". This is your vaunted "finest health care in the world". Take good care of yourself. Take vitamin-D, 5000 units per day if you have been taking it awhile, but 10,000 units/d until June if you have not been taking it and you are not an outdoorsy nudist or surf-lifeguard. Avoid crowds, especially indoors. Wash hands with soap and water before after touching things. Avoid touching people, things they touch, your nose and your mouth in creative ways.

Chloroquine phosphate disappeared from pharmacy shelves by early March, here in the US, after 500 mg dose twice per day for 10 days was recommended for coronavirus disease.    
Here is today’s GOOD NEWS:
I just got information from Michael-the-communist that hydroxychloroquine/Plaquenil 200 mg twice per day, is just as effective in treating novel coronavirus, maybe even a hair better. This is available, used long term in some forms of arthritis and autoimmune disease, but would only be used short term for this.
Good Rx Coupons show #60 of hydroxychloroquine 200 mg costing about $20 to $60 at area pharmacies. That would be 3 X 10 day treatments of 200 mg twice per day.

The scientific journal, Nature posted this article 11/12/15
Engineered bat virus stirs debate over risky research
Lab-made coronavirus related to SARS can infect human cells.
Editors’ note, March 2020: We are aware that this story is being used as the basis for unverified theories that the novel coronavirus causing COVID-19 was engineered. There is no evidence that this is true; scientists believe that an animal is the most likely source of the coronavirus.

 Rep. Tulsi Gabbard (HI-02) introduced H.Res.897 which provides for a universal basic payment to help Americans across the country weather the storm caused by the COVID-19 coronavirus pandemic.
“The coronavirus pandemic has created a threat to the health and well-being of the American people, as well as to our country’s economic stability. While some in Washington are focused on taking care of Wall Street, everyday Americans get left behind. That’s wrong. Instead, we must act swiftly to provide a temporary universal basic payment of $1,000 per month to every American adult to help them weather the storm created by this crisis. Taking care of all Americans will stimulate our economy during this downturn,” said Rep. Tulsi Gabbard. “I’ve introduced a resolution that prioritizes people so our economic relief is placed directly into the hands of every American, rather than getting stuck in bureaucracy or ending up in the pockets of big corporations.”

Extra medical capacity and contingency plans are costly liabilities; not allowed; ​they ​​reduce​ shareholder-value.  
A USA Today analysis of American Hospital Association (AHA) hospital bed data shows that if confirmed Covid-19 cases and deaths follow similar growth curves as in China, Italy, and Iran, there could be six patients for every existing hospital bed. This means that no hospital system in the US is prepared for a pandemic.  

​This is really unacceptable behavior among members of Mr Ma's social class. Can somebody inform him?​ 
Thanks again, Michael-the-communist.
​ ​Asia’s richest man announced his intention on Friday to ship 500,000 testing kits and 1 million masks to the U.S. in an effort to combat the coronavirus pandemic.
​ ​Jack Ma’s charitable foundation and his China-based company's foundation, the Alibaba Foundation, have also sourced and donated supplies to other countries being hit by the virus, including Japan, Korea, Italy, Iran and Spain.

​People infected with novel coronavirus shed virus for up to 37 days, with a typical shed of about 3 weeks. 
The drug lopinavir/ritonavir is Kaletra, a once daily pill mainly used to treat AIDS. The Lancet:
For survivors, the median duration of viral shedding was 20·0 days (IQR 17·0–24·0) from illness onset, but the virus was continuously detectable until death in non-survivors (table 2; figure 1). The shortest observed duration of viral shedding among survivors was 8 days, whereas the longest was 37 days. Among 29 patients who received lopinavir/ritonavir and were discharged, the median time from illness onset to initiation of antiviral treatment was 14·0 days (IQR 10·0–17·0) and the median duration of viral shedding was 22·0 days (18·0–24·0). The median duration of viral shedding was 19·0 days (17·0–22·0) in patients with severe disease status and 24·0 days (22·0–30·0) in patients with critical disease status.

​Jet-setting schmoozers seem to be a vector for this virus. It's hitting the elite class faster than street-dwellers.
AUSTIN (KXAN) — There’s no word from UT yet regarding COVID-19 test results of UT President Greg Fenves, who started having a fever Thursday night, according to a UT spokesman. Meanwhile, some people who had contact with Fenves on campus Thursday continue to wait for any guidance from UT.
 In a letter sent out to the University of Texas community Friday, Fenves announced his wife has tested positive for the coronavirus.
Trump tests negative (whew!), France and Spain enter lock-down, and other coronavirus headlines.

