Now ye're talking - to a consultant in the HSE [ANSWERS thread]

Boards.ie: Niamh

Answers from our AMA guest to questions asked in the Questions thread.

Please only post your questions in the dedicated thread here.

Pseudonym121

Hi, I'm the HSE Consultant who is doing the AMA. I'm NOT representing the HSE, just trying to help out by providing some answers to questions people ask... I'm going to start by reserving a few posts which I intend to use to post some particularly pertinent information.

Then I'll start replying. I went asleep as soon as I got home and only just woke up so I'll be up for a while yet answering questions listening to my youtube playlist.

P.s. Please keep comments or questions in the questions thread. The main reason I agreed to do the AMA is that I want my answers to be available in one place for people to read without being buried in a swathe of comments, jokes etc. I'm trying to do this as a public service during this difficult time.

Pseudonym121

I'm going to use this post to link to webpages/sites which I believe could be useful for those with medical questions/specific risk factors. I am willing to give some general opinions and repeat information which appears factual and has been published by reputable sources but specialist bodies and your own GPs and Specialists are definitely the place to go for individualised advice which will always be more useful to you as individuals than any general broad advice online. I am NOT offering anyone specific, individualised medical advice and wish to be clear on that. If you want that phone your GP or Specialist.

1. WHO myth busting page... VERY useful at this time. Some of the advice and rumours online are just so dangerous.

2. WHO Coronavirus page. Lots of useful, detailed, evidence based advice there.

3. HSE's Coronavirus page.

4. Royal College of Obs & Gobs UK advice re: Pregnancy & Coronavirus.

5. UK Asthma Society Coronavirus Advice

6. Irish Asthma Society Coronavirus Advice




Errata:
1. Phylogenetics of SARS-CoV2

2. COVID-19 Infected/Recovered etc Updates

3. A really good site for getting a breakdown by country, by date and multiple useful categories. Very succinct and easy to comprehend.

I'll add to this as

Pseudonym121

I posted this previously in the mega thread but I think it is useful to repost it here for those who wish to learn how best to use masks, gloves, handwash etc. There's the normal way you do these things - which is effective - and then there's a medical way - which is likely to be MUCH more effective. If you've gone through the time and effort to do these things then you might as well get the greatest benefit possible from them.

Social Isolation:

Lets be very clear the best way to avoid catching SARS-CoV2 and avoid passing it on to other is Social Isolation. Social Isolation is far superior to any other strategy but it isn’t always feasible, especially if you’ve got a job which involves public interaction. With that said the safest thing you can do is socially isolate yourself as much as possible.

What does this mean? If you’re retired or otherwise not working at this time then stay at home. Don’t go out unless it is a matter of life and death – you must get food or you will starve or you must get medicines. Even in these cases I would ask why you have to go out? Have it delivered by the shop or pharmacy or have a relative who has to be out and about for work pick it up for you and drop it at your door without coming inside.


Social Distancing:

If you absolutely must go out to the shop then don’t touch others, don’t stand within 1 metre ( preferably two metres ) of them and don’t dally. Don’t lean against counters, don’t use cash, go contactless or if you absolutely must pay in cash let them keep the change or put it in the charity box. Don’t touch staff’s hands to get a few pence back and then put potentially infected money in your pocket contaminating your hands, clothes etc. Get in, do what needs doing and get out. SARS-CoV2 is very infections even with limited contact.

If you are working in a job where you cannot work from home then socially isolate as much as possible from other employees and members of the public. All of the above advice applies.

If you decide to go out for something non-essential then simply don’t. By doing that you risk catching and spreading SARS-CoV2. If you catch it and pass it to two people and they pass it to two others and the doubling rate is 4 days then after 28 days you will be responsible for 128 people having it. Of those 128 people 2 to 3 will die. Was that worth the price? I would argue that almost nothing except a matter of your own life and death or essential work warrants putting others at that risk.


Face Masks:
A lot of conflicting things have been said about face masks. The bottom line is that most of the face masks people are purchasing aren’t of any use and even if they were members of the public don’t know how to use them appropriately in order to gain effective protection.

For this reason I would say that buying face masks is ineffective UNLESS you have been advised on which ones to purchase and how to put them on, fit them and take them off. There is going to be a huge shortage of face masks for medical staff in Ireland soon. In Italy many hospitals have run out of face masks and the doctors and nurses have been treating patients without wearing facemasks themselves. This pretty much guarantees they will get infected and is why we’ve seen a rise in the number of doctors and nurses dying in Italy in recent days.

The only face masks which are worth getting are surgical masks or ones rated as either N95/FFP2 or N99/FFP3. Simply put these two ratings mean they stop 95 or 99% of particles above a certain size IF put on properly but almost certainly the vast majority of you with these masks aren’t getting any protection from them.

So, now that I’ve told you that in all the panic you’ve probably bought masks which won’t screen out viruses AND even if they did you don’t know how to wear them properly so as to protect yourself AND even if you get that bit right the way you put them on and off will spread infection do I offer any solutions? Sure, if you’ve already bought them you’re hardly going to return them to hospitals so the people who really need them ( front line healthcare workers ) can benefit from them so you might as well learn how to get some benefit from them.

Here are three good videos I have found and can recommend to show how to put on, fit and remove both surgical masks and more general oval N95 face masks.

How to properly put on, fit and remove Surgical Masks:
https://youtu.be/OABvzu9e-hw
https://www.youtube.com/watch?v=2xLjCfmx0iE

N95 Oval Type Mask:
https://www.youtube.com/watch?v=zoxpvDVo_NI

Once removed the face masks should be placed in a bin which is in a relatively well-ventilated area and which you don’t use often. I use a bin on a balcony which has no risk of being spread to others and also doesn’t act as a source of infection in the living area and has no risk of spreading to my neighbours.



Gloves:

Buying pairs of disposable gloves is a reasonable precaution. I, personally, have purchased several hundred pairs of vinyl, transparent powder-free gloves as they don’t irritate my skin as much as powdered or latex gloves. Why transparent? Well, they don’t attract as much attention when out in public. I’d also consider whitish ones. If you can’t source them then any colour will do. This isn’t after all, about fashion.

Again, gloves are almost useless if you don’t know how to use them properly. There is a set procedure for how to put them on and remove them and, yes, you guessed it there’s a video for that.

How to put on and take off surgical gloves without contaminating oneself.


Once removed the disposable gloves should be placed in a bin which is in a relatively well-ventilated area and which you don’t use often. I use a bin on a balcony which has no risk of being spread to others and also doesn’t act as a source of infection in the living area.

Do NOT re-use them. If you do that you might as well just go around shaking hands with everyone you meet and then smearing your hands all over your face repeatedly every few minutes.

The gloves won’t help much if you keep touching your face. The outside of the glove will transmit COVID-19 droplets to your face readily. So is there anything you can do to prevent yourself subconsciously touching your face out of habit? Yes, read the next paragraph.

Doctors and nurses need to get used to not contaminating sterile gloves by touching our faces or other non-sterile things. I’ve always found it useful to purposely interlace my fingers so that to touch my face I’d have to consciously uninterlace them. Since this isn’t always practical and with COVID-19 we are less worried about maintaining a perfectly sterile environment I’ve taken to carrying a tissue in one hand and a biro in the other. I find that carrying something in each hand prevents the vast majority of habitual face touching because I don’t want to poke my eye out with the biro and/or I have to move the tissue in order to free that hand up. By the time I’ve thought of doing that I realise what I’m about to do and can prevent myself from touching my own face. You might find different things that work for you, this is just something that works for me.


Handwashing:

Handwashing is a good idea but, obviously, social isolation is the best followed by social distancing and protective gear ( masks and gloves ). After all of those though it is still well worth washing one’s hands…. Yeah you’ve guess it…. So long as you do it properly. The sort of handwashing most people do verges on useless. On the positive side there are, as ever, videos to show you how. Here is one I found useful and have recommended to non-clinical staff/friends and family.

How to wash your hands the medical way.

As ever, I'm simply providing some basic advice and links to videos by reputable sources. If you don't like it, do it your way and take your chances with your own style of doing things. I'm just telling you how generations of doctors and nurses have been trained to do these sorts of things. If you think you know better then you do you.

Pseudonym121

another post

Pseudonym121

last one and then answers

Pseudonym121

celt262 wrote: »

What medicine should be taken if symptoms start to develop?

Thanks for the question. Honestly that would depend on what your underlying conditions are, the severity of symptoms you exhibit and your likely progression as well as what allergies you have so it is impossible to give a one size fits all answer here.

With that said the best advice is that IF you start having symptoms you should contact your GP and be assessed by them ( almost certainly over the phone ) and follow their advice. At this point in the pandemic in Ireland most people who think they have COVID-19 don’t, they have other more common viral or bacterial infections or even just psychosomatic issues. So long as you aren’t allergic I think you can’t go wrong with some paracetamol, rest and ensuring you are hydrated though.

As re: NSAIDs the best thing I can do is link to the HSE's advice. Might this change as we know more? Certainly but this is the advice as it stands at the moment. You'll have to make up your mind whose advice to follow. I have no reason, at this time, to doubt the HSE's advice on this issue.

dartboardio wrote: »

Hi,
Do you find yourself turning away lots of patients who don't have any real symptoms of the virus and are just taking up waiting rooms out of worry?
Are all your staff/colleagues full of panic/worry ? Is this the busiest you have ever been?

Thanks for the questions. I’ve certainly heard of a lot of people thinking that because they have a cough or whatever that they might have COVID-19 and I’ve heard a lot of frustration from people who want to be tested but don’t meet the criteria for testing.

It should be noted that Ireland had very few testing kits although that number is ramping up massively and will continue to ramp up. As availability increases the criteria for testing will be widened until we reach a point where we can test everyone we should be testing.

A lot of GPs are really struggling with the numbers of people phoning them seeking advice and testing and that isn’t helping. Thankfully most of those people have the sense not to come in in person and:
A) Clog up waiting rooms and
Risk spreading it to others if they do have COVID-19

I don’t think patients are being turned away but there are a lot of worried well who would do best to just self-isolate, phone their GP and then follow the GP’s advice. On a population level you don’t need to do anything amazing, just follow governmental advice and your doctors’ advices.

My medical colleagues and I ( Consultants and NCHDs) are worried but not really about ourselves so much, although we do know that if this gets really bad then we ourselves and our friends and colleagues stand to have higher rates of infection and mortality per capita (age adjusted) than the rest of the population. This was seen in both swine flu and SARS and I expect it will be seen with SARS-CoV2/COVID-19 also. What I see and hear much more than that is a grim determination to do our duties and pay whatever price needs to be paid. I’ve been saying for a while now that we need to gear up as though Ireland is about to fight a medium-sized war, with all of the sacrifice and difficulty and loss that that entails. I’m starting to hear colleagues use the same language … I heard it said a few times today.

This is going to be a war, there are going to be losses but I think the vast majority of doctors are determined not to let Ireland down, no matter the cost. Sure we REALLY don’t want to die ourselves but we’ll do our bit, roll the die and know it’ll happen to some of us.
I, personally, am more worried about my parents than I am about myself and I think anyone with parents feels the same way. You have to remember we’re just like you in terms of families and being more concerned about those we love than we are about ourselves right now.
I’m not a spring chicken anymore and I have two underlying health conditions which increase my risk of dying if I catch COVID-19. I estimate I have a 15 to 20% chance of dying if I catch it but I’m going in because that is what is needed to try and save as many people as possible. I don’t think my place is directly on a COVID-19 ward because I’ll absolutely catch it for sure then and I won’t do anyone any good becoming another patient and using up resources which could be used to treat others but I have a role to play and I’ll play it. I think everyone else feels the same.

My nursing colleagues have the same attitudes really. I know nurses who have been doing non-front line duties for years and who have worried wives, husbands and children and have simply accepted that they’re going to be deployed wherever they can do most good. They know the risk this puts them at --- nurses also die at higher rates per capita ( age adjusted ) during pandemics --- but they’re not going to let you, the public, our patients down. Some, with health issues etc, will be deployed in places where they are less likely to catch it so that they can contribute care as opposed to consuming it but everyone’s grimly determined to do their absolute best.

As for allied health professionals… Well, the secretaries and admin staff are still showing up, doing their best as are the OTs, Physios, Dieticians, Radiographers etc… And let’s not forget the security staff, porters, kitchen staff and cleaning staff. A few weeks from now it will be a definite act of courage for a kitchen staff or cleaning staff to come into work because they’ll be exposing themselves to high risks of infection with COVID-19. Some will falter but I expect the vast majority to continue showing up and doing their bit. We need them ALL to do their bits because doctors and nurses on their own can’t make a hospital or GPs surgery run. It is a team effort.

I do think that some the allied health professionals who haven’t done nursing or medical duties on wards don’t quite “get” just how serious this is yet. I’ve definitely had push-back from some line managers about instructions I’ve given my team because I wasn’t following HSE protocol etc but this isn’t because they’re bad people or managers it is just because it is a big ask to go from peacetime HSE footing where there’s a protocol for everything and a change in work practices is a big deal to a mindset of, this is war and in war we do WHATEVER is necessary. When the whistle sounds, we all charge, we won’t all make it but we all charge. That is one hell of a mindset change and it takes time to make it… but even today people who hadn’t made the adjustment yesterday were contacting me to let me know they’d made the adjustment and were now of the “do whatever it takes mindset”.

A lot of (insert expletive of your choice here) ;-) is spoken about the HSE and, to be fair, some of it is even justified but, right now, while I’m a bit scared for myself and my family and I’m sad that some people I’ve known and worked with aren’t going to survive this it really makes me proud of Ireland and the HSE and socialised healthcare in general to see people knuckle down and prepare to go to war and fight this. We aren’t all coming back but we won’t let you down. We will, to quote the Marvel Universe, make the Big Play.

One thing I would just say on a slightly self-serving note is that when this is all over and a year or two from now doctor and nurses etc are advocating for funding and better working conditions please do remember who ran towards the fire at this time while everyone else was avoiding it as much as possible. Support us as much as we will support you in the months to come.

I’m sure this applies to the Army and Fire Brigade and Gardai and many others as well. I just don’t have as much contact with them so can’t address their attitudes directly.


Is this the busiest we’ve ever been?

No, a lot of the people who used to clog A&E with stuff that they should never have come in with seem to be staying at home. I don’t know if this is out of civic duty or fear of catching COVID-19 but myself and a lot of colleagues are ticking over doing the day jobs but aren’t as swamped as we usually are with the worried well etc.

We’re all still busy though as we’re preparing for what is to come.

Pseudonym121

expectationlost wrote: »

is it possible to protect yourself from the covid19 and treat patients, how are health workers still getting sick?, are not wearing some level protection now?

Thanks for the question. Well, you wear protective gear - goggles, masks, gloves, possibly even full coveralls over the other protective gear, taped up to prevent air flowing in or out. They're hellish to work in and exhaust you very quickly. This is one of the reasons you heard about Chinese healthcare workers dying of exhaustion and/or dehydration when they were battling this.

Why will health care workers still get sick? Cause viruses are tiny, we'll all be working long hours in exhausting stressful conditions and it only takes the tiniest mistake to get infected... especially when you're working in a ward or room in which the virus saturates everything because it is full of people with COVID-19 just spewing it into the air and on all of the surfaces as they breathe/move etc.

As to protective gear being worn now. Sure, in some areas, but we don't have limitless stocks of it and if we use it all now we won't have it when we really need it. If you listen to the reports from Lombardy in Italy doctors there are talking about running out of face masks and having to go into COVID-19 without facemasks ensuring they will catch it. Doctors and nurses and paramedics etc are dying there as we speak. Healthcare workers in Ireland will be dying in a few weeks time, alongside the members of the public they've been treating. There's no avoiding that now. We just need to knuckle down, do our best to protect ourselves and yourselves and pay whatever price we need to pay to try and save as many as we can.

TheValeyard wrote: »

Are there still the usual cough, colds, flu going around that could also be affecting people. If my toddler has a runny nose and slight cough, it's not immediately Covid19 but still the usual suspects?

Good question. Yeah, I right now have a runny nose and a dry cough but I've had that for a few weeks. I've had a tangential exposure to a COVID-19 patient last week and so I'm being careful about my contact with family etc just in case BUT even in my case since the cough etc predated the exposure this is almost certainly just the normal stuff that goes around this time of year rather than COVID-19.

The same applies to your and yours, except even more strongly. Right now if you have those symptoms you are far more likely to have something other than COVID-19. If the public doesn't play its part with social isolation and distancing, hand-washing etc then that may not be the case a couple of weeks from now.

With that said while children do seem to be able to be infected they do not seem to be at high risk of becoming severely unwell. So you can allay your concerns there somewhat. If in doubt though do keep your toddler away from elderly relatives. Just because the toddler won't become severely ill doesn't mean that whoever they pass it to won't die.

JP Liz V1 wrote: »

I have so many questions, where to start as an asthma sufferer ( and nothing on line ) how do you differentiate between an asthma attack or Covid19?

Well, an acute asthma attack is acute and should be relieved by whatever inhalers your GP or respiratory specialist has prescribed while COVID-19 will come on, last over time and often be associated by symptoms other than shortness of breath.

That's just very general advice though.... If in doubt contact your GP and allow them to assess you and follow their individualised advice.

banie01 wrote: »

Do you think that our effort to shift the curve and flatten growth will be successful?

Thanks for the question. I don't know, it ALL depends on what members of the public do. The scenes with people going out to pubs over the weekend made my heart and the hearts of my colleagues sink. Some of the people in those pubs will almost certainly have been infected and will have passed it on to other.

Superspreaders are a real thing with this virus and Patient 31 in South Korea appears to have infected over 1,000 people, roughly 1 in 8 of ALL cases in the country. The last thing we need in Ireland is someone like that. If they infect 1,000 people you can expect 20 or more to die.... and yet people were draped all over eachother in pubs. If Irish people continue to do this it will cause more infections, more people to become seriously ill and run a greater risk of overwhelming the health service and increasing the death rate from roughly 2% ( if we have enough ventilators ) to up to 10% ( if we run out of ventilators and capacity in the health service ). You are seeing this happen in italy where the % mortality rate is creeping ever upwards towards 10% as their health service becomes more and more overwhelmed.

We need to make that sort of behaviour as taboo as incest and child abuse for the duration. Otherwise it will condemn other Irish people to death over coming weeks and months.

banie01 wrote: »

Or that we took our measures a week or 2 too late for maximum efficacy?

Well, the best time to plant an oak tree was 25 years ago. The second best time is today. I'm definitely of the opinion that we need to have the strictest possible measures today but, you have to bear in mind that this is an unprecedented situation for most governments and governments don't turn on a dime, they take a long time to change course. Given the realistic exingencies of governing a country I think the government is doing OK actually.

I think we've completely missed our chance to be Singapore but they had experience with SARS and learned a lot of lessons. One of those lessons was to go in hard and early if this ever happened again. They went too easy initially with SARS. I think European governments are going to have that same experience now but I don't think this makes them negligent or anything like that, it just means that it is really hard to change your mindset and get your head around how bad this could be and what measures are really needed.

For example, when I started posting about this a fortnight or more ago because I felt people weren't taking this seriously enough I was called a scaremongerer and a lunatic and was abused for posting. Now, much of what I said then appears really mild compared to what is actually happening and going to happen over the coming week and into the future.

So, yeah it would have been better to be stricter sooner but it takes people time to get their heads around this. At least the Irish government isn't taking the callous approach of the British government. We're still putting people first as much as possible

Pseudonym121

CtevenSrowder wrote: »

How long do you think the lockdowns will be required to last?

I don't think anyone knows precisely but any lockdown will need to last long enough to significantly impact on the chain of infection. To do that you MUST exceed at least one incubation period. Anything less than that is utterly useless. So that gives us a lower bound of 14 days. The more multiples of one incubation period you lock down for and the more completely the lockdown and social isolation is observed the better.

So, 8 weeks is better than 6 which is better than 4 which is better than 2.

I assume that what the government will do, and I have no behind the scenes insight into this and if I did I wouldn't be answering this question, is lock down for 2 to 4 weeks initially ( 1 to 2 incubation periods ) and then re-assess the situation. Then they'll decide whether they need another 2 to 4 weeks at the same intensity or whether we can ease it up a gradually.

How can you help at this time? Observe social isolation, handwashing, social distancing etc. The more strictly the public observes these measures the quicker the less transmission we will have, the fewer people will get sick and die and the quicker the lockdown will be over.

It is very true that while healthcare workers can save many of those who get sick it is you, the public, who can beat this. If you all go out and stand next to eachother in queues, don't wah your hands etc etc then the healthcare system WILL be overwhelmed and we will be traumatised as a nation like we were with the famine. If you follow all the advice about social isolation, distancing and handwashing and stay in as much as possible then this will hurt but we'll get through it fairly ok.

CtevenSrowder wrote: »

Why is it presumed that warm weather will reduce the number of cases?

Well, that's because a lot of respiratory viruses have a seasonal component and people are assuming that SARS-CoV2 will also. This seems to be a reasonable assumption but we don't know if it is correct. We could be surprised.

I think most people are using the Spanish Flu model where it hit in three waves, early 1918, October to December 1918 and then again in Spring 1919 before being pretty much burnt out by the end of 1919. Is that the right model to use? Well, it seems reasonable but we don't know for sure.

sgthighway wrote: »

What is your speciality?

A reasonable question but not one I will not answer for the following reasons:
1. when I posted here initially a few weeks ago I got abuse for posting. People online can be horrendous to eachother and I don't care to expose myself and my family to that abuse online or in the real world. If my identity became known I fear that could happen.

2. The HSE can be very vindictive and were I to identify myself I don't trust them not to go after me if I survive this.

I'm being careful not to present myself as an HSE representative. I'm just a doctor answering questions using my experience and knowledge to provide the best quality answers I can at this time of national emergency. I'm trying to be responsible in my answers and be open about the fact that I don't know everything and thus can't answer every question. Plus I'm fallible and make mistakes.

With that said when a Consultant came out a few years ago to talk about the trolley crisis the HSE went after him by querying whether or not he broke patient confidentiality in doing so. he clearly didn't but they just wanted to punish him and warn the rest of us to shut up. We're pulling together now but I'm very aware that if I survive the HSE management will likely return to their previous form and seek to punish doctors who say things they dislike - even if those things are true.

If I said what specialty I work in I would hugely narrow down the field for them to search to find me. I'm already concerned enough about Boards knowing my identity and technical means being used but:
a) I think this is my ethical obligation as a doctor and my moral obligation as a human
b) I think there's about a 15-20% chance I won't be alive in 6 months to be gone after and I'd hate to die thinking I hadn't done what I felt was right and
c) If I'm lucky enough to survive and they do decide to come after me then I'll just have to emigrate to Australia or Canada and get paid a lot more money for doing the same job. There are worse fates ;-)

So, I hope people will respect me desire to remain anonymous so as to avoid reprisals.

History Queen wrote: »

Have ye received any further guidance regarding coronavirus and pregnancy? Specifically the case in the UK where the newborn tested positive for the virus, has that changed anything regarding the treatment/guidance for dealing with pregnancy?

Thanks for the question. I think that the number of pregnant women who have been confirmed to have been infected is so low that it is difficult to draw any definitive conclusions. With that said I have been directing patients and staff ( there are lots of pregnant nurses and doctors who are worried about this on a personal level ) who are concerned about this to the Royal College of Obstetricians and Gynaecologists website which has a really good page on this:

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

I think that explains it really well. I think the bottom line is that we must all assume pregnant women are more prone to infection and therefore they and their families need to be really strict about social isolation and distancing and hand washing measures.

coastwatch wrote: »

No question yet, but just to say a sincere Thank You to all HSE staff, frontline and support for the huge effort that has gone into the preparations for the spread of this virus, and for the ongoing effort that will be required to deal with it over the coming months.

Thanks. There has been a real sense of people beginning to understand the severity of this since the Taoiseach's statement last Thursday - which almost seems like weeks ago at this stage. Before Thursday some of patients and family members were complaining about delays in being seen or not being seen in person etc but today they seemed to understand that this was an emergency situation and previous norms no longer applied. Sure, not all of them but most of them ;-).

This is really helpful because over coming months a lot of assumptions about what the HSE should and shouldn't be doing are going to be thrown out the window. As a country but particularly in the HSE we're at war and we'll do our best for you but you need to understand that what you consider urgent and severe and what we consider urgent and severe is going to be very different over the next few months to a year. We're not trying to be unsympathetic but we're at war and we have a much better idea of what will keep most people alive at this instant. You'd better believe that's what we're going to focus on --- while doing our best to provide a service to everyone in the country who isn't infected with COVID-19.

For example: People will still get pregnant, get cancer, get asthma attacks, get heart attacks, develop depression, anxiety, OCD, have car crashes, fall and break bones etc. We are going to be dealing with ALL of the above PLUS COVID-19 and no-one suddenly found clones of us to flesh out the service. All we have to make up the numbers are redeployment of staff from non-essential services, retirees called back to the colours and early-graduation medical students and nursing students. With that said we will work harder than we've ever worked before (and we weren't slackers previously no matter what you might have heard or read) and will , inevitably, die in some numbers over the coming months but what we WON'T do is let you down. That simply isn't an option. We WILL be there for as many of you as possible for as long as you need us and as long as we can still stand.

I'm sorry if that comes across as wishy washy or emotional but, you know, I'm really inspired by my colleagues in the health service right now. Anyways, massive emotional outburst over for now ;-). My team would be surprised to think I wrote the above, this is another reason I can't be identified. I've got a reputation as a bit of a tough SOB to maintain and if I'm ever linked to this post my street cred with the cool kids will be totally shot ;-)

What you can do to help us is pretty simple but really powerful. You need to socially isolate, socially distance, hand wash and convince any of your friends and family who still think this is overblown that no, this is war and if they are selfish and think of themselves first and foremost they are going to condemn a lot of good people to death over the coming weeks and months.

Pseudonym121

humberklog wrote: »

Whenever my mate is asked what he does for a living he says "Doctor". He's an Ed. D (Dr. of Education) and does indeed work in this field (Adult education). Does it get your goat when you hear people claiming to be a doctor when their field is non med/psych?

LOL! That made me laugh. My dad has a PhD and always tells me he's a doctor too. I remind him that he's the useless type of doctor ;-) The greatest joy of my medical career is using the qualifications to harrass him ;-). Hey, I never said I was a good son, just his son ;-).

In all seriousness though, what your friend does for a living is work in education. And he worked really hard and needs to be commended for getting a Doctorate. That's quite an achievement and is to be respected but when one says one's a doctor I do think most people assume that means medical doctor so it does seem that he might be compensating for something --- hmm, I'm rubbish with the tech on Boards but this would, I believe, be the appropriate time to put in a winky emoji beside an eggplant emoji.

I'm happening and with it despite my age but the rest of you old foggies can have the coolest kid you know explain what I'm alluding to. ;-)

Damien360 wrote: »

Serious question. What would be your honest opinion of the current trolley watch numbers ? Why have they collapsed ? People didn't suddenly not require A&E or are the vast majority of A&E overblown ? Figures before Covid-19 over 300. Last year same time 180. This week reported as zero.
And thank you for putting yourselves in the way of harm to deal with this. It cannot be easy for your families.

Great question. When I worked A&E as part of my NCHD ( Non Consultant Hospital Doctor ) training scheme we used to get so many people presenting who didn't need to be there. It was cheaper or easier than seeing the GP. Or they were just drunk or high on drugs... I remember one guy who had been macheted 3 times by a drug dealer whose girlfriend he'd chatted up who kept physically assaulting us when we tried to help him. Eventually I gave the instructions to leave him be till he passed out from a combination of the drugs, drink and blood loss and then when he was unconscious we rushed him and were able to treat his injuries. A LOT of what presents to A&E should never have gone there and would be best dealt with by the GP etc. Every week I come across situations where someone has had an issue for 3 months or 6 months and done nothing about it but has now decided, at 2am on a Saturday morning that they need immediate review in A&E. It is ridiculous.

I think a lot of those kinds of presentations are down and I think that a lot of work has been done on the discharge/capacity side also. To be fair to the government the purse strings have been loosened and to be fair to management and the various Medical Colleges the rules and regulations which would hamper a response have also been set aside. Everyone has been freed up to focus on fighting the war instead of doing the paperwork.

As to families: Yeah, I think there's a lot of worry there alright... but we have to do what we have to do. It'll be far worse for everyone if we don't and by doing our jobs we don't just protect strangers, by doing our jobs and protecting those strangers we protect our loved ones also. I know that's in the minds of healthcare workers also. We are ALL in this together in a very real and impactful way.

Darwin wrote: »

First off, sincere thanks and respect to you and all your colleagues for working at the coal face in these unprecedented times.
My brother is to be tested for covid19 shortly, I wouldn’t expect him to be in the severe risk category. I’ve read of non acute cases that develop ‘mild’ pneumonia. Can this category of patient recover at home without intervention?

Great question. I'm sorry to hear your brother will need testing. My thoughts are with him. The good news for him is that the majority of people who test positive for COVID-19 don't seem to require hospitalisation ( up to 80% of all confirmed cases ).

Of the other 20% it seems 10% need hospitalisation but don't need ventilation/high dependency care while 10% need ventilation/high dependency care. Deaths are overwhelmingly clustered in this latter group.

Obviously these are rough figures and they'll vary from country to country but the bottom line is that:
a) lots of people will catch it and have such mild symptoms they aren't even tested.
b) of those who are tested and are confirmed 80% won't need hospital.

I hope that helps allay some of your concerns for your brother.

Boulevardier wrote: »

A friend is having a small dinner party (4 in total) at her home tomorrow night. Is this contrary to current HSE advice?
BTW I don't understand where the answers are. I will try again.

Hi, here is a link to the answer thread:
https://www.boards.ie/vbulletin/showthread.php?p=112858492#post112858492

I asked Boards to preserve the answers thread for just answers as I wanted to have it be a concentrated source of reasonable, rational information. My hope is that people could direct family members and friends to it to have their questions answered. This is one way in which I hope to do my bit for the country at this time.

No it isn't contrary to current HSE advice and four people isn't a big high risk gathering. Still these sorts of "small" gatherings still increase the risk of passing it on above and beyond staying at home and self-isolating whenever possible.

My personal view is that when this is all over you can have all the dinner parties you want but right now I wouldn't be hosting or going to them. For however long this lasts the ONLY person entering my place is going to be the Tesco Delivery driver. I won't be having face to face contact with my parents, my siblings or my friends (outside of running into them at work). This isn't medical advice, simply me outlining where I'm drawing the social isolation line. The stricter we all are the fewer people will get sick and die and the sooner we'll be over the worst of this.

ironwalk wrote: »

Much respect and gratitude to all the doctors, nurses, ambulance personnel, in-hospital cleaners, admin staff, radiographers, porters, med lab scientists, etc etc.
All putting yourselves in the firing line, mentally and physically.
The vast majority of the public understands this....but you are more likely to hear from the terrified few who will shout at you.
Have you heard from your colleagues in Italy? and did the HSE start to ramp up capacity in line with the warnings that were coming from there last week?

Thanks for the kind words. As to the question... I haven't heard personally from colleagues in Italy but I'm well aware that in Lombardy they are reporting having run out of protective gear, treating patients without protection and growing numbers of doctors and nurses and others are getting sick and beginning to die. It is pretty grim but if they stick with the lockdown in about a month's time they should really see significant improvements and their situation could become more manageable. The death toll there is going to keep rising though. last week I calculated it was likely to exceed 1,000 a day before it starts to improve. Tough, tough days ahead for them.

I have a lot of friends in the US and they are beginning to get really terrified in medical circles. I think America is going to make Italy look like a walk in the park over the next year. Their federal government response is utterly incompetent and their healthcare system isn't set up for socialised care at all and in a pandemic like this having 10% of your population without any medical insurance or the infrastructure that a socialised healthcare system has is going to doom a lot of people. I think the states etc are beginning to realise this and take some action which will mitigate things but I'm really glad I don't live in America right now.

This evening one of my friends texted me that 20% of the doctors in their hospital are currently in self-isolation after exposure and they have ramped up the number of in-patients the interns can look after. They are supposed to limit it to 12 as a maximum. They are going to have to change that rule and god bless them but those interns and their patients aren't going to have good outcomes once they become overwhelmed.

ironwalk wrote: »

and did the HSE start to ramp up capacity in line with the warnings that were coming from there last week?

Well, I won't comment on specifics as I want to hold the line of giving advice but not divulging privileged information but I think it is fair to say that after the government was briefed last Monday a lot of people throughout the public services seem to have made preparing for this their number one priority. I don't know what was in the briefing to the government although I can guess because I ran the numbers for myself about 3 weeks ago and that's when I got scared and began contacting my family to inform them of what was coming and the need to prepare.... and then later decided I needed to try to raise the alert here because it didn't seem most people understood what was about to happen.

Anyways, I don't know what was in the briefing but I think it scared them sh**less and afterwards the government realised it needed to prepare for war.... and to the credit of the state all of the arms of the state involved in responding to emergencies ( Gardai, Army, HSE, Fire Brigade etc ) do seem to have taken this to heart and began preparing to go to war.

Massive efforts are underway to free up hospital beds and create extempore hospital beds throughout the state. I expect that those measures will be announced over coming days - I had thought they might start being announced Monday but I was wrong.

Boulevardier wrote: »

Not sure what is going on here. I have been several times now on the "answers thread" and there is nothing there.

Mea culpa, Mea Maxima Culpa ;-)... I was up till 3am working last night and so went straight to bed when I got home. I woke at half eleven and then began replying here. I think my hours going forward are going to be best described as "erratic". I'll reply as and when I can and do my best to address every question but, I hope you'll all understand that when this really gets going I may have to priotise things other than an internet forum.

With that said I personally think this could be a very valuable service and so I intend to continue replying here. If and when I get COVID-19 I also intend to post here with my obs ( temperature, pulse oximeter readings ) and other observations for as long as I'm physically able to because I think that might prove valulable. Don't know how but there's a long tradition of doctors documenting their illnesses which has proven useful later so I might as well do that in between bingeing Netflix ;-) I definitely need to crack out the Babylon 5 boxset again...

begbysback wrote: »

Is vitamin D really any good as a prevention of the virus, niacin in particular.

Niacin is Vitamin B3 not Vitamin D. I am not aware of any evidence that Vitamin B or B3 in particular is useful. By FAR the most useful thing anyone can do is to socially isolate, socially distance and hand wash. All the vitamins and other medicines in the world won't be as effective as simply not getting infected in the first place. I know that is really obvious but it does bear stating again and again and again.

I've heard of people saying that Vitamin D3 ( which is what I think you may have been thinking of ) may be beneficial in preventing cytokine storms etc and that Vitamin C boosts the immune system etc but I think we need to be really clear that the BEST thing anyone can do is socially isolate, socially distance and hand wash. If you sit in a room with an infected person who coughs and splutters and then touch surfaces they have touched and don't handwash then all of the Vitamins in the world won't help you.

With that said as I've gotten older I decided a couple of years ago to start taking some Vitamins which I felt had an evidence base for general health. I take a daily multivitamin containing cod liver oil and I take daily Vitamin C. Over the past two winters I have definitely had fewer chest infections than previously. I think part of that is that I also wasn't overworking myself as much and was trying to be a little bit more conscious of my stress levels but some part was probably the vitamins so I keep buying them and taking them daily.

Do I believe that Multivitamin and Vitamin C will protect me from SARS-CoV2? Absolutely not. Social isolation, social withdrawal, gloves and handwashing will protect me. Multivitamins and Vitamin C won't protect me if I don't observe the above precautions.

To put it another way multivitamins are great but if I were to smoke 40 cigarettes a day for 30 years I'd expect to get COAD and lung cancer no matter what vitamins I took. I hope that helps. Vitamins may be helpful in general but they are not the panacea some make them out to be.

Pseudonym121

little bess wrote: »

The Uk are asking over 70’s to self isolate, would you recommend the same thing to that age group here?

Yes, absolutely. My parents are in that age group and they've been self-isolating for almost two weeks now on my advice. They told me they went out to the pharmacy for medicines and I almost lost it with them... but they'd have been upset if I said that so I bit my tongue... They should have let me go to the pharmacy instead and take that risk instead of them.

So, I would advise anyone over 70 to really strictly self-isolate and have food and medicines delivered to them. Show them how to use kindle and netflix and let them spend the time reading, doing netflix and chill and skyping with everyone in the family. I've spoken with my family on the phone more in the last two weeks than I did all last year.

little bess wrote: »

I’ve heard diabetes, hypertension, copd are all extra risk factors, should these people take more care with social distancing?
Many Thanks

Yes, absolutely. It is unclear precisely how much these increase the risk of mortality but it is clear that they increase it. Most figures I've seen say each of these factors increases the risk of mortality by roughly 5% and having more than 1 of these risk factors would likely increase your risk of mortality more then 10% ( risk factors don't cause risk to go up additively they compound ).

Gloomtastic! wrote: »

What’s the difference between a bad dose of the flu and Covid-19?

Wow!!! I'm going to rephrase this question slightly so we are comparing apples to apples. What's the difference between a bad dose of the fly and a bad dose of COVID-19... Well the difference for people over 70 is the difference between having a 1 in a thousand chance of dying and a roughly 10% chance of dying. Those are rough figures but the general gist is that if you are over 70 you are 100 times more likely to die if infected with COVID-19 than the flu.

That SHOULD terrify anyone who has a loved one in that age group and why we all need to encourage them to socially isolate, get their messages, medicines etc and practice social isolation, social distancing and hand washing ourselves.

And lastly two pictures showing fatality rate by age and risk factor in China. It isn't the most up to date but I think they make the point graphically and eloquently.

Pseudonym121

patsy_mccabe wrote: »

If someone gets the virus, get sick and get well again, at what point can they be confident that they have stopped shedding the virus?

This is actually a really interesting and important question, thanks for asking it. As with a lot of medical questions it has multiple answers depending on the level of certainty and detail of the explanation required.

E.g I can be asked the same question by seven groups of people generally speaking:
a) patients
b) non-nurses, non-doctors but working within the HSE
c) nurses
d) NCHDs
e) Consultant Colleagues not in my specialty
f) Consultant Colleagues in my specialty
g) family and non-medical friends

Each of them will require a different answer pitched at a different level because they come to the answer with different levels of knowledge, different anxieties and agendas and my role with each of them is different.

With a patient I might answer a question about risk factors for COVID-19 by saying:
"Well, here's two graphs which show you that the older you get the more at risk of dying you are and the more chronic illnesses you have the more at risk of dying you are. Now, in your specific case you are x years old and have y so that means your risk could be about z%. My advice on how best to deal with this is a, b, c etc."

With a junior doctor on my team this is a teachable moment and I would present that data, I would seek to personalise it for them ( which aids their learning and memory ) by relating it to patients they have recently seen in clinical - ideally patients I know they have formed an attachment with so that I can link an emotional response to the information and hopefully aid its remembrance I'd also talk about how this related to other illnesses they are more familiar with so as to help them contextualise this knowledge and then I'd invite questions and allow for discussion. I'd also be aware that this sort of question might be their way of asking about their own family members' risks and I would probably reference my own risk factors and estimated mortality if/when I am infected and then link that to someone in their family they'd mentioned previously and what risk factors they might have ( a pregnant sibling or spouse, parent etc). By doing this I'd hope to subtly give them permission to raise their concerns and ask what was on their mind.

I've done that with a few NCHDs in the last couple of weeks.


With Consultant colleagues the discussion might be as simple as:
"Oh you know, elderly and crocs."
With all the shared experience and argot and the ruthless training in efficient effective professional communication which is such a large part of our training we can communicate an awful lot with very little.

And yeah I do accept that doctors can be woeful when communicating with the public. ;-). I'm talking about efficient effective professional communication with eachother.


Anyways this is my way of explaining why I can't give you a nice simple answer. It seems that you can still shed the virus in faeces for quite some time even after you've gotten "better" but the real question we're interested in is not duration of viral shedding it is duration of infectivity.

You can still be shedding via faeces but this doesn't seem to have be a significant source of infecting others even though viable virus has been found in faeces.

In terms of sputum and droplets after getting "better". We don't know precisely. We are still learning. I think our current best guess is that if you're coughing you're definitely infective but once your symptoms have disappeared your risk of infecting others should be low. How low? We don't know yet.

Welcome to real world medicine. It isn't like on TV, in the real world there are lots of unknowns and maybes and "we think that"s. Plus people do really weird stuff writers would never even imagine putting in their shows.

KKV wrote: »

To re-word it, how are you managing to get time to do a Q+A on here? Has your actual working day/week changed with the virus? Or are ye folks still working the same hours, albeit arguably with more to do during those hours? Or has the trolley crisis suddenly getting solved actually meant that your working day is easier than it was before the virus became so known?

Good question. I've rambled on about it below... ;-)

KKV wrote: »

Has your actual working day/week changed with the virus? Or are ye folks still working the same hours, albeit arguably with more to do during those hours?

Same hours or more. I think we're just prepping for this to really hit and every extra day of preparation you all can buy us through social isolation, distancing and handwashing will help reduce mortality. Please buy us those days. Not for our sakes, but for yours and those you love in the risk groups.

KKV wrote: »

Or has the trolley crisis suddenly getting solved actually meant that your working day is easier than it was before the virus became so known?

Oh Jesus, I'd trade the trolley crisis for this any day of the week. Any doctor I know would be down on their knees giving thanks to go back to the bad old days of a trolley crisis without COVID-19 on our radars. Give me a thousand letters of complaint about waiting lists or how my NCHD said something in a way which made someone feel they insinuated x or y instead of this.... and I HATE those letters. I could be seeing patients cutting down waiting lists instead of writing replies to them.

What are healthcare staff doing with all of our free time these days? Girding our loins and preparing to go to war.

I'll tell you some of my preparations to give you a sense of it...
I ordered food delivers, disposable gloves, masks and various other protective supplies about two weeks ago. Enough to see me through about a month of food and 3 months of personal protection.

I got my family up to speed and got them to make the same preparations. I made sure my parents got 3 months of their medicines in so they wouldn't have to go out if/when this got bad.

I figured out what my mortality rate was and wrote a will for the first time. That was a surreal experience.

I made sure my finances are in order so that if I become ill, incapacitated and die they can be dealt with by my family.

