Covid19 Part XV - 15,251 in ROI (610 deaths) 2,645 in NI (194 deaths) (19/04) Read OP

ZX7R · 11-04-2020 11:54AM

Danno wrote: »

We (Irish Authorities) now have three weeks until May 5th to do something about this virus, here is what should be done IMHO:

* Order 5 million anti-body tests
* downscale current C19 testing and upscale with this new anti-body test
* issue clear-to-go cards for citizens who are C19 immune who are then allowed to move freely
* mandatory anti-body testing for the entire population - put those 50 testing centres into actual meaningful use
* lockdown to remain in place for those over 66 (retired) or with a compromised immune system unless they pass an anti-body test
* relax restrictions for the remainder of the population to pre-March 28th levels from May 5th
* require that anyone entering Ireland has an anti-body test on the spot - if you refuse, immediate denial of entry to the state.
* full opening of all businesses by May 18th.

This operation would require that we get up to 100,000 antibody tests done a day. With ~50 centres this would require a throughput of 2,000 people each day. Manageable?

What do you do with the majority of people you test that came back negative for antibodies it does not appear that there is mass spread in the community.
You can't lock them away for ever

Unearthly · 11-04-2020 11:55AM

Belgium the latest country to have more reported deaths than China.

iguana · 11-04-2020 11:55AM

Martina1991 wrote: »

Wait too late after infection and antibodies may have subsided to below a detectable limit.

Is that just true of strip testing? Is lab testing more comprehensive? When I was 33 I tested positive for antibodies for measles, mumps, rubella and chickenpox, which I had when I was, respectively, 3, 5, 5 and 8.

And my mum's heaf tests showed her to have TB antibodies when she was 8 and 17. She is suspected to have had TB as a baby.

Nonoperational · 11-04-2020 11:56AM

Guys I really think a bit of perspective is needed on some of the articles being posted and long term consequences etc.

https://www.latimes.com/science/story/2020-04-10/coronavirus-infection-can-do-lasting-damage-to-the-heart-liver?_amp=true&__twitter_impression=true

I would consider the above a very poor mish mash of an article and would have many issues with it.

I am a relatively senior doctor who has treated many COVID patients in a large hospital in Ireland and have assessed at least 100 patients in the emergency department who presented to the COVID pathway. I have now been diagnosed with it myself. My experience is anecdotal but so are these opinion pieces dressed up as scientific fact about 30 patients in a particular area. I have discussed COVID with many colleagues including imminent ID physicians from Ireland and abroad. This is just my opinion.

The human race has likely being battling coronaviruses since day dot along with influenza viruses and likely viruses we never heard of or identified. This is a novel virus but at the end of the day most of us are equipped to deal with it. Our immune system is the most remarkable thing I've ever seen described and for a large part of the population it will see them through this.

The vast majority of 'healthy' young people we see in the COVID ED who think they may have COVID or have been diagnosed in the community we discharge back home to self isolate and they do not require hospitalisation. Their bloods are essentially normal, their chest x-rays are normal. Their troponin and NT-BNP are normal and they do not have cardiac involvement. Their liver function is normal. These people make up the majority of cases in the under 50 years age group. This is important to emphasise. These people still carry it and give it to more vulnerable but the clinical syndrome they get is usually mild. The likelihood of these people having long term issues is very very minimal because they don't really have any significant issues to begin with.

On the other side I have seen many patients some with risk factors as 'benign' as obesity get very sick with bilateral interstitial pneumonia. They do have a characteristic blood pattern of raised LDH and ferritin, raised CRP, and lymphopenia. Depending on the risk profile some of these recover and bloods etc normalise pre discharge and some get sick and require protracted hospital admissions or sadly don't make it.

The issue is when this virus causes pneumonia (the most common complication by miles), myocarditis (inflammation of the heart muscle) and other anomalies like raised liver function tests. If anyone gets a severe pneumonia they are likely to scar an area of lung. COVID may or may not make this more likely. We don't know. These are the group that may have long term sequela in my opinion.

Articles that post gripping headlines about how COVID causes long term effects etc are aimed to shock. We don't know yet the full course of the disease. The point is that many critical illnesses (of which COVID pneumonia is) can cause long term issues.

Although there are always a long line of people wanting to criticise and throw stones, we are doing ok as a health service so far. One more big push and get the R0 below 1 and we can hopefully consider a life beyond this.

Esse85 · 11-04-2020 11:57AM

The amount of cyclists and joggers either spitting or blowing their nose all over the pavement is disgusting.

I feel like chasing after them and beating them with a shovel every time I see it.

How ignorant can you be.

