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

[Montanan]

Decades of research shows many of the sickest ICU patients will never return to their former selves. An ailment called Post-Intensive Care Syndrome (PICS) causes cognitive, physical, and psychological problems in up to 80 percent of all critical-care survivors. About a third never return to work.

http://https://www.yahoo.com/news/ne...090134376.html

Now physicians say they are witnessing many of these effects in COVID-19 survivors, at a scale they’ve never seen before. And some are not sure we’re ready for the influx of ICU survivors this crisis will bring.

“I believe and I feel this with every part of me, that the same way there's been a surge in need for hospital beds, there's going to be a surge in need for rehab beds,” said Miguel Escalón, the vice chair of the rehabilitation department at Mount Sinai. “The question is, how will the system step up to meet this?”

Of the hundreds of thousands of Americans projected to contract the coronavirus, a small percentage will require hospitalization. An even smaller percentage will require care in the ICU—often because of a lung condition called acute respiratory distress syndrome (ARDS). Many of them will require mechanical breathing devices called ventilators to keep them alive.

The confusion Mendez felt coming off of the ventilator is common for patients with extended ICU stays—so common it has a name: “ICU delirium.” The extreme stress of critical illness on the body, combined with the sedative drugs and the foreign surroundings of the ICU, leave many people feeling confused and disoriented, occasionally plagued by memories of things that never happened.

Mendez says she spent 10 days on the ventilator thinking she was a character in the Netflix show On My Block. Her imagined exploits on the “show” felt real, but everything happening in real life felt like a dream. When she finally came to, the hospital wing was covered in Christmas decorations. She assumed she’d been in a coma for almost a year, until a nurse told her they were only an April Fools prank.

According to the Society of Critical Care Medicine, between 30 and 80 percent of ICU survivors struggle with some sort of cognitive impairment after their stay. A year after being released from the ICU, a third of patients have cognitive test scores consistent with someone who suffered a traumatic brain injury, like a car crash. A quarter have test scores in the range of mild Alzheimer’s.

Others will suffer from lasting mental health effects. Almost a third of all ICU survivors show clinically important symptoms of depression, and a quarter show signs of Post-Traumatic Stress Disorder—nightmares, flashbacks, fear of going back to the doctor. A study of ARDS survivors found that a third were never able to return to work.

“We talk about physical cognitive and mental health, but it becomes very understandable to everyone when you talk about not returning to work and the lost income,” said Dale Needham, medical director of the critical care and rehabilitation program at Johns Hopkins Hospital. “The impact that this has not just on the patient but their entire family is profound.”

While it’s too early to know the lasting effects of COVID-19 on survivors, doctors told The Daily Beast these patients often awoke confused and disoriented, with no idea what happened to them. Benjamin Seidel, a rehabilitation physician at Burke Hospital in New York, said some of his patients had noticeably different MRI results compared to when they were admitted.

"Some of these COVID patients that we see, if I get my neurologic expert therapist to evaluate them, they say, ‘This person must have had a brain injury,’” said Kyle Ridgeway, an inpatient acute physical therapist at University of Colorado Hospital. For those who have been in the ICU for weeks, he said, “this is going to be a life-altering situation for them.”

Generally, the level of impairment depends on how healthy the patient was before they entered the ICU and how long they had to stay there. But some coronavirus patients who were not admitted to the ICU still show signs of severe mental distress, according Sean Smith, a rehabilitation physician at the University of Michigan.

“A lot of these patients are pretty mentally shaken up,” he said. “I think [overarching] all of this is going to be some element of PTSD for the patients—and for the doctors—who were in the emergency rooms and ICUs.”

For Mendez, the cognitive issues ended mercifully fast. A born-and-bred New Yorker, she said she remembered her name as soon as someone reminded her what street she was on. “The minute they told me it was 114th, I said, ‘Hey I’m close to the house!’” she recalled. Later, she entertained herself and stayed sharp by counting, multiplying and dividing the ceiling tiles above her bed.