​ ​Hence, the question remains why the age distribution of cases is shaped so differently in Italy compared to South Korea. It has also been pointed out that the testing procedures for coronavirus in the countries are very different — Italy has predominantly been testing people with symptoms of a coronavirus infection, while South Korea has been testing basically everyone since the outbreak had become apparent. Consequently, South Korea has detected more asymptomatic, but positive cases of coronavirus than Italy, in particular among young people.  

​ ​If you roll up to a drive-through COVID-19 testing center in South Korea, you might notice that safety procedures extend all the way to your car's air conditioning. You will be advised to hit the recirculation button so that if you're sick, you can keep your pathogens to yourself, in your car, and avoid infecting the medical personnel doing the testing.
​ ​The test takes 10 minutes at most. Results are texted to you, usually the next day. And it's free — paid for by the government.
​ ​Drive-through centers have helped South Korea do some of the fastest, most-extensive testing of any country. And while nobody is claiming that South Korea has defeated the outbreak, experts credit the emphasis on testing with reducing case numbers and fatalities.​''...

 A nation of 51 million, South Korea has tested about 250,000 people since its outbreak began on Jan. 20, with a daily capacity of 15,000. It has conducted 3,600 tests per million people compared to five per million in the U.S.

Just as Gov. Cuomo promised on Thursday, New York’s first coronavirus drive-through testing center opened Friday morning in New Rochelle, and is up and running, collecting samples from anxious New Yorkers in the Westchester County town that has emerged as a hot spot for the national epidemic.  

New York will be the next Italy, but it doesn't have to be.​ 
(Being like Italy is actually "aspirational" for any US city.)
Analysis strongly suggests that the NYC metro area has 5–10 days to quarantine the city or face dramatically overwhelmed hospitals, extremely high death rates, and a ruined economy.  

Speaking of drive-throughs, this article looks at traffic congestion in cities with quarantine (Wuhan) or social-distancing and work-from-home, and other milder precautions. There is a big difference between what China did, shutting everything down and keeping everybody in their houses, vs the helpful measures being progressively instituted by the west. We can't assume we will get the same results, can we? Graphs of traffic congestion make this easy to see.
America has no real public health system – coronavirus has a clear run​, ​Robert Reich
​ ​Instead of a public health system, we have a private for-profit system for individuals lucky enough to afford it and a rickety social insurance system for people fortunate enough to have a full-time job.
​ ​At their best, both systems respond to the needs of individuals rather than the needs of the public as a whole. In America, the word “public” – as in public health, public education or public welfare – means a sum total of individual needs, not the common good.  

.The Pentagon announces "minimal staffing" and all soldiers confined to base. 
Pizza deliveries may soon be curtailed, as well. 
No mention of nuclear sub personnel having virus, or tank crews, or strategic bombers, or missile silo teams, or...

Michael sends this story about how the US military makes mistakes with full staffing and is now the unwelcome-guest:
  Three US servicemen were wounded, along with two Iraqi soldiers, during daylight hours on Saturday when some 33 katyusha rockets slammed into al-Taji Base north of Baghdad. Two of the US soldiers were seriously wounded and are in hospital in Baghdad.
​ ​The rocket attacks were likely revenge for US air strikes on Friday that killed 5 Iraqi soldiers and security police and one civilian, on a base at Jurf al-Sakhar. Kata’ib Hizbullah announced that its fighters took no casualties at all at the base. Indeed, it appears to have been wholly manned by the Iraqi Army but that used to have Shiite militiamen.
​ ​The US intelligence about that base appears to have been entirely out of date, so that the Trump administration actually bombed its own Iraqi ally, the very troops it is supposed to be in Iraq training.  

Here's a chance to break something that really needs breaking. 
Will NATO grab that golden ring?
Defender Europe 2020 can not be cancelled due to corona virus
Although it would be better not to test the ability of NATO doctrines to withstand the modern virus.
And then what? Cancel? This makes no sense. Although many are already starting to support this idea. Currently on the Internet you can find many petitions for the abolition of the exercise. Under them are the signatures of thousands of Europeans.  

​Coronavirus won't slow down the capabilities of artificially-intelligent-autonomous-killing machines, will it? 
What should we call them?​
The US Navy is Developing Autonomous Submarines That Can Kill on Their Own

​I never considered this...
​ ​Coronavirus isn't just causing humans to fight in the aisles of Target over toilet paper. Today in "signs of the apocalypse", hungry monkey gangs are also swarming and fighting - for food - on the streets of Thailand.
​ ​Monkeys in the country are usually well fed by tourists who visit Central Thailand, but visitors have plummeted
as a result of the coronavirus outbreak, which has hit the Asian region hard.
​ ​The animals shown in a video are reported to be two separate "rival gangs" that dwell in the city, according to the Daily Mail.
​ ​Half of the monkeys are said to live in the temple areas, while the others live in the city. The two groups don't usually meet but ended up doing so this past week.

​Disoriented Primate​

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