Being a *rick isn't cool either...but you got that one down...and no I don't give a crap if you have a problem with your or you're and no I'm not going to edit it..in fact sometimes I do that just to mess with folks like you that have problems with it...enjoy...if that's even possible for you. Honestly is it really "plagiarism" to quote a song everyone knows on a backwoods sports message board in order to bring some livety and perhaps bring folks together?
Being a *rick isn't cool either...but you got that one down...and no I don't give a crap if you have a problem with your or you're and no I'm not going to edit it..in fact sometimes I do that just to mess with folks like you that have problems with it...enjoy...if that's even possible for you. Honestly is it really "plagiarism" to quote a song everyone knows on a backwards sports message board in order to bring some livety and perhaps bring folks together?
"They pulled 3k random test in Italy to create a number to make an estimate of how many people have the virus that haven't been tested."
Just to point out, you must've misunderstood this part. The people who have been tested have been symptomatic enough to seek care. If you are going to estimate the number of asymptomatic carriers or people with mild disease you do not pull from a population that's symptomatic enough to get tested. We aren't going to know that number for quite some time and it's not a number that we can know right now.
People with asymptomatic or mildly symptomatic flu who never get tested and don't count in the numbers. I had flu-like symptoms in Feb but didn't get tested. Just stayed home for a couple of days. How would anyone count me?
But, again.... okie doke and I'll pass your expertise along to my friend.
Not agreeing with the other poster, but you estimate that kind of missingness based in random samples and surveys. If you roughly know how often people with flu-like symptoms have the flu and then do random surveys to find out how often people have those symptoms and don't seek care, you can create decently reliable population estimates. We do this all the time. Second, you do random tests of people who are asymptomatic or mildly symptomatic combined with known estimates of how many people test positive with more significant symptoms (either as part of the same study or established estimates) and you derive models for how many people in a given population have the disease but don't show symptoms. This is also a commonly used approach. Put the two together and you have a decent population estimate of disease prevalence. You can look up NHANES as just one example of this kind of approach.
It's epidemiology 101 that you never rely on disease estimates just from those who seek care. We have a robust set of research tools to work around this exact problem. The issue here is that things are evolving so rapidly that it's hard to keep up and do all of these estimates as the pandemic is unfolding. We usually spend a minimum of a year deriving these kinds of estimates that people now want overnight.
No doubt you and others are voting for Trump even though on:
Jan. 22: President Donald Trump said the U.S. has the outbreak of the coronavirus under control and has been briefed by the Centers for Disease Control and Prevention. Speaking to CNBC, Trump said he wasn't worried it would turn into a pandemic and said the only person infected had flown in from China.
Feb. 25: House National Economic Council director Larry Kudlow said, "We have contained this, I won't say airtight but pretty close to airtight." Kudlow said again on March 6 that the coronavirus "is contained". (Yeah, let's trust that Kudlow knows his ass from a hole in the ground, the guy who said no recession was coming in 2008.)
Feb. 26: Trump said: "I think every aspect of our society should be prepared. I don't think it's going to come to that, especially with the fact that we're going down, not up. We're going very substantially down, not up. And again, when you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that's a pretty good job we've done." Huh?
Mar. 6: Trump said: "Anybody that wants a test can get a test. That's what the bottom line is."
Mar. 24: Trump wants churches filled Easter Sunday.
After the above, it's hard to believe that 60% feel in a Gallup poll that Trump has been doing a good job with handling the virus crisis. Better hope drug treatment is working well to counter the deaths.
Trump says too much crap that doesn't need said or tweeted. Yet, a lot of people don't seem to mind. Yes, of course, it's very frustrating. And Democrats attempting to run Biden, who doesn't act all there in a lot worse way than Trump, doesn't help the sad and urgent situation this country faces. It's like we're now living in the Twilight Zone.
If we the people absolutely refuse to hold our leaders accountable for themselves, who will? Our enemies?
A summary of the current state of clinical treatment from Jama:
JAMA Clinical Guidelines Synopsis
March 26, 2020
Management of Critically Ill Adults With COVID-19
Jason T. Poston, MD; Bhakti K. Patel, MD; Andrew M. Davis, MD, MPH
JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4914
Guideline title Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults With COVID-19
Developer Surviving Sepsis Campaign (SSC)
Release date March 23, 2020
Target population Critically ill adults with COVID-19
Selected major recommendations
Infection Control and Testing
For health care workers performing aerosol-generating procedures (eg, endotracheal intubation, nebulized treatments, open suctioning) use of fitted respirator masks is recommended (N95 respirators, FFP2), instead of surgical masks, in addition to other personal protective equipment (PPE) (best practice statement).
For usual care of nonventilated patients, or for performing non–aerosol-generating procedures on patients receiving mechanical ventilation, use of medical masks is recommended, instead of respirator masks, in addition to other PPE (weak recommendation, low-quality evidence [LQE]).
