Mailvox: testing results

A lab technician emails and reminds of the important efforts that are taking place behind the scenes.

I work in a medical testing lab and have been involved in reporting out COVID lab results. From my experience, the negative result to positive result ratio is roughly between 5:1 to 10:1. Only the positives are being reported to public health agencies, and that’s what eventually makes its way to the Hopkins page and other pages.

As an aside, there is probably a 2-to-3-day delay in what happens in the lab, and what shows up on the internet. The latest numbers of new cases reported in the US for today are about 8,000. So this probably represents 40,000 to 80,000 new test results reported in a day. If you understand the work involved to produce a single test result, that is an astounding amount of test results for a test that no clinical labs had just one month ago.

The point is that the private sector industry has done an amazing job responding to this demand in a short amount of time. They are doing much better than any government effort could muster.


The lockdowns cometh

This paper appears to be the primary rationale behind the nationwide lockdowns that are being gradually imposed by governments around the world:

The optimal timing of interventions differs between suppression and mitigation strategies, as well as depending on the definition of optimal. However, for mitigation, the majority of the effect of such a strategy can be achieved by targeting interventions in a three-month window around the peak of the epidemic.  For suppression, early action is important, and interventions need to be in place well before healthcare capacity is overwhelmed. Given the most systematic surveillance occurs in the hospital context, the typical delay from infection to hospitalisation means there is a 2- to 3-week lag between interventions being introduced and the impact being seen in hospitalised case numbers, depending on whether all hospital admissions are tested or only those entering critical care units. In the GB context, this means acting before COVID-19 admissions to ICUs exceed 200 per week.

Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over. In the most effective mitigation strategy examined, which leads to a single, relatively short epidemic (case isolation, household quarantine and social distancing of the elderly), the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined. In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB, and 1.1-1.2 million in the US.

In the UK, this conclusion has only been reached in the last few days, with the refinement of estimates of likely ICU demand due to COVID-19 based on experience in Italy and the UK (previous planning estimates assumed half the demand now estimated) and with the NHS providing increasing certainty around the limits of hospital surge capacity.

We therefore conclude that epidemic suppression is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound. Many countries have adopted such measures already, but even those countries at an earlier stage of their epidemic (such as the UK) will need to do so imminently.

Basically, the less strict the measures, the more likely it is that the number of people requiring treatment will overwhelm the available medical serves at the peak. Hence the term “flattening the curve” which refers to the peak of the bell curve. Different nations are at very different risk in this regard; Germany has 25,000 ICU beds with full respiratory support, or one for every 3,312 people, vs 4,000 for the UK, or one for every 16,610 people.

The USA has 32,000 ICU beds, which puts it right in between at one ICU bed for every 10,000 people. This means that if the mitigation calculations are correct, the medical resources would be overwhelmed by a factor of 8x, thereby leading to fatalities in excess of 2 million. The suppression measures are expected to reduce that by three orders of magnitude, which is why it is safe to expect that they will be imposed, sooner rather than later, in the US, the UK, and other countries that have not yet officially adopted them.

UPDATE: As expected, the UK announced a three-week nationwide lockdown.


The anosmia omen

If you lost your sense of smell, you may be a corona-chan carrier:

In the areas of Italy most heavily affected by the virus, doctors say they have concluded that loss of taste and smell is an indication that a person who otherwise seems healthy is in fact carrying the virus and may be spreading it to others.

“Almost everybody who is hospitalized has this same story,” said Dr. Marco Metra, chief of the cardiology department at the main hospital in Brescia, where 700 of 1,200 inpatients have the coronavirus. “You ask about the patient’s wife or husband. And the patient says, ‘My wife has just lost her smell and taste but otherwise she is well.’ So she is likely infected, and she is spreading it with a very mild form.”

It might be useful to keep in mind, anyhow. On the plus side, the latest numbers out of Italy may indicate that the peak has been passed, as new cases are down 27 percent and new deaths are down 24 percent since March 21.


Mailvox: notes from the frontlines

A nurse-practitioner from the Midwest:

The hotline for this medical system has been receiving 1500 to 2000 calls per day. It is the job of the various Providers to respond to these calls with a general medical prognosis and directions based on the symptoms the patient has described over the phone. Coronavirus has very specific symptoms and unless those symptoms are present it is unlikely the person has it. If they do have that list of specific symptoms, the patient is then told that they “likely have COVID19 and to continue to quarantine themselves for at least 14 days, and if symptoms get worse to go to the ER.” These patients are NOT being actually tested, nor recorded officially.

This specific medical system is big enough that they have developed their own, internal test for the Coronavirus, however patients are not actually tested unless they have to symptoms sufficiently severe to place them in to Tier 1/ER/ICU levels of care. Such symptoms would be a either a very high fever or problems breathing. Medical Professionals who have been exposed to the Coronavirus are also being tested. The phone system is a fairly effective way of dealing with patients at the volumes that medical professionals are needing to wade through them.