KiKi III · 11-04-2020 11:58AM

Gretas Gonna Get Ya! wrote: »

These are some seriously efficient human beings... no bullsh!t, no PR nonsense, no waiting for the WHO or anyone else to hold their hand... they just spring into action and attacked this virus from every possible angle!

Hugely impressive - makes our lot look like complete amateurs by comparison!

No point showing this to many people around here. Any country that has better stats than us, is just written off as fiddling their numbers... China, Germany etc etc... (No real evidence required btw)

Even if China’s numbers are 100% true, they were able to do the above because of a fairly flexible approach to human rights.

To do what they’ve done there would involve turning the ethical system we’ve been building since WW2 upside down and governments are understandably reluctant to do that.

unhappys10 · 11-04-2020 11:58AM

Esse85 wrote: »

The amount of cyclists and joggers either spitting or blowing their nose all over the pavement is disgusting.

I feel like chasing after them and beating them with a shovel every time I see it.

How ignorant can you be.

Most were ignorant before this, not gonna change now!

Hobgoblin11 · 11-04-2020 11:59AM

Esse85 wrote: »

The amount of cyclists and joggers either spitting or blowing their nose all over the pavement is disgusting.

I feel like chasing after them and beating them with a shovel every time I see it.

How ignorant can you be.

you would do well to catch a cyclist while running with a shovel in hand

Martina1991 · 11-04-2020 12:00PM

mandrake04 wrote: »

Reliable Lab based serology test on something like a Elecsys 801 only takes about 18 minutes. Of course you have to collect the sample and centrifuge, in theory you could have a result within 45 mins if pushed.

Multiply that by thousands of samples a day.

And explain to a Dr in ED that their patients Troponin is taking hours because there's a fleet of Covid antibody tests from the community ahead of it.

Esse85 · 11-04-2020 12:00PM

Hobgoblin11 wrote: »

you would do well to catch a cyclist while running with a shovel in hand

Why run when I have a car.

Jeez

Xertz · 11-04-2020 12:01PM

Just hearing a lot of people raise concern about the Gardai not wearing masks and leaning into cars during stops.

They should be wearing them for protection in both directions and staying well back.

munsterlegend · 11-04-2020 12:01PM

Nonoperational wrote: »

Guys I really think a bit of perspective is needed on some of the articles being posted and long term consequences etc.

https://www.latimes.com/science/story/2020-04-10/coronavirus-infection-can-do-lasting-damage-to-the-heart-liver?_amp=true&__twitter_impression=true

I would consider the above a very poor mish mash of an article and would have many issues with it.

I am a relatively senior doctor who has treated many COVID patients in a large hospital in Ireland and have assessed at least 100 patients in the emergency department who presented to the COVID pathway. I have now been diagnosed with it myself. My experience is anecdotal but so are these opinion pieces dressed up as scientific fact about 30 patients in a particular area. I have discussed COVID with many colleagues including imminent ID physicians from Ireland and abroad. This is just my opinion.

The human race has likely being battling coronaviruses since day dot along with influenza viruses and likely viruses we never heard of or identified. This is a novel virus but at the end of the day most of us are equipped to deal with it. Our immune system is the most remarkable thing I've ever seen described and for a large part of the population it will see them through this.

The vast majority of 'healthy' young people we see in the COVID ED who think they may have COVID or have been diagnosed in the community we discharge back home to self isolate and they do not require hospitalisation. Their bloods are essentially normal, their chest x-rays are normal. Their troponin and NT-BNP are normal and they do not have cardiac involvement. Their liver function is normal. These people make up the majority of cases in the under 50 years age group. This is important to emphasise. These people still carry it and give it to more vulnerable but the clinical syndrome they get is usually mild. The likelihood of these people having long term issues is very very minimal because they don't really have any significant issues to begin with.

On the other side I have seen many patients some with risk factors as 'benign' as obesity get very sick with bilateral interstitial pneumonia. They do have a characteristic blood pattern of raised LDH and ferritin, raised CRP, and lymphopenia. Depending on the risk profile some of these recover and bloods etc normalise pre discharge and some get sick and require protracted hospital admissions or sadly don't make it.

The issue is when this virus causes pneumonia (the most common complication by miles), myocarditis (inflammation of the heart muscle) and other anomalies like raised liver function tests. If anyone gets a severe pneumonia they are likely to scar an area of lung. COVID may or may not make this more likely. We don't know. These are the group that may have long term sequela in my opinion.

Articles that post gripping headlines about how COVID causes long term effects etc are aimed to shock. We don't know yet the full course of the disease. The point is that many critical illnesses (of which COVID pneumonia is) can cause long term issues.

