Links 13 March 2020

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Leith van Onselen

Comments

  1. Nice links, but no cigar.

    “Coronavirus cases in NSW increase to 78 with public advised to ‘be alert'”

    I heard from a credible source in doing testing in ONE hospital that 20 new cases were being found per day in that hospital.
    I’m not alert – I’m alarmed.

  2. Analyst who predicted 2008 global financial crash warns another one is on the way — and not just because of coronavirus – Independent
    Bit late with that prediction. The car is upside down and half way through the first roll of many.

  3. migtronixMEMBER

    4 handle Scott, the sting in the obstinate retiree voter tail.

    Ruh roh, enjoying AUD at 63c yet?

  4. In a general statement released this afternoon, Victoria’s chief health officer Brett Sutton said the situation in Victoria was “evolving rapidly”.

    “For the virus to spread, extended close personal contact is most likely required,” he said.

    “But visitors to locations where cases have been should be aware of the signs and symptoms of COVID-19.”

    Close personal contact is at least 15 minutes face-to-face or more than two hours in the same room.”

    https://mobile.abc.net.au/news/2020-03-12/golden-plains-coronavirus-person-diagnosed-after-music-festival/12049154?pfmredir=sm

    Everything we’ve seen overseas shows the above statement to be a load of bull.

    • That was the case for SARS. This virus has been shown to linger in the air for 30min. A guy was was infected on a Chinese bus when he got on 30 min after the coronavirus carrier got off.

  5. WHAT A PITY AUSTRALIA AND NEW ZEALAND HAVE LEFT THEMSELVES SO VULNERABLE WITH MASSIVE HOUSING BUBBLES … http://www.demographia.com

    Stock market news live: Stock futures slump, hit limit-down after Trump declares Europe travel restrictions … Yahoo Finance

    https://finance.yahoo.com/news/stock-market-news-live-march-12-013620137.html

    Carnival’s Princess Cruises suspends global operations for 2 months on coronavirus fears … Reuters / Yahoo Finance

    https://finance.yahoo.com/news/carnivals-princess-cruises-suspends-global-125121046.html

  6. Historic day. Markets.

    The S Show is over.

    This will make the GFC look like a teddybear picnic in heaven.

    • It will for this place. Because we missed the GFC, the entire country has been behaving like we are teflon coated. Well, I’m afraid the sh!t is about to stick! Very thick coating…..

        • The ten people plus their cousins, nieces and nephews who miraculously obtained apprenticeships at the family business on or about March 1.

    • Arthur Schopenhauer

      Baldrick, I have a cunning plan….

      The average immunity conferred from a bout of general
      Corona virus (common cold) is 4 months. If wu-flu behaves the same way, herd immunity is not possible.

      At the moment, there is no way to know the behavior of Wu-flu immunity. The UK strategy is far riskier than the Polish & Hungarian ‘shut it down, shut it all down’ strategy.

      Run an experiment on tens of millions of people. The end of the Anglo-sphere.

    • This is ScoMo & the LNP herds plan, you only have to hear the health dept ticking about expected cases to know that

  7. A sobering read. Very similar to accounts from clinicians in Northern Italy

    80% minimal symptoms / mildly unwell
    14% sick enough to require hospital care for oxygen
    6-8% critically ill, with perhaps half of this group dying.

    Most deaths are in the elderly.
    But some young ones have died in Seattle And remember the 31 year old doctor in Wuhan

    Spend many days in ICU, seem to improve, and then some suddenly die (this phenomenon was also described in Wuhan).

    Long time in ICU before getting better or dying means not nearly enough ICU beds, despite hospitals now trying to double their ICU capacity. Which leads to rationing (in Italy, no ICU if older than 65 or if have underlying medical issues).

