Some people are basing their short-term investing on how well our health system may be handling the viral problem (at least in part) including whether the testing will be adequate.
Here is the present policy in one US hospital for those who may find the information useful.
The “Asses Clinical Suspicion of COVID-19” leaves the ER doctor with a signifiant amount of latitude, it would seem.
I can say from experience the different physicians will behave differently with Dr. uhhh “Smith” (I have someone in mind) testing everyone and the risk of malpractice (and true concern) guaranteeing a high level of testing in the ER if the physicians are truly given the latitude to do so.
It’s similar to what most jurisdictions are doing.
Countries are running out of swabs and protective equipment so things have to be rationed.
China had a very strict quarantine system that I don’t think would work in the States (jsut yet).
They found that social distancing and travel bans helped slow things down but it still spread. It wasn’t until they began quarantining all suspect cases as well. They split patients into 4 groups
Confirmed - patients went into stable hospital or dedicated ICU hospital
Suspected - quarantined in specialized hotels/schools/lobbies
Suspected with fever - Quarantined in specialized hotels/schools/lobbies
Resolved
Try telling an American to go sit alone in a hotel while their swabs are being processed.
Quarantined and immediately isolated from their families. Patients being tested have to wait 4 hours for the results and if positive they are sent away. Really doubt that’s happening in Italy. Certainly not here. How long does the test take here if you can even get one ? Few days, right ?
… «Significa che se in America ci sono 3.500 casi di COVID-19 confermati - spiega il coordinatore del lavoro Jeffrey Shaman - in realtà ce ne potrebbero essere 35mila in tutto»…
Rough translation:
Some research from data in China indicates that there are about 10x more infected that actually detected (3500 to 35000). People that are non-symptomatic are responsible for the majority of new cases.
Cleveland Clinic web site says: “Cleveland Clinic’s on-site testing should yield results within one day….”
This from Bloomberg: “Labs don’t have to send the CDC samples of their coronavirus test results anymore to get confirmation of positive cases thanks to an FDA policy change effective as of yesterday.”
I work for a hospital here in Canada and we are under strict lock down with skeleton crews, front line staff and non essential patients being turned away at the door. Everyone non staff is screened before being allowed in. In our city we have a testing center that was setup last week for CV19 only. They can do about 400 tests/day and will only test if you have a fever and have been out of country in the last 14days or have been in contact with someone that has tested positive. It still takes a couple of days to get the test results but all suspected cases have to self quarantine at home, unless you show signs of respiratory issues. Then get to the hospital. The province has ordered shutdown of almost everything non essential and everyone is to stay at home and keep distance and order when out of your house. So far I think it’s working really well and Canada’s case count is still quite low.
Same here except they stuck a thermometer in my mouth while I nodded to questions about travel (screening staff too). Visitors are restricted and elective surgical cases are cancelled.
I only post to say test results do take several days at our hospital still (as Marco posted) but the nurses say better kits will be here soon. No cases at our hospital yet.
I work at 2 different hospitals and we have each had a case show up. Since they opened the dedicated CV19 test center in the middle of the city I haven’t heard of anymore cases coming in.
From the article: “…….had hypertension and 12% had diabetes. Notably, the most frequent comorbidities reported in these three studies of patients with COVID-19 are often treated with angiotensin-converting enzyme (ACE) inhibitors;”
The relation of ibuprofen to the ACE receptor is one reason French authorities are recommending that we stay away from ibuprofen to treat symptoms and use acetaminophen (Tylenol) instead.
From another article: “…human pathogenic coronaviruses bind target cells together using angiotensin-converting enzyme 2 (ACE2),…”
Here in France a friend of mine, a physician, was tested yesterday morning and got the result in the afternoon (negative).
Unlike in Germany where everyone going to the doctor for a cold is tested, here there are criteria of testability: age, existing pathology, symptoms, and a priority for healthcare professionals. People with mild symptoms are not tested and told to stay home and to call only if it gets worse. We have much, much more infected people than the numbers tell.
A concerning point is that about half of people going in ICU are under 60 (unofficial information, TBC). Most people dying are old or with comorbidity causes, but younger and healthy patients may be at risk if ICU beds are saturated.
I confirm Jim’s information: the General Director of Health (kind of deputy Health Minister, a physician and expert in infectious diseases and epidemics), warned against ibuprofen and all NSAID. Exception for patients who need them for another reason, of course. The only recommended self- treatment for fever and pain is paracetamol (=acetaminophen). Paracetamol sales have been restricted to avoid shortage. We are locked down and must fill a form of self-certication every time we go out, 5 reasons are allowed: work when remote workin is impossible, buying necessary items, health care, taking care of people at risk, and physical activity alone close to home (typically running or a walking alone or with one’s dog). I’m lucky to be locked in a place where I can go for a run in the hills and the forest, I can’t imagine that for people locked in a small appartment in a big city with children.
After Europeans, a lot of Americans are under lockdown rules now. If your state has not yet made a decision, make it for your family. The attached chart should convince the skeptics of the efficiency of a lockdown to “flatten the curve” and avoid a healthcare system breakdown. It tracks the number of Covid-19 positive cases in 2 districts of northern Italy. Lodi has enforced a lockdown 2 weeks before Bergamo.
Idea For a Respiratory Ventilator For Many Patients
Members of P123 who are Doctors and Engineers please have a look at this idea. It could help with the ventilator problems, especially for countries with minimum resources to buy hi-tech equipment. If you have some comments please lets hear them.
