NHL suspends season due to COVID-19 pandemic part two

[Sens of Anarchy]

Asymptomatic when it comes to COVID-19.

What's the beef with cause of death... just questioning the numbers? Why?

 

[Pierre from Orleans]

ARDS isn't a COVID-19 symptom? I thought it was. Or maybe more accurately it's a condition that is one of the outcomes of COVID-19. So if you have ARDS symptoms, you have COVID-19 symptoms.

ARDS is a symptom of Covid-19 but that does not mean its caused by it in some cases. Someone could have had it before they got Covid-19.

Perhaps my example wasn't clear but if someone had ARDS and dies, the coroner or whomever signs the death certificate see's there were complications due to ARDS, knows its a symptom of Covid-19, tests for it, tests return positive or don't even test for it because that's a valid option and puts Covid-19 as the cause of death, it gets tallied as another Covid-19 death. That's misleading

 

[Micklebot]

ARDS is a symptom of Covid-19 but that does not mean its caused by it in some cases. Someone could have had it before they got Covid-19.

Perhaps my example wasn't clear but if someone had ARDS and dies, the coroner or whomever signs the death certificate see's there were complications due to ARDS, knows its a symptom of Covid-19, puts Covid-19 as the cause of death, it gets tallied as another Covid-19 death. That's misleading

ARDS isn't something you have long term and just carry on with. So its unlikely anyone would have it before contracting COVID19. If sombody tested positive for covid, the likelihood of ARDS being caused by something else is likely extremely low. They might have another issue like chronic bronchitis that puts them at higher risk, but the Covid19 would likely be a contributing factor.

Or are you suggesting coroners would attribute ARDS to covid19 with no compelling evidence of the person having or even being expoaed ti covid19?

 

[The Lewler]

Again , does anyone seriously think the death numbers are off by an order of magnitude? Either via under or over reporting ?

The most relevant number to the way forward in whatever direction is the denominator , put simply the number of people who have been infected .

I agree with @thinkwild , if random sampling antibody tests indicate a low percentage of the population has been infected , then you have a hard choice to make but it’s likely a severe testing , tracing , and isolation regime like “regular” pandemic control .

If antibody testing indicates a significant portion of the population has been infected already , then likely your denominator is much higher than most models indicate , meaning your case fatality rate drops , and we start talking about maintaining ICU capacity , isolating vulnerable groups and then easing up on the rest of the population .

Because nothing is easy I expect the number to come in at more infections than expected but not enough to make the call that it’s actually not lethal / critically damaging enough to keep the whole population locked down .

And we will be stuck in for some hard calls.

 

[thinkwild]

All this talk about attributing cause of death reminds of this old story.

A medical examiner viewed the body of Ronald Opus and concluded that he died from a gunshot wound of the head caused by a shotgun. Investigation to that point had revealed that the decedent had jumped from the top of a ten-story building with the intent to commit suicide. (He left a note indicating his despondency.) As he passed the 9th floor on the way down, his life was interrupted by a shotgun blast through a window, killing him instantly. Neither the shooter nor the decedent was aware that a safety net had been erected at the 8th floor level to protect some window washers, and that the decedent would most likely not have been able to complete his intent to commit suicide because of this.

Ordinarily, a person who sets out to commit suicide and ultimately succeeds, even if the mechanism might not be what they intended, is defined as having committed suicide. That he was shot on the way to certain death nine stories below probably would not change his mode of death from suicide to homicide, but the fact that his suicide intent would not have been achieved under any circumstance caused the medical examiner to feel that he had homicide on his hands.

Further investigation led to the discovery that the room on the 9th floor whence the shotgun blast emanated was occupied by an elderly man and his wife. He was threatening her with the shotgun because of an interspousal spat and became so upset that he could not hold the shotgun straight. Therefore, when he pulled the trigger, he completely missed his wife, and the pellets went through the window, striking the decedent.

When one intends to kill subject A but kills subject B in the attempt, one is guilty of the murder of subject B. The old man was confronted with this conclusion, but both he and his wife were adamant in stating that neither knew that the shotgun was loaded. It was the longtime habit of the old man to threaten his wife with an unloaded shotgun. He had no intent to murder her; therefore, the killing of the decedent appeared then to be accident. That is, the gun had been accidentally loaded.

But further investigation turned up a witness that their son was seen loading the shotgun approximately six weeks prior to the fatal accident. That investigation showed that the mother (the old lady) had cut off her son's financial support, and her son, knowing the propensity of his father to use the shotgun threateningly, loaded the gun with the expectation that the father would shoot his mother. The case now becomes one of murder on the part of the son for the death of Ronald Opus.

Now comes the exquisite twist. Further investigation revealed that the son, Ronald Opus himself, had become increasingly despondent over the failure of his attempt to get his mother murdered. This led him to jump off the ten-story building on March 23, only to be killed by a shotgun blast through a 9th story window.

The medical examiner closed the case as a suicide.

