COVID 2019 Comorbidity with Diabetes

jjraak

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Ask yourself the question, why does corona virus affect the oil price and the economy whereas cancer doesn't?

Its because we dont know what's going to happen. If deaths are 3% and sixty million in the country get it, just do the maths.

It looks to be 5% in Italy atm, just do the maths if 10s of millions get it and you'll get your answer why the markets are concerned.
I hope the tide can be turned, perhaps we are like Canute and can't change the outcome.
D.
and it is something we have lived with for ages, of course..sad as that may be.

this has the potential to cause chaos if not managed correctly world wide.
i did read that in regards to the Spanish flu, IF we had all this back then we COULD have contained that so much better...never a good time, but we do have the best chance ever to really manage such and outbreak

lets hope the measures we do take, reduce the effects as MUCH as possible,
both populace wise and economically
don't forget an awful lot of that money invested is our pension monies
we ALL need this be over asap.
 
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HSSS

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Who buys if we are all in quarantine ?

It's the unknown it always spooks investors
Perhaps we’d, as a human race, be better off with a few less businesses and financial profit less of a focus. I know - I’m naive to even wish it. I know no matter how bad this does or doesn’t get that’s not going to change sadly.
i know you mean it in a nice way..

But i don't catch cancer by some one coughing on me
i can avoid most snakes and mozzies (If i choose) most days
and the suicide.yeah, well the less said there i suppose.
and murder rate in the uk..mmhh..

but for all that i DO take the point made.and i the manner it is made.

Lets hope the many others who choose to see this as "Just flu", do at least take the precautions seriously,
it is ONLY that... that defends us at the moment...we have no other line of defense as yet..

as with quarantine, if we ain't ALL doing it, it makes little difference
just needs a few to ignore it, and we are back to square one
Yep I know you get it (and are just keeping my cortisol levels up to keep me alert:)) but to reinforce, with one exception no-one chooses those deaths either. They presumably did at least a bit to avoid it but it happened anyway. And a lot more often than this will. I hope. Statistically this isn’t going to be what gets me.
 

kokhongw

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I hipe he isn't serious about this....
upload_2020-3-10_9-46-1.png


With the Italian numbers double every 3 days...and close to 5% fatalities... these are the possible numbers if nothing is done...
upload_2020-3-10_9-47-14.png


4.7 million cases with up to 230K fatalities within 27 days... Should he take that gamble?
 

Indy51

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The twitter threads from doctors on the front line in Italy are truly terrifying :(

Especially the "triage" system they are forced to implement for the over 60s and those with comorbidities in a hospital system collapsing under the pressure.
 

Debandez

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Taken from a facebook post on covid 19

'From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:

I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity. We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask. Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV.. We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern: 1.A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick. 2.;Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great. 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2. 4. Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly. Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to. Another
typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.

Supplemental article: https://www.brusselstimes.com/all-n...s-italian-doctor-covid-19-christian-salaroli/'
 
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Winnie53

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Debandez, I can't get my head around these descriptions of what's happening. We were talking today at the office about how none of us have experienced anything like this in our lifetime.
 
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kokhongw

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It is easy to see why hospitals get overwhelmed when a large number of healthcare workers get infected and need to go offline. How do you replace 5-600 healthcare workers at short notice?

That's why city administrators need to consider how to prevent this from happening to their city...rather than risk inaction.

South Korea has been remarkable in handling this crisis even when they did get a huge outbreak.

upload_2020-3-10_14-47-56.png
 
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Morning.
I saw a quick snippet on the news last night regarding testing for COVID-19 at a containment lab in Liverpool, with quick results, possibly hours. It would be tracking the route of the virus to understand the disease better.
I haven't the time at the moment to do a google search, did anyone else see the it ?
 

jjraak

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Yes, it was a simple test. Almost instant results
Saw it on Twitter.. Think the last line was
"too simple so will be ignored. "
 

jjraak

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Taken from a facebook post on covid 19

'From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:

I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity. We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask. Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV.. We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern: 1.A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick. 2.;Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great. 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2. 4. Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly. Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to. Another
typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.

Supplemental article: https://www.brusselstimes.com/all-n...s-italian-doctor-covid-19-christian-salaroli/'

I put useful as there is no HORRIFIC emoji.
They said it was triage... That was the spike.. And it's only going higher at the moment.

