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[phillm]

So he's saying that ventilators as currently used for Covid-19 take over the work of the muscles that usually get air into the lungs. And that that's useful, if your lungs are inflamed (pneumonia) and can't do that mechanical work by themselves. If the mechanics of the lungs fail, you don't get enough oxygen.

But he's seeing that people with Covid-19 illness do have working lung mechanics; that the reason they're not getting enough oxygen isn't because the lungs don't work, but because the virus, uniquely as far as we know thus far, affects our ability to utilise oxygen. And that putting extra pressure on lungs that actually aren't inflamed inadvertently does more harm than good to the lungs themselves, even while also providing more oxygen.

No idea whether what he's saying is batshit, but did I get that right? He's saying we're starting from a false premise and that that's why treatment is unreliable?

He seems to be what he says he is an Emergency Doctor. He has a latest, shorter cri-de-coeur that he feels that the current, newly forming 'medical orthodoxies' about treating this novel virus are looking in the wrong places.

Cameron Kylesidell, MD | Maimonides Medical Center

www.maimonidesmed.org

Do COVID-19 Vent Protocols Need a Second Look?

How what Cameron Kyle-Sidell, MD, saw in an NYC ICU prompted him to re-examine COVID-19 ventilator protocols

www.medscape.com

Whyte: This is more like a high-altitude sickness. Is that right?

Kyle-Sidell: Yes. The patients in front of me are unlike any patients I've ever seen., and I've seen a great many patients and have treated many diseases. You get used to seeing certain patterns, and the patterns I was seeing did not make sense. This originally came to me when we had a patient who had hit what we call our trigger to put in a breathing tube, meaning she had displayed a level of hypoxia of low oxygen levels where we thought she would need a breathing tube. Most of the time, when patients hit that level of hypoxia, they're in distress and they can barely talk; they can't say complete sentences. She could do all of those and she did not want a breathing tube. So she asked that we put it in at the last minute possible. It was this perplexing clinical condition: When was I supposed to put the breathing tube in? When was the last minute possible? All the instincts as a physician—like looking to see if she tires out —none of those things occurred. It's extremely perplexing. But I came to realize that this condition is nothing I've ever seen before. And so I started to read to try to figure it out, leaving aside the exact mechanism of how this disease is causing havoc on the body, but instead trying to figure out what the clinical syndrome looked like.

 

[Mation]

(Sorry I didn’t tag you in my call out for medic folks in my post where I put some other links).

S'ok. I'm not a medic.

(I used to do science and science communication, but this is nowhere near my area of expertish!)

 

[Mation]

He seems to be what he says he is an Emergency Doctor. He has a latest, shorter cri-de-coeur that he feels that the current, newly forming 'medical orthodoxies' about treating this novel virus are looking in the wrong places.

Cameron Kylesidell, MD | Maimonides Medical Center

www.maimonidesmed.org

Do COVID-19 Vent Protocols Need a Second Look?

How what Cameron Kyle-Sidell, MD, saw in an NYC ICU prompted him to re-examine COVID-19 ventilator protocols

www.medscape.com

Whyte: This is more like a high-altitude sickness. Is that right?

Kyle-Sidell: Yes. The patients in front of me are unlike any patients I've ever seen., and I've seen a great many patients and have treated many diseases. You get used to seeing certain patterns, and the patterns I was seeing did not make sense. This originally came to me when we had a patient who had hit what we call our trigger to put in a breathing tube, meaning she had displayed a level of hypoxia of low oxygen levels where we thought she would need a breathing tube. Most of the time, when patients hit that level of hypoxia, they're in distress and they can barely talk; they can't say complete sentences. She could do all of those and she did not want a breathing tube. So she asked that we put it in at the last minute possible. It was this perplexing clinical condition: When was I supposed to put the breathing tube in? When was the last minute possible? All the instincts as a physician—like looking to see if she tires out —none of those things occurred. It's extremely perplexing. But I came to realize that this condition is nothing I've ever seen before. And so I started to read to try to figure it out, leaving aside the exact mechanism of how this disease is causing havoc on the body, but instead trying to figure out what the clinical syndrome looked like.

Fuck

Thank you for posting that.

Let's hope people are able to listen to him and start thinking about how to change tack. It's encouraging that Medscape/WebMD are taking the idea that this is an entirely new disease seriously enough to publish that interview.

