corona virus alerts - Latest cruising Information for vessels/locations/rules

[tp12]

Conspiracy theories and those responding in kind are not on topic for a thread designed to give the latest information on COVID-19 - can we stay on topic, please.


Thanks.

[Montanan]

Originally Posted by tp12

Conspiracy theories and those responding in kind are not on topic for a thread designed to give the latest information on COVID-19 - can we stay on topic, please.


Thanks.

PLEASE.

[smbdyiam2]

Charlette from Charlette's Web died today from the virus she had seizure's and breathing problems. This affects lots of people some indirectly.

[Singularity]

A curious development in conceptualization of what is causing respiratory failure with Covid and how to manage it. I don't mean to parse the science in this thread, but the ~newer observations connects dots together in a very logical manner that is promising, in the least, to potentially reduce the deaths caused by inappropriate protocol/shotgun ventilator treatment.

-----------------

Dr. Gattinoni and colleagues hypothesized that COVID-19 patterns at patient presentation depend on interaction between three sets of factors: 1) disease severity, host response, physiological reserve and comorbidities; 2) ventilatory responsiveness of the patient to hypoxemia; and 3) time elapsed between disease onset and hospitalization.[/COLOR]
They identified two primary phenotypes based on the interaction of these factors: Type L, characterized by low elastance, low ventilator perfusion ratio, low lung weight, and low recruitability; and Type H, characterized by high elastance, high right-to-left shunt, high lung weight, and high recruitability.[/COLOR] “Given this conceptual model, it follows that the respiratory treatment offered to Type L and Type H patients must be different,” Dr. Gattinoni said.

[COLOR=dark red]While not willing to name the hospitals at this time, he said that one center in Europe has had a 0% mortality rate among COVID-19 patients in the ICU when using this approach, compared with a 60% mortality rate at a nearby hospital using a protocol-driven approach.[/COLOR]

https://www.mdedge.com/internalmedic...ratory-therapy

https://www.atsjournals.org/doi/10.1....202003-0817LE

https://www.medscape.com/viewarticle/928156

[Woodland Hills]

Originally Posted by Singularity

A curious development in conceptualization of what is causing respiratory failure with Covid and how to manage it. I don't mean to parse the science in this thread, but the ~newer observations connects dots together in a very logical manner that is promising, in the least, to potentially reduce the deaths caused by inappropriate protocol/shotgun ventilator treatment.

-----------------

Dr. Gattinoni and colleagues hypothesized that COVID-19 patterns at patient presentation depend on interaction between three sets of factors: 1) disease severity, host response, physiological reserve and comorbidities; 2) ventilatory responsiveness of the patient to hypoxemia; and 3) time elapsed between disease onset and hospitalization.
They identified two primary phenotypes based on the interaction of these factors: Type L, characterized by low elastance, low ventilator perfusion ratio, low lung weight, and low recruitability; and Type H, characterized by high elastance, high right-to-left shunt, high lung weight, and high recruitability.
“Given this conceptual model, it follows that the respiratory treatment offered to Type L and Type H patients must be different,” Dr. Gattinoni said.
While not willing to name the hospitals at this time, he said that one center in Europe has had a 0% mortality rate among COVID-19 patients in the ICU when using this approach, compared with a 60% mortality rate at a nearby hospital using a protocol-driven approach.
https://www.mdedge.com/internalmedicine/article/220301/coronavirus-updates/protocol-driven-covid-19-respiratory-therapy

https://www.atsjournals.org/doi/10.1164/rccm.202003-0817LE

https://www.medscape.com/viewarticle/928156

This reinforces what the doc in the video I posted last night: https://youtu.be/k9GYTc53r2o was saying. A one size fits all approach to ventilator therapy may be doing harm to some patients.

[weavis]

Originally Posted by Woodland Hills

This reinforces what the doc in the video I posted last night: https://youtu.be/k9GYTc53r2o was saying. A one size fits all approach to ventilator therapy may be doing harm to some patients.

It does.

[Montanan]

IMHO, It ain't over until it is over. We will be dealing with this for a very long time of social distancing and continual minimization of non-essential travel and exposures, an easing from a total ban.

Dr. Birx warns of 'very acute second wave' of coronavirus infections if social distancing measures are relaxed
insider@insider.com (Connor Perrett)
Business Insider April 8, 2020, 9:10 AM MDT

https://www.yahoo.com/news/dr-birx-w...151003365.html

Dr. Deborah Birx, the White House coronavirus response coordinator, warned Wednesday that social distancing practices needed to be maintained to avoid another wave of COVID-19 infections.

