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Questions for Native and Coronavirus discussion Thread

Native

ToungeInCheek since 2010
Staff member
10 Year Member


I think there are valid concerns brought up in the article. A lot of our reaction as a nation is copycat in nature, political posturing is real.... so of course some things are valid, just how valid and whose stats are you going to believe and determining the correct assumptions when making projections is huge. I can link you to a doomsday tweet thread by reputable minds as well.

My personal views are that lack of kids being tested and not really having a clue how many asymptotic individuals exist either here or anywhere else in the world other than maybe S. Korea really skews things.

Also in today's world anybody in a leadership position basically isn't allowed to miss by erring on the side of a cavalier approach. Best take a snow day rather than what? Risk someone with an AWD suv go in the ditch for a bit on their way to school?
 

CrabHusker

Stifling Dissent Since 1965
5 Year Member
I think there are valid concerns brought up in the article. A lot of our reaction as a nation is copycat in nature, political posturing is real.... so of course some things are valid, just how valid and whose stats are you going to believe and determining the correct assumptions when making projections is huge. I can link you to a doomsday tweet thread by reputable minds as well.

My personal views are that lack of kids being tested and not really having a clue how many asymptotic individuals exist either here or anywhere else in the world other than maybe S. Korea really skews things.

Also in today's world anybody in a leadership position basically isn't allowed to miss by erring on the side of a cavalier approach. Best take a snow day rather than what? Risk someone with an AWD suv go in the ditch for a bit on their way to school?

If it saves just one life.

My concern is we're throwing a hand grenade in our own fox hole, just in case.
 

Native

ToungeInCheek since 2010
Staff member
10 Year Member
@Native a whole bunch of potential positives in the article. https://hotair.com/archives/jazz-shaw/2020/03/19/japanese-come-coronavirus-cure/

What do you think?

I think when thinks are presented in a way where they are too good to be true, they often are too good to be true. Chloroquine is showing some positive effects, 100% cure rate? no way. I also like that the link is from "hotair". But it is giving options of a nice off label use that likely won't do any harm. I have also seen it being pair with azithromycin, (z-pack drug), which is surprising to me. Drug studies need way bigger N to be interpreted.
 

Huskerthom

All Big 10
5 Year Member
I think when thinks are presented in a way where they are too good to be true, they often are too good to be true. Chloroquine is showing some positive effects, 100% cure rate? no way. I also like that the link is from "hotair". But it is giving options of a nice off label use that likely won't do any harm. I have also seen it being pair with azithromycin, (z-pack drug), which is surprising to me. Drug studies need way bigger N to be interpreted.
Yep in fairness the person writing the article just quotes other articles and intended to only present what was written elsewhere. So after a while it becomes a big game of telephone. I only put it here because it is something I had not heard elsewhere. I knew you would cut through the BS. thanks
 

Nehunter88

Travel Squad
5 Year Member
A question on testing the healthy person. A lot is being said about more testing, drive thru lines so more people can be tested.

The other day at a news conference Dr Adi Pour, Douglas County Health Director talked about testing. She said a person could be tested and it would come back negative, but a couple days later they could be positive.

Right now they really try to nail stuff down about a person before they test. I wonder if all the drive thru testing will result in more people thinking they are healthy and safe, when in fact a couple days later they may not be safe.

Seems it's kind of a catch 22.
 

Husker Country Doc

Heisman
15 Year Member
On the front lines, we have redirected clinic/hospital workflow to have a "clean" side, and a "dirty" (pts with cough, fever, URI sx) side.

Pts are being triaged at the door.

So far, I've seen influenza and RSV

Today's latest HAN from Tom Safranek details many of the issues we are dealing with at my facility. Whom to see in clinic, who should be told to simply stay at home, whom to test, how to stretch our limited personal protective equipment:

BACKGROUND: CURRENT STATUS OF COVID-19

Community transmission has been identified in Nebraska. Nebraskans are increasingly at risk for COVID-19.
A national mandate to practice social distancing and non-pharmaceutical interventions is now in place: this is our most critical mitigation tool. Err on the side of stricter social distancing. Individual choices protect both individuals and the entire community.
Given the consequences of widespread transmission, public health authorities nationally are broadening the range of clinical syndromes warranting self-isolation:

Temperature ≥100.4°F
• Cough
• Shortness of breath
• Sore throat


To limit potential transmission, if any of these symptoms are present, alone or in combination (in the absence of a known alternative diagnosis): patients should self-isolate.

Evidence suggests >80% of COVID-19 infections are mild (fever is variable with COVID-19 infection and may be absent), might not warrant a healthcare visit or lab test, and do not require hospitalization. Telephone triage and appropriate self-isolation can suffice in most cases.

UPDATED TESTING RECOMMENDATIONS

Capacity and supplies for COVID-19 laboratory testing cannot meet current demand. A simple clinical diagnosis of COVID-19 infection warrants self-isolation, and should be the norm, even in the absence of a positive COVID-19 lab result. This could change if testing capacity expands.

Rapid influenza tests and multiplex PCR respiratory pathogen panel (RPP) tests are still available at in-state laboratories, and if positive, should usually preclude the need for COVID-19 testing (co-infections appear to be uncommon).

