When will this shit end?

[Avalon_Fields]

1 minute ago, crazyfool1 said:

I wonder what these nightingale hospitals will be used for ... I thought the numbers were starting to drop ... so will they be used specifically for all CV19 patients freeing up the standard hospitals to get back as close to normal service as possible ? or are they just too spaced out ... or the other thought was do they use them for more of the elderly from care homes thus giving the uninfected within them more of a chance .. or do they just get held in reserve for a possible second peak ?

It's looking more likely they won't have really been needed at all, but in my view was a sensible step to ensure we could cope with numbers.

They could use the spare capacity to re-start non-Covid 19 medical treatments again, cancer for example, some studies are worryingly projecting more deaths may result from this than from the virus itself.

[gigpusher]

7 minutes ago, Deaf Nobby Burton said:

The thing that worries me as a nation compared to say Sweden is that we’ve shown large swathes won’t listen unless they have to. That said I don’t doubt it will have changed how a lot behave, potentially indefinitely. We certainly seem to be more of a nation of people who if they lets us do it, well do it though. 

That's why I said they have that they are effectively doing the same as us anyway. I've noticed when out for my daily walk that where I live seems to be having an explosion of same sex relationships that I have never noticed before. I didn't realise I was in such an LGBT hotspot!!  

[Toilet Duck]

21 minutes ago, Avalon_Fields said:

But I understand masks are still unproven (i.e. WHO advice for example), and may give the user a wrong sense of security, and can't get them for the general population until there's more than enough for all carers, etc.

What we really need is some proper public information on this. My mask protects you. That's the message and it needs to be drilled into everyone. It doesn't protect me, your mask does. The data on transmission reduction from wearers is pretty clear. What frontline workers needs is PPE that protects them, and it's different to what the general population need to wear to protect each other. The two things have been conflated, but they are separate issues. Interesting paper currently under review showing how vaporised hydrogen peroxide can be used to repeatedly sterilise and reuse PPE (FFP2/3 respirators) with no damage to the seal or the mask. Stuff is sterilised in hospitals all the time, PPE can now be added into that and it could ease the shortage. Even cotton masks for the general public reduce transmission, so it just needs a bit of smart thinking to sort this out and allow massive easing of restriction (sporting events, gigs, flights etc all possible if everybody wears a mask while in attendance). 

Edit: and keeps cleaning their hands obviously! 😁

Edited April 21, 2020 by Toilet Duck

[Deaf Nobby Burton]

5 minutes ago, Toilet Duck said:

What we really need is some proper public information on this. My mask protects you. That's the message and it needs to be drilled into everyone. It doesn't protect me, your mask does. The data on transmission reduction from wearers is pretty clear. What frontline workers needs is PPE that protects them, and it's different to what the general population need to wear to protect each other. The two things have been conflated, but they are separate issues. Interesting paper currently under review showing how vaporised hydrogen peroxide can be used to repeatedly sterilise and reuse PPE (FFP2/3 respirators) with no damage to the seal or the mask. Stuff is sterilised in hospitals all the time, PPE can now be added into that and it could ease the shortage. Even cotton masks for the general public reduce transmission, so it just needs a bit of smart thinking to sort this out and allow massive easing of restriction (sporting events, gigs, flights etc all possible if everybody wears a mask while in attendance). 

Agreed, It was already on the news this morning that NHS bosses are concerned that telling the public to wear them will put strain in their supplies. I know we’ve discussed the differences between the general public’s masks and health care professionals; but either way the government can’t afford to balls this up. They need a proper coordinated campaign and enough separate stock for the public to support it.

Edited April 21, 2020 by Deaf Nobby Burton

[Crazyfool01]

3 minutes ago, Avalon_Fields said:

It's looking more likely they won't have really been needed at all, but in my view was a sensible step to ensure we could cope with numbers.

They could use the spare capacity to re-start non-Covid 19 medical treatments again, cancer for example, some studies are worryingly projecting more deaths may result from this than from the virus itself.

yes absolutely .... get things up and running and as close as is possible to back to normal as quickly as possible .... I just dont want to see them left as empty and the health service overwhelmed for months /years because of the long term effects of the virus on other medical needs ... obviously understanding that we only have limited nursing / dr capacity 

[Toilet Duck]

2 minutes ago, Deaf Nobby Burton said:

Agreed, It was already on the news this morning that NHS bosses are concerned that telling the public to wear them will put strain in their supplies. I know we’ve discussed the differences between the general public’s masks and health care professionals; but either way the government afford two balls this up. They need a proper coordinated campaign and enough separate stock for the public to support it.

Exactly! 

[steviewevie]

In some parts of the world, like Japan, wearing masks is very normal...people wear them when ill to stop other people catching it.