I live alone so set up a plan of daily phone checks if/when I become infected so that should I rapidly deteriorate and become incapacitated or die an ambulance can be called to bring me to hospital or the morgue.

I don't expect there to be much point to my being brought to hospital though if things get really bad because with two underlying health conditions I wouldn't be intubated in Italy today so if it gets really bad here I wouldn't expect to be intubated. That's pity for me personally but terms the breaks. With that said I'm hoping for a good outcome here. 20% mortality means 80% chance of living so the world had better get ready for Party Consultant if I get out the other side of this ;-).

I've written letters to those I care for to open if I die.

I've packed certain things into boxes and labelled them with the names of whom I wish them to go to if I die and put them in the spare room along with written instructions.

I've packed non-essentials away so that:
a) I will have less clutter to deal with and
b) it'll make it easier to manage things for my family if I pass.


I had a think about what I would do once this was spreading in the community. I decided that I wouldn't go out except for work and food/medicines. I feel, as do my colleagues, that I/we have an obligation to the public to protect ourselves so we are available to treat them if/when they become ill. That means being a hermit for the next few months.

Then I had to decide what I would do with my time. There are a couple of shows I'd really like to finish to see how they end and Westworld Season 3 is starting so, you know, a reason to live ;-).

I then decided that with the rest of my time I'd like to be of use and try to help out. Posting to Boards.ie seemed like a pretty good way of doing that without having to go out #introversionforthewin ;-)

Professionally I've changed the entire way my team works, I've been trying to help management prepare any way I can, I've been talking to other colleagues trying to find any way I can to help them - and they've done the same for me - and I've reached out to other services and hospitals to see if there's anything I can do to support them.

Tomorrow I'll be splitting my time between dropping some stuff over to my parents, answering on boards and researching online, reading some HSE and NHS protocols, reading some relevant research and writing some proposals/procedures etc which might help another service. I'll also prepare food, clothes etc so I won't have to do anything but go to work and sleep for Wednesday to Friday.

It is all about prioritisation and time management. You don't become a Consultant without being able to ruthlessly prioritise and time manage. So, that's what I'm doing in order to prioritise the stuff I think I can be most helpful doing... and as you can see I've also thought a lot about my own mortality and the fact that I may not be here 3 or 6 months from now.

And, you know, nerding out watching Picard when it comes out... Mostly though I need to survive in order to see Season 2 of The Mandalorian #lifegoals ;-)

Pseudonym121

dharma200 wrote: »

All my Chinese students families have been wearing masks at home at all times. They take the masks off for bed. The children ( my students) do not wear masks. They have emphatically told me over and over again to wear a mask, at all times. That this is the success against the virus. I have been seeing my parents with masks on now for five weeks. At home.
I am wondering why the advice here is not to wear masks. is it that it is a false sense of security?
My chinese families do not understand why everyone here in the west is not being told to wear a mask.
Thanks,

Great question. To be honest I think masks for the public are worse than useless for one simple reason: People don't know how to put the masks on properly, fit them properly and take them off properly and therefore they are useless for most people.

Also, it is FAR safer to stay at home socially isolated than be out and about wearing a mask so I think the government has hit on one simple message and are focusing on that - socially isolate/distance and handwash. I think they are probably right to do so.

Almost every picture I've seen online of people wearing masks shows them not being worn properly and being useless.


Even with this simple message they are having to fight idiots who just make up lies and rumours which will kill people. If they went for more nuanced messaging it would be difficult to get a consistent message through to people.


With that said it is different for healthcare workers and people who know how to use the masks and MUST be out and about. E.g. I plan to wear masks on my way into work and home starting Wednesday. But I know how to put them on, fit them and take them off so they'll be effective for me, hopefully.


In the picture below from the BBC this mask isn't being worn properly and thus provides almost no protection. All this woman is doing is preventing a healthcare worker from using this mask properly and being protected at work.

Pseudonym121

PaybackPayroll wrote: »

1. Do a proportion of people who recover have permanent lung damage?

1. Well, interstitial lung disease often results in long-term chronic lung issues with decreased long-term survival. We don't know what the long-term effects of COVID-19 infection will be but it is a reasonable assumption that a portion of those who have severe or moderate illness and survive will have long-term sequelae which will both limit their ability to function as freely as they'd wish and their long-term survival.

2. SARS-CoV2 hasn't been around long enough to say this for certain but I suspect we'll have to see a significant investment in respiratory clinics etc going forward.

PaybackPayroll wrote: »

2. Is the Irish strategy to get 60% of people infected and recovered, but at a steady rate so a not to overwhelm the HSE, or is there some other strategy?

No, absolutely not. The Irish strategy is to save as many lives as possible no matter what the cost. This is war and while this means people will die and Consultants are going to have to make horrifying decisions which will stain their souls and minds forever we are NOT going to write anyone off at this stage.

WE want to save EVERYONE we can so do your part and help us, socially isolate yourselves, socially distance and handwash. That's what you can do to save lives so please for the love of all that's holy do that and correct any muppet you see not doing it.

PaybackPayroll wrote: »

3. Roughly, how long does each phase of the illness last?

I'm not sure I understand what you mean by this. Could you clarify please, sorry if I'm being dense.

PaybackPayroll wrote: »

4. What is the current ICU capacity, and is this being massively ramped up?

Well, as a matter of public record we have about 250 ventilators in ICUs/high dependency beds. We also have additional ventilators as spares for when one goes down, ventilators in Operating Rooms etc. They are ALL being repurposed to front-line use.

Operating rooms (ORs) will become extempore isolation rooms - they're pretty good for this purpose actually but it will mean routine operations being cancelled. That's just a price we'll have to bear.

Private hospitals have more ventilators, probably mostly in their ORs and they'll all be requisitioned going forward. If you assume that someone who is amongst the 10% with COVID-19 who is most severely ill will need ventilation for 2 weeks to recover sufficiently to move onto supplementary oxygen every ventilator we find could save 24 lives over the next year.

So, holding a ventilator back will be tantamount to mass murder. We'll still need a few for emergency surgery etc obviously but every one not reserved for that purpose will need to be used to ventilate COVID-19 patients.

To give you a sense of what I mean by decisions staining souls lets do some mental maths here.

You're a surgeon in a hospital and you have to figure out how many ORs you can convert to COVID-19 patients. Lets say you have 8 ORs. If you convert 7 you can maybe save 168 ventilated patients a year... but if you have more than 1 emergency needing surgery at a time during that year the 2nd emergency might die before you can operate on them.

So you only convert 6 rooms... At the end of the year you find you only needed that 2nd OR 12 times... Sure, you saved those 12 lives at the cost of 24 others.

You did your maths in good faith but because you miscalculated more people died than needed to. You know this but tomorrow you have to go in and do it all again because your patients need you and if you break even more will die.

This sort of thing is what my Consultant colleagues are looking at right now. If we guess wrong now more will die than need to and we will carry that with us, always.

That's why I think we're going to have a lot of doctors quit medicine, develop addictions or commit suicide after this is over. I'm sure this will happen to other healthcare professionals also but when push comes to shove the Consultants and the NCHDs are the ones making these calls and the group I'm most familiar with obviously. Fortunately Consultants are tough... I think it is going to hit the junior doctors really hard. I'm worried about them, and the younger nurses too.

Anyways this is why I think we'll need to provide ring-fenced mental health care for healthcare workers after this. I think we owe it to them, especially the younger ones who haven't had time to develop the defences us old foggies have ;-).

PaybackPayroll wrote: »

Thank you for taking the time to do this AMA, and also for all of your efforts in tackling this horror.

Thanks. Others are doing far more but I hope this thread increases my contribution a bit. I wish I could do more.

Pseudonym121

And that's me done for the evening/morning. I wanted to answer the first two pages. I'm going to bed now, catch you all later today. I hope you found some useful information here and you got an insight into how Consultants' minds work. We're... different.

Pseudonym121

Day Lewin wrote: »

Is this rumour true, that anti-inflammatories like aspirin and Nurofen make you more prone to the virus?

No, at this stage I've got Ibuprofen and Paracetamol and intend to use both if and when the time comes.

Official HSE advice and information about this issue can be found here:
https://www.hse.ie/eng/services/news/media/pressrel/advice-about-anti-inflammatory-medication-and-covid-19.html

The French Health Minister did come out with a statement advising differently but they appear to be in a minority of one in terms of countries and I expect that they'll change tack once more information comes in.

With that said asthmatics and others who may have issues with NSAIDs ( non-steroidal anti-inflammatories ) should exercise caution and follow their GP's or Consultant's advice regarding any medication to be taken if they are diagnosed with COVID-19.

celt262 wrote: »

Just seen this pic online. Does it frustrate you that people are making up stuff and posting on social media?

Frustration isn't the word. This is willful sabotage of health on a national and global scale. Because people are scared they will panic and believe this sort of thing and it will lead to additional deaths.

When this is over I would be in favour of anyone who originates these sorts of things being charged with whatever the civilian equivalent of war crimes is.

Scot_in_Dublin wrote: »

Not a question, just a very sincere thank you to you and all of your colleagues globally who are working around the clock to keep the rest of us going.

Thanks. I'm trying to do my small part. Others are risking far more and doing far more in many places around the world.... the healthcare staff in Italy in particular are going through hell right now.

YFlyer wrote: »

Can you explain the 15 minute in contact time?

I think they had to come up with guidance early on in this. I think that at the time it was based on best evidence and useful because some people seem to assume that if you walk past someone with the virus then you're immediately infected. That isn't true.

With that said I don't think that sitting within 1 metre of someone who has COVID-19 for 10 minutes is somehow perfectly safe. Medicine and advice to the public needs to have certain cut-offs to make it easily understandable and you only have to look at the behaviour of some in our society to see that even very simple messages don't get through to some people.

So they went with the 15 minute advice which is a reasonable guide BUT I have always advised that social isolation or extreme distancing ( teleconference whenever possible, staying more than 2 metres others ) is far preferable.

Also a 2 metre distance won't do you any good if you don't handwash/wear gloves and touch something that has COVID-19 droplets on it and then touch your face.

Ladybird18 wrote: »

My child who is asthmatic is complaining with sore throat and nausea tonight.
Should I be worried?

That's an impossible question based on many factors including your baseline anxiety levels. What I can say is that children get sore throats and nausea from time to time. Nausea isn't a major symptom of COVID-19 and it is FAR more likely your child just has something other than COVID-19... remember all the other stuff that happens this time of year is still circulating in the community also.

In addition the death rate among under 18s is extraordinarily low. They can catch it and transmit it but they tend not to become too unwell themselves.

I'm linking a graphic I have recommended to a number of people when asked similar --- I have x is it COVID-19? type questions.

Pseudonym121

Fann Linn wrote: »

What happens after you've self isolated for the 14 days after testing positive?
Have you built up an immuninty?
Could you catch it again?

And a big well done to all in emergency services and the HSE.

Well, if you test positive it isn't about waiting 14 days and then going out and about again. It is about waiting until you are symptom free, fully recovered + a few days. You will be advised about this by your GP or Consultant/treating medical team. That may be 14 days, it may be significantly longer.

Illnesses and human bodies don't run to schedules, when we have a lot of experience with them we can talk about the range within which most people fall but it is still early days with this virus and we are learning more about it all the time.

Fann Linn wrote: »

Have you built up an immuninty? Could you catch it again?

You'll have built up an immunity to the strain of COVID-19 you caught. There is some evidence there might be another strain out there already although that isn't confirmed yet. The two strains are tentatively labelled L and R

What we do know is that RNA - which is what this virus is made from - has a really poor error checker and so mutations are very common. When enough mutations happen a new strain can develop which is sufficiently different from previous strains that having been infected by other strains doesn't confer immunity.

This is what happens with the flu and cold etc so that catching it once doesn't make you immune to other strains the next year, or even the same year.

Most doctors expect that SARS-CoV2 will mutate sufficiently to create new strains eventually, if it hasn't already, and thus become seasonal. When will this happen? No-one knows for sure.

I'll link to a really nice website which helps people visualise the phylogenetics of this. If you press the play button on the image on the right you can see the genetic drift as we've tracked it over time.

https://nextstrain.org/ncov

Pseudonym121

LuckyLloyd wrote: »

Best of luck over the coming days, weeks and months.

Are the HSE trying experimental treatments ala South Korea and China? I'm referencing chloroquine here and some of the old HIV drugs that have been mentioned.

Irish doctors will try everything they think will work. We've already got data from China and Italy and the US about some treatments which might work - retrovirals and monoclonal antibodies and suchlike. Doctors in every country are throwing everything at this and when we find things which definitely work their production will be ramped up like you can't even believe right now... any company which tries to make a signficiant profit out of any drug which will work will find itself destroyed by governments worldwide so I think that once we prove one or several treatments work they'll be produced worldwide in huge numbers. That will, however, take time. You've got to build the factory or repurpose the pharma site to produce this drug and that doesn't happen quickly or cheaply.

So, again, socially distance, socially isolate, handwash and do all of the things we need you to do to buy us time. We need everything but what we need more than anything is for the rate of infection to slow, lowering the peak, and time to build and buy ventilators, to convert hotels, barracks etc to hospitals and to produce more medical equipment ( in Italy they ran out of valves for their respirators and people are 3D printing them at home and rushing them to hospitals). People in Italy have died because the 50,000 Euro ventilator didn't have a 1 Euro part.

This leads me to another point...
Could people in the know here point me in the direction of ( or point others in the direction of me ) groups of individuals with 3D printers? Enthusiast groups and suchlike.

I think it might be a useful to gather a list of people with 3D printers and design ability who would be willing to help out by printing parts which could be used when/if current stocks run out in the hospitals. PM me with info please. The government may already be doing this behind the scenes but I haven't heard a peep and so I thought it might be good to put a call out here.

Hopefully we won't need this capacity but it is best to plan ahead now and then, if it is needed a month from now, it could be ready to go instead of only trying to organise it then. This is a time for lateral thinking --- and government departments tend not to be good at that sort of thing.

Andrew H wrote: »

I work in the public service as a Clerical Officer and there are rumours that we will be sent home on Friday. Is there any way I can volunteer to help out?

I don't know the official answer to that but I would suggest just letting your line manager know that if sent home you'd like to help out anyway you can. I think that, in the future, there will be lots of opportunities to help out with contact tracing or grocery deliveries to the elderly etc ( that mightn't seem like a big deal but it will free Gardai and Army personnel for more essential tasks and every bit helps).

Drumpot wrote: »

Can I ask if it’s true that “mile symptoms” can actually be like a nasty pneumonia, so while it’s medically mild it could really knock people back?

Yes, something we keep from you most of the time is that when you think you're severely ill we think, "Jesus, you haven't seen severely ill yet mate." We obviously don't say that because it wouldn't go down well and if you're feeling unwell it is severe for you and we get that.

Here's a rough guide i published previously... What most of you call severe illness is, at best, moderate to a doctor. Often it is mild. When doctors are talking about COVID-19 cases as mild, moderate and severe here’s what they really mean:

1. Mild: Doesn’t need hospitalisation. You may feel really sick, you may need home nebulisers, you may be on antibiotics. Doesn’t matter, if you don’t need hospital then you’re mild. Generally when people say they’re severely ill at home we don’t contradict them (since they certainly feel very ill) but in our minds you’re all mildly ill with varying levels of whining ;-). Doctors and nurses’ families will tell you how little sympathy they get from us when they tell us they’re sick. We’re the epitome of “If you aren’t hospitalised then you’re fine” even in general life most of the time ;-).

2. Moderate: One of the 10% who are hospitalised but don’t need ventilators. Some of those might still die but most will be just fine – albeit the interstitial lung disease may cause them problems in the medium to long term.

3. Severe: One of the 10% who need ventilation.

So, being "mildly" ill with COVID-19 could still really sick and take a month to recover from... but this is battlefield triage, you'll live without hospital therefore you're mild to our eyes right now. When we're out of this emergency you will have the luxury of calling that mild illness "severe" and we'll go along with you again.

Drumpot wrote: »

At what stage should a person contact the emergency services for help? What fever in adult and if they find it hard to breath?

I'd definitely call a doctor if I was having significant shortness of breath unexplained by any other underlying illness.

Drumpot wrote: »

Would keeping track of BP and Oxegen levels help emergency services decide whether you need hospitalisation? (Oximeter readings)

Yes, my parents have a blood pressure monitor and thermometer and I made sure they bought a pulse oximeter in the run-up to this. I have instructed them that if they think they might be unwell to take their blood pressure and oxygen saturation every morning and record the results on a different sheet of paper each along with the date.

That way they'll be able to tell me and/or their GP their routine obs over the phone and it'll help establish that they're not just anxious as well as creating a timeline of any deterioration in their health.

I have the same and will post my temperature, oxygen saturation and BP if/when I get COVID-19.

Drumpot wrote: »

Asides from being tested will a lot of people with “mild symptoms” possibly not ever know that they had the disease unless for some reason they are tested? Is it possible in the future to be tested to see if you had it or have antibodies?

messinkiapina wrote: »

For individuals who experience mild symptoms to the point they may not even know they've contracted it (and presumably develop immunity afterwards), will testing be available to them at some stage? And would those tests show that the virus had been present but overcome?

It would be ideal if everyone who's had this knew about it, they could stop social distancing and help the vulnerable and those in need of care?

Yes, that should be possible but will be a luxury we only have once we've largely beaten this, have enough test kits to test new suspected cases + a surplus and are trying to return to normal.

I can see the value in being able to re-assure people that if they go out and about they are likely to be immune to the circulating strain.

sadie1502 wrote: »

Drugs to treat malaria and arthritis have been showing positive signs in treatment. Will these be available in Ireland if required?
Thank you for your help in uncharted territories. Keep safe.

Well any medicine which shows promise will have some availability in Ireland. E.g. some anti-HIV drugs have shown promise. We have about 5,000 individuals living with HIV in Ireland so we have supplies commensurate with treating those 5,000 individuals. Let's imagine an anti-HIV drug was proven to cure COVID-19 100% of the time... but we have 200,000 infected per month with 20,000 needing hospitalisation and thus being ill enough to need the drug.

You now have 25,000 people who need that drug per month. Even with unlimited money the companies which make that drug didn't build 400% additional capacity a year ago just sitting there wasted so while they can increase production there is no way they can increase it to 25,000 in a matter of weeks.

So, doctors have to make choices, hard, hard choices of who will live and who will die. I refer you back to my previous post about stained souls and minds and the mental health fallout.

Of course the more you socially isolate, distance and handwash the lower the peak in infections. If it is 50,000 instead of 200,000 and we have 5,000 who need hospitalisation a month then we can probably figure out a way to stretch supplies to those 10,000 people and save a lot of lives. That is where you, the public, come in.


And that takes me to the bottom of page 3. I'm going out to run supplies to the parental units. I'll do the 4th page on my return.

Pseudonym121

Cork Boy 53 wrote: »

I am just curious as to whether you think a time may come when a virus or some type of infectious disease will appear that will have the potential to effectively wipe out all of humanity. I`m talking 12 Monkeys style here. Hopefully this one won`t be it! Anyway my thoughts and prayers are with you and your colleagues for the ordeal that lays ahead of you.

Wow!!! and my posts are accused of increasing anxiety ;-). I think that over the past two decades we've had Swine Flu, SARS, MERS and now SARS-CoV2. That's pretty much one pandemic or potential pandemic every 5 years.

Unless we change our relationship to the planet I see no reason that that pattern won't continue but if we continue to fund vaccine research and pandemic prevention planning beyond the current crisis I think we won't be wiped out by one.

With that said on a philosophical level I agree with Elon Musk that so long as humanity exists only on one planet that planet represents a critical vulnerability for the human race and so the sooner we get self-sufficient colonies on other planets the better. But that's more a philosophical point than the death knell of humanity in the next few months. Even the absolute worst case scenario for SARS-CoV2 won't wipe us out or reduce human civilisation to Mad Max levels .

Funnyonion79 wrote: »

My question is this...in two weeks time, after self isolating at home with my husband and children, is it safe for us to visit my parents/in-laws, who have also been self isolating at home, during this time? The only time any of us would've left the house is to go for a walk or go to the supermarket. The in-laws are mid 70s but in good health.

Well, I am not trying to dodge the answer here but I don't think there's a simple yes or no answer to that. Certainly after two weeks of self-isolation your risk of being infected without symptoms is low but it isn't zero. And going to the supermarket definitely creates a risk of infection.

My position with my family is that I'm dropping things at their door and picking things up from their door while the door remains closed. We wave at eachother through the window and talk on the phone or via skype. I think that's the safest way to proceed.

You can certainly go and visit them but that introduces a bit more risk and only you can balance that risk/benefit ratio for you and your family. Either way I wish you the best.

JustAThought wrote: »

Still wondering where the answers are, please - is there a link?

Q: While front line staff paid are being allowed home on paid sick leave inc to mind their children off school unpaid inexperienced volunteers are being emailed from the HSE asking them to go into hospitals to help with the virus. Something fundamentally wrong with this. Surely the time for paid HSE staff to pull their weight is when there is a crisis and they are needed and not be asking or relying on emailing randomers from a charity database to pick up their slack.

My family member called in sick on full HSE pay to mind her children - surely this type of abuse should be stopped.

I'm not an HR professional so cannot address this but I do know we've all received memos stating that the HSE is recording who steps up and who doesn't at this time. You don't have to be a genius to figure out what that means for people who are adjudged not to have made themselves available when they could have. With that said individual circumstances are often highly personal and I'd be slow to rush to judgement. There may be stuff going on you aren't aware of ( undisclosed medical conditions etc ).

So, my general policy at this time has to try to be kind and thoughtful and not jump to the assumption that people are shirking... but I'm sure those cases will be looked into afterward.


@Purgative,
Thanks. I'm glad to hear you found my answers of some value and hope those you shared them with find them helpful also.

irishgeo wrote: »

How long is the recovery period?

I think that depends very much on the severity.
1. It seems that most "mild" cases ( meaning not requiring hospitalisation ) should be fine within less than a fortnight... and may just need to self-isolate up to 14 days to make sure they're not shedding the virus even though recovered.

2. I've seen figures from China and Italy which say the 10% who require hospitalisation but not ventilation can take somewhere from a week to a month to be fit for discharge. The median reported by Wang was about ten days.

3. I've heard figures of about a month being quoted as the average for patients with severe illness requiring ventilation but I think that figure will change as we get more data from more recovered patients.

Seamai wrote: »

What is the protocol if a work colleague tests positive? Is the work place contacted? and if so by who? What happens after that?

I think that advice has changed a few times based on exingent factors and developing medical understanding over recent weeks so I'll answer with two general points:

1. The affected individual will be contact traced by the HSE as per their protocols.

2. If you haven't been contacted but are concerned you can phone your GP who can assess you and determine whether you meet testing criteria. Follow their advice as it will be individualised to you and thus be higher quality than any general advice you can get on the internet.

JoChervil wrote: »

It was a disease running around late December/early January. In reports from that time it was said that there was a 25% increase in hospital admissions of patients over 75.

So my question is: how HSE ruled out that it was not Covid-19? How many tests were made to prove it was something else like a different kind of flu (I mean percentage of cases checked for it)?

Not in Ireland it wasn't. The phylogenetics of SARS-CoV2 show it wasn't in Ireland at that time. This is an unhelpful assumption/internet rumour not supported by facts.

I'm sure the seasonal flu was around and quite a few people got sick and died from it, as they do every year. But it wasn't SARS-CoV2. Check out the link I've provided above to look at the genomic epidemiology yourself. The phylogenetics speak for themselves.

I hope you find this answer helpful and can put this unhelpful internet rumour to bed.

piplip87 wrote: »

Hi there,

Have you seen any day services cancelled ? My OH has MS and is on a monthly infusion. As far as I understand there is a massive increase in the risk of an attack if left for more than 5 weeks between treatments.

Have you seen or heard if any alternative arrangements for these treatments ?

I think that, whenever possible, essential services will continue to be provided. With that said if we have 20,000 cases a month the number of normal services we can decide are essential will be a LOT more than if we have 100,000 cases a month.

So, again, it comes down to social isolation, social distancing and handwashing. The best thing any member of the public who is worried about a relative with treatment which may be cancelled is work to reduce the spread. That gives the greatest chance that we will have the staff and space to continue these sorts of services.

Kerry25x wrote: »

How do you feel about the speculation happening that health care workers are at much higher risk of developing severe/critical illness if they come infected? Have you any advice for other front line hospital staff?

I am not familiar with this speculation. Healthcare workers on the front lines, doctors, nurses, cleaning staff etc get infected at higher rates than the rest of the population but I'm unaware of any increased mortality rate ( as opposed to absolute mortality ).

laserlad2010 wrote: »

If you're not a public health specialist you have no business providing official COVID-19 advice, even cloaked as personal advice, to the public. It's bad enough with the Whatsapp rumours, but talking about writing your own will at the same time as attempting to give advice in your capacity as a consultant is inapproriate. Regardless of whether it turns into a "war".
Even if you claim you're not representing the HSE people will still place weight on your words.

I've been explicitly clear that I'm posting in my personal capacity informed by my training and experience. It isn't my problem if you cannot read and say I'm "providing official COVID-19 advice".

As to the will. It is what I've done. It is a sensible precaution.

Balf wrote: »

Maybe we should ask him if threats like Covid 19 show the impracticality of organising access to medical knowledge through a tiny bunch of highly paid consultants. I think he'll know what we mean.

I actually don't know what you're getting at. I'm assuming it is some sort of class warfare dig at Consultants which makes the mistake of thinking that being able to google a thing and UNDERSTANDING IT enough to be able to make really difficult decisions are the same thing. They aren't but, you know, you do you.

What I will say is the two of you amply demonstrate:
a) that some people still don't understand what we're facing and
b) why I want to remain anonymous. You're the sort of people I don't want to run into in the real world.

With that said I wish you and yours the best of health into the future.

Agus wrote: »

Thanks for taking the time to do this, I think it really helps to have good information out there as much as possible.

1. How soon do you think the number of infected people in Ireland who need treatment will reach a level where the health service is finding it hard to treat them all?

This is a really great question actually. It gets at the heart of a lot of confusion out there about models and probabilities - and humans are really bad at understanding probability.

What doctors and the state have are models which show what estimated numbers of infected will be based on various levels of social isolation, distancing and handwashing as well as curbs on flights, pubs etc.

In simple terms the outcomes of those models range from - "Oh that wouldn't be too bad" to "Oh S**t!!!". The more the public socially isolates whenever possible, socially distances whenever going outside is essential and hand washes the closer we'll get to the "Oh that wouldn't be too bad" level of outcome.

I've heard reporting on the radio that the government is estimating there could be 10,000 to 15,000 cases by the end of the month, two weeks from now. If we assume 10% may need ventilation that would be a requirement for 1,000 to 1,500 ventilators. We have about 250 although as explained previously we can repurpose more. That's pretty grim.

And, yeah, you guessed it the best thing you all can do is socially isolate, socially distance and handwash.

Agus wrote: »

2. I've seen reports that asthma may be a risk factor because Covid might exacerbate the asthma, but the actual Covid illness itself isn't necessarily more severe. In other words, the claim is that the main extra risk to people with asthma is that they will end up with both Covid illness & a severe exacerbation of the asthma, and therefore the additional risk for people with mild asthma is probably not much greater than people without asthma. Is this likely to be accurate or not?

I think that gets into an unnecessary level of detail of disease action which we just don't know yet. It appears that anyone with a chronic respiratory illness is at increased risk of mortality. It certainly seems reasonable to assume that someone with COAD is going to be at more risk than someone with mild asthma well-controlled with inhalers but I simply don't know that for certain at this stage and certainly don't know any figures I could quote which I'd consider reliable and solid.

I can provide you two links which could be useful:
1. UK Asthma Organisation advice page. This seems solid to me.

2. Irish Asthma Society's page. The UK one seems better to me honestly but I provide this for the Irish perspective.

In this situation the best thing to do is read those organisations' websites and if you have further questions/symptoms seek advice from your GP or treating Respiratory team.

Pseudonym121

Sour Lemonz wrote: »

My eldest nephew (age 11) has cystic fibrosis, my sister does all his IV's at home, he is on orkambi, lung capacity up and all good stuff at the moment. However with the virus going around there is obviously a concern for him as lung functionality could become an issue. He is very good at washing hands and looking after himself like meds for his age, but there are going to be times where he cant control a situation and may pick this virus up.

Some advice that was given to me today (cant confirm person is a health professional) was that if my nephew showed symptoms then get him to a sauna 2-4 times a week for 30 mins at a time that and the heat and steam of the sauna would kill the virus as it lodges in eyeducts, nasal cavity. Is there any truth to this ?

I would be astounded if any health professional gave that "advice". That sounds like extraordinarily dangerous and unhelpful advice.

If your nephew started showing symptoms you should contact your GP and his specialist treating team as a matter of urgency. There doesn't seem to be much definite information about individuals with Cystic Fibrosis being infected with Coronavirus as it is relatively rare worldwide. I wouldn't assume that means it'll be a mild illness if they're infected. I'd socially isolate strictly out of an excess of caution. Better to be too strict with self-isolation and then relax it than to be lax now and regret it down the line IMO.

Here's information from Cystic Fibrosis UK
Uk Cystic Fibrosis Trust Q&A page

Cystic Fibrosis Ireland hasn't updated their info in the last 5 days and I believe events have moved on significantly since then. Here's a link to the latest advice from them.

If you are unsure what to do you should contact your GP or treating specialist and receive individualised advice for your nephew. I can't give individualised advice for your nephew. I just know what I've said to patients of mine with CF or those with relatives with CF.

Beasty

A reminder - this thread is for the AMA answers only. Questions should only be posted in this thread

Pseudonym121

To those who have contacted me re: 3D printing links...Thanks, I'll pass it up the chain just in case they aren't pursuing that line yet.

I have an image I edited on my computer I want to upload. Does anyone know how I can upload it to boards or somewhere else so I can link it here in this answer?

tatranska wrote: »

I watching a UK parliament committee asking about the lack of appropriate PPE for medical staff on the front line of the NHS.
How are medical staff fixed for safety equipment in treating patients.

Well, I don't think any health service has enough PPE for their staff given what is coming. We are awaiting deliveries of new supplies and I'm sure production is ramping up massively worldwide and China will be able to provide masses of PPE once they have their outbreak under better control.

It is a worry but not treating people isn't an acceptable option. In Italy when they ran out of masks etc they just worked and got sick. Then they kept working until they got too sick to work and became patients themselves.

I'd expect no less will happen here. But the more time the public buys with social distancing, isolation and hand washing the more likely we are to avoid such a scenario.

Fishorsealant wrote: »

What do you think of the situation regarding dentists?
One of the professions most at risk yet very little guidance available. One of the last professions to be considered despite providing an essential role and being at high risk.
Many dentists taking it on their own to decide whether to open or close.
Do you think forced closure except for emergency treatment would be wise?

It seems to me that dentistry is a pretty close proximity job. If I were a dentist I wouldn't risk it. I think it would be helpful for them to receive official guidance but it seems many of them are doing their own risk assessment and deciding to close already without official advice. Obviously though I can't tell dentists what to do. I just know I wouldn't take the risk were I a dentist.

I'm sure some public dentistry will remain open for real emergencies for the duration.

Away With The Fairies wrote: »

Keep hearing that the majority of people will get through this fine at home?

Do we ring doctor on day 1 just to make them aware that you're not feeling the best?

I think that would be reasonable so they can arrange for testing and confirm whether this is COVID-19 or just some more common garden bug. As we have more testing kits available we will be able to test more widely.


@JoChervil
The phylogenetics of the Irish cases doesn't appear to support what you suggest... but people believe what they want to believe. I'll try to add a picture illustrating that one of the cases can clearly be traced to a nexus from the Netherlands in late February.

That's what makes this type of analysis so powerful, you can see how closely related viruses in individual people are and build up a picture of where they came from and how long they circulated.

If it had been here since 2019 we'd see the phylogenetics of Irish cases being far less closely related to other European cases from 2020 than we currently see.

The science of European cases simply doesn't support your assertion and it is clear that Irish cases are related to these recent European cases. It is your choice whether or not to disregard the scientific evidence though.

Either way I wish you and yours the best of luck at this time.

locohobo wrote: »

No questions..Just to say well done to you and you're fellow front line staff....
From the description you gave of you're own self imposed current isolated lifestyle it should be enough to make people aware as to just how serious this threat is..
Myself:- Legionnaires disease 10/'19...COPD..Smoker...SO I realise the limitations of my survival through this and have already come to terms with it..will not be expecting to tie up an incubator....

Well, let's both try to be extra safe then and wish eachother a Happy Paddy's day this day next year eh?

Multipass wrote: »

Thank you so much, it’s great to have so much information in one place. I’m just wondering, as A & Es become overwhelmed with this - will there be seperate areas for people coming in with other problems. Thinking of elderly parents having middle of the night heart symptoms or similar. Would letting people wait in cars be an option?

This is what they've done in Italy and China with A&Es and their hospitals. They've segregated COVID-19 and non-Covid-19 patients as much as possible to keep the non-COVID-19 patients from becoming infected. Similar segregation will happen here. How it will be organised will change depending on local factors obviously.

AndrewJRenko wrote: »

Thanks for your inputs, very helpful, and thanks for your ongoing work.

What's your understanding of the risk of outdoor activities, particularly for teenagers? Is there risk arising from a brisk walk, or a chat at a picnic table outdoors? Mental health is a real concern, and they do need to have some contacts outside the family circle.

I think you'll have to decide how you want to balance that risk vs benefit individually. Obviously then going out at all is more risky than them staying inside and just skyping their friends.

I think a walk outside is pretty low risk all things considered so long as you aren't in a group or stopping to chat to others but a chat at a picnic table or anything else which resulted in close contact isn't something I would see as a good idea.

They may not like it but just give them unlimited screen time and the right to skype their friends as much as they wish

Pseudonym121

Quick answer to something and then some links...

1. I think the best preventive measure is total social isolation but recognise that isn't possible for most. So, going for walks is a calculated risk.

Ideally if you're going for a walk it should be alone or only accompanied by whoever you are in social isolation with ( partner, children etc ), you should avoid other groups of people and do your best not to touch anything with your bare hands - e.g. door handles to apartment buildings, lift buttons, gates etc -- which others who might be infected might have touched.

Those steps should reduce the risk significantly. So, in summary, going for a walk when lots of people are around and having chats with them while touching door handles, lift buttons, gates, then popping in to the local shop to pick up a coffee all increase the risks.

Going out for a walk with your partner and/or kids when/where there aren't large groups out walking, having a walk, taking care not to touch things with your bare hands others may have touched and not stopping for chats - even if you stand 1 metre apart - all contribute to a walk being a low risk.

I happen to have a treadmill at home and so I've made the decision to only use that from now on but I recognise that isn't an option for most people.


In other news I've been contacted about Remdesivir and other potentially effective treatments and I think it would be worthwhile to curate a post with links to scientific journals about possible treatments. I am NOT endorsing any treatment or anything like that, just hoping to:
a) provide a little hope
b) provide links to actual research articles as opposed to whatsapp rumours and
c) provide a short summary ( a couple of paragraphs which are simplified and should be easily understood ) so as to "translate" from "medical" to English ;-)

Let me know if you think this linking to research is useful or not. If not I'll find better ways to spend my time.

1. New England Journal Of Medicine Case Report of US Male with COVID-19 successfully treated with Remdesivir.

Basically a patient who was in Wuhan and then returned to America tested positive for COVID-19 and was then admitted to hospital. They received supportive care (paracetamol, ibuprofen, saline) for the first 5 days of hospitalisation. On Day 5 their Oxygen Saturation fell below 90% ( anything below 92% is significant in a previously healthy person ) and they were started on supplementary oxygen ( the nasal prongs or oxygen mask you'll often have seen people on in hospital ) and antibiotics for query hospital acquired pneumonia.

On Day 6 their chest X-rays were showing worsening lung involvement and the doctors applied for "compassionate use" of a the drug Remdesivir ( a known antiviral which had been trialled in the treatment of Ebola in 2019 but didn't do well ) and started it on Day 7.

By Day 8 the patient was improving.

Conclusion: Remdesivir may have utility. More evidence needed. A single case study so hardly proof positive of a treatment for all. Still, a damn sight better than giving it to someone and them not recovering. We WILL find existing medications and/or new medications which work to kill the virus and then survival rates will improve markedly. It is just a matter of time. Buy us that time with social distancing, social isolation and handwashing.

Pseudonym121

mrsherself wrote: »

Hi!
I was just wondering - I know best advice is to stay inside, but for those of us who will end up going mad, is there anything wrong with going for a walk outside by yourself?
Is it not a good idea to go to a park where there will be other people?

Well, exercise is good but the trick will be not exposing yourself to risk by being around others so if I were going out for a walk I'd take care not to run into others, stop for chats or touch things others might have touched. Those are the real danger points.

malpas wrote: »

My wife and I are in our late 60's. She has well controlled bronchiectasis for c.5 years and I was hospitalised and successfully treated for septicaemia around then also. No major issues, both in good health and walk daily. Would either condition mean a greater risk of complications if we got infected?

We are taking all recommended precautions and don't expect a medical opinion, just any general views you feel you can offer.

Yes, I don't want to get into giving the impression that I'm giving individualised medical advice as that isn't really appropriate over the internet. The best bet is ALWAYS to phone your GP or treating specialist and ask them about your individual case. With that said while septicaemia is generally once and done I believe the vast majority of doctors would classify bronchiectasis as a chronic respiratory condition. We know chronic health conditions increase the mortality of those infected with COVID-19 so I think it would be very sensible for you and your wife to be exceedingly careful and very strict in your social isolation.

I hope that helps give you actionable information.

Sober Crappy Chemis wrote: »

Realistically, is it a big risk to go to a supermarket or pharmacy obeying physical distance etc, if one has asthma and is also immunosuppressed?

Well I think immunosuppression clearly puts you in a high risk category and supermarkets and pharmacies are places people congregate. I wouldn't be taking any avoidable risks if I were in a high risk category. I have two underlying conditions which increase my risk of mortality and if I weren't in the health service I would simply be staying at home, having my groceries delivered by Tesco/Supervalu/Lidl/local shops and would be asking the pharmacy or a younger relative to pick up my prescription and drop it at my door.

I don't have that choice and so am out and about because I have to go to work, fill the car etc but I only do those things because they are unavoidable and I'm very conscious that being out and about significantly increases the risk of me catching SARS-CoV2. For those who aren't in essential jobs I just don't see the point in taking those kinds of risks.

Obviously we're all adults here and have to balance the risks vs benefits for ourselves and you might decide that balance lies in a different place than I do.

Damien360 wrote: »

This question and answer thread(s) has taken me completely away from the main rumour and conjecture thread. It has done wonders for my well being with regards to worry. Yes I know it’s coming and unavoidable but the main thread lacks the sanity in these.

Thanks, I'm glad it has been helpful to you in that way. Later in the week I'll get to posting some maintaining your mental health advice gleaned from colleagues etc as I think that's an important aspect for people also.

Olaz wrote: »

Thank you for your informative and reassuring answers so far.

What is your opinion of small children (aged 5-9ish) playing together in small groups on driveways/on the road while doing their very best to maintain social distancing; children who play together everyday and who, under normal circumstances, are in and out of each others houses almost everyday. They wash their hands immediately after coming in, and door handles etc are cleaned regularly throughout the day. Are they putting us, their parents, at risk? They are isolated from everyone other than their own parents and those few pals. Is this behaviour potentially speeding up the spread?

Yes, they are absolutely putting anyone they come into contact with at risk. Kids playing together simply will not maintain the necessary social distancing and no touching rules and so the risk of one child infecting the others is high. Those other children will then bring it home to each of their families who then have a high risk of becoming infected.

I saw this happening where I love repeatedly on Paddy's Day. There were groups of 4 and 5 children playing outside. Some of my colleagues reported seeing the same. We all thought it was insane behaviour by their parents to let them out like that. If you allow the kids out like that then you should absolutely expect the entire family and road/apartment building to become infected sooner rather than later.

Social isolation means just that... It doesn't mean seeing almost no-one but having the occasional dinner party or play date. You should do it fully or not at all because half-assing social isolation will simply not work.

Hell, I have to get diesel for the care and I'm going out after I finish this post ( about 2:30am) to an all night garage because I'm awake and assume that there are a lot of asymptomatic spreaders out there and if I go during the morning rush hour I'll have to contend with a lot of people paying in the shop at the same time. Now I wouldn't stay up purposely till 2am to make that run but I definitely planned, today, to do the run in the middle of the night as I knew I'd be up so as to avoid social contact as much as possible.... and I'll fill up with more than 30 Euro so can't use contactless payment... so I'll be buying 50 Euro of diesel and handing over a 50 Euro note so I won't have to receive change or touch a credit card machine. Sure, it sounds paranoid but once the deaths start occurring in large numbers more and more people will think that way. I'm just basing my decisions on where I know we'll be two weeks from now rather than today. For me, being infected really is a matter of life and death ( about 20% chance in my estimation ) so I'm taking it pretty seriously.

up for anything wrote: »

I met a friend I haven't seen for a couple of years the other day. We were chatting about our children, one 'stranded' on a Spanish island and mine just home. I asked her kind of tongue in cheek about what her husband, a fairly senior detective locally, and his colleagues thought of the whole Covid-19 'business'. She replied that his job description had been changed to one thing, just the one thing. When I asked her what, she replied, "transporting dead bodies". From what the undertakers were told and from general knowledge I know that the bodies of those who die of Covid-19 will be hastened to the crematorium and into the ground as quickly as possible and will need people to be responsible for the process. However, the way she said it and the look on her face seemed to say volumes. Are you expecting many people to die in the next couple of months and what is the figure? I assume a figure must be available from the data from other countries and applied to Ireland. Morbid question, I know.

Well no-one knows how many will die. We can make estimates. For a few weeks now I've been saying that my optimistic best case scenario is about 1 to 2,000 dead over the next few months. My reasonable best case is about 5,000 dead. My pessimistic best case is about 10,000 dead . You really don't even want to hear the middle and worst case scenarios.

With all of the steps the government has taken I am confident we are bending the curve towards these best case scenarios rather than the middle and worst case scenarios. I think it all really comes down to how the public behave. If the public actually practice social isolation instead of "social isolation with a splash of dinner parties or kids playing etc etc" then I think we'll be closer to the optimistic best case scenario. If the public are cavalier about social isolation then the death rate will be much higher.

