Over 3,500 people quarantined on Diamond Princess cruise

[smmco]

You keep assuming you will ever know how many people have the virus. We don’t know how many people have influenza each year, but you seem to hold those numbers in high regard.

Based on the only numbers we have. Lets be cautious, not alarmist.

If people come to the ED, urgent care or doctor's office with respiratory issues we swab them for influenza. We are not testing for Coronavirus. Granted not everyone seeks medical help when they have the flu, but it's still more accurate than the Coronavirus. There could be thousands in this country with Corona and we would not know. A lot of people may die from the flu, but the fatality rate is still very low. The fatality rate for this virus may be just as low, but we'll never have an idea until we start testing people.

 

[QueenElinor]

Just looking at the CDC website, they've put a Level1 travel advisory for Iran and Italy; also still a level 2 for Japan and South Korea, and Level 3 for China. Interesting that with all these countries they advise people who have been there to call their doctor if they don't feel well. This implies that screening is also expanded to individuals who've been to these countries, so that's good. However, US doctors need to be able to screen anyone they choose to. Although some of them would anyway it would be nice to have the go-ahead from the CDC.

 

[Dreams&wishes]

If people come to the ED, urgent care or doctor's office with respiratory issues we swab them for influenza. We are not testing for Coronavirus. Granted not everyone seeks medical help when they have the flu, but it's still more accurate than the Coronavirus. There could be thousands in this country with Corona and we would not know. A lot of people may die from the flu, but the fatality rate is still very low. The fatality rate for this virus may be just as low, but we'll never have an idea until we start testing people.

You are probably right. But I think that the Princess Cruise, S.Korea and now Italy are offering a good insight on numbers all of which seem to match.Btw one more death in Italy now.

 

[Karin1984]

You are probably right. But I think that the Princess Cruise, S.Korea and now Italy are offering a good insight on numbers all of which seem to match.Btw one more death in Italy now.

Here in NL newspapers say that 3 out of 4 deaths in Italy were elderly people who already were ill, is that what Italian newspapers report as well?

 

[Dreams&wishes]

Here in NL newspapers say that 3 out of 4 deaths in Italy were elderly people who already were ill, is that what Italian newspapers report as well?

Yes that's true. But I don't think that because a person is elderly his life is worth less. I'm sure that for their relatives the age of the person is irrelevant. Also influenza generally affects the most, the elderly, the young and those with pre existing conditions. And that's why we vaccinate them. Italy is an old country, the effects of a virus like that could be huge.

 

[Karin1984]

Yes that's true. But I don't think that because a person is elderly his life is worth less. I'm sure that for their relatives the age of the person is irrelevant. Also influenza generally affects the most, the elderly, the young and those with pre existing conditions. And that's why we vaccinate them. Italy is an old country, the effects of a virus like that could be huge.

No, that's definitely true. I was more thinking about chances to get better.
Does anyone know how they treat people with Coronavirus?

 

[GlamMistress]

Stock futures are going bonkers right now. I think we're officially in black swan territory.

New:

https://twitter.com/x/status/1231909997241602049

And about Italy:

https://twitter.com/x/status/1231907150508756995

 

[Starwind]

If people come to the ED, urgent care or doctor's office with respiratory issues we swab them for influenza. We are not testing for Coronavirus. Granted not everyone seeks medical help when they have the flu, but it's still more accurate than the Coronavirus. There could be thousands in this country with Corona and we would not know. A lot of people may die from the flu, but the fatality rate is still very low. The fatality rate for this virus may be just as low, but we'll never have an idea until we start testing people.

As a small data point, here in Ontario, "Influenza testing is not currently available through the Public Health Ontario (PHO) Laboratory for patients in ambulatory settings, including those at high risk for influenza complications or patients in emergency department settings who will not be admitted to hospital. " (https://www.toronto.ca/community-pe...nals/influenza-info-for-health-professionals/). and "In Ontario, laboratory testing for influenza is only available for hospitalized patients or in the context of institutional outbreaks. Laboratory testing for influenza is not available to community-based healthcare providers in Ontario, except through the Canadian Sentinel Practitioner Surveillance Network. " (https://www.ottawapublichealth.ca/e...-influenza.aspx#Diagnosis--Laboratory-testing) See the provincial guidelines at https://www.publichealthontario.ca/...orithm-enhanced-surveillance-update.pdf?la=en .

