First Story on Coronavirus Mortality Rate

[iolaire]

This is the first story on mortality rates in coronavirus patients with preexisting conditions.  It doesn't cover dialysis but does include diabetes.  The risks are higher with preexisting conditions but our chance of survival is still in the 90% range.  It should also be noted that in China men in their 40's have a fairly high death rate, probably because of the high smoking rates.
https://news.yahoo.com/coronavirus-patients-heart-disease-10-231300794.html

Now a longer story with age and sex stats.
https://www.bbc.com/news/health-51674743

[Simon Dog]

The procedure at my Xplant hospital is interesting:

Do not take a mask as the dispenser by the entrance from the garage, with posted instructions.

Interpreting the instructions into what it really says "Walk through a long corridor unmasked, pass the hospital pharmacy then the lunch counter, finally get into a crowded elevator to spread your virus, go to the first floor, walk across the lobby and someone at the reception desk will give you a mask".

My doc tells me it is because the masks were being stolen in bulk.

[iolaire]

At my center they had masks at the checkin desk as you describe at your center now. I do believe with the hysteria they would get stolen. I’m adding to the hysteria in my own way. 

[Simon Dog]

At my center they had masks at the checkin desk as you describe at your center now. I do believe with the hysteria they would get stolen. I’m adding to the hysteria in my own way.

It was not the dialysis center per-say, but the entire hospital.

[Michael Murphy]

Get on to amazon and check the price of masks the prices are very high, the claim is that huge numbers are being ordered by people with relatives in countries that masks are in short supply like Japan and China.

[MooseMom]

Iolaiire, thanks for posting the chart of mortality rates in people with preexisting conditions.  I notice that "organ transplant" is not listed, and while I realize that while it is natural to think that people who are immunosuppressed are at greater risk, I am wondering if otherwise healthy immunocompromised people (like us) are at greater risk of actually dying.

I did manage to find this a couple of days ago and thought about posting it, but I don't know if it is entirely factual.  But you all can decide for yourselves.

http://www.china.org.cn/china/Off_the_Wire/2020-02/18/content_75718506.htm

[iolaire]

MooseMom, thanks for that link.  Sounds like its a delicate balance but something you can work through with your transplant center.  That prompted me to finally google it and found a few links, mostly they seem old and travel related.
https://www.myast.org/information-transplant-programs-and-opos-regarding-2019-novel-coronavirus
https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians

The myast pdf talks about masks and treatment without major new insights:
5. Should transplant patients wear a mask or avoid public places?
In general, transplant patients should exercise caution about being in overcrowded situations.  Frequent handwashing or hand sanitizer use helps prevent infection.  The benefit of wearing masks in public is controversial even for transplant patients and it is unknown how much wearing a mask will help prevent infection.  Most surgical masks are not tight fitting and aerosols can get through. However, they may prevent patients from touching their nose and mouth.  It is unclear if an N95 mask is better than a regular surgical mask since proper fit-testing has not been performed.    An N95 mask can be uncomfortable to wear for prolonged periods.  At this point in the United States and Canada, COVID-19 cases are generally linked to travel.
 
 
6. What is the approach to transplant recipients with flu-like/respiratory symptoms?
There are many different causes for flu-like/respiratory symptoms.  Your hospital should have protocols in place for transplant patients with flu-like/respiratory symptoms.  Consult your local hospital practices for outpatient transplant clinic
screening or visitor restrictions for transplant recipients as these may evolve over time.  A travel history or contact with recently returning travelers from China (or other areas where there is local transmission) should be elicited.  Other causes of respiratory illness including influenza and RSV should be sought.  Patients suspected of the COVID-19 should be placed in isolation and infection control should be notified.  CDC has updated guidelines for infection control https://www.cdc.gov/coronavirus/2019-ncov/infection-control.html
 The CDC has also established interim risk criteria for exposure to the COVID-19  https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html.
 Testing for COVID-19 is done via a specific RT-PCR on nasopharyngeal and oropharyngeal swabs. The novel coronavirus is not detected using the standard respiratory virus multiplex tests. 

