DawgTalkers.net Forums DawgTalk Everything Else... Contagion : COVID-19 Continued

Kinda surprised about that, too, but at this point I could see them resuming and just skipping summer break to get back on track.

My kids still have schoolwork, so going into summer wouldn't make much sense...

My senior would probably just quit school if they went into summer lol. I kid, but not really. He's already has enough credits to graduate. He is likely joining the military.

I saw that article shared on Facespace several days ago, and it is indeed sobering.

The notion of several periods of resuming/lockdown is, I think, why some areas may not be on lockdown for much longer. If an area doesn't have many cases, you may as well let the natives out for a bit. Yes, it will then spread faster, but it also spreads almost as fast when people don't adhere 100% to social distancing and lockdown rules.

The simple fact is this: we cannot stay like this indefinitely. The more we are locked down, the longer the curve is protracted. Yes, it is flatter, but it is also longer. So, what I believe we are going to see is a pulsed effect just like the article describes where we relax things and let the virus spread a bit, but we also get some people back to work. Then, once the virus starts to ramp up again, we lock it all back down again. Wash, rinse, and repeat until we hit herd immunity, develop treatments that mitigate the load on hospitals, or develop immunizations.

Like it said, there is essentially no outcome here where it just goes away. Even if we somehow get rid of it here in Ohio, it will only take one person travelling through from anywhere else to touch it off again. Same on a larger scale should we do the utterly impossible and eliminate it in the United States; the first business trip from overseas, or the first person crossing one of our borders, would bring it right back to us.

So, given that it is NOT going away, period, the focus MUST switch to figuring out how to best get through the next year to eighteen months, and that is to do it while accomplishing two things simultaneously: advance us toward herd immunity while still protecting people and not shuttering the entire economy. The only realistic way of doing that is that once we have more tests distributed, we make it available everywhere so people can get those new 5-minute tests and then we let everyone out... and monitor test results to adjust policy as needed. As it flares, we lock things down in that area until it slows.

There are currently 20 states that do not have a stay in place order.

Getting titer tests out to those of us that have been ill in the last couple of months (I was about a month ago) but were never tested could be huge step in moving forward. If there is any immunity to this after having gotten it, those that had it could be out working, keeping the economy moving.
I know there have been mixed reports about testing positive again but this could be the best chance to get people working again.

What reason did the FDA give for placing such a strict limit on mask sterilization? I've never heard, despite the numerous reports on this story.

j/c...

If we are talking about the same issue, Clem, the FDA lifted all restrictions last night...

They just announced a new antibody test to test people to see if they've had it and either didn't know or the symptoms weren't that bad. This will in effect test for immunity allowing those people to return to work/public life. They said it will be available in the states in a week or so.

Our grandkids, 8 and 6 year olds, are taking their classes online.

School system set it up.

Surprised other school systems haven't set that up yet.

Immunity? Hmm.. from what I understood surviving this doesn't grant immunity.. am I wrong?

Mixed reporting at this point, but they are saying if you recover from having it that you will have the antibodies to help fight off reinfection for 1-2 years after. But they can't be sure about the duration and it does not rule out reinfection altogether.

Hmmph.. I'd just as soon not have to do this again in 2 or 3 years

Well by then there should be a vaccine.

Or two or three months.

That would be HUGE.
Of course, again, it depends upon whether or not actual immunity is granted.

Most likely, the reports we've had from reinfections are weaker immune systems or they were very mild cases, or perhaps both, I'd bet.

Mild case and a slowly responding immune system could easily process a virus but not build up a ton of antigens.



We still need to know more in regard to how long people remain contagious and shedding; particularly for the asymptomatic cases as that is likely the largest vector of spread.




I kinda wonder if this is how it was with the other seasonal coronaviruses we deal with all the time and natural selection just weeded out those genetic branches that were most susceptible to severe disease, and if this means that in a generation or two this thing is nothing but another "common cold" to most people.

President says 1 million have been tested in the USA, more than anywhere else.

imo,

hmm, given the population of the USA, I probably will get access to a test by groundhog day next February, well in time for some "other" end of the world catastrophe to take the front page headlines.

(We're good on paper, Freddie Kitchens)

State of New York, number for 3/30/20, almost 66,500 cases,
that's up from 59,500+ a day before.