The main takeaways from what I have overhead and know is that Coronavirus cases that aren’t severe aren’t being tested, so what effect this will have on the reported numbers, I’m not sure. Also, that larger hospital and medical systems have developed the tests internally, so whether or not the CDC/HHS or any other Federal agency acquires them in bulk isn’t as urgent as it is being portrayed.

A medical security officer, also in the Midwest:

I went into the EOC and suggested that they push the idea up that since there are literally HUNDREDS of vacant restaurants all over, that they rent them for a song (using eminent domain or even Trump’s emergency declaration) and institute drive-through testing like they have in Korea… Literally powerwash them, slap your signs over theirs and use the drive-through and mic hookups already in place…

The lady who I told, who is a senior nurse and emergency response director, paused, thought for a few seconds and said “Well, that could work, but there’s so much more we have to do than just driving through, we have to take temperatures etc”

All I could think was, “bitch, that’s what the WINDOW is for!  Have a tent by the lane, have them rub the stupid thing on their own forehead!  Jesus, use your goddamn imagination!”

We’re fucking doomed… And it’s due to the same stupidity I saw in the senior leadership in the Army that led me to leave…

A nurse in the Southwest:

I can confirm that ED nurses have been instructed to forgo masks. In our particular situation, I believe that it is mostly due to supply issues. People off the street have come in and stolen boxes of masks that we usually leave sitting around and non-clinical people have come onto the unit and taken them as well. Nevertheless, it is frustrating because, prior to now, we have all worn masks on a regular basis during flu season.

The real idiocy is that our N-95 masks, for which we were all fitted upon hire into the ED, have been slated for provider-use only. We nurses do not have any, yet we are the people that go face-to-face more often than any other. However, there are some options, less than ideal, being made available. I am not completely sympathetic to these decisions but the supply matter has hit us hard and I have some understanding of the motives behind them.

A doctor from the South:

I am a medical doctor and I believe both my wife and I have contracted corona. We were unable to test for it because it was unavailable given the strict guidelines in place at the time. One of the things I noticed on a pathology report I saw from a patient in China are these so-called thick mucous secretions in the lungs . This reminded me of what happens to an asthmatic’s lungs when they are having an attack. For asthmatics, they die because they cannot oxygenate their bodies because there is so much mucous in their lungs.

I thought, why not treat these lung symptoms from corona  the way you would for an asthmatic .The reason for the mucous shouldn’t matter.  One of those ways is to use a medication called albuterol which you nebulize and give yourself a breathing treatment several times a day if necessary.

I had been listening to my wife’s lungs for several day,s and on one day I noticed a decrease in breath sounds in one of her lobes along with some wheezing. This is an indication that mucous was plugging up the bronchiole. A worrisome sign and a harbinger of pneumonia potentially coming. I started her on two treatments a day which immediately caused the mucous to break up. We knew this because she started coughing it up. One day later, her lungs were clear and there was no wheezing. I did it to myself just as a preventive measure one time a day. We continued this for about a week before stopping it. It appears we have recovered from the infection.

A retired nursing director from the South:

The corona virus has exasperated the shortage of nurses.  Many of them are mothers and now that schools and daycare are closed they must stay home to take care of their children.  The state medical system is now short hundreds of nurses. Observation – this is what happens when you have to have two parents working in order to be average middle class, no margin.  Not only have we leaned our supply system with no inventory buffer, but we have done the same to our labor pool. 


Hoarding vs debt

It’s fascinating to see people preaching against “hoarding” when they have no problem with debt-funded purchases. Both involve pulling the demand curve forward, but debt is considerably worse than hoarding because you’re making the purchases with money you don’t have.

And yet, people have no problem when it’s done in the much more harmful manner, mostly because they don’t understand the underlying mechanics or the inevitable consequences. Whereas, they are capable of grasping the cause-and-effect resulting in an empty shelf at the local supermarket.


Panic is not the problem

Absolute idiocy is the real problem. And most people are idiots.

I just got off the phone with doctors in Bergen County, New Jersey who told me their hospitals are saying doctors & nurses will be *disciplined* for wearing protective gear, including masks. This is dangerous and may be illegal. And their stories are alarming…

Hospital physicians tell me this is happening across the state. Nurses worry they could be fired if they wear protective gear, but worry if they don’t they’re putting themselves & patients at risk. It comes as NJ has an explosion in COVID cases, particularly Bergen County. I’ve heard other hospitals nationwide are enforcing this policy, too. Who knows how rampant it is? Some internal documents we obtained suggest certain federal restrictions by the CDC may be guiding this decision.

