Open Note to Doctors – COVID 19 Notes

The following was posted by Peter Lawrence Thompson to another blog. Given the many unknowns about the COVID 19 virus the blogmaster thought it useful to repost. Obviously the target is the medical community – David, Blogmaster

 


This has a lot of medical jargon, but if you read it carefully it gives a picture of what front line medical staff are faced with. I was written by an Emergency MD in a New Orleans hospital – Peter Lawrence Thompson

“I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won’t make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the “lockdown”, our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn’t appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil’s potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient’s standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn’t often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.”

170 comments

  • Dr. Vladimir Zelenko has now treated 699 coronavirus patients with 100% success using Hydroxychloroquine Sulfate, Zinc and Z-Pak [UPDATES] | Tech News | Startups News.

    https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-treated-699-coronavirus-patients-100-success-using-hydroxychloroquine-sulfate-zinc-z-pak-update/?fbclid=IwAR20aaqoQB5AnjdboT47aNbUBJtBbu8lfksTWALFpUCoJhrH9NL1mdtm6FQ

    Dr Didier Raoult, French top flight Infectious Disease Specialist, in Marseille, did a limited 80 infected study, peer reviewed. Results are 78 better 1 in ICU and 1 died.
    Found that Hydoxychloroquine and Azithromicin works, accepted by Stanford ID professor, Dr Stephen Smith ID specialist on East Coast, most Docs at Presbytarian Hospitals in NY and many others.

    Man in FLA actually told family goodbye, expected to die, and took this and better in a couple days.

    Dr GP please comment.

    Like

  • @MoneyBrain

    This conflicts with what Dr. Fauci said at the press briefing only yesterday.

    Like

  • Dr Fauci was also incharge of the original Test Kits sent to Wash State that had a high error rate. I am not a Doc of Medicine, but it is posssiblr Dr Fauci knows there are limited supplies so does not want to hype it. WHO et al are telling people that masks dont work, why? Then they say that Medics are short of masks? I am certain that there is massive amounts of disinformation.

    Like

  • MB I believe you , but it seems that this drug is tied to trump, people are willing to downplay positive results for a political end. Yesterday on fox they said DR,s were prescribing it to themselves as a prophylactic that should tell us something.

    Like

  • @lawson

    Do not spout nonsense or turn this blog into an anti Trump affair. At yesterday’s press conference even Trump admitted that there is no conclusive evidence that FDA approved drugs are working, too soon.

    Liked by 2 people

  • and you believe anything on FAUX NEWS. man get outta here. so now Dr Fauci is the problem? what nonsense unnuh does spout tho?

    Like

  • @David,

    showing some balls there David. you beat me to it lol

    Like

  • Please be awre that the Chinese are controlling the WHO. Bruce Alwyard, a Canadian in a seniorWHO positon was aked by an ASian journalist what the WHO was doing to help Taiwan, he pretended he could not hear although everything appeared perfect. Then when recontacted and asked about Taiwan he said that All of China is good. WHY? China pushed for the President of WHO to get the job???????

    Like

  • @MoneyBrain

    What does this comment have to do with the efficacy of Hydroxychloroquineas it pertains to treating COVID 19?

    Like

  • Whether anyone here cares to accept it or not this whole COVID19 situation has gargantuan political overtones. BUT lets see how we can ensure Bajans survive.

    Liked by 1 person

  • @Moneybrain

    Please enlighten us. Conspiracy theories or not are not unfamiliar to BU.

    Liked by 1 person

  • No Greene and David read the NYT from march 24 about DR”s and hydrxchloriquine, Greene please refrain licking Davids balls, covid is everywhere on the rock any solution should be explored and not after you cant get it.

    Like

  • David, my first comment or info is key so please prove that wrong BUT make sure the info is from the very best Infectious Disease Specialists that want to save lives right now. Any knowledgeable person is aware that at least 2 phases and Double Blind studies etc are the norm but this is not mormal this is a crisis of epic proportions, supposedly. Crises and Wars demand action.