But regaining her physical bearings was another story. A formerly healthy 33-year-old, Mendez could not even sit up on her own when she first woke up. Her first task—moving from her bed to a chair—made her feel dizzy and required an oxygen mask. It took her four days to muster the strength to walk to the bathroom on her own; even then, using it on her own was beyond her ability. She took a three-hour nap the first time she tried.

The experience tracks with what many physicians have seen in their post-ICU coronavirus patients. Every doctor who spoke with The Daily Beast said their patients showed significant muscle loss, reduced lung capacity, and decreased endurance. Some of the most severe patients suffered a temporary paralysis called neuropathy in their hands, feet or limbs.

Ridgeway said what struck him about COVID-19 patients compared to other ARDS survivors was their profound exhaustion. Some of his more muscular patients still struggled to stand for more than 30 seconds without getting fatigued.

“Not an insignificant proportion of them really do feel—even if their oxygen is stable—they just feel profoundly short of breath, especially if they're trying to exert,” he said. “And for some of these patients, ‘trying to exert’ is sitting up to the side of the bed.”

While most of the coronavirus patients who require rehabilitation are older, Ridgeway said he had treated patients in their thirties and forties, some of whom were unable to walk when they entered his care. Heidi Engel, an intensive care physical therapist at the University of San Francisco, described a man in his fifties who caught the virus while on an active outdoors vacation. It took the man a week to relearn how to walk—a progression Engel described as surprisingly fast.

For many of these patients, there is a psychological burden in suddenly waking up with a body that cannot do what it used to. Engel said she’d seen several patients try to walk and fall, forgetting that their legs could not support them.

“I spend a lot of time explaining to people, ‘You have this new body you’re inheriting,’” she said. “‘You’re a fragmented person, and you need to now start to bring all these fragmented pieces back together.’”

Bringing these patients back together is hard to begin with, and even harder when they’re on the heels of a highly contagious virus. Responsible disease prevention requires limiting how many people are exposed to the patient, meaning therapists sometimes don’t get in the room with their patients at all. Ridgeway said he’d started treating some patients through a window in the hospital, with a nurse inside the room to help the patient move.

At Burke, Seidel said they are no longer using shared equipment like treadmills with COVID-positive patients, instead making due with whatever props can be left in the patient's room. When a therapist does make it into the room, they are decked out in head-to-toe personal protective equipment, which makes hands-on treatment difficult. “When you’re basically wearing a hazmat suit it becomes a little more difficult to do some of the therapies,” he said.

At some hospitals in New York City, the epicenter of the disease, inpatient rehab floors have been entirely repurposed into beds for coronavirus patients. At Mount Sinai, rehabilitation doctors are making rounds as general medicine doctors. And at NYU Langone, a rehab physician said he was sending patients home sooner than he’d like, simply because the hospital was not considered safe.

The constraints left a number of doctors worried about how their patients would fare long-term.

“The focus has shifted from usual care to emergency care, meaning things like physical therapy and rehabilitation are taking a back seat, rightfully so, to oxygen status and things like that,” said Smith from the University of Michigan. “But you suffer when you do that. There are patients that aren’t going to get out of bed.”

Still, most of the doctors agreed they hadn't seen the worst of the crisis yet. That will come after the surge in hospitalizations has flattened, and more recovered patients start flooding rehabilitation centers and floors. In New York, where hospitalizations have fallen in the last few days, that could be coming sooner rather than later.

Long-term rehabilitation centers in the state, which take patients who are ready to leave the hospital but not strong enough to go home, are already struggling with the same constraints as major hospitals. Brian Im, a rehabilitation doctor at NYU Langone, said some long-term centers are running with limited personal protective gear and less than half the usual number of staff, making him think twice about where to send his patients.

“You have an already stretched-thin system now reduced beyond that,” he said. “You can just see the safety and the ability to care for patients is severely limited.”

