Coronavirus outbreak

[Slick]

In part,but the goal posts keep moving.
I'd have thought the patient would be protected from inhaling and absorbing?

I did hear the shadow health secretary's interview that you mention and I did wonder the same thing. In my world PPE is supposed to protect the wearer when the risk can't be removed by any other means, so it must afford at least some protection for the staff.

 

[PK99]

Was there not some work going into finding out why some people died and some didn't? I'm sure the best they came up with was being constantly re-infected or those being constantly exposed to the virus had a much higher likelihood of a poor outcome.

IIRC, the reports you are thinking of suggested that Viral load at the point of infection was important in determining disease progression.

Specifially, a high one off dose (medic from a very sick patient) or repeated smaller doses (medics from spending long time around many low level infected patients) presents a large challenge to the immune system whereas a smaller initial exposure/load allows the immune system to respond progressively.

 

[Slick]

IIRC, the reports you are thinking of suggested that Viral load at the point of infection was important in determining disease progression.

Specifially, a high one off dose (medic from a very sick patient) or repeated smaller doses (medics from spending long time around many low level infected patients) presents a large challenge to the immune system whereas a smaller initial exposure/load allows the immune system to respond progressively.

Couldn't have put it better myself but that's exactly what I meant. 👍

 

[tom73]

Right I can see your thinking but it's not black and white. So sorry for the length of the post.
You can't assume none covid related ICU has not got covid so some level of PPE is needed.
Just because they have they may have other none related infections on top of it.
So won't want that spreading around. PPE in clinical environments is as much about protecting the staff as it is to protect the patient.
Some people have been in ICU for weeks long before all this and can't be moved out.
So they can now find themselves in a room full of covid cases. So fresh PPE will be needed.
Some will be recovering from covid but still need a ICU bed the last thing they need is to come down with something else.

Anyone who enters, leaves then returns into the Red zone will require fresh PPE.
Dr's come and go they have other patients in other parts of the hospital to deal with.
Other HCP's and none clinical staff come and go too even none covid nurse may be asked to do part of a shift in the covid area.

Even the nurse at some point needs to leave for something to eat ,have a break or even a pee.
You get hot very quickly and can't work a full shift without some change into fresh PPE.
Between patients the PPE may get contaminated covid patients still throw up all over you. they will need suction at some point.
So a face shield is of little use if you can see though it. Gowns get damp as do the masks so they are then of little use.
It may get damaged so needs changing. It has a set order for on and off so it may not be possible to change just the one item.
Covid patient can't get it that's true but the nurse can. Even if the room is full of the virus you still want to minimise the amount as much as possible. One way of helping to limit the viral load.

PPE only works if it's clean , dry, and undamaged none of which can the guaranteed to last a full shift.
The goal posts keep moving because the right one's had not been in place from the start.

 

[MarkF]

Often a patients can't/won't wear a mask, a good % have dementia, not a clue where they are or what is happening, they are scared and just want "it" away from their face.

We ran out of regular PPE gowns well over a week ago, these were the full sleeved, wrap around type with thumb holes, the plastic being a far thinner gauge than a supermarket bag, very inexpensive. Since then we've used surgeons gowns, these are very robust items, much thicker, velcro fastening, wrap around fit, proper elasticated cuffs etc. I don't see how they would offer any more protection though right now, I'd imagine they do offer a lot more protection from bodily fluids in theatre and would last a decent amount of time, they don't appear to me to be a disposal item, an item with a lifespan of a few minutes, I'd imagine they cost a few £ each and we are ploughing through them.

Somebody mentioned the army regarding PPE distribution and I think that they were right. This is not a time for some to hide, to ring fence positions/jobs, to not take control for fear of their name carrying some responsibility should things to awry.

 

[Pale Rider]

As regards vaccine take up, unlike flu, I think Covid has given the public a sufficiently big scare to make them want to take a vaccine.

It would help if it could be produced in tablet or liquid form.

 

[Levo-Lon]

Right I can see your thinking but it's not black and white. So sorry for the length of the post.
You can't assume none covid related ICU has not got covid so some level of PPE is needed.
Just because they have they may have other none related infections on top of it.
So won't want that spreading around. PPE in clinical environments is as much about protecting the staff as it is to protect the patient.
Some people have been in ICU for weeks long before all this and can't be moved out.
So they can now find themselves in a room full of covid cases. So fresh PPE will be needed.
Some will be recovering from covid but still need a ICU bed the last thing they need is to come down with something else.

Anyone who enters, leaves then returns into the Red zone will require fresh PPE.
Dr's come and go they have other patients in other parts of the hospital to deal with.
Other HCP's and none clinical staff come and go too even none covid nurse may be asked to do part of a shift in the covid area.