    Liked by 1 person

  • @Lawson,

    right wing conspiracy theory nonsense is quite tiring, FAUX NEWS is sickening and you sycophants are exhausting. so bye

    Like

  • @lawson and MoneyBrain

    The simple point is that at yesterday’s press briefing BOTH Fauci and Trump admitted testing of the drug has not yielded conclusive results, too soon.

    Liked by 1 person

  • Whether anyone here cares to accept it or not this whole COVID19 situation has gargantuan political overtones. BUT lets see how we can ensure Bajans survive

    100% correct. I’ve had to monitor this situation since mid-December long before most were even aware of what was going on. In late December the Chinese were downplaying the virus and incorrectly stating that human to human transmission was not possible. The WHO went along. When spread started the Chinese said that it was limited to a small area and a few cases and under control. The WHO went along. When the outbreak spread rapidly in China, the WHO were tardy in drawing international attention to the unfolding crisis. After that the WHO were tardy in declaring a pandemic even though it clear to anyone following events.

    Luckily those in Taiwan, Hong Kong and South Korea were aware of the Chinese shenanigans what was going on and were among the first to adopt robust controls.

    This is not conspiracy. These are all facts.

    Like

  • Here is a document prepared by academia for those with the medical literacy.

    Not for conspiracy theorists!

    Contrary to media promoted statistics, this study reveals COVID-19 has an infection rate 19.4 times faster than SARS, and is already four times deadlier two months into the spread of this disease (December 8, 2019-February 8, 2020). Authorities in China and the United States are both claiming that COVID-19 came about in a natural way implying it was definitely not the result of an accidental or intentional containment breech at Wuhan Virology Institute or a more sophisticated biological weapon attack.

    https://www.academia.edu/42018477/Probability_Model_of_the_Genesis_of_COVID-19_in_Wuhan_China

    Like

  • Here is a document prepared by academia for those with the medical literacy.
    Not for conspiracy theorists!

    Hey, have you read this or even understand what it is saying? Do you know what a probability model means?

    Like

  • @Dullard

    The blogmaster is appallingly ignorant, educate him if you must.

    Certainly, correlation does not prove causation and the USA cannot possibly be responsible for every leaf that falls from the tree of life. Simultaneously it is also true that in a room full of smoking guns and dead bodies, some kind of crime probably occurred. And, when it occurs that there is a chorus on the sidelines laughing merrily, cheering the whole thing on and profiting from the slaughter, it is not unreasonable to wonder if some members of that chorus might possibly have had something to with that crime. It is presumed that virologists studying COVID-19 are already aware there is at least a 50% probability this virus did not occur naturally, as they are not naïve, and probably also realize that the Chinese government would have to keep the possibility of a containment breech or biological attack secret in order to maintain public order. Were the Chinese public to be fully aware of the potential or probable American complicity in the COVID-2019 epidemic, Americans might not be safe in China. Surviving victim family members of those who died of COVID-19 would have a lot of justifiable anger and unfortunately
    mobs can form in an instant, anywhere in the world. This kind of thing would “fit” perfectly into
    a hypothetical American game-plan for further isolating and defaming China. Thus, logically, the Chinese government has no choice but to continue to assert the origin of COVID-19 is of natural causes and hope the next American president is not so virulently anti-China as is the present American administration. American foreign policy always capitalizes on radicalizing target populations in order to provoke responses used as justification for even greater aggression by the US DoD directed towards those target populations

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  • @Dullard
    Do you expect me to believe that the US with its vast network of intelligence sources weren’t aware of what was going on in Wuhan? Were they relying on China to provide accurate info? There is a move afoot to blame what is going on in the US to blame everyone but the current Administration, from Obama (remember he didn’t leave us with enough supplies) to Democrats to WHO. This is a President who rely on Fox TV for information and it was downplaying the epidemic plus he is surrounded by yes men who are just glad to have a “pick” so they don’t dare say anything that would annoy him.

    I expect to hear echoes of this blame on WHO as it goes along, Rand Paul wants to open an investigation of WHO in the US Senate.