Right now the public has the ability to save far more lives than the health service by practicing ACTUAL STRICT social isolation, instead of an approximation of it which isn't actually it.

But while I see some people taking it very seriously I know friends who have gone into work and worked directly beside others ( the other person is now a suspected case and my friend is in self-isolation awaiting symptoms. Since exposure they visited a sibling who has also now been exposed and that sibling is now visiting their parents who both are in high risk groups... that's not social isolation, that's just being stupid. I warned them last week when they told me their plans but they went ahead anyway. It could cost their parents their lives. ), who go to supermarkets without gloves and masks and use the same trolley that a dozen other people pushed that day ( SARS-CoV2 has been shown to survive on plastic surfaces for more than a few hours ) etc. All of those people have told me they are following all the advice and socially isolating but in reality they aren't, they're still doing things which pretty much ensure they'll be infected and they mistake sitting at home in the evenings as being social isolation. It isn't.

But in my job I learned long ago that people only listen to what they want to hear.

up for anything wrote: »

Oh, another question, if you don't mind. People with Diabetes are very much at risk apparently. Is it more those with Type 1 or those with Type 2 or those who have Diabetes which needs to be treated with insulin rather than Metformin/exercise/diet. Are Type 2s with just over the borderline sugar levels, more at risk than someone without it. If you're not sure, would you be able to point me in the direction of some information please and thanks?

Again I don't want to get into individualised advice but what I can say is that the Chinese figures we all are working off didn't, to the best of my knowledge, differentiate between Type 1 and Type 2 or whether it was well controlled or not. They just say that if you're diabetic you have a much higher mortality than if you're not ( independent of age ). So, I would simply take it that ANY and ALL diabetics are in a high risk category and should exercise strict social isolation.

Here's a decent summary medscape article.... I would caution though that while they seem to say that how well controlled your diabetes is could play a factor ( better control leading to better outcomes ) it is early days and the best way to play this is to assume the diagnosis makes you high risk no matter how good your control is and be very strict with your social isolation accordingly.

Gentleman Off The Pitch wrote: »

There are reports of people successfully overcoming the fever after a few days, only for them to be hit with severe shortness of breath and pneumonia a few days after that again.

Are there are warning signs of this occurring and are there specific instructions for people who suddenly find themselves in that position, particularly those in the at risk category, so that they make the correct decisions and attempt to get appropriate help as soon as possible?

If possible have a thermometer and pulse oximeter and begin recording them once a day when well. Then note when you feel you might have been exposed and keep an eye out for any deterioration. If you see the oxygen saturation fall significantly after you think you might be infected then I would call the GP and describe the symptoms as well as the timeline of exposure and changes in temperature and oxygen saturation.

That'd be the best situation and how I've advised my parents to deal with this. If you don't have a pulse oximeter then I think you need to call your GP if you think you might have symptoms indicative of COVID-19. Your GP will then assess and advise you appropriately.

AidenL wrote: »

On underlying conditions - I have had a heart bypass, 10 years ago, 54 now, in good shape generally, did a 13 minute treadmill test a month ago and had follow up with cardiologist in Mater. Hit 100% max heart rate, etc, so cardiologist was happy with the performance.

Just wondering if a bypass fixed the heart issue, is CVD still a reason to self isolate when the time comes with my underlying condition? Am I at the same risk as someone with COPD, heart failure etc, or can I go about my business?

I know the bypass fixed the problem, and the disease still exists. Hence my question, mortality rate for CVD is quite high, seemingly 13%, so I have that concern of course.

Thanks in advance.

Thanks for the question. It sounds like your Cardiologist is right to be happy with that performance. Well done.

I would take a cautious approach to this and say that until proven otherwise I would consider having required a heart bypass to represent underlying cardiovascular disease and thus I would consider myself to be in a high risk category if I had required one. That would be my general, "better safe than sorry" approach.

However with that said I recommend you contact your treating Cardiologist and ask them this question. They will know your individual circumstances and history better and thus be able to give you an individualised answer which will take into account the myriad other factors which impact this.

Simdruid wrote: »

Many thanks for both this thread, and all the work you are going to be doing over the next period of time. Stay safe.

For those of us with underlying conditions, with regard to Leo's speech last night, he mentioned elderly and vulnerable and cocooning. Do you have any idea how we are going to identify whether our underlying condition is sufficiently risky to warrant this when we are not elderly?

The graphic on page 1 of the answer thread shows some of the main risk factors which increase mortality. Bottom line though Hypertension, COAD, Cardiovascular Disease, Chronic Respiratory Illness ( this could include asthma, bronchiectasis, existing fibrotic lung disease), Cancer, Epilepsy and other underlying neurological illnesses, Diabetes all seem to increase your risk of mortality significantly irrespective of age.

With that said this illness is so new that we are constantly learning about it and two things I'm certain about are that:
a) Not all things we think are true now will remain true 6 months from now.
b) There are many things we simply don't know about it at all which we'll know 6 months from now.

So, we don't know everything that increases risk. 6 months from now we'll know much more precisely what illnesses increase your risk. So, right now you have a choice between being cavalier about your health and assuming a chronic health issue doesn't increase risk and being cautious and assuming it might and thus being stricter with your isolation. Some illnesses ( the ones I listed above in the answer ) are ones we are pretty certain increase risk. Others we simply aren't sure of.

beolight wrote: »

Asking for a friend ��...There’s lots of us here with partners working in the healthcare system ( me included) What precautions do you take or recommend when coming home from work to protect your own family

Well the best thing they can do is just follow all of the infection control advice at work, ensure they have the right PPE gear, take the time to work smart etc. Also a lot of healthcare workers in previous viral outbreaks have gotten infected via community transmission not transmission from sick patients at work so while your partner should be careful at work you all need to be careful at home/in the community because that's actually a surprisingly large vector for infection of healthcare workers.

One thing I'd definitely say is they should leave all their workwear at work to be cleaned there and chance back into "community clothes" in as close to a clean room as they can manage at work. That way the only thing you bring home from an infected ward is your body --- which should have been protected by the PPE gear.

DevilsHaircut wrote: »

Should we be making it completely and unambiguously clear that SELF-medicating with anything for Covid19 symptoms will do nothing to fight the actual virus?

https://www.boards.ie/vbulletin/showpost.php?p=112861398&postcount=5158

RANT MODE ENGAGED. Oh FFS!!!!! My patients do this all the time. Deciding to chop and change medicines, increase or lower doses without bothering to phone my service first and then phoning weeks later when their health has acutely deteriorated. I'm not an electrician so I don't decide to rip all the wires out of the walls at random times and try cross-wiring them cause I think I could do better.

Medicine is complicated. Self-medication based on almost complete ignorance of how drugs interact and work is a wonderful way to save the virus the trouble of killing you cause you'll do it to yourself.

Now, obviously if you've got a temperature and you aren't allergic something like Paracetamol seems safe enough based on the evidence we have but apart from that I'd be phoning the GP. Hell, I'm on medication which deals with an underlying condition outside of my specialty. I NEVER tamper with it and I sure as hell know a lot more about medicines than 99% of people reading this thread. If I KNOW it is such a damned stupid thing to do that I don't even touch it with a ten foot barge pole just what the hell are any of you considering it for.

Seriously, I've seen quite a few patients die from self-medication. Don't do it.

banie01 wrote: »

Hi again Psuedo,

just a question that came up over on the Diabetes thread. As Diabetics are a high risk group as per the advice from Government/WHO, many of us are taking all available precautions.

is there however any difference in the advice for T1 and T2?
Or is it a blanket advice?

My own understanding of T1.5, T2 in particular is that as inflammation is a particular risk in any event that it should be a case of isolate and stay safe?
Does one's control have any bearing?
or is it really a case of suck it up, mitigate and isolate?

It really seems to be blanket advice for T1 or T2. As to control... we don't have the evidence yet to definitively say whether better control leads to better outcomes with COVID-19. With that said better control is just a good idea anyway so aim for better control cause that's a good thing in general but assume no matter how good your control or whether it is T1 or T2 that you're in a high mortality category.

I hope that helps inform your decision making.

celticWario wrote: »

In relation to claims by a HSE whistleblower that the current state of hospitals are "filthy", has there been an effort to deep clean our hospitals in the past few weeks in preparation for what's to come?

https://www.dublinlive.ie/news/dublin-news/coronavirus-filthy-hospitals-wont-able-17884118

Well I don't know all the specifics but this person sounds quite extreme and out of touch with the realities of the situation. Calling the army in to do a deep clean would be both ineffective and impractical. It makes me wonder just what their experience and level is. You often hear this sort of thing from relatively junior people who think that a certain thing is wrong and then lose all perspective. This reminds me of that sort of situation.

The army has NO particular experience, ability or equipment necessary for a "deep" clean. Certainly they don't have the ability, experience or equipment necessary to deal with CPE. There are specialist firms which do that.

Additionally I don't think a "deep clean" would be of any great value now. In fact I'm certain it would hamper preparations far more than it would provide any benefit. So, really, I think that that is unhelpful, wrong and harmful. Whoever this person is I'm not surprised their management don't listen to them.

mariaalice wrote: »

If someone suspects they have the virus but are generally well and have painkillers at home and they decide to stay at home for two weeks and just get through it.

Do they need to get tested or can they just stay at home?

I think they should contact their GP and follow the advice of their GP. I think once we get enough testing kits it'd be useful to be tested to know they had COVID-19 as once you know you have it you should be able to interact freely in society again without fear --- until/unless a new strain develops. I think knowing you had it and thus being able to go out freely again would be well worth having the test done.

Yester wrote: »

How can we help? At the moment we are taking this seriously and avoiding all unnecessary contact with others. We do ring older people to see if they need anything but they have been ok so far. When things get worse, will there be volunteers needed or is continuing to isolate the best thing we can do?

Edit: Do you think things like this interactive map connecting volunteers with the self-isolated are a good idea?
https://www.limerickleader.ie/news/community/526492/interactive-map-connects-volunteers-with-self-isolated-in-limerick-during-covid-19-crisis.html

I think the MOST important thing you can do is socially isolate, distance and hand wash and convince friends and family to do the same... STRICTLY!!!!

Next I think anything whereby we try to help others helps us all. I am responding to these questions at 3:23 am because I felt this was the best way I could contribute outside of my day job. I think other people should ask themselves how they could best contribute. That might be volunteering or it might be the HSE "Be On Call For Ireland" campaign ( link included )

Goldenkt wrote: »

Quick question regarding self-quarantine, should someone whos in remission from hodgkins lymphoma for just over a year and received 6 months of ABVD chemo be travelling into work on public transport & work in a busy office in the city centre or do they fall under the at risk group advised by HSE to self-quarantine?

We don't know the answer to that yet. We know that if you HAVE cancer or are receiving treatment for cancer then you are at higher risk of mortality.

I haven't seen any solid data about survivors of cancer who aren't currently on treatment.

However I have been advising people I know to avoid public transport if at all possible - unless they wear gloves and a face mask - because why take the risk? People and crowds are dangerous now. There are lots of people in public transport ( buses, dart etc ) and they touch everything. Also the ventilation usually isn't amazing. So I just think they're to be avoided if possible unless you have gloves and a really good N95/FFP2 mask at least.

I can't prove that with research but that's certainly the route I've advised friends and family to take... but I'm advising a lot of caution around this as I think this is going to be worse than most people think even now. I would LOVE to be proven wrong on that though. The wronger I am the more people live so I'll take that trade all day long.

Call me Al wrote: »

Thank you for your guidance, and the work you and your colleagues will be doing.
Your last post said this:

"It is just a matter of time. Buy us that time with social distancing, social isolation and handwashing."

Do you think we are doing enough?
My household is doing absolutely everything by the book but its frustrating as hell when I heard about people going to house parties last night and kids like my own on playdates who are all unable to self-regulate the social distancing.
I called my health insurer nurseline about information I'd read, (both media and scientific journals) about ace inhibitors and concerns surrounding these. I was told that their medical teams were aware of this and that there were many uncertainties. Now I'm not coming off the medication or anything extreme like that, and I did contact my gp with my questions, which we all should do!
Is there any verifiable science surrounding these medications and their interactions with covid19?

I think the public don't get it yet. I think they'd look at the precautions I and my family are taking and thing I'm some sort of crazy prepper. But I'm just someone who did the maths weeks ago and started raising the alarm weeks ago and is behaving based on where we are going to be 2 weeks from now and 4 weeks from now rather than where we are today.

These play dates and dinner parties etc honestly annoy me. They are spreading SARS-CoV2 and by doing that are condemning citizens of the state to death. It is THAT simple. I think it is incredibly foolish and selfish behaviour.... but I also understand that most people doing that sort of thing aren't bad people, they just haven't really come to terms with the seriousness of the situation. It'll take an increase in death toll in Ireland to get them to change their behaviour... but in the interim they'll keep spreading it ensuring more die than necessary and overwhelming the health service more and more.

They'll probably also be the ones b****ing about the health service and governments' failure to protect them when this is all done. I could say more but I'd just get really annoyed and that'll do no-one any good. Plus it is time for me to do my run to partially fill the car.

I'll be back tomorrow or Friday to answer the remaining questions.

Best of luck to all.

Pseudonym121

RiseAbove4 wrote: »

I’ve been reading your posts with both interest and high anxiety. I believe all your facts and thank you for doing this.

Question:

I’m a 44 year old male with Cerebral Palsy. In addition I’ve early Osteopenia and I’ve picked up some kidney stones in the last couple of years. I’m also allergic to Penicillin which is used to fight off lots of bugs. .

My CP is mild compared to others. I can still walk and I try to exercise as much as possible.

Am I at any higher a risk than another 44 year old male?

I’ve been distancing myself from most people for about 10 days now and I’m going to focus on looking after my immunity with high dosage Vitamin C, Zinc and more.

Cheers again.

Thanks for the question... I haven't seen any clinical data on mortality rates of individuals with Cerebral Palsy with COVID-19 so I can't give you an evidence-based answer in that sense. With that said having discussed this with a couple of colleagues today our consensus was that we don't think someone with mild CP who is able to walk unaided and exercise should be at higher risk.

As to the penicillin allergy. I wouldn't worry about that, there are lots of other effective antibiotics still available to treat any bacterial pneumonia which might develop should you develop COVID-19.

With that said I would, as ever, urge social isolation, distancing and handwashing.

faceman wrote: »

As the Americans say to the veterans, “thank you for your service sir”

My question is probably more complex than I think but here goes

Viral loads and contagions. How does it work with this virus. We know that there are drugs for example that can suppress viral loads of HIV to levels that make it virtually not transmittable. What is it that makes this virus so contagious? Is it it’s ability to replicate itself? Or have I oversimplified it?

LOL! You were right that any answer to your question would be very complex and nuanced. At a basic level though different viruses have different levels of infectivity and we have just gotten quite unlucky that SARS-CoV2 combines quite high infectivity with a high R0 and quite a high rate of causing severe infections when it infects people. This basically gives it a high chance of overwhelming critical care resources. When this happens death rates could be reasonably expected to rise from roughly 2% ( when the system has enough critical care resources ) to 10% ( when the critical care resources are overwhelmed ). If you run the numbers from Italy you can see that their number of dead has been slowly but surely creeping up towards 10%.


@ Dummy_crusher
Thanks. I'll pass you over then.

Imreoir2 wrote: »

Is there a reason for the high mortality rate experianced in Italy to date as compared to other countries?

Discussing it with colleagues we think there are four main factors.
1. We don't yet have proven, effective treatments to beat the virus back in those who present with it.

2. Italy has a proportionally high number of aged individuals - who have higher mortalities.

3. They didn't react quickly and aggressively enough in terms of aggressively imposing social isolation on their citizens. They ratcheted it up gradually and by the time they got serious about it their numbers were destined to climb so high that their healthcare system got overwhelmed.

I think it is really encouraging that their numbers aren't breaching 500 dead a day yet. On a worst case scenario I had thought they could be breaching 1,000 dead a day by now so clearly their lockdowns have had some impact but they needed to take the Singapore approach ( mass testing, harsh, massive enforced social isolation) much earlier to prevent this death rate. They didn't and so they'll likely end up with somewhere between 8,000 to 10,000 dead by the end of the month - it could be a bit less if their lockdown from two weeks ago kicks in but I think that any [positive impact in Lombardy will be negated by rising cases and deaths in other regions of Italy where they didn't take it as seriously until much more recently.

4. The healthcare system in Lombardy has been overwhelmed and in that region it seems their death rate is at 10% already and has been for some time - this is the sign that their critical care systems have been overwhelmed.

I talked about mass casualty ethical triage previously and mentioned "black tagging" people as not suitable for any treatment. Channel 4 News is, in my opinion, providing the best news reports on this. They had a very interesting piece in which an Italian healthcare worker spoke about their active black tagging policy. This shows you how overwhelmed they are.

Channel 4 News Link: The relevant section begins about 3:20 but watch the whole thing. It is striking.

Also note that none of the civilians with face masks are actually wearing them properly. If you freeze frame at 4:40 you can see two people with face masks ( wife and daughter of a COVID-19 patient ) both of whom haven't fitted the masks properly. They think they're getting protection but I guarantee you they will both come down with COVID-19 Essentially all they've done is wasted those masks.

At 5:25 the kids of the man being taken to intensive care are allowed to touch his hand before he goes into ICU. He's lucky enough to get a bed but their awareness of infection control is very poor. To be fair, they're young and almost certainly will have caught it before this but it hurts to see the lack of infection control measures evidenced throughout this video by the public in Italy.

To be fair when I started enforcing this in my clinic a couple of weeks ago long before the HSE was mandating it co-workers thought I was hysterical too. They've come around.

Remember, every time you don't socially distance or hand wash properly you, personally, are making this scenario from Italy more likely to happen in Ireland.

The One Doctor wrote: »

No questions, just thank you for your forthrightness, bravery and determination. If we ever meet, I will buy you a beer. Several beers.

LOL! In all seriousness there's only two things I'd accept as thanks:
1. People passing this info/thread on to others so they could become informed and change their behaviours and

2. If you really want to give thanks I treated a lot of survivors of rape in A&E when I was a junior doctor. It left an indelible impression on me as a young male and so ever since I've supported the Rape Crisis Centre. Maybe drop them a donation in the name of Pseudonym121 ;-).
a) It'll help a very worthwhile organisation and
b) It just tickles my funny bone to think of how confused they'll be about any donations coming in with that nickname attached ;-)

Drumpot wrote: »

https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf

————————————————-
Conclusion: We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these findings.

—————————————————-

There are some reports that Gastro problems (like diarrhoea) can be an advance warning and in a small study of Hubei patients, just under 50% had this as their primary symptom. Have you heard anything regarding this or is there any sign that this has been a symptom from what you have seen thus far?

Thanks for answering all these questions, it really helps...

Fortunately we have a fox what used to be Professor of Cunning at Oxford Univesity but has moved on and is working for the UN at the High Commission Of International Cunning Planning working on this. ;-)

Yeah, gastro problems definitely seem to be more common than with the common flu. I know there is talk about this as a marker of potential severity of illness down the road but I don't consider that proven definitively by research yet. It is an evolving situation so that answer could chance a month from now.

Either way though you're just better off focusing on social isolation, distancing and hand washing.

Standman wrote: »

I'm a bit confused about the advice regarding hygiene/social distancing - HSE website says masks are unlikely to be effective for healthy people and seems to advise against gloves, but you reckon it's irresponsible to go to a supermarket without gloves and masks? Also, if we're worried about touching surfaces in a supermarket then what about the things we buy and take home? Should we be disinfecting packaging? Thanks.

Well the answer is nuanced:
1. Masks tend to be useless for the public because they don't know how to use them properly and so don't get much if any protection from them. Social isolation, distancing and hand washing are much easier for the public to actually do properly.

2. I think that if given the option one shouldn't go to the supermarket at all. One should just have food delivered. I haven't set foot in a supermarket for about a month now. I've moved to only home delivery.

3. If, however, you are determined to go to the supermarket in person then, yes, I'd suggest taking all the precautions you can... with that said there's no point wearing a face mask unless you've watched videos outlining how to properly put them on, fit them and take them off ( I provided several links for this in this thread ). Otherwise you're just wasting resources that healthcare workers could use.

As for the things you take home... That's a really good question. I use the following procedure and even then I think it isn't perfect but it is about as good as I'm going to get without professional equipment.

1. When a food delivery comes in I have an area set aside for the delivery to be dropped to. I now assume that the hallway it passed through and the room it is dropped into are infected. I wear a mask and gloves during the delivery process.

2. I don't go into the hallway or room it was dropped into for 3 hours without wearing a mask... Ideally I just don't go there at all. This is to let droplets settle.

3. I now retrieve the frozen goods, wipe them down with disinfectant wipes and place them in the freezer.

4. Non-frozen goods are wiped down or placed in a UV light steriliser ( for baby bottles ) as that has a decent chance of breaking down viruses etc and is a quick and easy thing to do with ready meals, keys, swipe cards etc which can be contaminated when out and about. I don't think is a perfect solution at all but in a home environment it is a a cheap enough intervention ( disinfectant wipes are cheap, gloves are cheap and the mask I wear is an N99/FFP3 reusable half face mask - the UV sterilisers can be bought on Amazon for 40 Euro to 100 Euro depending on size etc ).

5. Other jars, bags of pasta, rice etc are wiped down with a disinfectant wipe and then popped into the UV steriliser for about ten minutes at a time. Sure it might take me 6 hours to process a delivery but 3 hours of that is just leaving it sit in a closed room and then the next three hours is processing the delivery for storage and mopping the floor with bleach and cleaning other exposed surfaces.

It isn't perfect by any means but:
a) it only cost me the cost of the UV steriliser and
b) I only get a delivery every fortnight
c) I can have the radio and TV on during the process so am not missing out on any news etc. I don't make phonecalls during the time as being distracted is how mistakes happen.

Is it overly cautious? Well, it certainly is on the extreme end of preparations but, then again, I figure I have between 15 to 20% mortality if I catch this and if I survive I can expect to live maybe another 30 years so spending a few hours cleaning once a fortnight and looking like a weird survivalist prepper to the deliveryman is a price I'm prepared to pay. ;-). Additionally I have a responsibility to my patients and colleagues to stay as well as long as possible in order to continue providing care. Even if I were to die from this dying 6 months from now vs dying a month from now is 5 months of useful work supporting patients and staff. That's well worth it.

Obviously once a vaccine rolls around, even an experimental one, I'll take it and be delighted to abandon all of these precautions.


If there is interest in the routines and habits I'm trying to instill in myself to minimise the chance of bringing this into the home I would be happy to outline them in a post. Let me know.... you can't rely on yourself remembering these things willy nilly. You really need to think it out and have either a mental or written checklist. That's how we do things in surgery and when dealing with infectious or immunocompromised patients. We're learned that checklists work.

Skygord wrote: »

My wife finished chemotherapy 6 months ago, and had a splenectomy 3.5 years ago.

We understand she is in an at risk group.

Are there any extra precautions that we should follow - over and above the guidelines for self-isolation?

No, I would just stress that you need to really practice self-isolation... not self-isolation with the occasional chat across the fence or when I run into someone on a walk. Self-isolation means staying at home for the duration with only essential trips out ( for food or medicine but even there if your pharmacy will deliver then have them deliver). I'm picking up some medication tomorrow and I'll be wearing the latest Spring Armageddon look - gloves and facemask - when I go. With that said I am trained in how to properly use the gloves and facemask ( privately purchased, not from HSE stores ) which is why I say I don't think a facemask makes much difference for most people - as they don't get any benefit because they put them on, fit them and take them off incorrectly.

Drumpot wrote: »

My sister smokes but had leukemia when she was a child. ( not had problems or check ups in decades). She works in a hospital up north and when I asked her if she had spoken to a doctor about her risk factor she said she didn’t see it being a problem. She’s also refusing to buy these personalized masks they are offering. Would a person who has , I think, fully recovered from this illness theoretically not be anymore at risk then the average person? I appreciate you cannot give medical advice here, I am just wondering how insistent I should be with my sister that she should talk to a doctor regarding her risk profile, especially while she’s working in a hospital....

Yeah I can't really give individualised advice because I don't know the full situation but my compromise is that I can talk about the generalities which seem to apply and then suggest what I think would be a reasonable course of action.

I would imagine that a fully treated and in remission cancer from many years ago for which she isn't still taking any chemo shouldn't put her in a high risk category because, essentially, she had an illness, treated it and now doesn't have it any longer. With that said a lot would depend on individual factors - some jobs in the health service are lowish risk, some are very high risk and I'd expect 100% infection rates in some roles.

I think it would be smart for her to talk to a doctor regarding her risk profile given the fact she works in a hospital. With that said I'd expect they'll say that a resolved cancer with no ongoing treatment doesn't put her in a higher risk group. So, I expect it'd be good news.

Fluorescence wrote: »

Thank you for taking the time to answer the questions, and for continuing to work despite being at considerable risk. This really is a war.

I work in the veterinary sector. Many of our clinics and hospitals have ventilators. In the UK, the AHT is compiling a list of veterinary ventilators and liasing with officials to coordinate their potential donation/use in the hospitals in the weeks to come. I don't know if the Irish bodies are aware that these facilities may be available to draw upon?
It's not a standard piece of kit in every hospital but there are many around, which may be worth investigating.

Aside from ventilators, is there anything veterinary staff in particular can do to assist in the coming crisis?

Well, I think you can do two main things:
1. Contact your representative body and ensure they are in contact with the government about these ventilators. It does seem to me that the HSE has been pretty good about scouring the country for ventilators and it seems to me we have roughly doubled the number of usable ventilators ( from private hospitals, converting ORs and buying more ). That's going to have a huge impact on keeping people alive. We still need more though so I think ANY ventilator going would be welcome. Funnily enough we make a large portion of the world's ICU type ventilators in Ireland so that'll be helpful.


2. Consider contacting the Ireland's Call website. If you know how to place lines etc then I could see there being a role for you and others doing minor clinical tasks which would normally be done by nurses etc which would allow them to be freed up for more crucial tasks.

It seems you understand this but it bears restating. Ireland is about to have a small to medium sized war, with all of the casualties that entails. Anyone who has skills in treating mammals will be useful because humans are just unusually hairless mammals with pretensions ;-). With that said I'm sure that if you aren't comfortable taking on a clinical role there will be a lot of roles in providing deliveries to the elderly during the cocooning phase etc.

Hobgoblin11 wrote: »

Is sex ok during this crisis or should we be avoiding that also?

When can we go back to this type of thing if it's not recommended?

Do you contact trace your partner?

Well I think having sex with someone you don't already live with is certainly increasing your risk. I'm not even sure this is a serious question but I'll answer it as though it is. I'm single and I certainly amn't going to be dating until either a vaccine is available or I've been infected and, hopefully, survive.

As to contact tracing... I assume that's a joke but if it isn't then I'd suggest that you can't know whether someone is infective or not no matter what level of contract tracing you plan to undertake. With that said people often put themselves in danger in pursuit of sex so I'm sure many people will continue behaving less than logically in this area going forward.

17-pdr wrote: »

I see that having high blood pressure is one of the risk factors. If you are on medication for it and your BP is now ok, is an underlying risk still there?

Yes but I would expect that well-controlled high blood pressure is less risky than poorly controlled high blood pressure. With that said even with well-controlled high blood pressure I would consider myself to be in a high risk group.

Arlessienne wrote: »

In your opinion, how high risk is someone (aged 40) with Inappropriate Sinus Tachycardia requiring 7.5mg bisoprolol daily and suffering fairly significant exercise intolerance? They are an ex medical scientist and looking to volunteer - is their risk of further burdening the health service if they get sick low enough to go ahead? It's impossible to get any response at the moment from gp or cardiologist. Obviously this would be just your theoretical opinion on this condition generally, without knowing full details.

Thanks for all you are doing both in the hospital and in spreading awareness here. Your posts are scary but I believe them to be realistic. Thanks for trying to get people to wake up to reality.

Thanks for the question. I don't wish to be difficult but there's no such thing as inappropriate Sinus Tachycardia. I think I know what whoever used that term meant though and I would think that this would qualify as Cardiovascular Disease and thus put them in a high risk category.

In terms of volunteering with the Ireland's Call initiative... There will be need for people taking on clinical roles and non-clinical roles. With the non-clinical roles some will be asked to present themselves to certain sites and others will be able to work from home.

So, even if in a high risk group and completely socially isolating at home I think there will be roles that this individually could do without increasing their risk of exposure one iota. If I were in your shoes I would encourage them to volunteer ( I think that's really helpful right now and everyone who can help out should ) but to do so in a role which could be done from home without them breaching their social isolation.

There are LOTS of young people in their 20s and 30s without any health conditions who should volunteer for patient-facing roles if at all possible. Some of us with health conditions need to put ourselves in the firing line because that's just where we need to be right now BUT I don't see any sense in this individual putting themselves in the firing line when there's an option to help out which won't increase their risk.

Obviously that's just a general answer but I hope you find it helpful.

lillycakes2 wrote: »

I am a nurse, I live with my mum who is over 70,self caring. I am not going near her, I am using just one room (my bedroom), with door closed, I am using my own toilet, my own cutlery and I just walk out front door when I go to work, she is not allowed to use this door , she uses the back door.i am not using any room in the house ,I am showering etc in work....
Does this sound ok to you ?.

Hi lilycakes2. Those all sound like sensible precautions alright. It seems there's a desire to have a post on how to prevent bringing infection into the home. I'll write an essay type answer up for that over the next couple of days but it definitely sounds to me like you're doing much more than most. There might be a few areas one could improve though through the purposeful establishment of a room to clean and change on entering or prior to leaving the house so that the rest of the house could basically be considered a "clean house". That's the approach I've taken -turning a spare bedroom into a changing area and taking off my clothes from work there and then cleaning my hands and showering on return from work. Once that's done I consider myself clean and then can just potter around the place with no concerns. When I'm going out I go into that room, assume everything in there is infected, change and then go out.

I'll write it up in fuller detail as I think there are a number of people living with elderly relatives who are concerned about this sort of issue and want to make reasonable changes ( which would have sounded utterly hysterical just a few weeks ago ) to make things as safe as possible.

supermouse wrote: »

Firstly, thank you for doing this AMA. Furthermore, thank you so very much for everything you have done to date and will no doubt continue to do well into the future to protect us all.

Why do you think we haven’t been put in lockdown yet? As we’ve all heard and seen, social distancing is working for some but so many are ignoring the rules. Mr Varadkar has access to the same data as you, is a medical doctor himself and is surrounded by some of the brightest minds we have in this country. Why are we delaying the inevitable do you think?

Stay safe. I truly mean that.

Thanks. This is part of my small contribution to this and I'll continue answering questions for the duration or until I'm no longer able.

I think that people, on average, are self-deluding and prefer to live with imaginary safety rather than real-world reality. It takes time for people's mentality to shift from their rose-tinted view of the world to the reality we now find ourselves living in. This is made worse by the fact that what scares me and others who understand viruses and epidemiology is NOT today's figures but where they'll be 1 month from now if we don't act now. People in general are very bad at visualising a future situation and acting now to prevent it. They look at today's situation and base their decisions on that --- you see this with climate change. People have really only started getting on board when current storms have undeniably become more frequent and severe --- even though we KNEW that would happen for at least two decades.

As to Leo being a medical doctor. LOL! If I remember correctly he went straight from internship into GP and from there into politics. I mean I was an intern and SHO at one stage too but God help us all if interns and SHOs are making these decisions. They're very much still learning. I see this with my own NCHDs whom I've been talking with about the epidemiology of this. They have a basic understanding but not enough to really get as scared of this as they should have been --- to be fair I think mine have been scared enough that they and their families took appropriate steps weeks ago because I sat them down and had some significant chats with them about how serious this was going to be and their responsibility to prepare in order to be of use to the health service and public going forward. I don't think too highly of Leo's insights into medicine - hell, I remember him as a GP trainee, I had occasion to interact with him professionally back then. He was fine but I wouldn't be listening to him on epidemiology right now. To be fair to him he hasn't made any claim that his medical background such as it was gives him any special insight right now. He has, as far as I've seen, stuck to the line that he's listening to the expert group. I am not a fan of him on a personal or elective representative level but I think he is managing this pretty well all things considered.

Anyways, the government has a public who just don't get it and moving them to where they need to be takes time. I think we are seeing that process in action. This reminds me a lot of how Singapore managed things with SARS back in the day. They tried gradually increasing restrictions etc too, realised it cost a lot more deaths and went straight to the full suite of measures this time. End result, they have this largely under control.

While I think we should have adopted the 2020 Singapore model from Day 1 I recognise that:
a) the resources and planning just weren't there and
b) the Irish people wouldn't have gone along with it... I think the public has had to go on a journey to understanding this was serious --- and even today there are really disheartening images of groups of people in town and shops etc.

Overall I think that going with the mass testing, contact tracing and delaying spread while building up ventilator and hospital bed capacity model is probably the best we could realistically do given the fact that Irish people just didn't have the SARS experience that Singapore had back in the day.

Whiplashy wrote: »

I live with my elderly parents and I myself am on weekly benepali injections. When the government recommends cocooning, would I need to follow that recommendation as well as my parents? We live in the country with no family nearby so would need to be thinking about trying to put arrangements in place if necessary.

I think that if they cocoon and you are out and about then there's a significant risk you'll bring SARS-CoV2 home. As I said above I'll post about the steps you could take to minimise the risk of bringing that into the home.

But the basic point is that if one person in a home is going out then they certainly have a risk of bringing it into the home and should take significant measures to reduce that risk.


Right now the real countries to look out for are, IMO:
1. Iran - but that's pointless because they are not being honest about their figures.

2. Italy - this is where we'll see lockdown in a Western European country work first. This should then enable the Irish government to sell these measures to Irish people.

3. UK - they're our closest neighbour, are taking a different approach and should exceed 100 deaths per day 5 to 6 days from now. I think that will be a psychological benchmark for them.

4. USA - I think they're going to have a horrendous outbreak of this. I think they're going to make Italy and the UK look like nothing. The Federal response has been terrible and only local state and even university-level actions have been in any way effective there. I think their number of undiagnosed individuals actively spreading it currently is huge and their healthcare system is NOT set up to provide the socialised care a pandemic needs so structurally unless the federal government steps in they're in terrible trouble.

They'll show us the path out of this for us ( Italy ) and the worse (UK) and worst (USA) case scenarios we could have experienced if we didn't have the response the state has generated.

To their credit I keep hearing management tell us that "money is no object" right now and that if we need something which will improve outcomes then the money will be there. Obviously there's a lag time in ramping up production but at least the government in Ireland really is taking the attitude that it'll spend whatever it has to to save the most lives possible --- we just need you, the public, to do more social isolation. Right now you aren't doing your part and this will cost hundreds, possibly thousands, of lives in coming months.

Beasty

Another reminder - this thread is for the AMA answers only. Questions should only be posted in this thread

Pseudonym121

Xertz wrote: »

A genuine question, and I know it might be impossible to answer, but do you foresee this going on for a few months or are we looking at a new normal well into 2021?

I've been on record since I first starting posting about this 3 or so weeks ago that we will still be talking about this in March 2021.

We will be talking about this until we get a vaccine and even then we'll still talk about it because by its nature I expect it will generate enough generations of infection to mutate into different strains. I expect ( but this isn't proven, just my expectation based on my understanding of how new strains develop ) that COVID will become a seasonal thing like the flu and generate COVID-21, 22, 23 etc and become just like seasonal flu except much, much deadlier to the elderly. It will probably drop worldwide life expectancy by a few months to a year over the next decade.

Arlessienne wrote: »

Thanks so much for your response. It was very helpful. I will pass on your advice about volunteering for a role with no or little contact and he will hopefully eventually get a specific response too from one of his doctors to be safe. (IST is the official diagnosis written in medical reports from a cardiologist specialising in electrophysiology and was deemed to be a type of SVT and possibly a form of dysautonomia or SA node malfunction.)

Best of luck and thanks to you and all your colleagues.

Hi, thanks for the reply. I can see i was unclear when I said there is no such thing as inappropriate sinus tachy. Sure it is a term that is used but it doesn't describe underlying pathology. It can be caused by anything from drinking too much caffeine to a serious life-threatening disorder of the electrophysiology of the heart. That's why I was saying there's no such thing --- although I can see that wasn't as precise as I should have been.

So, now you're saying that IST actually represented either the cardiac pathology of SVT or SA node dysfunction. Either SA node issues or SVT are cardiac issues. I think the best way to deal with this and play it safe and say - "Well, if I have a cardiac diagnosis then I'm going to assume that puts me at higher risk". Other doctors might differ.

I am unaware of any evidence which says SVT and A Fib are not associated with high mortality in COVID-19 so I'd prefer to play it safe and assume they are higher risk. If that evidence evolves or someone can post a link to such a paper I would obviously defer to it. Our knowledge base re: COVID-19 is continuously evolving.


Damn, I just deleted the answer I'd written to the next question. here goes again.
We simply don't know why some people incubate for 5 days or 14 days. We also don't know how long they are infective before they develop symptoms although most people now think it is at least 12 to 24 hours. For the test to be positive enough viral RNA needs to be on the swab to be amenable to PCR. But we don't know how long that takes and if that varies from the 5 day incubators to the 14 day incubators. We are still learning a lot about this virus.

up for anything wrote: »

Based on our figures today, 20th March, and the lack of proper social distancing going on, what do you think our best, medium and worst case scenarios are going to be regarding deaths?

Good questions albeit I think the answers may not be re-assuring. I've explained previously that in this sort of situation one method is to come up with 9 scenarios - Best, Middle and Worst and then divide each of these into Optimistic, Reasonable and Pessimistic.

I'm on record previously as stating that the best case scenarios I foresaw for Ireland over the next year were as follows:
Optimistic Best: 2,000 Dead.
Reasonable Best: 5,000 Dead.
Pessimistic Best: 10,000 Dead

Optimistic Middle: 20,000 Dead.
Reasonable Middle 50,000 Dead.

Given the steps we have taken I don't see us exceeding a reasonably middle case scenario anymore so I won't go into the worst case scenario numbers. I'm sure the government has even better estimates. These were my estimates created when I began researching this 3 to 4 weeks ago. I think they're still valid although we're now more likely to be in best case scenario territory than middle and worst case like we were 4 weeks ago.

The proviso for the above is that IF we got an experimental vaccine in good numbers by September 2020 then you could see those numbers fall by 80%. The reason is that if this follows the Spanish flu modality then we could expect a massive spike in deaths in Q4 ( I believe roughly 80% of all Irish deaths over 1918 and 1919 occurred in just 8 winter weeks in 1918). Is it guaranteed to follow this pattern? No, but I think that assuming it will isn't unreasonable. It could still be wrong though.

up for anything wrote: »

Are there going to be enough ventilators, do you reckon, for say the medium case scenario? I assume, probably wrongly, that as we are a manufacturer of them we may get first dibs on them.

No, no there won't be. The state has done amazing things to increase the numbers of ventilators, staff and beds but the public has NOT done its part in terms of social isolation and distancing and, as such, the public has condemned many more to death than were unavoidable. Well done guys.

Medtronic makes a large number of worldwide ventilators seemingly. They have boosted production and will boost it more. My understanding is that what they would have produced normally is already bought by other countries and it would be very foolish for the Irish state to requisition them - we'll need other countries soon enough and they'll remember if we screw them over and return the favour. I'm sure we've negotiated/strong-armed quite a good proportion of the increased production though - and this would be more tolerable to other countries.

up for anything wrote: »

Are patients who are within some hours of inevitable death actually in any sort of condition to say goodbye to family via phone or iPad like I've heard they've been doing in Italy?

If they're tubed and sedated then they're not. If they are more conscious then a remote goodbye may be possible so long as staff aren't overwhelmed.

LadyMayBelle wrote: »

Thank you so much for your advice and info, as well as your dedication. I'm glad you gave example of how you managed food delivery and wiping down items, as I worry about this as well as good intentioned people leaving items and bags of things at people's doors, esp elderly. I made clear in another thread that it's not about stopping kindness but a need to be mindful that more harm could be done than good? Once proper measures are in place then it's ok..ish.

Would love your broken down list you referred to..we would have been chuckled at for being preppers but took a lot of advice from your posts. Thank you.

Well, I actually enjoy watching those prepper shows for a laugh because I find their risk assessments and planning so one-sided and often missing huge issues which render the whole thing impractical. I've never gone in for that... but, like I said, when I figured out the stats behind this when I read into it 3 to 4 weeks ago I knew I had to prepare... and so I did and persuaded my family to also.

I'll write something up today/tomorrow re: dealing with food deliveries...

Funsterdelux wrote: »

Howdy doody Pseudy,

I was up on scaffold there starting to get the battens ready for slating the back of my cottage, the east wind is eating the face and hands off me. It got me thinking, with the measures of social distancing/isolation in place for months perhaps, other viruses such as the cold and flu would also find it hard to spread(i know we're going out of season). Would this have a positive or negative effect on our collective immune system? If a majority of us dont catch sars cov2 and other viruses, when/if things go back to normal would we be more at risk from getting a more severe cold/flu?

The question always sounds better in my head, anyway thanks again and good luck!

No worries. I don't think that the impact of social isolation on flu will have much impact on the flu season 2021.

trisha e wrote: »

If suspected cases have to wait days for a test and,as a result, test negative because theyre better what is the point in testing if not testing for antibodies at the same time?
Surely these tests should be allocated to people on the list with symptoms.
A work colleague of mine was sick for 2 weeks
GP booked a test on Monday and still waiting. Says he's feeling better now and wonders should he give his slot to someone else on the list. Thanks to you all.

I'd still go for the testing as enough RNA might remain to give a positive test and re-assure the individual that they are now immune to the current strain of SARS-CoV2.

I think the delays in testing and overly strict testing criteria will both change as more tests are available and more lab capacity is diverted to COVID-19 testing.