The Nebraska Public Health Laboratory (NPHL) has limited capacity but will attempt to test specimens on any patient in the following groups who are high-priority for lab testing:
Inpatients: for suspected COVID-19, rule out flu and RPP, then order COVID-19
Outpatients: vulnerable or high-risk populations with a clinical diagnosis of COVID-19, after ruling out alternative diagnoses (negative flu/RPP), will be considered for testing
o Healthcare workers
o Public safety (EMS, law enforcement, firefighters)
o Nursing home, group home, daycare attendees or employees

HOW TO BEST UTILIZE COMMERCIAL LABORATORY TESTING

Consider if a lab test is warranted: assess whether clinical diagnosis of COVID-19 infection suffices, or if laboratory diagnosis is even necessary.

Patients with a clear source of exposure (e.g., household member of a known lab-confirmed case) and a clinical presentation consistent with COVID-19 are now a lower priority for testing.

Prioritize our limited laboratory testing capacity for patients with the highest pre-test probability
(the most severely ill who fit COVID-19 profile) and lacking a clearly identifiable source/exposure and flu/RPP tests negative. We need a better understanding of community transmission in the Nebraska population.

Commercial testing has expanded and will expand further, but for now these labs are experiencing bottlenecks which may delay results (ARUP is currently experiencing reagent shortages; Mayo Labs are restricted to Mayo system patients only; Quest and Labcorp are performing COVID-19 and are attempting to increase capacity).

PERSONAL PROTECTIVE EQUIPMENT (PPE)/DEDICATED SPECIMEN COLLECTION SITES

PPE supplies are in short supply. Allocate remaining supplies for healthcare providers caring for hospitalized COVID-19 patients, and for persons collecting nasopharyngeal (NP) swabs from suspected COVID-19 patients.
Localities should establish a limited number of sites to collect NP swabs on persons with suspected COVID-19 to insure best allocation of PPE and NP collection swabs/media.

UPDATED PUBLIC HEALTH RECOMMENDATIONS FOR TRAVELERS

• All returning travelers, from any international or domestic location, have an increased risk of COVID-19 infection.
• All returning travelers, from any international or domestic location, should limit public interactions, practice strict social distancing, and self-monitor for symptoms.
• IF a returning traveler develops fever or respiratory illness, they need to IMMEDIATELY self-isolate and report to a healthcare provider or local health department.
• Returning travelers should assume that COVID-19 disease is present at the locations they have visited and traveled through. Additional specific information might available on CDC, state, and local public health websites and from media sources.
• More jurisdictions have widespread sustained transmission (e.g., CDC Level 3 countries - https://wwwnc.cdc.gov/travel/notices#alert - plus U.S. locales such as Seattle, WA; New York City; and Santa Clara County, CA).
• To limit spread in Nebraska, all travelers should self-quarantine for 14 days upon returning home and immediately report any symptoms consistent with COVID-19 infection to their health care provider. Individuals unable to observe the 14-day self-quarantine should consult with their local health department about appropriate actions.
• Every health care worker who returns from travel should consult with a trained medical professional at their facility (e.g., infection preventionist or physician) and establish a specific infection control protocol (e.g., home quarantine, self-monitoring, PPE while at work) that mitigates patient and co-worker exposures.

W HEN TO DISCONTINUE SELF-ISOLATION

Persons with COVID-19 who have symptoms and who are directed to care for themselves at home may discontinue home isolation under the following conditions:
• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
• At least 7 days have passed since symptoms first appeared.
 

Native

ToungeInCheek since 2010
Staff member
10 Year Member
A question on testing the healthy person. A lot is being said about more testing, drive thru lines so more people can be tested.

The other day at a news conference Dr Adi Pour, Douglas County Health Director talked about testing. She said a person could be tested and it would come back negative, but a couple days later they could be positive.

Right now they really try to nail stuff down about a person before they test. I wonder if all the drive thru testing will result in more people thinking they are healthy and safe, when in fact a couple days later they may not be safe.

Seems it's kind of a catch 22.

Paralysis by analysis. Everyone who sniffles is gonna want a test. And as @Husker Country Doc pointed out in the previous post, the amount of testing reagents and supplies are limited. Impossible to have a very specific test up and running across the country, let alone have it be for the masses. It is even sorta rare for everyone with influenza symptoms to get testing done. Hence why they are doing a triage style testing okay.

Going to get tested when you are healthy is similar to being healthy and starting to search WebMD to find out you have all sorts of cancer symptoms and are going to die. ;)
1584642349560.png
 

Nehunter88

Travel Squad
5 Year Member
Paralysis by analysis. Everyone who sniffles is gonna want a test. And as @Husker Country Doc pointed out in the previous post, the amount of testing reagents and supplies are limited. Impossible to have a very specific test up and running across the country, let alone have it be for the masses. It is even sorta rare for everyone with influenza symptoms to get testing done. Hence why they are doing a triage style testing okay.

Going to get tested when you are healthy is similar to being healthy and starting to search WebMD to find out you have all sorts of cancer symptoms and are going to die. ;)
View attachment 39734
So you're saying most of those people waiting in line at the drive thru testing site are on their phone searching for WebMD while they wait.

Wonder how many tell the tester, WebMD says you didn't stick that thing far enough up my nose.
 
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