If that’s the case, @realdonaldtrump should immediately intervene & prohibit public hospitals from being able to threaten their staff for wearing protective equipment during this crisis, including gloves and masks. This is urgent and common sense. And it will save lives.

Folks have been asking for what the “explanation” is for this decision. We’ve been told the hospital administrators are concerned patients & visitors would be unduly alarmed & fearful if they saw health care workers wearing protective clothing & masks.

I am always very skeptical of decisions that are supposedly made on the basis of “preventing panic”. In most cases, that translates as “the denial of information in order to prevent rational self-interested behavior on the part of the correctly informed”.

And no, it’s not just rumors out of New Jersey, as this case of an Oklahoma nurse fired for wearing a mask will demonstrate:

Kevin Readel worked at the Oklahoma Heart Hospital South for over five years. That was until Wednesday when he claims he was fired for wearing a droplet isolation mask.

“It was to protect myself, to protect the patient and to protect my family,” Readel said.

Readel worked in the Cardiac Care Unit, an ICU area for the heart hospital. Readel said he didn’t wear it all the time, but he was wearing it while putting an IV in a patient on Monday.

“I was trying to maintain some level of barrier,” he said when referencing himself and the patient.

According to Readel, his supervisor approached him and allegedly told him he needed to take it off, stating that it could cause fear and panic among the patients and staff.

Fear and panic are not the problems. Infectious disease and a failure to take basic precautions are. What are they going to do for an encore, ban surgeons from washing their hands prior to an operation for fear that impious ablutions could cause the surgery gods to frown upon the surgery?

We literally had an anesthesiologist WALK OUT because our Chief of nursing refused him having a mask.  

He did the right thing. All medical workers should refuse to work under unnecessarily unsafe conditions. They are on the front lines and their health should be the absolute top priority of everyone involved.

UPDATE: It should not be surprising to learn that the CDC’s policies are insanely counterproductive. It’s being run by corrupt Deep State clowns:

As the coronavirus spread to all fifty states over the last two months, the Trump administration faced mounting criticism for the lack of reliable, widely accessible test kits. Now, a former senior federal health official nominated to his post by President Trump, alleges that the delays in testing occurred because leaders at the Centers for Disease Control “lied” to the president, and to Health and Human Services Secretary Alex Azar, about the center’s ability to produce the kits.

In making the allegation, Chris Meekins, a former assistant secretary of Health and Human Services for preparedness and response, cited private discussions he has held in recent weeks with top federal officials and physicians and scientists employed in private-sector industries that are active in the anti-coronavirus effort. Meekins described his contacts on the White House Coronavirus Task Force as “friends,” some of whom he has known for many years.

“From my conversations with members of the task force, both inside and outside the administration,” Meekins told Sinclair in an exclusive interview, “The U.S. government, from Secretary Azar to the president relied on the Centers for Disease Control to produce a test; they failed….CDC said they would handle it….What we have found out is that these leaders at the CDC lied to both the HHS secretary and, by extension, the president. And as a result the nation got weeks behind.”

This is yet another reason why the Swamp must be drained.


Mailvox: leaving a converged company

A reader writes about leaving his job. He’s doing the right thing, because he has correctly assessed the situation and that place is going to go out of business with or without the assistance of Corona-chan.

Today I handed in my resignation at my current work, after the situation the last few months has turned from bad to intolerable.

I am currently reading Corporate Cancer, and it has become quite obvious that I myself am working in a converged company. In this case it is the HR department that is leading the convergence. Interestingly, they are not going against the wish of the customers, but rather their own employees, more specifically the most valuable ones. I guess they are too difficult to work with because they have an opinion of their own?

This is a very new company without any revenue yet, but here are some examples of the HR-led convergence craziness:

  • They are now doing all the hiring, even though none in HR knows anything about the industry
  • One colleague went from pre-HR employee of the year to “Drama King” within a few months, and was subsequently forced to quit. All because a young women at work that was in love with him repeatedly made complaints about him to HR because he did not reciprocate her feelings.
  • The same young woman, with no prior work experience – except for one year where she did less than what was required, spending most of her time complaining that her job was boring – was promoted to [a junior executive position].
  • They required that we should have transgender bathrooms, which resulted in unisex bathrooms instead, to the dismay of all the women.

In the last four months four key employees have resigned, but they do not seem to understand the problem, or even be willing to see that there is one.

In general, however, I recommend always finding a new job before leaving the old one. But regardless of the ideal sequence, the point is to understand that a company’s convergence is a flashing red sign to start looking for work elsewhere.


Advice from Spain

Spacebunny transcribed some translated advice from Spanish medical professionals who are fighting Corona-chan and are up on the latest protocols. Keep in mind this is advice for the medical personnel who are in regular contact with the infected; no need to be paranoid or apply the “every 20 minutes” advice. It’s also consistent with other information that is being passed around by informed European sources.