This gets to be quite a bit more complicated. The devil is literally in the details. Not only do you have to worry about sterilizing air going out but also coming in. You don’t want to have mold, bacteria, fungus, etc going into peoples lungs that could be forming in the lines. I’m not sure PVC is appropriate for that. There are certain materials that you have to use for medical applications and in the medical device industry they are well known. The functional requirements are a good start, but they would need to be further expanded upon. From an electrical standpoint you have to design a robust circuit in combination with software that has to be verified and validated. You need to verify that the system will not only perform but won’t fail to work or kill your patient when the software or hardware reaches fault conditions. You are going to have to perform some level of environmental qualification testing to ensure you electronics, fittings, tubing maintain functionality, sealing, and structural integrity. Then you need to make sure your design can actually be manufactured without defects, within a reasonable timeframe, and for a cheap enough cost. Of course there’s FDA approval.
This is not everything, but you can begin to see why medical equipment development and production is so pricey and wrought with risk.
Maybe other countries might be more relaxed about what I mentioned above. Obviously FDA approval doesn’t matter in that case, but you still need a reliable, safe, easy to manufacture design.
FYI, I don’t personally work in medical devices, but my wife does as a quality engineer. I am an Electrical engineer but design test equipment in a different industry.
As soon as my work allowed work from home a week and a half ago, my wife and I work from home all the time. We only leave our home to get groceries, gas, or pick up my daughter from grandmas. Grandparents are also working from home as well. My wife and I live in Minnesota and we have been taking this seriously for a month. We know this is going to extend longer than officials are suggesting.
Since I live somewhere different from most of you I thought I’d share what’s been going on here. In the Philippines most of the main island of Luzon was put on quarantine after Italy but right before France. The number of official cases was low at the time but because there were already cases of untraceable community spread showing up the quarantine was implemented. Everyone here recognizes that the local medical system is simply not up to snuff—there were only 2000 tests kits at the time for a country of 100 million—and the government had to get ahead of the problem as much as possible.
The official numbers have remained somewhat low in comparison to other countries but the lack of testing capabilities is likely underestimating substantially the spread even after 100000 test kits were donated by China. Still the way disease has overtaken Western countries especially the United States is somewhat shocking from my perspective.
Most people here wear a mask when they go out to buy essentials. It helped that there was a volcanic eruption nearby spewing ash fall about a month before covid-19 started up. I don’t get why authorities aren’t encouraging all people to wear masks. The reasons they are giving sound spurious. With it being known that asymptomatic individuals can spread the virus it seems obvious to me that it should be encouraged. One of the dramatic differences one sees with most Asian nations is that people are wearing masks. Japan from what I can tell hasn’t really handled the situation much differently than Western nations—but people there wear masks and they have been able to keep numbers lower for longer.
Respirators and/or ventilators are essential and necessary. Making more of them and getting them into hospitals is critical for further treatment. But keeping the right perspective is also critical. For the vast majority of people, if infected with the Corona virus, will only result in minor symptoms or none at all. Most likely like an “oridinary cold” or even something less.
At the moment your immune system is the only way to fight this virus at the root. Therefore paying attention to this is critical and vital. Plus you can become active and do something yourself:
Pay attention to your diet: No junk food and more veggies and fruits.
Stress is a killer. Try meditation or Yoga to get your stress level down.
Take walks in nature, enjoy clean and fresh air, get plenty of sun (the virus does not like UV rays).
Specific foods: Load up on raw garlic, ginger, licorice root (real one, not the sugary one)
Supplements: High dose of Vitmain-C, preferably IV. Take a minimum of 2-3000 mg over the course of a day, liposomale forumulations are better, they allow you to take much higher doses without side effects (loose stool). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032839/
Vitamin-D is critical. Aim for 50 ng in your blood (90% do not reach this level)
Sauna is good. High heat for a minimum of 20 minutes will kill the virus (this is controversial)
Sufficient magnesium and zinc
Take pro-biotics. Eat fermented food (i.e. Kimchi). Your colon is the most important part of your immune system and needs the “good bacteria” (Bifido and Lacto), deficiency in most people.
Vitamin A (not Beta corotene) is the most important Vitamin for your mucous membranes: they are everywhere in your body, especially in your colon). This is where the virus is attaching first.
With this regimen the vast majority of people should sail safely through this crisis.
All the best.
Goldman Sachs’ predictions. While not the best epidemiologist themselves perhaps they have hired a decent one (or a few):
“While the exact timing of the medical and economic recovery is highly uncertain and relapses are plausible, our assumption is that stronger lockdown and social distancing measures and perhaps some weather effects reduce new infections sharply over the next month. Combined with potential medical breakthroughs or adaptation by firms and consumers, this slowdown in new infections is likely to lead to a gradual economic recovery. The slow pace of recovery in our forecast even in 2021 allows for longer-lasting scarring effects on businesses and workers”
Here is GS’s predicted Q2 on some of the service sector:
“We expect claims to remain very elevated—likely over 2mn—for at least another week (March 29-April 4) and somewhat elevated after that. Widespread reports of application bottlenecks suggest that many laid off workers have yet to file. Some employers, especially in the retail sector, are taking a staggered approach to layoffs. And many business owners and workers are just beginning to learn about the more generous unemployment insurance benefits—which will exceed normal wages for many workers—and the expansion of coverage included in the Phase 3 legislation. In total, we expect over 11mn claims to be filed in the first three weeks of the coronacrisis and at least a couple million more in the rest of April.”
“Goldman now projects a nearly 12% increase in the unemployment rate to a peak rate of 15%.”
Comment: The healthcare sector may do better than I expected if the projection for hospitals above is correct. We can expect the government to pour money into the health sector. I was wondering if hospitals would take a hit because of the loss of elective surgeries, a change in the insurance mix to medicare and medicaid etc.
This above analysis allows for that possible hit to hospitals in Q1 but predicts a recovery from that low in Q2.