    Like

  • Sarge, do I have to remind U that the same sources said there were WMDs in Iraq?haha

    Liked by 1 person

  • The biggest economy in the world, on purchasing power parity, is China. Yet, officially, it is still rated as a developing nation, along with South Korea. Canada, the 11th biggest economy, is a member of the G7. Why?
    What does that tell you.

    Like

  • Model from Imperial College in London predicted ridiculous number of deaths and much more that is way out of line.

    Liked by 1 person

  • @ Blogmaster @ Sarge

    Apologies. I think you misunderstand me. All I am saying is that
    1) The Chinese are/ were not forthcoming
    2) The WHO is being and/ or has been manipulated or influenced unduly by China
    3)As stated above, “COVID19 situation has gargantuan political overtones”

    As to whether COVID was started in a lab or came from Mars that is not my main concern and matters not at this stage.

    Liked by 1 person

  • @ Dullard

    You have tried. There is a point when you give up and allow people to wallow in their own mess. The one thing I have learned in my working life is never trust the state. There are always gullible people willing to go native when it comes to official sources.
    As American journalists like to tell us, ‘a source told them…..’ …..what they often mean is the press officer. It is mostly PR. The role of a good journalist is to be always sceptical.

    Liked by 1 person

  • @Dullard

    No problem.

    Like

  • @ Sarge
    ”Do you expect me to believe that the US with its vast network of intelligence sources weren’t aware of what was going on in Wuhan? Were they relying on China to provide accurate info**

    As mighty as the US intelligence complex is, the data coming out of China is extremely valuable from medical and epidemiological perspectives. What data do you think was used to calibrate all the models that initially informed decisions like social distancing, lock downs, etc?

    Liked by 1 person

  • Journalism in the USA has been DEAD for years. Few appreciate real investigative journalism

    Like

  • 60 Minutes Australia Expose.

    Like

  • @ Moneybrain

    What they call investigative journalism often is just getting reports etc from an insider or whistleblower. Nothing ‘investigative’ about that.

    Liked by 1 person

  • this is turning into FAUX news, right wing conspiracy nonsense. cant understand how grown ass men could tolerate such crap day in day out. MAN!!!

    Like

  • Yeap it is all Trump fault serving up his own medical opinion from making outrageous comments earlier while downplaying the dangers of the virus
    Even on occasion said “oh it is nothing more than the flu and would be finished by May
    Instead of talking Presidential and bringing facts to the nation excluding his gut feelings

    Like

  • peterlawrencethompson

    @MoneyBrain
    You are so full of shite that I don’t know where to start. If this is the brain that you use to manage money then it is no mystery why you are still working your ass off for a second rate brokerage.

    To begin with, when the naturally occuring survival rate is 98.6% according to current research then for Dr Didier Raoult to brag about a drug assisted survival rate of 98.7% in a small sample with no control group like you would have in a proper study makes it seem to me that we should hold off on popping the champagne corks.
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30257-7/fulltext

    Come on man, even though you are only used to playing with money, not lives, you should have the math skills to tell that small samples in uncontrolled trials tell us nothing of value.

    Liked by 1 person

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 9:55 AM
    “Model from Imperial College in London predicted ridiculous number of deaths…”
    +++++++++++++++
    Did you actually read the reports from Imperial College London? Or did you just lap up what Fox News said about them? Here is the link, go and try to educate yourself: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/

    The reports stated their assumptions clearly and projected what would happen if the UK government did not take action. The reports then pointed the way to what actions would reduce the death toll. The UK government then took these actions and, lo and behold, the death toll has been reduced.

    But ignorant (and igrunt) people like you now seek to slander the experts who were instrumental in saving many thousands of lives so far by criticising what you clearly do not comprehend.

    You are a disappointment.

    Like

  • Bajans please note that Diabetes is the number 1 medical condition that predisposes to serious effects.

    Liked by 1 person

  • Lil Pete, you really think your contribution is more professional? I have presented several different professionals and U post one unknown Doc—really lame Peter. I am NOT at all surprised by this BUT had hoped we could maintain a focused approach regarding solutions. Only U know everything the rest of humanity should be subserviant except me of course! I will take medical professionals on the front lines seriously. Heard a Doc coming out of hospital say that he is using the Hydroxychloroquine as prophylatic but U know better.

