Prepping for a pandemic...3

[wheresmymojo]

Third thread on prepping for a pandemic and following the risk of a NCoV pandemic.

General NCoV Info

The estimated replication rate is R= 2 to 4.8 based on latest expert estimates. This means each infected person spreads the virus to between 2 and 4.8 people. This means it's a fairly contagious virus, probably around the level of swine flu or more.

Around 15-20% of cases are thought to be severe - that is resulting in the need for hospitalisation. Around 3-5% requiring ventilation.

The estimated mortality rate is around 1-2% at the moment. This may change as it is very difficult to estimate mortality.

Children tend to have milder symptoms. Those over 60 with underlying health issues and a history of smoking are more likely to be severe (although not exclusively this type of person).

Spread of NCoV

It is estimated that the average incubation period is 3-5 days but can be as long as 24 days.

It can be spread with no symptoms.

It can be spread via droplet (cough/sneeze), aerosol (breathing same air in very close quarters), bodily fluids, fecal/oral route and formites (via surfaces, up to 28 days in the right circumstances but up to 3-5 days in more typical circumstances).*

Updates*

As this is a novel virus and knowledge is constantly being updated - I will post updates as they become available with links to source.

I am not a medical expert so any opinions or conjecture of my own should be taken with a pinch of salt!

@Legoandloldolls
It is not uncommon for all 3 hospitals to be bed blocked at the same time! So yes, it is very very bad.

I think you could increase the number of ICU staff by closing the majority of operating theatres, so only the most life saving surgery still going on (which to be fair you probably wouldn't want to have elective or semi elective surgery in a hospital full of patients with Coronavirus!). This would free up a significant number of anaesthetists (who whilst they aren't necessarily critical care specialist are more than capable of doing the job), scrub nurses, recovery nurses and ODPs and I supposed they could turn operating theaters, anaesthesic rooms and recovery rooms into makeshift ICU beds. But that still isn't going to come close to the numbers that might be needed.

I can't see the UK government/NHS managing to build whole new hospitals in days or weeks.

www.newscientist.com/article/2233269-how-bad-is-the-covid-19-coronavirus-outbreak-likely-to-get/ - interesting article that also talks about the different age profiles of China vs over here.

psandman.com/col/SARS-1.htm - this specific article from the above website is a long and very interesting read!

If anyone wants to super size their prepping you can purchase devices that monitor your oxygen saturation levels to decide whether you need to go to hospital.

Disclaimer: I have no idea how accurate they are

@ofwarren

From reading journal articles from wuhan. They are having to intubate/ventilate patients, these would need ICU, put some patients on non invasive ventilation (NIV) these patients would sometimes be on ICU sometimes on the ward (NIV machines are very limited in number in hospitals), or ECMO, which is a whole other level of care entirely, basically the blood is circulated out of the body into a machine where it is oxygenated and then back into the body (or at least that's my understanding of it) this is only available in 5 or 6 hospitals in the UK.

Obviously less unwell patients would just need oxygen but it certainly wouldn't be enough for all patients.

I'm at a uni with a huge proportion of students from China who returned here after the Christmas break... I do a placement in a nursery school and get on rammed commuter trains daily. If it's coming - I'm gonna end up with it. Not worried for me - do worry for the kids, both ex-preemies and one who ended up seriously ill with pneumonia (in a bloody heat wave) a couple of years ago.

Incidentally her severe pneumonia (it was borderline HDU at several points) was dealt with just on a standard ward bay in one of the hospitals previously mentioned. I've added it to my "shit I worry about at 2am" list which is already amusingly long.

That makes sense thankyou @Cyw2018

@wheresmymojo I have a saturation monitor due to DDs chronic lung disease.

I only use it in combination with looking for signs of respiratory distress and making a judgement call, as I don't want to rely on something that could be inaccurate meaning a trip to A&E when it's not necessary.

With that said, I have tested it against the hospital sp02 monitor and it was very accurate. Also, when DD has had to go in an ambulance before the paramedic has asked if he can use my one as he didn't have his to hand. So I think they are typically fairly accurate.

Thats good to know allthesharks

We're a bit skint at the moment so I'm not going to purchase one but would consider it if anyone in the close family actually caught CV should it spread (I'm working on the assumption that there wouldn't be a run on them as most people wouldn't know they exist - could turn out to be wrong about that).

Just in case you were thinking of it - don't pretend to have CV in Russia.

A guy there is facing 5 years in prison for it.

Coronavirus prankster faces five-years' jail for Moscow metro stunt www.bbc.co.uk/news/world-europe-51457610

Apparently the WHO daily briefing is worth watching from today re: the tone of the meeting (very serious) and the answer in Q&A re: China's numbers.