Yes, you're right that an antibody test would be very useful but, in the meantime, we use what we have because widespread testing and enforced isolation has been shown to be hugely beneficial in preventing spread.

fjortal wrote: »

Hello and thank you so much for answering questions during this time. My dad found out he needs a triple Bypass a week and a half ago. He is meeting with the surgeon on Monday. He is 75 and will be tested for Cov 19. My question is, in your opinion, could I visit him in relative safety before and after the operation while keeping 6ft between us, wearing gloves and mask? I am in good health, no symptoms whatsoever. I do have children. I am extremely close to my parents and other family members have visited, keeping their distance. I am torn between fear of passing something on and the negative mental health effects not seeing them is having. Many thanks Fjortal

I think that elective surgeries like that won't go ahead soon.... I'm unclear if you're saying he is due to be operated on on Monday - in which case it might still go ahead - OR if he is meeting with the surgeon to discuss surgery at a future date - in which case I would expect it to be postponed for the foreseeable future unless he would die without the surgery.

If it were me I wouldn't visit him. I'd use skype to videocall. I haven't seen my own parents except through a window or skype for about 3 weeks now. You have to balance the risks vs benefits yourself but heart surgery is a significant operation and putting him at extra risk seems madness to me - especially when we have skype. Sure it'll be a low level of extra risk but I just don't think it'd be worth it if it were my father.

You'll have far more negative mental health effects if you infect him with COVID-19 and he dies.

That'd be my attitude but you know yourself and your parents in a way I never could so you'll need to balance that yourself.

Potentially wrote: »

Firstly, thanks, no words could say it enough

Secondly: I am a single Mum with 12yo. Ex wants to continue contact, he has just collected her and has gone off for the day. He has been working as a salesman to pharmacies and has continued his normal socialising routines, with his new partner (nurse who home-cares for newborns) and others home recently from abroad....
I have been really careful to keep social isolation but is all that down the drain now?
My elderly parents and aunts rely on me; and if I get ill, there is no where for my child to go.
Please advise.

I can't tell you what to do in your situation but your ex's behaviour seems to be begging to be infected. If he continues having access to your child you should assume she will be infected also and from her you'll be infected.... and you could pass it on to whomever you have contact with.

I've heard many separated couples are fighting about this sort of thing when one partner isolates and the other doesn't. I think that is a tough situation to find oneself in.

Notsomindful wrote: »

Thanks for all you are doing.
My local testing centre is a drive through centre.
I have been referred for testing awaiting appointment.
Can I walk to test centre- as I dont have access to a car and dont want to risk spreading it to others unnecessarily like taxi drivers etc...

Yes, just be very careful to stay more than 2 metres from anyone if at all possible while on the way there. The risk of passing it to others outdoors if you pass by briskly and stay more than 2 meters away is low. Not zero, but low.

RobbingBandit wrote: »

Thanks for taking the time to do this.

I'm a diabetic I've just had my next couple of appointments postponed indefinitely I am currently dealing with several complications including foot and eye issues which require routine care and can turn nasty I am unable to contact anyone in the departments so far and really don't want to find myself going to a&e.

In short what is happening to patients with ongoing chronic issues in this current climate is my question.

I think we're doing our best to keep services going for our routine appointments but in a crisis like this routine care will inevitably suffer.

One of the unmentioned aspects of crises like this is that you only ever hear about the people who died from the crisis illness ( e.g. ebola, COVID-19 etc ). You don't hear about what epidemiologists call "excess mortality" which is those people who died in excess of the normal rate for that time of year.

So, let's say 100 people a day die in Ireland normally in April and this year we have 20 COVID-19 deaths per day in April but when we pull all the figures we find actually 130 people a day died in April. In that situation 30 additional people died every day due to the crisis, 20 from COVID-19, 10 from other illnesses who would normally have been saved but couldn't be because the health service was overwhelmed.

In Italy they are reporting an increase in death rates from cardiac problems and other issues even in patients who don't have COVID-19 because where it used to take 8 to 10 minutes to get an ambulance out to a heart attack it now takes hours - by which time many are dead.

So, that's grim.

In your case I'd try to make contact with the Public Health nurse or your GP if you can't reach your specialist. I'd also redouble whatever efforts you are making to manage your blood sugars etc as well as possible yourself.

So, in short we'll do our best but, yes, you won't get the quality of care you're used to and the more selfish A***oles go around not socially isolating and distancing and handwashing the more medical and mental health services will be overwhelmed, the more appointments will be cancelled, the more surgeries will be cancelled and the more people with ordinary health issues but not COVID-19 will die. Congratulations Irish public.

Airyfairy12 wrote: »

Hi I just have a question about coronavirus symptoms. Do they come on suddenly like in the case of a flu were you all of a sudden feel unwell or do they come on gradually, do you feel like youre coming down with something for a day or two before symptoms become obvious? Are swollen lymph nodes in the neck common with coronavirus like they are with cold and flu?

Thank you so much for taking the time to answer questions.

It is really quite variable. A lot of doctors have gotten it over the past week and many of them have described really rapid onset of symptoms. Some have literally sat down to dinner fine and been unable to finish the meal because they've become unwell.

Others report a gradual worsening of symptoms over days.

So, I think it varies a lot and there isn't a one size fits all presentation.

As to lymph nodes. I haven't heard much about swollen lymph nodes being a significant sign in COVID-19 presentations. With that said I think we're learning more all the time. Hell even today they're beginning to coalesce around anosmia etc as a significant symptom and that wasn't on anyone's radar in Europe a week ago. So, it is an evolving situation.

Ok, hope that was helpful, I think I'm caught up now.


Edited to clarify the answer for SVT/ A Fib and make it clear that the answer was based on "erring on the side of caution" in the absence of evidence of either issue not increasing the risk.

Pseudonym121

@ SilentRunning.

Controlled A Fib is a chronic cardiovascular condition and chronic cardiovascular conditions are known to increase risk of mortality.


@Fishy Fishy
Re: having complete faith in your ability to survive it... You shouldn’t. Younger people are dying in Italy and the US. About 20% of recent deaths in the US were below 65 years of age.

Re: Asymptomatic spread. It is all about viral load vs presence of symptoms. It seems that many people with COVID-19 have a period of time where they have a high viral load in their throats/nasal passages prior to the onset of what they recognise as symptoms and so can spread the virus to others while being “asymptomatic”.

No, my level of preparation is not common. WHen I read up on it about a month ago now and decided that this was going to be a huge problem none of my colleagues outside of, perhaps, infectious diseases and public health seemed to be as worried as I became. They certainly didn’t buy in the masks, gloves etc which I did and urged my family to do.


Re: survival rates on ventilators. Read this and prepare to despair.
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext

86% of those who required invasive ventilation died and 79% of those who required non-invasive ventilation died. So, basically 42 out of 52 ICU admissions ideas. That’s one hospital in Wuhan and small numbers but even with ventilation they were looking at over 80% mortality for those admitted to ICU.

It sounds like the numbers are even worse in Italy but they’re too busy treating patients right now to be writing peer-reviewed papers.

It is GRIM and everyone going out and about and not rigidly socially isolating or distancing is actively adding to the death toll in Ireland.

The One Doctor wrote: »

Does the current low number of deaths from CoVid 19 in Ireland give you any cause for hope about this pandemic?

Thank you for your stalwart work.

No, given the public’s failure to socially isolate and sufficiently socially distance we are still on track to have thousands die over the next year, possibly over ten thousand.

digzy wrote: »

Hi
I’m a dentist. Like most of my profession I’ve shut my practice due to safety issues.
Unfortunately the chief dental officer made a statement that we’re to work as normal despite not having appropriate PPE.
Her advice is plain wrong. I don’t want to be a super spreader ( because I don’t have PPE) , nor put my staff or our families health at risk by remaining open. However I also feel a duty of care to my patients.
The hse needs to order all dental practices to shut down. We might save a tooth but loose a life!

Hi. I’m sorry to hear your difficulties. Yes, I was being given advice/instructions by the HSE a couple of weeks ago which were not in keeping with the objective reality of what the risk was. I ignored them and enacted precautions which the rest of the HSE moved to some time later.

When instructions from on high don’t make sense it is time to take one’s own authority and do what you know is right. I may get fired for it but at least I know I tried to protect my patients and team as best I could.

You also have to bear in mind there isn’t enough PPE so that plays a part in telling you you don’t need it. If they told you you needed it they’d then have to tell you they had none for you. Cynical, moi? To be fair nowhere in the world has enough PPE so just like in some wars the first wave or two of healthcare professionals are going to the front lines without the right equipment. They are therefore suffering very high infection rates right now.

Is that a failing? Not really, very few people saw this coming a month ago and one cannot really blame them as this is really an outside context problem. Very few humans or organisations cope well with these.

We are doing OK as a country so far. Could have done better of course but we are doing better than a lot of places. At this point the public is letting us down massively with the cavalier attitude in many areas.

Pseudonym121

Bidd wrote: »

If you’ve had the vaccine for pneumonia would this protect you from pneumonia if you get Covid-19.

Not significantly no. Streptococcal Pneumonia is what this vaccine protects you from. Not all pneumonias are caused by streptococci and it isn't, to the best of my knowledge, a major contributor to the bilateral interstitial pneumonia people with COVID-19 often die from ( they die from other complications also of course ).

TLDR: No.

begbysback wrote: »

Given that deaths can be kept at a minimum by early diagnosis and treatment, are you guys lobbying for this, or just waiting at the doors of hospitals for critical cases?

Where are you getting this from? There aren't any validated treatments which are widely available beyond attempts to treat complications and/or support people with oxygen/ventilation until such time as oxygen and ventilators run out.

You assumption that there is a validated treatment which changes the course of illness if someone is diagnosed early isn't where medicine is at right now. The Chloroquinine and azithromycin combo is in a single small study which could have numerous confounding factors.

I think your assumption re: "early diagnosis and treatment" is incorrect, unfortunately, at this stage. Once we have a validated treatment then that could chance but we won't be in that position for weeks or possibly months and that's going to be too late for the people who will die in the initial peak in Ireland over the next 2 to 3 months.

Notsomindful wrote: »

Thanks for link.

That's reassuring for all of us who dont have access to a car/dont drive and dont want to risk.infecting others.in taxis/ high risk themselves...according to the hse, we" may be tested at home".

So we may not get tested at all.

Woohoo.

Absent a validated treatment the benefit of testing lies more in contact tracing and you knowing you must self-isolate. It doesn't benefit the individual hugely as there isn't a validated treatment which alters disease course and outcome yet.

So, just assume you're infected if you have those symptoms and stay at home.

It is dangerous to just make unwarranted assumptions about treatment evidence, availability and efficacy. We really aren't there yet. Everything will be thrown at this and weeks and months from now we will know what does and doesn't work but for the next several weeks to 2 months our best defence is the public socially isolating, distancing and hand washing.

Unfortunately you're doing a piss-poor job of it. I was delivering supplies to my parents today and there were large groups of people out and about chatting to eachother and not observing social isolation at all.

Pseudonym121

leggo wrote: »

Thanks for doing this OP, first thread I’ll check anytime I’m on now.

I’ve noticed a change in your tone and attitude towards the public over the past few days (not saying it’s unwarranted btw). Do you find yourself overwhelmed already with the workload and job ahead or do you feel it’s more your own personal anxiety about what’s to come? I’m trying to gauge what of this is based on your actual day-to-day work/lived experience and what is (educated) worry.

On a similar note how do you compare your own state of mind to that of the colleagues you’re working with on the front line: are you one of the few preaching concern or are the majority of frontline workers freaking out about the public too?

My attitude is coming from simply seeing so many people out and about standing within 18 inches of eachother and having "the chat". Obviously a lot of people are taking it all very seriously but many others are just behaving in a manner which ensures easy spread. I've had to tell a number of people to stand back when they have come within a foot of me when out and about.

I can't talk for everyone but I don't think any doctor or nurse is happy to see people behaving in a manner which causes this to spread further.

Nonoperational wrote: »

From reading your posts I suspect I know what speciality you are in but I appreciate you don't want to answer that publicly. I am heavily involved in GIM and have already completed numerous covid shifts in ED and have seen nearly 100 patients ?COVID. May I ask, will you actually be seeing COVID patients during this and be involved in their management?

I appreciate you not wanting to let people know your speciality but could you at least clarify if you are GIM/Surgery/Psych etc. A broad category. Just so people have some context.
Thanks

Hi, fair points... and I saw this before the edit so I'll address that as well.

I've always been clear that:
a) My attitude is maximum caution with this and
b) that i can't give individualised advice for the reasons you mentioned before the edit but that where possible I would give a general view if I felt that was reasonable.

When someone says... I have cardiology problem A, should I be more careful? I see it as follows:
A) There might be evidence that it is absolutely high risk - point them to the relevant article or graph and say - here's the scientific consensus.

There might not be evidence one way or the other. At that point one has three options:
B1. Sorry, no idea whatsoever until the meta-analysis comes out, won't even extrapolate slightly. This doesn't really help someone who has been unable to reach their treating team

B2. Since it isn't obviously high risk I guess it must be low risk - we are learning about this all the time and things we thought we knew one month ago are now known to have been incorrect. I'm sure we'll know more about it 1 month from now and some of our knowns will change and many of our unknowns will be clarified. Things we think aren't high risk now may turn out to be high risk down the road.... and vice versa.

B3. Since it isn't obviously high risk or low risk the safest way to behave would be to assume you're high risk. If this is wrong then someone may worry a little additionally unnecessarily. If this is right it could prevent them being infected and having a significantly sub-optimal outcome.

I've been very clear that where there is evidence I'll always defer to evidence but where there isn't strong, clear evidence one way or the other then I'd prefer to err on the side of caution. I think that is more helpful than just saying - since there isn't a meta-analysis on the subject I won't answer. I don't claim to have absolute knowledge but I do know how to err on the side of caution.

Are you saying that there's strong evidence that SVT or A Fib don't constitute an increased risk of mortality in those infected with COVID-19? You may well draw the line differently than I and if you do I'd be more than happy for you to pipe up. I am absolutely not trying to hold myself out as the font of all medical knowledge. That would be ridiculous. With that said pointing people to scientific evidence where possible and urging maximum caution where things are less clear is, I believe, a reasonable course of action. Don't you?

If not I'd be happy to have a discussion with you here or via PM as our schedules allow. No-one should slavishly believe what I say but I think there's a lot of information which is just blindly false out there and someone who is trying to give scientific evidence where possible and erring on the side of caution where evidence is less clear is a helpful contribution, IMO. You can of course differ and I'm open-minded enough to be open to persuasion.

As to the category... As I said, I'd rather not because even broad categories really lessen the parameters. I'm not forcing anyone to believe me or forcing anyone to do anything. I'm just trying to give evidence-based advice where possible and erring on the side of caution where there's less evidence.

So much is being learned about COVID-19 at such a rapid pace that no-one can keep up with everything. You may be aware of something I'm not. If you have better knowledge/evidence I'd be very happy for you to post it and help people. I'd have no problems with that.

With that said... I hear you about the shifts and wish you the best.

I've read back the A Fib/ SVT answer and edited it to make it clearer that the answer is an "err on the side of caution" in the context of A Fib and SVT being cardiac conditions so why take the chance... as opposed to "there are multiple meta-analyses which prove this definitely with a P < 0.0001 and a significant effect size". As always, the best solution is to have a chat with your treating cardiologist --- but in the meantime I think it is prudent to be extra-cautious until and unless your own treating cardiologist tells you that there's no extra risk in your, individual, case.

ooter wrote: »

apologies if this has already been asked.
it's horrible hearing the figures of people who may die from this virus but especially the fact that healthcare workers in our hospitals will also die, are all healthcare workers at risk due to their high exposure or is it the same as the general public, older with underlying conditions?

You're going to have different levels of exposure based on the different national and local situations. E.g. in China about 4% of cases were healthcare workers. In Italy it is over 8%. A lot of that may be down to the relative lack of PPE in Italy.

That's risk of exposure. Risk of mortality will largely come down to pre-existing medical conditions. There is some evidence out there that healthcare workers have increased mortality but I don't think that evidence is solid yet. It may prove true but I don't think it is quite at the necessary level to say it is certain yet. With that said if you have hundreds of thousands of healthcare workers become infected and even if only one in a thousand dies then the sheer numbers of infected add up to a large number of deaths.

con747 wrote: »

Do you think the number of cases so far is an accurate number? Also, is there a shortage of testing kits as 2 members of my family have waited 6 days after being referred for testing due to symptoms and underlying conditions and are still waiting. Thanks for your time and effort in this thread.

No, I believe it is quite openly admitted that there was a lack of testing kits which resulted in very stringent criteria being set for testing --- so stringent that a lot of people who may well have had COVID-19 didn't meet the testing criteria. This isn't negligence, it is just what happens when a disease blows up like this.

Availability of testing kits has improved significantly recently. The issue now is building the capacity to actually do the tests - that is low but is being increased every day. It will take time to clear the backlog and then engage in really wide-scale community testing.

Pseudonym121

Sorry, I think I overlooked two questions somehow.

Beagslife wrote: »

Hi Pseudonym121,

Thanks for doing this. It's very informative and thought provoking. Stay well.

My questions is regarding suppressants (not sure if that is the right term) like cold and flu medications/remedies. I used to typically get a couple chest infections (with harsh chesty cough and perhaps sore throat and sometimes fever) a year. For the last few years I find that at the onset of symptoms if I take echinacea capsules regularly I can usually hold it at bay and after a few days I am back to normal. Where I have let it get deeper I would add astragalus to help clear it up. By the way, I'm not advocating the above in any way, shape or form as regards Covid-19.

Could the use of any of the above remedies by the general public cause problems by perhaps masking the Virus (reducing the symptoms and as a result people not looking for testing or being less cautious)? I think I read somewhere that some products had been banned in China for this reason. Possible fake news of course but perhaps you have better knowledge of this.

Would you have an opinion on this?

Sorry if it's not really relevant.

Anyway keep up the good fight and take care of yourself.

If in doubt I think you should ask your GP or respiratory specialist as that advice might vary depending on underlying medical issues. It has a quite a broad range of answers depending on underlying issues, sorry.

Fleetwoodmac wrote: »

Is there any truth in WHO giving directives regarding taking zithromax and chloroquine as prophilacs for covid?

Not that I've heard of. This appears to have been a very small study. Colleagues in the US have messaged me today with several messages from doctors using this combination to little effect... but Trump has run with it and so it is in the media.

It may end up being effective but I do not believe the evidence base is there to say that yet.

Happy4all wrote: »

Thanks for doing this and two questions if you don't mind:

1. My daughter works in a pharmacy and I fear for her health from additional exposure and then surely that impacts on the household's effort of social isolation, being made somewhat null and void. Should we be taken any additional measures?

2. The UK only reported 7 deaths today. A long way short of the daily 100+ prediction. Is this from lack of true testing numbers or signs that things are not as bad as feared?

Hmm... 7 Dead? I think it has been running quite a bit higher than that recently. Here's a good site which allows a breakdown of cases, mortality etc by country. Here's the UK page, scroll down for their daily number of deaths.

https://www.worldometers.info/coronavirus/country/uk/

They've had over 30 deaths a day for the last five days by my reckoning. Unfortunately I think it is only a matter of time ( just under a week probably ) until they have 100 deaths per day. It is very sad.

Pseudonym121

derb12 wrote: »

I’ve always understood that a fever is the bodies way of fighting back at an infection and so I’m wondering if it’s always best to take paracetamol straightaway if I get a temp. I know that an extreme temp of 40(?) can be dangerous, but could it be better to see where a 37 or 38 temp goes before taking something to lower it? I’ve always given my kids calpol as they are so wretched with a temperature and to be honest, I can’t remember the last time I had a temp myself but just wondering.

The best thing to do here is, IMO, to point you to the portion of the HSE website re: symptomatic relief.

Cork Boy 53 wrote: »

Hi. Does it concern you that the number of ICU cases has jumped from 13 to 29 in a single day? Do you still think we are on track for the best case scenario of fatalities from this outbreak?

I don't think this progression surprised most doctors. This is what happens with a disease which doubles every 3.5 days.

aquarius10 wrote: »

My question is if she has COVID19 but has ‘recovered’ by the time she’s tested will it still show in her swab ??

It depends. Even after recovery there is still enough viral RNA present to yield a positive result for some time. How many days exactly is this? Figures vary but I wouldn't be confident enough in any figure to give you an exact number.

up for anything wrote: »

Do you have any idea what ages the four people were who have died from Covid19? All I can find are vague references to elderly.

Sure, but I said that I wouldn't reveal privileged information which I come across through the day job. I am answering questions using publicly available information, official websites, publications and extrapolations.

shesty wrote: »

This question may be more around epidemiology and disease spread, than one you can answer directly, but I will throw it out there anyway.

I am not asking you to commit to a time line here, but does there come a point on the graph of the disease spread where we decide that there is a certain amount of saturation in society, and that people can start moving about normally again?

My angle on this is that if we have flattened the (infamous) curve enough, we essentially have extended the timeline. If you look at it as a mathematical exercise, I don't know what that time extension is, but say it extended to maybe 1 year. It isn't practical to shut the country down for a year. So are there citeria, or decision points along the way where the balance stops being about stopping the spread and become about slowly allowing the herd immunity to build instead?? Is there any information anywhere on that - I think the main point of the question is when does it stop becoming about prevention and move into some form of building up immunity, or whatever the phrase is?

I guess, I am at home with 3 kids, all healthy, keeping away from everyone....how long are we supposed to go on trying to run away from it vs just accepting getting it anyway?

I wouldn't be in a rush to get this even if everyone in your home is healthy. People without underlying conditions can get quite sick also. People act as though not having underlying conditions and being under 60 is a guarantee of good outcome. It certainly makes it much more likely but it isn't certain.

As to quarantine - it won't be for a year. I'll link to an interesting piece from the Imperial College COVID-19 team which shows how, in the longer run, "lockdown" ( or whatever you want to call it ) will most likely be switched on and off in response to ICU capacity issues. It'll be at the end... I suspect that is the model they and we will adopt if we can't get full control like they seem to be achieving in South Korea and Singapore.... with that said I think we should totally aim for the South Korean model if at all possible --- this appears to be what is being done.

I'll also link to an interesting website in the US which, while it may not be a perfect mathematical model, does show how various levels of physical distancing to lockdown impact peak figures and total dead over the next year. I see I'm getting given out to for being direct about possibilities so I think I'll let other models do the talking here - then people can go give out to those model creators.

Purple Mountain wrote: »

Would you ever forsee home testing kits that could even be purchased for a small fee at a pharmacy to cut down on testing clinics?

Certainly. Four things dictate this will certainly happen.
1. Capitalism - there will be lots of money to be made from home testing kits.

2. DIY tests will reduce the exposure of healthcare workers to infection when they swab people.

3. It'll reduce the stress on laboratories reading the tests.

4. Public demand - once home kits become available people WILL buy them. Especially once they have an antibody kit which will show exposure as people will want to know if they can go back to behaving as normal without anxiety and will pay for that privilege.

The Americans are already working on DIY swabbing kits. They said it in the daily Trump/Pence pony show today.

Purple Mountain wrote: »

Also, those who are hospitalised as a result of this, are they going to be billed for their care in the hospital?

I would presume not as we have socialised medicine in Ireland but I honestly haven't given the billing of patients even one second of thought in this whole situation so I haven't explored it and sought out an answer one way or the other.

xzanti wrote: »

Hi, thanks for doing this. Very informative.

I've been giving my kids probiotics for years (FMD Udo's Choice).

I read somewhere that this virus actually uses a persons immune system against them.

Sorry, if this is a stupid question, but could the probiotics actually be a hinderance to them should they catch the virus? Should I stop or continue with them in your opinion?

Edit. They are fit and healthy with no underlying conditions.

Cheers.

I honestly don't know. I haven't seen any evidence one way or the other in terms of probiotics and COVID-19. I can't imagine a way in which probiotics would help or hinder things much either way but I am not aware of any research proving this.

Sorry I can't be more helpful on this question.

Mwengwe wrote: »

This isn't technically a question and feel free to delete it but i've been reading his answers and I think this is going way, way over the line between informing people/impressing on them the gravity of the situation and just plain terrifying people into paralysis. I've read some bleak articles over the past few weeks but the thread of answers by this guy leaves me feeling completely, utterly hopeless. There's got to be a better way to inform.

Thanks for the comment. Yes, I get this can be difficult and upsetting. But understanding how difficult and dangerous a time this could be might move people to:
a) physically distance more and
b) prepare and
c) be more cautious and thus prevent themselves and others becoming infected.

Cynically speaking people don't change behaviours because they're asked. They change because they're motivated by either self-interest ( the vast majority ), group interest ( a minority ) or altruism ( an even smaller minority ).

Reading this thread should, IMO, give people the following messages:
1. You are underestimating how bad this could be if you do nothing.

2. The sooner you do something/change behaviour the better for you and society in terms of personal and overall outcomes. With a doubling time of 3.5 days a week's delay in acting results in four times the cases. So time is of the essence.

3. BUT if you DO change your behaviours then you CAN play a major role in protecting yourself and protecting others.

4. SO, change those behaviours and stay safe, keep others safe and stop the health service from becoming overwhelmed.

I think that last point is crucial --- by changing the behaviours and focusing on that you can focus on something YOU CAN CONTROL and that is a great way of coping with anxiety... Don't focus on the stuff outside your control, focus on the stuff in your control.

With that said if you find this thread too stark for you then the best advice is not to read it. That isn't a dig at you or anyone else, it is simply a realisation that different people have different thresholds for what they can handle and remain functional. This thread may exceed that for you and if it does you shouldn't keep reading it. No casting of aspersions or anything like that just don't read it if it isn't helpful to you. If you find it helpful and can cope with it then keep reading.

I certainly wish you and yours the best and I hope you can read the above in the spirit in which it is intended.

beolight wrote: »

The HSE tells us they have plenty of PPE... How else do you propose we get the message across?

There are definitely issues with availability of PPE. To be fair it would be unfair to expect that the HSE or any health organisation would have enough PPE for a pandemic situation like this just sitting around. I do believe management are doing the best they can... Sure there are failures but they're actually doing the best they can.

Mwengwe wrote: »

There's a medium point (happy medium seems an inappropriate phrase to use) is what I'm saying... I was someone who was already really conscious of social distancing to the point of anxiety. After reading the Answers thread for this I feel like I just want to go to bed for 12 months, or check out altogether. It's too much, he's going on about disinfecting shopping for 6 hours. He's going to lose people who are fighting his corner.
I think some of his more extreme points could really do with a bit more perspective and a bit of challenging. We're not going to get through these dark times by fostering despair.

Thanks for the comments again. I'll deal with them in series....

1. You were already anxious.
If you were already conscious of social distancing to the point of anxiety then you probably don't need to read things which would make you more anxious. You should consider taking a break from media and social media except for maybe the 9 o'clock news and just focus on what you can do.

I, personally, have begun a big decluttering of the place and am planning to start a new exercise regime next week. I'd do it this week but I need to get some work stuff sorted first for obvious reasons. Both of those things are helpful to me in keeping me occupied and giving me something within my control that I can do at home.

At work I just focus on running the best service possible for the patients and supporting the staff so they can sustain themselves through this difficult time.


2. Shopping disinfection.
Well, you make it sound way more extreme and prepper-ish than it really is. My system is pretty simple and is as follows:
A) I assume the delivery man is infected ( this is no different than what the GP was saying on Claire Byrne tonight so isn't really an extreme position to take ) and so ask him to leave the things in the hall.

Since he breathed in the hall and it is a small space I follow HSE guidelines of allowing one hour for droplets to settle. Since nothing will defrost too badly if I give it a little extra time just to be on the safe side I leave it for three hours. In that time I can do whatever I want in the living room, kitchen etc. So it really doesn't impact on me much.

C) After three hours of doing whatever else I'm doing that evening I move the food onto a table beside my UV light steriliser. Now I'm sure I'll be accused of scaremongering for this but the Chinese are on record as saying UV light works to destroy SARS-CoV2, we have used UV light to destroy viruses on surfaces for quite some time and there's a lot of evidence that UV light sterilisation is quicker and more effective than sterilisation by hand for those who aren't trained in disinfection techniques - I also got this same UV steriliser for my parents who need a simple solution.

Here's a nice NY Times article about what the University of Nebrasks has been doing with UV light --- sterilising masks was a significant use case for me.

The other reason I got a UV light steriliser is that it relies on electricity to work and I figured electricity supplies would be protected by all means necessary whereas disinfectant wipes are a consumable resource which I assumed would quickly be very difficult to replace once panic started. Having the UV light steriliser allows me to preserve the limited resource of disinfectant wipes by using the plentiful resource of electricity. It was logical, effective and efficient and this is how Consultants' minds work. We're trained to think logically, be effective and efficient and follow the evidence base without allowing emotions get in the way.

The UV light steriliser was not something I had even dreamed of 5 weeks ago but when I read the Chinese evidence base and worked through the likely actions of governments and the public and the timeline for all of this I realised that buying a UV light steriliser would actually be a reasonable course of action and save me money ( vs using disinfectant wipes even if they had unlimited availability ) over the next year. So it is also economically efficient, an important consideration.

Why do I assume all delivery items are infected?
1. An excess of caution.

2. Here's a link to a New England Journal of Medicine article which points out that SARS-CoV2 can exist for several hours on cardboard and plastic ( the majority of packaging of delivered foodstuffs ). I feel this article supports my assumptions ( which, to be fair, I was operating from for several weeks out of an excess of caution ).


D) I then put the items into the UV light steriliser one or two at a time (frozen food first of course ) , press one button on top and then go and do something else ( TV, cooking, work etc ) until it pings 11 minutes later. The item(s) are now sterilised and I can put them in the fridge or cupboards without having to worry about contaminating anything.

So, the process takes me the time it takes to move things from the hallway to the table where they await UV light sterilisation and maybe 10 seconds per item to put them in the steriliser and turn it on. If I have a 24 item shop that is only about 4 or 5 minutes of extra work above and beyond the normal work of putting them away I'd be doing anyway.

So, not quite the all-day nightmare you seem to think and, to me, it seems like a really efficient, effective and logical solution both in terms of time and money. You may well draw the line differently and you're welcome to do so.

Perhaps the issue lies more in your perception of what I say and less in what I say?

Either way I wish you the best and I would re-iterate my advice that if reading this makes you so anxious then you probably shouldn't read it. I am fine with making people anxious enough to change their behaviour so that they keep themselves and others safer but I amn't interested in making people so anxious it is harmful. If I've done that to you I apologise.

Heighway61 wrote: »

Would you know if any consideration is given to health care workers who live with family members (or others) who are in a high risk category? For example, a spouse or child with cancer, COPD etc.

The percentages are large for:
health care workers infected
rate of transmission in the home
death rates due to existing condtions?

Also, "cocooning" fails in such a scenario.

I'm sorry but I'm unclear on what you mean by "consideration". Consideration in terms of where they would be deployed? I think that is what you're asking. Yes I've seen consideration given to that but the reality is that if everyone who lived with someone who had a significant risk factor was redeployed to a non-COVID ward/location then the shortages of staff would be even worse so the amount of consideration which can be given is limited. That's what I've seen where I work. I am not an HR professional and so can't give you a breakdown across the HSE on that question though, sorry.

rn wrote: »

There's a fine balance that our politicians have to achieve between not invoking complete panic in the population, but yet take the right measures.

What do you think of the German proposal for groups more than 2 to be banned?

Firstly, congratulations to you and your wife. Secondly, best wishes to you all going forward.

Thirdly, I don't have any insight into high-level planning for lockdown etc etc but I expect that most countries worldwide will end up with something pretty close to lockdown ( a la Germany or the UK ) sooner rather than later. I see no reason to expect Ireland will be an outlier. I have wanted this level of enforced distancing for some time but I can understand why the government etc have gotten there in stages as they had to bring people along with them.

begbysback wrote: »

I agree, the tone from the very outset has been condescending, the forecast of death rate exaggerated with no specific reasoning, the request that the public are failing to take directions and need to do more, basically asking the public to get tested and if your positive then stay home and hope it doesn’t get too bad, and if it does get bad then all we can do is put you on a ventilator, if we have one which is unlikely given that they are in short supply.

I apologize that I am a bit irate, but unless some of the answers start including some hope then I don’t see any point of continuing the AMA

I will refer you to the Imperial College COVID 19 Response Team's estimate for UK deaths without mitigation measures. Their estimate was 510,000 deaths in the UK and 2.2 million in the US. That would translate to approximately 50,000 dead in Ireland. So, I don't think the possible death rates for very limited mitigation in Ireland are "exaggerated with no specific reasoning". I understand you may not like those figures but liking them doesn't change the model.

Here is a requote from Post 27 of this thread with the figures I estimated:
"I'm on record previously as stating that the best case scenarios I foresaw for Ireland over the next year were as follows:
Optimistic Best: 2,000 Dead.
Reasonable Best: 5,000 Dead.
Pessimistic Best: 10,000 Dead

Optimistic Middle: 20,000 Dead.
Reasonable Middle 50,000 Dead."

FYI Here's a link to the Imperial College COVID 19 Response Team paper where you can read their model. It came out last week and makes interesting reading.

FYI the UK population is about 65 million, the Irish population about 5 million so just divide their numbers by 13 to get the Irish numbers - assuming you think the HSE is as good and well prepared as the NHS. Divide by more if you think the HSE is better prepared, divide by less if you think the HSE is less prepared.


And lastly, if you find this thread troubling then feel free not to read it. There's no point reading it if you find it so upsetting. I wish you and yours the best at this difficult time and in the months to come.

Yester wrote: »

I've been hearing a bit about "viral load" which seems to mean the longer you are exposed to the virus the more infected/sicker you are likely to get. Do you think there is any truth to this?

Wow, this is one of those... it seems easy but is really complex questions. Are you asking about viral load within the person who is infected or viral load in the environment in which a person is exposed? Sorry I'm just not clear on which you mean. If it is higher viral load in the infected individual I think we are still learning about COVID-19 and there is some evidence that one of the mechanisms of poor prognosis is immunopathological. Here's a summary of a study which is due out in the Lancet next week based on research from Hong Kong. So I think it is fair to say the picture isn't entirely clear yet as regards this new virus. With that said, in general, with other viruses lower viral loads are usually better.... I assume it will end up being the same with COVID-19 but I can't say it has been definitively proven yet.

swirley wrote: »

Thank you for taking the time to answer all the questions.

Is it known how long the virus can live on different surfaces? we have been getting groceries delivered and I have been trying to wipe them down with Dettol wipes in case it's on them - my husband says I am being over cautious.
Do you think it is a good idea?

I think it is a good idea based on the paper I'm linking to here.

I think that if you want to be very cautious you should assume everyone you meet is infected and everthing delivered to your house has been exposed. That way you can clean it and remove the risk. Some may see that as extreme and in that case you do you but the GP on Claire Byrne tonight was saying exactly the same thing so take that for what it is worth.

I use a UV Light Steriliser for this purpose and find it a simple one button push solution to the problem. I much prefer it to wiping things down manually because that takes longer, relies on disinfectant wipes which are/will be difficult to replace and is just a lot more hassle. I think in the long run a UV light steriliser will be cheaper also - although there is, admittedly, more up front cost.

WhiteLight20 wrote: »

Not at all. I am doing the same thing. It’s time consuming but it’s worth it. Supermarkets are the places people are going so it’s definitely in there!!! I’ve also been leaving my post. In a few weeks we’ll be wishing we did more.

Ah, the post... Again I think a UV light steriliser is great for this. I had initially considered just microwaving or heating things in the oven to over 80 degrees centigrade to destroy the virus but that would have spoiled food and wouldn't be suitable for mail. This is one major reason I went with a UV light steriliser as it really doesn't heat anything.

I've been using it on any mail I receive since I received the UV light steriliser. I will provide a link to the one I purchased below. I am NOT endorsing it or anything, just trying to show what I went with. I got this before they started price gouging. I think the price has gone up about 40 euro in just the last few days and even more over the last few weeks.

Anyways, it is big enough to fit any mail, a ready meal, several tins at the same time, my car and house keys at the same time and/or my iphone ( I always pop my phone in there when i get home because I've been using it through gloves during the day and so I assume it is absolutely riddled ). 11 Minutes after I pop any of those items in they come out nicely disinfected without me having to do anything but a button press.

Of note... there appears to be a risk that the UV light might discolour the case or phone over time but, frankly, I couldn't care less about that vs the peace of mind and simplicity of the UV light steriliser.

Also, if you buy a UV wand do NOT use it on your own skin. It can irritate and harm your skin... Another reason I bought my parents the box-type steriliser. They get weird ideas sometimes and I wouldn't put it past them to try to UV sterilise their skin with a UV light if given half the opportunity. I love them but sometimes you just have to smile and shake your head...

UV Light Steriliser

There are loads of different types on Amazon for you to choose from. i'm just showing the one I chose in the hope it will be helpful.


So, interesting links:
1. Imperial College COVID group study

2. I quite like this site which was shown me by a US colleague which shows the impact of different levels of isolation/lockdown very vividly and illustrates the impact of the peak overwhelming health systems there very visually. Obviously their numbers are based on their model which is based on their assumptions and we don't know for certain how accurate their assumptions are ( although I've read the model and underlying assumptions and it seems fairly reasonable to me ). Anyways, here's the link.

Pseudonym121

up for anything wrote: »

Ah sorry, I didn't realise it was privileged information although that's a bit disingenuous because I suppose I did on some level based on the fact that the actual ages are not released. Why is it privileged? Surely knowing what ages they were would not violate patient confidentiality?

Thank you for answering all the questions. It is reassuring to have somewhere to come and get some clarification from the coal face so to speak. I had another question but can't for the life of me remember what it was now.

That's not how I meant privileged information. At the beginning of the thread I said I wouldn't divulge information which I came across through the day job. I know that information from the day job and so I won't answer that question.

Once that information comes out through other means then I would be able to address it. I resent you saying that my response was disingenuous. Doctors may make incorrect assessments and diagnoses but we don't lie to people/patients. A doctor who lies isn't fit to practice. You may not like where I draw the line, that is your right. But to say I'm being disingenuous is entirely uncalled for.

Wanderer78 wrote: »

I just want to say thank you, thank you for putting your life in danger every time you go to work, we need our health professionals more than ever now, going to work must be a truly terrifying experience for you now. Thank you and best of luck

Lots of people are taking risks. We all have to do our part in order to get through this with as few deaths and long-term complications as possible. I think all of this talk of heroes etc is all very American and not something I and my colleagues ( Consultants, NCHDs, nurses etc ) identify with much. Sure we are scared but we are needed and the overwhelming sense is one of not wanting to let our patients or the public down and not letting our colleagues down. That's important because that will help staff cope.

On the other hand I have heard a few ( including myself ) say that we hope the public remember this the next time we advocate for more resources for the health service and proper staffing levels, in particular the number of consultant posts and equal pay for equal work so our well-trained NCHDs no longer emigrate to Australia, the UK and Canada instead of choosing to stay here. Functionally doing that will help us and you all a lot more in years to come than nice words... and mean that the next time you need us the right numbers and calibre of people are available to help you and give you the best chance of survival.

As to going to work being terrifying... Well, I think what I see people doing is just blocking it out, focusing on what is in front of them, doing what they can to practice safely and then recognising that there's a chance they'll get it and then what will happen will happen. Coping with what is directly in front of you and ignoring the scary context is a time-honoured coping mechanism and I see a lot of that around. But, yeah, a lot of people are scared.

I think that some of the higher levels of management and clinical staff are more scared than the front-line because they are looking into the future more and what MAY be instead of what IS TODAY. For example, I'm doing the day job ( all of my existing patients ), an influx of new patients and redesigning services/re-allocating resources in order to meet future needs. That latter part, redesigning services and re-allocating resources is by far the most stressful part of my day and what I've spent my non-working time largely doing for the past week and a bit. It involves a lot of friction, stress and frustration as well as some really scary possibilities. Mostly I ( and others ) are just worried about letting people down and I find the realisation that if I get the design and resource allocation wrong then people may die and/or suffer life-long consequences.... and since I'm just a jobbing consultant and not a specially trained disaster management expert I'm just going with my best guesses and what I've gleaned from whatever research I can do online and by phone I know I won't get every choice right. I will do my best but I know I'll make mistakes and mistakes will result in ruined lives.

That is the heaviest of all burdens. When I talk to senior management ( hospital management, CHO management etc, the ones looking into the future as opposed to middle management and clinical roles focused on the here and now ) the senior management sound really, really fatigued... and not just physically.

But now isn't a time for weakness. It is definitely affecting people though... I was up working on service re-allocation and re-design for multiple services till about 3:30am and then woke up at 6:45am... and I'm a really good sleeper normally. So, for me, that's a sign that I'm feeling stressed, my sleep goes off. But, what am I going to do? Quit? Of course not.


In terms of disaster response healthcare workers etc are in the heroic phase of response. That won't last. Over the coming weeks I expect we'll begin to see a lot of staff becoming dysfunctional and having to be moved into non-critical tasks ( this isn't cowardice, it is just the reality that different people have different abilities to cope with things and some will become dysfunctional when this is exceeded - and what they face could be very bad ) while others just have nervous breakdowns and become psychiatric casualties. We will have to support them acutely and in the long-term --- this is another area we will need the public's support. When this is all done with, healthcare workers and other front-line staff ( Gardai, Fire Brigade, paramedics ) are going to have much higher rates of mental health problems ( addiction issues, suicide, marriage breakdown, PTSD etc ). I hope that the public will ensure the politicians ring-fence the funding required to help these psychologically wounded individuals recover as much as is possible.

If you want to give thanks then please do it through advocating for all of the people on the front line to receive the supports they will need in the future and support us when we advocate for a better health service for the public and the staff within it.

With that said thanks for the sentiment.

joeguevara wrote: »

Thank you and to all medics (and everyone else involved) for the work that you are doing.

I think politicians should not have a platform like we are seeing. It is clear that medics and scientists have issues with what is being said to the public. That frightens me.

https://time.com/5808283/infectious-disease-fauci-trump-coronavirus/

Well Fauci has had the temerity to disagree with Trump recently. Based on what I've seen he wasn't at the last two press briefings so it looks to me like he's done for... He has criticised The Great Leader and that isn't tolerated... irrespective of how correct he was.

The only question is whether they'll get rid of him now or keep him around and then use him as a sacrificial scapegoat, blaming him for their poor response to this crisis. My money is on the latter.

My colleagues in America are really freaking out about this at this stage. Ones who were pretty chilled five days ago are beginning to freak out. It is also interesting to see it cascade down the levels... Attendings ( their equivalent of consultant ) got scared first, then it went down to Fellows and has proceeded down the grades... I've seen some of their interns begin to really get scared via online postings in the past couple of days as their individual hospitals are enacting measures which have made it all real for them. It is escalating really rapidly and none of the ones I'm in contact with ( a small sample size to be sure ) don't have any faith in the Trump government's response.