Truly dreadful... Prays for Italy
As little as that does, what else can we do.
 

Bill_St

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Given our current numbers and the rate of growth (double every 3 days), how far are we behind Italy?
Perhaps 1 week? Can we delay that to 10 days?

So what must we change? How can we be different?
Doctors saying that they don’t even look at people with underlying illness (PWD) OR over 65 - do we believe that?

Do we just give up? Is that what is intended?
 
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ickihun

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I'd hv to just hope for the best but not ignore it nor keep it from medics knowledge. My home isn't able to help me but I can hugely help my family.
Sometimes I feel a light dose may make us stronger. In a controlled fashion. So sign of government doing any controlled natural or synthetic immunisation.
 

NaijaChick

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BBC breakfast this morning had a man with T2D and respiratory issues who had decided to self isolate. This was the first time that I have heard a doctor respond that diabetes IS an issue and even T2Ds that is badly controlled, may cause issues. Please watch BBC breakfast on IPlayer. Now I am worried!!!!
 

Bill_St

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A long copy of an email - I will have to split it into two - or more - but perhaps we can realise that this is what we all Must do.
Go Science!

What I think about COVID-19 this morning

March 5, 2020


Maybe I'm the closest thing you personally know to an infectious disease epidemiologist. Maybe not--I'm not an expert on this virus by any stretch, but I have general knowledge and training from studying epidemics that is applicable, so here are my thoughts.



First and foremost: we are going to see a tremendous increase in the number of US cases of COVID-19 in the next week. This is not because of some new pattern in the spread of the disease, but rather due to a major change in the requirements to be tested. Until yesterday, if you had flulike illness but had not recently traveled to China, Italy, South Korea, or Iran, you could not be tested. This is just the way healthcare works, you get tested if you meet the case definition and the case definition included travel.

As of yesterday, you can be tested if you are sick and have a doctor's order to be tested. So expect things to feel a lot more panicky all of a sudden. We will see hundreds or thousands of new cases as a result of testing increases.


Second: is that panic legitimate? Sort of. This is not the zombie apocalypse. The death rate of 30 deaths per 1000 cases is probably a wild overestimate. (The denominator is almost certainly wrong because it is confirmed cases--and we only confirm cases when we test for them). That said, even at 3 per 1000 cases, this would be a big deal. A very big deal. By way of comparison, the death rate for influenza is between 1 and 2 in 1000 cases. So, yeah. Roughly 0x to 30x worse than a bad seasonal flu year? That's a problem.

Unlike flu, COVID-19 is not *particularly* dangerous for children, so that’s some happy news. It is dangerous for older adults and those with lung conditions, so we need to be extra careful to protect those populations from exposure.



Also, for millions of Americans, getting any serious illness requiring a hospitalization is a major problem because they can't pay for it. And our health care system is probably going to struggle to keep up with it all. And with China basically closed, our global economy is going to take a huge hit and we'll feel the shockwaves for years. Those are real concerns.


What can we do? Our focus should be on *slowing down the spread* of this disease so that we have time to get caught up. Here is my advice:

1. Wash. Your. Hands. Wash them so much.

The current best guess is that coronavirus is transmitted via close contact and surface contamination. A very small study came out yesterday suggesting that the virus causing COVID-19 is *mostly* transmitted via contact with contaminated surfaces.

I have started washing my hands each time I enter a new building and after being in shared spaces (classrooms especially), in addition to the standard practice of washing after using the bathroom and before eating. Soap and water. Hand sanitizer also kills this virus, as does rubbing alcohol (the main ingredient in hand sanitizer).

There is no need to be obsessive about this. Just wash your hands. A little bit more effort here goes a long way.



2. Don’t pick your nose. Or put your fingers in your mouth, on your lips, or in your eyes. Surface contact works like this: you touch something dirty. Maybe it's an elevator button. Virus sticks to your hands. Then you rub your eye. Then you touch your sandwich, and put the sandwich in your mouth. Now there is virus in your eyes and mouth. See?

You may be thinking, but I don’t pick my nose because I am an adult! An observational study found that people sitting at a desk working touched their eyes, nose, or lips between 3 and 50 times per hour. Perfectly normal grown-ups, not lowlifes like my friends.