Although there are always a long line of people wanting to criticise and throw stones, we are doing ok as a health service so far. One more big push and get the R0 below 1 and we can hopefully consider a life beyond this.

Thanks for your post. With regards to the reactivation of the virus in Korean patients would you have any views or is it too early to say?

Hobgoblin11 · 11-04-2020 12:02PM

Germany are testing 116k per day , the UK are hoping to be testing 100k a day by the end of this month , Ireland tests how many a day?

flanna01 · 11-04-2020 12:02PM

BanditLuke wrote: »

Something is going to have to be done about the jogger situation in Dublin. I understand people must exercise but as these selfish people refuse to give way on footpaths and insist on imposing themselves on people out walking by sweating and breathing heavy as they pass us maybe they could have alloted time slots for running such as 8am to 9am and 9pm to 10pm or similar.

What part don't you get about transmitting the disease..???

Being near a person (within six feet) for approx 15 minutes!

Now, unless it's a 90yr old medically obese jogger passing you by, he'd surely pass you by in under three seconds..??

Quit moaning ffs...

Most joggers I see are solitary runners, they run past you with without hassle, with the majority of them bidding you a good day...

Have one look around the Supermarket the next time you are shopping, you will see many, many more virus spreading potential risks...

Martina1991 · 11-04-2020 12:03PM

iguana wrote: »

Is that just true of strip testing? Is lab testing more comprehensive? When I was 33 I tested positive for antibodies for measles, mumps, rubella and chickenpox, which I had when I was, respectively, 3, 5, 5 and 8.

Lab testing would be much more sensitive (able to detect very tiny amounts of antibodies present) and specific (only detecting the relevant antibodies and not other ones).

Hobgoblin11 · 11-04-2020 12:03PM

Esse85 wrote: »

Why run when I have a car.

Jeez

is that an essential trip?

munsterlegend · 11-04-2020 12:03PM

Hobgoblin11 wrote: »

Germany are testing 116k per day , the UK are hoping to be testing 100k a day by the end of this month , Ireland tests how many a day?

When you say test do you mean swabs taken or swabs analysed in a laboratory?

cameramonkey · 11-04-2020 12:04PM

Nonoperational wrote: »

Guys I really think a bit of perspective is needed on some of the articles being posted and long term consequences etc.

https://www.latimes.com/science/story/2020-04-10/coronavirus-infection-can-do-lasting-damage-to-the-heart-liver?_amp=true&__twitter_impression=true

I would consider the above a very poor mish mash of an article and would have many issues with it.

I am a relatively senior doctor who has treated many COVID patients in a large hospital in Ireland and have assessed at least 100 patients in the emergency department who presented to the COVID pathway. I have now been diagnosed with it myself. My experience is anecdotal but so are these opinion pieces dressed up as scientific fact about 30 patients in a particular area. I have discussed COVID with many colleagues including imminent ID physicians from Ireland and abroad. This is just my opinion.

The human race has likely being battling coronaviruses since day dot along with influenza viruses and likely viruses we never heard of or identified. This is a novel virus but at the end of the day most of us are equipped to deal with it. Our immune system is the most remarkable thing I've ever seen described and for a large part of the population it will see them through this.

The vast majority of 'healthy' young people we see in the COVID ED who think they may have COVID or have been diagnosed in the community we discharge back home to self isolate and they do not require hospitalisation. Their bloods are essentially normal, their chest x-rays are normal. Their troponin and NT-BNP are normal and they do not have cardiac involvement. Their liver function is normal. These people make up the majority of cases in the under 50 years age group. This is important to emphasise. These people still carry it and give it to more vulnerable but the clinical syndrome they get is usually mild. The likelihood of these people having long term issues is very very minimal because they don't really have any significant issues to begin with.

On the other side I have seen many patients some with risk factors as 'benign' as obesity get very sick with bilateral interstitial pneumonia. They do have a characteristic blood pattern of raised LDH and ferritin, raised CRP, and lymphopenia. Depending on the risk profile some of these recover and bloods etc normalise pre discharge and some get sick and require protracted hospital admissions or sadly don't make it.

The issue is when this virus causes pneumonia (the most common complication by miles), myocarditis (inflammation of the heart muscle) and other anomalies like raised liver function tests. If anyone gets a severe pneumonia they are likely to scar an area of lung. COVID may or may not make this more likely. We don't know. These are the group that may have long term sequela in my opinion.

Articles that post gripping headlines about how COVID causes long term effects etc are aimed to shock. We don't know yet the full course of the disease. The point is that many critical illnesses (of which COVID pneumonia is) can cause long term issues.

