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  1. #1661
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    Over 900 deaths on Friday (3/27/2020) alone in Italy

    Running total of OVER 9000 in Italy

    Coronavirus: More than 900 deaths in a day in Italy - BBC News

    Over 27000 worldwide to date Coronavirus Update (Live): 595,952 Cases and 27,341 Deaths from COVID-19 Virus Outbreak - Worldometer

    And with it just reaching Africa and India ????? ……..and little or no mention of S.America

    WE AIN'T SEEN NOTHING YET

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    Quote Originally Posted by Trboatworks View Post
    That says UK, no mention of USA...........

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    Quote Originally Posted by Trboatworks View Post
    Yeah...I can order a box of 100 tests at $15/ea in USA already, stated delivery is the first week of April.


    Sent from my iPhone using Tapatalk

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    Quote Originally Posted by dalmatiangirl61 View Post
    That says UK, no mention of USA...........
    Yes but the test didn’t exist a week ago.
    “Coming to market” is groundbreaking.
    We will have it in the US as well.

    I have a sig other delaying infusion therapy on doctors orders due to heighten risk factors.
    Every step taken towards cornering this bastard is good news.
    It can free up many others who face similar restrictions:

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    Quote Originally Posted by snowman View Post
    Yeah...I can order a box of 100 tests at $15/ea in USA already, stated delivery is the first week of April.


    Sent from my iPhone using Tapatalk
    From where?

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    I see this is broader based already:

    https://www.google.com/amp/s/www.blo...lmost-anywhere


    I say again.
    Woo hoo!

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    When this shows up I have to wonder about Theranos , seemed like real low dollar magic and great if had worked.
    Bob

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    America, Trump: " We need beautiful American Test Kits for the Chinese Virus".

    China, Xi Jingping: " We have People's Republic of China Test kits for the AMERICA Virus ".

    U.K., Boris Johnson: "Just bloodywell get on with it ! ".

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    Quote Originally Posted by CarbideBob View Post
    When this shows up I have to wonder about Theranos , seemed like real low dollar magic and great if had worked.
    Bob

    It was magic and it did work. Went viral and then miraculously made zillions of venture capital disappear. We'll likely see dozens of smaller scale efforts at wallet extraction over the next couple months.

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    Quote Originally Posted by PeteM View Post
    It was magic and it did work. Went viral and then miraculously made zillions of venture capital disappear. We'll likely see dozens of smaller scale efforts at wallet extraction over the next couple months.
    The saving grace here is that there will be unprecedented oversight and peer review of the process, so a fake test will be uncovered immediately (and the scammer flayed alive).

    How to proceed with this capability, to scale it up and use it most wisely is the question. Hopefully the few grownups in the administration will be able to guide the process.

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    Quote Originally Posted by Milland View Post
    The saving grace here is that there will be unprecedented oversight and peer review of the process, so a fake test will be uncovered immediately (and the scammer flayed alive).

    How to proceed with this capability, to scale it up and use it most wisely is the question. Hopefully the few grownups in the administration will be able to guide the process.
    'cuz Jarred Kushner's got it all figured out.

    What grown ups ?

    I thought the "grown ups" were in the...

    'Deep state department" <--- Trump's words not mine.

    An antibody test kit would be super useful. Seems the UK's NHS are full in on this one.

    + BoJo's got it too,

    not just "Big Ears" Charles von Sax coburg gotha "Windsor" Mountbatten/Battenberg. Obviously a plot from QEII to make sure he never gets the throne ! (Obvi) .

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  16. #1672
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    Quote Originally Posted by cameraman View Post
    China, Xi Jingping: " We have People's Republic of China Test kits for the AMERICA Virus ".
    The actual speech, in case you effing care about facts ...

    Quote Originally Posted by Xi Jinping
    Your Majesty King Salman bin Abdulaziz Al Saud,

    Dear Colleagues,

    It is good to join you. Let me begin by expressing my sincere appreciation to His Majesty King Salman and Saudi Arabia for having done tremendous work of communication and coordination to make this summit possible.