[MooseMom]

Thanks for that, iolaire.

My transplant clinic is 2 hours away, but my local hospital is only 10 minutes away.  It has recently been absorbed into the Northwestern Medicine web here in Chicagoland.  The main Northwestern hospital is a well-regarded tx center, but my local hospiital doesn't have a tx clinic, specifically.

So, my question is this:  if you were to become ill with what you think just might possibly be covid-19, and you are aware that you are part of a "fragile" population, at what point would you seek hospital care?  Would you go sooner rather than later, or would you just wait to see how sick you actually get?

Also, would you attempt to get to your tx hospital, or would you be satisfied in going to your "regular" hospital?

[iolaire]

Once I was showing a fever I would contact the transplant center to discuss how to proceed. I think I your case I would error towards the transplant center despite the distance assuming its not that big of a hurdle to get there. 

I assume if you did have the virus you would be isolated so there would be no family visits etc... so the distance should matter less.

[MooseMom]

The only problem I see in going to my tx hospital is how it would affect my husband and his job.  It would be easier on him if I was nearby instead of being in another state. 

My tx clinic is also out of network for me, so I'd have to faff about getting a referral to go there, and I'd probably be dead by then.

I'm sure I'm not the only person here thinking along these lines.  Who else here is posing these same hypothetical questions?

Me, I'm banking on Mike Pence to just pray it all away.

[Cupcake]

Oh MooseMom you crack me up! Mike Pence!

I'm snowbirding it in Florida for the winter so my transplant center is 1000 miles away! Agree with Iolaire its best to call your transplant center for advice; this situation is changing daily and won't be going away any time soon. I don't think the change of seasons will have much of an effect on the spread of the virus.
Myy family is coming here to Florida on spring break with 2 small children, flying from the Quad cities on a 2 hop flight. I'm nervous; Delta airways says they will hold their tickets for a date to be determined in the future (up to a year) if you are apprehensive about flying (and visiting a transplanted auntie) during the coronavirus thing.

[iolaire]

I've not read the PDF linked to in the article so I'm trusting the summary in this reddit post:

https://www.reddit.com/r/China_Flu/comments/fbt49e/the_who_sent_25_international_experts_to_china/?fbclid=IwAR1kmHNb60czB7R_iQkrgDbJ6cnRGP7wo6cW0KBcSMMBS2GY1eMoYIN_alE&_branch_match_id=712695768628977344

The thing that worries me the most is the bullets regarding artificial respiration and oxygen.  I seriously worried our healthcare system is not ready to have accomidate a large number of people needing these services.  Already at most hospitals I've been treated in there is always a weight for beds.

5% of people who are diagnosed with Covid require artificial respiration. Another 15% need to breathe in highly concentrated oxygen - and not just for a few days. The duration from the beginning of the disease until recovery is 3 to 6 weeks on average for these severe and critical patients (compared to only 2 weeks for the mildly ill). The mass and duration of the treatments overburdened the existing health care system in Wuhan many times over. The province of Hubei, whose capital is Wuhan, had 65,596 infected persons so far. A total of 40,000 employees were sent to Hubei from other provinces to help fight the epidemic. 45 hospitals in Wuhan are caring for Covid patients, 6 of which are for patients in critical condition and 39 are caring for seriously ill patients and for infected people over the age of 65. Two makeshift hospitals with 2,600 beds were built within a short time. 80% of the infected have mild disease, ten temporary hospitals were set up in gymnasiums and exhibition halls for those.

An examination of 44,672 infected people in China showed a fatality rate of 3.4%. Fatality is strongly influenced by age, pre-existing conditions, gender, and especially the response of the health care system

[iolaire]

Accidently replied rather than edited...

I've not read the PDF linked to in the article, nor watched the video press conference, so I'm trusting the summary in this reddit post:

[MooseMom]

I guess it was inevitable.

https://www.cnn.com/2020/03/06/health/coronavirus-older-people-social-distancing/index.html

Do you all intend to follow these guidelines?  I am.  I injured myself 3 weeks ago and have had to miss a hockey match and a show, and now I'm glad I did.  I haven't been able to drive so have been pretty much stuck at home, and it's just as well, I guess. 