Although there are always a long line of people wanting to criticise and throw stones, we are doing ok as a health service so far. One more big push and get the R0 below 1 and we can hopefully consider a life beyond this.

Hope you recover quickly. Is there enough ppe coming through the system now to protect health care workers?

Hobgoblin11 · 11-04-2020 12:04PM

munsterlegend wrote: »

When you say test do you mean swabs taken or swabs analysed in a laboratory?

swabs taken

Nonoperational · 11-04-2020 12:04PM

munsterlegend wrote: »

Thanks for your post. With regards to the reactivation of the virus in Korean patients would you have any views or is it too early to say?

I don't know to be honest. There is certainly the potential that this virus causes quite a long illness that appears to be resolved and then reappears in some people. it may be a case that it was never gone.

In Ireland it hasn't been something that I have come across. But really we are only seeing the start of the sick COVID patients going home. Up to now the people going home have been the ones that were not too sick to begin with. So maybe a signal will appear.

eagle eye · 11-04-2020 12:07PM

Bannasidhe wrote:

What we never get is treated like adults, transparency, lack of spin, or any kind of openness.

So true.
Really enjoyed reading your post, good fun and basically telling the whole story as it was and is. Great job.

owlbethere · 11-04-2020 12:07PM

Nonoperational wrote: »

Guys I really think a bit of perspective is needed on some of the articles being posted and long term consequences etc.

https://www.latimes.com/science/story/2020-04-10/coronavirus-infection-can-do-lasting-damage-to-the-heart-liver?_amp=true&__twitter_impression=true

I would consider the above a very poor mish mash of an article and would have many issues with it.

I am a relatively senior doctor who has treated many COVID patients in a large hospital in Ireland and have assessed at least 100 patients in the emergency department who presented to the COVID pathway. I have now been diagnosed with it myself. My experience is anecdotal but so are these opinion pieces dressed up as scientific fact about 30 patients in a particular area. I have discussed COVID with many colleagues including imminent ID physicians from Ireland and abroad. This is just my opinion.

The human race has likely being battling coronaviruses since day dot along with influenza viruses and likely viruses we never heard of or identified. This is a novel virus but at the end of the day most of us are equipped to deal with it. Our immune system is the most remarkable thing I've ever seen described and for a large part of the population it will see them through this.

The vast majority of 'healthy' young people we see in the COVID ED who think they may have COVID or have been diagnosed in the community we discharge back home to self isolate and they do not require hospitalisation. Their bloods are essentially normal, their chest x-rays are normal. Their troponin and NT-BNP are normal and they do not have cardiac involvement. Their liver function is normal. These people make up the majority of cases in the under 50 years age group. This is important to emphasise. These people still carry it and give it to more vulnerable but the clinical syndrome they get is usually mild. The likelihood of these people having long term issues is very very minimal because they don't really have any significant issues to begin with.

On the other side I have seen many patients some with risk factors as 'benign' as obesity get very sick with bilateral interstitial pneumonia. They do have a characteristic blood pattern of raised LDH and ferritin, raised CRP, and lymphopenia. Depending on the risk profile some of these recover and bloods etc normalise pre discharge and some get sick and require protracted hospital admissions or sadly don't make it.

The issue is when this virus causes pneumonia (the most common complication by miles), myocarditis (inflammation of the heart muscle) and other anomalies like raised liver function tests. If anyone gets a severe pneumonia they are likely to scar an area of lung. COVID may or may not make this more likely. We don't know. These are the group that may have long term sequela in my opinion.

Articles that post gripping headlines about how COVID causes long term effects etc are aimed to shock. We don't know yet the full course of the disease. The point is that many critical illnesses (of which COVID pneumonia is) can cause long term issues.

Although there are always a long line of people wanting to criticise and throw stones, we are doing ok as a health service so far. One more big push and get the R0 below 1 and we can hopefully consider a life beyond this.

Thank you so much for your beautiful, lovely and hopeful post. I'm wishing you all the best and a speady recovery.

easypazz · 11-04-2020 12:07PM

Hobgoblin11 wrote: »

swabs taken

4500 a day next week but increasing past that if necessary afaik.

Main issue is reagents, which seems to be improving.

Xertz · 11-04-2020 12:07PM

Hobgoblin11 wrote: »

Germany are testing 116k per day , the UK are hoping to be testing 100k a day by the end of this month , Ireland tests how many a day?

To put that in Irish population context divide the German figure by 17.44 which is 6651 tests per day.

mandrake04 · 11-04-2020 12:10PM

Martina1991 wrote: »

Multiply that by thousands of samples a day.