At the same time, home health aides are reluctant to visit former coronavirus patients in their houses, and many outpatient physical therapy clinics are closed for the foreseeable future. Even after the pandemic ends, the national shortage in home-care workers and physical therapists could make it difficult to treat everyone who needs help.

Needham, who has studied PICS for years at Johns Hopkins, said many of these workers will have to be trained in how to treat critical illness survivors, rather than the survivors of heart attacks or brain injuries they are used to.

“Because of COVID, we now have this massive influx of critically ill patients,” he said. “We need to think about the survivorship wave we’re going to face.”

Mendez appears to be on her way to a full recovery. When she finally made it home, it was in an ambulance. After 10 days of recuperation in the hospital, she still cannot get around without a walker. The hospital had to send her home in an ambulance because she couldn’t manage the subway stairs..

Mendez said she plans to return to work as an office administrator at Dominos when she can walk on her own, but doesn’t know when that will be.

“It took a toll on my body,” she said of the virus. “Right now, I'm like a newborn trying to walk again.”

For some reason, Mendez still hasn’t regained her sense of taste—a bitter pill for the daughter of a chef, who has a passion for Italian food. She’s also struggling with another problem: her hair. After nearly a month of not showering in the hospital, it took her two hours at home to get knots out of her curls. At this point, she’s thinking of cutting it all off and starting again.

"I'm in quarantine anyway,” she said. “Nobody’s going to see me.”

[Sand crab]

Georgia announced some businesses will be allowed to reopen this week:


Kemp said specifically that fitness centers, bowling alleys, body art studios, barbers, hair and nail salons, and massage therapy businesses can reopen as early Friday, April 24. Theaters and restaurants will be allowed to open on Monday, April 27, while bars and night clubs will remain closed for now.



Tennessee and South Carolina predict opening some businesses before May1.


https://www.cnn.com/2020/04/20/polit...rus/index.html

[rbk]

Originally Posted by Montanan

[B][SIZE="3"]

In regards to looking ahead there is one thing I have not seen brought up throughout this pandemic. With humans attempting to sterilize the planet, what super bacteria are we currently breeding. We know that over sterilization can cause bacteria to harden making them resistant to antibiotics as well as anti-bacterial chemicals. We could very well be creating a new monster here. The idea that we continue to cleanse the planet until a vaccine is found may do more harm than good in the long run.

[Gadagirl]

Originally Posted by lestersails

It really makes me sad when I see such cynical and insulting posts. I and hundreds of my colleagues work hard to generate and freely share the highest quality health information. This is as mean spirited as it is false.

Please don't take his coments to heart. If you read up on alt-right news sources he's just been parrotting what's being said/posted/reported there and on others like it. They've been ralleying their troops to cause cival strife in hopes of riots, cival disobedience etc. this past week. If you paid attention first he claimed to be in the Bahamas, then in Cape Canaveral Florida, then a later post claiming he's somewhere in the Caribbean? Grenadine? I don't remember. He claimed being a humble cruiser all the way to being a wealthy land holder in mutiple countries that enabled him multiple passports. Says he cares nothing about anyone or anything except himself and his finances, yet makes several posts trying to act like he has real sympathy with the working poor so that we should disregard advice coming from the hardworking scientists and medical experts.

Please just be skeptcal of people like him. Listen to the experts. And arguing with people like him just allows him to respond and spew another falsehood. So yeah, ive broken that rule, leaving open that he will respond and spew more. But I just had to say it. Do not feed the trolls not matter how angry they make you.

[Montanan]

Are we even seeing the tip of the iceberg with the rate of infection?

The Santa Clara county antibody testing indicated a potential of around 1 to 2+% spread of infection and the small LA test indicated perhaps upwards to 5.6%.

A freshwater iceberg will show about 11% of its mass above the surface of the saltwater, a.k.a. the tip of the iceberg, and that leaves 89% hidden below the surface.

