Good lead article in the Wall Street journal about the failure of CDC, HHS, FDA, FEMA and a few others. Long term government employees, vs the appointees, and turf wars (not called that, but were any way.).
I do not like Trump's mouthing off on TV or tweets. The President is always going to be blamed for all of the mistakes made (especially those who hate (and yes there are many the current leader) , even if they were the result of previous administrations mistakes.
I am reading a book called "Expedition Home", written by a physician who had outfitted a number of Arctic expeditions. He writes about a severe coming pandemic which we all need to be prepared for, in 2006, The book is out of print, and an internet friend from Wilderness medicine forum bought the remaining copies.
Prior to 1965, the US Government was not directly involved in general population health care. The States and counties provided the resources. There was a paradigm shift in the way health care was given and paid for. I was acting head of internal medicine dept. in a teaching charity hospital at the time.
Getting back to the science and reality. Unfortunately the fever is only present for a very brief period from day 5 to day 9 of the infection with CORVID 19. This misses the time with the most virus in the nasopharyngeal area.
I am posting a crude graphic. The bottom is days from exposure to about a month out. Some people remain carriers for long periods of time. We do not know if having the disease and developing a good IGG antibody titer will confer absolute immunity.
The Virus test is a swab from the nasopharyngeal area. Overall it has has about a 25% false negative (that is the test shows "no virus", yet the person has the virus infection. The dotted red line shows when the person can infect others,
The IGM (Purple) line, is the antibodies to fight the infection--and during this time the worse pulmonary symptoms, but the virus can affect the heart, kidneys, liver GI track and neurological system.
The green is the IGG and the test which should show immunity, There may some people who show good titers of IGG who are still infectious.
Another poorly recognized danger is virus in the stool. 30% from day 5 to 100% at day 15 and out out to day 28, when many are recovered. We do not know if the virus can be transmitted "hand to mouth", but if lack of hygiene prevails, and a worker touches a hard surface--you touch that hard surface, and touch your face--there is a slight chance of infection. There are also some cases where apparently only the GI tract is infected. Unfortunately much of this information was coming out of China and these articles have all be censored by the Communist government. Paris has documented virus and CV19 Virus particles in the sewers and is using this to trace contacts in highly infected areas.
Why is this important? Because just checking a fever may miss a very large number of both acutely infected people (and at the height of virus spread by droplet) and carriers.
The IGG (needs to be cheap, fast and reliable) gives good evidence of past infection. (An unknown is how much immunity it confers).
The industries which should not have been closed down were those where it was "safe" (This would include many "non-essemtial", and businesses where it could be shown that proper use of mask and distancing would allow safe operation of the facility.). There has been an abuse of government power at the state level.
Going forward many states, some with county options, which are going to open up some businesses which will still not be safe. (Barber shops, and Bowling alleys in Georgia for example.). Beaches etc can be opened, IF people will obey the distance and mask requirements. They won't.
One last comment about medical facilities--I should have answered it before.
Westward wrote:
Many hospital procedures are done thru surgical centers attached to the hospital, as well as in outpatient type of centers. These can be reasonably safely ramped up. CDC has addressed the negative pressure issue. It is being used in the hospital where Marie was hospitalized recently for a hand/arm infection. The entire floor where COVID 19 Patients were housed, was put under negative pressure by some simple alterations of the ventilation system. CDC only requires negative pressure rooms where there may be CV19 procedures run which create aerosols. With relative lack of dedicated negative pressure rooms, and operating suites, and in some hospitals the overwhelming number of CV19 patients it is just impossible to use negative pressure rooms for all. The rest of the hospital must function normally, and this can include the OR suites.
Better to get the hospital beds filled and the hospitals making money than the government (your taxes) paying out large amounts. (Yes I believe that hospital charges are way out of line)
Glad to hear a heart transplant patient survived. There are a number of reports of those on low dose immunosuppressants recovering--but also a number dying. Many of the transplant patients have comorbidity factors with diabetes, hypertension, other organ functions which are marginal. Transplant patients need to be particularly careful about exposure. (My secondary speciality was Nephrology. so I dealt with a number of renal transplant patents years ago.
BE Safe--Distance and wear masks when in close proximity with others, not in your immediate household. Wear gloves and don't touch your face, unless your hands are clean (20 second scrub, sanitizer, or safe removal of the gloves.