 

[SheilaNaGig]

Fuck

Thank you for posting that.

Let's hope people are able to listen to him and start thinking about how to change tack. It's encouraging that Medscape/WebMD are taking the idea that this is an entirely new disease seriously enough to publish that interview.

Yes, it's very interesting and it could be that he's right. It chimes with some stuff an Italian doctor was saying a few weeks ago too.

https://www.esicm.org/wp-content/uploads/2020/04/684_author-proof.pdf

Is Protocol-Driven COVID-19 Ventilation Doing More Harm Than Good?

'This is a kind of disease in which you don't have to follow the protocol — you have to follow the physiology. Unfortunately many doctors...cannot think outside the protocol,' said Dr. Luciano Gattinoni.

www.medscape.com

However ... (and this isn't directed at you Mation, I'm making the general point) ....

Dr Kyle-Sidell be especially good at seeing things in the round, seeing something that has been missed or overlooked by others in the panic and fast moving mayhem, he may well be especially good at seeinghtings from a novel perspective, he may be good at synthesising knowledge. He may have cracked the problem with C-19, or made basecamp in the journey towards that

BUT it's also possible that he's grasping at straws, misinterpreting what he's seeing, plain misguided or wrongheaded.


It's far too early to be able to make any kind of judgement about this. I'm guessing that Dr Kyle-Sidell will be trying hard to read and study and extrapolate and interpolate from other front line findings, and also trying to treat according to his hypotheses at least in some cases. He'll presumably be discussing this with his colleagues as well. All of this will help to unpick it. But we just don't know, and it's too soon to be able to dig into the facts and details. Theres' going to be a huge amount of debriefing and archeology when this is over.

(I'm really worried that if this turns out to be valid, it will suggest that an enormous number of people died who could have been saved. That's an awful dreadful thing to think about.)





Anecdotally, I was talking about this with a colleague last night (we both have medical degrees and primary health care experience) . She is suspicious that she may have C-19 but with mild symptoms. She said that the way her lungs feel is exactly the same as living/working at 2,500 feet for two week stints at bi-monthly intervals (i.e. not for long enough to become fully acclimatised to the altitude). She said she - quite independently of this hypothesis from Dr Kyle-Siddow - had compared the way she was feeling now, at sea level, with the way it felt to be at 2,500 feet. She was struck by the fact that this idea is now being suggested by a front line critical care doctor. Disclaimer : IN NO WAY is this any kind of support for the hypothesis, it's just a little bit of background colour.

 

[elbows]

He may also just be pointing out in more dramatic fashion what has already been noted and acted on elsewhere. I dont have enough evidence to support this conclusion yet, but I expect others have and are continuing to look at the issue.

 

[elbows]

I've not heard anything from the Porton Down serology/antibody studies yet, so here is something from Germany instead. I'm afraid this is a machine translation but as I found the detail interesting and didnt have time to look around to see if its been reported, it will have to do for now:

https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt.pdf

Background: The municipality of Gangelt is one of the most affected places in Germany by COVID19 in Germany. The infection is believed to be due to a carnival session on February 15, 2020, as several people tested positive for SARSCoV2 after this session. The carnival session and the outbreak of the session are currently being examined in more detail. A representative sample was drawn from the community of Gangelt (12,529 inhabitants) in the Heinsberg district. The World Health Organization (WHO) recommends a protocol in which 100 to 300 households are sampled depending on the expected prevalence. This sample was coordinated with its representativeness with Prof. Manfred Güllner (Forsa).

Aim: The aim of the study is to determine the level of the SARS-CoV2 infections (percentage of all infected) that have passed through and are still occurring in the Gangelt community. In addition, the status of the current SARS-CoV2 immunity is to be determined.

Procedure: A form letter was sent to approximately 600 households. A total of around 1000 residents from around 400 households took part in the study. Questionnaires were collected, throat swabs were taken and blood was tested for the presence of antibodies (IgG, IgA). The interim results and conclusions of approx. 500 people are included in this first evaluation.

Preliminary result: An existing immunity of approx. 14% (anti-SARS-CoV2 IgG positive, specificity of the method>, 99%) was determined. About 2% of the people had a current SARS-CoV-2 infection determined using the PCR method. The overall infection rate (current infection or already gone through) was approximately 15%. The mortality rate (case fatality rate) based on the total number of infected people in the community of Gangelt is approx. 0.37% with the preliminary data from this study. The lethality currently calculated by the Johns-Hopkins University in Germany is 1.98% and is 5 times higher. Mortality based on the total population in Gangelt is currently 0.15%.