2a. There was one note that came out suggesting that face masks actually promote surface contamination because you're always adjusting them--i.e., touching your face. I don’t know if that’s true. But face masks should not be worn by the public right now, unless you are the person who is sick and you're on your way to or actually at the doctor's office. The mask’s function is to prevent spit from flying out of your mouth and landing on things when you cough or sneeze. It flies out of your mouth and is caught in the mask instead. If you are the person who is sick and not on the way to the doctor, go home. Let the people who really need them have the masks. Like doctors.

[ETA on 3/6/2020 honestly people I am getting so much push back on the mask recommendation! The world is running low on masks. If everyone wants a mask so they can feel ok about keeping their Daytona Beach Spring Break plans and then hospitals in India can't buy them anymore, shame on us.]


Coronavirus does not appear to be airborne in the sense that doesn't remain floating around freely in the air for a long time, like measles does. You are probably not going to breathe it in, unless someone is coughing in front of you. If someone is coughing in your face, feel free to tell them to get their ass home and move 6 feet away from them. (Yeah I know, if you have a toddler, you're screwed.)


3. Sanitize the objects you and lots of other people touch, especially people outside your family--like door handles, shared keyboards at schools (brrr), salad bar tongs, etc. Best guesses are that the virus can live on surfaces for 2-48 hours, maybe even longer, depending on the surface, temperature, and humidity.

Many common household cleaning products will kill this virus. However, white vinegar solution does not. You can make your own inexpensive antimicrobial spray by mixing 1 part household bleach to 99 parts cold tap water. Spray this on surfaces and leave for 10-30 minutes. Note: this is bleach. It will ruin your sofa.


4. "Social distancing." You're going to get so sick of this phrase. This means keeping people apart from one another (preferably 6 feet apart, and sanitizing shared objects). This public health strategy is our next line of defense, and its implementation is what will lead to flights and events cancelled, borders closed, and schools closed.

For now, you could limit face-to-face meetings, especially large ones. Zoom is an excellent videoconferencing option. If you spend time in shared spaces, see #1. Ask your child's school about their hygiene plan, if they haven't already told you what it is. If I were in charge of a school setting, I'd be hand sanitizing the s*** out of the kids' hands, including in and out of each space, and taking temperatures at the door. I am planning to email our school nurse right after this to ask if they need my volunteer help cleaning surfaces.

If you can telecommute, do that a little more. If you are someone's boss and they could do their job remotely, encourage them to do that.

Avoid large gatherings of people if at all possible, especially if they are in an area with cases OR places that lots of people travel to. If you attend group events and start to feel even a little bit sick within 2 to 14 days, you need to self isolate immediately. Like for a tiny tickle in your throat.


5. All your travel plans are about to get screwed up. If you are considering booking flights right now, get refundable tickets. ETA: most trip insurance will not cover cancellations due to a pandemic. Look for "cancel for any reason" trip insurance.

Considerations for risks related to that trip you’re planning: how bad would it be if you got stuck where you are going for 3 to 6 weeks? How bad would it be to be isolated at home for 2-3 weeks upon your return? Do you have direct contact with people who are over 70 and/or have lung conditions? If those seem really bad to you, rethink your trip, especially if it is to a location where there are confirmed cases.



6. If you are sick, stay home. Please! For the love of all that is holy. Stay at home. Your contributions to the world are really just not that important.


TBC
 
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Bill_St

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a continuation.

7. There is a good chance some communities will see school cancelled and asked to limit non-essential movement. If someone in your family gets sick your family will almost certainly be isolated for 2-3 weeks (asked to stay at home). You could start stocking up with essentials for that scenario, but don't run out and buy a years' worth of toilet paper. Again, not the apocalypse. 2 weeks' worth of essential items. Refill any prescriptions, check your supply of coffee, kitty litter, and jigsaw puzzles.


8. I do want to remind everyone that when public health works, the result is the least newsworthy thing ever: nothing happens. If this all fizzles out and you start feeling like ‘Wah, all that fuss for nothing??’ Then send a thank-you note to your local department of public health for a job well done. Fingers crossed for that outcome.