That would mean we are possibly seeing only the tip of the tip of the iceberg, or covidberg.

If the antibody tests are 1) reasonably accurate as to not having false results and 2) if the tested population is representative of the full population, then we are possibly only in the start of this pandemic. Those are some big IFs. Lot's of unknowns.

Maybe we are riding near the crest of a first wave with a lot of more waves to come, or perhaps bigger waves to come.

Oh boy, its going to be hard to go to sleep pondering all the uncertainties.

[Montanan]

Originally Posted by rbk

In regards to looking ahead there is one thing I have not seen brought up throughout this pandemic. With humans attempting to sterilize the planet, what super bacteria are we currently breeding. We know that over sterilization can cause bacteria to harden making them resistant to antibiotics as well as anti-bacterial chemicals. We could very well be creating a new monster here. The idea that we continue to cleanse the planet until a vaccine is found may do more harm than good in the long run.

I think some of us are suffering from Covid Isolation Syndrome, and a certain percentage will suffer Post Covid Isolation Syndrome. PCIS.

Oh well, one things for certain I will not be racking up airline mileages and using the awards anytime soon. I'll probably see my Chinese clients say in late 2021 or 2022, down from spending 25% of the time with either they being in Montana or the Montana team traveling to China.

[delmarrey]

Just curious! What business does the Chinese have in Montana?

Montana is mostly mountains and grass lands with very little industry. My father was born in Biem.

[Discovery 15797]

Originally Posted by Montanan

Are we even seeing the tip of the iceberg with the rate of infection?

The Santa Clara county antibody testing indicated a potential of around 1 to 2+% spread of infection and the small LA test indicated perhaps upwards to 5.6%.

A freshwater iceberg will show about 11% of its mass above the surface of the saltwater, a.k.a. the tip of the iceberg, and that leaves 89% hidden below the surface.

That would mean we are possibly seeing only the tip of the tip of the iceberg, or covidberg.

If the antibody tests are 1) reasonably accurate as to not having false results and 2) if the tested population is representative of the full population, then we are possibly only in the start of this pandemic. Those are some big IFs. Lot's of unknowns.

Maybe we are riding near the crest of a first wave with a lot of more waves to come, or perhaps bigger waves to come.

Oh boy, its going to be hard to go to sleep pondering all the uncertainties.

Serological tests can play a critical role in the fight against COVID-19 by helping healthcare professionals to identify individuals who have overcome an infection in the past and have developed an immune response.

This FDA paper discusses false positive and false negative results, but doesn't say the probability of occurrence in random sampling.

False negatives could result from taking a blood sample too soon, but if the virus was present a molecular test would likely detect the virus.

Antibodies are produced by the immune system response to the virus of past infections. In other words...people who were exposed, possibly asymptomatic or mild symptoms, and their immunity system conquered the virus and they are not contagious.

So, using your iceberg analogy, they are revealing the part of the iceberg below the waterline which many have suspected is much larger.

[rbk]

Originally Posted by Discovery 15797

This FDA paper discusses false positive and false negative results, but doesn't say the probability of occurrence in random sampling.

False negatives could result from taking a blood sample too soon, but if the virus was present a molecular test would likely detect the virus.

Antibodies are produced by the immune system response to the virus of past infections. In other words...people who were exposed, possibly asymptomatic or mild symptoms, and their immunity system conquered the virus and they are not contagious.

So, using your iceberg analogy, they are revealing the part of the iceberg below the waterline which many have suspected is much larger.

What I took from that was that at 2% (790,000 ppl) to 5.6% (2.212mil ppl) of people in California have already possibly have had covid 19 and tested positive for antibodies outside the 23,900 positive known cases. WHO figures state between 2-3% (227.8mil ppl) around the globe have potentially had it and are producing antibodies. While this number is a moving target as the virus spreads with larger concentrations in places where the virus has been for longer periods. This supports the theory that it is far more widespread than current figures indicate. Of course assuming that the antibodies tests aren’t totally bogus.