I'll see if I can find a full video of it and post a link later.

I'm really worried now. The "forcibly quarentined" nurses, it all sounds so sinister.
On the positive side I have emptied/decluttered a whole kitchen cupboard tonight for a store cupboard stash. Though now I'm thinking it might be worth investing my time, energy and money into quarentine/hospital grab bags - as that sounds more and more likely now.

So, hospital-wise:

• Hospitals can cut down elective care significantly, which would free up beds for use.

-Reducing elective care would increase doctor and nurse availability for those with illnesses.

-Staff shifts could be increased. Standard shifts for junior doctors are about 48 hours a week in my area: this could fairly realistically be increased to 60-72 or even higher if necessary. Nurse shifts are based on 3x 12.5 hours per week = 37.5, so this could be upped significantly as well to increase nursing provision.

There's also significant differences in care provision levels between ECMO (used in cases where the cells in the lungs are shutting down and failing to oxygenate the air even when the lungs are being artificially inflated and deflated to exchange the air in them), ventilation (artificial respiration where the lungs are being mechanically inflated and deflated, and this is usually combined with providing additional oxygen), and then when you need support in the form of additional oxygen, but can breathe unassisted (increased oxygen concentration means your lungs can be functioning less efficiently and you still get enough oxygen). The top level really rarely needs to be used, and is highly highly invasive. Even in severe instances this is unlikely to be needed. The second level down is the level generally being referred to where people are thinking about "artificial breathing". This is also used in pretty much all operations donenunder general anesthesia so would be much easier to roll out to more beds as required. Oxygen is even easier again to provide to those who need it - because this can even be provided to patients at home if necessary. So I wouldn't be immediately concerned that the number of intensive care beds isn't high enough, because i think intensive care beds or semi-intensive care beds providing the appropriate care will be able to be "stepped up" from the remaining hospital population of beds.

Most areas also have "cottage" hospitals which aren't generally in full use. If I were in planning I would be looking at stepping these wards back into full use, if the number of cases increases significantly.

Furthermore, all hospitals are required to have procedures in place in case of a disaster. This can include the use of temporary structures to house functions that can be moved out of the main buildings to make extra room inside as required.

This lot isn't going to solve all the problems if the outbreak reaches the worst predictions where it isn't controlled at all. But assuming control measures are taken, the above will go a significant way to ensuring the pressures on the healthcare system are manageable.

I'm not sure I'd put much store in the Daily Fail saying the nurses were forcibly isolated.

I suspect the nurses were quarantined with zero force involved because they're professional health workers (and the DF is just using those words because theoretically they could be forced under current powers).

Personally my opinion is the Fail are being sensationalist.

It's spreading in Brighton
this

So, evening clinic at work today(GP practice), we had signs up with the warning about not coming in if you have symptoms and returned from China or Wuhan or have contact with someone who has. All callers for an appointment will be asked certain questions and we have guidance for what to do if we suspect a patient has it (basically get them to call 111, leave the room, gel hands and keep patient isolated until they can be removed) as well as a newly updated Business Continuity Plan (basically covers all possible mild to severe disasters but updated for new pandemic advice) so I printed that off for some bedtime reading...
No one at work seems concerned yet. I did refill the handgel dispenser in the waiting room (no one ever uses it and it's been empty for a while!). General practice is no where near as clean and hygienic as a hospital, so please do use the alcohol gel when entering and leaving a surgery, I have taught my DCs to do this and always do myself when I go.

Thanks @wheresmymojo you are talking sense and I needed to hear that.

That Brighton article says 5 but goes on to say 8 confirmed in UK which is the same as yesterday. Confusing.

My GP surgery has a touchscreen for you to sign in when you arrive which has always seemed like an utterly stupid idea to me. Just why would you encourage the sharing of germs like that? They also sit everyone very close together when the waiting are is massive and could easily have a few different areas for waiting away from others.

I can't find any confirmation that the number of confirmed UK cases has increased since the 8 yesterday.

I'd take with a pinch of salt - could be a typo in The Argus.

It's still 8, 2 in York, Steve and 5 people who caught it from him... I think

There are two more confirmed cases in Germany linked to the Webasto cluster (the company that had the visitor from China)

That's concerning as it seemed they'd managed to keep it under control.

That’s interesting @eeeyoresmiles.
If I was to guess I’d have expected it to be the other way around, with China having a higher proportion of older people due to the one child policy.
They do have a slightly lower life expectancy than Europe so perhaps that has something to do with it.