The Chinese now understand the behaviour of the covid19 virus thanks to autopsies that have carried out. This virus is characterized by obstructing respiratory pathways with thick mucus that solidifies and blocks the airways and lungs. They have discovered that in order to apply a medicine and unblock these airways so that the treatment can be used to take affect. However, all of this takes a number of days.

Their recommendations for what you can do to safeguard yourself are

  1. Drink lots of hot liquids. Coffees, soups, teas, warm water. In addition take a sip of warm water every 20 minutes because this keeps your mouth moist and washes any virus that’s entered your mouth into your stomach where gastric juices will neutralize it before it can get to the lungs.
  2. Gargle with an antiseptic in warm water, like vinegar, or salt, or lemon, every day if possible.
  3. The virus attaches itself to hair and clothes, any detergent or soap kills it, but you must take a bath or shower when you get in from the street. Avoid sitting down anywhere and go straight to the bathroom and shower. If you cannot wash your clothes daily, hang them in direct sunlight which also neutralizes the virus.
  4. Wash metallic surfaces very carefully because the virus can remain viable for up to nine days. Take note and be vigilant about touching handrails and door handles, etc. I guess within your own houses you can keep those clean by wiping them down regularly.
  5. Don’t smoke.
  6. Wash your hands every 20 minutes using any soap that foams, do this for 20 seconds and wash your hands thoroughly.
  7. Eat fruits and vegetables. Try to elevate your zinc level not just vitamin C levels.
  8. Animals do not spread the virus to people. It is person-to-person transmission.
  9. Try to avoid getting the common flu, I guess because this just already weakens your system. And try avoid eating and drinking cold things.
  10. If you feel any discomfort in your throat, or a sore throat coming on, attack it immediately using the above methods. The virus enters the system this way and remains for 3 or 4 days within the throat before it passes into the lungs.
I’m beginning to notice a note of confidence that was previously absent as the medical authorities seem to feel they are beginning to get a handle on this whole thing. There is no panic, and the young people are actively cooperating and doing everything they can to help the elderly stay well supplied.

I wonder why he needs them

The President requires enhanced detention powers… because the virus must be arrested!

The Justice Department has quietly asked Congress for the ability to ask chief judges to detain people indefinitely without trial during emergencies — part of a push for new powers that comes as the coronavirus spreads through the United States.

The move has tapped into a broader fear among civil liberties advocates and Donald Trump’s critics — that the president will use a moment of crisis to push for controversial policy changes. Already, he has cited the pandemic as a reason for heightening border restrictions and restricting asylum claims. He has also pushed for further tax cuts as the economy withers, arguing that it would soften the financial blow to Americans. And even without policy changes, Trump has vast emergency powers that he could legally deploy right now to try and slow the coronavirus outbreak.

Wait, the President is using a crisis for the benefit of the American people? Surely that is an impeachable offense.


Coronavirus and medication

Spacebunny passed on a translated warning concerning several common over-the-counter medications from the French government. TL;DR: do not take aspirin or Advil or other forms of ibuprofin for headaches, flu, or fever at this time. Tylenol is to be preferred.

The virus has just been shown to enter the lung alveolus cell through the ECAII receptor. When it binds to it it overexpresses it and kills the alveolar cell. Hence everything it produces. Men have more receptors than women, Asians more than Caucasians and people who take anti-hypertensive drugs such as antiECAs and especially Anti-ECAII have a brutal overexpression of the receptor and therefore are more susceptible to infection and infection is more serious.

The serious cases of young people are patients who have taken anti-inflammatory drugs at the beginning of the disease. Aspirin, ibuprofen, naproxen, voltarene (diclofenac), etc. must be avoided, because they favor the grave forms. You should only take Paracetamol.

Do not take ibuprofen or anti-inflammatory if you suspect Covid. In France, four serious cases of young people without previous pathology have in common the taking of ibuprofen. Apparently it makes the infection develop much faster.

They are reminded that they should NOT take Ibuprofen, Motrin, Advil, or aspirin for flu or fever symptoms. In Italy and France they have discovered that people who have died from Covid-19 have taken ibuprofen and causes the virus to be potentiated five or more times.

Anyone who has symptoms should take only and exclusively PARACETAMOL  (except, of course, medical prescription), drink plenty of water, and very often (if possible sips every 15 minutes). We also have natural antivirals such as Garlic, Ginger, Propolis, and almost all aromatic plants (Mint, Melissa (Torongil), Rosemary …) Cinnamon, Curcuma, Fruits with Vitamin C … in direct infusion.

I’ve also heard from various sources that large daily doses of Vitamins C and D3, as well as zinc, have been reported to be efficacious.