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[News] COVID-19
#1
COVID-19
There is little doubt in my mind that the politicians and news media are sensationalizing the current pandemic to gain political power, and in the case of the media, attract a large audience which translates into increased revenue.

So I was surprised to see a letter published in the New England Journal of Medicine by Dr. Anthony Fauci, President Trump's medical sidekick that suggests that the current situation, while serious -- especially for the elderly and those with underlying medical conditions -- may not be as grave as being hyped 24/7.


Quote:Covid-19 — Navigating the Uncharted (March 26, 2020)

List of authors. Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.

The latest threat to global health is the ongoing outbreak of the respiratory disease that was recently given the name Coronavirus Disease 2019 (Covid-19). Covid-19 was recognized in December 2019.1 It was rapidly shown to be caused by a novel coronavirus that is structurally related to the virus that causes severe acute respiratory syndrome (SARS). As in two preceding instances of emergence of coronavirus disease in the past 18 years — SARS (2002 and 2003) and Middle East respiratory syndrome (MERS) (2012 to the present) — the Covid-19 outbreak has posed critical challenges for the public health, research, and medical communities.

In their Journal article, Li and colleagues provide a detailed clinical and epidemiologic description of the first 425 cases reported in the epicenter of the outbreak: the city of Wuhan in Hubei province, China. Although this information is critical in informing the appropriate response to this outbreak, as the authors point out, the study faces the limitation associated with reporting in real time the evolution of an emerging pathogen in its earliest stages. Nonetheless, a degree of clarity is emerging from this report. The median age of the patients was 59 years, with higher morbidity and mortality among the elderly and among those with coexisting conditions (similar to the situation with influenza); 56% of the patients were male. Of note, there were no cases in children younger than 15 years of age. Either children are less likely to become infected, which would have important epidemiologic implications, or their symptoms were so mild that their infection escaped detection, which has implications for the size of the denominator of total community infections.

On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.

The efficiency of transmission for any respiratory virus has important implications for containment and mitigation strategies. The current study indicates an estimated basic reproduction number (R0) of 2.2, which means that, on average, each infected person spreads the infection to an additional two persons. As the authors note, until this number falls below 1.0, it is likely that the outbreak will continue to spread. Recent reports of high titers of virus in the oropharynx early in the course of disease arouse concern about increased infectivity during the period of minimal symptoms.

China, the United States, and several other countries have instituted temporary restrictions on travel with an eye toward slowing the spread of this new disease within China and throughout the rest of the world. The United States has seen a dramatic reduction in the number of travelers from China, especially from Hubei province. At least on a temporary basis, such restrictions may have helped slow the spread of the virus: whereas 78,191 laboratory-confirmed cases had been identified in China as of February 26, 2020, a total of 2918 cases had been confirmed in 37 other countries or territories. As of February 26, 2020, there had been 14 cases detected in the United States involving travel to China or close contacts with travelers, 3 cases among U.S. citizens repatriated from China, and 42 cases among U.S. passengers repatriated from a cruise ship where the infection had spread.

However, given the efficiency of transmission as indicated in the current report, we should be prepared for Covid-19 to gain a foothold throughout the world, including in the United States. Community spread in the United States could require a shift from containment to mitigation strategies such as social distancing in order to reduce transmission. Such strategies could include isolating ill persons (including voluntary isolation at home), school closures, and telecommuting where possible.


A robust research effort is currently under way to develop a vaccine against Covid-19.10 We anticipate that the first candidates will enter phase 1 trials by early spring. Therapy currently consists of supportive care while a variety of investigational approaches are being explored. Among these are the antiviral medication lopinavir–ritonavir, interferon-1β, the RNA polymerase inhibitor remdesivir, chloroquine, and a variety of traditional Chinese medicine products. Once available, intravenous hyperimmune globulin from recovered persons and monoclonal antibodies may be attractive candidates to study in early intervention. Critical to moving the field forward, even in the context of an outbreak, is ensuring that investigational products are evaluated in scientifically and ethically sound studies.

Every outbreak provides an opportunity to gain important information, some of which is associated with a limited window of opportunity. For example, Li et al. report a mean interval of 9.1 to 12.5 days between the onset of illness and hospitalization. This finding of a delay in the progression to serious disease may be telling us something important about the pathogenesis of this new virus and may provide a unique window of opportunity for intervention. Achieving a better understanding of the pathogenesis of this disease will be invaluable in navigating our responses in this uncharted arena. Furthermore, genomic studies could delineate host factors that predispose persons to acquisition of infection and disease progression.

The Covid-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging infectious pathogens and the need for constant surveillance,prompt diagnosis, and robust research to understand the basic biology of new organisms and our susceptibilities to them, as well as to develop effective countermeasures. 
You may also be interested in Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1


Be well.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#2
RE: COVID-19
What will be interesting to find out is if 2 weeks from now things start to turn a bit. I think until mid-March, and later in some areas, people still congregated fairly regularly.

If older people, and those who are vulnerable, have refrained from interacting with others, there will hopefully be a drop in deaths. Nursing homes will always be an issue.

What I would like to know, but there doesn’t seem to be any data, are the number people who were infected from shopping carts, pizza boxes, delivered items, etc. There seems to be a lot of theoretical surmising about how long the virus survives on surfaces, but little in the way of tangible data that a self isolated person contracted the disease that way.