As regards the heroic phase I mentioned above. Here's a little reading about what healthcare workers and society as a whole are currently going through and will be going through going forward.

Pseudonym121

Yester wrote: »

Thank you for all your answers so far. Could I get your opinion on this? Recently we have met 2 separate people that believe it is perfectly safe to be within 2 meters of us as long as it is for less than 15 minutes. One even thought they were going to be invited in for a quick cup of tea. That wasn't going to happen as we are being very careful. They seem to be getting the 15 minute idea from articles like this

https://www.rte.ie/news/2020/0323/1124891-irish-figures-coronavirus/

The relevant bit says "Generally, you need to be 15 minutes or more in the vicinity of an infected person, within 1-2 metres, to be considered at-risk or a close contact."

It seems like dangerous advice to be giving and makes it harder to get people to stay away when they are getting the impression that less than 15 mins is fine.

What do you think of this?

Well, I wouldn’t trust my life to “general advice” especially when all it takes is the other person, who thinks they’re fine, having one cough unexpectedly and suddenly you’re covered with droplets.

The government had to draw the line somewhere and I think they’re balancing panic with practicality. It is my life and my choice when I’m not at work and so I get to err on the side of caution when not in work. I think that for something potentially this severe it is reasonable to err on the side of caution and stick rigidly to the 2 metre distance + whatever level of protection you feel is appropriate for you ( gloves, masks etc ).

With that said I’ve been keeping an eye out for mask usage in public and in recent days I’ve counted 8 people wearing masks in public - not a single one of them was wearing the mask properly and so was getting almost no benefit ( other than psychological ) from wearing the mask.

RiseAbove4 wrote: »

Thanks for asking my previous question

I was wondering;

If you’re living with someone in their mid 60s and you get it or have strong symptoms of it, what do you do if you share a kitchen with them?

Is going to a budget hotel for 3 weeks a bit much Going to the kitchen would be fairly essential for all

Or maybe order tskeaways and clean down door latch after?

Thanks

I believe the advice in that situation is to isolate yourself in a bedroom with en suite if possible, have food left at the door and picked up at the door. I do not believe that the possibly infected person going to the kitchen is at all essential. Isolate yourself and let the other person make and deliver your meals and pick them up after you are done for the duration of the isolation.

If you both use the same kitchen while one person is infective I believe that it is almost inevitable it would be passed on.

Our definitions of what is “essential and necessary” need to change a bit for the next 3 months... and then possibly in Q4 again.

As to a hotel... I doubt you’d get into one especially as they’d be suspicious you were self-isolating and thus putting their staff at risk.

locohobo wrote: »

Hi again....Just reading you're reply on UV sterilization on home items. As you said the cost of them has gone through the roof and then if can be got...
Am wondering here if a home made option could be put together..
I have one of these..https://www.nisbets.ie/electric-fly-killers
Would it be of enough UV intensity to be effective..
Just put it in a light proof box for 20/30 nmins along with items to be sterilized...
What you reckon??

I honestly don’t know. I’m a doctor not an electrician. WIth that said the UV light used to sterilise medical equipment is VERY strong. It would seriously irritate skin if you exposed your skin to it. These fly zappers are very weak in comparison so I seriously doubt they’d have the power to sterilise things successfully.... but I’m no electrician so cannot be sure.

If you want to sterilise things and don’t have a UV light steriliser then you can simply use disinfectant wipes or a cloth with some water containing bleach etc ( and you wearing gloves to protect your hands). There’s lots of other options which will be effective with a little additional effort without going to something like an extempore UV light box which probably won’t work. I’m just super lazy cloaked in a guise of trying to be efficient ;-)

fishy_fishy wrote: »

You mentioned that a lot of support will be needed for medical and emergency services staff in time to come, and that it will be afterwards that it hits (badly paraphrasing, sorry, but I think that is something that the public will be 100% behind in the aftermath of this).

Are there any formal techniques that are taught to medical staff for dealing with crises? It's one thing to be busy and sort of just keep going and not stop, but presumably staff all go home and have time alone and need some sort of coping mechanism then, even with the crisis ongoing.

The whole crisis has caused a knot of anxiety to develop in my throat so can't imagine how tough it must be for medical staff at the moment.

Well, I think there will be a requirement for a lot of support afterwards but I think a lot of staff will need psychological and even psychiatric support during the next 2 to 3 months. This is going to be rough, especially if and when colleagues die puncturing their belief that it won’t happen to them. I think those of us, like me, who have calculated the odds and made the preparations ( will etc ) may make it through better because we will suffer less shock to our preconceptions when doctors and nurses start dying.... I don’t know if that’s true, just my sense/hope.

As to how staff cope. Lots and lots of dark humour... the sort of stuff that if the public ever overheard us would result in massive levels of complaints for inappropriate behaviour.

So, teams band together by making light of the unbearable to make it bearable. It is either laugh or have a breakdown sometimes. There are some techniques people are taught but they are much more focused at either:
A) coping with stress over the long-term or
support after one off overwhelming incidents.

Earlier today I got a bit overwhelmed at something I considered stupid and hindering effective working and really got annoyed, felt very stressed and at one point felt a little like saying F it all and retiring but I knew that was just the stress getting to me - I have NEVER worked as hard as I have in the last two weeks and I’m sure many others feel the same - and I finished the work i was doing, went and did something else and knew that when I got home I could sleep for a bit and that once I’d slept I’d feel better. Experience gives you the knowledge that whatever it is will pass.

Of course I made sure that none of my NCHDs or my team heard or saw that... I just vented to another consultant who knows the drill - we sometimes form our own pity party when we’re annoyed at HSE stuff ;-) - and got on with it. I’m sure there’s a lot of that going on at all levels and in all types of worker within the HSE/ other first line responders right now. Some level of showing junior staff that it is OK to be stressed is useful as it gives them permission to admit the same but showing them the true stress levels just isn’t helpful. Before I was a Consultant I just assumed they were always entirely unflappable ( except for the ones who had legendary tempers ) now I know they were all very mindful of the fact that if they looked like they were going to crack then the entire team would suffer and I wonder just what was really going on when the NCHDs etc couldn’t see them. I figure it was much the same stuff as I think about when making sure the team doesn’t see the cracks.

THe other thing that helps is the thing that was bothering me is something which I can deliver on by the end of the week - one of the reasons I’ve been working on this every day after work, cause it is urgent - and so I know that once it is done I can go back to focusing more on the clinical day to day stuff which is actually less stressful. I think that is important cause I;m conscious that I can’t go into this worn out or I’ll be at very high risk of burning out and becoming ineffective. So, same as with the need to take care of oneself physically in order to be available for patients etc I think we all are conscious of the need to take care of ourselves a bit mentally so we are available too. So, burn out to get this piece of work done ASAP and then recover ready for the next few weeks.

This is likely to be a long-term overwhelming incident and so I think what has gotten people through up until now will fail a lot of them.... especially the younger doctors and nurses, Gardai etc who haven’t had the time to build up the mental calluses us older, more senior folks have. I think it will also hit staff who have been redeployed quite hard because they may be much more clinically facing and see a lot more death and suffering than they’re used to. I think a lot of them will find it very difficult also.

I think we’ll need to look out for and support them both acutely and with, ideally, ring-fenced funding for mental health supports and a compassionate HR/Occupational Health policy etc going forward.

volchitsa wrote: »

Hi and thanks for making yourself available to answer questions in such detail.

Like many others, including our government, I've been worried by the Neil Ferguson/Imperial College model of death rates, but there is another more upbeat model, mentioned in the Financial Times (sorry, it's behind a paywall, here's another: https://theweek.com/speedreads/904584/new-oxford-study-suggests-millions-people-may-have-already-built-coronavirus-immunity)

This is an Oxford University study by Prof Gupta IIRC, and they believe that the virus had been circulating for a month or more in the UK before it was identified there, and that many people are already infected and have been fine.

That should mean that the more optimistic herd immunity approach could be the right one, although they do call for far more widespread testing, like SK is doing. But basically, is it wishful thinking to say 50% could already be better?

I'm dubious, going by what I hear from Italy (won't count China as I know nothing of their health service) but do you have any technical detail of why the Neil Ferguson model seems to have been adopted without reserve? Does the Oxford study have some massive flaws we should know of?

I’m dubious about the idea that it was circulating for a long time for a number of reasons:
1. The phylogenetic that Ive seen simply don’t support that view. We’d see much more divergence in Irish and UK samples than we currently do if that were true.


2. If, let’s say, 2.5 million Irish had it and it has at least a 1% overall death rate then where are the 25,000 dead since October/November ( which is when I hear a lot of people say this was circulating ). We WOULD have noticed 25,000 people dropping dead over 3 to 5 months. Obviously this is oversimplified but the general gist of “If that’s so then where are the bodies?” Is, I think, a persuasive argument against that hypothesis. In Britain that number would be even higher.

3. Even if you take the one month circulation hypothesis the nature of exponential growth is that if you started with one person infected at the beginning of that month then with a doubling rate of 3.5 days ( twice a week ) that would have become 256 by the end of the month. It would have had to circulate for at least 13 weeks to infected half the British populace.

4. If it HAD infected half the British populace then it should have infected the rest within 3.5 days of infecting half the populace. This simply isn’t what is being seen.

So, I get that they are approaching it from a different angle and thinking outside the box is good and it is good to challenge orthodoxies of thought BUT I just don’t find this view to fit with the facts as we know them.

Even if you assume it had been circulating for 2 months before it was officially spotted - which I think is unlikely - it would only have infected about 65,000 people (doubling every 3.5 days) not enough to give herd immunity. But if that was true then over the NEXT month the number of infections would have jumped to 16 million and we’d have been looking at over 167,000 dead with just a 1% mortality rate. That simply isn’t what we are seeing.

So, it is an interesting hypothesis but even if it is correct it wouldn’t have resulted in the sort of herd immunity that they posit without causing a LOT more deaths than the UK is currently seeing. They seem to have some weird obsession with this herd immunity concept over there. I can only imagine that it is because it would allow them to restart the economy much more quickly.

I don’t get why so many people online ( not you, just a general observation ) seem to be pushing this idea that it has been around since earlier this year or last year because “what I had was no flu”. The maths of exponential growth, phylogenetic and death rates just do not support those theories.


And lastly, I thought I’d provide a link to a sobering site. It is from the Italian doctors council ( I can’t read Italian so I’m sure I’m off in my translation ) and lists the number of doctors who have died. I have tried to find a similar list for nurses but can’t. If anyone finds it I’d be happy to list it also. We’re all in this together and the virus surely doesn’t discriminate.

So, the stand out number yesterday was 24, today it is 33.... 33 dead doctors. https://portale.fnomceo.it/elenco-dei-medici-caduti-nel-corso-dellepidemia-di-covid-19/ It’ll be higher tomorrow. Sobering stuff.

And now I’m off to fit a little work in around the leisurely days on the golf course ;-). Good luck to all and take care.

Pseudonym121

Strawberry Swan wrote: »

Thank you for giving such detailed information on all this. All your posts over the past month have been an eye opener for me and this is an invaluable place to come to for honest upfront advice and information. I've shared with others.

I have donated to the Rape Crisis Centre on your behalf. What other charities / campaigns would you recommend donating to, to help the fight?

Thanks for the comment. I don't have any other charities or campaigns I'd recommend donating to to help the fight. In general I support the ISPCA because how some people mistreat pets/animals in general is very upsetting but at this time I'd just keep my powder dry and wait the 8 weeks or so of this lockdown.

If you want to support medical staff/help the fight then the best things you can do are (IMO):
1. Stick to the lockdown and advise anyone else who chafes at the restrictions to stick by them.

2. Afterward keep social distancing and handwashing - this isn't over yet. In fact the next two months may only be a dress rehearsal for winter time if this follows the Spanish Flu pattern.

3. Keep supporting healthcare workers - not by going on clapping hands, breaking social distancing and actually picking it up from your neighbours - but by actually listening over the next few years when we advocate for more resources for our hospitals and better pay and conditions so good doctors and nurses stay in the health service to look after you all the next time this happens, and it will.

IrishAlice wrote: »

Thank you for everything you are doing.

I have seen an increased amount of coverage about the supplies of PPE dwindling.

Paddy Cosgrave has been particularly vocal about this on twitter and tweeted last night that one of Ireland's shipments was intercepted and taken by a larger EU country.

Are you concerned that there won't be enough supplies when we actually reach the peak of the curve?

There aren't enough now. It is a race between getting the supplies in from China, figuring out how to sterilise and re-use what we have - beautician/hair dresser UV light sterilisers may have a role there - and the onset of the peak.

If the peak outstrips our ability to re-use and fly in from China then things are going to get even worse for healthcare workers. It is out of our hands - this is why I and others were begging you all to socially isolate, distance and hand wash over the past few weeks. The more you did that the more you helped keep the peak low, ensure we won't run out of PPE and that we won't have to expose ourselves to risk unnecessarily.

This is what people misunderstood about my tone earlier. It wasn't condescending or hopeless... It was simply realistic about where I could see we were going to end up if people didn't listen. I know a lot of people listened to doctors' messages on TV and radio ( and in my small way here ) and hopefully it will have proven to be enough.

Buford T. Justice VI wrote: »

I'd like to echo the many thanks from all of us here for what you are doing and the risks you're taking for us.

A small question if you get time, I'm curious about the strong male bias in the infection rate, some 55% versus 45% for females.

Would this be mostly due to males having riskier behaviour and not washing/disinfecting as often as women or is there a higher susceptibility in males to the virus?

I wouldn't be as worried about the disparity in infection rate vs gender in Ireland as I would be about the expected disparity in death rate vs gender.

Essentially men are dying at a disproportionate rate to women. So, men are more likely to get infected and more likely to die if infected.

Here's a good article for the guardian which makes easy reading for those who want to disseminate it. https://www.theguardian.com/world/2020/mar/26/men-are-much-more-likely-to-die-from-coronavirus-but-why


I think you can see some reflection of this on the page listing the Italian doctors who have died from COVID-19... They are overwhelmingly male.

And on that note the number is now 51, that's up from 33 yesterday.
https://portale.fnomceo.it/elenco-dei-medici-caduti-nel-corso-dellepidemia-di-covid-19/

And our first here . Sad but inevitable news.


As to the 23% healthcare worker infection proportion... It isn't what it seems.
FWIW the 23% figure for health care worker infections is an artefact of the low level of community testing. I expect the actual the percentage of healthcare workers infected vs total number of infected will probably be closer to 10% by the time the first wave is done - sometime end of May/beginning of June. By this time next year I expect that the number of healthcare workers infected relative to total infections ( absent a vaccine ) would tend to fall towards the percentage of healthcare workers in society as more of society becomes infected during the putative second wave we might see over winter 2020 ( absent a vaccine ).

At present it simply reflects that we haven't done enough community testing to get a true sense of the number of infected in the community.

Pseudonym121

feargale wrote: »

Could the virus be carried by paper? Should I cancel delivery of newspapers and magazines?

We are clear that it can survive on paper ( and other surfaces ). It is unclear how long it survives but most research I've seen says it survives at least 12 hours and possibly for several days.

One of the steps I took when I realised how serious this would be in February was that I stopped getting newspapers and magazines in person and subscribed to the online versions. They're actually great on a laptop, tablet or ipad.

That way you still get the newspaper and magazine, frequently save money as the online version is cheaper than the paper version AND you cut down the risk of fomite transmission within the home. Win, win, win.

With that said I can't tell you what to do as regards your magazine or newspaper delivery except to say that if the delivery person has it on their hand and delivers the paper to you then it is likely to be on the paper you bring into your home.

s1ippy wrote: »

Hi Pseudonym,

Just wanted to say thanks for everything. Reading your information has been a great consolation and help. I donated in to the local RCC and women's refuge in your name. Your input is so appreciated.

I was looking at UV lamps, this one says not to have humans or animals present when it's in use.
http://vi.raptor.ebaydesc.com/ws/eBayISAPI.dll?ViewItemDescV4&item=372985569977&category=20706&pm=1&ds=0&t=1585363933585&cspheader=1

Do you think this would be more or less risky to use than a bleach solution to sterilise shopping? Just to note that I don't spray the solution directly onto goods that will be consumed, just packaging, and once the veg are unwrapped, I scrub them thoroughly with warm water.

I think UV lamps are really irritating to skin and I think people who buy those sorts of wands are highly likely to damage their skin and eyes. That's why I avoided them myself and why I eschewed them for my parents/siblings.

If you can't get an enclosed UV light steriliser I would just stick with disinfectant wipes etc as I think those wands are more dangerous than beneficial to the average person. That's just an opinion though and not something I can point to research papers on, I just know I wouldn't trust my parents to use them properly.

s1ippy wrote: »

We follow protocols similar to what you outlined. We do click and collect for our shopping quarantining an area for when we return, adhering to rigorous IPC measures, disinfecting everything and then leaving area for a few hours and washing clothes and showering off any potential virus on skin. Even then, when we load the shopping into the cupboards and fridge, we use gloves to pack the stuff up and keep it separate and don't use it for a few days.

It's possibly overkill but we are exercising an abundance of caution. I wonder what your thoughts might be on this University of Nebraska study. It's as-yet not peer reviewed, to my knowledge, as it's only five days old.
https://t.co/ZpCXu3JBv2?amp=1

No worries if you can't get to it, I'm sure you are amply occupied at this particular juncture. Thanks again.

I had a quick scan and it seems to simply say that SARS-CoV2 is spread by droplets, toileting and fomites and thus can be spread directly and indirectly. That has always been my understanding. I definitely assume that it can survive on paper, cardboard, plastic etc on deliveries to my place.

Purple Mountain wrote: »

Hi.

I just wanted to ask about what actually kills a CoVid patient?
I read today about a patient in another country who actually was stabilised in hospital after it but then got a superbug.
Is it a case of the fluid on the lungs gets too much and that's what takes the patient or in some cases does the virus travel to the heart and cause cardiac arrest?

Well the main cause of death seems to be Bilateral Interstitial Pneumonia which appears to be directly caused by COVID-19. However as with any viral infection you can get superimposed infections ( superbugs and ordinary pneumonias ) and you can get involvement of other organs... figures I have seen show 20%+ of patients have elevated Troponin levels - indicative of heart damage - and colleagues in America have told me patients there have died of cardiac complications. SARS-CoV2 has also been isolated from cerebrospinal fluid and found to be shed in stools.

So, it seems to get pretty much everywhere and if any organ system is weakened/vulnerable that could be a pathway for it to cause death. With that said the main avenue certainly appears to be the lungs.

About 3 to 4 months from now when Europe has had time to get over the peak and crunch the numbers I think we'll have a very clear sense of the ways in which it killed people relative to their underlying risk factors. I think this will help us tremendously in preparing for the likely second wave of infections in Q4.

Purple Mountain wrote: »

I mentioned this in another thread but I'll ask here and I hope you don't take offence because none is intended.
With the Dept of Health quoting ICU beds going overcapacity, they don't seem (in my opinion) to take into account people leaving ICU and going back to a regular isolation ward or unfortunately god forbid dying.

Many thanks for your information and of course your service.
Wishing you a good night's rest hopefully if you're off.

Well, someone tubed in an ICU bed with COVID-19 is going to be there for quite some time - likely more than two weeks - and over the next two weeks as we experience the peak people tubed today are going to either die or still be taking up a ventilator. With an exponentially growing infection like this which is doubling ever 3 or 4 days the growth is such that 2 weeks from now we could be seeing 16 times the number of new people needing a ventilator per day than currently newly need one.

So for two weeks, until we peak, the only people coming off will be the ones dying, not recovering and by the time the people from today recover we'll need so many more new ventilators per day that the number recovering will be a small % of the new ventilators needed that day ( 5 to 10%).

So, statistically right now the number of people recovering over the next 2 weeks is a small proportion of the number who will need ventilation over the next 2 weeks. I think people still don't quite "get" how bad this is going to be. We are likely to see between 30 to 60 deaths per day for an extended period of time ( 4 weeks or so ) when this hits its peak. Somewhere between 1,000 to 2,000 people are going to die from this in April and May if we do everything right. If we make mistakes during this period then even more will die.

Add in the fact that 80% of all deaths from this are likely to occur in Q4 unless we get an experimental vaccine/absolutely massive increases in ventilator capacity weekly between now and October and you can see that my pessimistic best case scenario of 10,000 dead in the 12 months from 1st March 2020 to end February 2021 is pretty much what we're looking at now.

If we get even an experimental vaccine for high risk people by September than we should be able to reduce the 8,000 additional deaths (after May ) massively but up to 2,000 by the end of May is pretty much guaranteed at this point.

With that said the reason I started speaking out about a month ago was that we were sleep-walking to my reasonable middle case estimate of 50,000 dead in the year with about 10,000 of them being in April to May so by the actions taken we have avoided many thousands of deaths over the next 8 weeks. The state has done an amazing job - yeah, lots of mistakes have been made too and the lack of PPE is a real tragedy but this is a crisis and to expect a perfect response when there's such a dearth of information is unreasonable. They've done well once they got going... I just wish they'd gotten going about 2 weeks earlier. It would have saved a lot of lives.

avalidusername wrote: »

Hi Pseudonym,

Just a couple of questions.

1) Long term, do you think the lockdown/social isolation could have a beneficial effect on Irish society in general? By this I mean an increased awareness of hygiene, maybe reducing the winter vomiting bug outbreaks. Or people generally having more respect for the health services and not running to the hospital for minor ailments?

Well, I think the next time we get a pandemic - and we will get another one given human encroachment into natural areas and attitudes to bushmeat/live markets etc - people will order masks in earlier and wear them more. I think people will also be more tolerant of moving to mass testing and self-isolation more rapidly. The state will be able to do that in days rather than weeks.

Do I think it'll result in more respect for the health service?
I hope so. I doubt it though. I think it'll be like Rudyard Kipling's poem, Tommy. At a time of crisis people will go out clapping and call everyone in the health service "heroes" - so Fing American - but when it comes time to advocate for equal pay for equal work for Consultants and nursing staff a year or two from now people will have forgotten and go back to calling Consultants lazy, privileged etc etc. And if they do that then more and more of the juniors will emigrate once they finish their training and the Public will be left with a hollowed out HSE for the next pandemic, resulting in more deaths.

So, do I think the public will change and maintain that change? No, it isn't the way people work. Sorry for sounding so jaded but this is what happens when you have to read what the public write about us online or say on the media for years running. It'll go back to that vitriol soon enough.


Will it change people running to hospital for minor ailments?
No, I doubt it. A lot of Irish people have a tremendous sense of personal entitlement and very little sense of personal responsibility and, in the long run, I expect that they'll revert back to thinking that their minor ailment is the most important thing in the history of important things and needs to be treated RIGHT NOW!!!! The number of people who have had a niggle for 4 to 6 months and then decide at 2am on a weekend morning that they should call an ambulance and be brought to A&E to have it treated RIGHT NOW would amaze you if you could experience it.

I see that happening every week and the sorts of people who do that will continue to do that in years to come.

With that said a lot of people are brilliant and don't over-react but a significant minority ruin it for the rest of the population. One of the real privileges of my work is that you get to meet so many people and, even when they're in a bad place - sick, scared, in pain - many of them are just decent human beings... and to be a decent human being when you're sick, scare and in pain is magnificent to see. Some days I feel the job grinds me down and makes me think everyone is a selfish you know what.... and then I have an interaction where I genuinely laugh at someone's wry sense of humour or the thoughtfulness they have towards others while they themselves are ill or see them being more worried for their family than themselves. It really gives you hope for humanity.

Recently I've been touched by the number of my routine out-patient reviews which have finished by the patient actually sincerely wishing me good luck over the next few weeks with the full knowledge that the next few weeks are going to be tough for people in the health service. Several colleagues have reported the same. It has been very unexpected and quite touching really.

avalidusername wrote: »

2) A former colleague of mine has recovered from the virus. He's from Bergamo and we think he contracted it at the Atalanta v Valencia Champions League game they're calling Game 0 now. With this game being possibly linked to the massive outbreak, what was your view on Cheltenham going ahead this year?

I was on record at the time as saying it was ridiculous and would act as a major nexus of infection. I'm certain this will be proven so when we look back at who was infected and where they were exposed. Same for letting the Italian fans into Ireland. Those were two of the mistakes made by the state.

avalidusername wrote: »

Finally, many thanks for your input. You will be blessed for your efforts, if not by a higher being, then by science for protecting your nearest and dearest with your isolation.

LOL! Wow that sounds amazing... I could be a hero of science ;-). Nah, I'm just a jobbing consultant trying to do my best for the people of Ireland as I and my colleagues try to do every day - whether there's a pandemic or not.

The one self-serving thing I'd ask is that the next time you hear Consultants and nurses advocate for better services and equal pay for equal work don't just dismiss their pleas out of hand. Don't necessarily agree but at least remember that these are the same people who put their bodies and lives on the line for the rest of you and just hear us out the next time we speak up on our and your behalves.

leggo wrote: »

What are your thoughts on doctors in NYC using antibodies of recovered patients or patients in Norway and Spain being trialled with new medication? Obviously the point of these trials means you don’t have an answer for whether they’ll work or not, but with industry knowledge do you see how quickly these are being developed as a positive sign or would this be standard fare expected of a situation like this? And say one of these treatments were to have initial success, how would you anticipate that playing out and affecting the overall global fight against this?

In a situation like this? We haven't had a situation like this since 1918. Without lockdowns and massive medical interventions SARS-CoV2/COVID-19 had the potential to kill a minimum of 2% of the world's population ( 150 million people ) and a maximum of about 10% (750 million ).

We won't see those numbers... In Italy the 2% number would have meant 1.2 million dead by end of February 2021 with about 240,000 of those dying by the end of May 2020. Instead I think Italy is looking at between 25,000 to 30,000 dead by the end of May. So that's a tremendously good results all things considered. Absent a vaccine it still means they are on track to have 200,000 to 240,000 dead by the end of February 2021 though.

I've said for some time that American is going to be the Western liberal democracy which comes out of this the worst. Right now it is difficult to imagine them having less than 100,000 dead by the end of May with a minimum of 500,000 dead by the end of February 2021. America is really difficult to predict though because when you run a model for someplace like Italy you can at least assume the government acts rationally. They may not listen to medical experts for some time as they re-orient to the new reality but they are at least rational. Trump is just chaos and you can't predict what he'll do from one day to the next. America SHOULD have been well able to deal with this. They have tremendous resources and reserves of equipment but Trump is squandering time and these reserves and resources. I wouldn't be at all surprised to see 2 million dead in American by end of February 2021 if Trump continues with his current "management" style.

I think that what we are currently seeing will go quite some way to accelerating China's overtaking of American, at least in terms of soft power, on the world stage and will obviate the Thucydides Trap that we have been looking at occurring sometime around 2030. America will fall faster, China will rise more quickly and America will become far more insular with Trump on a second term. All in all that will obviate the military outcome of the Thucydides Trap. IMO of course.

Anyways, back to your question: Everywhere will throw everything they have at this. Rushed vaccine trials, compassionate trials of unproven meds on dying patients, retooling of factories, repurposing of entire sections of the economy etc. I think trying to use convalescent antibodies is a reasonable thing to try. It has a long history in medicine with variable results but in this situation it is absolutely a reasonable thing to try.

Let us be clear though, absent a vaccine by Q4, more people are about to die worldwide than died during the entirety of World War 2. By that I mean about 1% of the current world's population of approximately 7.5 Billion people. This is unprecedented since the Spanish Flu of 1918 to 1920. That 1% figure won't apply to countries like Ireland ( I've said before I think we're in the top 15 countries in the world for getting through this well, America is only in the top 30 ) but when this really gets going in Africa, Indonesia and South America it will easily kill 20% of the elderly infected there... the one bit of "good" news is that a lot of those areas are relatively young but if you're old and not rich in those areas then you are in deep, deep trouble.

So I think we'll see a mix of 20% mortality in the elderly in countries with a lot of income inequality, poor healthcare systems and poor/weak centralised governments and 2% mortality among the elderly in rich western countries with socialised healthcare/ Asian countries with a culture of obedience to social norms and experience of surviving SARS. You then need to take those stratified death rates and run them through the % of elderly in those countries. Rich western countries with good healthcare systems have a lot of elderly people --- because of those healthcare systems being good - while the countries with high income inequality and poor healthcare systems frequently have much lower %s of elderly as so many die young. So it all gets very complex.

With that said I'd rather be elderly in a European liberal democracy than almost anywhere in the world right now - Singapore and Taiwan excepted.

dermob wrote: »

Hi, and thanks for all your help!

Is there a specific test for Covid 19

Yes and tests for antibody presence are also being developed/deployed so soon we will be able to tell if you've ever had it, not just if you have it now.

Purple Mountain wrote: »

I just thought of another question, sorry maybe this isn't a medical question really!

If Ireland is very successful with curtailing the spread of this with our restriction measures and in a few weeks/months, it's all but eradicated here - great.
But then if our airports and ports are open and we have traffic from countries that haven't taken the same measures or been successful, then we just go back to square one again?

This will be around until we have a vaccine. At that point it all depends on whether there is sufficient genetic change in the virus to constitute a new strain. If there is then this will circulate seasonally just like the flu.

So, yes, I'd expect that most countries around the world with any sense will institute a 14 day mandatory or voluntary self-isolation for visitors. Countries reliant on tourism may not do so. Ireland could be one of those countries. Theoretically if we have massive testing regimes then we could open the borders without mandatory quarantine for incoming travelers. Right now though I'm just focused on the next 8 weeks for obvious reasons.


The good news is that the evolutionary pressure on a virus like this is to select for increased infectivity and decreases mortality so if we do get strains circulating and changing seasonally they should select for decreased mortality rates and over time it will become more flu-like. People not born now won't be able to believe, when they are 30 or 40, that we were ever so scared of COVID-2060 because by then it'll have selected for decreased mortality so many times that it won't be the threat it is now.

The reason it is such a threat now is that it has spread around the world so rapidly after transferring from animals and so is still in a very lethal form.

This sort of stuff is what makes virology/epidemiology and the study of pandemics so fascinating. So, bottom line, the vast majority of the world's population will be just fine and 20 to 40 years from now even if this is seasonal it will be massively attenuated and people not born now won't understand what all the fuss is about when people alive now are anxious about getting their yearly vaccine. I look forward to that day.

Pseudonym121

I think this deserves a separate post:

I think one key message here is that with the efforts the medical community, aided by management ( for once, they're usually an Fing hindrance ), the Gardai etc and the government are making we are going to come out of this better than the vast majority of countries in the world. Europe in general, Taiwan, Singapore and possibly China are going to come out of this better than elsewhere.

This endless - the HSE is sh!t, the Irish response has been woeful commentary is ridiculous. I am FAR from a cheerleader for the HSE or the government BUT both have done quite well ( albeit with some mistakes ) given the unprecedented nature of this.

We all need to do our part - including the public by staying at home for a couple of months and keeping the b!tching about it to a minimum but, as a country, we are going to be OK and come out of this better than most others.

I'm not in favour of mindless optimism BUT I am in favour of keeping this in perspective. We're about to take a really painful hit but this isn't armageddon on a societal basis.

Pseudonym121

barrymanilow wrote: »

Hi thank you for taking the time to do this.

My Question is if you were going to go to the trouble of wearing a properly fitted suitable mask in public then should you not also be wearing goggles ? could droplets get in through the eyes as easily as through the mouth or nose ?

I think I'd feel too self conscious to wear goggles in a shop for example , I might wear a mask but what would be the point of doing one without the other?

Well, I have goggles in addition to respirator N99 and general N95 masks and while one could be infected through someone sneezing into your eyes while out in public I rate that as quite low risk at the moment. If we hadn't gone through with all of the mitigation that has been enacted over the past month I think I might be wearing goggles by now but, as it is, I think that unless someone sneezed in my face from close range in public then I don't think goggles are necessary.

We all have to draw the line in terms of protection vs looking like a Mad Max extra for ourselves and that's where I draw the line. We don't have enough community spread ( and likely won't have during this phase of the pandemic ) for goggles to be something I deem essential. Your mileage may well vary obviously.

Walking through a space where there are droplets or even aerosols with your eyes open without goggles vs breathing that air into your lungs are two very different levels of exposure with very different levels of risk. hence a mask is a good idea, but goggles are, IMO, overkill right now.

barrymanilow wrote: »

Also do you think that members of the public who have PPE should donate it to front line health care workers who might need it more once it comes down to that?

It already has come down to that in our hospitals and nursing homes. I was talking to someone today involved in worker's health in several major hospitals and was concerned for their psychological health given how angry and upset they were over the whole situation. But, it is what it is, and you go to war with the weapons and supplies you have, not what you wish you had. They were so upset they couldn't see that.

volchitsa wrote: »

Just related to this question, would normal glasses for sight be of any use?

I've been assuming that my normal glasses would be of some use there, although TBH as I don't wear a mask when I go out, it might be a moot point anyway.

I do try not to go out much though. I just can't work out whether wearing a mask is a sensible precaution or complete selfishness when anyone not directly in the front line but still exposed, like delivery men or shop workers, often seem not to be able to get as many as they need.

Well the use of goggles in a hospital vs when out shopping are in two very different environments. I'm going to reply based on joe public popping down to the shops. In that case I think your main risk would be someone sneezing into your face and literally sneezing droplets into your eyes. In that case if you are wearing glasses the glasses would act as a barrier and may prevent the droplets hitting your eyes and then passing through the mucous membranes.

Failing glasses or full on goggles one could also use swimming goggles as they have a good tight fit and are watertight... They definitely would draw more attention than just glasses though. With that said I could be wearing glasses when out and about and don't bother as I think that risk is very manageable by just not standing in crowds etc.

In terms of donating masks --- well, you have to be aware that even if donated there is no guarantee they'll be used. I have heard several cases of people in healthcare being forbidden from using their own personal masks etc in work and being instructed not to use any PPE or to use lesser PPE than their own personal equipment. I faced something similar and just ignored the individual involved. I've currently had 2 complaints/episodes of being reported to management about my preparedness/instructions to my team/department on how to protect themselves better long before the HSE enacted the sort of stuff I was instructing them to do. Over the last couple of weeks both of them have been withdrawn and apologies given as the individuals involved came to realise how serious it was. Even if they hadn't been and had been upheld I'd just emigrate to Australia next year after this is over rather than keep dealing with this sh!t.

With that said I've got to say as they've begun to understand the seriousness of this they're coming around. It is just a pity they weren't were they are now 4 weeks ago. it would have saved lives but I guess it was a big mental shift to make and it takes time for people to adjust.

This is what clinicians mean when we talk about the HSE being dysfunctional. Even just two weeks ago people were reporting doctors and nurses who could see how bad this was going to get for trying to protect themselves because we weren't following protocol 16.3, subsection c or whatever bloody protocol people who didn't understand anything had come up with. It is an Fing disgrace.

MonkieSocks wrote: »

I posted this on main thread

One reply stated

How much of a virus payload is needed for a test to be Positive?

I mean you either got it or you don't got it, if the present test is that ambiguous it very worrying going forward with diagnosing this virus

The main thread is a cesspool of ignorance and conspiracy theorists from what I can see. I don't read it because it made me think maybe the virus should win. With that said I can say that this sort of simplification of medicine - you either have it or you don't - is the sort of thing people who watch medical tv shows often come out with. Those shows make really grey, complex situations seem like they can be resolved by a single test. That just isn't how medicine is.

You can be infected by SARS-CoV2 and be on the way to developing COVID-19 and if there isn't enough viral RNA in your nose or throat ( where they swab ) to be replicated by the PCR test then you will test negative. Just because you have COVID-19 doesn't mean you have huge amounts of virus in your nose or throat all the time. Real life and medicine is so much greyer, subtle and more complex than TV shows make it appear.

Mwengwe wrote: »

You say:


"This sort of stuff is what makes virology/epidemiology and the study of pandemics so fascinating. So, bottom line, the vast majority of the world's population will be just fine and 20 to 40 years from now even if this is seasonal it will be massively attenuated and people not born now won't understand what all the fuss is about when people alive now are anxious about getting their yearly vaccine. I look forward to that day."

Sounds optimistic in isolation, but by your own reckoning earlier in the same post, we'll probably have another pandemic before then? Am i right? Do you think the next one will be worse?

Good point. Well I think that over the last 20 years we've had a potential pandemic every 5 years. I see no reason for that pattern to change over the coming 20 years. With that said I think that the next time there's an outbreak in nowheresville somewhere on the planet the WHO will be funded to send a metric f*cktonne ( that's a medical term of measurement for a lot of virologists and epidemiologists ;-) )of people down to squash it in its tracks.

Singapore got their response to SARS-CoV2 so right now because they learnt from their mistakes with SARS. We will do better next time because when we get a vaccine next year we will do a full post-mortem and put plans in place for next time... and be in a position to jump to total lockdown much, much earlier than the public would accept this time.

This one is pretty much a reasonable middle case pandemic. It therefore is probable that the next one will less severe or no worse than this with truly worse case scenarios significantly less likely. With that said it is certainly possible it could be worse. I'll outline how it could be worse ( basically longer asymptomatic infectivity and increased mortality ) ....


The ultimate nightmare is as follows:
An airborne ( via droplet AND aerosol spread + fomites ) virus with a very high rate of mutations ( causing multiple strains and thus decreasing vaccine viability ) with a high R0 of say 40 to 50 ( people who say this is the most infective thing ever annoy me. This has an R0 of maybe 2.5 to 3.5, measles has one of between 12 to 18, the infectivity could be a lot worse. ) with a prolonged incubation period ( 2 weeks or more would be ideal ) AND with a significant duration of asymptomatic spread before symptoms appear. Ideally mortality would be upward of 50% but for the process of dying/recovering to take a long time so as to overwhelm the healthcare system and for survivors to have long-term sequelae. After 1 year you'd have maybe 50% mortality, year 2 would take 50% of the remainder and so on and so forth until either some cure was developed or only those with natural immunity remained. Even if you assume 2 to 3% natural immunity you'd reduce the population to that level after only 5 to 6 years.

Is something with that potential out there? Probably. There are a lot of viruses which exist in animals which haven't yet spread to humans. Most of them will do very little harm but if even one in a thousand of these mammalian viruses in animals has this potential then we have literally hundreds of candidates out there for a pandemic which would make this look like a picnic.

On the other hand maybe it will provide the impetus for us to start treating nature better... because nature has the potential to wipe us out as a technological civilisation and if we keep prodding it that might just happen. This is one reason I agree with Musk ( who can be a bit of a nutter a lot of the time ) that we need to become a multi-planet species ASAP. The survival of a technologically advanced civilisation on earth is not guaranteed - I'm not talking extinction, just removal of the critical density of people you need to maintain technologically advanced civilisation. We'd regress technologically.

SARS-CoV2 is scary but if we had more asymptomatic spreaders and a higher mortality rate amongst the young this would be much, much worse. So, while this might be difficult to believe, what we are experiencing now is not the worst case scenario for a pandemic at all. This is much more like a reasonable middle case scenario. The pessimistic worst case scenario I outlined above, R0-50, mortality 50-90%, asymptomatic spreaders for 1 to 2 weeks before symptoms develop would wipe out technological civilisation as we know it.

This, thankfully, is not that... it isn't even close to being that. We got lucky this time but we need to learn from this cause next time we may not be as lucky. So, good news wrapped in a sh!t sandwich ;-)


66, that's the number of Italian doctors dead now. Unless we get more PPE to the places that need it in order to allow proper levels of protection we'll be letting our frontline staff ( doctors, nurses, porters, nursing assistants, people working in nursing homes ) down massively.
https://portale.fnomceo.it/elenco-dei-medici-caduti-nel-corso-dellepidemia-di-covid-19/

Pseudonym121

Hi MrMagnolia,

Yeah I noticed a few days ago that it was over 20,000 or so... I have no idea how that compares because I’m a neophyte here but at least it means some people got some benefit, hopefully, from reading my posts and got a chance to prepare properly for this/understand how serious this is and how long-term this is going to be.

Honestly I can’t give you a diagnosis over the internet but I can say that they way I’d treat that is as follows:
1. I probably had it/some strain of it
2. But that won’t mean that I assume immunity.

Various strains of this are inevitable and until it attenuated its lethality as it adapts to humans I wouldn’t assume that I’d dodged this particular bullet.

As regards the masks... what type of mask? Surgical, N95 without valve, N95 with valve, replaceable filters or not, respirator mask?

I have quite different processes for the three types I have - surgical masks, N95 with valve and replaceable filters and respirator masks. Also I’ll assume you don’t have a UV light steriliser but have disinfectant wipes, correct?

I’ll give a quick outline below depending on mask and equipment levels:

1. If you have an enclosed UV light steriliser —- i believe they are for sale on amazon UK again.

A. Surgical masks - simply put them in, run the automatic programme and they come out sterilised. Let them rest till the next day and they can be re-used. Obviously single use is best but if you only had one surgical mask I’d re-use it until it became uncomfortable to breathe through as a surgical mask is better than a scarf or nothing at all.

B. N95 mask with or without valve with replaceable filters.
Take out the filters and place them beside the mask in the UV light steriliser. Turn on, run the programme, everything is sterilised. I’d then be happy to re-use the mask the next day but would put the filters aside in a box set aside for this purpose and leave them in there until such time as I’d gone through all of my other filters. Then I’d start back on the Day 1 filters.

This assumes one cannot get resupply. When I realised this was coming back in February I ordered 6 months worth of replacement filters ( about 200 ) for my N95 masks with valves and replacement filters and 3 respirators. The N95 masks with filters give me 6 months with no re-use of filters and 1 respirator should do for a year, the other two should do for about 6 months each. So all in all I prepared for 2.5 years with no resupply. I estimated that in the worst case scenario I’d only need 1.5 years worth of filters/masks but I wanted a reserve because in the worst case scenario I could envision people with masks having them robbed by those without and so I wanted to have sufficient reserve that if I was robbed twice I’d still have a minimum of 18 months worth of usable masks/filters. I also got 4 different types of masks/filter combos so that if supply chains failed I’d be able to order multiple replacements and if even one type came through I’d be fine.

