CoVid19 Part XII - 4,604 in ROI (137 deaths) 998 in NI (56 deaths)(04/04) **Read OP**

igCorcaigh

macmahon wrote: »

Im suggesting people should be mindful of the wording coronavirus/covid19 when it comes to media...that is all.

Yes sure. I understand. You are correct.

The WHO took their time in naming the new virus, and in the meantime everyone was talking about the novel Coronavirus. Since called simply Coronavirus.

I think the current virus is called SARS 2 Coronavirus, and the illness it causes, Covid19.

Obviously most people will know what you mean by the word Coronavirus in the current context, but it's a shorthand.

CitizenFloor

Wish one of the journalists would ask about ventilators. Great, we created extra capacity with ICU beds. Does each ICU bed have a ventilator? The ventilators are the important piece of equipment. If we have 500 ICU beds but only 250 ICU beds have ventilators, I know which bed I'd choose.......my own bed at home, but you get the point.

ihdxwz4a3pem9j

10000maniacs wrote: »

How many people in that photo can you picture hooked up to a ventilator? Three at least. That guy with the beard stuffing his face, was it worth it?

People can be incredibly naive. When I speak to people in the hospital who develop an acute illness (they were previously well), the common theme is shock, that they were going around their daily lives as normal, and suddenly they have landed in critical care.

On behalf of society and ourselves, we should not be complacent. Any of us can find ourselves on that ventilator.

That said, I think unlike the American people in that photo, we are doing a terrific job at the minute, with the restrictions. People really care about curbing the spread, and protecting the vulnerable. I am really proud to be Irish.

Also, I have friends working in critical care abroad. They have absolutely zero, or minimal PPE. They feel completely let-down by their systems. I feel very relieved that I stayed put in Ireland

igCorcaigh

I've seen many wear scarves over their mouths when I went shopping a few days ago.

Is there any evidence for this measure? Or should we just do it anyway before the evidence comes in, one way or another?

https://twitter.com/BNODesk/status/1245822708337827840?s=19

blackcard

kilkenny31 wrote: »

I know. But the fact is the rate at which people are dying and the rate at which people are being admitted into ICU is low and not growing at a substantial rate. Obviously the hospitals are going to be busy but not overwhelmed giving the numbers that have been released to date. I'd imagine at the peak it may be 30-50 deaths per day which is awful but nowhere near as bad as it could have been.

Jeez, a week with that type of death rate would have us up where Belgium is at the moment. I was hoping that it wouldn't get to that

macmahon

amadangomor wrote: »

He's right influenza is not a coronavirus. You are being unnecessarily pedantic over terminology.

Most people call Covid-19 the coronavirus, yes and we all know there are other coronaviruses!

Trust me. Im not being pedantic. Im aspergers and just read things as they are! I just don't understand shutting down the whole country for such small numbers of death due to covid19? Every other day here in Ireland there are on average 90 deaths a day! Why are we just RIP ing just Covid19 deaths and not the others in that day?

kilkenny31

blackcard wrote: »

Jeez, a week with that type of death rate would have us up where Belgium is at the moment. I was hoping that it wouldn't get to that

I would hope so too. But we have to be realistic. It would be surprising if this thing didn't kill 500-1000 people like a bad flu season. We have already seen 10-15 people die in a day. Its not unreasonable to suspect that this could double over the next few weeks.

tuxy

macmahon wrote: »

Trust me. Im not being pedantic. Im aspergers and just read things as they are! I just don't understand shutting down the whole country for such small numbers of death due to covid19? Every other day here in Ireland there are on average 90 deaths a day! Why are we just RIP ing just Covid19 deaths and not the others in that day?

The difference is for other issues we have measures in our society to deal with it.
This is new and can overrun our entire health care system. Other things can kill many people but they do not cause the total collapse of a countries health care.

Logan Roy

blackcard wrote: »

Jeez, a week with that type of death rate would have us up where Belgium is at the moment. I was hoping that it wouldn't get to that

What? Belgium have 900 more deaths than us. It would take nearly 3 weeks of 50 deaths a day to get to where they are now.

BanditLuke

Kermit.de.frog wrote: »

Interesting program about China's response. It is good that these programs are being aired because I feel China in some form should be held accountable after this is over.

https://www.youtube.com/watch?v=pEQcvcyzQGE

Imagine RTE doing a piece like that.