"We're very hopeful because of the seriousness of which the American people have taken these guidelines," Birx said when "Today" show anchor Savannah Guthrie asked whether she believed the death toll would be lower than previous estimates of 100,000 to 240,000. "What's really important is that people don't turn these early signs of hope into releasing from the 30 days to stop the spread. It's really critical."

"You can see the delay," Birx said. "So, if people start going out again and socially interacting, we could see a very acute second wave very early. We are really encouraging every American to continue to follow the guidelines for these 30 days."

"Each of these epidemics are sub-epidemics," Birx told "Today." She added the federal government was watching various cities and states throughout the US "very carefully for where they are on the curve."

Birx said in Washington state and in California, the curves look "persistently flat" due to social distancing mitigation measures that were adopted early on.

"Obviously New York and New Jersey had a logarithmic rise in the number of new cases, but we're seeing that stabilizing and that gives us great encouragement," she said, adding that the "high levels of mortality" in those hotspots reflect people who were infected with the virus "two to three weeks ago."

The White House at the beginning of April announced its "30 days to slow the spread" initiative, which encourages Americans to follow social distancing practices, though it does not mandate them on a national level. Most states have enacted some form of a stay-at-home order, though, which have closed non-essential businesses and asked residents to remain in their residences.

In New York, which has seen the worst outbreak in the US, Gov. Andrew Cuomo on Monday extended the state's PAUSE order, which orders non-essential businesses closed and forbids the gathering of people, until at least April 29.

On Tuesday, the US experienced its deadliest COVID-19 day so far, with nearly 2,000 reported deaths in a 24-hour period. At least 399,929 people have been infected with the virus in the US, and at least 12,911 have died as of April 8

[Sand crab]

423,135 cases in the US with 14,390 deaths.

1,500,830 case world wide with 87,984 deaths.
https://coronavirus.jhu.edu/map.html

[Montanan]

According to the Navy, 93 percent of the US Aircraft Carrier Theodore Roosevelt’s roughly 4,800 crew members have been tested for COVID-19, the disease caused by the coronavirus. Those tests have so far yielded 286 positive results and 2,588 negative results, the Navy announced. Those numbers mean that so far roughly 10 percent of those who have received results have tested positive for the disease, with more than 1,900 sailors either yet to be tested or awaiting results. As of Wednesday, 2,329 sailors had moved ashore in Guam. The Navy has been working with the local authorities there to gain access to hotel rooms in which sailors can be quarantined. However, only those with negative test results are allowed to stay in the hotel rooms.

“Sailors will only be permitted to depart Naval Base Guam following a negative COVID-19 test result and they must remain in quarantine in their assigned hotel rooms for the duration of the mandatory 14-day period,” said Cmdr. J. Myers Vasquez, a spokesman for the Navy’s Pacific Fleet in an emailed response to questions from Yahoo News. “As testing continues, the ship will keep enough sailors on board to sustain essential services and sanitize the ship in port.”

None of the crew’s COVID-19 cases have required hospitalization, according to the Navy.

One of the Theodore Roosevelt sailors to test positive was its former commanding officer, Capt. Brett Crozier, whose decision to send an urgent memo up his chain of command expressing concerns about the pace of the Navy’s response to the COVID-19 outbreak on his ship cost him his job. Then-acting Navy Secretary Thomas Modly relieved Crozier for putting too many people on the “cc” line of his email containing the memo. Modly resigned Tuesday after coming under intense criticism for a speech he gave Monday to the Theodore Roosevelt crew in which he was harshly critical of Crozier.

How long the Theodore Roosevelt will remain in Guam is unclear, but the standard quarantine period is 14 days. The carrier arrived in Guam around March 27.

Meanwhile, the Nimitz is hoping to avoid a similar outbreak this spring. After a sailor from the Nimitz contracted COVID-19 on a trip to see his family and was ordered not to return to the ship, another sailor on board the ship began exhibiting symptoms of the disease within the last two weeks, according to a Navy official who did not want to be identified discussing the combat readiness of individual ships. Test results on the second sailor were “inconclusive,” but the sailor was removed from the ship and isolated as a precautionary measure, the Navy official said.
The cases involving the Nimitz were first reported by Politico.
The Nimitz’s home port of Bremerton is in Washington state, where the first COVID-19 case in the United States was confirmed on Jan. 21. By April 6, the state had 8.682 confirmed cases, of whom 394 had died.
The Navy has embarked the carrier’s full-time crew of about 3,000 sailors in an attempt to safeguard them from the virus that has spread around the state. “No one goes on the ship each day without being asked a set of questions,” said Cmdr. Ronald Flanders, a spokesperson for U.S. Naval Air Forces. “If they have traveled to a high-risk area or if they feel ill in any way they are vectored away.”