This is good news, as it's no longer a 30% increase per 24-36 hours;, 2 - 3 days ago this was on pace to hit about 117,000 by this afternoon or before,

If NY state keeps from doubling that 66,500 case number until the end of next week,

it's good news.

Surreal.

Reminds me of the age old call throughout the history of the Human Race...

Bring Out Your Dead!
Bring Out Your Dead!

sad.

They tried, Bring Out Your Live...

...but only on Saturday Night.

You mean like the Browns winning the Super Bowl next season...

Colorado governor stated doubling of cases slowed from 2 days to 5 days.

Is there less testing on weekends? See first bar chart in this link. The one for cases by onset date. All those low points are weekends.

There's not enough consistency in testing anywhere in the country for that "number of cases" figure to be meaningful. To quote decreases as something positive is very misleading. Like you said, they could have tested even fewer people on the weekends.

The only numbers that are accurate are ICU patients and deaths. Even the hospitalized patients showing respiratory symptoms aren't all tested.

j/c:

This is a follow-up to Milk's post about the refrigerated trailers in NYC. I don't know about you, but I find this to be alarming. 85 trailers? Jesus!

I've been getting in my car and going for a drive every single day, sometimes with the windows down. It's kind of a nice change of pace compared to staying inside. I also go the grocery whenever I want and go for walks. Anytime I touch anything in public, right after wards I don't touch my face and carry hydrogen peroxide to wipe down everything. I also wash my hands when I get home and before I eat anything just in case. Hopefully that's enough.

After being out and about take your shoes off at the door. Coat too. Minimal.

Dr. Fauci anticipates coronavirus outbreak in the fall


WASHINGTON (WJW) — Dr. Anthony Fauci said it’s likely there will be a second coronavirus outbreak in the fall.

The director of the National Institute of Allergy and Infectious Diseases answered a few questions during the White House Coronavirus Task Force briefing on Monday. It came a day after President Donald Trump extended federal social distancing guidelines through April.

Fauci said he anticipates coronavirus will be cyclical and return in the fall because of its degree of transmissibility.

Fauci said the second outbreak will be a different ball game compared to when the virus was first detected in the United States. We have better ability to test and contact trace, there are clinical trials for therapeutic intervention and a vaccine is on track, the doctor said.

“What we’re going through now is more than just lessons learned, it’s going to be things we have available to us that we didn’t have before,” Fauci said.

When asked about the possibility of a second outbreak, Trump said, “I hope it doesn’t happen, but we’re certainly prepared.”

https://www.wivb.com/news/dr-fauci-anticipates-coronavirus-outbreak-in-the-fall/

The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed.

As the coronavirus spreads, the collapse of the project helps explain America’s acute shortage.

Thirteen years ago, a group of U.S. public health officials came up with a plan to address what they regarded as one of the medical system’s crucial vulnerabilities: a shortage of ventilators.

The breathing-assistance machines tended to be bulky, expensive and limited in number. The plan was to build a large fleet of inexpensive portable devices to deploy in a flu pandemic or another crisis.

Money was budgeted. A federal contract was signed. Work got underway.

And then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.

That failure delayed the development of an affordable ventilator by at least half a decade, depriving hospitals, states and the federal government of the ability to stock up. The federal government started over with another company in 2014, whose ventilator was approved only last year and whose products have not yet been delivered.

Today, with the coronavirus ravaging America’s health care system, the nation’s emergency-response stockpile is still waiting on its first shipment. The scarcity of ventilators has become an emergency, forcing doctors to make life-or-death decisions about who gets to breathe and who does not.

The stalled efforts to create a new class of cheap, easy-to-use ventilators highlight the perils of outsourcing projects with critical public-health implications to private companies; their focus on maximizing profits is not always consistent with the government’s goal of preparing for a future crisis.

“We definitely saw the problem,” said Dr. Thomas R. Frieden, who ran the Centers for Disease Control and Prevention from 2009 to 2017. “We innovated to try and get a solution. We made really good progress, but it doesn’t appear to have resulted in the volume that we needed.”

The project — code-named Aura — came in the wake of a parade of near-miss pandemics: SARS, MERS, bird flu and swine flu.