Nah me neither.

Solli

CitizenFloor wrote: »

Wish one of the journalists would ask about ventilators. Great, we created extra capacity with ICU beds. Does each ICU bed have a ventilator? The ventilators are the important piece of equipment. If we have 500 ICU beds but only 250 ICU beds have ventilators, I know which bed I'd choose.......my own bed at home, but you get the point.

I’m going to paste a previous post, it’s not the ventilators that are the issue here

Interesting read from a health sector worker in the UK.

I'll be honest, as I see it due to working in Intensive Care. The lack of ventilators, which the government is falling over itself to sort, is not the biggest issue at the moment, it'll be the lack of suitably trained people to operate the ventilators effectively, as part of overall care for a critically unwell patient.

You can give (and we are) non-Intensive Care nurses basic training on ventilators but, as experience is showing, many Covid-19 patients that are being ventilated on Intensive Care Units are effectively in multi organ failure, requiring wider treatment than 'just' ventilation.

Even those patients who aren't in multi organ failure require more complex treatment regimes due to the nature of the high pressures required for effective ventilation and to keep patients as sedated as we can in order that they are compliant with the ventilation settings.

(My apologies but some 'shop talk' will appear now, I'll link to articles explaining what I'm talking about where I can)

We are having to heavily sedate patients far deeper than the levels we usually aim for.

Usually we try to sedate patients to a RASS of 0 to -2, which means patients are very lightly sedated, often able to breath spontaneously under the sedation. This helps maintain strength in muscle groups required for breathing and means that hospital stays are shortened, less rehabilitation is required and patients outcomes are overall much better.

With Covid-19 though we are having to ventilate patients with much higher pressures than we normally would in order to counter the effects of the pneumonia that it causes. These higher pressures cause issues with patients not 'sycronising' with the events, in short because the body finds it uncomfortable and triesto resist (desyncronising). As a result we're generally having to sedate patients to a RASS of-4 to -5 (so-called "flattening them out") and are very often also having to use paralysing medications to ensure total compliance.

This level of sedation then introduces other issues, predominately sedation-related hypotension (low blood pressure), for which we then have to give other medications (inotropes) in order to vasoconstrict the vascular system and keep blood pressure high around the core organs to keep them perfused (well oxygenated via blood flow).

Using inotropes though has a knock-on issue of it's own, or rather two predominate ones; lower blood pressure in kidneys and poor blood flow at the extremities. The former causes a reduction in urine production, leading to poor excretion of harmful waste products within the blood stream, the latter can lead (in extreme case) to necrosis (cell death from oxygen starvation).

To add to this, we are unable to directly treat Covid-19 as there is currently no cure, so we're relying upon patients own immune system to deal with it. This causes other issues, among them; the immune response requiring large amounts of glucose to be released into the blood system to 'feed the body' and, as a consequence of so much glucose being used metabolically, an increase in the amount of Ketones within the blood.

The large amount of glucose needs to both be supplemented (through Nasogastric Feeding) and controlled (with Insulin) to try and restrict the levels of blood glucose. If left unchecked the body will just keep glucose (causing Hyperglycemia) and 'burning it' metabolically and in doing so releasing increasing amounts of Ketone (which is an acid, so causing Ketoacidosis). This rise in acidity, compounded by a drop in urine output, causes a drop in blood Ph, which is incredibly damaging to all parts of the body at a cellular level.

Whilst there is far more involved in looking afte a patient on Intensive Care I hope that this brief explanation shows that 'merely' putting someone on a ventilator has a knock-on to multiple organ groups, all that in turn have a knock-on to other ones.

Teaching someone to operate a ventilator is (comparatively) simple. Teaching someone how to titrate medications, adjust ventilator settings, when to give additional medications to address issues with observed patient 'vitals' etc is not. This is why, as I mentioned earlier in the thread, it can take 12-18 months of additional specialist training before a registered nurse can operate safely as an Intensive Care nurse.

We have to be able to keep the most dependant patients alive without the benefit of calling a doctor for advice all the time. Indeed, generally, the junior doctors will cede to the knowledge of nurses with regards to Intensive Care patients as we're often far more experienced in such s specialist ares than they are (due to the nature of their training/placement program).

