California is way behind NY in testing per capita.
You have to keep testing those coming up negative, because that doesn’t mean they’re not infected tomorrow. There is an antibody test now, which will help immensely because it will identify those who aren’t positive but are now immune - having had it and beat it and so have the antibodies in their blood. No idea how quickly they can roll out this test, though, given how they sucked at rolling out the virus test.
People can be infectious but asymptomatic for 30 days or more, but it’s usually more like 10 days. This comes on slowly, but then you have a week to 10 days of 100+ fever. Most recover and the fever breaks, but some “crash” after about a week and need hospitalization and even intensive care. Some of these folks die.
One of the many insidious things with this virus is the slow burn. It delays testing and seeking treatment, meaning that it gets spread farther before you know about it, and then people start showing up at hospital in bigger and bigger waves. We’re not at that point yet, but NY will be in a matter of days.
I have patients in their early 40s and, yeah, I was kind of shocked. I’m seeing people who look relatively healthy with a minimal health history, and they are completely wiped out, like they’ve been hit by a truck. This is knocking out what should be perfectly fit, healthy people. Patients will be on minimal support, on a little bit of oxygen, and then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all.
Normally, [acute respiratory distress syndrome] is something that happens over time as the lungs get more and more inflamed. But with this virus, it seems like it happens overnight. … With our coronavirus patients, once they’re on ventilators, most need about the highest settings that we can do. About 90% oxygen, and 16 of PEEP, positive end-expiratory pressure, which keeps the lung inflated. This is nearly as high as I’ve ever seen. The level we’re at means we are running out of options.
In my experience, this severity of ARDS is usually more typical of someone who has a near drowning experience — they have a bunch of dirty water in their lungs — or people who inhale caustic gas. Especially for it to have such an acute onset like that. I’ve never seen a microorganism or an infectious process cause such acute damage to the lungs so rapidly.
Your risk of mortality increases every day that you spend on a ventilator. The high pressures from high vent settings is pushing air into the lung and can overinflate those little balloons. They can pop. It can destroy the alveoli. Even if you survive ARDS, although some damage can heal, it can also do long-lasting damage to the lungs. They can get filled up with scar tissue. ARDS can lead to cognitive decline. Some people’s muscles waste away, and it takes them a long time to recover once they come off the ventilator.
I know everyone is overanalyzing their own symptoms right now, but I’m about 80% sure I got a mild case of it. Last Tuesday 3/17 I developed a dry cough and some chest pressure, and although I never developed a “fever” I consistently had chills and ran 99.0-99.6 for days, which is high for me (my normal is mid-97s). Then two days ago I learned that I was definitely indirectly exposed to COVID-19 on two separate occasions, both times between the dates of March 9-11, both times physically interacting with a computer that a person who would later test positive had touched 24-48 hours prior.
Once I learned all that, I went through an online screening and was told that, despite my potential exposure and having some symptoms, I wouldn’t get tested unless my temp went north of 100.6 and/or I got pneumonia. I’m on the back side of symptoms now - still have a cough but temp and chest are back to normal - so I may never know if I actually had it. The timing of it all seems pretty spot on, though.
We have a disaster bill that I will sign. We will have a signing, it will be a beautiful signing ceremony.
We are testing more than anyone. By far. We’re testing more in a week than any other country has done in a month.
South Korea called and said they are amazed at our testing program, no one thought it could be as good as it is in the US
It’s really hard not to be happy with the job I’m doing
Like everything else, our emergency response system was totally depleted before I was elected, but like everything else, I have built up more than anyone thought was possible.
I have created an entirely new military. We have lots of new missiles, you should see them, they are beautiful.
Lot of counties are in trouble, but not us
Believe it or not, it’s not all me, lots of people chipping in.
The EU is playing games with us, and I’m the only president who has stood up to them. Europe is simply terrible to us. I will get even with them when the time is right.
I kinda hope you had it, because you’ll be immune now (they don’t know if people can get re-infected sans viral mutation, but it’s rare in other viruses). The flip side is that you don’t know if you gave it to anyone. The antibody test will show one way or the other, and I suspect we’ll all have to have that prior to vaccination.
The problem is that other people ARE watching. Trump’s approval ratings are at an all-time high (for him), and it’s because he gets two hours of wall-to-wall TV coverage in which he talks about all these great things he’s doing, none of which he’s actually doing. For those watching not from the big cities or WA, it all rings true because it hasn’t properly hit them yet.
It’s insane, of course, but that’s where we are today.
In the end, though, either Trump is right and these folks will be none the wiser, or Trump will be wrong and they’ll be overrun by the virus and suffer sickness and death that they didn’t see coming because they listened to the President who told them not to listen to the media.