Preliminary conclusion: The 5-fold higher lethality calculated by Johns-Hopkins University compared to this study in Gangelt is explained by the different reference size of the infected. In Gangelt, this study includes all infected people in the sample, including those with asymptomatic and mild courses. The proportion of the population that has already developed immunity to SARS-CoV-2 is about 15%. This means that 15% of the population in Gangelt can no longer become infected with SARS-CoV-2, and the process has already begun until herd immunity is reached. This 15 percent share of the population reduces the speed (net reproduction number R in epidemiological models) of a further spread of SARS-CoV-2.

 

[teuchter]

I've not heard anything from the Porton Down serology/antibody studies yet, so here is something from Germany instead. I'm afraid this is a machine translation but as I found the detail interesting and didnt have time to look around to see if its been reported, it will have to do for now:

https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt.pdf

Posted earlier on this very thread!
There was a bit of confusion about the mortality numbers.

 

[teuchter]

I was in Germany right around that time - mid-late February. Carnival in full flow with lots of big gatherings, crowded trains and so on. At that time, no-one (including me) really thinking of the virus as an immediate threat but already spreading unseen I guess.

 

[elbows]

Ah, sorry I missed it earlier, impossible to keep on top of everything as time has gone on.

 

[weltweit]

Cranfield and Georgia Tech roll-out flat pack BVM ventilator

Cranfield University and Georgia Tech have designed and built a low-cost, BVM ventilator
..
The Bag Valve Mask (BVM) ventilator is said to serve two patients simultaneously and its so-called ‘flat-pack’ design means it can be quickly manufactured at scale at a cost of under £75 ($100) per unit.
..

Professor Leon Williams, head of the Centre for Competitive Creative Design (C4D) at Cranfield University, joined forces with Associate Professor Shannon Yee from Georgia Tech (Georgia Institute of Technology in Atlanta, USA) to rapidly design and build the low-cost and robust makeshift ventilator.
..

A small batch of the devices has already been assembled for testing. The research team intends to make plans for the device to be available to manufacturers as quickly as possible.

from 07/04/2020 Cranfield and Georgia Tech roll-out flat pack BVM ventilator | The Engineer

Lots of uni / industry collaborations involved in the issue of ventilators, and breathing aids, many are making their designs open source so the developing world can use them in their own responses to the pandemic.

 

[weltweit]

20,000 Brits in India want to come home
source BBC News

A flight, probably the first of many, arrived back at Heathrow today.

 

[teqniq]

What?

 

[weltweit]

teqniq seems a pretty stupid decision at this point in time.

Is this Trump's doing or someone else?

 

[teqniq]

Looks more like a colossal fuck up to me. but who knows?

 

[two sheds]

Obama probably said it was a good idea to keep it open some time.

 

[weltweit]

A little about Japan

Japan's sudden spike in coronavirus cases after Olympics postponement raises eyebrows

Japan reported more than 500 new positive cases of the novel coronavirus for the first time Thursday, the latest in a sudden spike in infections since the Tokyo Olympicswere postponed till next year.

from 09/04/2020 Japan's sudden spike in coronavirus cases after Olympics postponement raises eyebrows

Japan coronavirus cases pass 5,000 as state of emergency fails to keep people home

The total number of Japanese novel coronavirus infections hit at least 5,002 on Thursday, NHK public broadcaster said, showing no signs of slowing despite a state of emergency being imposed this week on Tokyo and six other areas.
..

In contrast to stringent lockdowns in some countries, mandating fines and arrests for non-compliance, enforcement will rely more on peer pressure and a deep-rooted Japanese tradition of respect for authority.

Tokyo's nightlife districts of Shibuya, Akasaka and Ginza areas were much quieter than usual overnight as the state of emergency took effect, but elsewhere on Thursday things seemed as busy as usual.

from 09/04/2020 Japan coronavirus cases pass 5,000 as state of emergency fails to keep people home

 

[oryx]

Could anyone explain to me in simple terms (because to say I'm no statistician is a very gross understatement) why the UK seems to have a high rate of deaths against cases, as compared to most other countries)?