This is all getting pretty sucky.

[iolaire]

I guess it was inevitable.

https://www.cnn.com/2020/03/06/health/coronavirus-older-people-social-distancing/index.html

Do you all intend to follow these guidelines?  I am.  I injured myself 3 weeks ago and have had to miss a hockey match and a show, and now I'm glad I did.  I haven't been able to drive so have been pretty much stuck at home, and it's just as well, I guess. 

This is all getting pretty sucky.

I’m reading that now. 

Tonight will decide if I go to Irish parade tomorrow.

Have until Monday to decide if I work from home. Luckily I don’t think there will be pushback if I work from home before others.  My employer is being very proactive as far as cleaning and contingency plans as we acquired a company with true global scope last year and have people quarantined and working from home in China already.  I know two us coworkers of Chinese decent who had to self quarantine on return from their holidays.

The CDC site mending the is starting to have real info us in the high risk group.
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

[MooseMom]

Thanks so much for the CDC link! 

It is easy for me to avoid crowds, but my husband goes to work every day, and I admit to being concerned about what he might bring home.  The management structure is such that I don't think they'd look kindly at the whole working from home idea.  He's actually in Canada at the moment, so that means having to faff about at O'Hare and then sit on an airplane.  He has meeting with people and probably hasn't really thought about being careful despite my gentle reminders.

Please don't go to the parade, iolaire.  You've been through too much to risk throwing it all away on St. Patrick!

Let us know what you decide about going to work. 

[iolaire]

The management structure is such that I don't think they'd look kindly at the whole working from home idea. 

This is the type of thing that might change their view if he and other employees basically work via phone and computers. Company’s really need to this about will they survive if some larger than normal percentage of their employees are out of commission at the same time.

Otherwise lots of the public health statements say travel is still ok, avoid large groups, don’t shake hands, wash hands, etc.  lots of the travel bloggers are happily booking discounted trips and they probably will be ok, unless they are not.

I hope your hubby stays healthy. He can do a lot to minimize the risks with the basic hand washing type instructions. The airplanes’s air is fairly good due to the filters, but move away from anyone who seems to have a cold or allergies. 

[Simon Dog]

This work from home thing is continuing to become more the norm in the tech industry.   I am in a group of 8 people stationed at a large corporate facility (multiple buildings, thousands of geeks and a decent supply of REMFs).   I tend to go in more than work from home to interact with co-workers directly, but that is becoming difficult.   It's now typical for me to encounter only one other person in the group at the office, and that was down to none when my Chinese co-worker was persona non grata for 14 days because he hosted house guests from mainland China.   Since most of the people I work with are either half way across the country or world, they and my boss don't know or care where I am working from as long as I get the job done.

The company has an official "ban from the  facilities for 14 days" if you are an infection suspect, but the assumption is that you can work from home if you are well enough.

I have noticed when I have on-line meetings that it is not unusual to hear crying babies or barking dogs in the background from participants who forgot to mute their session.

I've received conceptually identical emails warning about what to do in the age of infection (Someone has to remake that old song) from my employer, three doctors offices and one of the colleges I went to.    The MDs told me to cancel any appointments if I was having symptoms or possibly exposed, and offering either phone consults or Skype sessions in place of office visits.

This is getting real, and there are a lot of cases in the US that are not making the news.

[iolaire]

Please don't go to the parade, iolaire.  You've been through too much to risk throwing it all away on St. Patrick!

Let us know what you decide about going to work.

I’ve decided that CDC warning is the notice that I should listen to. No parade, will start working from home on Monday as long as there is no push back. No book club with friends next weekend.

[MooseMom]

Simon Dog, I'm glad to see that you can work from home quite easily.  I'm sure that will ease a lot of anxiety!

iolaire, good call about the parade!  Why bother looking at the CDC warnings if we're going to just ignore them and go to parades or concerts, etc?  LOL!  Spring has arrived here where I live, just in time, so I can happily busy myself working in my garden and not be stuck indoors.  I may run to the store for some basic food items on Monday; I've noticed they have placed large containers of disinfecting wipes by the doors so that you can clean the grocery cart handles.