To be clear this isn’t being some insane prepper, this is just how doctors are trained. Assume everything goes to sh!t and have plans A, B, C and D to deal with all of the ramifications, include fallbacks, redundancy etc. It is simply how I think about patients’ illnesses all day so I took the same worst case scenario planning + redundancy mindset to this.

Anyways, for me that means even with the N95 masks with replaceable filters I will have 200 days of single use filters before I need to go back and use the 1st sterilised one again. Pro tip: store them in 2 separate boxes so the first box holds your first 3 months and the second box your 2nd 3 months - prevents cross-contamination and protects against other unforeseen sources of loss ( fungus etc ). With that said at present the world isn’t heading for the worst case scenario so I expect supply chains to be relatively preserved and in three months time I expect to be able to buy replacement filters easily and relatively cheaply again. In fact I’d say we’re heading for one of the three best case scenarios I envisioned in February - so that’s good news for the world.


C. Respirators
After use I simply pop them in the UV light steriliser and 11 minutes later they come out clean. I avoid any alcohol-based wipes because I don’t trust the alcohol in them not to damage the filters.



2. You only have disinfectant wipes/bleach and water and a microwave.

A, B and C. Surgical masks, N95 masks with replaceable filters and respirators.

The problem here is that alcohol-based disinfectants may break down the filters and so while it is possible to wipe down the masks with disinfectant wipes I would assume that if I wipe the filters they may become ineffective.

This would lead me to assume that surgical masks I’d wiped with alcohol-based disinfectant would no longer work while N95 masks ( with the filter removed ) and respirators ( wiping around the filters ) would be able to be cleaned just fine.

In terms of the filters - if you set them aside for a week or more I think they should be safe. The longer you can set them aside the better. One week ought to be OK but my plan of being able to put them aside for 6 months would leave me extremely confident that they’d be safe and before the price gouging I got 6 months worth of replacement filters for about 50 Euro so it was worth doing.


Heating should also break the hydroxyl bonds in the RNA and I believe if you heat something above 80 Centigrade it should be safe BUT I don’t know how that would effect the masks or filters so while that’s a reserve I just preferred to get the UV light steriliser for about 100 euro as, amortised over the next year to 18 months, I figured it would save me money and time vs disinfectant wipes. Assume two wipes at 10 cent each per day to clean the mask x 365 days x 1.5 years = 109.5 Euro. That was my maths supporting the purchase decision. Add in the cans and food packages which it allows me to sterilise and the UV light steriliser saves even more money - and as I said, I expected the Irish government to do all it could to preserve electricity production so assumed electricity would be available under even the worst case scenario... and that if the worst case was developing I’d see it coming early and just buy a battery pack and one of the small portable solar panels for backpacks which would allow me to charge my phone. I also have more faith in technology to do this cleaning than myself.


So, the key things are not to get so intense in your cleaning that you actually destroy the filters. Even without any cleaning products just putting things aside for two weeks should ensure the virus is dead.

Here’s a link to some WHO findings about virus survival on various surfaces/at various temperatures etc:
https://www.who.int/csr/sars/survival_2003_05_04/en/


ShineOn7,

1. Number of strains:
The Chinese believe they had at least two strains. I’ve heard some chatter in Europe that we’ve identified a third strain here. One should also assume that the USA will generate several different strains given how utterly Fed they are with their response and just the general numbers who will be infected there.

The bottom line is different strains are almost inevitable the longer this circulates. At this point in time I expect it to be circulating well into next year. Back over a month ago I was on record as saying we’d still be dealing with this in March 2021. I’ve seen nothing to change my opinion. By March 2021 we’ll have treatments which we know work and survival for the seriously afflicted will be much improved but it will still be circulating and I expect there will be several different strains by then. The good news is most of the strains should select for greater infectivity but less lethality... but there are no guarantees, just probabilities.

I don’t know how many strains are circulating now but once it is more than 1 that means that just because you were infected you aren’t necessarily immune. That would lead me to continue taking precautions until such time as a vaccine with proven efficacy is released. So, whether it is 2 or 22 doesn’t matter once it is more than 1... and I believe the Chinese when they say it is more than 1.... I don’t believe their death figures BUT you have to bear in mind that them saying it is more than 1 is bad news and their censorship was all about keeping bad news out of the limelight so if they say it is more than 1 strain and that got through the censors I believe it to be true.


2. Doom? Well, here’s my perspective on that...

When I first posted about this I was attacked and called a lunatic publicly and privately. I was told that I wasn’t fit to be a doctor for saying what I said. If you look at what I initially said it has largely come to pass - OR been avoided by an absolutely unprecedented worldwide reaction the likes of which we’ve never seen previously in human history. Governments wouldn’t be doing that if their internal briefings weren’t painting at least as worrying a picture as I painted.

With that said I outlined how you model scenarios as best, middle and worst case and then within each of those strata as optimistic, reasonable and pessimistic.

My reasonable middle case death toll for Ireland was 50k, my optimistic middle case was 20K. My pessimistic best case was 10K, reasonable best case was 5K and optimistic best case was 2K.

At the time we were sleep-walking into 50K or much worse death tolls over the next 12 months. Given our reactions I believe we are now in pessimistic best case territory over the next year - that’s 10,000 dead. That’s bad but it is already 80% better than we were looking at 5 weeks ago.

So what determines whether it’ll be 10k, 5k or 2K? Well I think we’re looking at 1500 to 2,000 dead in the next 2 months based on our current situation. My assumption is that we’ll follow the Spanish Flu timeline and have the largest wave of this in Q4 accounting for another 6 to 8K dead. If we get an find an effective treatment by then we’ll be able to get the death toll down to 5K, the middle best case scenario. If we get an experimental vaccine we can keep it even lower - but I don’t think we’ll have a safe one by September unfortunately.

So, is it doom or is it just reality? I take the view that I have been honest about my assessments and that honesty has helped some people prepare and hopefully not get infected and possibly saved lives. I haven’t forced anyone to read anything and have still gotten some messages privately giving out about my posting - although to be fair most have been positive.

We are currently heading for 20% of the mortality I thought was our best possible outcome just 5 weeks ago and there’s a potential that if we find a good treatment from all these trials we could reduce that to 10% of what we were looking at just 5 weeks ago. I think that’s great news and am feeling quite positive about things.

With that said I think that I have known since February that lockdown was coming and that some element of threat would remain until next March and so I am not having to come to terms with that. I think a lot of people still think this will be done and dusted in 2 months and are having to struggle with the growing realisation that it’ll be a longer term issue. I don’t feel responsible for that - that’s the virus’ fault - I’m just trying to tell those who wish to listen what is likely so they can prepare.

Preparation increases the likelihood you and those you love will make it out alive and so is, in my mind, a good thing. YOu have to also bear in mind my professional experience and training. I’m trained and habituated to be able to think about death without significant emotional response because if I have an emotional response your odds of dying have just increased. So, I look at this as another medical problem and it is my job to problem-solve it as efficiently and effectively as possible for myself and my family. I’ve done that.

I then decided I could help others by posting here and have allocated time to do that.

I’m not emotional about any of those things because being emotional isn’t helpful and so allowing myself to be emotional about those things is harmful —- and I’m trained and habituated not to allow emotions to cause patients harm. I could die and so I wrote a will and made reasonable preparations. My parents could die and if they do that’ll be sad but there’s no point worrying about it now except to make it clear that I won’t be going to their funerals etc and advising my siblings to stay at home also. Being emotional about those things isn’t helpful so I choose not to allow emotions to impinge on my decision-making.

With that said of course I’m very anti dying myself or my parents dying but Consultants only get to be Consultants if we can pack the emotions up and problem solve while our patients/families need us. As a colleague said to me recently, “We can puke afterwards” ;-).


With that said... the good news story here is that with 10,000 dead about 4,490,000 people in the Republic will not die from COVID-19 so we need to keep a sense of perspective. Life will go on and in several years time when the virus has adapted to us and we have vaccines life will largely go back to normal. I think that’s a pretty good news story.... but I can see that if you had thought “ Everything is gonna be just fine” up until a week or two ago realising this isn’t a two month problem might be very difficult to process. Nothing I can do about that though unless I’m to start not being honest... and one thing I decided before I started this Q&A was that I’d answer every question honestly - albeit only using publicly available information.


3. No I wouldn’t move. It is everywhere throughout the country. You can see that from publicly released information. I see no sense in moving anywhere in an effort to find a low penetration county.

Given my job I could actually move if I wished to. I amn’t Doing so for two reasons:
1. It is everywhere.
2. Moving would require van rental and people to move my stuff etc and those two things would hugely increase my exposure beyond the setup I have now.



Lastly, I know this is difficult but I believe it is better to just be honest about the reality of the situation than try to sugarcoat things which will lead to people being less careful and taking risks they shouldn’t. My goal here is to provide information and extrapolation so people can make informed decisions and my larger goal was hopefully to save a life or two - which is something I’ve dedicated my entire adult life to doing.

The situation is frightening but I amn’t trying to frighten people beyond the reality of the situation and the probabilities which will unfold in the future. Hell, I could definitely tell you some stuff which would terrify you all but I don’t because it is low likelihood and so I have decided I don’t need to go into low likelihood really bad news scenarios.

If asked directly I’ll answer directly but you’ll note I don’t do — “No-one asked me this but let me paint a gloom and doom scenario none of you have ever thought of” - type posts. I answer the questions asked and sometimes make a post about something which I think is helpful and hasn’t been considered ( PPE donning and doffing etc ).

So, keep a sense of perspective. The situation is not nearly as bad as it could be. It will last longer than you think, more will die than you thought even a few weeks ago BUT that number will be FAR less than I feared would die just a few weeks ago ( so overall good news ) and over the next 18 months we will develop treaments and some sort of vaccine which will really help life get back to a new normal.

Is that - Everything’ll be OK? No, but at least I’m treating you like adults and being honest with you - as opposed to the shovels of sh!t Trump is feeding Americans.

Pseudonym121

One other thing. channel 4 news is doing some really great reporting every evening on this. I’ve been recommending it to family and non-medical friends.

There’s two pieces from today which were particularly interesting.

1. An ICU Consultant in Wales talks about their situation. He is clearly trying to be positive but I think it should be eye-opening for the “its been a week, I’ll go outside if I want to brigade”
https://youtu.be/ejlbCmRJMW4

2. A piece from Italy. I have been in that doc’s situation of breaking the bad news over the phone. There’s also a hinted at subtext of the new nurse being unwarrantedly positive. I’ve had those discussions with juniors over the years. It’s great they’re so hopeful but you need to make them realistic or losing the person will just crush them and they’ll become dysfunctional and lose more/have to leave the job. Still, a really good piece, and seeing those nurses walking out in their civvies just reminded me so much of mine. Docs and nurses around the world are so similar at the basics - just people trying to do the best job as empathically as possible in the middle of a total sh!tstorm
https://youtu.be/CuKdj4TKc6M

If you’re not watching Channel 4 news already I’d highly recommend it. It regularly has the best coverage of the situation of any channel.

Pseudonym121

Gynoid wrote: »

Hi,

Having read your posts a couple of weeks ago I bought the UV light box you recommended. Question - Does the light have to fall on all parts of items inside box? So for eg if there are tins in there, do they have to be turned after the 11 minute cycle?

Well, if you look at the one I recommended the bottom of the box is crenelated.. as are the sides etc. The goal of that is to get the UV light to scatter and achieve greater coverage of areas out of the path of the direct UV light - coming from lights at the top of the box.

I personally don't turn food packaging upside down in order to ensure the bottom is thoroughly exposed for two reasons:
1. I handle packaging at the top and side, never the bottom.

2. I've moved from using individual ingredients for cooking and moved to simplified cooking - ready meals, meat + sauce in the slow cooker etc - which means that I can cook a full meal by using just 3 or 4 pieces of packaging.

let's give two examples:
a) Slow cooker: Chicken Tikka Masala with rice:
Ingredients - 2 x packages of diced chicken breast, 2 x pots of tikka masala sauce. Empty the pots into the slow cooker and then throw them into the bin. Then I wash my hands ( because I assume that even though I sterilised the packages and pots that I missed something and they are infected ) and then touch the slow cooker to set it on for 6 hours - this means I don't have do the much more time-consuming job of disinfecting the slow cooker.

Later I apportion them to containers and whenever I want one of those meals I just take the container out of the freezer, cook rice - either from a microwaveable pouch or via a rice cooker. Since I know my own containers are clean and the microwaveable pouch is clean I don't need to disinfect any of this prepped food.


b) let's say I made chilli con carne. That's pretty much the same process. Lay out a carton of mince, a can of chilli con carne sauce, a pot of kidney beans. Add them all to the slow cooker without touching it, then throw them all into the bin and then go wash my hands and then turn on the slow cooker.

It is just about thinking it through and doing it a little slowly so you maintain awareness of what you're doing and in what order. Once you form it as a habit it becomes pretty easy really.


With that said you can certainly turn things upside down to be even more certain about sterilising the bottom if you wish. I just don't think it is worth the extra hassle but part of that may be because of my training I'm very confident and quick about handwashing with soap and I have taps in my place which I can turn on and off with my elbows just like in hospitals so hand washing is very easy for me at home. For you taking double the time to sterilise with UV might be the easier solution.

Also bear in mind that I'm doing my cooking after coming home shattered from work. I've never worked as hard in my entire career as I have over the last few weeks so for me I just want to eat and crawl into bed as quickly as possible. If you're self-isolating you have a lot more time on your hands than I do.

TLDR: Turning them upside down to sterilise them is even more effective than just putting them in face up for one UV light cycle. If you have the time and find that easier than the hand washing routine then by all means do it. Better safe than sorry. I draw the line for many of these measures because some things are easy for me because of my training and setup, what is right for you will differ.

Gynoid wrote: »

Do you know any more definite things on issues like Type A blood susceptibility, why there is gender difference in susceptibility, if some people are more vulnerable like Mediterranean populations due to genetic factors, that kind of thing?

I don't think anyone KNOWS the why of those things. When we heard those conclusions from asia I think a lot of people put it down to Chinese men smoking like chimneys and the fact that they are obsessed about blood type in many parts of Asia and ascribe all sorts of things to it - it is a bit like astrology here in the West. Now that it is in Western Europe we find men dying at twice the rate of women and are no longer saying that is explained by things other than gender. Do we KNOW why? No, we have lots of theories but nothing which I'd say is proven one way or other yet.

In terms of Italy and susceptibility. I think we will find that cultural factors - living in close quarters and often in intergenerational households will turn out to be far more significant than any genetic factors due to being Mediterranean.

For this reason I think over the next few weeks we'll find the non-settled traveler and Roma gypsy communities in Ireland are EXTREMELY hard hit by this for a number of reasons including close quarter living and intergenerational living - if not within the same caravan/abode but within the same halting site etc.

Once SARS-CoV2 gets into a halting site or Roma grouping I expect it'll run riot and result in very high mortality relative to the settled population. This isn't being broken out in the figures but I think that is because a lot of morons would take the opportunity to become racist about this as opposed to realising that it is simply a medical reality/problem and that the solution to problems is to try to treat everyone well instead of dividing ourselves into US and OTHERS and beginning to let bigotry run riot. I don't hear journalists asking about this either but in any review when this is all over I strongly expect that these two groups will have been seen to come out of all of this very badly, unfortunately.

Gynoid wrote: »

Last maybe silly question, if I go out to shop, which is rare, I wear an outer layer that I take off in hall and bring to wash immediately because I have this sort of old fashioned idea about the possibility of lingering miasmas in supermarket aisles. Suspended micro particles might be the more modern description. I also wear a mask and a hat, which I wash also on return. Am I being a silly billy?

Miasmas ;-). LOL! Yeah well while I won't quite ascribe to miasma and the humours being the best way to understand this I definitely get your point.

I'll tell you my routine for that...

1. I wear simple to clean clothes with as much natural fibre as possible - a rule of thumb seems to be that the more processed the surface the longer SARS-CoV2 survives on the surface- + mask when leaving the house. I don't bother with gloves because I have good discipline about touching my face from the job and if I touch my face while wearing gloves the gloves would just transfer it anyways.

2. I assume every surface is infected - door handles, the door of my car, the steering wheel, handrails etc.

3. I assume that once I've sat in a chair or walked into a shop or shared a lift that all of my clothes are contaminated.

4. Once I'm in work I can change out of my "travel clothes" into whatever level of protection is appropriate for the task. I won't go into that since that's not relevant to people here.

5. Once I'm on way way home I change back into the "travel clothes" + mask. I now assume I'm simply covered in SARS-CoV2 and don't touch my face again until I'm home and have cleaned my hands.

6. When I get home I remove my shoes in the hall - I've heard that there are messaging circulating on social media which are trying to paint shoes as some sort of uber-vector because asphalt is thought to be some sort of sump for SARS-CoV2. This is ridiculous. I'm sure there's some SARS-CoV2 on the ground and shoes pick it up but I'm not in the habit of rubbing the soles of my shoes into my eyeballs or licking them with my tongue when I get home so I think the risk is minimal. With that said taking them off in the hall is no big deal so I do that.

7. I then take off my mask and put it aside for UV sterilisation later.

8. I then take off my coat in my "dirty room" the spare bedroom. I assume everything in that room is covered with SARS-CoV2 and never enter it unless I'm fully ready to go out and am only picking up my coat and heading out within 10 seconds.

9. Once done with that I go into the bathroom, take off my clothes and only THEN wash my hands ( I don't wash them before that since I'm assuming the clothes are riddled with SARS-CoV2 ). At this point I can go into the shower with "clean" hands and a relatively "clean" body. I then shower.

10. On my way out I pick up the clothes - infecting my hands again - and bring them to the washing machine. I put them in - in the morning I leave the door to the washing machine open so I don't have to touch it with "dirty" hands in the evening.

11. I then wash my hands again and then close throw in the washing machine pod, close the door and turn on the washing machine.

12. I then go into my actual bedroom and put on clothes for slumming it around my place.

13. I then pick up one of my C Fold Disposable Hand Towels, use that to pick up the mask and immediately put it in the UV steriliser, turn on the TV or begin preparing dinner or calling family.

14. Then I throw the C Fold Disposable Hand Towel into a bin I have set beside the UV light steriliser in order to contain “dirty” waste. I empty that bin once a week and apart from that don’t touch the bin at all. When emptying the bin I don gloves and assume that anything the bin touches is contaminated – I have chosen a small bin so that the entirety of it fits nicely inside a normal large refuse sack, this prevents spillage when emptying it.

So, this is probably a good time to talk about C fold, V fold and Z fold hand towels. Part of this is personal preference and I’m more used to C Fold ones. I also think they’re very easy to use and the flaps on both edges of the paper help prevent inadvertent side of hand contact with side of picked up object.
I dislike the lack of side flaps on the V and Z fold. You may love them, if so you do you and all that.
Back when I ordered mine from Amazon UK I got about 5,000 for less than 50 Euro and I figured that would be about an 18 month supply which would be enough to see me through to the end of this. Prices have gone up since then but they’re still reasonably priced.

For those of you who aren’t quite as up on your google-fu ( Z Nation reference there ;-) ) here’s a link to C fold 2 ply hand towels, limited to those available by prime only. Hope it helps.
https://www.amazon.co.uk/s?k=c+fold+hand+towels&rh=p_76%3A419158031&dc&qid=1586026337&rnid=419157031&ref=sr_nr_p_76_1

And thanks to Silent Running for spotting that I'd left a step out... Kudos.

The above doesn't really add more than 5 minutes to my normal coming home routine as I always would have the shower anyways. Really the only things I've changed are where I hang my coat, where I leave my shoes and the washing off my clothes every day + a bit of handwashing. I don't think that's too much to do to gain a fair bit of protection. Your mileage may, of course, vary.

It is important though to follow the process exactly every time. This means that the first few times you do it you may have to do it very slowly. I should also point out that I began trying to follow this process at the end of February because I could see what was coming and knew that it takes time to embed new habits so I started doing it then so I'd have learned this new "good habit" thoroughly by the time things became serious ( middle of April ). In the first few weeks I did find myself forgetting the shoes, or touching clothes after washing my hands etc. If that happens just stop, clean whatever part of your body you've just infected and move on from there. Mistakes will happen, it is all part of the process. Don't beat yourself up over them but just try to be aware of what you messed up last time next time. Over the course of a few weeks you'll get the new habit down and it'll just become the way you do it instinctually --- and that'll pay off over the next year.

For going out my process is as follows:
1. Put on clean clothes.

2. Put on mask. Up until this point my hands are still clean.

3. Go into "dirty room" and put on coat. At this point my hands and clothes are now "dirty".

4. Go into hallway and put on my shoes- my hands are now definitely "dirty".

5. Go out.

6. No touching of the face until I'm in work and can wash my hands properly.

7. In extremis I have a bottle of hand sanitiser in the car just in case. Pro Tip - don't leave any of these sorts of materials in sight in your car. It won't be long before people start smashing windows for bottles of hand sanitisers. Panic makes humans act like animals. It isn't a nice thing to say but, in this thread, we're about realism and not political correctness.

So that's my ingress/egress or doffing/donning routine at home. It is a lot more complex in the day job obviously.

My donning/doffing routine at home isn't airtight. I've heard of people leaving shoes in the car and walking barefoot to the house and stripping the second they're in the door. But this is where I draw the line between being safe and not having the neighbours call the cops on me for flashing them ;-). If you aim for perfect safety you will create a routine which takes up hours of your day and probably cause you to develop mental health problems. My process is pretty simple, quick and much safer than what 99% of the population does. Whatever you decide to do please do remember you will probably be doing it for a year so it NEEDS to be sustainable. Some of the routines I've heard described are just not going to be sustainable for a year.

You'll also note that my routine doesn't waste disinfectant wipes ( I think they'll be difficult to replace so I gave thought to minimising their use when I was preparing for this in February ), uses electricity for sterilisation ( i expect electricity supplies to be preserved ) and really the only daily wastage is a single washing machine pod - and I ordered enough of those to use one daily till mid July... and I don't expect they'll become scarce.


The benefit of this is that between the donning/doffing processes and the UV sterilising of food/drink coming into my place I can assume that my place is actually "clean" and just wander around in a relaxed state not worrying about touching things or my face once I'm at home. I think this is incredibly important for anyone who is out during this. I'm out 6 to 7 days a week with the day job right now and being able to have a place where I can just relax and not worry about contamination is, I believe, going to be crucially important to maintaining functionality over the next year. If you don't have a place you can relax and not have to be vigilant I think you'll have a breakdown pretty quickly.

Well, hope that has been helpful. If you have any questions you know where to go.... the questions thread ;-)


I also see a UV Steriliser question has appeared while I've been typing. Here's my best answer Cork boy 53 with the caveat that I'm no UV light specialist. I just have some experience with them from work and so decided they'd be a good solution to my problem of having to disinfect masks on a daily basis --- where alcohol-based wipes could damage the filters.

1. I don't recommend wand ones unless you have no choice because they're fiddly and time consuming and I think people will inadvertently damage their skin and eyes using them. If you know how to use them and can't find anything else then feel free obviously but I wouldn't feel safe using one personally and I definitely wouldn't trust my parents not to harm themselves with one.

2. Here's two:
a. The one I purchased and which holds everything from 3 or 4 pots of sauce/cans at a time or one full size ready meal quite easily. It will also fit 1 litre bottles of milk, but won't handily fit anything over a 1 litre liquid bottle size.
https://www.amazon.co.uk/Baby-Ultraviolet-Maintenance-Sterilisation-443853/dp/B07YB7V5QJ

I got it when it was about 30% cheaper but even at this price I think it'll pay for itself in saving disinfectant wipes over the next year. Plus, you know, if you're younger.... baby boom. My obs and gobs colleagues are all expecting January and February of next year to be very busy.


b. https://www.amazon.co.uk/PEIKUN-Professional-Ultraviolet-Disinfection-Sterilization/dp/B084JT6KK7/
This one is much smaller, isn't available via Prime BUT it is a lot cheaper. I don't expect this would be able to hold a full ready meal, or 1 litre bottle so I think it has much more limited utility.

With that said I'm sure this one would disinfect anything you could fit into it but the question is more about what you can fit in while leaving enough space on the sides for the UV light to scatter and get into all the nooks and crannies. So I think it is worth paying for the bigger one not because it would disinfect something better or multiple things at the same time but because you'll be able to use it to disinfect things the small one can't fit.

For example the small one wouldn't hold my respirator mask - the mask takes up almost all of the first UV light steriliser and that was one of my major use cases so guided my choice.

I hope that's helpful. Unfortunately in this case the more expensive option really is better IMO.


As to the strain comment. Yeah but we'll keep going till we can't go on any more and then we'll shake it off and go some more. Its simply the way we're trained and habituated. With that said --- broken record warning coming ;-) - when we're through this and ask for support for equal pay for equal work and ring-fenced mental health support for those of us who are survive this physically but are broken by it mentally please support us. We will be there for you over the coming weeks and months, please be there for us afterward. We'll need you then because the HSE management and government don't give a flying f!ck about us and will cast us aside the second it is convenient to do so.

You wouldn't believe the fights I've had to secure proper PPE for staff over the past few weeks... or even to get the PPE they have available but locked away distributed to people who need it. There's a reason so many frontline staff are out sick... they sent us into battle without the equipment we need to survive the battle... and yeah there's a certain amount of you have to go to war with the equipment you have not what you wish you had but there was time to see this coming and while we were never going to have everything we needed we should have had more than we had. You can be sure they'd find enough PPE for themselves if the politicians or HSE management had to spend an hour in any A&E in the country though. It is sickening, but not unexpected. It is the way they've always treated clinical staff. Why would they change now? This sort of thing is why so many doctors and nurses have left and are leaving. You are all only now seeing how little they give a sh!t about frontline staff in ireland. When we go abroad we are paid better, have better work life balance and are treated more fairly.... it is why so many have left.

Anyways, I'll only be accused of whining so I'll shut up now.

Pseudonym121

So, I see lots of talk about when restrictions will be lifted and the probable course and so I think it makes sense to post a reasonable middle case scenario ( not best case and not worst case ). I'll refer to best and worst case alternatives later. The key point about this post is that NO-ONE knows how this will turn out. What we can know is what is probable based on a number of assumptions.

So, what are those assumptions:
1. That this has some seasonality - there is growing evidence that this will be so. This would lead to a scenario where we could expect a Q4 resurgence.

2. That a vaccine is possible - it isn't possible for all viruses or at least isn't possible in the sort of time frame we need. Everything I've seen says that vaccines should be possible for SARS-CoV2.

3. That by the time a vaccine arrives there will be multiple strains. This isn't a huge problem as we have many vaccines for seasonal viruses which protect against multiple strains of said virus.

4. That the decision about lifting restrictions will be at least partly political and economic and not just based purely on medical advice.

5. That the decision about lifting restrictions will be based largely on medical advice, although not solely - this doesn't contradict point 4.

6. That SOME treatment currently being trialled will be found to be effective by September 2020. I don't know which one but I'm certain some reasonable treatment(s) will be found and production increased to meet demand.

7. That the majority of high risk individuals will continue to largely cocoon until such time as they can access a vaccine. If they come out before a vaccine is available, irrespective of government advice, deaths will skyrocket again.


Overall I think this is a good news story in that we aren't facing the destruction of technological society or the death of western liberal democracy but we are about to lose a lot more people than seems to be understood in the megathread. This isn't surprising as one of the defence mechanisms most people use to deal with the fragility of life is simply denial of its fragility... in spite of all evidence to the contrary.


So, first phase: Now till end of September
This will be the phase in which we will likely see 1500 to 2000 dead in Ireland by the end of May and a smaller daily number from June to September - I expect Ireland would tolerate 5 to 10 dead per day during that period in return for things largely returning to normal. So call it a low of 2100 and a high of 3200 dead by end of September. The main clusters will be in nursing homes, roma gypsies and traveller groupings because of their medical risk factors, proximity and intergenerational living setups.

Interpreting the data for Ireland is difficult because due to the lack of results from testing there is such a huge backlog that the one thing we can say is that our current numbers bear no relation to reality. Saying they might is purely a PR exercise. I understand why that is being said but that information isn't good enough for me to base decisions on the health of my loved ones on.

Anyways the normal rule for an epidemic is that you can say it is over when you've gone two 95% confidence intervals of the incubation period without a new case. This equates to about 28 days for SARS-CoV2.

Another way of looking at this is that we need to get the R0 below 1 to have fewer infections every day than the previous day. With an R0 of 3 and 90% of people obeying the lockdown/disinfecting rules 90% of the time and actually being effective with this 90% of the time you can see that we'd end up with roughly a 73% reduction in R0 from those assumptions. So R0 = 3 would become 0.813. Let's round that to 0.8 and if we had 5,000 transmissions a day to start with that'd drop as follows:
Day 0: beginning of lockdown 5000 new cases per day
Infection Cycle 1: 4,000
IC 2: 3,200
IC 3: 2560
IC 4: 2048
IC 5: 1638
IC 6: 1310
IC 7: 1049
IC 14: 220
IC 21: 46
IC 28: 10

Obviously I'm rounding and just approximating here but as you can see by IC7 you'd reduce transmission by about 80%.

A lot of people would look at IC 14 and say that by then with the number of new daily infections falling by 96% that if you lifted the restrictions then things would be fine but if we went back to the way we were behaving previously you'd be back to 5000 infections a day in 14 more ICs.

Why IC and not day? Well, the best data out there is that infections were growing at about 25% a day when we were looking at an R0 and doubling every 3 days but there's no guarantee that things will rise or fall by 20 to 25% per day. So I used IC. For ease of examples going forward lets just assume an IC is a day as that'll make it easier for people to grasp.


So what does the above tell us?
Well, it tells us that even if do a massive lockdown obeyed by 90% of the people 90% of the time with 90% effectiveness for 28 days if we go back to "life as normal" after that we'll be right back where we starting 28 days later.

And bearing in mind the death rate lags behind infection rate by somewhere between 14 to 26 days the death rate would start to fall just as new infections were really starting to rise again and we'd end up with another bad peak of deaths.


So, where to from there?
Well, it seems that the best way to play this would be to keep a really strict lockdown for about 28 days and then reduce it slightly, combined with advice for people to ALL wear masks when out and about, really strong, rapid testing and contact tracing. There would be separate advice for high risk groups who would be asked to continue cocooning as much as possible for as long as possible.

The 28 days gives the state the time to ramp up swabbing ability and test throughput ability as well as to train and man contact tracing centres and establish rapid response teams to respond once a new case is confirmed.

This would be something akin to the South Korean/Singaporean model and the goal would be to allow low risk groups to return to normal economic activity ( albeit with masks for everyone ) while cocooning those likely to die. Usage of masks by the young would be enforced by peer pressure as there would be a constant drumbeat of people in their 20s and 30s still dying and that would act to motivate them to wear masks. The goal wouldn't be to stop deaths but to keep them to a reasonable level - say 5 to 10 per day with the majority of those being the elderly obviously but probably a good 10% being young to middle-aged.

After another 28 days go by the government could look at loosening restrictions a little more if the death rate was on the lower side. Essentially they'd be balancing daily deaths vs economic activity... And before someone argues that every life is priceless. No it isn't. Your lives all have a very specific monetary value. The measure most used in the UK by NICE is called the QALY - Quality Adjusted Life Year. Most recently it was somewhere between about 15k and 20k Euro

Here's a link to explain it: https://en.wikipedia.org/wiki/Quality-adjusted_life_year

For what it is worth this is why we will always have private health insurance. Some people have a lot more than 20K discretionary income per year and if faced with death or spending 30K a year to stay alive with a discretionary income of 50K per year you can bet a rich person will spend the 30K. You can have all the ideology you want but when push comes to shove people who can afford to pay to live longer will find a way to pay for it. Perhaps not a popular thing to say but I'm all about objective reality and that's just objective reality.


I'd imagine that every 14 to 28 days restrictions will be loosened somewhat. This will be possible because even if the R0 remains above 1 we should find some treatments which reduce mortality. Statistically this will allow us to keep the same death rate for higher rates of infection than is currently possible.



So, Phase 2: October to December
I'll assume we don't even have an experimental vaccine... If that is true then we'll have a choice between accepting higher daily death rates - which we'll have become accustomed to by the next two months - for those three months or we'll go into whatever of lockdown the statisticians and PR guys have figured will result in the daily death rate which the public will tolerate versus the severity of the lockdown.

This will be when you'll really see the selfishness in society. Things happened so quickly this time there wasn't much debate. Come October there will be a very active pushback against another lockdown. There will be a very active - but they're old and will die soon anyway lobby, much more active than it is now.

Unfortunately when push comes to shove people tend to be very selfish and when they've had a taste of freedom after two months of lockdown they really won't, en masse, want to go back to lockdown. The line that those whose families are high risk can choose to behave how they want instead of forcing all of society into lockdown will be prevalent.

How many will die in Q4? Well, easily 6k to 8k but a lot of that depends on the political and economic balancing vs deaths. How many die will be a choice the public and our government will make. They'll have the information to project the death rates from various courses of action much more accurately than they had now. This is why they were so cautious this time. Come October they'll have greater confidence in balancing life vs economics.

I suspect they'll strike a balance somewhat below the peak of April/May as people will be habituated to view anything below that peak as being "good". That would argue that they won't exceed 50 daily deaths for those 3 months and would result in 4500 dead in Q4. They may draw the line differently but I don't see the government enacting a full three month lockdown. I'd be impressed if they did, but I just don't see it happening for economic reasons.

The key point is we'll have the number of dead in Q4 we choose to have politically. There's a lower bound on that number below which we probably can't go but that lower bound may be as low as 1,000... but achieving that number would really impact the economy.


Phase 3: 2021 Q1-Q3 aka waiting for the vaccine.
Well that's what it will all be about. We'll throttle economic and social activity to control death rates. As our treatments improve and the virus adapts to us and selects for greater infectivity at the cost of lethality we'll be able to have more economic and social activity for the same number of daily deaths.

Once we get a vaccine which is good for the main strains around we'll largely return to normal. I, personally, expect we'll have a vaccine which is usable for the majority of the population by March of 2021.

We will probably have an experimental one by Q4 but the risks may outweigh the benefits for all but the highest risk groups with that experimental vaccine as they just won't have had time to prove its long-term safety.


Phase 4: Q4 2021
At that point we'll really get a sense for how effective the vaccine was and whether or not we get a strain which the vaccine doesn't provide protection for. If we guess right with the vaccine then Q4 2021 will be alright and this will just become a yearly "bad flu". If we guess wrong with the vaccine then Q4 2021 will be bad and we'll just have to work harder to get the vaccine right for 2022.

This is the same process that we follow with seasonal flu. The good news is that mostly we get the seasonal flu vaccines right.



Summary:
People talking with any certainty about lockdown being done in 2 to 4 weeks or in for the whole year don't know what they're talking about. The probability is lockdown till the end of May followed by a gradual reduction in the severity of lockdown until a death rate, which is deemed the maximum level which the public will tolerate on an ongoing basis, is reached and allowed run to October. In Q4 we'll have to see a tightening of restrictions again to keep the death rate down. What death rate will they view as acceptable? I suspect 50 dead a day or less will be the level but don't know, a lot depends on what the public tells them is acceptable. In 2021 it'll all be about keeping the death rate at an acceptable daily level until we get the vaccine. As treatments improve fewer social and economic restrictions will be required to maintain a stable daily death rate which is acceptable to the public.

Pseudonym121

Stheno,

Good questions. I think that the results from the initial tranches of antibody tests are encouraging. The more people who are shown to have antibodies the better as this means they can go out and about and begin economic activity again. The one caveat to that is that having antibodies to one strain of SARS-CoV2 doesn’t necessarily confer immunity to other strains. We won’t know the impact of that until we have a large group of people who are shown to have antibodies going about normal daily life and can see just what portion of them get infected and, if infected, what portion die compared to the cohort of those who have no antibodies.

So a test to show the presence of antibodies is good but people are losing sight of the fight that presence of antibodies to Strain 1 mightn’t stop you catching Strain 2 and dying from that strain.


When will antibody tests be available? Well several countries are rolling them out already. It’ll take weeks before production can ramp up enough for us to get them in large quantities and even then initial testing will be reserved for those at high risk of exposure ( healthcare workers etc ) before becoming more widely available. This is as it should be.

With that said the fact that the more we learn about the illness the more proof we are gathering that there’s quite a lot of asymptomatic people who have been exposed is good news. It also provides more impetus to the whole - you should be wearing masks and gloves if at all possible ( and you know how to put them on and take them off properly ) whenever outside. With that said I’d say 75% of the people wearing masks I see in public are still not wearing them properly and so getting little real benefit from them.

Roanmore,
Unfortunately what you’re describing is unlikely to be viewed as an essential procedure for the next 2 or 3 months and as such unless you can source it privately it is unlikely to happen. With that said the government is being its usual jackass self with the contracts for private consultants and so they’re being advised not to sign the contracts at present. That’ll get sorted because they’ll need those 500 to 600 consultants to replace those who fall ill/run the private hospitals.

In the meantime though if I were you I’d contact your wife’s private consultant and ask if this treatment can be administered elsewhere other than the hospital under their supervision. Depending on the exact treatment it may be possible to provide it safely outside of hospital. If it is an infusion then that is less likely but the best bet would be to try to contact them directly and ask if it could be safely provided outside of a hospital setting. Depending on what it is that might be possible. If an injection then it may well be possible but if it is a surgical procedure then I don’t think it’ll be possible.

If that isn’t possible then, unfortunately, the best thing you can do is ask their advice on how best to manage in the meantime and advise everyone you know to stay indoors etc since the sooner this peak resolves the sooner the hospital system can go back to treating things like this which while really serious and impactful on people’s lives aren’t immediate matters of life and death.

Pseudonym121

Drumpot wrote: »

Thanks again for answering all questions.

I don’t understand why people are suggesting you are scaring anybody, some people really can’t face the truth. For what it’s worth I find the blunt honesty of your responses so refreshing. I also find, as an anxious person in general, that trusting what I read and understand about what’s going on is more important then being told a fairytale about how everything will be fine. I find your posts comforting and they actually relax me... So thank you again for your honesty, I for one have read every word you have posted here and have taken steps to follow your guidelines.

There are some suggestions that treating this like a pneumonia can be dangerous. That using ventilators can damage the lungs because it’s the oxygen levels that are an issue. I watched one doctors YouTube clip there say that he has patients that he thinks are starved of oxygen as if they are on top of a mountain without acclimatising to the height. I thought that was hypoxia but he didn’t use that word. Are you finding it that this may not be the kind of disease you thought? This doctor seemed to be implying every hospital was gearing up to treat this as a pneumonia but it’s not that?! Does this also explain why there are so many people in ICU with no underlying medical conditions in some hospitals or is there a chance that different countries are being hit with different strains of virus? (There were suggestions that the original strain was most potent).

Is it a case that this virus can attack in multiple ways depending on the person/strain? Is it also the case that it might also effect a person differently based on an underlying medical condition? Would this explain why smokers are not necessarily showing up as a big risk because it doesn’t necessarily attack the lungs but affects oxygen getting into the body? (Perhaps my layman understanding is off there).

Well as I’ve said several times I think we’re learning a lot about this. I believe if you read what I said a month or more ago that I said that there were things we believed were true which we would later find to be untrue and other things which we hadn’t conceived of that we’d find out. I think that medicine worldwide is learning a lot about this illness and that includes its mechanism of acting on people.

It definitely seems that this impacts the heart more than we thought it would, causes emboli which can end up in the lungs causing pulmonary emboli or in the kidneys causing kidney problems, multi-organ failure, cytokine storms which can kill those who have had mild/moderate symptoms linger for some time and superimposed bacterial infections. It is impacting younger people more than a lot of people expected.

So, we’re learning about it and at times it is surprising doctors worldwide. I think that the good news is that the more we learn about it the better our supportive treatments will get and we’ll get better at keeping more people who get it alive while we wait for an effective curative treatment and vaccine.

Drumpot wrote: »

Lastly , I bought a blood presssure monitor and oximeter to go with our digital thermometer (also got them for my mum and parents in laws). Would the oximeter in particularly help diagnose the lower oxygen levels quicker ? That is, if you were monitoring them for days and were phoning up your doctor , would this be a potential early warning tool for him to know you were deteriorating? It seems some people deteriorate quickly after looking like they were improving.

I’ve been also monitoring myself and my wife’s BLood pressure and temperatures daily. Would having these stats (along with oximeter) potentially lead to us getting medical treatment quicker because it can give a doctor or healthcare person a better idea of where we are at internally and how this has been progressing daily? (As opppsed to just phoning up a Gp and saying “I feel awful” but having no readings).

Lastly I had a temp (as did my wife) of 39oC a few weeks ago but not for long only day or two. Would it be too optimistic to think that could of been our COViD bout ? We had been battling coughs for weeks so can’t say if the cough with temp was cough that we had been battling before.

AN oximeter will give you a very good sense of any sudden change in the oxygenation of your blood which COULD be a sign of a worsening lung issue. It could also be a sign that your finger is cold, that it has dirt on it, that your posture is hunched over thus preventing full lung expansion etc. Never rely on a single reading.

But, yeah, I think pulse oximeters are a good idea for people to monitor their own oxygen saturation at home and have a set of readings they can tell their GP about if they decide to call them with a query. Same with thermometers. Objective readings are always preferred to subjective feelings.

Maybe you were lucky and only got a mild dose but there’s no way to know. If it were me I would assume I hadn’t caught it and therefore didn’t have immunity and I’d continue taking precautions. I think that’s the safest way to play it.

mountai wrote: »

What is your opinion of the latest HSE contract foisted on Doctors working in the Private sector , whereby , they MUST place their patients into the Public system , thus taking control for their ongoing treatment protocol out of their hands ? . how can this be justified when Drs who are seeing private patients in public hospitals ( which is allowed under their contract) can carry on as before ??.

Well, I think the government wanted to secure the private beds for the national good and it did so. I think they were right to do so given the potential situation we were looking at. I think that this has had consequences for private patients but I also think the government was mindful of the optics of suspending most public non-covid procedures and taking over the private hospitals and then having video of private patients going in to get their private procedures. I think those images would have damaged social cohesion and so I think they made a calculation that they could do whatever they wanted to those consultants with very little public outcry and so that’s what they did. I think they’ll get away with it also.