Sailors also have their temperature taken before boarding the ship, and anyone running a fever is placed in isolation, according to Flanders.
Once the crew members are aboard, they are expected to follow all the now familiar Centers for Disease Control and Prevention guidelines about frequent hand washing and social distancing “to the greatest extent possible,” said Flanders. “It’s difficult to practice aboard a fully manned warship,” he added.

https://www.yahoo.com/news/one-in-10...224147009.html

[Montanan]

The State of New Jersey has issued Stay At Home orders which will go into effect Friday April 10.

Non-essential travel will be banned as well as closure of non-essential businesses.

https://covid19.nj.gov/faqs/nj-infor...ses-are-closed

New Jersey Gov. Phil Murphy has issued Executive Order 118 ordering the closure of all county and state parks and forests due to the COVID-19 crisis as of 8 p.m. tuesday.

[Montanan]

Governor Mills Issues Executive Order Mandating Quarantine Restrictions on Travelers Arriving in Maine to Protect Public Health and Safety
April 3, 2020
Governor Janet Mills today issued an Executive Order mandating that travelers arriving in Maine, regardless of their state of residency, self-quarantine for 14 days to mitigate the spread of COVID-19. The Order, which directs the Maine Department of Transportation, the Maine Turnpike Authority, and others to post this guidance at all major points of entry into the State, exempts individuals who are providing essential services as defined by Governor Mills’ March 24 Executive Order (PDF).

“To slow the spread of this deadly virus and prevent our health care system from being overwhelmed, we must all do our part,” said Governor Mills. “I am mandating that anyone entering Maine self-quarantine for 14 days and abide by Maine’s Stay Healthy at Home Order. These actions will protect the health and safety of everyone.”

Additionally, the Order instructs visitors not to travel to Maine if they are displaying symptoms of COVID-19 and advises them not to travel to Maine if they are traveling from cities or regions identified as COVID-19 hot spots.

To deter travel, the Order also suspends lodging operations, including hotels, motels, bed and breakfasts, inns, and short-term rentals such as those available through VRBO Airbnb, RV parks and campgrounds, and all public and private camping facilities as well as online reservations effective April 5, 2020 at 12:00 p.m.

However, the Order states that lodging can be provided for housing vulnerable populations – such as for children in emergency placements, persons at risk of domestic violence, and homeless individuals as permitted by the State – and for accommodations for health care workers or other workers deemed necessary to support public health, public safety, or critical infrastructure.

While Governor Mills hopes compliance with this Order will be voluntary, it may also be enforced by law enforcement, as necessary. Individual violations of this Order may be charged as a Class E crime subject to a penalty of up to six months in jail and a $1,000 fine. Additionally, any lodging, park, or campground operator who violates this Order may be construed as violating any license, permit or other authorization to operate and be subject to appropriate penalties.

“We are facing one of the greatest public health crises of the world in more than a century. But if we pull together, we can and will defeat this virus,” said Governor Mills. “Maine is a welcoming state, and we welcome the many servicemembers and medical professionals and others who are coming here to help us. I ask Maine people not to make assumptions about others, and we welcome the cooperation of other visitors and returning residents in quarantining themselves and keeping us all safe in accordance with this order. Let us treat all people in Maine with compassion and kindness. That is how we will get through this.”

The Order is effective immediately and extends until at least April 30, 2020.

https://www.maine.gov/governor/mills...elers-arriving

[Montanan]

The U.S. Centers for Disease Control and Prevention has abruptly switched its guidance for use of a drug touted by President Donald Trump as a possible treatment for COVID-19, dropping its reference to anecdotal dosages to say simply that there are no approved drugs for dealing with the disease.

The CDC's online advice for hydroxychloroquine was updated April 7, three days after Reuters reported that the CDC was offering what the news agency called "highly unusual guidance" for the drug's use based on "unattributed anecdotes rather than peer-reviewed science."

The updated, and shortened, guidance says simply that "hydroxychloroquine and chloroquine are under investigation in clinical trials” for use on coronavirus patients and "there are no drugs or other therapeutics approved by the U.S. Food and Drug Administration to prevent or treat COVID-19."

The CDC originally told Reuters that the earlier guidance was crafted for doctors at the request of a White House coronavirus task force, which had urged prompt action.

The CDC did not immediately respond to USA TODAY's queries about the revised guidance.

Hydroxychloroquine, the anti-malarial drug, was thrust into the spotlight by Trump, who has regularly touted its potential to fight the virus, saying “there are some very strong, powerful signs” of its potential.