    Like

  • Lil Pete, if U get it real sick with COVID19, REFUSE the protocols that I presented because they have not gone through every normal stage of Trials and Double Blind. Where did I say that anything is statistically proven?

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 11:00 AM
    Correction, you posted clickbait anecdotes that have not been peer reviewed… I posted (a) peer reviewed published research it one of the top three global medical journals, and (b) research reports that you yourself referenced but clearly have not read. If you cannot see the difference you are beyond hope.

    Like

  • Lil Pete, I was very finacially defensive before COVID and will be picking up nufty plenty Stock bargains in the period ahead. hahaha

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 11:04 AM
    Will I trust my health to clickbait anecdotal interventions scraped off the internet that brag about a 98.7% survival rate when the statistically established survival rate without such interventions is 98.6%. Well no I’m not and I’m entirely comfortable with that.

    Like

  • de pedantic Dribbler

    @David, you said otherwise that “[I] should read the top blog to appreciate how important mask handling is.”…. I presume it is this to which you referred.

    I am fully invested in the importance of mask handling… and I stated my clear objections re WHO’s dissembling on wide spread use… the needs by professionals and use by general public are NOT two mutually impossible results… in spite or despite the current supply issues!

    WHO cannot fill their narrative with basic BS …. it must speak frankly about the pressing needs and cut the BS…otherwise as the narrative changes – as it will – then more like @MoneyB fill the space with calling it a political lackey… not a good look!

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 11:00 AM
    Meanwhile, of course, people like you are creating dangerous shortages of the medication for patients with lupus and rheumatoid arthritis who really need it.

    Liked by 1 person

  • Lil Pete, dont go oevrboard using BS stats to confuse yourself and others. If U had a brain U would have seen that I asked GP for his comments NOT U. Shortages of medication because qualified Docs are now using it heavily, NOTHING to do with me. Are U also fully upto date on the war between the Oxford U and Imperial College, check that out.

    Like

  • de pedantic Dribbler

    “Journalism in the USA has been DEAD for years. Few appreciate real investigative journalism”

    This is high end comedy or simply a foolish non point! I’ll go with the former.

    Despite, the comic relief one should note that annually a number of journalists in US are nominated for investigative reporting excellence and one or a team are awarded as a winner… the most well known likely the Pulitzer Prize for Investigative Reporting.

    Besides that and again despite the serious ad and money issues which has forced the closure of various media houses there are still deep dive media hounds at places like The Atlantic, Just Security, The LawFareBlog and Vox to name those few.

    We may not like what some journalists/commentators say, nor like their ideological spin or even like to read past 140 words but there are still several very credible and balanced journos and commentators (quasi journalists) out there who do very impressive investigations and write extensive pieces to inform our views…

    The recently deceased former Ambassador Joe Wilson was a commentator who certainly did a deep, deep dive in the Iraq WMD and “the yellowcake in Niger”, as an example.

    Let’s be fair and note when we are striking up the comedy hour band!

    Like

  • peterlawrencethompson

    MoneyBrain April 1, 2020 11:43 AM
    Sorry to have confused you… the difference between a 98.6 survival rate and a 98.7% survival rate in a sample size of 78 with one case yet to resolve is not what we math literate people call “statistically significant.”

    Liked by 1 person

  • @ David April 1, 2020 9:03 AM

    Seems to be some truth to the allegations. Do some research and you get the gist of things.

    Like

  • “Do not spout nonsense or turn this blog into an anti Trump affair.”

    Lawson will never do that to Prince Donald, never.

    “Dr GP please comment.”

    that’s the doctor with all the inside info now in hiding, we gotta flush him out..

    Like

  • Lil Pete, where did I state it was statistically significant? I am fully aware that the Left and people like U are praying for America to fail so that Trump will not be re-elected. Important that everyone reading this understands your motivation.