As for the US testing for coronavirus, as of February 14 it appears there is some of that happening, using the existing surveillance network to try to detect if coronavirus is spreading in the community. Widespread reporting suggests that at 5 public health laboratories (and that number will expand), samples that test negative for influenza will be tested for coronavirus.

See e.g. https://www.aappublications.org/news/2020/02/14/coronavirus021420 and https://www.infectioncontroltoday.com/hai-types/cdc-seeks-test-some-flu-symptoms-covid-19 and https://www.cdc.gov/media/releases/2020/t0214-covid-19-update.html.html

 

[Starwind]

No, that's definitely true. I was more thinking about chances to get better.
Does anyone know how they treat people with Coronavirus?

Monitoring and Supportive care based on symptoms, like oxygen therapy or ventilation support or ECMO.

And there have been some reports of experimenting with medications and treatments used for other diseases, eg using some HIV antiviral drugs.

There is no specific treatment.

CDC Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

 

[Starwind]

Just looking at the CDC website, they've put a Level1 travel advisory for Iran and Italy; also still a level 2 for Japan and South Korea, and Level 3 for China. Interesting that with all these countries they advise people who have been there to call their doctor if they don't feel well. This implies that screening is also expanded to individuals who've been to these countries, so that's good. However, US doctors need to be able to screen anyone they choose to. Although some of them would anyway it would be nice to have the go-ahead from the CDC.

COVID-19 testing is not done like other types of testing, including influenza, so it isn't as simple as just screening everyone a doctor chooses to. That just is not an option.

CDC guidance is still based on travel to china or close contact to known case: https://www.cdc.gov/coronavirus/2019-ncov/hcp/identify-assess-flowchart.html and https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

But see also https://www.cdc.gov/coronavirus/201.../coronavirus/2019-ncov/clinical-criteria.html

QUOTE

• For any patient meeting criteria for evaluation for COVID-19, clinicians are encouraged to contact and collaborate with their state or local health department.
• For patients that are severely ill, evaluation for COVID-19 may be considered even if a known source of exposure has not been identified.

END QUOTE

QUOTE

Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a 2019-nCoV PUI case investigation form available below.

• Download fillable PDF form pdf icon[PDF – 211 KB]
• Download Microsoft Word form word icon[DOC – 90 KB]

CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC.

Testing for other respiratory pathogens should not delay specimen shipping to CDC. If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible 2019-nCoV co-infections.

END QUOTE

 

[Adventurelawyer]

If people come to the ED, urgent care or doctor's office with respiratory issues we swab them for influenza. We are not testing for Coronavirus. Granted not everyone seeks medical help when they have the flu, but it's still more accurate than the Coronavirus. There could be thousands in this country with Corona and we would not know. A lot of people may die from the flu, but the fatality rate is still very low. The fatality rate for this virus may be just as low, but we'll never have an idea until we start testing people.

Not everyone is swabbed in the Emergency Room for Influenza, nor does everyone with Influenza show up at the Emergency room. Nor is everyone with coronavirus sick enough to raise the the flag which would trigger a swab. Logically speaking, your suggestion of testing “everyone” doesn’t hold water for CV or flu.

what is happening now is that those with presenting with ILI, get a CV swab IF the Influenza rapid test comes back negative. But again, we don’t really want people waltzing into the hospital with flu like symptoms because we don’t want to continue the spread (regardless of the cause of those symptoms). Furthermore, Emergency rooms are for emergencies. The flu is not necessarily an emergency unless you have difficulty breathing,seizures or other complications, leave those beds for cardiac patients, traumas, etc. Places where there are major outbreaks or large clusters, have tested to the limits of their abilities and we know they haven’t tested everyone.

Just to summarize, not everyone with influenza is counted, because they cannot be counted. Similarly, not everyone with Coronavirus is or will be counted because they cannot be counted. The only way will ever know the true R0 and the mortality rate is with controlled scientific sample.

 

[QueenElinor]

COVID-19 testing is not done like other types of testing, including influenza, so it isn't as simple as just screening everyone a doctor chooses to. That just is not an option.

CDC guidance is still based on travel to china or close contact to known case: https://www.cdc.gov/coronavirus/2019-ncov/hcp/identify-assess-flowchart.html and https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

But see also https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/clinical-criteria.html

• For patients that are severely ill, evaluation for COVID-19 may be considered even if a known source of exposure has not been identified.