And explain to a Dr in ED that their patients Troponin is taking hours because there's a fleet of Covid antibody tests from the community ahead of it.

You would need a dedicated line of maybe 4 modules just for serology you could chew through plenty of samples, keep your usual Chem/Immunology line for routine hospital work that’s the smart way.

Ideally you would have a dedicated serology lab. Off course the Assay needs to be developed first which it will.

Nonoperational · 11-04-2020 12:10PM

cameramonkey wrote: »

Hope you recover quickly. Is there enough ppe coming through the system now to protect health care workers?

My honest assessment of PPE in my hospital is that:

There are plenty aprons, gloves, surgical masks and goggles we clean.

I would have preferred to have worn FFP2 masks, disposable face shields and better suits, but that wasn't the case.

Saying that when this all began I was pretty sure working in a hospital I was going to get this. I was somewhat at peace with that. I'm absolutely no hero, and I get plenty benefits from being a doctor, but I knew that if I was to work with COVID patients in close contact that the chances were I'd get it. I don't resent that fact. Thats just the way it is.

Gretas Gonna Get Ya! · 11-04-2020 12:11PM

KiKi III wrote: »

Even if China’s numbers are 100% true, they were able to do the above because of a fairly flexible approach to human rights.

To do what they’ve done there would involve turning the ethical system we’ve been building since WW2 upside down and governments are understandably reluctant to do that.

There's no real evidence of widespread denial of human rights throughout this process in wuhan... civil liberties yes, but not human rights abuses. People are prone to exaggerating these things!

But yes, lets go a bit old school on the civil liberties for a while... in order to save lives. Why the hell not?

We're already halfway there anyway, with the current restrictions... what's a couple of degrees more gonna do in the long term? It's not like the population is going to fall in love with this new authoritarian lifestyle and vote in a communist dictatorship in the next elections!

A big part of the power of what they did in wuhan, was the speed in which they did it... and the efficiency of how they carried it out.

People need to get past this nonsense of political ideologies, and just implement the most efficient strategy to combat this virus - if that means copying methods of a communist dictatorship - then that's what you have to do. It's about saving lives, not making ideological / political stances!

Gynoid · 11-04-2020 12:11PM

Nonoperational wrote: »

Guys I really think a bit of perspective is needed on some of the articles being posted and long term consequences etc.

https://www.latimes.com/science/story/2020-04-10/coronavirus-infection-can-do-lasting-damage-to-the-heart-liver?_amp=true&__twitter_impression=true

I would consider the above a very poor mish mash of an article and would have many issues with it.

I am a relatively senior doctor who has treated many COVID patients in a large hospital in Ireland and have assessed at least 100 patients in the emergency department who presented to the COVID pathway. I have now been diagnosed with it myself. My experience is anecdotal but so are these opinion pieces dressed up as scientific fact about 30 patients in a particular area. I have discussed COVID with many colleagues including imminent ID physicians from Ireland and abroad. This is just my opinion.

**Doctor Talk***

.

Listen here, Doctor. I have been casually reading around this subject for, gosh I don't know, probably 11 or 12 weeks now and consider myself a reasonably well informed epidemiologist at this stage. I cannot understand what takes ye so long with all those years in college and in practise to get a handle on this kind of stuff. Bunch of messers.

Nonoperational · 11-04-2020 12:13PM

Gynoid wrote: »

Listen here, Doctor. I have been casually reading around this subject for, gosh I don't know, probably 11 or 12 weeks now and consider myself a reasonably well informed epidemiologist at this stage. I cannot understand what takes ye so long with all those years in college and in practise to get a handle on this kind of stuff. Bunch of messers.

My apologies, will try harder

iguana · 11-04-2020 12:14PM

Nonoperational wrote: »

I don't know to be honest. There is certainly the potential that this virus causes quite a long illness that appears to be resolved and then reappears in some people. it may be a case that it was never gone.

I have an illness that I suspect may be Covid 19. It's reminding me in some ways of the glandular fever my son had last year. In that he'd get sick, seem to recover, do something physical and get sick again. After he was diagnosed I was told to keep his physical activity to a minimum for a month or two to avoid triggering a relapse. With my current illness I keep feeling better, stepping up my physical activity and then my symptoms come back. I thought this week that I was completely better. Had 3 days without symptoms, really good energy level, felt totally fit and heathy. Then completely and totally overdid it on Thursday (I really should have had more cop on) and have had symptoms again. They are mild, I suspect they'll be gone again completely in a few days, but I'll (hopefully) know to carefully phase in physical activity from here on.

Covid19 Part XV - 15,251 in ROI (610 deaths) 2,645 in NI (194 deaths) (19/04) Read OP

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