9. Look, I think there are some positives here. All this handwashing could stop flu season in its tracks! We have an opportunity to reduce our global carbon footprint by telecommuting more, flying less, and understanding where our stuff comes from. We can use this to think about the problems with our healthcare system. We can use this to reflect on our positions of privilege and implicit biases. We can start greeting each other using jazz hands. I'm genuinely excited about those opportunities.

There is a lot we don't yet know about this virus. It didn't even exist 90 days ago. So stay tuned, it is an evolving situation. The WHO website has a decent FAQ. Free to email or text with questions, and you can forward this to others if you think it's useful.


May the force be with you.

Malia Jones, PhD, MPH


I’m a social epidemiologist and demographer by training. I have a master of public health and a doctorate in public health from UCLA Fielding School of Public Health.I work as an Assistant Scientist in Health Geography at the Applied Population Laboratory at the University of Wisconsin-Madison. I study social contact of humans, and spatial patterns of infectious disease, among other things.



I didn't write this for professional purposes, so I didn't put my work email on it. It was really just meant to be an email to my friends and family in advance of what I expect to be an escalation in the panic level. But it was apparently welcome information and went viral on FB. I've decided not to edit out the swears, even though I wrote this with a much smaller audience in mind.

Thanks for checking your facts! Go science!
 
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jjraak

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Nice post @Bill_St

I think he's being optimistic.

The US is going to have to seriously re evaluate how it delivers health care.
Too many are outside the loop
Too many homeless
And that no sick pay/ work ethic

We also need to be taking some actions outside of what we are doing

If as expected this increases,
The simple things we haven't even begun to consider come to the fore

The prison riots in Italy for example...
It's going to be a rocky road, if we go down the Italian route

And still far too many saying it's just flu.. So they won't take this seriously...,( Until the simple things that could would should be dealt with early, won't be if the systems over whelmed
And they are left with a more permanent health issue...)
. So are thinking "I'm ok"...
But no even considering the mums dad's aunts uncles grans & granddad's... And a whole multitude of family members.

We ALL stop it, together.
Or these people just make it last longer and harder then it needs to be.
 

HSSS

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Taken from a facebook post on covid 19

'From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:

I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity. We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask. Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV.. We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern: 1.A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick. 2.;Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great. 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2. 4. Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly. Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to. Another
typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.

Supplemental article: https://www.brusselstimes.com/all-n...s-italian-doctor-covid-19-christian-salaroli/'
Where is the terrifying emoji? So even well controlled, uncomplicated t2 in excellent health other than the virus will be left to fight it alone if it gets to the state it has in Italy if this is a full and accurate account. I’m becoming torn between stopping reading about this because the anxiety it is creating is increasing, perhaps unreasonably, and a need to take in all I can to feel some (false) semblance of control
 

Bill_St

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Nice post @Bill_St

I think he's being optimistic.

The US is going to have to seriously re evaluate how it delivers health care.
Too many are outside the loop

.....

We ALL stop it, together.
Or these people just make it last longer and harder then it needs to be.

That email was written 5 days ago and for All, not just PWD, but still had the keys words.
This is something WE ALL MUST DO - or we end up like Italy in One Week.

Panic will not help but we do need to be forceful.
 

Indy51

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I'm currently vascillating between panic and fatalism. Reading the Italian stuff has really put the wind up me because my lung condition makes me one of the most vulnerable. I also have an advanced health directive in place that specifically includes DNR and DNI. I'm not second guessing that decision, but it's making it a lot more real than it has been up till now.

One of the Italian doctors referred to CT results on affected patients as uniformly “bilateral interstitial pneumonia”, a term that has very strong and frightening associations for those of us with IPF/UIP (Idiopathic Pulmonary Fibrosis/Usual Interstitial Pneumonitis). The other worrying aspect mentioned by one of the docs is that since we don't know about long term effects, even if one manages to survive the medical treatment (which can be ventilation/heart-lung bypass) for the virus, there is possibility of long term further lung damage as can occur with SARS and other respiratory viruses.

My current plan is keeping myself as isolated as possible for as long as possible. Online grocery shopping sounds safer than going out to shop. I’m even wondering about my weekly pulmonary rehab as the sessions take place in a community health centre where a number of people of all ages congregate and present for appointments for all sorts of medical conditions. I’m beginning to think the risks probably outweigh the benefits for the foreseeable future.

These front line stories have been a massive reality check for me.