    Information Intensivist (ICU doctor) front line Seattle
    * we have 21 pts and 11 deaths since 2/28.
    * we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen.
    * Currently, all of ICU is for critically ill COVIDs, all of floor medsurg for stable COVIDs and EOL care, half of PCU, half of ER. New resp-sx pts Pulmonary Clinic offshoot is open
    * the Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data very skewed by late and very limited testing, and the number of our elderly pts going to comfort care.
    * being young & healthy (zero medical problems) does not rule out becoming vented or dead – probably the time course to developing significant lower resp sx is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb).
    * fevers, often high, may be intermittent; persistently febrile, often for >10d. It isn’t the dexmed, it’s the SARS2.
    * thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate.
    * multiple pts here have had nl EF on formal Echo or POCUS at time of admit (or in a couple of cases EF 40ish, chronically). Also nl Tpn from ED. Then they get the horrible resp failure, sans sepsis or shock. Then they turn the corner, off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less, then either VT->VF-> dead or PEA-> asystole in less than a day. Needless to say this is awful for families who had started to have hope.
    * we have actually had more asystole than VT, other facilities report more VT/VF, but same time course, a few days or a week after admit, around the time they’re turning the corner.
    * could be unrelated, but I’ve never seen anything like it before, esp in a pt who had been HD stable without sepsis.

    • Here is the full version, esp. if any are medically inclined

      This is from a front-line ICU physician in a Seattle hospital – shared on facebook – so ok to post here

      * we have 21 pts and 11 deaths since 2/28.
      * we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen.
      * US has been past containment since January
      * Currently, all of ICU is for critically ill COVIDs, all of floor medsurg for stable COVIDs and EOL care, half of PCU, half of ER. New resp-sx pts Pulmonary Clinic offshoot is open
      * CDC is no longer imposing home quarantine on providers who were wearing only droplet iso PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne iso PPE for aerosol-generating procedures in ANY pt in whom you suspect COVID, just to prevent the mass quarantines.

      * we ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs, which is not the manufacturer’s recommendation. Not surprised on N95s as we use mostly CAPRs anyway, but still.

      *terminal cleans (inc UV light) for ER COVID rooms are taking forever, Enviro Services is overwhelmed. Bad as pts are stuck coughing in the waiting room. Rec planning now for Enviro upstaffing, or having a plan for sick pts to wait in their cars (that is not legal here, sadly).

      * CLINICAL INFO based on our cases and info from CDC conf call today with other COVID providers in US:
      * the Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data very skewed by late and very limited testing, and the number of our elderly pts going to comfort care. – being young & healthy (zero medical problems) does not rule out becoming vented or dead – probably the time course to developing significant lower resp sx is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb). – based on our hospitalized cases (including the not formally diagnosed ones who are obviously COVID – it is quite clinically unique) about 1/3 have mild lower resp sx, need 1-5L NC. 1/3 are sicker, FM or NRB. 1/3 tubed with ARDS. Thus far, everyone is seeing: – nl WBC. Almost always lymphopenic, occasionally poly-predominant but with nl total WBC. Doesn’t change, even 10days in. – BAL lymphocytic despite blood lymphopenic (try not to bronch these pts; this data is from pre-testing time when we had several idiopathic ARDS cases) – fevers, often high, may be intermittent; persistently febrile, often for >10d. It isn’t the dexmed, it’s the SARS2. – low ProCalc; may be useful to check initially for later trending if later concern for VAP etc. – up AST/ALT, sometimes alk phos. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis at admit (150-200) correlates with clinical deterioration and progression to ARDS. LFTs typically begin to bump in 2nd week of clinical course. – mild AKI (Cr NPPV. Next 12-24hrs -> vent/proned/Flolan. – interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you’d notice and say hmmm. – thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate. – given the inevitable rapid progression to ETT once resp decompensation begins, we and other hosps, including Wuhan, are doing early intubation. Facemask is fine, but if needing HFNC or NPPV just tube them. They definitely will need a tube anyway, & no point risking the aerosols. – no MOSF. There’s the mild AST/ALT elevation, maybe a small Cr bump, but no florid failure. except cardiomyopathy. – multiple pts here have had nl EF on formal Echo or POCUS at time of admit (or in a couple of cases EF 40ish, chronically). Also nl Tpn from ED. Then they get the horrible resp failure, sans sepsis or shock. Then they turn the corner, off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less, then either VT->VF-> dead or PEA-> asystole in less than a day. Needless to say this is awful for families who had started to have hope. – We have actually had more asystole than VT, other facilities report more VT/VF, but same time course, a few days or a week after admit, around the time they’re turning the corner. This occurs on med-surg pts too; one today who is elderly and chronically ill but baseline EF preserved, newly hypoTN overnight, EF5d. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting then rapidly back to normal – suggests not a primary toxic hepatitis.
      *unfortunately, the Gilead compassionate use and trial programs require AST/ALT 30, which is fine. CDC is working with Gilead to get LFT reqs changed now that we know this is a mild viral hepatitis.
      -currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin can’t remember where.