Even the nurse at some point needs to leave for something to eat ,have a break or even a pee.
You get hot very quickly and can't work a full shift without some change into fresh PPE.
Between patients the PPE may get contaminated covid patients still throw up all over you. they will need suction at some point.
So a face shield is of little use if you can see though it. Gowns get damp as do the masks so they are then of little use.
It may get damaged so needs changing. It has a set order for on and off so it may not be possible to change just the one item.
Covid patient can't get it that's true but the nurse can. Even if the room is full of the virus you still want to minimise the amount as much as possible. One way of helping to limit the viral load.

PPE only works if it's clean , dry, and undamaged none of which can the guaranteed to last a full shift.
The goal posts keep moving because the right one's had not been in place from the start.

Thank you for that @tom73
That now makes complete sense.

 

[Milzy]

This is true.

 

[Levo-Lon]

This is true.

I don't think it is.

 

[Milzy]

I don't think it is.

Oooooohhhhhhhh yes it is!! 😃

 

[mjr]

Is one of the symptoms of covid-19 channeling Widow Twanky?

 

[PK99]

This is true.

By definition, it is not true, as it has not yet happened.

It is what you imagine might be true

 

[tom73]

@MarkF brings up a good point about masks many just can't cope with them.
A look of mainstream talk has been about the use of NIV which involves having a heavy duty mask strapped to your head.
They get hot and uncomfortable quickly and most can't take it for long.
So they have to come off from time to time plus they are conscious so have to eat or drink.
Anyone who has been fully trained in NIV will have had to wear one to fully understand what it really feels like.
Your mouth get's dry so often the oxygen will be passed though water.
Even well fitted mask will leak so added to the coughing is a fine moist mist.
They still need suction, they may need nebs so all adds to the mix.
NIV mostly happens outside ICU So even none ICU PPE will need changing often and none ICU staff will need full PPE.
All adding to the need for extra supply.

A few of use have talked about the need for the Army and for one's in power to admit they need help with this.
But sadly they look to be putting saving face above saving life.

 

[Yellow Fang]

The index case being in close proximity to one of those research labs is circumstantial evidence. It would need to be established that the first person with the disease definitively caught it there. That would probably need the genetics of coronaviruses at that lab to be very similar to the one in the wild.

Given that the last two coronavirus infections have emerged without the assistance of research labs, it's more likely that this is how SARS-CoV-2 came about. It has taken many years of work to show that MERS probably came from bats via camels, which may now be acting as a reservoir for MERS. Failure to find any intermediary species quickly does not mean one does not exist. Nor should the lack of any intermediary indicate that the virus must have come from a research lab - there are many viruses which don't have any intermediary (Lassa, the hantaviruses and probably Marburg are all examples of this).

Shi Zhengli, China's batwoman, was worried that the outbreak came from her lab, but she checked Corvid 19 against the samples they had in the lab and none matched, so it does not seem likely it came from that lab. There is another lab connected to their university; I assume they have done the same checks there. If the virus did escape from a lab, you'd expect patient zero to be a lab worker, and I expect they have all been tested.

The article says 3% of villagers near a big bat cave (Shitou Cave) were carrying coronavirus (not Corvid 19) antibodies. So patient zero could have been someone who caught the virus near one of these big bat caves.

https://www.scientificamerican.com/...wn-viruses-from-sars-to-the-new-coronavirus1/

 

[marinyork]

As regards vaccine take up, unlike flu, I think Covid has given the public a sufficiently big scare to make them want to take a vaccine.

It would help if it could be produced in tablet or liquid form.

I saw the press conference yesterday. I saw Vallance talk. I'm sure the principles of who gets it are done on similar things.

A bit of this is replying to Bruce's post, but it makes me worry if someone says it'll be like a normal flu vaccine as that has all sorts of low level problems that aren't worried about on distribution and communication if replicated for covid-19 could spell disaster.

The list of people that would get a preliminary covid-19 dose needs to be absolutely watertight and communicated with clarity. Much better the communication thusfar. The normal flu vaccine is over 65s and a complicated list of conditions that has taken years to communicate and still there are problems. It needs to be communicated to many of the people on the standard flu list, that they probably wouldn't get a covid-19 vaccine straight away. Many of these people will be scared and so it needs communicating and reassuring. Similarly the 65-69 age group this needs to be communicated that there might be those substantially ahead of them in the queue - some will get really angry about this. The year of the flu where there was a 3 strain and 4 strain vaccine shows how the public can react - there were a lot of the public wanting to get the 4 strain vaccine and sod anyone else.

Probably not so relevant for the vaccine, but here and elsewhere the number of people seeking help for heart attacks and strokes has gone down by 50%. Some might be scared of someone giving them the vaccine. I don't really know the answer on that. I suspect a lot of people think they'll be 1-peak, that's my sense of talking to a lot of people. If it becomes obvious there's a second peak that'll have an effect on the sort of thing. What form of shielding/lockdown and other things are in effect will influence how people behave. For swine flu there was a 2nd peak which people forgot about. Will this be downplayed/forgotten about for covid-19 just like swine flu? Probably not, but it could change behaviours a lot.