And, I hope you will be able to work mostly from home.  I'd hope that considering your tx status, your employer would allow this instead of risk losing your expertise for the weeks you'd need to recover should you become ill.

Good luck to everyone!  Keep us posted on how you plan to survive this thing!

[MooseMom]

Then again, I've just remembered that I've got labs next week, and Quest Diagnostics is located in the same complex as my PCP, my (non-tx) neph, and a physical therapist.  They all share a common waiting room.  It will be filled with sick people.  Hmmm.

Two weeks ago, my husband made us reservations for the annual Easter Brunch at the Arboretum, something we attend each year.  Probably should rethink that.  I don't want my husband to miss out, though, just because I'm a bit of a weenie.  That's a bit of a dilemma.  I don't want to curtail any activities that he might enjoy, you know?

[iolaire]

Here is what I shared on Facebook.


iolaire's note on working from home and no longer going out:

(I’m immune suppressed because of a kidney transplant.).

Hi everyone, on Friday the CDC issued their recommendation that old and at risk people stay home as much as possible. 

I've been waiting for a signal that it's time to work from home and stop going out and have decided that the notice should be that trigger.  I have known that by the time people get seriously worried it will be to late, so I'm trying to be proactive.  To me the CDC notice is significant given the political pressure they face to say everything is fine and dandy virus wise.

At work, our China based employees have been quarantined at home for some time, including families where people are stuck quarantined in different parts of the country because the quarantines hit before they could get home.  Two people I know here in the US were under self quarantine at home when they returned from holidays to China. 

One coworker, on the same team as me, who is from the virus epicenter Wuhan says that now her family has moved from being worried about themselves to being worried about her because they know Americans are not taking it seriously.

Anyway, I'm going to start working from home and not go out.  I do plan to try to go for some walks on the weekend since we do not get close to people.

CDC recommendations for elderly and at risk people - its a good read for everyone as it lists steps should someone in a household become sick:
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

CDC story on the change:
https://www.cnn.com/2020/03/06/health/coronavirus-older-people-social-distancing/index.html

[MooseMom]

Well said, iolaire!

I've been thinking more about how self-isolation would affect other family members, especially a spouse.  My husband has become a big fan of a particular band from Mexico, and next month they will be making their first appearance in Chicago.  They are a new-ish band and will be performing in a small venue.  My husband got us tickets and has booked us a hotel room close by.  He is so excited!  It means so much to him, the chance to get a selfie and some autographs....the whole "fan boy" routine!  How in the world am I going to tell him that I'm really wary of going?  I'm sure he has not even thought about the possible consequences.  He knows I'm immunosuppressed, but he doesn't really think about it because, well, why should he?  I'm healthy as far as he can tell. 

How about the rest of you?  If you are going to start staying at home to be safe, will this affect your other family members, and if so, will they be miffed?  I REALLY don't want to tell him I am worried about going, but I just don't know what to do. 

What good is self-isolation if your other family members don't do the same?

[cassandra]

I’ve just decided not to go on the boat to the Netherlands end of this month. Would love to see my mum and friends, but it might not be worth the risk. I’m already tired of cleaning all services around me other people touch etc. washing hands constantly, pushing people away trying to kiss me and all  

[cassandra]

Mmmmm changed my mind nearly into going after all. Hubby works at petrol station where (not all    people cough in his face and the like) ..... Also the discussion headed towards the ‘who is moving out stage’. I know I don’t have a tx to worry about, just my life on D. Still worth living, well I love it (yeah, as if there is a choice) and I’d kick myself pretty hard if something were to happen to me or my mum and I hadn’t seen her because of a virus that might kill me, or I might not even notice having. So MooseMom I would go I would go to that concert, take wipes, and gels, stay hydrated, tell Hubby to not hug people too, and enjoy yourself.


Decision made (for now), love, Cas