END QUOTE

QUOTE

Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a 2019-nCoV PUI case investigation form available below.

• Download fillable PDF form pdf icon[PDF – 211 KB]
• Download Microsoft Word form word icon[DOC – 90 KB]

CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC.

Testing for other respiratory pathogens should not delay specimen shipping to CDC. If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible 2019-nCoV co-infections.

END QUOTE

I know covid19 isn't done like other forms of testing. I also know that this:

• For patients that are severely ill, evaluation for COVID-19 may be considered even if a known source of exposure has not been identified.

Is an open door for a doctor to test who they think needs to be tested. So yes, it IS anyone the doctor chooses to be tested. One hopes they choose wisely, they're going to have to justify it.

But the reason the CDC included the following language in the travel advisories to Japan, Iran, Italy and South Korea is to open the door a little wider:

If you spent time in Italy during the past 14 days and feel sick with fever, cough, or difficulty breathing:

• Seek medical advice. Call ahead before going to a doctor’s office or emergency room. Tell them about your recent travel to Italy, an area with community spread of coronavirus, and your symptoms.

Do you really think doctors aren't going to test for COVID19 if the case doesn't meet the strict CDC criteria with language like that in the travel advisory? I know for a fact that they will. A lot depends on one's relationship with the local public health department, and in my town, it's a good one. I am pretty sure we can get what we want, but then again we're not dummies and neither are they.

No one wants to be responsible for the first outbreak in America, that's for sure.

 

[DLgal]

How do you know its one in five when we don't know how many people have the virus?

Those are the numbers given by CDC. THEY say 80% have mild symptoms and the rest require hospitalization. In this case, and in ALL cases of illness, not everyone is counted. They are basing the numbers they publish as statistics taken from the patient population who has been tested and follows the outcome of those, specifically. That is always how it is done.

No one truly ever knows how many people catch the flu every year, or how many people catch colds, or how many people die from cancer (because yes, many times people die from that without ever being diagnosed). Health statistics are based on sample sizes, for the most part, extrapolated out to larger populations to make estimates.

 

[smmco]

Not everyone is swabbed in the Emergency Room for Influenza, nor does everyone with Influenza show up at the Emergency room. Nor is everyone with coronavirus sick enough to raise the the flag which would trigger a swab. Logically speaking, your suggestion of testing “everyone” doesn’t hold water for CV or flu.

what is happening now is that those with presenting with ILI, get a CV swab IF the Influenza rapid test comes back negative. But again, we don’t really want people waltzing into the hospital with flu like symptoms because we don’t want to continue the spread (regardless of the cause of those symptoms). Furthermore, Emergency rooms are for emergencies. The flu is not necessarily an emergency unless you have difficulty breathing,seizures or other complications, leave those beds for cardiac patients, traumas, etc. Places where there are major outbreaks or large clusters, have tested to the limits of their abilities and we know they haven’t tested everyone.

Just to summarize, not everyone with influenza is counted, because they cannot be counted. Similarly, not everyone with Coronavirus is or will be counted because they cannot be counted. The only way will ever know the true R0 and the mortality rate is with controlled scientific sample.

I didnt say everyone is tested. I I said people with respitory symptoms are swabbed. Lots of people in the US use the emergency room as a doctors office because they don’t have insurance. You would be shocked at what people come to the ED for. You obviously have no clue what goes on in our hospitals.

 

[smmco]

Those are the numbers given by CDC. THEY say 80% have mild symptoms and the rest require hospitalization. In this case, and in ALL cases of illness, not everyone is counted. They are basing the numbers they publish as statistics taken from the patient population who has been tested and follows the outcome of those, specifically. That is always how it is done.

No one truly ever knows how many people catch the flu every year, or how many people catch colds, or how many people die from cancer (because yes, many times people die from that without ever being diagnosed). Health statistics are based on sample sizes, for the most part, extrapolated out to larger populations to make estimates.

I agree with all that, but until we start testing people we can’t even make an educated guess.

 

[DLgal]

I agree with all that, but until we start testing people we can’t even make an educated guess.

They have tested over 70,000 people in China already and have based their numbers on both that AND what they have seen happen in the cases that show up outside of China. You don't need a huge sample size to come up with these types of estimates. It seems like 2% is a consistent estimate of deaths based on confirmed cases and 20% hospitalization is as well. They are seeing the same thing play out outside of China.

