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Italy is extending its coronavirus quarantine measures to the entire country

bbc.com

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Re: Italy is extending its coronavirus quarantine measures to the entire country

#551

The US really really /really/ needs to get out in front of this. We have the lowest per-capita testing rate in the world, there are likely already significant outbreaks in Seattle, Santa Clara co, NYC, and DC. Probably elsewhere. We are literally like 12 days behind and can see into our future. If this virus does indeed require such intense hospital resources (as in Wuhan and now Northern Italy) letting it spike is j…

We have the lowest testing rate because the CDC made some big mistakes early on.

1) the CDC told all the other labs to stand down and wait for the CDC test kit

2) the CDC refused permission to test except under very narrow conditions

3) the CDC test kit was defective due to being over engineered, and delayed availability during a very critical period

Now that we're behind the exponential growth curve, any measures that politicians can take are going to be much less effective.

https://www.nbcnews.com/health/health-news/after-missteps-cd...

Re: Italy is extending its coronavirus quarantine measures to the entire country

#552

This is an account from one of the doctors in Italy. https://twitter.com/jasonvanschoor/status/123714289107769753... Read the whole thing, but this passage in particular is just chilling. "5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are start…

I am struggling to reconcile this story with the numbers of deaths so far vs the number of deaths in any given year. A french infectious disease specialist mentioned that 2017 had been a bad year for infectious respiratory diseases in France, with over 60,000 additional deaths in winter, to the point that it affected life expectancy tables [1]. I don’t remember any mention of hospitals being overwhelmed and doing war-time triage then.

It is possible than one hospital may be overwhelmed, but surely it cannot be representative of hospitals across Italy or even a region.

[1] for french speakers: https://www.youtube.com/watch?v=pb8Q1yr2cjo

Re: Italy is extending its coronavirus quarantine measures to the entire country

#553
post #516

Earlier quoted context omitted.

You sound correct about the hypocracy but as far as I can find out the normal tests are reported about 40-70% accurate (reports vary but my understanding is more near 40 than 70) in non-symptomatic people and around here they are thus only used and done twice if one has symptoms as even then they are not fool-proof. The test is thus pretty useless to perform on everybody as it gives too many false positives and too m…

This is incorrect. The sequence test has low false positive rate and higher false negative rate. The positive results alone are significant and informative from a policy perspective. Combined with other measurements like CT, the accuracy can be high.

CT for a virus? You can only see that something is inflamed. I mean you can guess the diagnosis, but that doesn't really increases my confidence in testing. If inflammation can be detected, you probably also have symptoms already. That aside, you should limit CTs if possible. And you won't be able to do mass scans anyway. So it is just for specific cases. MRTs could also help and are not as invasive, but maybe they don't show enough.

Re: Italy is extending its coronavirus quarantine measures to the entire country

#554
post #296

Earlier quoted context omitted.

I am a Chinese living in Bay Area. What's described by the Italian doctor was exactly like the situation in Wuhan right after the lockdown for the first 2-3 weeks. Unfortunately, I think it will hit Italy harder this time, China locked down Wuhan but every other provinces send in supplies and doctors to help, just building new hospitals is not enough, and I don't see France/Germany doing the same to Italy. The US res…

It's not just the US though, you have other countries in Europe handling this abysmally like The Netherlands. Indonesia is still in the "pray to make it go away" stage despite multiple cases in Singapore being traced back to Indonesian travel (including one rich Indonesian who couldn't find anyone to treat them in Indonesia so deliberately flew to Singapore on a private plane to get healthcare).

Going with the abysmal handing theory. What concrete steps should, in your regard, be taken to contain the virus from spreading? How would these steps contribute to contain the virus and how would the be implemented without causing disproportional damage elsewhere?

Just saying the situation is handled badly is easy. Just like being a better football coach after a big game. There is a german saying that everytime the national soccer team looses Germany has 81 million national soccer trainers. Providing better solutions is the hrd part, almost as hard a judging why exactly current solutions are not sufficiet.

Re: Italy is extending its coronavirus quarantine measures to the entire country

#555
post #394

Earlier quoted context omitted.