I do not like Trump's mouthing off on TV or tweets. The President is always going to be blamed for all of the mistakes made (especially those who hate (and yes there are many the current leader) , even if they were the result of previous administrations mistakes.
I am reading a book called "Expedition Home", written by a physician who had outfitted a number of Arctic expeditions. He writes about a severe coming pandemic which we all need to be prepared for, in 2006, The book is out of print, and an internet friend from Wilderness medicine forum bought the remaining copies.
Prior to 1965, the US Government was not directly involved in general population health care. The States and counties provided the resources. There was a paradigm shift in the way health care was given and paid for. I was acting head of internal medicine dept. in a teaching charity hospital at the time.
Getting back to the science and reality. Unfortunately the fever is only present for a very brief period from day 5 to day 9 of the infection with CORVID 19. This misses the time with the most virus in the nasopharyngeal area.
I am posting a crude graphic. The bottom is days from exposure to about a month out. Some people remain carriers for long periods of time. We do not know if having the disease and developing a good IGG antibody titer will confer absolute immunity.
The Virus test is a swab from the nasopharyngeal area. Overall it has has about a 25% false negative (that is the test shows "no virus", yet the person has the virus infection. The dotted red line shows when the person can infect others,
The IGM (Purple) line, is the antibodies to fight the infection--and during this time the worse pulmonary symptoms, but the virus can affect the heart, kidneys, liver GI track and neurological system.
The green is the IGG and the test which should show immunity, There may some people who show good titers of IGG who are still infectious.
Another poorly recognized danger is virus in the stool. 30% from day 5 to 100% at day 15 and out out to day 28, when many are recovered. We do not know if the virus can be transmitted "hand to mouth", but if lack of hygiene prevails, and a worker touches a hard surface--you touch that hard surface, and touch your face--there is a slight chance of infection. There are also some cases where apparently only the GI tract is infected. Unfortunately much of this information was coming out of China and these articles have all be censored by the Communist government. Paris has documented virus and CV19 Virus particles in the sewers and is using this to trace contacts in highly infected areas.
Why is this important? Because just checking a fever may miss a very large number of both acutely infected people (and at the height of virus spread by droplet) and carriers.
The IGG (needs to be cheap, fast and reliable) gives good evidence of past infection. (An unknown is how much immunity it confers).
The industries which should not have been closed down were those where it was "safe" (This would include many "non-essemtial", and businesses where it could be shown that proper use of mask and distancing would allow safe operation of the facility.). There has been an abuse of government power at the state level.
Going forward many states, some with county options, which are going to open up some businesses which will still not be safe. (Barber shops, and Bowling alleys in Georgia for example.). Beaches etc can be opened, IF people will obey the distance and mask requirements. They won't.
One last comment about medical facilities--I should have answered it before.
Westward wrote:
Many hospital procedures are done thru surgical centers attached to the hospital, as well as in outpatient type of centers. These can be reasonably safely ramped up. CDC has addressed the negative pressure issue. It is being used in the hospital where Marie was hospitalized recently for a hand/arm infection. The entire floor where COVID 19 Patients were housed, was put under negative pressure by some simple alterations of the ventilation system. CDC only requires negative pressure rooms where there may be CV19 procedures run which create aerosols. With relative lack of dedicated negative pressure rooms, and operating suites, and in some hospitals the overwhelming number of CV19 patients it is just impossible to use negative pressure rooms for all. The rest of the hospital must function normally, and this can include the OR suites.
Better to get the hospital beds filled and the hospitals making money than the government (your taxes) paying out large amounts. (Yes I believe that hospital charges are way out of line)
Glad to hear a heart transplant patient survived. There are a number of reports of those on low dose immunosuppressants recovering--but also a number dying. Many of the transplant patients have comorbidity factors with diabetes, hypertension, other organ functions which are marginal. Transplant patients need to be particularly careful about exposure. (My secondary speciality was Nephrology. so I dealt with a number of renal transplant patents years ago.
BE Safe--Distance and wear masks when in close proximity with others, not in your immediate household. Wear gloves and don't touch your face, unless your hands are clean (20 second scrub, sanitizer, or safe removal of the gloves.