 

[smmco]

As a small data point, here in Ontario, "Influenza testing is not currently available through the Public Health Ontario (PHO) Laboratory for patients in ambulatory settings, including those at high risk for influenza complications or patients in emergency department settings who will not be admitted to hospital. " (https://www.toronto.ca/community-pe...nals/influenza-info-for-health-professionals/). and "In Ontario, laboratory testing for influenza is only available for hospitalized patients or in the context of institutional outbreaks. Laboratory testing for influenza is not available to community-based healthcare providers in Ontario, except through the Canadian Sentinel Practitioner Surveillance Network. " (https://www.ottawapublichealth.ca/e...-influenza.aspx#Diagnosis--Laboratory-testing) See the provincial guidelines at https://www.publichealthontario.ca/...orithm-enhanced-surveillance-update.pdf?la=en .

As for the US testing for coronavirus, as of February 14 it appears there is some of that happening, using the existing surveillance network to try to detect if coronavirus is spreading in the community. Widespread reporting suggests that at 5 public health laboratories (and that number will expand), samples that test negative for influenza will be tested for coronavirus.

See e.g. https://www.aappublications.org/news/2020/02/14/coronavirus021420 and https://www.infectioncontroltoday.com/hai-types/cdc-seeks-test-some-flu-symptoms-covid-19 and https://www.cdc.gov/media/releases/2020/t0214-covid-19-update.html.html

I can only tell you in my healthcare system. We swab everyone with respiratory-symptoms and they are put on droplet precautions until the results come back negative.

 

[DLgal]

I didnt say everyone is tested. I I said people with respitory symptoms are swabbed. Lots of people in the US use the emergency room as a doctors office because they don’t have insurance. You would be shocked at what people come to the ED for. You obviously have no clue what goes on in our hospitals.

Very true. Last time I was at the ER (my son had a nosebleed that lasted for 4 HOURS that even they had a hard time stopping), there was a man in the bed next to us who was there because he "had a hard time sleeping last night and was tired."

 

[Adventurelawyer]

I didnt say everyone is tested. I I said people with respitory symptoms are swabbed. Lots of people in the US use the emergency room as a doctors office because they don’t have insurance. You would be shocked at what people come to the ED for. You obviously have no clue what goes on in our hospitals.

No you did not. You said we test for influenza in the ED. Do I need to start screen caping your posts? Furthermore, you failed to read my post beyond the first sentence, people need not and DO NOT, go to the ER for ILI, and most with the flu don’t even report to any doctor, let alone an ER which costs thousands because they are not there for an emergency. Thus causing the numbers on infection to be inaccurate; no one can ever know with certainty. However, you cling to thise numbers as a gold standard for viral outbreak and response, but refuse to accept the educated calculations of your scientific betters.

Moreover, I see you tossing out how you are in the medical field and that you work in infectious disease, I suspect that if you were very high up in the ED or infectious disease food chain, you would understand how epidemics work, how actual scientists make educated guesses based on numbers and how risk is calculated. You would also know that different regions have different standards of care, which means not everyone with ILI is swabbed. My suspicion is you have overstated you importance in order to be an important influencer in this conversation, while vacillating between “its not that bad, because it has the same numbers as influenza,” and the “sky is falling because we don’t know the numbers,”stoking fear against reason and logic. So which is it for you, is it not as bad as flu because the known numbers are on par with that family of viruses or is the sky falling because the known numbers are on par with influenza, in your learned medical opinion?

 

[QueenElinor]

Once caveat about that "80% are mild"- it is not what we usually think "mild" is. The case definition in that study which is being quoted all the time is that "mild" is upper respiratory infection or mild pneumonia. That is a pretty wide case definition and could definitely include hospitalized patients needing oxygen and IV fluids. Since it came out of China, I'm leaning toward those cases being more on the pneumonia end of things, as they are usually diagnosing and treating only the more serious cases.

However, another study came out today with data from the Diamond Princess and it showed that about a third of people with COVID19 were asymptomatic. That's encouraging on the one hand in terms of mild disease being a big part of this epidemic, but very discouraging from a containment standpoint.

Putting this all together, it seems that at least one-third of all cases might need hospitalization, and that is a huge burden on any health system.