    Facing the COVID-19 outbreak that caught us all by surprise, the Chinese government and Chinese people have been undaunted as we took on this formidable task. From day one of our fight against the outbreak, we have put people's life and health first. We have acted according to the overall principle of shoring up confidence, strengthening unity, ensuring science-based control and treatment and imposing targeted measures. We have mobilized the whole nation, set up collective control and treatment mechanisms and acted with openness and transparency. What we fought was a people's war against the outbreak. We have put up a strenuous struggle and made tremendous sacrifices. Now the situation in China is moving steadily in a positive direction. Life and work are quickly returning to normal. Yet, there is no way we will lower our guard or relax control.

    At the most difficult moment in our fight against the outbreak, China received assistance and help from a lot of members of the global community. Such expressions of friendship will always be remembered and cherished by the Chinese people.

    Major infectious disease is the enemy of all. As we speak, the COVID-19 outbreak is spreading worldwide, posing enormous threat to life and health and bringing formidable challenge to global public health security. The situation is disturbing and unsettling. At such a moment, it is imperative for the international community to strengthen confidence, act with unity and work together in a collective response. We must comprehensively step up international cooperation and foster greater synergy so that humanity as one could win the battle against such a major infectious disease.

    For that to happen, I would like to put forth four proposals.

    First, we need to be resolute in fighting an all-out global war against the COVID-19 outbreak. The community of nations must move swiftly to stem the spread of the virus. In this regard, I propose that a G20 health ministers' meeting be convened as quick as possible to improve information sharing, strengthen cooperation on drugs, vaccines and epidemic control, and cut off cross-border infections. G20 members need to jointly help developing countries with weak public health systems enhance preparedness and response. I propose a G20 COVID-19 assistance initiative for better information sharing and policy and action coordination with the support of the World Health Organization. Guided by the vision of building a community with a shared future for mankind, China will be more than ready to share our good practices, conduct joint research and development of drugs and vaccines, and provide assistance where we can to countries hit by the growing outbreak.

    Second, we need to make a collective response for control and treatment at the international level. This is a virus that respects no borders. The outbreak we are battling is our common enemy. All must work together to build a strongest global network of control and treatment that the world has ever seen. China has set up its online COVID-19 knowledge center that is open to all countries. It is imperative that countries pool their strengths and speed up research and development of drugs, vaccines and testing capabilities in the hope to achieve early breakthrough to the benefit of all. Discussions are also needed regarding the establishment of regional emergency liaison mechanisms to enable quicker response to public health emergencies.

    Third, we need to support international organizations in playing their active roles. China supports WHO in leading the global efforts to develop science-based and proper control and treatment and minimize cross-border spread. I call on G20 members to enhance anti-epidemic information sharing with the support of WHO and to promote control and treatment protocols that are comprehensive, systematic and effective. The G20 platform for communication and coordination may be used to increase policy dialogue and exchange, and a high-level meeting on international public health security may be convened in due course. For China, we will be happy to join other countries and scale up support for relevant international and regional organizations.

    Fourth, we need to enhance international macro-economic policy coordination. The outbreak has disrupted production and demand across the globe. Countries need to leverage and coordinate their macro policies to counteract the negative impact and prevent the world economy from falling into recession. We need to implement strong and effective fiscal and monetary policies to keep our exchange rates basically stable. We need to better coordinate financial regulation to keep global financial markets stable. We need to jointly keep the global industrial and supply chains stable. What China will do in this regard is to increase its supply of active pharmaceutical ingredients, daily necessities, and anti-epidemic and other supplies to the international market. What's more, we also need to protect women, children, the elderly, people with disabilities and other vulnerable groups, and provide for people's basic needs. China will continue to pursue a proactive fiscal policy and prudent monetary policy. We will continue to advance reform and opening-up, widen market access, improve the business environment, and expand imports and outbound investment to contribute to a stable world economy.