I am looking at the BBC's tally and dividing the number of cases by deaths. Is it because we have a lower rate of testing and therefore the infection rate is skewed to look lower than it would if the testing rate was higher?

I've been looking at the CV threads and can't remember seeing anything about this.

 

[prunus]

Could anyone explain to me in simple terms (because to say I'm no statistician is a very gross understatement) why the UK seems to have a high rate of deaths against cases, as compared to most other countries)?

I am looking at the BBC's tally and dividing the number of cases by deaths. Is it because we have a lower rate of testing and therefore the infection rate is skewed to look lower than it would if the testing rate was higher?

I've been looking at the CV threads and can't remember seeing anything about this.

It is as you say, because we are hardly doing any testing; also most (almost all at the moment) of the testing we are doing is of people who have been hospitalised, who are naturally going to be a subset of all cases with the most severe disease, and hence more likely to die.

 

[weltweit]

South Korea

South Korea took rapid, intrusive measures against Covid-19 – and they worked

South Korea immediately began testing hundreds of thousands of asymptomatic people, including at drive-through centres. South Korea employed a central tracking app, Corona 100m, that publicly informs citizens of known cases within 100 metres of where they are. Surprisingly, a culture that has often rebelliously rejected authoritarianism has embraced intrusive measures.

..
From 16 March, South Korea started to screen all people arriving at airports, Koreans included. South Koreans have universal health care, double the number of hospital beds compared to Organisation for Economic Cooperation and Development (OECD) norms (and triple that of the UK), and are accustomed to paying half what Americans pay for similar medical procedures.

from 20/03/2020 South Korea took rapid, intrusive measures against Covid-19 – and they worked | Alexis Dudden and Andrew Marks

South Korea's Foreign Minister explains how the country contained COVID-19

Despite a sudden spike in infections, South Korea is now winning the fight against the COVID-19 coronavirus.
..
“We acted early. But much of it surprised us – especially how fast it moves,” the Foreign Minister explains. The first 30 cases identified in South Korea were handled in a steady and diligent manner. But that all changed with the appearance of Patient 31.

..
Between 19 January and 18 February, South Korea had recorded a total of 30 cases and no deaths. That slow increase in infections soon changed – 18 February was the day it recorded its 31st case. Within 10 days, there were more than 2,300 cases.

Patient 31 was what is known as a super-spreader – someone who passes the infection on to a larger number of people.

..
Foreign Minister Kang also explains that being open with people and securing their trust is vitally important. “The key to our success has been absolute transparency with the public – sharing every detail of how this virus is evolving, how it is spreading and what the government is doing about it, warts and all.”
..

“Testing is absolutely critical with a fast-travelling virus like this,” says Kang. “We have tested over 350,000 cases so far – some patients are tested many times before they are released, so we can say they are fully cured.
..

“Even with schools opening, we realize it’s not going to be normal like things were before the coronavirus. Normal after the virus is going to look very different. This will be with us for a long time. So we all need to find a way to manage it at a status quo level.”

from 31/03/2020 South Korea's foreign minister explains how the country contained COVID-19

 

[oryx]

It is as you say, because we are hardly doing any testing; also most (almost all at the moment) of the testing we are doing is of people who have been hospitalised, who are naturally going to be a subset of all cases with the most severe disease, and hence more likely to die.

Thanks prunus . I thought that was probably the case but wondered if I was missing something.

 

[editor]

This is a good read. NZ really are a fucking excellent country.

At home in an Auckland hotel: My two weeks in Covid-19 quarantine

He came straight off a plane and into quarantine. Now his Auckland hotel feels like a sort of home.

thespinoff.co.nz

 

[weltweit]

EU agrees €500bn coronavirus rescue package

EU finance ministers have agreed a €500bn (£440bn) rescue package for European countries hit hard by the coronavirus pandemic.
..
But the ministers failed to accept a demand from France and Italy to share out the cost of the crisis by issuing so-called coronabonds.

The package is smaller than the European Central Bank had urged.

The ECB has said the bloc may need up to €1.5tn (£1.3tn) to tackle the crisis.
..
The coronavirus pandemic has exposed deep divisions in Europe, where Italy and Spain have accused northern nations - led by Germany and the Netherlands - of not doing enough.

from 09/04/2020 EU agrees €500bn coronavirus rescue package

 

[zahir]

The lockdown in Greenland.