    Like

  • Lol any of you would cozy up to hitler if you thought he had a pill that would save ya. I hear some of you spout this and that about whether it will work or wont but at least its something to try rather than wearing an amulet like Mexicans. we will see as soon as it effects you your if mindset will change like the liberals of rhode island , conneticut etc …now they want border security…..not from Mexicans ….but from newyorkers

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 12:12 PM
    This blog is not about your lord and master, it is about medical responses to COVID-19 infection.

    Liked by 1 person

  • check out people being sprayed with sanitizer as they sit along the road in india in the news …very similar to your fogging …

    Like

  • Lil Pete, Where did I mention Jesus Christ? I realise that you would like to convert me like Saul on the road to Damscus but your puny flashlight just wont cut it, Lil Pete.

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 1:05 PM
    You never mentioned Jesus Christ of course, because you could never lie so much if you followed Him… but you were dragging the conversation around to your true lord and master Trump, who you mentioned out of context 12:12 PM post.

    Like

  • No one is safe.

    Like

  • @PLT

    I think you mean “statistically insignificant” instead of “statistically significant”

    Like

  • @ MoneyBrain April 1, 2020 12:12 PM “Lil Pete, where did I state it was statistically significant? I am fully aware that the Left and people like U are praying for America to fail so that Trump will not be re-elected. Important that everyone reading this understands your motivation.”

    Why are you calling Peter Lil Pete. Peter, like you, like me, like many of us on BU is an adult not a lil boy. Like you he is an old man even. I think that you should call him Mr. Thompson.

    Why do you impute that Peter is praying for Trump to fail? Are you just making up things? Are you lying?

    Like

  • China Concealed Extent of Virus Outbreak, U.S. Intelligence Says

    China has concealed the extent of the coronavirus outbreak in its country, under-reporting both total cases and deaths it’s suffered from the disease, the U.S. intelligence community concluded in a classified report to the White House, according to three U.S. officials.

    The officials asked not to be identified because the report is secret, and they declined to detail its contents. But the thrust, they said, is that China’s public reporting on cases and deaths is intentionally incomplete. Two of the officials said the report concludes that China’s numbers are fake.

    The report was received by the White House last week, one of the officials said.

    he outbreak began in China’s Hubei province in late 2019, but the country has publicly reported only about 82,000 cases and 3,300 deaths, according to data compiled by Johns Hopkins University. That compares to more than 189,000 cases and more than 4,000 deaths in the U.S., which has the largest publicly reported outbreak in the world.

    Read More: New York’s Coronavirus Patients Skew Young, Surprising Doctors

    Communications staff at the White House and the Chinese embassy in Washington didn’t immediately respond to requests for comment.

    “The reality is that we could have been better off if China had been more forthcoming,” Vice President Mike Pence said Wednesday on CNN. “What appears evident now is that long before the world learned in December that China was dealing with this, and maybe as much as a month earlier than that, that the outbreak was real in China.

    While China eventually imposed a strict lockdown beyond those of less autocratic nations, there has been considerable skepticism toward China’s reported numbers, both outside and within the country. The Chinese government has repeatedly revised its methodology for counting cases, for weeks excluding people without symptoms entirely, and only on Tuesday added more than 1,500 asymptomatic cases to its total.

    Stacks of thousands of urns outside funeral homes in Hubei province have driven public doubt in Beijing’s
    reporting.

    https://www.bloomberg.com/news/articles/2020-04-01/china-concealed-extent-of-virus-outbreak-u-s-intelligence-says?srnd=premium

    Like

  • @PLT
    Sorry for that I misread your response “statistically significant’ is correct

    Like

  • Santia Bradshaw is addressing the nation this evening. Where is the president? Is she still recuperating from her medical procedure? How serious was/is it?

    Like

  • What do you care.

    Like

  • peterlawrencethompsonApril 1, 2020 10:48 AM

    Why are you so brutal to your fellow blogger moneybrain today? Lol.

    Do enjoy your musings,analysis and commentary more than every now on Covid-19. Thanks.