Weirdos.

[Toilet Duck]

2 minutes ago, steviewevie said:

In some parts of the world, like Japan, wearing masks is very normal...people wear them when ill to stop other people catching it.

Weirdos.

I know, socially responsible idiots! 😛

 

Edit: On a more serious note, if it did become more normal, rates of other, milder respiratory infections would drop. everyone is banging on about the economic cost of COVID, but massive amounts of economic damage is done by mild illnesses every year and we make no effort to mitigate this. 

Edited April 21, 2020 by Toilet Duck
further thoughts

[DeanoL]

2 hours ago, Homer said:

do we still have people entering the country and not self-quarantining? If so, why?

I've seen this a few times and don't get what the benefit is meant to be? Quarantining people entering the country makes sense if the virus isn't yet in the country. But it is, and it's clearly wide-spread. Someone coming from another country is no more or less likely to have it than someone at the supermarket.

The only other issue is that they've been on a plane, close to other people, for some hours. Which yes, is an issue. But no more so than someone getting the tube. We're not quarantining anyone that makes a journey on public transport.

[Waterdeep]

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378

 

Looks like SARS left a lot of people with chronic illness. Anyone with any knowledge care to guess at the likelihood of similar with this? It's pretty similar in makeup to SARS right?

[Superscally]

In defence of the American protestors, if not necessarily the protests themselves, you may not realise how "on the breadline" many or most of these people are. Having a unique eye on all sorts of communities in America, I saw the lack of safety net, the living for today forced out of necessity, rather than choice. If these people don't work, they're up the creek. That $1500 bailout won't go far. The tragedy is the lack of social support in America. Trump kind of has to go along with this to avoid people asking the questions he doesn't want to answer. In the meantime, he'll be hoping that the majority of people will distance and the fact that apart from a few cities, life is far more spread out than here will help the US in the long run. It is rapidly becoming an open goal for Biden, if he genuinely seeks to institute social reform...

[Deaf Nobby Burton]

4 minutes ago, DeanoL said:

I've seen this a few times and don't get what the benefit is meant to be? Quarantining people entering the country makes sense if the virus isn't yet in the country. But it is, and it's clearly wide-spread. Someone coming from another country is no more or less likely to have it than someone at the supermarket.

The only other issue is that they've been on a plane, close to other people, for some hours. Which yes, is an issue. But no more so than someone getting the tube. We're not quarantining anyone that makes a journey on public transport.

Precisely, and as a nation we’re in lockdown so they can’t spread it around anymore than the rest of us can anyway. 

It would only really be a benefit if we were in the situation China are currently in and they want to stop imported cases 

[Toilet Duck]

3 minutes ago, Waterdeep said:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378

 

Looks like SARS left a lot of people with chronic illness. Anyone with any knowledge care to guess at the likelihood of similar with this? It's pretty similar in makeup to SARS right?

Yes, early evidence suggests significant chronic problems for those who had severe disease. I looked at pathology slides of COVID patients early on in the outbreak and it looks very like emphysema, complete alveolar destruction in the regions of the lung affected. As this evolves, I wouldn't be surprised to see people who had sever disease develop COPD-like symptoms in the future. It's still early though, it will only become apparent as more people have resolved disease and we follow them up over the next few years. 

[Toilet Duck]

2 minutes ago, Deaf Nobby Burton said:

Precisely, and as a nation we’re in lockdown so they can’t spread it around anymore than the rest of us can anyway. 

It would only really be a benefit if we were in the situation China are currently in and they want to stop imported cases 

Interestingly, the HEPA filters on a plane change the air entirely in the cabin every couple of minutes. I would hazard a guess that the risk on the plane is far less than it is in the airport, or on the bus/train to/from the airport. So, if travelling from a country that isn't currently experiencing widespread community transmission, the risk should be low and the guidance should be restrict movements if you have been in close contact with a case, self-isolate if you develop symptoms. Contact tracing apps would allow this, even internationally. I've no problem with anonymous apps with strict privacy protection for this (not keen on using them to enforce restricted movement/self-isolation). 

[Reckoner]

Singapore lockdown extended till 1st June.

Initially dealt with well, with limited restrictions but massively underestimated the amount of cases coming in from other countries before borders closed mid march.  Cases have now found their way into the construction worker dorms and numbers of new cases are out of control. Would also be similar to the chat above regarding household density and its contribution.

[Waterdeep]

5 minutes ago, Toilet Duck said:

Yes, early evidence suggests significant chronic problems for those who had severe disease. I looked at pathology slides of COVID patients early on in the outbreak and it looks very like emphysema, complete alveolar destruction in the regions of the lung affected. As this evolves, I wouldn't be surprised to see people who had sever disease develop COPD-like symptoms in the future. It's still early though, it will only become apparent as more people have resolved disease and we follow them up over the next few years. 

