There are more and more stories like this coming to light. I just got back from the store. It seems people are heading the message, so I thought. I drove by a packed gym! But, all of the people at the store were staying apart, wearing masks, and handsfree hand sanitizer dispensers were at each checkout lane.
My bride went to a store yesterday to get dog food for our loyal eat the ass out of an alligator companion. Masks and hand cleaner were out and about. We may get through this after all. And cheap gas.
The US just jumped over Spain for 3rd place. So it goes, China, Italy, and now US at 25,492 confirmed coronavirus cases. Nearly half are in New York.
Spain, Germany and Iran all in one day! Great things! Go āMerica! Next weāll crush China and their Chinese virus. Then Italy will fall in a fortnight. Woo!
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No surprises here.
Flew home this week and the airport naturally continued to crush everyone together at security screening. And my plane was full. Now will live in mortal terror for another week or two.
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Singapore close boarders to short term visitors and transit pax.:
This is drastic measures for a transport hub and open economy like Singapore.
The latest reports and statistics from Singapore show a rapid increase in imported cases since Europe and North America became hot spot of COVID-19 infections:
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Theyāre going to have to stay like that for a while. As @DeckApe pointed out, the price of knocking the epidemic down is that you still have a naive population ripe for it to start up again.
Perhaps the practice will be revived of flying the Q flag to request free pratique.
Malaria medicine being tested against COVID-19 in Norway:
This is part of a WHO worldwide collaboration.
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For those interested in the clinical course of the disease once a patient requires ventilation, this will tell you about it. Itās written for the trade so the language is technical. Donāt be fooled by the smiling nurse in the thumbnail. Itās grim.
Hereās the meat of the post. There are three pages of comments from other nurses.
The most surprising thing has been the duration of acute illness, I sort of figured it would be like other respiratory viruses just more severe, but with acute symptoms lasting up to 7 days or so.
Weāve seen timelines similar to what China was reporting; about 10 days from symptom onset to needing ICU care, then critically ill for weeks, the shortest recovery weāve seen is 3 weeks of aggressive life support. Time from symptoms onset to death has ranged from 2 to 8 weeks in China. So itās not just the number of patients that will require vents and other equipment, itās the length of time they will need them for.
The first week or so on the vent is similar to a bad influenza; lots of vent support, maybe proning, maybe flolan, not typically requiring inotropes or vasopressors, then they seem to have turned the corner and are out of the woods.
Then they crump, big time. From nothing to max pressors and inotropes and an EF that drops from normal to 10-15% in as little as 12 hours. Sudden onset renal and liver failure, with impressively severe liver failure in such a short amount of time.
Deaths appear more cardiogenic than respiratory, lethal rhythms have varied the full gamut; VT, VF, PEA, and asystole.
Weāve had enough ventilators so far, but what likely lies ahead will be the need to figure out a process for taking ventilators and other life support equipment away from patients less likely to survive to make them available to patients more likely to survive. Things seem dicey now, but thatās a whole 'nuther level of dicey.
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Excellent interactive graphics from the NYT:
https://www.nytimes.com/interactive/2020/03/22/world/coronavirus-spread.html
Thatās one of the most intuitive graphics that Iāve seen. After South Korea got hit extremely hard 17 years ago with the Sars coronavirus, Iāve come to realize how they were so prepared now and testing 20,000 per day from the beginning. Itās easier to pull from stock versus the creation of one. Until now, Iāve never really respected the fact of why Iāve seen a lot of people wearing masks every time Iāve flown through Busan, Narita, or Hong Kong.
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So, hearing through our company (OSV operator) that Thunderhorse had a rig hand medevacād earlier this week and has tested positive for COVID-19. Our company has decided not to carry passengers with out prior approval by the owners. Not sure how this goes for our crew boats, but it for sure applies to PSVs. Itās not often we carry passengers, but we were recently asked to carry a passenger onboard so he could escort his equipment back to the dock.
For those who canāt get past the paywall:
Itās popular to accuse Americans of being soft, unwilling to sacrifice. But the counterpart to that conventional wisdom ā namely, that Americans rise to the occasion ā was on full display this week. Instances of individual generosity, humane business decisions and neighborly good deeds abound.
We should not forget that we saw unprecedented actions from governors in California, Illinois and New York to essentially shut down their states, asking people to stay home and businesses to shutter except for essential activities (e.g., keeping hospitals running, food shopping going). Governors instituted the most dramatic and widespread disruption in memory, affecting tens of millions of people. (Other states are also ordering less extensive lockdowns.)
Illinois Gov. J.B. Pritzker (D) announced on Friday afternoon his stay-at-home directive. āI donāt come to this decision easily,ā he said. āI fully recognize that in some cases, I am choosing between saving peopleās lives and saving peopleās livelihoods. But ultimately you canāt have a livelihood if you donāt have your life."
In New York, Gov. Andrew M. Cuomo (D) dubbed his order āMatildaās Law,ā a reference to his elderly mother, who is in the category of those most at risk.
Not only did they and other governors act decisively, but people generally cooperated. No riots broke out. No one marched on governorsā mansions with pitchforks. The streets emptied, subways and buses ran practically empty, and those people who could worked as best they could from home, juggling kids and other responsibilities. If people refused to comply, there would be little law enforcement could do to coerce compliance. But coercion was not necessary. Like the famous British World War II poster, Americans did ākeep calm and carry on,ā albeit with some understandable grumbling.
It is easy to point to miscreants hanging out on the Florida beaches or the toilet paper hoarders, but millions of people stayed put. Businesses told people not to come in. Schools and civic entities closed down. Americans were asked to put their lives on hold at great personal cost and with no end in sight. They responded not only out of a sense of their own well-being but because they understood that their actions could either increase or decrease the number of infected individuals, and in turn the number of fatalities.
I donāt want to jinx us. We should be aware that patience may wear thin and people may bend the rules after weeks or months of social distancing. However, as badly as some politicians have behaved, people as a whole have been good citizens and good neighbors. As German Chancellor Angela Merkel said in an exemplary speech to her countrymen, "We are a community in which every life and every person counts.ā It is comforting to know we are as well.
For their remarkable resilience, selflessness and patience, we can say, well done, Americans. For some inspiration and encouragement, take time to watch Merkelās speech (with subtitles):
If you havenāt heard Chancellor Merkelās extraordinary speech, here it is. Itās about twelve minutes.
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Merkel is a good leader. I grew up in Germany and a fluent speaker. There are some supply chain issues at the moment over there. My dad has made several trips to the commissary in Grafenwohr for items not available on the economy (Although he makes trips normally for his stammtisch buddies for steaks, turkeys, etc). Iāve been talking with him daily. I worry about him at 75 years old, but all seem to be well where he is at the moment.
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A maybe interesting report from the CDC about the ill-fated cruise ship āDiamond Princessā at Yokohama, and the transmission of COVID-19 among crew members during quarantine >>>
https://www.cdc.gov/mmwr/volumes/69/wr/mm6911e2.htm?s_cid=mm6911e2_w#contribAff
Probably shouldnāt read this thread, then.
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