Federal officials decided to re-evaluate their strategy for the next public health emergency. They considered vaccines, antiviral drugs, protective gear and ventilators, the last line of defense for patients suffering respiratory failure. The federal government’s Strategic National Stockpile had full-service ventilators in its warehouses, but not in the quantities that would be needed to combat a major pandemic.

In 2006, the Department of Health and Human Services established a new division, the Biomedical Advanced Research and Development Authority, with a mandate to prepare medical responses to chemical, biological and nuclear attacks, as well as infectious diseases.

In its first year in operation, the research agency considered how to expand the number of ventilators. It estimated that an additional 70,000 machines would be required in a moderate influenza pandemic.

The ventilators in the national stockpile were not ideal. In addition to being big and expensive, they required a lot of training to use. The research agency convened a panel of experts in November 2007 to devise a set of requirements for a new generation of mobile, easy-to-use ventilators.

In 2008, the government requested proposals from companies that were interested in designing and building the ventilators.

The goal was for the machines to be approved by regulators for mass development by 2010 or 2011, according to budget documents that the Department of Health and Human Services submitted to Congress in 2008. After that, the government would buy as many as 40,000 new ventilators and add them to the national stockpile.

The ventilators were to cost less than $3,000 each. The lower the price, the more machines the government would be able to buy.

Companies submitted bids for the Project Aura job. The research agency opted not to go with a large, established device maker. Instead it chose Newport Medical Instruments, a small outfit in Costa Mesa, Calif.

Newport, which was owned by a Japanese medical device company, only made ventilators. Being a small, nimble company, Newport executives said, would help it efficiently fulfill the government’s needs.

Ventilators at the time typically went for about $10,000 each, and getting the price down to $3,000 would be tough. But Newport’s executives bet they would be able to make up for any losses by selling the ventilators around the world.

“It would be very prestigious to be recognized as a supplier to the federal government,” said Richard Crawford, who was Newport’s head of research and development at the time. “We thought the international market would be strong, and there is where Newport would have a good profit on the product.”

Federal officials were pleased. In addition to replenishing the national stockpile, “we also thought they’d be so attractive that the commercial market would want to buy them, too,” said Nicole Lurie, who was then the assistant secretary for preparedness and response inside the Department of Health and Human Services. With luck, the new generation of ventilators would become ubiquitous, helping hospitals nationwide better prepare for a crisis.

The contract was officially awarded a few months after the H1N1 outbreak, which the C.D.C. estimated infected 60 million and killed 12,000 in the United States, began to taper off in 2010. The contract called for Newport to receive $6.1 million upfront, with the expectation that the government would pay millions more as it bought thousands of machines to fortify the stockpile.

Project Aura was Newport’s first job for the federal government. Things moved quickly and smoothly, employees and federal officials said in interviews.

Every three months, officials with the biomedical research agency would visit Newport’s headquarters. Mr. Crawford submitted monthly reports detailing the company’s spending and progress.

The federal officials “would check everything,” he said. “If we said we were buying equipment, they would want to know what it was used for. There were scheduled visits, scheduled requirements and deliverables each month.”

In 2011, Newport shipped three working prototypes from the company’s California plant to Washington for federal officials to review.

Dr. Frieden, who ran the C.D.C. at the time, got a demonstration in a small conference room attached to his office. “I got all excited,” he said. “It was a multiyear effort that had resulted in something that was going to be really useful.”

In April 2012, a senior Health and Human Services official testified before Congress that the program was “on schedule to file for market approval in September 2013.” After that, the machines would go into production.

Then everything changed.

The medical device industry was undergoing rapid consolidation, with one company after another merging with or acquiring other makers. Manufacturers wanted to pitch themselves as one-stop shops for hospitals, which were getting bigger, and that meant offering a broader suite of products. In May 2012, Covidien, a large medical device manufacturer, agreed to buy Newport for just over $100 million.

Covidien — a publicly traded company with sales of $12 billion that year — already sold traditional ventilators, but that was only a small part of its multifaceted businesses. In 2012 alone, Covidien bought five other medical device companies, in addition to Newport.

Newport executives and government officials working on the ventilator contract said they immediately noticed a change when Covidien took over. Developing inexpensive portable ventilators no longer seemed like a top priority.

Newport applied in June 2012 for clearance from the Food and Drug Administration to market the device, but two former federal officials said Covidien had demanded additional funding and a higher sales price for the ventilators. The government gave the company an additional $1.4 million, a drop in the bucket for a company Covidien’s size.

Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business.

Some Newport executives who worked on the project were reassigned to other roles. Others decided to leave the company.

“Up until the time the company sold, I was really happy and excited about the project,” said Hong-Lin Du, Newport’s president at the time of its sale. “Then I was assigned to a different job.”

In 2014, with no ventilators having been delivered to the government, Covidien executives told officials at the biomedical research agency that they wanted to get out of the contract, according to three former federal officials. The executives complained that it was not sufficiently profitable for the company.

The government agreed to cancel the contract. The world was focused at the time on the Ebola outbreak in West Africa. The research agency started over, awarding a new contract for $13.8 million to the giant Dutch company Philips. In 2015, Covidien was sold for $50 billion to another huge medical device company, Medtronic. Charles J. Dockendorff, Covidien’s former chief financial officer, said he did not know why the contract had fallen apart. “I am not aware of that issue,” he said in a text message.

Robert J. White, president of the minimally invasive therapies group at Medtronic who worked at Covidien during the Newport acquisition, initially said he had no recollection of the Project Aura contract. A Medtronic spokeswoman later said that Mr. White was under the impression that the contract had been winding down before Covidien bought Newport.

In a statement Sunday night, after the article was published, Medtronic said, “The prototype ventilator, developed by Newport Medical, would not have been able to meet the specifications required by the government, nor at the price required.” Medtronic said that one problem was that the machine was not going to be usable with newborns.

It wasn’t until last July that the F.D.A. signed off on the new Philips ventilator, the Trilogy Evo. The government ordered 10,000 units in December, setting a delivery date in mid-2020.

As the extent of the spread of the new coronavirus in the United States became clear, Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, revealed on March 15 that the stockpile had 12,700 ventilators ready to deploy. The government has since sped up maintenance to increase the number available to 16,660 — still fewer than a quarter of what officials years earlier had estimated would be required in a moderate flu pandemic.

Last week, the Health and Human Services Department contacted ventilator makers to see how soon they could produce thousands of machines. And it began pressing Philips to speed up its planned shipments.

The stockpile is “still awaiting delivery of the Trilogy Evo,” a Health and Human Services spokeswoman said. “We do not currently have any in inventory, though we are expecting them soon.”

https://www.nytimes.com/2020/03/29/business/coronavirus-us-ventilator-shortage.html

Looks like Sweden is rolling the dice.

WSJ

Inside Sweden’s Radically Different Approach to the Coronavirus
No lockdown, no quarantines, just voluntary advice and a big dose of hope

The ski pistes are open, the restaurants are doing ample business and the malls are awash with shoppers.

Welcome to Sweden, the last holdout among the small number of Western countries to have taken a radically different approach to the coronavirus pandemic.

While social life in Europe and much of the U.S. now centers on the home after governments imposed increasingly drastic curbs on freedom of movement, Sweden left offices and stores open, issued recommendations rather than restrictions, and waited to see what happens.

Businesses, kindergartens and schools remain open. After a long winter, Stockholm’s street cafes and outdoor bars swelled with people over the weekend, and the city’s old town drew large crowds as locals ventured out to enjoy the good weather. The only mandatory rules are a ban on meetings of more than 50 people and an order forcing bars and restaurants to only serve seated customers so as to avoid overcrowding.

The U.K. and the Netherlands also briefly considered letting the virus propagate through the population in a controlled manner so as to build a natural form of immunity. Both reversed course after academics warned they could face hundreds of thousands of deaths and an overwhelmed health care system.

It is too early to assess whether Sweden’s approach will have a benign or catastrophic outcome, but so far, the virus hasn’t spread widely there. Sweden, with 10 million inhabitants, had 4,028 confirmed infections and 146 deaths by Monday, according to a tally compiled by Johns Hopkins University. Austria, a similarly-sized European country with about 8.8 million people that is under lockdown, had 9,200 cases and 108 deaths.

Anders Tegnell, Sweden’s chief epidemiologist and architect of the policy, says the approach, much like the original British one, is to let the virus spread as slow as possible while sheltering the elderly and the vulnerable until much of the population becomes naturally immune or a vaccine becomes available.