Eek. So is it possible that if there's no effective treatment or vaccine and immunity is patchy/short lived, we keep getting it every year and get weaker from it each time?

[stuartbert two hats]

1 hour ago, Toilet Duck said:

It looks like it will become endemic. At the outset, based on nothing but a hunch I reckoned it would settle into our seasonal viruses and end up with a fatality rate somewhere around seasonal flu. Once we can protect vulnerable populations and we can treat those who develop severe symptoms, then it's something we can live with (and we live with much worse). The measures taken now have been to stop massive rates of infection very quickly (and the knock-on in massive fatalities). There will be a common refrain of "we over-reacted" over the next few weeks and months, but that's easy to say when the death rate has been reduced by an order of magnitude. If we didn't, the refrain would be "we should have locked down". You're damned if you do and you're damned if you don't. 

I thought influenza was so endemic because it changed so much from year to year, but coronaviruses were much more stable - do you not think that with herd immunity (via recovery and vaccination) we could wipe it out entirely - or at least reduce it down to a level where it's less of a problem than flu?

[Toilet Duck]

1 minute ago, Waterdeep said:

Eek. So is it possible that if there's no effective treatment or vaccine and immunity is patchy/short lived, we keep getting it every year and get weaker from it each time?

Not really. Its only those who develop severe symptoms that seem to get any damage. 95% of people who get infected don't develop pneumonia and the disease never gets too deep into their lungs. The virus binds very strongly to its receptor. There's some of these in the upper airways and loads of them in the lungs. SARS/MERS didn't bind very well to the same receptor, but you can increase the chances of a weakly binding virus interacting with its receptor by having more of them. So, in SARS/MERS, when patients developed disease, it was more frequently deep in the lungs where more of these receptors are. The vast majority of people who contract this virus will get infection in the upper airways (nasal passage, back of the throat etc). It never gets to their lungs to cause much damage. So, you will get repeatedly infected, same way you get repeatedly infected with other coronaviruses, but only develop a cough or a temp for a few days. 

[Toilet Duck]

14 minutes ago, stuartbert two hats said:

I thought influenza was so endemic because it changed so much from year to year, but coronaviruses were much more stable - do you not think that with herd immunity (via recovery and vaccination) we could wipe it out entirely - or at least reduce it down to a level where it's less of a problem than flu?

The immune response to flu is more stable. Immune response to other coronaviruses are very transient (almost seasonal in fact). So there's two things at play here, the stability of the virus and our response to it. Flu varies, so we need to keep vaccinating people to the new strains (but we also build up immunity to flu in general, which helped last time we had a new outbreak). This virus is stable, so the same vaccine should work for quite a while, but if even the vaccine only elicits a transient immune response, then repeated vaccination will be necessary. 

 

Edit: I should add that we have no idea what kind of immune response a validated vaccine will have. Its entirely possible that once we get one it can stimulate a sustained, even permanent immunological memory, won't know till we get a working vaccine and follow up over the course of years to see what people's antibody titres look like. 

 

Edit again: I should also point out that our transient immune response is one of the things that allows coronaviruses to remain stable. They have no need to change as our defence against it wanes every year. Flu needs to in order to get around our immune systems as we mount a stable response to it. It's natural selection occurring before your very eyes! Our immune systems provide the selective pressure for flu so that it has to mutate to survive. Without that selective pressure, no need to change. 

Edited April 21, 2020 by Toilet Duck

[Toilet Duck]

32 minutes ago, Toilet Duck said:

The immune response to flu is more stable. Immune response to other coronaviruses are very transient (almost seasonal in fact). So there's two things at play here, the stability of the virus and our response to it. Flu varies, so we need to keep vaccinating people to the new strains (but we also build up immunity to flu in general, which helped last time we had a new outbreak). This virus is stable, so the same vaccine should work for quite a while, but if even the vaccine only elicits a transient immune response, then repeated vaccination will be necessary. 

 

Edit: I should add that we have no idea what kind of immune response a validated vaccine will have. Its entirely possible that once we get one it can stimulate a sustained, even permanent immunological memory, won't know till we get a working vaccine and follow up over the course of years to see what people's antibody titres look like. 

 

Edit again: I should also point out that our transient immune response is one of the things that allows coronaviruses to remain stable. They have no need to change as our defence against it wanes every year. Flu needs to in order to get around our immune systems as we mount a stable response to it. It's natural selection occurring before your very eyes! Our immune systems provide the selective pressure for flu so that it has to mutate to survive. Without that selective pressure, no need to change. 