      *steroids are up in the air. In China usual clinical practice for all ARDS is high dose methylpred. Thus, ALL of their pts have had high dose methylpred. Some question whether this practice increases mortality.
      *it is likely that it increases seconday VAP/HAP. China has had a high rate of drug resistant GNR HAP/VAP and fungal pna in these pts, with resulting increases mortality. We have seen none, even in the earlier pts who were vented for >10d before being bronched (prior to test availability, again it is not a great idea to bronch these pts now).
      – unclear whether VAP-prevention strategies are also different, but wouldn’t think so?
      – Hong Kong is currently running an uncontrolled trial of HC 100IV Q8.
      – general consensus here (in US among docs who have cared for COVID pts) is that steroids will do more harm than good, unless needed for other indications.
      – many of our pts have COPD on ICS. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far pts are tolerating that, no major issues with ventilating them that can’t be managed with vent changes. We also have quite a few on AE-COPD/asthma doses of methylpred, so will be interesting to see how they do.

      Plz share info.

      • Saw a thimble on twitter, we have less critical care beds per 1000 people than China …. but we did at least almost get a budget surplus!

  8. From Twitter:

    Judd Legum @JuddLegum

    WORTH REPEATING: In 2018, Trump fired the entire US pandemic response team.
    These were the experts with decades of experience dealing with precisely the kind of situation we are in today.

    Trump did not replace them.

    He eliminated the positions.

    https://twitter.com/JuddLegum/status/1238108656950001666?s=20

    I mean who likes Government bloat … when the Market is more efficient ….

  9. Bazooka Backfires: Stocks Tumble, FRA/OIS Soars After Fed’s Massive Repo Operation Fails To Fix Liquidity Crisis … Zerohedge

    https://www.zerohedge.com/markets/stocks-tumble-after-feds-massive-repo-operation-sees-tiny-uptake-sparking-selloff

    Maybe the Fed’s repo bazooka was just a water pistol?

    Less than an hour after the Fed announced a massive expansion to its repo facilities, adding one $500 billion 3-month repo today, following by an identical repo tomorrow and subsequent weekly $500BN repos (in addition to officially expanding NOT QE to a coupon monetizing QE-5), many are asking if the Fed applied the wrong medicine for two reasons:

    The first, and obvious one, is that you can’t fix a viral pandemic with monetary easing… but let’s pretend that’s not an issue for now.

    The less obvious, bust just as important reason is that after the Fed announced the results of the first half a trillion dollar repo today, the uptake was a tiny 15.7%. … read more via hyperlink above …

    • A little history …

      Panic of 1893 – Wikipedia

      https://en.wikipedia.org/wiki/Panic_of_1893

      The Panic of 1893 was a serious economic depression in the United States that began in 1893 and ended in 1897.[1] It deeply affected every sector of the economy, and produced political upheaval that led to the realigning election of 1896 and the presidency of William McKinley. … read more via hyperlink above …

      • Yes, suspect USA will be ripe for some socialism by the time carnivorous is done … will it be son enough …

  10. From Twitter:

    Judd Legum @JuddLegum

    WORTH REPEATING: In 2018, Trump fired the entire US pandemic response team.
    These were the experts with decades of experience dealing with precisely the kind of situation we are in today.

    Trump did not replace them.

    He eliminated the positions.

    https://twitter.com/JuddLegum/status/1238108656950001666?s=20

    Who likes government bloat … markets are more efficient …