 

[Nac Mac Feegle]

Anyone else think maybe it's time we re-think PPE entirely for highly infectious diseases with no known vaccine or immunity?

It's pretty clear the PPE we have right now is far from perfect if nearly 20% of our cases are medical professionals. Should we not move to a complete body-suit of some kind or have the patient in a body suit and have the patient contained when brought in? Have some decontamination showers set up in the hospital if its the staff who will wear body suits? I understand the difficulty of working in one for hours on end but they have to put on all this stuff anyways... just as individual pieces.

I remember a news piece in the BBC about what it's like in an Italian hospital and it was like they were trying to create a full suit experience but with goggles, a mask, gloves and a body suit with holes for the face, hands and shoes... and it's just so easy to see how they could become infected taking it all off even when taking care. There has to be a better way that provides better security, is more breathable and that lessens chance of infection when removing.

Probably a bit too soon (technology wise), but seems like the perfect opportunity for robotics and AI to take over these aspects of patient care. From what I've read over the past few years, there are some AI out there already that can perform simple surgical procedures (stitching up wounds, grafting skin, etc). I would suppose there are some robotics out there right now that can tend to a patient that needs a respirator or other treatments like that.

 

[Sens]

Let’s get back to work

“That is a surprise”: Doctors still waiting for feared surge of COVID-19 patients in Canadian ICUs

 

[JD1]

Let’s get back to work

“That is a surprise”: Doctors still waiting for feared surge of COVID-19 patients in Canadian ICUs

I read that article yesterday and was chatting with a friend about it

We have models and we have data. Models that I've seen have kind of a low medium high to them wrt hospitalization, need for ICUs, infection rate. The "problem" at this point is that the data is running far underneath the best case scenario in the models and the media will get louder about that.

The "problem" is a really good thing.

I am wondering how long this can go with infection rates running below models? We cannot live like this for 18 months as we wait out a vaccine. The financial impacts across society are devastating.

 

[Sens]

I read that article yesterday and was chatting with a friend about it

We have models and we have data. Models that I've seen have kind of a low medium high to them wrt hospitalization, need for ICUs, infection rate. The "problem" at this point is that the data is running far underneath the best case scenario in the models and the media will get louder about that.

The "problem" is a really good thing.

I am wondering how long this can go with infection rates running below models? We cannot live like this for 18 months as we wait out a vaccine. The financial impacts across society are devastating.

in Hamilton a city of 590K
Have had 9 cases of community transmission the last 10 days
Status of Cases | City of Hamilton, Ontario, Canada
In the last 10 days, 7% of confirmed local COVID-19 cases are community acquired

the border was shut down 20 days ago... if there was a spike to see we’d be seeing it now

 

[The Lewler]

You will have increased calls for it but you need that sampling data we talked about earlier .

If your new projections are running even better than your previous best case scenario , what inputs changed ?

Can you really attribute it to an unexpected solidarity of social distancing ? Unlikely . You accounted for that in all models , remember ? Do nothing vs strict controls gave you worst and best case scenarios .

So , again , has the lethality rate surprised you as being lower than expected via the data ?

Is it a function of lethality or do you now believe that many more people have had Covid than expected so it drove your denominator exponentially higher and decreased the case fatality rate ?

 

[JD1]

in Hamilton a city of 590K
Have had 9 cases of community transmission the last 10 days
Status of Cases | City of Hamilton, Ontario, Canada
In the last 10 days, 7% of confirmed local COVID-19 cases are community acquired

the border was shut down 20 days ago... if there was a spike to see we’d be seeing it now

I think we're not seeing a spike because of the effectiveness of the social distancing

But the issue is that so long as this thing is out there, if you relax social distancing you run the risk of creating the spike

I think what we need are isolation places...if you test positive you get hauled away into an isolation facility until you are cleared

 

[JD1]

You will have increased calls for it but you need that sampling data we talked about earlier .

If your new projections are running even better than your previous best case scenario , what inputs changed ?

Can you really attribute it to an unexpected solidarity of social distancing ? Unlikely . You accounted for that in all models , remember ? Do nothing vs strict controls gave you worst and best case scenarios .

So , again , has the lethality rate surprised you as being lower than expected via the data ?

Is it a function of lethality or do you now believe that many more people have had Covid than expected so it drove your denominator exponentially higher and decreased the case fatality rate ?

Why do you think it's unlikely that the lower numbers are attributable to social distancing?

 

[Pierre from Orleans]

I think we're not seeing a spike because of the effectiveness of the social distancing

But the issue is that so long as this thing is out there, if you relax social distancing you run the risk of creating the spike

I think what we need are isolation places...if you test positive you get hauled away into an isolation facility until you are cleared

Would this be only for people who volunteer to get tested? How about people who are at home?

 

[JD1]

Would this be only for people who volunteer to get tested? How about people who are at home?