I’ll note that the private consultants aren’t being forced to accept the contracts. They’re free to say no and make alternative clinic arrangements. My understanding is that if they don’t accept the contracts they can occupy some of the currently unoccupied office space around and keep seeing private patients. If a procedure is safe to do in a clinic then they’re free to continue providing it. They simply won’t be able to provide treatments which can only be safely done in hospital.

So I’d expect a lot of them to rebase and re-open their rooms over coming weeks if they can’t reach an accommodation about the contract.


Anewme,
They won’t be discriminated against. They’ll get any appropriate treatment. Unfortunately as with the answer above what is now deemed appropriate and essential is different than what we would have deemed appropriate and essential 3 months ago.

With that said they won’t be abandoned and as we get more and more certainty that our ventilator capacity won’t be overwhelmed then more consideration will be given for reserving some of that capacity for the elderly. So the best thing you can do is to maintain and continue promoting social isolation and distancing so that the system doesn’t get overwhelmed and some capacity can be reserved for the elderly going forward.

Cyrus wrote: »

First off please dont take this as a criticism and i thank you and everyone working in health care for all you are doing for those touched by this virus (and the rest of our sick population)

however i would tend agree with the quoted post, my question is do you not feel it is in incumbent on you to temper your responses somewhat. my worry is that peope will assume that a consultant will know whats going to happen, when the reality is you dont. You have an opinion and a certain amount of knowledge the rest of us dont but thats it.

Any more than an accountant or economost can predict the future of the economy, they can have their opinion, but most of them will be wrong.

The factual answers that relate to the here and now are very useful, your opinion on the future is informative but id worry that people are taking it as gospel.

Ok, a couple of points in reply:
1. It isn’t my problem if people assume I’m a soothsayer. I’ve never claimed to have psychic powers to predict the future. I’ve been very clear that I am saying what i think is possible and that what I’m saying is my opinion. If people refuse to read and consider those caveats then that’s their issue not mine.

2. I’ve stated several times that when I’m extrapolating that is my own opinion. At some level if I say that isn’t enough then the only thing I can do is simply not post because some people refuse to actually read my caveats and have common sense. I think that would be worse than accepting that some people refuse to read the caveats and bear them in mind.

3. As regards tempering. No, I have decided to be honest instead of tempering things with PR. I presumed you were adults who would prefer the truth to facts massaged through a PR lens.

4. I think the days of society assuming Consultants were all-knowing and godlike is well in the past. Hell, today a patient abused one of my NCHDs so much they were in tears so, no, we’re not on a pedestal anymore.

But just to be clear - I’m not a psychic and don’t know the future. WIth that said I can say what is probable and possible and say that. I assume people are adult enough to understand that the probably and possible aren’t psychic predictions and they should bring their own judgement to bear on anything ANYONE ( including myself ) says. I’ve also very purposely said I’m just a bog standard Consultant and that people shouldn’t assume I’m the world’ leading epidemiologist/virologist etc. I’m just a Consultant ( who therefore does know more about medicine etc than the majority of you ) offering my opinions and advice for what they’re worth. I amn’t forcing anyone to listen, or believe me or anything.

I think the real problem you and others have isn;t that you think I’m setting myself up as some sort of prophet but that you wish I’d tell you nice comforting stories which you could believe whether they were true or not. Well, I’m not going to do that. I’m going to be as honest as I can for as long as I can. I’m basically going to treat you like adults. Some may prefer the comforting stories and if you do then that’s perfectly fine. Reality isn’t a comfortable place for some people... but then those people probably shouldn’t read this thread. That’s fine by me. If I survive this and when this is all over ( which it will be ) I plan to go back to asking questions about solar panels and how to make as green a house as possible which is why I initially signed up to Boards. I amn’t building any social media following or looking for anything beyond providing a resource that otherwise wouldn’t be accessible to people at this time. But pure intentions don’t mean I should be believed. With that said feel free to go back to my first posts where I was derided as a lunatic and see if what I said x weeks ago appears sensationalist now. If it does then feel free not to read anymore. I’m cool with that.

JCX BXC wrote: »

What do you make of the commentary today that we may have passed the peak? Does the larger (but arguably expected) death rate recorded today under shadow this

I wish it were true but I don’t believe it to be true. I still think we’re looking at between 1500 to 2000 dead by the end of May unfortunately. It is my fondest wish that this proves wrong and the more everyone does social distancing the lower the death rate will be and the happier I’ll be. With that said I saw a group of 7 people playing basketball in a park today, saw several full on picnics of groups of friends in the same park etc. So I don’t think 90% of people are following the rules 90% of the time with 90% accuracy.

But I hope I’m wrong as the more wrong I am the fewer people die and that’s a wonderful outcome.


Re: ShineOn7
Yeah. While I wish that the Irish government had acted sooner in instituting the lockdown and made some mistakes ( the Italians over here after the match was cancelled ) I think that overall the state has done very, very well. I think we are definitely going to come out of this significantly better than the UK and MUCH better than the USA.

I still think it is going to hurt more than many people thought or think at the moment but I think we’re going to come out of this in best case scenario territory which is not something we were heading for just 5 or 6 weeks ago.

So people who are spouting doom and gloom aren’t having a sense of perspective of what was possible 5 or 6 weeks ago and how much better things are now than they could have been. Hell, New York is talking about having so many dead that they will temporarily bury people in parks until such time as the death rate falls and they can dig them up and rebury them in cemeteries. Now look at Ireland and how far we are from such a scenario. We are doing very, very well but I think that very very well is still looking like 1500 to 2000 dead by the end of May.

The more everyone keeps observing social isolation the more likely it is we’ll do even better than 1500 dead. The great news is that this IS in the public’s (your) control. The public will determine how many die to a greater extent than any doctors. So, do your bit.

Shaunoc wrote: »

Have you been keeping in touch with UK colleagues and how they are handling within NHS as compared to HSE?
Any improvements and good collaboration with NI colleagues, sharing of resources or is that pie in the sky?
Is our country (gov, health, public etc) doing us proud in these extreme circumstances in relation to other European countries?
Some projections of UK deaths hitting nearly 3000 a day shortly are frightening.
Do you foresee any longer term positives with speed, red tape cutting and inter dept and public/private cooperation shown from the last month or we go back to status quo in a few years?
Thanks

Doctors around the world treat patients. SARS-CoV2/COVID-19 is a monster and we are all in this together. We are all just trying to keep other humans alive.

There’s a lot of information sharing going on, particularly via facebook and email. Modes that we didn’t traditionally use. Doctors are trying to get information out to other doctors worldwide as rapidly as possible to help those doctors save lives. It is utterly unprecedented, and is a sign of how serious this is.

Status quo in a few years? It won’t even take that long. It’ll be months not years before the vested interests and bureaucracy re-assert their supremacy. The government will have a VERY small window of opportunity to really make massive change as things are settling. If they don’t take that opportunity then things will settle back to normal and the foundations which are currently fluid will set like concrete again.

Do I expect the government to be so far-sighted? No, but I can hope.

One thing I do expect is that this will accelerate the adoption of slaintecare. It’ll become a national priority. I think this is great personally - although I still think there’s a role for a private sector - but I don’t expect them to go far enough in terms payment per procedure ( which would incentivise staff to work harder ) as per the Australian and Canadian models. I think if we adopted either of those models in which hard work was rewarded with additional pay combined with a modified Slaintecare system then waiting lists etc would be largely sorted due a combination of public care and the personal profit motive for clinical staff.

I think that’ll be a hard sell though so they’ll go for something easier and less effective. I’d love to be wrong though.

Pseudonym121

Metricspaces,

The design of the steriliser is such that light scatters onto the bottom of products. Do I assume that is 100% effective? No, but it is good enough for me.

I think we all draw the line in different places. I’m comfortable with this technological solution being sustainable for me and am comfortable with the bottom of the jar potentially not being 100% sterilised because I don’t touch the bottom of the jar and it takes a reasonable amount of virus to cause a successful
Infection. This isn’t a situation where a single viral organism will gain a foothold and cause illness. Hell even the N95 masks don’t stop every virus organism. They just decrease the amount you breathe in to a level that, hopefully, your body can handle. I’m comfortable that the UV light steriliser does a good enough job on the bottom of the jars.

If I have an object which is very long I often put it in slanted to ensure only a minimal area is in “shadow”. Common sense solves these sorts of things.

As to the six hours thing. Well three of those hours were to allow particulates in the air to settle. I think you’ve misunderstood how that timeline was arrived at.

With that said If you feel happier using Milton etc then you go right ahead and do that. If that’s where you need to draw the line to feel comfortable then that’s what you should do. I wish you the best with your approach.

As to what I do with items which don’t fit into the UV steriliser. I simply don’t purchase them. Or if I get the measurement wrong I’ll just wipe them with a disinfectant wipe. Easy.

Bottom line. If you have a way which you feel is safer then by all means do that. Everyone draws the line in different places with a lot of different reasons why they favour one approach over the other. I wish you the best of luck with whichever approach you feel suits you best.


And I see you’ve posted again on this issue:
I’ve decided on a solution which works for me and my elderly parents and my siblings. If you read what I have said I’ve never said it is the only way. If you prefer to take a different approach then I wish you nothing but the best. There are many ways to disinfect something. The effectiveness of Milton would rely entirely on your technique and how long you left it after before touching it again - they suggest ten minutes lay time per item. I think that, just like masks, they’re a great idea but so few wear them properly that actually they’re largely ineffective for the public. My fear would be the same with the Milton plus J cloth solution. Fine idea but the technique would matter and I fear many wouldn’t do it properly.

But you seem to be very confident with it so I’m sure your technique is good enough and so I wish you the best with your approach. I wouldn’t trust my parents’ lives to being able to replicate that though, nor mine.

Pseudonym121

metricspaces wrote: »

You give lots of fantastic information and insight which is very interesting to read so please don't take this the wrong way.

You mention a few times how you approach things in a logical manner. So when you provide a rationale for the UV sterilizer that does not seem to add up, it puzzles me. You could have easily bought enough Milton for a year or two and it's a less hassle approach as you can quickly wipe everything down; the mere fact you can get it over and done with in a few minutes as opposed to a few hours by definition is less hassle. This to me negates your rationale of wipes running out and it being more hassle to wipe everything.

From another angle. I understand you are just documenting your approach. However, as you have greater knowledge and insight than many others on here it may come across to people that this is the most effective route to follow. The gold standard. That disinfectant wipes will run out and you'll be snookered if you don't have a UV sterilizer as there's no other effective option. This may lead a lot of nervous people to buy expensive UV sterilizers or even panic if they cannot acquire one.

For the sake of balance. Would you deem wiping packaging with undiluted Milton using a throw away j cloth as effective as your approach with UV sterilizer? Or is there another approach you'd deem equally as effective as the UV sterilizer?

For the sake of balance? Are you a Milton salesperson or something? . I have bleach as a backup but my faith in the J Cloth and Bleach approach is less than total. My use case was simply immersing whatever tins/cans etc I needed to sterilise in a small receptacle of bleach for a short time and then picking them out using plastic kitchen gloves and letting them dry on a windowsill.

I'm very used to autoclaves and UV sterilisation given the day job so that's where I sought a solution which I had high confidence in. I have much less confidence in the bleach and j cloth solution which is why it is only a fallback for me. But, you seem to be more familiar with it so I hope it works for you.

It would be very wrong of me to give advice regarding how to use a sterilising method I really don't feel qualified to comment on in detail so I hope you'll respect that I don't do so. The best I could say is that either complete immersion or washing it with a cloth in such a way that you get into every nook and cranny - but I don't have confidence in myself or my parents' ability to do that properly. Feel free to make a post in the Questions thread outlining any methodology you might have though.

Notsomindful wrote: »

Thanks for answering all the questions so far.

I tested negative for covid 19. Had and still have a lot of symptoms.
So I have a few questions.
Could you have the virus and not test positive if it took a good while (2 weeks) to get tested?

Yes you could test negative for three main reasons:
1. You cleared the virus and there wasn't enough RNA to replicate to get a positive result on the PCR test.

2. You got a false negative - there are many different tests out there with varying false negative and false positive rates. Some tests have been so bad in other countries that they've proven unusable. That doesn't seem to be as large of an issue in Ireland.

3. Poor technique by the swabber meant they didn't swab properly and get enough of a sample to replicate for the PCR test.

In your case I would assume that it was simply a case that you either didn't have it or cleared it prior to getting swabbed.

Notsomindful wrote: »

What are chances of a false negative result in test?

It depends on the test done, the lab, the technique of the swabber etc. I don't know which lab etc so can't say. But in your case I think it is safe to say you either didn't have it or cleared it. I wouldn't be overly worried about a false negative if I were in your shoes.

Notsomindful wrote: »

Is it worth getting tested for antibodies to check if you did have it?

When a reliable antibody test comes out I think that would be a very reasonable course of action on your part. I certainly intend to get an antibody test to check my status once they are reliably available. I think checking one's antibody status ( all of the issues with these tests notwithstanding ) is an eminently reasonable thing to do.

With that said I wouldn't assume that having a positive antibody test gave me carte blanche to go swanning around as though I were invincible. I'm wary about the possibility of new strains to enter Ireland.

Notsomindful wrote: »

Is there another strain going around that isnt tested for in the current test available?

Well, the longer it circulates and the more people it infects the more likely the mutations will add up and something which changes the nature of the virus significantly enough to qualify as a new strain will develop. Right now though there isn't any evidence that a new strain which would be missed by testing is circulating among the community in Ireland.

That might not be the answer I give 9 months or even 6 months from now but it is the answer as of today.

Notsomindful wrote: »

Is there another respiratory illness going around that is similar to covid 19?

No, SARS-CoV2 and the illness it causes, COVID-19 are not close to anything else going around. A lot of people are still getting ordinary flu or other respiratory viral illnesses but the pathology of those things isn't close to COVID-19. Now of course you get into what we mean by the word "similar". The flu or cold are similar to COVID-19 in a lot of ways which is why I changed to the word "close". They have similarities but I'd take the flu over COVID-19 any day. COVID-19 scares me, the flu etc never have.

voluntary wrote: »

Can a person with symptoms request to be tested avoiding the €60 GP fee?

I'm unsure of all the subsidiary pathways one might use to get around phoning a GP to inform them of your symptoms and getting tested. I think by far the best way to approach this is to simply phone the GP and follow their advice.

feargale wrote: »

The 1965 power blackout in NYC and much of the East Coast reputedly resulted in an overload of the maternity hospitals nine months later. In a worst case scenario, given the lockdown, if the virus is still prevalent here around Christmas could we witness a similar scenario exacerbating already stretched resources?

P.S. As a septuagenarian I assure you my concern is purely altruistic.

Yeah I've joked about that with colleagues. This lockdown is going to cause a spike in relationship breakdowns but also a baby boom starting around Christmas time ;-). Humans are resilient and birth rates often rise for a period of time during and/or after a disaster situation.

Geuze wrote: »

It is the immune system response that kills, i.e the cytokine storm.

This is not entirely correct. The cytokine storm is one of the ways it kills but it also kills through cardiac complications, emboli/strokes, general multi-organ failure, pneumonia etc.

auspicious wrote: »

If you've caught it and recovered, isn't there the chance you can still pick it up and spread it for a limited time?

When you are recovered there appears to be evidence that you still shed virus particles for some time. Our best sense at the moment is that after a few days you aren't shedding enough to infect other people. You have to bear in mind that there's a difference between us being able to detect particles of virus in your stool and that being a viable way for you to continue infecting people.

As to "picking it up" again. No, once infected you will have immunity to that strain of the virus for some time - potentially for years or decades. The problem occurs if other strains which are sufficiently different develop over time and then you may be at risk of reinfection by a different strain. The probability is that such strains will become more infectious and less lethal over time but that's just probability. Hopefully we'll be lucky but there's no guarantee.

chka wrote: »

Today is a particularly bad day for Ireland having 33 new deaths due to coronavirus and 320 in total. If I compare the same day with my home country, Greece, we only had 1 today and 93 deaths in total. What confuses me is that Greece has virtually destroyed economy, the health system is in seriously bad shape after so many years of austerity: for example, if you have an accident, you need to bring your own bed sheets, gauze and toilet paper because hospitals have none. In addition, Greece has one of the oldest population (#5 in the world) and Ireland has one of the youngest. Finally, Greece has twice the population of Ireland, and not only that but it's also packed with Roma and migrands that have no respect of the lockdown or interest in hygiene. How do you explain that Ireland has more than 3 times the amount of deceased compared to Greece? Also, why we don't hear any medical research or ideas coming from Irish doctors when almost every day, I hear on the news of new, more successful treatment protocols and reports for huge amount of research happening inside Greece's medical system?

Greece enacted social distancing measures earlier than Ireland. My understanding is festivals and parades were being cancelled in February and Greece closed schools on March 10th and then rapidly progressed with the shutting down of other social venues over the next few days. Greece is now reaping the rewards of moving early with social isolation measures. Ireland moved more slowly - although still more rapidly than the UK - and so has a worse outbreak than Greece but better than the UK.

As to the future: Well, let's see what happens with the refugee camps and Roma communities. This is a long haul till at least the middle of next year. Greece is doing well so far in the first wave. The first wave isn't even over yet nevermind additional waves over the next 12 to 18 months.

As to the news about research. I wouldn't pay too much attention to PR designed to give the populace a sense of hope about the future. Greek research institutes have been gutted by austerity. I don't expect this PR to be reflected in real-world outcomes over the next year.... I'd love if it were but there's a difference between spin and substance.

Shaunoc wrote: »

With such a huge pressure on PPE, what of used PPE can be reused now that was not before - after being sterilized

Re-usability is a function of scarcity and resupply. If there were no more gloves coming into the country we'd be dipping used gloves into agents which can kill RNA viruses, sterilising them and re-using them. We have enough gloves so we aren't doing that.

The same applies to the other gear. Generally speaking pretty much anything could be sterilised and re-used if you couldn't get resupply but since we can get resupply and are getting resupply we don't have to re-use most things anymore.

With that said I'm aware PPE supply difficulties still exist in certain hospitals, GP hubs and in nursing homes etc. I think that it will take some more time for sufficient supply to become available in every healthcare setting. It is a process but we're doing pretty well with that process actually.

Satturnfalls wrote: »

Ive read somewhere that the virus can be mostly found in the floor and that peoples shoes are a source of contamination. Would you advise a sort of foot bath for entering and leaving the house for messages? And if so what would be a good chemical(s)

Hmm, a key word these is "mostly". SARS-CoV2 is not mostly found on the floor. It is mostly found in the air or on things people have touched after getting it on their own hands.

I think it is reasonable to have a single set of outdoor shoes at the moment and to keep them outside of your main house - I keep mine in a certain area in the hall. I only ever touch them when putting them on going out or taking them off coming home and immediately assume my hands are now "dirty".

I don't disinfect them with a bleach foot bath although I could easily make one using a shallow plastic bucket filled with slightly diluted bleach. I don't go around touching the floor with my hands or mucous membranes and so don't see the need for a bleach foot bath. I think the much easier step of just taking the shoes off before you enter the main house is good enough. But if you want a disinfectant bucket for shoes then you do you. I think it is unnecessary overkill driven by internet rumour and a failure to understand how the virus is really transmitted.

It is akin to why I am fine going out with just a mask but no goggles or gloves ( even though I have them available ). That's because I'm not about to go near someone coughing in public but am concerned about droplet spread in shops, lifts, stairwells and other enclosed, poorly ventilated spaces. I also amn't concerned about fomite spread from my hands because I simply don't touch my face when out until I arrive home or at work and have disinfected them.

But you may differ and you should suit your planning to your situation. I've never presented what I do as the "only" way to do anything. I've just offered advice regarding what I felt were reasonable precautions. You have to be safe but you have to balance that with practicality.

padser wrote: »

I'm interested in your assessment of your own mortality rate if you get it and in particular whether its changed since you first posted about it.

Originally, you gave yourself a 15% to 20% mortality rate if you caught the disease. I'm wondering if anything has changed your mind on that?

Given that roughly half of our deaths come from nursing home patients that leaves us with something like a 1.5% mortality rate for the rest of the population from the reported cases.

I assume this is grossly inflated due to
- significant gaps in testing
- testing concentrated on the most severe cases

Given that, I imagine you are assessing yourself as being maybe almost 2 orders of magnitude more at risk than the general population excluding nursing home residents.

Does your original assessment still hold?

Well, you're making a major mistake in looking at population level data and then assuming that has any applicability at the personal level.

Let's imagine a disease which kills only the Taoiseach of Ireland. On a population level the risk is 1 in 5 million BUT if you're the Taoiseach and you catch it you're guaranteed to die, a 100% mortality.

So, using population level risk to discuss individual risk is not valid in the slightest. As to my risk... Yes, if anything the risk of mortality if I catch it is even higher than I initially estimated. It really is worse for those under 65 than I think most of us thought a month ago.

zippy84 wrote: »

Thank you for all your efforts. You have been an invaluable source of information on here.

I have some disposable gloves, but haven't yet used them as in my own situation, I don't feel confident wearing them with any positive effect on my routine. I have seen your linked video on how to remove them effectively etc. When I go out, I carry a small bottle of 70% sanitizer. It pokes out of the back pocket, so I don't even have to touch clothes to grab it. Some examples of when I use it... before entering a shop, before and after using a card machine, before putting stuff in a boot, before getting back into car. Then when I get home everything either gets left to disinfect naturally, or it gets wiped down with disinfectant before getting put away. Clothes off and into a wash.

I absolutely will not touch my face when out and about. My thoughts are that gloves would complicate my situation, and potentially even aid the spread through infected surfaces as I wouldn't be sanitizing as much. Or should I wear gloves and continue to sanitize? I bought a few litres of isopropyl alcohol so there's no shortage of sanitizer for now.

I could see the value in wearing a mask (although I don't have any proper masks), but I'm at odds with gloves. Is there a point at which we could start looking to purchase proper protective masks? I know there is probably a shortage so I wouldn't have been on the lookout online.

Just to add... I didn't mention all the precautions I take and know they will never be perfect, but I do my best.

Well, I think you have to do you. Personally I wear a mask whenever I go out but I don't wear gloves or use hand sanitiser until I'm at work or at home. My reasoning is that I have the discipline built up over time of not touching my face for prolonged periods when wearing masks and so there's no benefit to hand sanitising when I assume that anything I touch is "dirty", including the door handles of my car etc.

If I were to use hand sanitiser on leaving a shop I'd simply assume my hands were "dirty" again the second they touched the car door so, to me, that seems like a waste of hand sanitiser. With that said the first thing I do when I arrive home or go into work is doff my mask, coat etc and then disinfect my hands.

With that said your approach is certainly not unsafe and if you have enough hand sanitiser to hand sanitise all the time then more power to you. Different people are comfortable with different approaches.

I think masks are hugely useful ONLY IF WORN PROPERLY because I'm much more concerned about some random stranger having coughed in a shop or stairwell a few minutes before I walk through that space than I am about me touching my own mucous membranes with "dirty" hands or having poor doffing technique at home or at work.

With that said IF you can get a good mask with replaceable filters and have the means to sterilise said mask then I would do so. I think we are ALL going to be wearing masks when out and about a few months from now. In fact once sufficient supply becomes available I'd expect that to be a requirement to enter a lot of shops.

Over the next few days I'll be editing the mask/PPE post with some additional tips and links to cheap gear on Amazon which will help make masks much more effective.


How are we doing?
Penultimately, there's been a lot of discussion on various threads about how well or how badly Ireland is doing with this and I thought it useful to address this. Several weeks ago I said that we'd peak at somewhere between 40 and 60 deaths a day. We have, now, unfortunately, reached the lower bound of this range. With that said Ireland is very much in best case scenario territory. I still think we'll end up with 1500 to 2,000 dead by the end of May but given what we were heading looking at in early March if we didn't take radical steps 1500 to 2,000 dead by end of May is testament to how well Ireland is doing. Sure, if we'd started taking steps in February we could be doing even better but this is a crisis and we're doing pretty well - certainly a lot better than the UK.

Honestly though I'm more positive about this whole situation every week as I see the measures having an effect and most people doing their best, however imperfectly, to socially distance. We really have avoided the worse scenarios. Hell, even HSE management mostly gets a a thumbs up from me and I'm normally VERY jaded and cynical about them. People have really pulled together and done what needed doing when it needed doing.



Masks
The other thing to note is that this is a marathon not a sprint. COVID-19 will be killing people in Ireland next April and May and will continue to do so, even if it doesn't mutate sufficiently to cause a new strain for which a vaccine is ineffective, until a safe vaccine is available next year. So, even if you are looking at a two month wait for a mask to be shipped from China go ahead and order it. You'll be glad to have it three months from now.

I would strongly urge everyone who has seen the videos of how to put a mask on and take a mask off and so will benefit from wearing one to go out and buy one - even if it'll take a month or two to get here. Yes, do gloves and hand sanitiser etc also if you wish when out but there's a reason why the only piece of PPE I think is essential when out is an airtight mask. All of the rest is nice but can be compensated for by awareness and good routine on entering and leaving your house/work. But without a mask you are at the mercy of whoever passed through space you are now passing through over the last hour or so. If they were sick and coughed you are defenceless without a mask.

With that said, if you don't fit it properly then it'll do more harm than good so look at the videos I posted about taking on and off. I'll post some tips about fitting them properly over the next couple of days.

I hope this was helpful. Stay safe.


P.s. I see someone posted while I was writing...
Locohobo. Thanks, I'm fine. I was just working and then shattered and sleeping. I feel human again today though, hence the post. Thankfully my department dodged a couple of bullets with negative tests among colleagues over the past week - just got the last result back today - so that was great news too.

Pseudonym121

Cork Boy 53 wrote: »

With the death toll in the USA rising virtually every day what do you think the total mortality rate will be there if things continue as they are with no change in restrictions?

Thanks for the question. Unfortunately it is impossible to give a definitive answer to this because of the Trump Factor. As I've outlined previously you can model the probably outcomes of any scenario as Best, Middle and Worst case and then within each of these cases you can have Optimistic, Reasonable and Pessimistic outcomes.

A few countries in the world are heading for Optimistic Best Case Scenario ( Taiwan, possibly Vietnam - I wouldn't include Greece here as I think that their lack of action re: refugee camps will cause their numbers of cases and death rates to spike over time ), others like Ireland are heading for Reasonable Best Case Scenarios. The UK, Italy and Spain are, I think, heading for Pessimistic Best Case Scenarios. Italy and Spain are heading for that because they had community spread before they realised what was happening and so while they've done a good job since they were on a bad trajectory before they realised what they were facing. The UK is on a different trajectory with, probably ( officially it is only double but this is more of an artefact of their inclusion criteria for COVID deaths than an objective reflection of reality ), triple the per capita death rate, than Ireland due to their week-long experiment with herd immunity.

The point about all of the above is that in all cases:
a) the governments are listening to doctors and epidemiologists albeit acting more rapidly or more slowly and
b) each country's government is reasonably efficient - some more so than others obviously and
c) each country's response is reasonably united - one can see this even in federal states like Germany or Belgium.

None of these three factors apply in America. You've got pockets of knowledge and excellence warring with pockets of anti-scientific, populist demagoguery within the government at different levels ( federal vs state vs local ) and within the same level and department.

I think what we are seeing is a scenario in which the federal response is more concerned with creating a scenario in which Trump can lay the blame for deaths at the State/Governor level - I refer here to his new position that the Federal Government shouldn't be responsible for testing, procurement of ventilators etc. He has basically just admitted these things are hard and so he thinks other people should do them, a hellish abrogation of his responsibility - than it is with effectively addressing the issue.

So, America had the potential to come out of this like Ireland with an equivalent of our 1500 to 2000 dead by the end of May ( which would be roughly 90,000 to 120,000 dead ). I think they will do significantly worse than that. Now it is necessary to state that the official numbers will NOT reflect the true death toll. I expect the official numbers will be under 100,000 dead by the end of May BUT:
a) I expect a lot of states will put pressure on doctors to record the primary cause of death as something other than COVID - e.g. if the person dies from a cardiac arrest and has COVID the state will create rules whereby the death is attributed to heart disease. I'm sure people will be say this couldn't happen but doctors work within systems and those systems generate procedures. In America the heads of many of those systems are political appointees and I find it very easy to imagine Republican appointees in Republican-dominated states coming under pressure to ensure their medical organisations issue guidelines which keep the number of COVID deaths low through administrative means.

b) the current figures in the US are basically correct for hospital deaths ( although even there see above ), partially correct for nursing home deaths ( albeit still missing quite a few cases there ) and, in most states, seem to be missing almost all COVID-related deaths taking place in people's homes - which seems to be a large portion of deaths in America. I refer you to the excellent Day Diary of a Paramedic the BBC posted about a week ago in which they had 12 deaths in a single shift, 11 of which were COVID related but none of which were included in that day's number of dead.... and that is ONE paramedic in ONE day.

So, in Ireland I think we are probably undercounting by about 15 to 25%, in the UK I think they're undercounting by closer to 50% and in America I think you could safely double the number of dead given by the "official numbers".

I've written previously, about a month ago, about the need to look at "excess mortality" in order to figure out the real number of deaths caused by COVID. I think that in six to twelve months time when these excess mortality numbers start becoming available we'll see that a lot more people died in America than the current numbers show. At present they are showing roughly 35,000 dead which I'm taking to mean 70,000 dead already.


So what will the total mortality be with no change in restrictions? There's no point answering that since restrictions will change. Already you can see Trump trying to ease the restrictions and states resisting him. This will enable him to blame them for any economic fallout - which is all he appears to care about. What I feel is safe to say is that America will suffer a multiple of the number of dead it had to suffer if it had an effective leader. If Trump is re-elected I think they will easily exceed 1 million dead over the next year - assuming there is no vaccine available until next year, that there's a Q4 spike a la Spanish flu and the Federal Government continues to fight reasonable restrictions and science ( as it currently does ). The real determinant will be whether or not there is a Q4 spike. If there isn't then even with woeful management you'll have only 25% of the number of deaths as if you have a Q4 spike. So that's the difference between 375000 dead and 1.5 Million dead. And right now no-one knows for certain whether we will see a Q4 spike or not. The way to bet in terms of preparation is that there will be a Q4 spike. It is a very sad state of affairs.

Purple Mountain wrote: »

Good to hear you sound rested today and positive. I just want to know.. Today we saw 40+ people die.
I just can't get my head around why our death numbers are creeping up slowly every day when we have had huge restrictions on our movements for 2 weeks.
What I mean is, I know the figures for new results are not in real time because of the backlog with test times etc but reported deaths are in real time.
I would have thought that given how less human interaction there is especially in the last 2 weeks and even since schools and universities closed the death cases would be down?

Well, the first thing to say is that a death rate of 40+ per day is no surprise. I can't find the post where I said it but by my recollection about 2 to 3 weeks ago when we were having far fewer dead a day I was on the record here as saying I expected us to plateau somewhere between 40 and 60 dead per day - this is implicit in the prediction of 1500 to 2,000 dead by the end of May. One other consideration is that I think you could safely add 15 to 25% to our recorded daily deaths by dint of people passing away in nursing homes and at home of COVID 19 but not having been tested or not having the results of the test back yet and so it not being notified. So I think 40 reported as dying in the daily press conference actually means 50 died from COVID19 that day.

So, firstly, it is no surprise, the number we are at is the number we were always going to get by locking down when we did. What you need to remember is that if we had delayed lockdown by, perhaps, 10 days we would be looking at four times this number of dead daily ten days from now. That's the nature of exponentiality.

Secondly, if you say that it takes 5 to 10 days for most people to become symptomatic and another 12 to 18 days for those who will die to die then you can see that if you lock down on the 1st of the month you will still see the number of dead rise for 17 to 28 days but clustering around 21 to 24 days ( call it 3 to 3.5 weeks on average ).

So what you're missing in your thought process is the length of time taken to incubate the virus and the length of time from onset of symptoms until you die. You should expect rising death rates for 21 to 24 days after the date of lockdown and I think that is precisely what we will see.

So, best case scenario I think we are looking at another week of rising cases and then a plateauing of cases in week 4 with a gradual fall in cases in week 5, accelerating as we go into weeks 6, 7 and 8. This is why I've been on record as stating that April and May will be very bad months but by the beginning of June things will very much be looking up. We should see some slight loosening of restrictions in May but in June I would expect that to accelerate significantly. Ideally I'd avoid any lifting of restrictions in June on medical grounds but politically and socially I think that may prove unavoidable - which will risk a an increase in infections and a yo-yoing of easing and strictening of restrictions and death rates.

Honestly, the daily deaths we are having now are pretty much right on track for where we should be for a Reasonable Best Case Scenario and not at all surprising. That I can say we are doing well when up to 50 citizens are dying daily is horrendous but these are horrendous times. That doesn't change the fact that we are doing well. The hospitals haven't been overwhelmed, ICUs which were looking a bit touch and go around the Easter Weekend made it through fine and a lot of our justified preparation in increasing bed capacity, taking over private hospitals etc is going to not be needed ( although it was ABSOLUTELY right to make those preparations ). We are solidly in best case scenario territory right now and that is NOT where we were 6 weeks ago so that needs to be recognised. Yes that we've gone from 90 deaths a day on average to about 140 is horrendous but we aren't at 280, which was eminently possible if we'd just delayed another week or been a bit less strict with the lockdown.

We'll know by the end of the month if the lockdown has worked. I think everything is looking good at the moment and I think we'll finish the month at about 1,000 dead officially ( so about 1250 in reality and even more by the time you look back and count excess mortality figures as others will have died by not coming in to hospital when they've had a heart attack/ delayed cancer treatment etc ) but with a clear plateau and the first signs of falling numbers. But I won't call that a trend until we have at least 5 days of plateau followed by 5 days of generally falling numbers ( the 5 days is based on mean incubation period ).

Then it all depends on us not loosening restrictions too quickly and us keeping the R0 down. If it spikes again we may need to lock down again. Otherwise deaths will fall to a socially acceptable number per day ( I bet somewhere between 10 and 20 ) and the economy will get going again - more slowly than some think - and we'll muddle through. We do absolutely need to prepare ourselves for a major depression and not just a recession or, even more wishfully, a V shaped recovery. We will be dealing with this till next year and that will depress the world economy until pretty much everyone is vaccinated - which will take till the end of 2022. So, 2 years of depressed economic activity. I think that will lead to a significant recession worldwide, especially when combined with a strategic move away from the production of strategic materials globally and a focus on more local manufacture of a lot of those goods.

Anyways, that is economics, a subject which I'm much less of an expert on so take that with a pinch of salt... I just think a lot of economists who are predicting a bounce back just don't understand the timeline of this illness. Reasonably speaking even if they have a vaccine in April 2021 it will be the end of the year before enough has been made to vaccinate everyone, so that's two years of economic activity negatively impacted by SARS-CoV2. I don't think they're taking that into account.

makeandcreate wrote: »

Hi - a question regarding masks - having followed your posts for a while, I realise you are advocating best practise/personal ideal solution.
Specifically regarding masks, I often had to wear one in the oncology out patients - no one advised us how to wear it, put it on etc - simply - in this room we wear a mask. For yourself, for others.
Going forward as a society; does in your opinion - using a layere cotton face mask have any benefit to us? I am not looking at this as "face masks make us invincible" or that is prevents infection from Covid-19 but if it reduced droplet spread in all users by 30% even, is that not beneficial?
And thanks for all the time, energy and sleepless nights you are putting in - there are not enough words to thank you.

I think that, as masks become available they will become mandatory in society. Whether that mandatory nature is through legislation or peer pressure I'm unsure of but I would, personally, be in favour of the following:
a) behavioural approach: Exempt people wearing masks from limits on numbers of people in shops. People who don't want to wait in queues to get in will get a mask and wear it in order to be allowed straight in.

b) behavioural: limit access to certain areas to people wearing masks - eg you can't go into a nursing home or hospital UNLESS you wear a mask. People will want to visit relatives so they'll buy and wear masks.

c) legislative: just make it a law that you need to wear a mask if you go into ANY establishment other than your own home.


I think that any masks is better than no mask. So a cotton mask with no filter is still better than no mask... and then a surgical mask is better yet and an N95 better again. I use an N99 respirator mask when out but they're contra-indicated for people with significant respiratory pathology and even then I find it significantly more difficult/tiring to move around much with it on.

So, yeah, if everyone wore a mask - even a cotton one - it would help reduce spread. Obviously the ideal would be everyone having a reusable N95 mask ( not even a respirator ) with replaceable filters and they're pretty cheap. I got two for like 30 Euro before this started and replacement filters are about 25 cents per day. So, a year's worth of protection with daily travel and filter replacement would come to about 120 Euro. At that level it'd be the sort of thing which would make economic sense for the government to provide ( a day in hospital costs about 1,000 Euros per day and an ICU bed about 5,000 a day ) so avoiding admissions ( and taxes lost due to those ill but not hospitalised ) very quickly pays for itself.

makeandcreate wrote: »

And thanks for all the time, energy and sleepless nights you are putting in - there are not enough words to thank you.

Thanks, we're all just doing our bit. I'm no different in that way, just trying to do my bit.

ZX7R wrote: »

Hello pseudonym 121.

For example your child is special needs and you needed to fly.
If the child was unable to wear a mask how would you see them been able to travel if a repatriation flight was needed for them and the family.

I think that is a very difficult situation. I think there are three possible solutions which vary in terms of feasability depending on the individual circumstances - which I'm obviously not privy to....
1. Innoculate the child to mask wearing using behavioural techniques - treats etc in the days prior to the flight - so that they'd be able to tolerate the mask by the flight. This may not be possible depending on the severity of the impairment.

2. A mild level of sedation could be considered such that a mask could be worn while the child basically sleeps through the flight. This would have to be discussed with their treating team though and could be risky.

3. Probably the simplest solution which might work is for the family simply to bring a lot of extra masks and pass them out to other passengers sitting nearby and explaining that the child is vulnerable, cannot wear a mask and just asking the other passengers to be decent human beings.

5 or 6 rows should be 2.5 to 3 metres and with 6 seats a row that'd be 30 to 36 people requiring masks. That relies on the understanding of others but:
a) most people are decent.
b) most people on any repatriation flight should be delighted to be coming home and scared of the virus so hopefully even a bit more understanding.


4. I'd also highlight this issue to the airline beforehand so that, if the flight wasn't full, some sort of buffer zone where people who didn't want to wear a mask weren't seated close to your child and were moved to empty seats elsewhere in the plane. I'd be willing to bet that if you offered free masks to people you'd have a lot of volunteers to swap seats and move into that buffer zone. Fear is a great motivator.

I think points 3 and 4 are probably most feasible. I want to be clear that the above is just my initial best thoughts on the subject and not medical advice... but I'd be surprised if 3 + 4 plus a chat with the airline didn't solve the problem... plus a bit of habituation a la point 1.

I hope that helps.

Pseudonym121

s1ippy wrote: »

Our neighbours along the road all have this virus, nine other houses. As they spend a lot of time out their back gardens, we are keeping our cat inside because we're worried he'll bring coronavirus into our house.

For context he is very upset, I'm worried it'll give him bowel troubles as he only really goes out to poop and doesn't do any socialising with people or other cats etc. He's pooping at his regular times in the litter box but only after about an hour of wailing at the door.

Are we being overly cautious? I feel cruel. There is only evidence of three pets and those lions having the weak positive but when we're so cautious it would be a shame for all our efforts to be subverted because our cat wants to take A dump somewhere exotic.

Well, I think it is important to treat pets well BUT my view is that if I were to die my pet is going to end up in a shelter and if not adopted euthanised. So, it is, I believe, a far greater kindness to keep healthy and give the pet a secure home for years to come than to take a risk.

This is a virus which infects mammals so jumping from human to cat and back again is not impossible. I, personally, am not taking that risk but I do accept that I’m being very cautious about this sort of thing. With that said I remember six weeks ago when I was talking about needing to treat everyone else as though they’re infected whether they show symptoms or not that I was called a lunatic for saying this. Now the growing consensus is that at least 50% of spreaders are asymptomatic. So, just because the evidence isn’t there at the moment of pet to human spread doesn’t mean it won’t be there six months from now.

I assume it can happen and work off that basis. Better safe than sorry IMO.

volchitsa wrote: »

Hi Pseudonym121

Glad to see you're still doing okay. I have two (more) questions:

I heard on the BBC about a woman who had been saved beyond expectations - her family had been called in because she was dying, but after discussion and as a last resort they agreed to try a technique called "proning" which is basically just putting her on her stomach (still on the ventilator obv). It seems just putting her on her stomach was likely to kill her, so it wasn't something they intended to try without the family's express request.

Now I missed if this was because just moving her could kill her or whether it was something else to do with being left in that position, but I wanted to know what you thought about this - and also how quickly "new" information like this is transmitted to other medical teams around the world?

Do you all wait until proper studies have been run before adopting new procedures, or do you tend to try these things out if, say, a mate in a London hospital tells you that his team has been having success with it?

I read that piece myself. It seemed very exaggerated. Proning isn’t some “last gasp, experimental, this kills half of all people we try it on but without it everyone dies” treatment. Proning is a well recognised treatment which has multiple randomised controlled trials backing it up. The way it was presented in that article was very sensationalist.

Here’s a good link which is easy to read if you want to find out more about it.
https://m.oxfordmedicine.com/mobile/view/10.1093/med/9780199600830.001.0001/med-9780199600830-chapter-99


Normally one of two things happens:
1. Ideally you wait for studies to be carried out in specialist centres. Ideally you wait for multiple randomised controlled trials which are methodologically sound and then you change your practice when the proof is there that it will do more good than harm.

2. Sometimes you have a patient where the situation is such that you take a chance on something which isn’t quite as clearly proven because this patient is in such a dire situation that the benefits of trying this new treatment - which seems to work but hasn’t been fully proven yet - far outweigh the risks. Where you draw this line varies from clinician to clinician and on the individual situation of the patient.

I have certainly done off-label prescribing and tried things which aren’t fully proven when I’ve had patients who I felt were going to die otherwise. Some of the time they still die and some of the time it makes a difference.

With COVID-19 there is a lot of chatter between doctors about what seems to be working in a given hospital or region or country which is being shared. We recognise that this doesn’t have the same level of authority as an RCT BUT this virus has moved so fast that we don’t have time to wait for this research before trying things which seem like they help. This is where 20+ years of experience with patients etc helps and why so much internet opinion about these treatments is useless.