Although health experts say that the data on the drug's effectiveness is extremely limited and that more study is needed, Trump said recently that “if it does work, it would be a shame we did not do it early.” He added: “But what do I know? I’m not a doctor.”

As a sign of the president's influence on the issue, Trump noted this week that the federal government had purchased and stockpiled 29 million pills of the drug. “We are sending them to various labs, our military, we’re sending them to the hospitals,” he said.

The question of the drug's effectiveness has divided some key Trump advisers.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has expressed skepticism over the drug, saying, “The data are really, just, at best, suggestive.”

“There have been cases that show there may be an effect, and there are others to show there's no effect," Fauci said on CBS's "Face the Nation. "So, I think in terms of science, I don't think we could definitively say it works.”

Peter Navarro, the top trade and manufacturing aide to the president who is coordinating the use of the Defense Production Act against the virus for the White House, told CNN's John Berman recently that he believes a "second opinion" is needed about hydroxychloroquine as a treatment.

"I let (Fauci) speak for himself, John, but I would have two words for you: second opinion," Navarro said. "Doctors disagree about things all the time."

According to the CDC, hydroxychloroquine is an arthritis medicine that can also be used as a prevention or treatment of malaria and is used to treat rheumatoid arthritis and lupus. It’s available in the U.S. under prescription only.

The most recent study came from China and found that the anti-malaria drug helped speed the recovery of a small number of patients who were mildly or moderately ill. The study notes that the evidence is limited. Authors of the report said that cough, fever and pneumonia went away faster and that patients’ illnesses were less likely to become severe.

The study was made up of 62 patients where half the subjects were given the usual care and the other half were given the usual care plus hydroxychloroquine.

They were treated for five days, and their fevers and cough were monitored. Pneumonia improved in 25 of the 31 patients who were given the drug vs. 17 patients in the control group. However, authors concluded that more research is needed.

The study was posted on medRxiv before it was accepted by the International Journal of Antimicrobial Agents with limited to no peer review.

Consider this: The first US coronavirus patients are being treated with convalescent plasma therapy. Will it work? Not even the doctors know

Trump has also cited another small study from France of just a couple dozen patients that found that the drug, combined with common antibiotics, was effective in fighting COVID-19. A subsequent study of 80 patients in France found clinical improvement in all but one.

Other experts criticize the studies' design and lack of information on drug side effects.

“We often see antiviral therapies (that are promising) in the test tube and animal models. But before we give it to patients with confidence, we really need to see the data in humans,” said Jeffrey Klausner, a professor of medicine and public health at the University of California-Los Angeles.

Elisabeth Bik, a microbiologist and scientific integrity consultant who writes the medical blog Science Integrity Digest, says it is "very unusual for the CDC to promote a drug that has no proven ability to cure or prevent a disease."

"The CDC is one of the most reliable sources in this country, and their online information is usually very well curated and trustworthy," Bik says, speculating that the CDC might have initially felt pressure "from high-level leadership."

"So it looks as if the CDC is indeed listening and responding to these concerns by changing their statement and removing the recommended dosages," said Bik, who has challenged the findings of a French study of the drug. "I applaud them for doing the right thing."

https://www.yahoo.com/news/cdc-websi...165821932.html

[Montanan]

France said Wednesday it would extend a lockdown aimed at slowing the spread of the coronavirus as the death toll soared across Europe and the US -- though Washington said it saw "glimmers of hope" on the horizon.

. . .

The confinement order issued on March 17 "will be extended" beyond the current deadline of April 15, an official close to Macron told AFP.

. . .

As some European countries weighed easing lockdown measures to allow economic activity to resume in earnest, the World Health Organization urged against it.

"Now is not the time to relax measures," said WHO's Europe director Hans Kluge.

"It is the time to once again double and triple our collective efforts to drive towards suppression with the whole support of society."

https://www.yahoo.com/news/wuhan-exo...070230030.html

[rbk]

Originally Posted by Montanan

The U.S. Centers for Disease Control and Prevention has abruptly switched its guidance for use of a drug touted by President Donald Trump as a possible treatment for COVID-19, dropping its reference to anecdotal dosages to say simply that there are no approved drugs for dealing with the disease.

The CDC's online advice for hydroxychloroquine was updated April 7, three days after Reuters reported that the CDC was offering what the news agency called "highly unusual guidance" for the drug's use based on "unattributed anecdotes rather than peer-reviewed science."

The updated, and shortened, guidance says simply that "hydroxychloroquine and chloroquine are under investigation in clinical trials” for use on coronavirus patients and "there are no drugs or other therapeutics approved by the U.S. Food and Drug Administration to prevent or treat COVID-19."