For anyone that has tested positive

 

[FormentonTheFuture]

in Hamilton a city of 590K
Have had 9 cases of community transmission the last 10 days
Status of Cases | City of Hamilton, Ontario, Canada
In the last 10 days, 7% of confirmed local COVID-19 cases are community acquired

the border was shut down 20 days ago... if there was a spike to see we’d be seeing it now

Test numbers in Ontario mean nothing. The province is performing the least number of tests in the country. The fact is that social distancing is clearly helping and it would be foolish to suddenly let everyone go back to work just because the number of cases are low

 

[Sens]

Test numbers in Ontario mean nothing. The province is performing the least number of tests in the country. The fact is that social distancing is clearly helping and it would be foolish to suddenly let everyone go back to work just because the number of cases are low

I hope tons of people have it when they up the tests... with 78% of ICU beds available in the province that means the virus is having limited effect on the population here

Hamilton has 20 Hospitalizations currently... a number that’s been steady the last week... I check every day

what I’m seeing is Covid-19 is not causing Canadians to hit the Hospital

 

[Sens]

The Border was closed 20 days ago
The virus takes 10 days to hit

there should be a flood of hospitalizations happening right now

it’s not
78% icu beds still available

“n my centre, we have still a lot of empty beds in the ICU,” said D’Aragon Thursday. “That is a surprise. We changed all our schedules, our ICU schedules three weeks ago, to be on call. We cancelled all the teaching classes, all other administrative activities … So far, today, I’m at home. It’s not what we expected.”

Dudes literally sitting at home with his feet up

 

[5ive4Fighting]

ARDS is a symptom of Covid-19 but that does not mean its caused by it in some cases. Someone could have had it before they got Covid-19.

Perhaps my example wasn't clear but if someone had ARDS and dies, the coroner or whomever signs the death certificate see's there were complications due to ARDS, knows its a symptom of Covid-19, tests for it, tests return positive or don't even test for it because that's a valid option and puts Covid-19 as the cause of death, it gets tallied as another Covid-19 death. That's misleading

ARDS is the complication. The A in the syndrome means “Acute”, so people aren’t crawling around with chronic ARDS waiting to gasp in this virus. If a Covid-19 patient develops ARDS, it will be as a complication of pneumonia, not a direct symptom. It always follows some insult to the lungs, and it’s severe. Poor air quality that you mentioned previously might have, over time, made your lungs vulnerable to the point that you are a person more at risk for a dangerous a case of Covid-19. But you’ll still have developed ARDS because you developed pneumonia because you caught the Coronavirus. It’s then effectively an underlying condition, not an uncaught cause of death.

 

[Sens]

Wait it another 1-2 weeks
Keep travel shutdown
Have isolation centers ready
Open up all business that does not involve travel

let’s go

 

[The Lewler]

Why do you think it's unlikely that the lower numbers are attributable to social distancing?

Because strict social distancing was already an inputted variable under the modelling outcomes with strict control measures in place . It’s not like it’s a new variable .

For me it’s just a probability speculation .

What is more probable:

That expert epidemiologists radically underestimated the effect of social distancing in their models causing them to revise downwards repeatedly their projections ?

or

The actual infection rate was significantly underestimated based on insufficient best available data early on , which has been driving down the fatality and hospitalization rate calculations ?

 

[FormentonTheFuture]

Wait it another 1-2 weeks
Keep travel shutdown
Have isolation centers ready
Open up all business that does not involve travel

let’s go

Not gonna happen. I don’t want to be cooped up at home either, but you need to start realizing this is a long term thing here. Backing out now would cripple the nation

 

[The Lewler]

Wait it another 1-2 weeks
Keep travel shutdown
Have isolation centers ready
Open up all business that does not involve travel

let’s go

Not gonna happen .

If I had to spit ball it you will see some kind of plan to relax things in certain ways heading into July.

The US situation is going to impact ours .

The basically green lighting school in September and preparing for 2nd wave .

 

[Sens]

Not gonna happen. I don’t want to be cooped up at home either, but you need to start realizing this is a long term thing here. Backing out now would cripple the nation

It’s going to be a hard sell as Covid cases dry up.., another month at this pace and there’s going to be nothing

 

[FormentonTheFuture]

It’s going to be a hard sell as Covid cases dry up.., another month at this pace and there’s going to be nothing

Again do you realize why these measures are taking place? To reduce the strain in our healthcare system. If you open up all business again, the risk of hospitals being overrun would skyrocket.

we’re almost near summer which is when a ton of people take time off work anyway. I doubt they will lift any restrictions until late summer or fall.

 

[Sens]

Again do you realize why these measures are taking place? To reduce the strain in our healthcare system. If you open up all business again, the risk of hospitals being overrun would skyrocket.

we’re almost near summer which is when a ton of people take time off work anyway. I doubt they will lift any restrictions until late summer or fall.

if that’s the case there is going to be riots
Toronto is already boarding up all businesses
Will be G20 on steroids