Greenland watches ... and waits for virus

It would take relatively few seriously ill patients on Greenland, the world's largest island, to outrun the capacity of the nation's health services.

euobserver.com

 

[Yu_Gi_Oh]

This is a good read. NZ really are a fucking excellent country.

At home in an Auckland hotel: My two weeks in Covid-19 quarantine

He came straight off a plane and into quarantine. Now his Auckland hotel feels like a sort of home.

thespinoff.co.nz

I agree so much. NZ's response to this has been incredible.

I was thinking yesterday of those people who were repatriated on that flight from Wuhan early on, and held in a centralized quarantine. It seems so pointless now. What a waste of their time that was. I can't get my head around how there was clearly a point when we understood that imported cases were going to be an issue, and then we just let everyone keep flying in from infected areas without any screening at all, and barely tested our population.

 

[DaveCinzano]

UK now fifth (out of 209 countries/territories ) in terms of deaths, and set to step over Iran tomorrow into seventh place for total confirmed cases

 

[2hats]

Could anyone explain to me in simple terms (because to say I'm no statistician is a very gross understatement) why the UK seems to have a high rate of deaths against cases, as compared to most other countries)?

The true number of UK cases is likely several times the published figure (currently just over 65k).

Aside from the lack of testing and bias arising from hospitalisation figures...

The crude case fatality ratio has, over the last couple of months, been variously estimated as somewhere in the range 0.1-3%. However more recent estimates are of 0.7% from modelling (Imperial, DOI: 10.1016/S1473-3099(20)30243-7) and 1.9% from testing (extensively in Germany, RKI). The ECDC currently estimate 1.5% from data across EU/EEA.

A CFR of say 1-2% would (currently) suggest around half a million UK cases about 2 weeks ago. Which would probably equate to something in the ballpark of 5-10 million by now (UK cases are doubling almost every 4 days). But since the fatality figure (8k) is certainly an undercount, there will be yet more cases still.

Separately, Imperial estimated from modelling, a couple of million cases for the UK (just over a week ago, so numbers obviously higher now). They've talked of about 5-10% of Londoners being infected which would fit well with a few million nationally.

One further data point: the total number of potential COVID19 cases (from NHS 111/Pathways online assessments, not actual testing) is about 2 million right now. If maybe up to half of cases are asymptomatic, there's a possible 4 million.

e2a: Additional datapoint.

 

[ice-is-forming]

We're doing okay, Australias death toll stands at 53 today. We have 6,000 cases nationally. The number of new cases each day continues to decline.

The number of drive through testing stations is increasing daily.

The test will be if people continue to obey the rules and stay home over Easter.

My son in law, who was laid off work at a restaurant a few weeks ago, is back at work with the gov paying him $750 a week wages for the next six months. The restaurants now doing home delivery or pick up service.

Which is just as well because our dole seems to have temporarily crashed under the weight of new applications.

Things probably wouldn't even be at this level if it hadn't had been for this incident..

Ruby Princess: battle begins to hold someone accountable for cruise ship coronavirus debacle

Conflicting accounts by federal and state authorities, and the company’s opaque corporate structure, stand in way of claims by passengers on the ship

www.google.com

 

[bimble]

This is just a nightmare. "More than 90 people who fully recovered from the novel coronavirus have tested positive for COVID-19 again" .. scientists in S Korea saying this is not about faulty tests but that the virus is 'reactivating' in people.

91 recovered virus patients test positive again: KCDC | Yonhap News Agency

SEOUL, April 10 (Yonhap) -- More than 90 people who fully recovered from the novel coronav...

en.yna.co.kr

 

[platinumsage]

This is just a nightmare. "More than 90 people who fully recovered from the novel coronavirus have tested positive for COVID-19 again" .. scientists in S Korea saying this is not about faulty tests but that the virus is 'reactivating' in people.

91 recovered virus patients test positive again: KCDC | Yonhap News Agency

SEOUL, April 10 (Yonhap) -- More than 90 people who fully recovered from the novel coronav...

en.yna.co.kr

The two important things to discover about this are whether these people experience any symptoms of reinfection and whether they can infect others. If the answer to both is no, it's more a scientific curiosity than something to worry about.

 

[bimble]

thank you for that little offered bit of hope.