- Ventilators are not the sole issue.

Bob24

igCorcaigh wrote: »

I've seen many wear scarves over their mouths when I went shopping a few days ago.

Is there any evidence for this measure? Or should we just do it anyway before the evidence comes in, one way or another?

https://twitter.com/BNODesk/status/1245822708337827840?s=19

I’d say it has rather limited effect to protect you from others (might help a bit but even less than a simple surgical mask and nowhere near an FFP 2/3 mask, plus if the scarf blocks something then you might put the virus on your hands when you take it off so like with a mask you shouldn’t touch the part which was in from if your mouth).

However while not as good as a mask, IMO it will definitely block some of the droplets you exhale, so if you are sick it will reduce the quantity of virus you disseminate. Measurements would be needed to know exactly how much and it definitely won’t be as good as a surgical mask, but it will do something so even without knowing exactly how efficient it might be I guess it is always good to take.

bekker

ITman88 wrote: »

Yeah the last point here is critical.

I hope I don’t sound callous but in nursing homes, when people of ailing health with a median age of 92 contract an infection, they are not going to go to hospital.
The main object of the staff is to make the patient as comfortable as possible.

When a patient has a covid - 19 positive test and dies, it is often not the cause of death.

Where did you get the median 92 for nursing homes, sounds way off.
You didn't - scanning inaccuracy on my part

Yes it is, it's the proximate cause of death, death is inevitable, one can have an underlying condition with potentially years of life to enjoy and die prematurely from COVID-19 aggravation.

COVID-19 IS the proximate cause of death.

Popeleo

macmahon wrote: »

Trust me. Im not being pedantic. Im aspergers and just read things as they are! I just don't understand shutting down the whole country for such small numbers of death due to covid19? Every other day here in Ireland there are on average 90 deaths a day! Why are we just RIP ing just Covid19 deaths and not the others in that day?

Because of the exponential growth that is like nothing else we have experienced in several generations.

When the capacity of the hospital ICUs etc. is reached, the death rate can go from c. 1% to c. 10%. and it won't be just the old and frail that cannot be saved.

CIARAN_BOYLE

igCorcaigh wrote: »

I've seen many wear scarves over their mouths when I went shopping a few days ago.

Is there any evidence for this measure? Or should we just do it anyway before the evidence comes in, one way or another?

https://twitter.com/BNODesk/status/1245822708337827840?s=19

Might be more likely to protect others from anything you are carrying rather than protecting you from something others are carrying but it's a nice common sense simple approach tot ake rather than wearing masks every where when there is shortages.

igCorcaigh

macmahon wrote: »

Trust me. Im not being pedantic. Im aspergers and just read things as they are! I just don't understand shutting down the whole country for such small numbers of death due to covid19? Every other day here in Ireland there are on average 90 deaths a day! Why are we just RIP ing just Covid19 deaths and not the others in that day?

Because of how it rises exponentially. It's not the numbers of people currently dying from this is the concern, tragic as it is. But how it could swamp our health services. And, it's a new illness. How things could go from this now to something much worse very quickly, if we don't act.

It's a very interesting thing McM. It involves epidemiology, risk management, politics, medicine.... There are good reasons for the current measures.

ChikiChiki

igCorcaigh wrote: »

I've seen many wear scarves over their mouths when I went shopping a few days ago.

Is there any evidence for this measure? Or should we just do it anyway before the evidence comes in, one way or another?

https://twitter.com/BNODesk/status/1245822708337827840?s=19

Thinking about it logically it prevents some droplets/aerosols being exhaled into the wider atmosphere. And minimises the distance of spread.

ihdxwz4a3pem9j

macmahon wrote: »

Trust me. Im not being pedantic. Im aspergers and just read things as they are! I just don't understand shutting down the whole country for such small numbers of death due to covid19? Every other day here in Ireland there are on average 90 deaths a day! Why are we just RIP ing just Covid19 deaths and not the others in that day?

