re: Coronavirus Disease 2019 (COVID-19) ***W.H.O. DECLARES A GLOBAL PANDEMIC***

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Covered several pages back. Had underlying health issues which likely contributed.

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My bad. Been working on contingency plans and hadn't been surfing recently.

We all hate Florida. It's what brings us all together. We can harness the hate to stop this virus.

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This is from a front-line ICU physician in a Seattle hospital This is his personal account: * we have 21 pts and 11 deaths since 2/28. * we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen. * US has been past containment since January * Currently, all of ICU is for critically ill COVIDs, all of floor medsurg for stable COVIDs and EOL care, half of PCU, half of ER. New resp-sx pts Pulmonary Clinic offshoot is open * CDC is no longer imposing home quarantine on providers who were wearing only droplet iso PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne iso PPE for aerosol-generating procedures in ANY pt in whom you suspect COVID, just to prevent the mass quarantines. * we ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs, which is not the manufacturer's recommendation. Not surprised on N95s as we use mostly CAPRs anyway, but still. *terminal cleans (inc UV light) for ER COVID rooms are taking forever, Enviro Services is overwhelmed. Bad as pts are stuck coughing in the waiting room. Rec planning now for Enviro upstaffing, or having a plan for sick pts to wait in their cars (that is not legal here, sadly). * CLINICAL INFO based on our cases and info from CDC conf call today with other COVID providers in US: * the Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data very skewed by late and very limited testing, and the number of our elderly pts going to comfort care. - being young & healthy (zero medical problems) does not rule out becoming vented or dead - probably the time course to developing significant lower resp sx is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb). - based on our hospitalized cases (including the not formally diagnosed ones who are obviously COVID - it is quite clinically unique) about 1/3 have mild lower resp sx, need 1-5L NC. 1/3 are sicker, FM or NRB. 1/3 tubed with ARDS. Thus far, everyone is seeing: - nl WBC. Almost always lymphopenic, occasionally poly-predominant but with nl total WBC. Doesn't change, even 10days in. - BAL lymphocytic despite blood lymphopenic (try not to bronch these pts; this data is from pre-testing time when we had several idiopathic ARDS cases) - fevers, often high, may be intermittent; persistently febrile, often for >10d. It isn't the dexmed, it's the SARS2. - low ProCalc; may be useful to check initially for later trending if later concern for VAP etc. - up AST/ALT, sometimes alk phos. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis at admit (150-200) correlates with clinical deterioration and progression to ARDS. LFTs typically begin to bump in 2nd week of clinical course. - mild AKI (Cr <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood. * characteristic CXR always bilateral patchy or reticular infiltrates, sometimes perihilar despite nl EF and volume down at presentation. At time of presentation may be subtle, but always present, even in our pts on chronic high dose steroids. NO effusions. CT is as expected, rarely mild mediastinal LAD, occ small effusions late in course which might be related to volume status/cap leak.

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frick

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we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen.

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I guess this is the worrisome part if true

Sparties dun that one to me earlier.

That is like 3-4 days old

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guess this is the worrisome part if true

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Nobody said young people never ended up in the ICU.

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Is this reliable? I hope not

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Not a doctor here but that seems to imply a cardiac component to this. That has been mentioned in some of the other accounts I've seen from the Chinese b doctors. Can you provide a more meaningful description?

The part about turning the corner and ending up dead quickly seems to match the account I read from one of the family members of a nursing home patient in Washington.

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Someone said it’s been debunked. Is that true?

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I almost want to say that when I first read it it came from Italy

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I almost want to say that when I first read it it came from Italy

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I was thinking the same thing and some didn't trust it because the Twitter account had no history.