[rbk]

Originally Posted by delmarrey

Just curious! What business does the Chinese have in Montana?

Montana is mostly mountains and grass lands with very little industry. My father was born in Biem.

Assuming it’s nothing specifically business related, where I am they love to see the wilderness. They also consider it very lucky to conceive a child under the northern lights and yes they have tours for that we get plane loads of them all winter. They walk around downtown (the colder the better) in groups all wearing big red down parkas.

[transmitterdan]

https://apple.news/AQMpfmkEvQ-KJr6AC6GAu8Q

Try to ignore some of the political ranting in the article. I am having difficulty finding news sources that do not have it.

73% of inmates at one Ohio prison test positive for novel corona virus infection. These are reported as confirmed cases, most with no symptoms and zero deaths so far reported in the prison. The test results added about 20% to the states total case load.

This was apparently a well controlled test where 100% of the population and the staff were tested. Many of the staff were also found to have been infected.

Those attempting to “debunk” the higher than reported infection rate have a new data point to consider. This virus seems to be very highly transmissible but with a much lower infection fatality rate (IFR) than originally thought. A few weeks ago most experts thought that IFR was close to 1%. But that appears to be incorrect in the few datasets seen so far. I predict there will be more studies to better understand the fatality rate. It is the presumed IFR that frightened the experts and caused us to shelter in place.

It is truly frustrating that China did not do this type testing 3 months ago in Wuhan. They had a well controlled testing site and for whatever reason didn’t do the obvious.

[jimbunyard]

Not exactly 'latest', but gooda place as any, I reckon...

https://www.youtube.com/watch?v=5x_pIgvDLcg

[Exile]

Originally Posted by transmitterdan

This virus seems to be very highly transmissible but with a much lower infection fatality rate (IFR) than originally thought. A few weeks ago most experts thought that IFR was close to 1%. But that appears to be incorrect in the few datasets seen so far. I predict there will be more studies to better understand the fatality rate. It is the presumed IFR that frightened the experts and caused us to shelter in place.

There will have to be a lot more testing done before policymakers could responsibly act on such evidence, but if it pans out I would think it could be a game changer as far as the justification for the lockdowns go. If large percentages of the population are going to become infected no matter what we do, but the number of those infected requiring hospitalization would be small enough so as not to overwhelm health care systems, then the economic harm from the lockdowns may no longer be justified. All of this presupposes, however, the availability and implementation of widespread testing.

Or am I missing something? (no politics/partisan bickering please)

[GordMay]

Further to jimbunyard's YouTube video #1182:

“Democracy Now!” is a TV, radio and internet news program (non-profit) hosted by Progressive journalists Amy Goodman and Juan Gonzalez, with a strong Left biased reputation, based on story selection that consistently favors the left, and High for factual reporting, due to a clean fact check record.
I’d give generally credence to Democracy Now’s factual reporting (subject to cross-checking, as always), but would warn conservatives that their editorial bias is definitely progressive/left.

[Waveguide]

Originally Posted by transmitterdan

https://apple.news/AQMpfmkEvQ-KJr6AC6GAu8Q

Try to ignore some of the political ranting in the article. I am having difficulty finding news sources that do not have it.

If you're looking for medical news, I suggest STAT News: https://www.statnews.com/ that is written for medical workers, Johns Hopkins (which has been on the frontline since the 1918 Flu pandemic): https://www.jhsph.edu/, the New England Journal of Medicine: https://www.nejm.org/, and the Journal of the American Medical Association: https://jamanetwork.com/journals/jama.

There are also many good point-specifc papers published on the National Institutes of Health. Here's a list: https://www.ncbi.nlm.nih.gov/pubmed/?term=covid-19

Those are my go-to sources.

Sadly, suggesting science-based sources is itself "political" in some circles.