Most severe cases require trained medical staff. Since ~20% of infections requires hospitalization, no healthcare system is prepared for an exponential rise in SARS-CoV-2 infections. Most fatalities are from pneumonia. Lots of details are available all over. You may want to read up.

The numbers out of Korea are nowhere near 20%. About 0.9% of cases are considered severe, according to the most recent statements from the KCDC: https://m.yna.co.kr/view/AKR20200307046000017?fbclid=IwAR0tl... Someone is exaggerating, or something is fundamentally inadequate about the Italian response.

98% of cases in S Korea are classified as "no outcome" at this stage - that is, it's too early to make a call. It takes 11 days on average for the disease to get really severe, so we won't see the deaths for a while. With exponential growth the pct will consistently under report the severity.

Note also that S Korea has 3x the beds of the US, and covid-19 requires very high hospitalization rates and oxygen for weeks.

Tldr: don't expect US or Europe final stats to look anything like S Korea"s current stats.

Lots more detail, and responses to common misunderstandings, here: https://www.fast.ai/2020/03/09/coronavirus/

Re: Italy is extending its coronavirus quarantine measures to the entire country

#556
post #516

Earlier quoted context omitted.

You sound correct about the hypocracy but as far as I can find out the normal tests are reported about 40-70% accurate (reports vary but my understanding is more near 40 than 70) in non-symptomatic people and around here they are thus only used and done twice if one has symptoms as even then they are not fool-proof. The test is thus pretty useless to perform on everybody as it gives too many false positives and too m…

This is incorrect. The sequence test has low false positive rate and higher false negative rate. The positive results alone are significant and informative from a policy perspective. Combined with other measurements like CT, the accuracy can be high.

Good to know about the positive rate. The media has not been very forthcoming with actual data an usually only quotes wide numbers. What I meant is that is test alone will not do the job perfectly and that is what people expect. Higher false negative rates is what bothers me as people generally think "oh I'm safe now" when that might not be the case. Considering they wait here with testing to after symptoms it would likely make the tests way more useful then to test everyone. It requires labs and those might also be stressed to a point of breaking if you start testing everyone (if that is even possible) for instance.

Re: Italy is extending its coronavirus quarantine measures to the entire country

#558

This is an account from one of the doctors in Italy. https://twitter.com/jasonvanschoor/status/123714289107769753... Read the whole thing, but this passage in particular is just chilling. "5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are start…

I fixed the formatting, typos, and expanded the jargon: From a well respected friend and intensivist/A&E consultant who is currently in northern Italy: I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do. First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked i…

Thanks.

What does tubed mean here?

Re: Italy is extending its coronavirus quarantine measures to the entire country

#559

I was not very surprised that Italy turned out to be the (first?) major hit in Europe. Considering the strong business connections, it had to be either us or Germany. We are, as much of the world, importers from China, but many enterprises here are also, somewhat, strong exporters to China (I can see it from my dayjob as industrial automation SI), and if you factor in the small average size of Italian companies requi…

There is good evidence the initial cases in Italy were tourism related. As for praising the Chinese response - I think the reasons will be very clear soon to most people - without a very decisive and heavy handed response the health care systems in most developed countries will face very severe consequences or collapse. We are at the denial stage still with people finding excuses why Italy is different, etc, etc The…

Yes, not only are Chinese and Italian cases related, most southern German cases are also related to those in Italy.

Re: Italy is extending its coronavirus quarantine measures to the entire country

#560
post #471
post #447

Earlier quoted context omitted.

Now long would you maintain that quarantine? Is there some amount of time after which the virus will go away? Any call for drastic measures, even when drastic measures seem like common sense to some people , need to explain why the measures should be implemented and under what circumstances they should be lifted.

I concur with GP - but here in Australia we're run by fantasists, so it's not going to happen here either. > Now long would you maintain that quarantine? I'd suggest start with 2 weeks, and reassess after 10 days. I note that in TFA Italy's administration extended this (initially) out to the 3rd of April, which seems like a reasonable timeframe. Incarcerated people rioted ... and a churlish part of my brain suggests…

most people outside of the previous red zone is uncaring about the new emergency restrictions

step 1 should have been to bring military in the streets to enforce the thing, because police is both decimated by the virus and overwhelmed from the new responsibilities and cannot handle what's happening

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