John
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#3
RE: COVID-19
The "not as grave" conclusion is not the one I reach.

The consistent message from public health professionals has been that COVID-19 is much more infectious than, but with significantly lower mortality rates than MERS or SARS, and higher than the seasonal flu.

The lower mortality rate doesn't mean it's not a serious crisis; it actually means it's MUCH more dangerous, precisely because it's so infectious, and infection can happen when asymptomatic.

Just in terms of math, a quick search says there were 8000 cases of SARS in the 2003 outbreak. 10% of 8000 is 800, which is about the reported number of deaths in that outbreak.

We're well past that in the US already just in the US with COVID-19.

If you play out the modeling over the next few months, let's be conservative and say mortality rate with COVID-19 is 1%. That's a LOT of people dead, and many more with likely permanent lung damage.
Caveats: I'm just a patient, with no medical training.
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#4
RE: COVID-19
There is a real disconnect between the case fatality rate stated in that editorial and the more recent data that is being reported.

http://www.apneaboard.com/forums/Thread-...eath-rates
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#5
RE: COVID-19
Here is a reality of probably what is happening.

Our daughter-in-law started feeling ill a couple weeks ago. She left work and went to get checked. She was told that she had a virus, not the flu, and was sent home. Over the next 10 days she had a low fever, aches, and at times shortness of breath. She feels fine now.

Did she have Covid-19? Maybe? Probably? Neither her, nor I, nor any health professional knows.

Did she build up an immunity that would allow her to not self isolate and return to her workplace? Who knows? No one has figured that out.

Could there be hundreds of thousands (millions?) out there in the same position? Probably.

We as a country (and world) have no clue who might now be immure and can support those who must remain separated, or if there is no immunity in anyone. Or if immunity even prevents spreading the virus.

If we want to get past this we need to figure out who can’t contract or spread the virus.

John
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#6
RE: COVID-19
Fauci has a vested interest in not panicking the sheep.

Remember, he's the one who said back in February that COVID-19 was "no worse than the common flu", and then did a complete 180 and said this past month that it's "10 times worse than the flu".

Now apparently he's back closer to his original statement.

I suggest, as has already been said by others, that we look act the actual numbers and not be guided by someone so fickle as Fauci.

Fauci has proven to be unreliable as far as many of his statements are concerned.  And I'm not against those medical experts on Trump's team, either.  I'm actually in support of much of what's being done.

But the reality of all this does not match what Fauci is saying:

Shutting the entire country down for several weeks and Fauci's latest statement that "This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza" DO NOT MATCH UP.

Watch what they DO, instead of listening to what they SAY.

Their actions reveal the true nature of this virus, and the fact that we're looking at a death rate of anywhere between 30-45% of reported cases of COVID-19.

Read my post here on that:
http://www.apneaboard.com/forums/Thread-...eath-rates
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#7
RE: COVID-19
Social distancing. It's now looking as if keeping 6' away from others isn't enough. MIT researchers are saying that respiratory discharge droplets can reach as far as 27'.

And, there's no conclusive evidence that wearing a face mask does any good, other than making you feel safer. The best advice is still to keep your hands clean and off your face.
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#8
RE: COVID-19
(03-31-2020, 12:46 PM)Big Guy Wrote: And, there's no conclusive evidence that wearing a face mask does any good, other than making you feel safer.


A "surgical mask" yes, I would agree they're not all the good at filtering viruses.  But an N95 mask can actually filter out much of the virus.

But any degree of PPE is preferable to no PPE whatsoever.  Remember, we're talking about reducing your "viral load", not necessarily filtering out 100% of the virus.  

If all I had was a bandana or cotton cloth, I'd use that rather than simply relying upon the "wash your hands and keep your hand away from your face" advice.  I contend that it's near impossible to be perfect in every way and NEVER touch your fact.  It's a natural human thing to do that we do without even thinking about it.  You're going to make a mistake sooner or later, and unless you video yourself continuously, you're probably not even going to remember or realize that you just touched your face.  When you're out and about shopping, wearing a mask of any type is going to bring better results than simply relying on hand-washing and admonitions to "don't touch your face".

Coffee
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#9
RE: COVID-19
Well in my view, if I sneeze my droplets won’t go 6’ much less 27’ if I’m wearing a face mask.

That is really the reason to wear one, but since that will never happen, people are using them as protection and hoping for the best.

Patching a leak from the inside will hold so much better than putting a band-aid on the outside.

John
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#10
RE: COVID-19
How does anyone believe anything that is spouted out by the US government as fact?  

Don't wear a mask! Wear a mask!   Dont-know

Six feet of distance was always a joke.  As long as I can remember, medical "experts" have said if you cough or sneeze, particles can travel over 20 feet.  

After yesterday's horrendous display of the politization of this epidemic by Trump, his team Doctors and some business owners (that I was sure at any moment might get on their knees and kiss his feet), I will no longer watch the so called "Coronavirus Task Force Briefing".  

There is no doubt that Dr. Fauci and others on that team have been brainwashed by Trumpism.  They are afraid to say what they know is true and please Trump at the same time. Their loyalties are not with us sheep!
OpalRose
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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