    I want to call on all G20 members to take collective actions - cutting tariffs, removing barriers, and facilitating the unfettered flow of trade. Together, we can send a strong signal and restore confidence for global economic recovery. The G20 needs to draw up an action plan and promptly set up communication mechanisms and institutional arrangements for anti-epidemic macro policy coordination.

    Dear Colleagues,

    Now is a crucial moment, a time for us to rise up to challenge and act with swiftness. I am convinced that through solidarity and mutual assistance, we will prevail over this outbreak and we all will embrace a brighter future for mankind!

    Thank you.

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    Quote Originally Posted by EmanuelGoldstein View Post
    The actual speech, in case you effing care about facts ...
    I guess satire is lost on you...

    First PRC called it the Wuhan virus and then after things settled , things were spun around to call it the "America Virus".

    I don't care at this point about shitty politicians.

    Right now I'm still trying to figure out how to "Kick" Covid 19 'cuz it's real trixter and doesn't want to let go.

    I really don't give a flying f*ck what Xi Jingping has said to PRC populous and I don't really care for Trump's daily briefings.

    At least the NHS in the UK is trying to "Bring it".

    What the f*ck do I care about what Xi Jingping wrote in a letter to King Salman bin Abdulaziz Al Saud ?

    Pulling focus on Cuomo's struggles @NYC that IS pertinent.

    I'm sure there must be plenty of Chinese machining forums you can hangout on too where reposting of Xi Jingping's various letters would receive greater respect and attention.

  18. #1674
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    Just in case anyone still thinks this virus is just another form of the "flu," and that we really don't need respirators, here is a note intended for docs in other areas of the country from an ER doc working in New Orleans (sorry for some of the medical jargon but for those not so versed in that jargon, the gist is still quite clear)

    "I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.
    Clinical course is predictable.
    2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

    Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
    Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
    81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
    Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.
    China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
    Diagnostic
    CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

    Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
    CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
    Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

    Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.
    A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.
    An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.
    Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.
    Disposition
    I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

    We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.
    Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.
    Treatment
    Supportive

    worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.
    Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.
    We are also using Azithromycin, but are intermittently running out of IV.
    Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.
    Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.
    Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.
    Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.
    The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.
    Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.
    We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.
    One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.
    I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all"

    And this thing is just getting started. The best thing we can all do is to take social isolation very very seriously. Try to save the ventilator for someone else by not occupying one yourself.

    Denis















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  20. #1675
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    Denis - hard to "like" the content, but appreciate your posting this.

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    Quote Originally Posted by cameraman View Post
    I guess satire is lost on you...
    No. It was not satire, it was stupid.

    This is not a time for stupid shit.

    What the f*ck do I care about what Xi Jingping wrote in a letter to King Salman bin Abdulaziz Al Saud ?
    Speech to G20, dumbfuck.

    I'm sure there must be plenty of Chinese machining forums you can hangout on too where reposting of Xi Jingping's various letters would receive greater respect and attention.
    YOU are the ignorant ass who claimed "Xi Jingping said ...."

    What I did was put his words here to counter your lie. I do not like lies. That's all. Facts, m'am, just the facts.

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    Not to worry, right now are the tweets blaming GM and Ford for slow response and overcharging, now we know the real bad guys in this battle.
    Trump orders GM to start ventilator production for COVID-19 amid contract dispute – TechCrunch
    Bob

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    Quote Originally Posted by cameraman View Post
    'cuz Jarred Kushner's got it all figured out.

    What grown ups ?
    Fine - grown up. Dr. Fauci.

    How are you feeling? Any better, or still in the grips? [I guess you answered that in #1672]

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    Quote Originally Posted by EmanuelGoldstein View Post
    No. It was not satire, it was stupid.

    This is not a time for stupid shit.


    Speech to G20, dumbfuck.


    YOU are the ignorant ass who claimed "Xi Jingping said ...."

    What I did was put his words here to counter your lie. I do not like lies. That's all. Facts, m'am, just the facts.
    You still don't get it … I'm not wasting my time.

    BTW no matter how hard you shill for the PRC obtaining the equivalent of a green card or Chinese citizenship is extremely difficult.

    Good Luck.

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    Oh look ! A squirrel !


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