Sorry, even more edits!: All of the above with regard to this coronavirus assumes that it will be more like the endemic strains (current evidence suggests that this is most likely the case, but it's not definite). SARS/MERS elicited a permanent (or at least long lasting) immune response, so they died out (patients also became very sick with a high mortality rate, so it was more difficult for the virus to spread, in addition to the characteristics of the virus and its ability to colonise the upper airways). An interesting study later on will be to see if those who developed severe symptoms but recovered have more immunity to the virus than those who developed mild disease (and the virus was fought off by the innate immune system). SARS/MERS experience suggests this might be the case, but it's still all up in the air at this stage. 

[Waterdeep]

32 minutes ago, Toilet Duck said:

Not really. Its only those who develop severe symptoms that seem to get any damage. 95% of people who get infected don't develop pneumonia and the disease never gets too deep into their lungs. The virus binds very strongly to its receptor. There's some of these in the upper airways and loads of them in the lungs. SARS/MERS didn't bind very well to the same receptor, but you can increase the chances of a weakly binding virus interacting with its receptor by having more of them. So, in SARS/MERS, when patients developed disease, it was more frequently deep in the lungs where more of these receptors are. The vast majority of people who contract this virus will get infection in the upper airways (nasal passage, back of the throat etc). It never gets to their lungs to cause much damage. So, you will get repeatedly infected, same way you get repeatedly infected with other coronaviruses, but only develop a cough or a temp for a few days. 

Oh that 95% rate is good news, where are you seeing that? From reading around it seemed like there was a lot of pneumonia but that most people were able to manage it at home.

The point about it not travelling down to the lungs very much, how can that be? Once it gets into your nose/throat and you breathe, swallow etc, won't it travel down there quite easily?

[Toilet Duck]

2 minutes ago, Waterdeep said:

Oh that 95% rate is good news, where are you seeing that? From reading around it seemed like there was a lot of pneumonia but that most people were able to manage it at home.

The point about it not travelling down to the lungs very much, how can that be? Once it gets into your nose/throat and you breathe, swallow etc, won't it travel down there quite easily?

So, the 95% comes from the fact that most people develop mild symptoms. Of those that are symptomatic, only about 20% end up in hospital and of those in hospital, only a small percentage end up in critical care. Even those in critical care often don't have any pneumonia (Boris didn't for example). I've had pneumonia (for 6 months in my final year in school, great craic altogether it was), people who are coughing at home don't have it (for the most part) (same way that most people who say they have the flu, don't...they have some kind of respiratory virus infection, if they had the flu they'd know all about it!). So, the vast majority of people who contract this disease are either asymptomatic or have very mild disease. We get upper airway infections all the time. Most of the time they don't lead to lung infections (we cough, but it's not a lung infection, our airways are irritated by the inflammation caused by the infection, but our lungs or usually clear). Our immune systems kill the virus long before it manages to infect the lungs. You've definitely had a coronavirus infection at some point over your lifetime (probably loads of them), it's just that this is a new one, nobody has any immunity to it, so far more people are catching it than ones that are in general circulation.

[gigpusher]

1 hour ago, Superscally said:

In defence of the American protestors, if not necessarily the protests themselves, you may not realise how "on the breadline" many or most of these people are. Having a unique eye on all sorts of communities in America, I saw the lack of safety net, the living for today forced out of necessity, rather than choice. If these people don't work, they're up the creek. That $1500 bailout won't go far. The tragedy is the lack of social support in America. Trump kind of has to go along with this to avoid people asking the questions he doesn't want to answer. In the meantime, he'll be hoping that the majority of people will distance and the fact that apart from a few cities, life is far more spread out than here will help the US in the long run. It is rapidly becoming an open goal for Biden, if he genuinely seeks to institute social reform...

Oh yes from the very beginning I said America would struggle the most. A huge number are one pay cheque away from being on the streets. A huge number work several jobs just to exist. The American dream is really the greatest trick that they have ever pulled to make people think they could have it all when existing in reality at way less than first world levels. The craziest thing is just how bought into their own poverty cycle they are. 

[steviewevie]

In America it just seems to be part of the cultural war.

Edited April 21, 2020 by steviewevie

[WhoamI?]

37 minutes ago, Avalon_Fields said:

They could use the spare capacity to re-start non-Covid 19 medical treatments again, cancer for example, some studies are worryingly projecting more deaths may result from this than from the virus itself.

I know a mental health nurse who is worried about this possibility, emergency cutbacks in mental health care have definitely raised the suicide rate.

The rules at our local lidle have caused far more people to be inside the shop at the same time than their usually is.

Older people have been closed into care homes, unable to leave to get away from anyone who is ill, so obviously we have a peak in infection in care homes.

We have not even begun to see the human cost of economic impact yet.

It was always possible imho to end up with more deaths caused by lock down than prevented by it.