The CDC originally told Reuters that the earlier guidance was crafted for doctors at the request of a White House coronavirus task force, which had urged prompt action.

The CDC did not immediately respond to USA TODAY's queries about the revised guidance.

Hydroxychloroquine, the anti-malarial drug, was thrust into the spotlight by Trump, who has regularly touted its potential to fight the virus, saying “there are some very strong, powerful signs” of its potential.

Although health experts say that the data on the drug's effectiveness is extremely limited and that more study is needed, Trump said recently that “if it does work, it would be a shame we did not do it early.” He added: “But what do I know? I’m not a doctor.”

As a sign of the president's influence on the issue, Trump noted this week that the federal government had purchased and stockpiled 29 million pills of the drug. “We are sending them to various labs, our military, we’re sending them to the hospitals,” he said.

The question of the drug's effectiveness has divided some key Trump advisers.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has expressed skepticism over the drug, saying, “The data are really, just, at best, suggestive.”

“There have been cases that show there may be an effect, and there are others to show there's no effect," Fauci said on CBS's "Face the Nation. "So, I think in terms of science, I don't think we could definitively say it works.”

Peter Navarro, the top trade and manufacturing aide to the president who is coordinating the use of the Defense Production Act against the virus for the White House, told CNN's John Berman recently that he believes a "second opinion" is needed about hydroxychloroquine as a treatment.

"I let (Fauci) speak for himself, John, but I would have two words for you: second opinion," Navarro said. "Doctors disagree about things all the time."

According to the CDC, hydroxychloroquine is an arthritis medicine that can also be used as a prevention or treatment of malaria and is used to treat rheumatoid arthritis and lupus. It’s available in the U.S. under prescription only.

The most recent study came from China and found that the anti-malaria drug helped speed the recovery of a small number of patients who were mildly or moderately ill. The study notes that the evidence is limited. Authors of the report said that cough, fever and pneumonia went away faster and that patients’ illnesses were less likely to become severe.

The study was made up of 62 patients where half the subjects were given the usual care and the other half were given the usual care plus hydroxychloroquine.

They were treated for five days, and their fevers and cough were monitored. Pneumonia improved in 25 of the 31 patients who were given the drug vs. 17 patients in the control group. However, authors concluded that more research is needed.

The study was posted on medRxiv before it was accepted by the International Journal of Antimicrobial Agents with limited to no peer review.

Consider this: The first US coronavirus patients are being treated with convalescent plasma therapy. Will it work? Not even the doctors know

Trump has also cited another small study from France of just a couple dozen patients that found that the drug, combined with common antibiotics, was effective in fighting COVID-19. A subsequent study of 80 patients in France found clinical improvement in all but one.

Other experts criticize the studies' design and lack of information on drug side effects.

“We often see antiviral therapies (that are promising) in the test tube and animal models. But before we give it to patients with confidence, we really need to see the data in humans,” said Jeffrey Klausner, a professor of medicine and public health at the University of California-Los Angeles.

Elisabeth Bik, a microbiologist and scientific integrity consultant who writes the medical blog Science Integrity Digest, says it is "very unusual for the CDC to promote a drug that has no proven ability to cure or prevent a disease."

"The CDC is one of the most reliable sources in this country, and their online information is usually very well curated and trustworthy," Bik says, speculating that the CDC might have initially felt pressure "from high-level leadership."

"So it looks as if the CDC is indeed listening and responding to these concerns by changing their statement and removing the recommended dosages," said Bik, who has challenged the findings of a French study of the drug. "I applaud them for doing the right thing."

https://www.yahoo.com/news/cdc-websi...165821932.html

The CDC does not have the authority nor is the approving body for drugs in the US; the FDA is in charge of that of which they do approve of the use of HCQ for emergency off label use at the discretion of a medical doctor based on the following fact sheet: https://www.fda.gov/media/136537/download

[Montanan]

Originally Posted by rbk

The CDC does not have the authority nor is the approving body for drugs in the US; the FDA is in charge of that of which they do approve of the use of HCQ for emergency off label use at the discretion of a medical doctor based on the following fact sheet: https://www.fda.gov/media/136537/download

Correct the CDC provided medical guidance only the FDA has the authority for approval.

Which is likely why the CDC pulled the specific reference to anecdotal dosages. The updated, and shortened, guidance says simply that "hydroxychloroquine and chloroquine are under investigation in clinical trials” for use on coronavirus patients and "there are no drugs or other therapeutics approved by the U.S. Food and Drug Administration to prevent or treat COVID-19."