    Like

  • Ever*

    Like

  • Why the doubters don’t go out and let a COVID+ person cough on wunna?. #JenkinsAnnex

    Like

  • peterlawrencethompson

    @curley16
    MoneyBrain and I were at secondary school together, so it annoys me that he won’t use his brain to think with. But I should be kinder.

    Like

  • peterlawrencethompson

    @Enuff
    “We have a simple message to all countries – test, test, test,”
    —WHO Director General Tedros Adhanom Ghebreyesus

    Have you any insight Enuff, into why Barbados is not following WHO guidelines in respect of testing??

    Like

  • “now they want border security…..not from Mexicans ….but from newyorkers”

    imagine that..

    Like

  • Anyhow listen to the acting PM tonight wunna wouldn’t stand home!

    Like

  • @John A

    The rumour all about town today is that there will be a 24 hour lockdown. We will know soon.

    >

    Like

  • @ David.

    I think they will go with an extended curfew first say 6 to 6 and if that don’t work then lock it down.

    Like

  • Lil Pete, it annoys me that U seem to think that U are correct no matter what, very immature but then U associate mainly with sycophants
    a person who acts obsequiously toward someone they think is important in order to gain advantage.

    Like

  • Now all across social media is this woman who claims of having no placed of abode locked in handcuffs and decked on both sides by policeman
    Now what was her crime ..Oh she broke the curfew
    Here is an instance wherby this woman could not be having no place of abode
    But the first response by police was to locked the lady in hand cuffs and take her into custody
    I get the feeling that the image was to send a strong measure to the public
    But cuhdear there are many people who are mentally challenged and have no place of abode
    Instead of using the lady as an example could not the police released the information to the public without all the kudoment publicity
    I would bet this is another one of govt publicity stunts to win favour with the people after the govt disastrous handling of the Corona Virus
    With so much crime taking root in barbados daily would it not be better to place a stronger interest in finding the criminal element that keeps barbadians in fear
    How about the squatters living illegally on land why cant govt give them the same type of police treatment that is set aside for curfew law breakers

    Like

  • The immunosuppressive activity of chloroquine and hydroxychloroquine is likely to account for their capacity to reduce T-cell and B-cell hyperactivity as well as pro-inflammatory cytokine gene expression.

    Like

  • Sir Benwood Dick

    My Dear Friends,

    It is with strong conviction, that I, Benwood Dick, implore sincerely and most robustly, that each and every individual amongst your numbers, do adhere to the sound advice of the medical practitioners, many of whom may have come from similar institutes as the renowned Harley Street halls. Stay at your abodes.

    As we reminisce on glories of the past eras, when the cannons roared and the festive times were rich with rum and finery of the feminine sort, remember that those were more carefree days, even though having their own challenges. Those times were of another era, long lost.

    This virus will not succumb to the old ways of a gunship and one hundred men, but must be challenged by more clever and modern methods, that is, by isolating the sufferers.

    Lord Thompson has presented his case well and we, as gentlemen, should follow his guidance.

    As we walked away from past battles with the pirates of old, the smell of gunpowder and burn in the nose, we never relished those moments, but instead, were philosophical on the matter of lost lives, needless in the circumstances, considering that those battles involved choices.

    This is far more elusive and is not a matter of choice, this is a matter of desperate issue. In times like this, we must think of our families and compatriots.

    No sacrifice is too large, to save precious lives. Do these lives matter, the lives of countrymen, of kith and kin? Do these lives matter to you?

    Hearken then and attend to this with alacrity.

    I, Benwood Dick, implore and implore you.

    Sir Benwood Dick
    Manor House Cottage

    Like

  • @Mariposa

    What about the post-curfew shootings? The police are out looking for the wrong people.

    Like

  • I never totally believed this though i saw all the evidence, why the hell would anyone eat a dog or a cat…..at least now it’s banned.

    https://www.dailymail.co.uk/news/article-8177443/Chinese-city-BANS-eating-dogs-cats-new-law-wake-coronavirus-pandemic.html

    Like

  • Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug. The authors of the report said that the medication was promising, but that more research was needed to clarify how it might work in treating coronavirus disease and to determine the best way to use it.

