We have been on the same chat board for years and you all know I have a certain set of skills (when I say this, I picture Liam Neeson in Taken), so I figured I would give you guys an update.
COVID 19 is a virus that likely originated from a live animal market in Wuhan, China and successfully transmitted from one of the animals (thought to be a pangolin) to humans. Zoonotic infections can happen, but the virus then found the ability to transmit from human to human. From there, it became a deadly and very contagious viral illness that is in the process of spanning the globe. "The corona virus" is actually a misnomer, as there are many corona viruses and multiple strains already give us common cold symptoms. COVID 19 is different because it is specific for invading lung tissue, not the nasal passages and upper airways. So you typically don't see a runny nose with this. Standard symptoms start with cough, fever and may progress to shortness of breath and overwhelming respiratory failure. Now it started in Wuhan, China and has since made its way to many countries. To this point, off the top of my head, it's the US, China, South Korea, Croatia, Austria, Italy, Iran, Canada, Brazil. For those who don't think it is coming to our neighborhood, it is likely already here. So we should all panic and hide in our rooms, right? Well, the comparison is to SARS is easy to make, but SARS this isn't. SARS had a mortality rate on test positive patients of around 11%. This virus has a mortality rate in test positive patients of about 2%. Now, consider that you are only testing sick people, usually, and the mortality rate drops. The breakdown of the people who die from this shows a similar predilection to the flu for the elderly, immunocompromised, and those with lung and heart ailments. A whopping 15% of patients over 80 who tested positive in Wuhan, died. Now what about the other age groups. The rate of death for someone in my age group (30-50) is between 0.2-0.4%. There have been no reported fatalities in kids 9 or under.
Now back to the "it's already here" statement. The US sucks at testing for this. China built two hospitals in 10 days and started testing everyone rather rapidly. We fucked up our first test sent out nationally and needed to send a disclaimer with how to right the wrong and are now shipping out testing tools to every state in the union as of today. Doctors who are treating patients are not able to test for the disease. The only way to test is to convince the CDC to test the patient. There are 3 updated methods to get them to test.
1. Cough and fever + exposure to a test confirmed COVID 19+ patient within the last 14 days
2. Cough and fever plus shortness of breath bad enough to warrant admission + recent travel to an endemic area of COVID 19 within the last 14 days
3. Cough and fever and ARDS (severe, profound respiratory failure) without other reason (i.e. flu negative patients)
So once you hear the mortality rate of US patients with it, throw it out the window. The infection ranges from asymptomatic carrier to mild symptoms, all the way to fulminant respiratory failure and death. We are only going to be able to report mortality rate on the positive testing patients and we aren't testing the ones with a milder form of the disease. Hence, the media is sensationalizing a disease for which we are entirely unsure of it's mortality rate.
Also, most of us ED docs either have treated or know of a case in our departments that could have had the disease (yes, me too) and with the rigid CDC testing requirements, we couldn't test. Now, does testing help? Probably not. It is entirely expensive and right now there is no treatment beyond supportive measures. So I understand the positive the CDC has taken, but it contradicts the narrative thrown out there by government officials that we are doing what we can to quarantine this. We are absolutely not doing that. I hope this helps
Originally Posted by Slasher9