So you’re getting quite a lot of “compassionate use” of drugs which people think might help because if you do nothing then the person will almost certainly die. We then record which drugs seem to help and then if one seems to help a lot we move it into actual studies so we can begin to be confident that it is a good treatment. This is what is happening with Remdesivir. It went from “hey it might help” to “anecdotally it helps” and now it seems it might be moving into “ we’ve proven the benefits out weight the risks” This would be great news if it comes to pass. We’d finally have a treatment.

But yeah I’ve seen stuff from the US and UK and elsewhere where people are reporting what they’ve seen work in order to help other doctors elsewhere save more of their patients. We are all, after all, humans just trying to save other humans. Borders etc are artificial constructs compared to that reality.

Lisha wrote: »

Hello OP,

Thanks for doing this I find it very interesting and informative .

I’ve tested positive for Covid19.

I had high temps for 16days, then I did 5 days post fever before I came out of isolation. (Difficult enough with 10&12year old children.) neither husband nor children have shown symptoms. So I’m hoping that’s it. Gp told husband not to work since I showed symptoms and he didn’t do we hopeful we didn’t spread it. But who knows. I’ve no idea where I picked it up..

When can I be considered no longer infectious...? Work are slow about bringing me back, would prefer if I was tested again and negative. But I know that’s not possible here..

Date I first showed symptoms was 21st March.

I think that’s a really difficult question. I think that the research on that is changing all the time and that a few months from now we’ll know the correct answer but right now the best I can say is that once symptoms are gone the level of virus you shed falls rapidly at first but persists for quite some time ( up to three weeks in some studies so far ) at low levels. Are these low levels enough to infect others? Well, we are certain you’re far less likely to infect them with these low levels but can we say that you certainly won’t infect them? Not with 100% certainty.

So I’d say that to be cautious I’d give it a minimum of one week and a maximum of three weeks after symptom resolution at this stage. That is probably excessively cautious but excessive caution is, I believe, the way to treat this illness on both a personal and population level.

Sorry there isn’t a definite answer but the best the research can really support right now is a range with an assurance that even in week 2 and 3 the amount of virus you shed is much, much lower than when you were symptomatic or during week 1. I think That you should be guided by your GP/Occupational Health and shoudldn’t sweat it if they ask you to wait a couple more weeks. They are probably just being cautious like I am. That’s not a bad thing.

Pseudonym121

GaryByrne wrote: »

Hi I have a fairly difficult question to answer

My grandmother who is 93 is in a hse community hospital. There are more than a few confirmed cases within the hospital including 7 staff in isolation.

We get updates daily from the hospital and my Granny has a mobile and rings us upto 5 times a day asking when she can see us as she isn't sick but just needs constant care because of her age and frailty.

Last night her next door neighbour (from her street) passed away, in the same hospital from complications due to coronavirus, we can't even tell her of this as it would break her heart and she has nobody to comfort her.

My question is, with the word that restrictions will be eased gradually and people will be let back to work without a vaccine, this will obviously raises the risk of my Granny getting infected through staff coming in contact with her. Would we be better to take her out while she is fit and healthy now rather than leave her to eventually get infected as most probably will if it is to continue to go the way it is going.

I don't want to not see my grandmother for another year or at all as her neighbours relatives are now going through

Our local doctor said she is in the best possible place but it is so hard to actually believe that at the minute

And thank you for doing so much

Thanks for the question. I don't think the answer to that question is a strictly medical answer. The answer to that question is a balance between medicine and your feelings.

What I can say is that even if you were to bring her home:
a) it would likely be difficult to provide the care she needs and
b) it isn't as though you and your family will be immune to this over the next 18 months so if she comes home someone in the family could bring it into the house - and infect her.

Generally speaking you could be damned if you do and damned if you don't. Your local doctor is probably the person to follow with this but even following the best of advice there is no guarantee of a good outcome here.

One thing though: i expect that when restrictions are lifted some form of visiting within nursing homes will be allowed again but it will be of the, "You can visit but you must wear a mask and go straight to your relative's room and then leave immediately once the visit is over" type. The majority of Irish people won't tolerate a year of not seeing their relatives face to face. Ideally we would tolerate that but we won't. With that said it is the safest way to play this and while I drop supplies over to my parents I don't go inside and just wave through a window.

On a human level the next 18 months are going to be very tough for those with aged relatives. Sorry I cannot give you a definitive do this or that answer except to say that your local doctor is likely to give you good advice.

What Username Guidelines wrote: »

Any thoughts, or experience, on this?

https://www.today.com/today/amp/tdna178991#click=https://t.co/3vlCF2fWgn

Noticed by doctors treating covid patients in Spain, Italy, and US, along with dermatologists noting a spike in cases/reports.

My 4yo daughter developed a slight cough a week to ten days after schools closed. We thought it odd as she was cocooned with us (she’s a transplant recipient) but it was mild and only here and there through the day. Only just stopped in the last few days.

Middle to end of March I developed the exact symptoms shown in above article. All toes quite sensitive, swollen, itchy and felt “hot”. Similar to a fungal infection but on all toes equally and daktacort did nothing for it. Went away by itself after a about a week, pain went first, then swelling, skin still a little red but all fine now.

Are you noticing any similar symptoms or a pattern of patients displaying non-classical symptoms alongside the usual fever/breathlessness/etc?

Well I think a lot of unusual symptoms and signs are being seen. When I heard about this I immediately thought of micro-emboli and/or generalised inflammation, both of which can occur with COVID-19. With that said lots of people are ascribing lots of symptoms to COVID-19 and when they get tested they don't have it. I've had doctors and nurses around me have all sorts of symptoms, loss of sense of smell, taste, generalised malaise, shortness of breath, cough, generalised aches and pains and so far the vast majority have tested negative. I've also known a number of general members of the public who have been tested and so far none of them have tested positive.

I think that we'll just have to wait for antibody testing. Even then though it is questionable just what a positive antibody reaction will mean functionally in terms of being able to go back to life as normal... You may have antibodies but for how long does that mean you're immune? Probably months to a year or two but we can't be sure... and much will depend on your antibody titre. Lower will probably mean low or no protection, higher will likely mean more protection. I'm not sure the publicly available kits will give you a titre.

Purple Mountain wrote: »

I just have 2 more questions for you.

Are you aware of what Dr Phil (doctor of psychology in the US) said about reopening the economy?
Basically he says look at the figures for people who die in swimming pool accidents etc and the economy still goes on. He can't see the justification of an economic shutdowns.
How do you argue with his mentality?

Also, there's hints in the media, even from our leaders, that schools may return for one day a week.
But yet, I've heard that there are still some test centres or the proposed UL field hospital that hasn't even opened yet.
I just don't understand how we're near opening schools if that's the case.

Thanks.

Well Dr Phil says what his network wants him to say. He's not a medical doctor, and neither does he hold a licence to practice psychology. He voluntarily surrendered that in 2006 - and voluntary surrender is not a thing to inspire confidence. He has also had numerous ethical violations including breaching patient confidentiality and hiring a patient to work with him which resulted in the Texas board putting limitations on his practice in the 1980s.

So he has, to say the least, a checkered past, questionable morals and ethics and isn't the sort of person I'd refer a family member to.

So how would I argue with his mentality? I'd simply say that a lot of people with no real scientific or medical background have suddenly discovered that they're world-class statisticians, epidemiologists, virologists, research scientists and doctors all rolled into one person. You can either believe them or you can believe people who have spent 20 or 30 years doing one or more of those things.

If someone showed up to my place saying they had never had formal training but were a world-class plumber, electrician and carpenter and were much better than the trained, accredited plumber, carpenters and electricians I'd hired I'd have no hesitation in calling BS on their claim. Yet when people do this with science people seem to be much more accepting.

As to the specifics of Phil McGraw's claim. I have NO DOUBT that he is willing to open up America at the cost of many others dying. He certainly doesn't think he'll be among the dead. I think that says a lot about his morals. Certainly we have to strike a balance between death rate and economic catastrophe. I accept that. I do not think that what he is advocating is a very moral balance. I have no doubt that Ireland will strike a much more moral balance. Will many still die? Yes. Could we have reduced this toll if we'd acted earlier? yes, but in a crisis mistakes are made and hindsight is 20/20. Does any of the previous mean we should throw caution to the wind now and throw a 2 to 5% of the population to the wolves over the next year? No. We're better than that.

Purple Mountain wrote: »

Also, there's hints in the media, even from our leaders, that schools may return for one day a week. But yet, I've heard that there are still some test centres or the proposed UL field hospital that hasn't even opened yet.
I just don't understand how we're near opening schools if that's the case.
Thanks.

Well, talking about opening schools in the future could be viewed as an attempt to convince people that normal life will return. Talking about it now doesn't mean it'll happen in a couple of weeks. I think the government is trying to give people hope that a new normal which is livable will come within a reasonable timeframe. That is certainly the prism through which I view those pronouncements.

You only have to read the main COVID-19 thread here to see how many people are unable to put the needs of society above their own desires. To me this shows that they need to be given some hope that the lockdown will end and life will return to a new normal. Of course doing this will result in more deaths over the next year but, to be blunt, unless it is their deaths these people don't seem to care.


Oh and lastly... about masks.
1. If you can get the masks which don't use ear straps. They'll chafe and become uncomfortable and will lead you not to use the masks. Far better to use ones which tie around the back of your head/neck.

2. If you do have a mask strap which is chafing behind your ears or your neck you can wrap some adhesive tape around it which should go a long way to reducing the chafing.

3. So, which tape should you get. Well I've always found the 3M transparent hypoallergenic 2.5cm wide tape to be very good. A bonus is that it is really easy to tear when wearing gloves and is designed to stick well to skin and has reasonable water resistance. I've always had a few rolls of this at home ever since I first came across it almost 30 years ago in hospital.
https://www.amazon.co.uk/Transpore-Surgical-Hypoallergenic-Transparent-2-5cm/dp/B0741B3S4P

The 1.25cm wide version is just too narrow IMO but your mileage may well differ.


4. I've seen a LOT of people with very poorly fitting masks out and about. I've also seen a lot of masks which don't have good nasal bridges to allow shaping to the nose. So, pro tip... Use the tape to stick the facemask to your nose ( and if you wish under your eyes ). The hypoallergenic tape will greatly improve the quality of seal you get.

This won't apply so much to you guys but it'll also prevent hot air escaping upwards and fogging up goggles etc. You can do the same on the bottom and sides if you wish but you'll never fully prevent air leakage where the straps are. I've known some people to remove the straps and just tape the masks on but I wouldn't go so far.... Even if you just tape the top and bottom of the mask you will vastly reduce air leakage.


Word of caution: Hypoallergenic doesn't mean no-one will react to it so just use common sense.


5. If you find the mask chaffing along your nose you can always put a plaster over the bridge of your nose. Normally that would make the mask fit less securely but use a plaster to stop chaffing and use the hypoallergenic tape to create the seal again and you should be good to go. That's what I've been doing recently anyways after I had skin irritation from masks.

Pseudonym121

Lochobo, re: migrant workers.

I don't think the issue is migrant workers. The issue is that once a country ( defined as a geographical national polity with the ability to control ingress and egress ) has controlled the infection rate within its borders to whatever the populace within that country is willing to tolerate then allowing people in from outside without a strict, externally monitored/enforced 14 day quarantine ( as opposed to a relatively useless voluntary quarantine ) will become a source of new infections. I don't think people will tolerate that.

You have to bear in mind that in recent history ( the last 100 years or so ) pandemics and other major shocks to society have usually been followed by shifts to the right in terms of politics. For example, I would expect that support for Trump's wall will increase now that it can be painted as more than just an anti-immigrant measure. Now it'll be an anti-COVID measure also. That'll garner more support.

This will have to be balanced against the reality of our food production which, in many sectors, relies on people being paid below the minimum wage. One should expect food prices etc to increase as the friction caused by COVID on the economy is reflected in increased prices generally.

Will it cause inflation? Probably not because of the massive deflationary effect of many of the other measures that will have to be taken to combat COVID and the massive job losses which will follow over the next year.

zippy84 wrote: »

Any chance of a link to buy masks or are you still working on this? I've seen some for sale on Amazon, but I'm not sure on the quality and wouldn't be relying on reviews on there.

I have one at home that fits nicely, bought it in Woodies a year ago for spraying weeds... cost about 10eu... ffp2 according to the stamp on the side, Can I assume that this is the same effectiveness as a normal n95?

Would like to source a few more online all the same.

If you can source an N95/FFP2 mask on Amazon from a reputable manufacturer (3M etc ) then I would do so. My respirator masks (N99/FFP3) are both from 3M, I have some N95 from other sources. I got all of them from Amazon in late February/early March. Prices are higher now but if what you order doesn't look like what arrived then Amazon's return policy should cover you.

I would definitely invest in masks because as part of the opening up of society again I'd say masks will become de rigeur in any crowded situation.

There may be an issue with masks with valves not protecting others if you're infected - as the valve allows exhaled air out - and so in certain situations you may be forced to go for a valveless mask instead but even then I think valved masks are still worth purchasing... as well as non-valved ones... because they're much more comfortable and I doubt Ireland will tolerate legislation about mask type when masks are in such short supply.

Conelan wrote: »

Hi and thanks for your time,
I know a vaccine will be the longer term hope as a solution to this virus but could I just ask your opinion on the anti viral drugs being used/ being trialed at the moment? Is there any pattern of success emerging with one over another?? Hydroxychloroquine is getting alot of the media attention, less so Remdesivir. Are Irish hospitals using these or do you think is there anything out there that can help? I saw an Australian lab managed to kill the virus "in vitro" with Ivermectin. Is there a big difference in terms of success rate moving from "in vitro" into the human body??
Thanks.

When lecturing about these sorts of things there was a quote I found useful... "In theory there's no difference between theory and practice. In practice there is."

I've seen endless treatments look great in theory and in initial studies and prove worthless or actively harmful in the real world. With that said it seems that Remdesivir cuts down the duration of hospital stay which is useful BUT that is quite different than saying it reduces mortality. So even with Remdesivir it looks useful in a certain cohort but the jury is still out with respect to whether and how much it reduces mortality in those who may end up in ICU.

Still, even a partial treatment is welcome because reducing the duration of hospital stay by 25% reduces the strain on hospitals and that'll be useful to cope with the resurgence in infections when the lockdown ends / Q4 hits.

voluntary wrote: »

The Polish embassy in Dublin just announced the presidential election to take place in Dublin on May 10th. A personal vote in the Dublin 4 embassy itself. Tens of thousands of Polish living in Ireland. Will this be let run?

I'm not a politician just a doctor but my understanding is that the Polish Embassy is viewed as polish territory and so they can do whatever they want on their grounds.

I would expect that if the election goes ahead in Poland then voting will be allowed in the Polish Embassy in Ireland. How many people show up in person to vote is another matter though... but I expect that the vote will go ahead, yes. I, personally, think this is the right thing to do as otherwise various autocratic leaders would seize on these sorts of things as precedent to delay their elections in many countries.

Will going ahead with the election result in increased infections and deaths vs staying at home? Yes, but so long as voting isn't mandatory then those who don't want to risk it can stay at home and those who feel the risk is warranted can vote. It is a tough call but you have to remember many millions of people around the world have died to give this generation the right to vote. If there was another election in Ireland during a winter peak I'd go and vote - albeit with gloves and a respirator mask on. It really is an important thing to preserve....

With that said, that's just my personal opinion.

zippy84 wrote: »

Do you foresee a time-frame or any kind of guidance in relation to children with grandparents going forward? I am happy to keep things the way they are, but I fear in the future siblings may not stay the course, or my parents either.

Well, this has to be a personal decision. There's going to be a new baby in my family in the next few months and I can guarantee you that my parents won't be making a trip to see the baby or hold the baby etc until there's a vaccine. I'm sure there'll be a presentation of the baby through the front window etc but they don't want to see the baby enough to risk dying over it.

Different families and sets of grandparents will draw the line in a different place but that's where my parents are going to draw it. If people visit them then each visit will increase the risk of transmitting COVID - especially since we are now clear that at least half of people transmitting it are asymptomatic --- possibly significantly more.

I also won't be having anyone visit me in my place until such time as I've gotten vaccinated are have proof via an antibody test ( neutralising antibodies NOT binding antibodies ) that I have a sufficient titre to be immune to the prevalent strain in Ireland. I expect healthcare workers to have access to a vaccine during Q4 this year with it rolling out to others over the course of the next year as efficacy and safety are more rigorously proven and production ramps up.

So, I don't expect to visit my parents or family for at least 6 more months and I don't expect them to be able to visit eachother until the middle of next year - roughly 12 months time.

I'm sure many people will visit eachother freely and take the risk and most of them will be lucky and only get an asymptomatic or mild infection but I don't want to be the person who gives my parents something they have a 5 to 10% chance of dying from and so for myself and my family we'll hew to the more careful route. With that said even within my family some people are being noticeably less cautious than others. Even then I'd say they're being more cautious than most of the public but less cautious than I'd like. With that said I'm 100% certain my parents won't allow those individuals into their house until l say it is safe - and I won't be giving that imprimatur until they are vaccinated and/or have a proven neutralising antibody titre.


JoChervil,

I have no problem with complementary therapies per se. I do have an issue with the leaps of logic and evidence which these therapies and those promoting them often make.

Let us examine some of your thinking/supposition.

JoChervil wrote: »

If it was so, the remedy then should be the reduction of Fe3+ to Fe2+ and preferably removal of free iron ions from the blood.

Ok, well firstly we don't know if it IS so. We don't know that Fe3+ and Fe2+ are a central component of the pathology here. Lots of illnesses result in the breakdown of Haemoglobin and the release of its constituent compounds into the blood. There's no evidence that I'm aware of which says that the harm that COVID-19 causes is mediated by "free iron ions".

Secondly, since we don't know that the presence of free iron ions is a central component of the pathological process here - as opposed to just a byproduct of other ways in which the illness causes harm - then there's no reason to suspect that removing these "free iron ions" is "the remedy".

JoChervil wrote: »

I am not a physician but I suspect that BLACK SPOTS LEFT ON THE SKIN BY THE GLASS BUBBLES CONTAIN IRON (that is why they are black)

And here we get into opinion backed by statement transforming into fact. You suspect the black spots contain iron... and then you say that iron-containing spots would be black.

Firstly iron-containing spots wouldn't necessarily be black.
Secondly, the reason these spots are black isn't, as I understand it, due to any iron content. As I understand the colour of the spots it is a combination of suction and the rupturing of capillaries.

But, really, this is a case of making a guess and then a statement and then that somehow becoming a fact. This simply isn't how science and validated treatment works.

JoChervil wrote: »

What if “cupping-glasses” treatment is a method of "sucking off" a significant portion of toxic iron ions from the blood into the skin and thus reducing oxidative stress caused by toxic iron overload?

Ok, I'll counter with... And what is "cupping-glasses" treatment is a method of using the placebo effect to harness the power of the mind and suggestion to make people feel better. My statement has a lot more scientific veracity than yours.

JoChervil wrote: »

Now in hospitals there are a lot of patients with toxic iron ions in their blood causing damage to their vital organs.

Please quote the research which has proven this.

JoChervil wrote: »

I believe in therapeutic power of this method as the “cupping-glasses” helped my sister recover from severe pneumonia when she was a child.

And you are entitled to your belief. You are not entitled to place your belief on the same basis as facts proven by years and decades of research.

With that said, conduct the years and decades of research to put your belief on the same scientific basis as our current understanding of disease pathology and then I'll have no problem incorporating it into my treatment plans. Cupping isn't there yet and I strongly doubt it will ever be there - except insofar as it has a placebo effect similar to many complementary therapies... and let's be clear, placebo effects are real and welcome.

JoChervil wrote: »

The “cupping glasses” are not acknowledged by modern medicine, but has anyone ever tested their effectiveness of eliminating free iron ions (Fe3+) from the blood? Maybe the extravasated blood contains also some virus proteins transferred simultaneously to the skin, which tissue gives probably the strongest immune response in the body. So even, if the spots were only simple bruises with no iron but some virus, they could prod our immune system.

That isn't how immune system sensitisation works. It all sounds pseudo-scientific and I can see how it could persuade people who don't understand medicine or immunology properly but it simply isn't how the immune system works in the human body.

Also I'd love to see the research behind your claim that the skin "gives probably the strongest immune response in the body". It seems you really misunderstand the function of the skin.

JoChervil wrote: »

Why this kind of method can’t be tried and ruled out for good, if not working? Or approved and used, if working?

Probably because no doctor believes it would work given the lack of scientific basis and therefore isn't willing to condemn the intervention arm of the study ( those who get cupping ) to far worse outcomes vs the control arm ( those who are treated using 21st Century medicine ).

Cupping would have to have a LOT more scientific support before it would be ethical to use it instead of treatments which have been shown to have some benefit.

JoChervil wrote: »

It is only a question of applying cups (bubbles) and then analyzing the content of these spots. The advantage of the “cupping-glasses” method is that the therapy is very cheap. Much cheaper and safer than ventilators.

No, it wouldn't. This shows your lack of familiarity with medical research. Proving that the spots contained Iron Ions wouldn't be the end point of the study. The end point would be patient survival or duration of hospitalisation.

So, to test cupping properly you'd have to risk people's lives. We're willing to do that with antivirals and other medicines which we know or suspect will have efficacy against coronaviruses. We're not willing to do that with cupping. You, of course, are free to try it yourself if and when you are infected with SARS-CoV2. No-one will force you to avail of 21st Century Medicine.

And here's a debunking article about what appears to be the basis of your post and putative treatment:
https://medium.com/@amdahl/covid-19-debunking-the-hemoglobin-story-ce27773d1096


As to Phelps... I'm sure he believed it would help him. That doesn't mean it did. Also, we don't know whether it helped or hindered his performance as we don't have a "Control Phelps" who didn't undergo cupping to compare his performance to. And just because he's an Olympian doesn't mean his opinion on this is correct. Just because I'm a doctor doesn't my opinion on this is right but at least my opinion is backed by a lot of research, a lot more than his and yours.

I know which way I'd bet and which way I'd like any doctors treating me to lean.

auspicious wrote: »

Thank-you for all your work and that of your colleagues.

Going forward, should a conversation on diets which have strong scientific evidence of reducing the risk of developing comorbidities associated with Covid-19 be a priority to ease the burden of this disease on the healthcare system and increase the chances of ones ease of recovery?

Well, we've been trying to have that discussion with limited success for the last 60 years. I'm sure attempts will continue and some will listen, some won't.

Hmmzis wrote: »

Hi,
The short version of my question is: "Asymptomatic cases, what's the story there, why are they asymptomatic?"

Well it is becoming increasingly clear that there are a lot of asymptomatic cases. At present it is a safe bet that at least 50% of cases are asymptomatic, quite probably more. This is important because it does lower the case fatality rate significantly since up until recently we were only testing people with symptoms. I'm aware, over the last two weeks, of many colleagues who were asymptomatic testing positive.

One problem with this is that we don't yet know whether an asymptomatic infection results in a high titre of neutralising antibodies which may lead to immunity for a prolonged period of time - 1 year+. Or it may not lead to immunity but the likelihood is a high titre of neutralising antibodies would lead to immunity TO THE STRAIN YOU GOT but not other strains.

If asymptomatic infection doesn't lead to a high titre of neutralising antibodies then even though those individuals technically had the virus they won't be immune and so can get re-infected by the same strain again.

Generally speaking the more severe an infection you get the more likely you are to come out the other end with a high titre of neutralising antibodies which should confer some level of immunity for some period of time.

SARS-CoV2 hasn't been around long enough for us to know for certain but if it behaves like other viruses then there is a decent chance that those who had signficant symptoms will mostly have high titres of neutralising antibodies ( and some level of immunity for some period of time to be determined) while those who had asymptomatic infections will have mounted a lesser response and have lower titres of neutralisiing antibodies and a lesser level of immunity to no immunity for a lesser period of time. This is the way I'd bet it'll turn out BUT I must stress that we do not know this for certain yet. It won't become clear for several more months.

For example, I'm fairly sure I had COVID-19 back in late February after exposure to a probably case who didn't meet the testing criteria at the time. I had what we now know to be a number of symptoms of COVID-19 but which we didn't realise were related to it at the time (rigors x 2/7, no fever, no dyspnoea, abdominal pain x 2/7, intermittent chest pain x 2/52, dry cough once or twice a day on most days for 2 weeks, massive fatigue worse now at 2 months remove than in the immediate aftermath) and so I never met the testing criteria even though I asked to be tested. I'm assuming I have no immunity because that's the safe way to play it... although when a neutralising antibody titre test comes along I'll be first in line to do it.

locohobo wrote: »

Hello again!!..
Noticed you've not posted since 20/04//Hope all is ok and that the HSE have'nt nobbled you...
Just reading today that investigators in China noted, and now the French have noted also that there seems to be surprisingly a lot less smokers affected by coronavirus than non-smokers.. They are to conduct trials using nicotine parches to see if nicotine may be an inhibitor of the infection..
Am just wondering here that maybe its not the nicotine itself but rather the deposit from smoking that is built up in the lungs that may be causing this inhibition. As in that the virus cannot connect with the receptor in the lungs because of this coating..
Would like to hear you're thoughts on this....

No, they haven't nobbled me yet ;-). To be fair with how significantly the country has been locked down I think they'd be hard pressed at this stage to paint anything I said as unprofessional etc etc. It has mostly been just fatigue, massive fatigue which I think is probably a post-viral thing.

Yeah the nicotine findings really surprised us. We were expecting smokers to be particularly hard-hit and yet that isn't what seems to have happened. This virus is weird - largely because it has only just jumped to humans and so hasn't adapted to us yet so it kills us in lots of unusual ways.

I wouldn't think it is anything to do with any deposit from smoking. You have to bear in mind that these receptors are on individual cells and even in a heavy smoker the deposits in their lungs don't coat ever single cell in the lungs. I'd imagine that what we'll find is that the presence of nicotine competes with the virus for receptors and acts in that or some similar way. I really doubt it'll be something on the macroscopic level like deposits.

Tails142 wrote: »

Are you seeing many complications arising for people with asthma contracting covid-19, is it affecting them more severely? Are patients with covid-19 and asthma at much higher risk?

I wasn't overly concerned at the start as asthmatics are generally used to their condition being overhyped, a blast of ventolin and you're normally good to go. But I suppose
I've been dwelling on it the past few weeks - I have psoriasis too and caught cocksackie virus (hand food and mouth) last year from one of my kids, it really took hold in the skin affected by my psoriasis, I.e. My lower legs and arms and gave me a real good doing. It's unusual for adults to get it so I had been wondering if the psorisasis was an opening in my body for that virus to take hold. And likewise, now I'm wondering the same thing about covid-19 and my lungs, could my asthma be an opening for that virus to take hold in me and hit me severely.

Would be interested in your opinion or recent experiences or if you knew of any papers that have looked at this.

Well this is getting perilously close to individualised medical advice which is something I want to avoid. What I would say is that if you have severe asthma then, yes, COVID-19 could impact you more severely if you get it. With that said everyone is different and the best way to figure out the risk to yourself is to contact the respiratory specialist dealing with your asthma and inform them of your particular situation and what they would recommend.

They're going to be far more au fait with your particular illness and medication regimen than I could ever be and will be able to give you good advice. With that said I know several friends who have pretty severe asthma and I've certainly advised them to be extra-cautious. At worst they're now being overly cautious and will be a bit slower to go out again and mix freely as restrictions are lifted. At best they could avoid catching a really serious dose of SARS-CoV2. So, if I were you, I'd play it safe. It doesn't mean you couldn't return to work etc but it might mean that your specialist might advise you to maximise working from home and back it with a letter or advise you to be very diligent about wearing a mask even if others aren't etc.

eeeee wrote: »

Hoping you're alright at the moment, and getting rest in what must be an insanely busy time.

I was just wondering what you think of how the virus has progressed, in terms of your predictions, where do you see things heading now that there's an exit plan? Are the measures premature? Are ye run off your feet in hospital? Do you believe we have seen a rounded peak of sorts or is this level of infection and hospital stress the new normal until a vaccine comes in?

Well, I suggested that as restrictions came in we were looking at a reasonable best case scenario in the short-term ( to the end of May ) of 1500 to 2,000 dead. I think that has, unfortunately, been borne out.

I also suggested in a post earlier in this thread that what would determine our death toll over the next year would be the balance that would have to be struck between acceptable casualties and economic/social activity. At the time I said that everyone was backing the lockdown but, unfortunately, as I expected, human nature, short-sightedness and selfishness are presenting themselves again and already a significant minority of people are openly admitted they're happy to return to normal so long as they're only killing other peoples' parents/grandparents.

I suggested in that post that somewhere between 10 to 20 daily dead ( which would suggest that roughly 50 to 100 hospital admissions would occur daily, with an average treatment time of 2 weeks - so about 1,000 to 1500 hospitalised at any one time or 6 - 10% of the bed capacity) would be the acceptable figure to society. I think that is still so.

We have about 26,000 people in nursing homes in Ireland and when it gets into a nursing home/residential facility it seems the death rate is roughly 1/3rd of residents. I think that is in keeping with a mortality of about 10,000 dead up to March next year and another 300 to 500 per month after that until a vaccine becomes widely available.

So, I think we're still well on track for 10,000 dead in the year to March 2021 as a reasonable best case scenario and approximately about 13,000 till September 2021 IF we get the experimental vaccine in Q4 2020 and people continue to socially distance etc for the next 18 months.

IF we get a very safe and effective vaccine in September 2020 that situation will improve but while the vaccine will be effective I don't think they'll have proven safety by September 2020. There just isn't enough time to prove that and I expect stocks will be limited so I don't think there will be enough vaccine available to vaccinate healthcare staff and the elderly. In that situation healthcare staff should be prioritised as the best protection for the elderly then will be that the healthcare staff can't transmit it to them.

So, where are we. Pretty much on track for the reasonable best case scenario. The two things which will most impact this are:
1. Positively - a safer vaccine earlier. This could hugely reduce the death rate but while I think we'll have an experimental vaccine which is safe enough for high risk groups in Q4 2020 that won't solve the societal problem and I don't think we'll have the population vaccinated until Q4 2021.

2. Negatively - people being idiots once lockdown is lifted. I think this will absolutely happen. It won't be long before people are agitating to be able to go to pubs, soccer matches and to take advantage of all the cheap holidays in Spain, Croatia etc. If people behave in this way then we'll suffer significantly more dead and I think it would bump us up to the Pessimistic Best Case Scenario which would be 20,000 dead in the year to March 2021 and approximately 26,000 dead to September 2021.


I think though that the most likely outcome is somewhere between the two as people won't maintain social distancing and the government will find itself having to dial up and down restrictions at it seeks to balance economic activity with death rate.

So, if I had to bet money I'd say that from 1st March 2020 to 1st March 2021 we're probably looking at 15,000 dead, just splitting the difference, and with roughly 19,500 dead by the end of September 2021.

To put it into perspective we would normally have about 31,000 dead in a 12 month period so that 15,000 would mean 46,000 dead in the 12 month period which is a roughly 50% spike in deaths. That is very significant.

Are we lifting restrictions too soon? Yes, I think so but as I've said from the beginning, the lifting of restrictions will be based on a balancing of death rate and economic and social needs. Given the economic and social backlash the government's hand has been forced. As a society we can't blame the government for this, it is our fault.


@Barrymanilow,
It is certainly possible but it could have been a number of other things also. I think you're in the same boat as myself... We may have had it but we have to assume we didn't have it and should maintain all the precautions until a NEUTRALISING ANTIBODY TITRE test is available. At that point in time we can begin making informed decisions about whether or not we had it AND have some level of immunity.

After all I'm sure you don't care whether you had it or not if it gives you no immunity. You want to know whether you had it AND are now immune. A neutralising antibody titre should answer that. A binding antibody titre won't.

PMBC wrote: »

I see from one of your replies you expected the deaths to peak between 40 and 60 which looks to be what happened.

Where do you think Ireland's numbers are now heading and I appreciate that there are a lot of unknowns and variables?

Also, without being over critical of the decision makers, what mistakes were made regarding treatment of the nursing and care home sectors?

My own opinion is that mistakes have been made but decisions were made with the best of intentions

Thanks for the time you have taken and the information you have given here and wishing you well.

I've answered above. Basically we missed out on closing our borders and ramping up testing and tracing very early on. That meant that we missed the opportunity to be like New Zealand. That would have led to the Optimistic Best Case Scenario of maybe 2,000 dead in a year with less than 200 dead up until May.

By the time we entered lockdown etc we had enough spread within the population that it was highly unlikely we would eradicate this without a very long lockdown. We are now exiting lockdown far too early to have eradication, instead we're entering lockdown because of economic and social pressures and are accepting a certain death toll in order to do that. Hence why I think we would have 10K dead to March next year. The problem is I don't think the public will be sensible and so we will get peaks and then troughs as restrictions are ratcheted up again and we'll go through that cycle a few times over the next year. This will yield about 15K dead by March next year IMO - barring a much more successful treatment/vaccine - and about 19.5K by September 2021 when I expect us to have enough safe vaccine to conduct mass vaccinations at a national level.

Unfortunately it has become clear to me from seeing people out and about that people simply won't socially distance sufficiently when restrictions are lifted and so we will get significant spread again.


With respect to the nursing home and care sectors... Well, I think the original error was in not closing things down in late February/early March. If we'd done that we'd have had fewer deaths and could open everything up much more rapidly now. As it is by the time we started locking things down everyone was gearing up for a tsunami in the hospitals and it was right to focus on that since if that had happened we could have had many thousands of dead by the end of May.

There weren't enough resources to do everything and so, correctly, the nursing homes weren't prioritised, the hospitals were. To be honest we're all a bit surprised how well the lockdown worked and while things were close over the Easter Weekend we got through it without being swamped and have been pretty fine, overall, in the hospitals ever since.

You could argue that after that attention should have shifted to nursing homes more rapidly but I think that's a 20/20 hindsight argument to make.

So, I don't buy into the blame of the government for the nursing home situation. Nursing homes were always going to be hit hard and once the government didn't shut things down when they could have in late February/early March we missed the opportunity to have a New Zealand-like outcome. Right now my rule of thumb is that before this is over we'll lose 1/3rd of the current nursing home population of roughly 26,000 over the next year. So that's about 8,000 to 9,000 dead in the nursing homes absent a safeish vaccine in Q4 2020. I simply don't see how we are going to avoid that and no amount of switching resources a week or two earlier in April would have avoided that. We missed our chance to avoid that in late February/early March. That's the original, costly mistake.

The next really costly mistake will be allowing visitors into nursing homes again. If I were in charge we wouldn't allow any visitors into nursing homes for the next year but, again, people won't tolerate that so they'll all go in and visit and a few weeks to months later 1/3rd of the residents there will die because of it.


The crazy thing with SARS-CoV2 is that a 50% increase in year on year mortality is still a great outcome. Even if you assume complete immunity once infected and a 0.78% case fatality rate and 70% infections over the next year that yields 38 million dead. We won't get anywhere near that because of the actions we've taken. Sure we'll definitely lose a few million to it but I doubt we'll exceed 10 million dead worldwide before Q4 2021 even though I suspect we've already exceeded 500,000 dead (measured by excess mortality) by now rather than 250,000 as measured by officially. 10 million dead while an awful lot is significantly less than we were looking at just 2 months ago. And to be clear I'm certain the official toll won't be 10 million, it probably won't exceed 5 million but you have to bear in mind that in many African countries there isn't even a reliable central register of deaths so that in those countries they'll do well to record 25% of the COVID-related deaths officially.


So, overall, as a planet we've done really well. As a country we've done very well also but we definitely missed the opportunity to have a great outcome ( medically and economically ) in later February. I think the nursing home stuff has been blown out of all proportion given the nature of the crisis and the fact that once it gets into a nursing home you can expect to lose up to 1/3rd of the residents in short order and that it getting in is almost inevitable when you extrapolate this out for another 16 months before a vaccine becomes readily available.

But a lot of people don't want to hear logic and reality. This crisis has shown that. They just want to hear things which support what they want to happen, not what the reality is.

Pseudonym121

JoChervil,

With all due respect debating vaccines with someone who thinks injections are given “into the skin” rather than through it into deeper structures is rather pointless. You opine about complicated things without understanding the very basics. In addition while I respect your right to do whatever you want to yourself I don’t intend to respond further to your posts as I don’t want the Questions or Answers thread to become a haven for quackery which could harm people at this time.

As to others:
Yeah I did rather avoid this because I didn’t want to get drawn into a quackery vs science debate where you end up having to give parity of esteem to things which have no basis in our understanding of physiology and biochemistry beyond that appended by wishful and magical thinking.

I didn’t want to post because I didn’t want to have to deal with these sorts of posts and I had taken the policy of trying to answer anything. In the end I’m squaring this circle by just not responding to JoChervil again - which I’m sure will be misrepresented. Essentially cupping isn’t a treatment for COVID and debating it here isn’t the purpose of the thread. I support him/her discussing cupping wherever else they wish.

Saturnfalls,
Well, “under control” is a wide-ranging statement. It is under control now but most of us expect it to roar back in winter time, especially with America, India, South Africa and Brazil largely losing containment in recent weeks.

But basically my plan is to treat this as though it is still prevalent until Q1 2021. No-one knows for certain if it will have a resurgence in Q4 2020 but the cautious approach is to plan that it will and so I amn’t planning anything involving travel or large gatherings until 2021, and that includes moving home.

As I’ve said before I expect to be have the option of being vaccinated in Q4 2020 and will do so and so come Q1 2021 I’ll have a window of about 3 to 6 months to meet family and friends without putting them at risk and to move. I intend to use that window.

It might be longer but I won’t bet on it. I think things will get back to pretty much normal for everyone with a vaccine throughout 2021 but even then COVID will be a significant issue for years to come. It is a good lesson to us not to be so cavalier with the planet, it is far more powerful than us and bites back occasionally.

Re: mask sanitation... I’d recommend a UV light sanitiser. Heat could break down the plastic microfibres which create the protection/filtration in a mask and I don’t know how Milton could react with masks but figure it could damage them too. This is one of the reasons I bought a UV light steriliser back when I saw this coming.

I have multiple re-usable masks (N99, N95 and surgical types ) and sterilise them after each use without any trouble.


Locohobo,
We still aren’t sure about why some things seem to protect people so the answer is who knows? We are still learning so much about this.



Padser,

Where are we now?
Well, you have to bear in mind that we’ve just gotten through the first 3 months of this. We probably have another 18 months to go before we are largely out of the woods - through having a vaccine which provides some level of immunity to infection/reduction in severity of infection.

The same goes for other countries. You can see that America is going to lose control of its COVID numbers, Brazil is seeing rapid spread and South Africa and India are seeing significant rates of increase of numbers after initially baffling us as to why it wasn’t running rampant there. China is also experiencing another significant outbreak that hopefully they’ll be able to contain.

So, until we get a vaccine, once travel is re-instituted without mandatory quarantine we should expect to see countries re-infecting each other and multiple waves of infection, especially in non-island countries.


Our current pathway to restrictions... I support the easing of restrictions because it is inevitable. People won’t tolerate those restrictions. Way back I stated we would have between 1500 and 2,000 deaths by the end of May. We did so, thankfully on the lower end of that. I also said that as we opened up we’d likely see 10 to 20 deaths per day being tolerated by society. I see no reason to change that number. We will open up and accept an increase in infection and death rate.

If we have good track and trace and can institute local measures ( closing a factory for two weeks if there is an outbreak there etc ) then we will do fine. If we don’t we run the risk of it circulating freely in the community with a much higher death rate and the need for more aggressive and wide-ranging lockdowns.

But, basically, I think we will see a low level of deaths each day for the next 18 months with, potentially, a large peak in winter time. A lot now depends on luck ( will we get a winter peak ), the vaccine ( just how quickly is a working vaccine approved, how quickly can production be ramped up ( they’re already producing potential vaccines so whichever ones work will have supply ) and whether or not we find a treatment which can prevent the disease progressing to its severe presentation. I’m confident we will find useful treatments and a vaccine ( although less confident that it will provide meaningful protection beyond 6 months to possible a year ) but I don’t think we will avoid a winter resurgence.


Any promising therapies? Yes, quite a few but most of them are about keeping people who are severely ill alive to recover rather than being able to prevent them progressing to that stage. It is early days yet. Very early on I said that falling ill with this in April and falling ill with it in September would yield very different likelihood’s of survival. I stand by that. Even if you are going to get it the longer you can put that off the greater your chance of surviving as we get better at treating it and more prepared to do so.

What about treatment for non-COVID issues. Yes, we need to get back to that. It won’t be treatment as normal as capacities will be down and investment will be required. Costs will also escalate as improvements in ventilation and cleaning will be absolutely essential and restrictions will be put in place on how many patients can be passed through a single room in a day ( in out-patient’s etc ).

But yeah, we have to get back to normal... If you read some of my early posts I argued for a focus on “excess mortality” rather than deaths from COVID because I knew that the true impact of COVID would be both those who died from it and those who died from other things because services were curtailed.

We can expect a major increase in waiting lists, significant capital expenditure to bring existing buildings up to the spec necessary to be safe for COVID, significant costs on COVID testing and cleaning and also changes in the structure of services. Hospitals will not return to the way they were before, they will transition trying to provide the same services in new ways consistent with the new reality of COVID circulating in the community. I think we’ll also see a strain on services from COVID survivors who have lost significant lung and renal function as well as suffering significant strokes and that’ll be an added burden on the state and waiting lists for non-COVID cases.

I think psychiatry is going to see a massive increase in numbers after Winter. People generally can survive the first shock fairly well but it is follow-on shocks that cause them to shatter. Some have shattered already but if Winter is bad then I expect there will be a large increase in mental health problems with spikes in suicides, PTSD, anxiety disorders etc - including in those under 18.

Over the next year I think people who frequent OPDs and hospitals will see huge change, very little of which is appreciated outside of those working on these issues within the health service.


I’ll try to check in more regularly now that I’ve decided to break the “I’ll try to answer everything” policy I’d set for myself.

Bottom line though the lockdown worked very well, better even than I had expected but this was the first wave of a few over the 2 years that we can expect this to be a pressing issue for the country. The nation will survive, it isn’t the apocalypse but I don’t think people understand just how long-term and impactful this is going to be.