    “It’s going to send a ripple of excitement out through the treating community,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.

    Like

  • @WARU, when China was going though the depths of hunger in the 1960s, 1970s etc, some people resorted to eating grass! We all would if hungry enough. People in India and Africa eat all kinds of Bush Meat too.

    Like

  • @Sir Benwood

    It took COVID to bring you out?

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  • Do you know what no fixed place of abode means in this case?

    Spot on!

    Like

  • The fine for breaking the self quarantine in the usa is $5000 or a year in jail.

    hmmmmmmmm

    Like

  • COVID-19 Update 8: Zinc and chloroquine for the treatment of COVID-19?

    Liked by 1 person

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 4:33 PM
    “The immunosuppressive activity of chloroquine and hydroxychloroquine is…”
    ++++++++++++++++++
    Glad to see you using your brain. Would you not suspect that this drug cocktail should be reserved for those small percentage of patients facing “Day 10- Cytokine storm leading to acute ARDS and multiorgan failure.” that the New Orleans doctor talked about? Yet I have read about people using it as a prophylactic treatment. Fear makes people do illogical things, I guess.

    Liked by 2 people

  • David according to legal
    No fixed place could mean having no roof over head or living from place to place like a jipsy

    In this instance she was on the street
    Her words to the police can be interpreted by what they belived she said
    Anyhow the crux of this story lies on a principle which govt has been using to help squatters and those stuck at sea on the cruise ships and the stranded Trinidadians
    The image of the woman in handcuffs might have been meant to send a stern message but it also underscore the hypocrisy of a govt who has been waving the flag of humanity but could not wait to grab the first opportunity by way of publicity political stunt to handcuff a woman living on the street or no fix placed abode
    Overblown with an indulgence to ridicule a homeless person
    This govt has been trying every trick in the book to bring their thinking within the alignment of the populace
    This stunt might have backfired right in their face

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  • Lil Pete, If U had a brain U would appreciate that the drug cocktail I have referred to is not being hyped by Dr Fauci due to the fact that supplies are in doubt. U would also have the ability to realise that the bottleneck is going to be medical professionals, who are dropping like flies and therfore require a prophylaxis. U should have discovered by now that some Docs in NY are showing that given early, it saves hospital time which is also critical since it frees up beds, Vents and medical time which are all in short supply.

    Like

  • peterlawrencethompson

    @MoneyBrain
    Thanks for the Medmastery video. So it seems we have at least two competing theories to explain the therapeutic effect of chloroquine, one in concert with zinc to inhibit viral RNA duplication, and the other in concert with hydroxychloroquine to quiet the Cytokine storm. Radically different explanations at completely different phases of the disease process. Of course there is nothing to say that they are not both correct, but given that loading up cells with zinc (it’s toxic in excessive concentrations) as well as suppressing the immune system both have potentially negative health outcomes, we clearly have to push ahead with the research.

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 5:33 PM
    Hmmm, that would be Dr Fauci protecting the same supplies where I warned you above about “dangerous shortages of the medication for patients with lupus and rheumatoid arthritis who really need it.”

    Like

  • @Ping Pong, Prof at Stanford U backed him strongly but I did not catch his name. There are several Docs and hospitals using the protocol including Zinc and Azithromicin with the Hydroxychloroquine. Whatever anyone may say here this is better than nothing. Lil Pete just dislikes the fact that he can NOT convert me into one of his blind followers and fart catchers.

    Like

  • Lil Pete, that would be Dr Fauci who sent out error riden Test Kits to Seatle. He has admitted this.

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 5:13 PM
    I hope you noticed in the Medmastery video that the above average performance of South Korean public health authorities is based squarely on WIDESPREAD TESTING, not on widespread chloroquine treatment.

    Like

  • Lil Pete, U commented to the effect that I worked at a 2nd rate organisation. I do NOT work at or for any organisation, I work solely for my clients and have never been dependent on any one organisation in the last 35 yrs. My network of independent investment strategy thinkers is exceptional so stick to what U know.