The next two weeks will determine whether Sweden’s approach can succeed or if authorities bend to the reality of a rash of new cases, said Dr. Cecilia Söderberg-Nauclér, a physician and professor at the Karolinska Institute. She predicted the government would be forced to retreat because the virus was out of control due to the absence of restrictions and testing. Asian countries that have managed to avoid lockdowns relied on mass testing to isolate positive cases and stop the contagion, she said.

Sweden has a long tradition of favoring voluntary guidelines—which call on the elderly to self-isolate and the young to reduce social mobility—over coercive measures. Dr. Tegnell said that could lead to higher compliance.

“A majority of people will stay home if they get symptoms,” he said. “We want to slow down the epidemic until Sweden experiences some sort of peak, and if the peak is not too dramatic we can continue.”

Unlike in the U.K., there is little sign of a backlash against the voluntary approach from a worried public. A Novus poll last week showed 80% of people approved of a speech by Prime Minister Stefan Löfven, in which he appealed to the personal responsibility of each adult citizen to prevent the disease’s spread.

A field hospital in Stockholm appeared to have ample space for patients on Monday.

In Stockholm this past weekend, more people appeared to avoid closed spaces than the previous weekend, and travelers on public transport were sitting apart from each other. Some Stockholmers are staying home and many skiers have cut short their trips to popular resorts such as Åre. The number of people using Stockholm’s underground and commuter trains dropped by 50% last week, according to Storstockholms Lokaltrafik, the public transport company.

Some European experts and officials, including Ansgar Lohse, a prominent German doctor, and Sir Patrick Vallance, chief scientific adviser to the British government, have praised the approach.

But even some of these proponents say it might be hard to replicate outside the specific context of Scandinavia. In Swedish culture, they note, generations don’t interact as much as they do in, say Italy. More than half of Swedish households consist of a single person, according to official data. This means less risk of younger people passing on the virus to their elders.

It may also explain why a disproportionate number of Sweden’s Covid-19 deaths occurred within the country’s Somali community, whose members tend to live in cramped accommodation in poorer neighborhoods, with more intergenerational mingling and less access to government information.

Some Swedish economists have also criticized the government’s strategy as shortsighted, warning that the cost of an out-of-control epidemic could outweigh the benefits of avoiding lockdowns in the short term.

Yet the main expressions of concerns have come from scientists and doctors. Some are concerned that cases will pick up soon and fast. The Huddinge clinic in Stockholm has obtained refrigerated containers to store bodies if the death toll escalates as it has in other countries. Elective surgeries have been paused, and local authorities are building a makeshift Covid-19 clinic in Stockholm.

“This is a big and risky experiment with the entire population that could have a catastrophic outcome,” Joacim Rocklöv, a professor of epidemiology at Umeå University and one of several scientists campaigning for the government to change tack. “It is risky to leave it to people to decide what to do without any restrictions. As can be seen from other countries this is a serious disease, and Sweden is no different than other countries.”

Dr. Rocklöv’s research shows that pursuing herd immunity without suppressing the spread of the virus would overwhelm hospitals and result in large numbers of premature deaths. He is skeptical that high-risk groups can be effectively sheltered.

Fredrik Elgh, a professor of virology at Umea University, said that the current policy was frightening and called for Stockholm to be put under quarantine.

“We will be overwhelmed by cases further down the epidemic curve,” Dr. Elgh said.

7 - out, line away, pay the don'ts and the last come.

I thought I read the other day that their healthcare system was much more prepared for something like this than ours too and that was another reason they favored this approach.

Sweden is definitely rolling the dice -- it is not going to work out now, and their death rate is doubling every 4 days at present.

Their population is 10 million, compared to 327 million in the US.

Take their numbers and multiply them by 33 (est) to get a comparable number for them if they had the same size population.

It would be 133k cases, and 4.800 deaths, if their population was the same as ours. (rounded to the whole population number of 10 million)

The US has 164K reported cases, but "only" 3100 deaths.

They have, by a good margin, fewer beds per 1,000 citizens that both Italy and the U.S.

Well, there probably isn't a wrong decision. Every society is different and we're all just guessing.

Time will tell; I hope it works for them.... because the cost of it not working will be very hard to pay.


They have a comparable population to Ohio, but have twice the cases and four and a half times the deaths.... and they are probably running slow as they are just coming out of a deeper winter than us. As it warms and people get out, it will probably take off.

Interesting to see what happens in Sweden ... wow