That’s going to be the disconnect here: Trump spins his way from news cycle to news cycle while COVID-19 can’t be bargained with, can’t be reasoned with, doesn’t feel pity, or remorse, or fear, and it absolutely will not stop. Ever. Until we are dead!.
Here’s a handy - if scary and depressing - counter.
US surpassed 1,000 deaths total today as 247 deaths occurred. Total cases now 68,000. The graphs of the acceleration are terrifying, as are the numbers for New York (although they might be starting to flatten a little, thankfully).
Texas is sliding down the table (a good thing), presumably as a result of our cities mostly closing down last week (and likely the geographic benefit of wide open space).
Shocking to no one is that Florida is on the rise, jumping from 1500 to 2000 cases in one day.
New York has about a 30% rate of positive cases vs. total tests. Is that accurate, or did they stop reporting negative tests like some states have? 30% is a huge number, and not far off from the lower bound of some of the worst case scenarios we‘ve seen talked about.
The worst is yet to come - we’re probably still about a week or two from the spike in deaths.
The high positive rate could be due to stringent test criteria. I don’t know what NY is using, but if you allow testing of anybody with cold symptoms, you’ll have a lot more negatives. Whereas if you restrict testing to individuals highly likely to be positive ( and therefore not test folks like you who didn’t quite have a high enough temp), then you’ll enrich for truly infected individuals. With the shortage of tests, I would not be surprised if they are fairly restrictive.
And the worse is yet to come. Given the apparently long time between exposure and symptoms, folks testing positive now we’re likely infected before last week when most places starting putting in restrictions on movement. That means they’ve had plenty of time to spread. It’ll take a couple of weeks before test results start to give us a send of whether these measures are working. But I’m not sure “we” have the attention span to keep at it.
I have tried to stay out of these virus threads and to limit my reading of the morbid details of serious illness and death. I do, of course, read everything Dr. Fauci says, and I try to read as much as I can about things I should be doing or not doing. I am staying home and away from people, including family and friends. Missing my kids, grandkids, and close friends is the worst part, as I know all of you feel also.
I have lived mostly alone for the past eight years, and my days and nights are not much different than before this nightmare began. The solitariness is not the issue for me. What makes this feel so different is the knowledge I cannot see who I want to see or cannot do what I want to do. I try not to dwell on those things for sanity’s sake.
What is both infuriating and depressing is Trump’s plan to get back to business as usual after only a short period of time AND the apparent willingness of many Americans to follow his lead over the cliff like lemmings. Patrick says grandparents are willing to die to save the economy. I see people in my left-leaning neighborhood ignoring the sound medical advice from CDC and WHO. Right-wingers are starting to say Fauci is a Clinton plant, and Fox News says doctors should not be allowed to set policy. Policy? This is a public health crisis, not policy or politics, and medical advice should be guiding our actions and decisions, not politicians.
This murderous lunacy Trump is planning is going to kill many people who would be alive with intelligent and enlightened leadership. I hope I am not one of them. I am 74, am active and in reasonably good health, but I have a history (not current) of asthma and have been slightly anemic for years. I do not feel 74, and I am thankful for that, but an article I read a couple of weeks ago made a big impression on me. The article said “The virus does not give a damn about how old you feel.” I am being somewhat anal about staying out of even small groups and about staying away from people. I welcome the stay at home order And wish it were tougher. As I have said to others, I want to die a very old man, not now.
Where are we headed? I do not know, but the one thing I am sure of is if I get sick, the virus has a very good chance of killing me. I am going to do everything in one person’s power to stay healthy and sane, and I will continue to stay home until Fauci or other trusted medical advice says my going back to normal living is safe. I do not watch Trump or listen to him or to his sycophants. I am retired and can do this. I am not at all willing to die for the Dow.
Here’s an informative and current look from a pulmonologist (Dr. David Price of Weill Cornell Medical Center) in the NYC hotspot from the hospital that is taking 20% of the NYC cases. The video is personal and instructional, meant for his friends and family. He runs in some of the same professional circles I do. 57 minutes but worth every minute spent viewing. https://vimeo.com/399733860/description
Once they eventually gather all the knowledge, the phenomenon of hotspots will be very interesting. I gather it’s some interplay between total cases, proximity amongst people and climate. I suspect many areas will be spared from being a hotspot early on, through sheer happenstance and social distancing measures, but it will visit those places at some point. My concern is that people will live in a non-hotspot, conclude it’s no big deal, and make that area more susceptible in the future.
For Austinites and Central Texans, it’s my opinion that Mayor Adler did us very well. Cancelling SXSW was huge. I shudder to think what we’d being going through now if all those people had showed up and crowded together. On the flip side, I suspect the New Orleans hotspot is that they didn’t aggressively curtail Mardi Gras celebrations.