    Liked by 1 person

  • Lil Pete, I thought U did not want to waste precious resources. Who are U going to test? How often are U going to test, since the subject dould be asymptomatic for upto 14 days averaging 2-11? The head of WHO was backed for that post by the Chinese, had 3 cholera outbreaks during his “leadership” in Ethiopia and never announced that fact, why? China has him as a puppet, he will say what they tell him to say. hahaha The Chinese got plenty people coRNfuse.

    Liked by 1 person

  • peterlawrencethompson

    @MoneyBrain
    I have no wish to convert you to anything. I am a man completely devoid of belief… I trust only facts.

    Here is our state of affairs; we are in the midst of a crisis where every singe government has f*cked up to a greater or lesser degree. I simply look at the actions of those governments who have f8cked up the least; among whom I number: South Korea, Singapore, Iceland… what is a common element in their approaches? Widespread testing.

    This isn’t rocket science. We know for a fact that COVID is highly contagious. We know for a fact that we have no proven drugs to cure infections.

    Therefore it is obvious that the way to save the most lives is to pour available resources into stopping the spread of the infection. Every infected person who is tested, quarantined, and stopped from infecting others is an overwhelmingly more effective move in saving lives than throwing experimental drugs into the bodies of the people they infected because you had a lame testing system.

    Of course we should continue the drug research. But we have limited resources. Every dollar spent on widespread testing, isolation and quarantine is more effective than ten dollars spent on experimental therapies for people that you should have stopped from getting infected in the first place.

    We don’t know yet which drugs work for whom in what doses. We do know how to test. We do know how to isolate. We do know how to quarantine.

    Like I said, it’s not rocket science.

    Like

  • peterlawrencethompson

    @MoneyBrain April 1, 2020 6:03 PM
    By the middle of last month Singapore had done around 39,000 Covid-19 tests. They have saved themselves hundreds of millions of dollars with this strategy. They have, more importantly, saved hundreds of lives by slowing down the infection rate and maintaining it at as low a level as they can for as long as possible. By doing this they have not had to shut down their entire economy with panicky curfew measures that are too little too late.

    Like

  • “People in India and Africa eat all kinds of Bush Meat too.”

    bushmeat and grass i can understand, but cats and dogs, a whole nother animal..that is just me.

    Like

  • New CDC report finds COVID-19 can be spread 1-3 days before onset of symptoms

    A new report from the Centers for Disease Control and Prevention on Wednesday provides new evidence to bolster early reports that the transmission of the coronavirus — which has now infected over 887,000 people worldwide — can happen prior to symptoms. Published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), the study underscores the potential difficulty of containing a virus that may be spreading silently.

    The report focused on the transmission of COVID-19 from Jan. 23 to March 16 in Singapore — specifically, seven “clusters” in which presymptomatic transmission occurred. Presymptomatic transmission is defined by the researchers as “the transmission of SARS-CoV-2 from an infected person (source patient) to a secondary patient before the source patient developed symptoms.”

    Of the 243 cases recorded in Singapore by the end of the study, 157 were transmitted locally (meaning they were not brought in from travelers), and of those, at least 10 of the cases were connected to presymptomatic transmission. “The evidence of presymptomatic transmission in Singapore, in combination with evidence from other studies supports the likelihood that viral shedding can occur in the absence of symptoms and before symptom onset,” the authors write.

    Although it remains unclear exactly how long individuals may be carrying the virus before symptoms appear, the researchers found that exposure “occurred 1–3 days before the source patient developed symptoms.” At least two of the cases occurred from individuals who acquired the virus during a singing practice, another occurred between two housemates.

    The researchers say the virus may have been spread in multiple ways. “Presymptomatic transmission might occur through generation of respiratory droplets or possibly through indirect transmission,” they write. “Speech and other vocal activities such as singing have been shown to generate air particles, with the rate of emission corresponding to voice loudness.”

    The study is the latest to explore whether or not people who appear healthy may be contagious.

    https://www.yahoo.com/lifestyle/new-cdc-report-finds-covid-19-can-be-spread-13-days-before-onset-of-symptoms-174344709.html

    Like

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