Diagnostic lower respiratory tract samples (endotracheal aspirates) are preferred over bronchial washings, bronchoalveolar lavage, and upper respiratory tract (nasopharyngeal or oropharyngeal) samples (weak recommendation, LQE).
For acute resuscitation of adults with shock, the following are suggested: measuring dynamic parameters to assess fluid responsiveness (weak recommendation, LQE), using a conservative fluid administration strategy (weak recommendation, very LQE), and using crystalloids over colloids (strong recommendation; moderate QE). Balanced crystalloids are preferred over unbalanced crystalloids (weak recommendation, moderate QE).
For adults with shock, the following are suggested: using norepinephrine as the first-line vasoactive (weak recommendation, LQE), use of either vasopressin or epinephrine as the first line if norepinephrine is not available (weak recommendation, LQE). Dopamine is not recommended if norepinephrine is not available (strong recommendation, high QE). Adding vasopressin as a second-line agent is suggested if the target (60-65 mm Hg) mean arterial pressure cannot be achieved by norepinephrine alone (weak recommendation, moderate QE).
Starting supplemental oxygen is recommended if the Spo2 is less than 90% (strong recommendation, moderate QE). Spo2 should be maintained no higher than 96% (strong recommendation, moderate QE).
For acute hypoxemic respiratory failure despite conventional oxygen therapy, use of high-flow nasal cannula (HFNC) is suggested relative to conventional oxygen therapy and noninvasive positive pressure ventilation (NIPPV) (weak recommendation, LQE). If HFNC is not available, a trial of NIPPV is suggested (weak recommendation, very LQE). Close monitoring for worsening of respiratory status and early intubation if worsening occurs is recommended (best practice statement).
For adults receiving mechanical ventilation who have acute respiratory distress syndrome (ARDS), use of low tidal volume ventilation (4-8 mL/kg of predicted body weight) is recommended and preferred over higher tidal volumes (>8 mL/kg) (strong recommendation, moderate QE). Targeting plateau pressures of <30 cm H2O (strong recommendation, moderate QE) is recommended. Using a higher positive end-expiratory pressure (PEEP) strategy over lower PEEP strategy is suggested (weak recommendation, LQE).
For adults receiving mechanical ventilation who have moderate to severe ARDS, prone ventilation for 12 to 16 hours is suggested over no prone ventilation (weak recommendation, LQE). Using as-needed neuromuscular blocking agents (NMBAs) instead of continuous NMBA infusion to facilitate protective lung ventilation is suggested (weak recommendation, LQE).
For adults receiving mechanical ventilation who have severe ARDS and hypoxemia despite optimizing ventilation, a trial of inhaled pulmonary vasodilator is suggested. If no rapid improvement in oxygenation is observed, the treatment should be tapered (weak recommendation, very LQE). The use of lung recruitment maneuvers (intended to open otherwise closed lung segments, such as 40 cm H2O inspiratory hold for 40 seconds) is suggested, over not using recruitment maneuvers (weak recommendation, LQE), but using staircase (incremental PEEP) recruitment maneuvers is not recommended (strong recommendation, moderate QE). Use of veno-venous circulation for extracorporeal membrane oxygenation (ECMO) or referral to an ECMO center is suggested, if available, for selected patients (weak recommendation, LQE).
In adults receiving mechanical ventilation who do not have ARDS, routine use of systematic corticosteroids is suggested against (weak recommendation, LQE). In those with ARDS, use of corticosteroids is suggested (weak recommendation, LQE).
In COVID-19 patients receiving mechanical ventilation who have respiratory failure, use of empiric antimicrobial/antibacterial agents is suggested (no evidence rating); assess for deescalation.
In critically ill adults with fever, use of pharmacologic agents for temperature control is suggested over nonpharmacologic agents or no treatment. Routine use of standard IV immunoglobulins is not suggested. Convalescent plasma is not suggested. There is insufficient evidence to issue a recommendation on use of any of the following: antiviral agents, recombinant interferons, chloroquine/hydroxychloroquine, or tocilizumab.
Henry Ford Heath Systems hospital in Detroit has confirmed that Death Protocol memo circulating the internet is indeed real. The memo is providing their hospital workers guideline of who to treat and who to not treat for coronavirus as supplies run out in the hospital to treat COVID-19 patients
The hospitals said this is only precautionary and would only be put into place in a worst case scenario
"At EvergreenHealth Medical Center, two miles from the shuttered Lifecare nursing home where 35 patient deaths were linked to the virus, officials say their rate of new covid-19 cases has remained steady for two weeks, leveling off at a trickle. On some days, doctors here see just one new case and haven’t seen more than four in a single day since mid-March. Few need admission to the intensive care unit, which is now half full, two weeks after overflow necessitated transfers to nearby hospitals."