The difference between the 90 deaths per day, is that they are largely not due to contagious illnesses. If somebody sadly passes away from a heart attack, (s)he will not spread this. However, in the case of a contagious illness, this can be spread, and lead to an exponential (massive explosion of case) increase in the number of cases. About 6% of all cases will require critical care (which requires an incredible amount of resources per patient). Furthermore, each patient will require approximately 10-12 days of critical care. Since, Ireland (like every country in the world) has only a finite number of critical care beds, we have to try to reduce the overall rate of spread. By doing this, we reduce the number of patients requiring critical care at any given time. This ensures that people who are otherwise appropriate candidates for critical care will both receive critical care, and receive optimal care. If we let the virus spread like wildfire, the hospital-system starts to fall apart. Medical systems are expected to function in a chaotic and overwhelmed system.

Social restrictions has been demonstrated to reduce the transmission of the illness

blackcard

Logan Roy wrote: »

What? Belgium have 900 more deaths than us. It would take nearly 3 weeks of 50 deaths a day to get to where they are now.

Belgium has 87 deaths per million population, we have 20 deaths per million. If we had 50 deaths per day or 350 in a week, that would bring our rate to 92 deaths per million

MD1990

1,355 dead in france today.

very sad

CIARAN_BOYLE

MD1990 wrote: »

1,355 dead in france today.

very sad

884 of those is under reporting from previous weeks. Fatalities in nursing homes were not counted previously in the French total.

Loafing Oaf

macmahon wrote: »

Trust me. Im not being pedantic. Im aspergers and just read things as they are! I just don't understand shutting down the whole country for such small numbers of death due to covid19?

To prevent a much larger number of deaths due to covid-19.

beolight

blackcard wrote: »

Far too early to be complacent. Also, I think that only 14 of those that died had been in ICU. Not sure why such a small number, I thought the most serious cases would have been in ICU. Maybe not moving elderly people from nursing homes? An element of triaigeing?

https://en.m.wikipedia.org/wiki/Frailty_index

How many Nursing Homes have ventilators?

Triaging/palliative care/ euth .. it’s a thin line

Greentopia

devnull wrote: »

What is the average age and social care system like in Sweden?

Is there a significant problem to be solved or money to be saved by getting rid of a large number of elderly and sick?

Elder care is highly developed and generally well funded, mostly by taxes through municipalities, though private care has increased in the last decade or so with mixed results.
The emphasis is on keeping people independent and in their own homes with home help services and other care interventions as needed, as much as possible.

Around 20% of the population is +65 years old, increasing to one in four by 2040 so has one of the oldest populations in the world. Costs therefore would be significant- https://www.statista.com/statistics/531109/sweden-expenditure-on-elderly-care/-around €11 billion, and I may be naive but I genuinely don't think the aim of their approach to the virus is about saving money or solving problems.

It's not like they're doing nothing, they're practicing good hygiene, social distancing (which is the norm there anyway tbh), advising over 70s to stay home and all those who can work from home are doing so. They're just trusting that people will follow the government and clinical advice willingly.

macmahon

tuxy wrote: »

The difference is for other issues we have measures in our society to deal with it.
This is new and can overrun our entire health care system. Other things can kill many people but they do not cause the total collapse of a countries health care.

Thankyou. But so far this isn't and it seems to be going on for a long time. I was up at the CUH today for an appointment and everything was quiet? Never seen the place so quiet!

Beanybabog

How long do people think the ban on family visits will be?

Achasanai

Logan Roy wrote: »

What? Belgium have 900 more deaths than us. It would take nearly 3 weeks of 50 deaths a day to get to where they are now.

I presume the poster means per head of population. We're not quite at Belgium's level (when comparing in terms of days since the first death) but far ahead of the UK, Sweden, Italy, US on day 9 (per head of population).


http://91-divoc.com/pages/covid-visualization/

bekker

igCorcaigh wrote: »

Yes sure. I understand. You are correct.

The WHO took their time in naming the new virus, and in the meantime everyone was talking about the novel Coronavirus. Since called simply Coronavirus.

I think the current virus is called SARS 2 Coronavirus, and the illness it causes, Covid19.

Obviously most people will know what you mean by the word Coronavirus in the current context, but it's a shorthand.

Not shorthand, sloppy.

Sloppy language leads to sloppy thinking, and there's enough of that are around already.

Thinking COVID-19 = coronavirus negates the ability to correctly filter memes on coronavirus.

Misinformation has an R0 of >10k.

CitizenFloor

Solli wrote:

- Ventilators are not the sole issue.

Thanks for the explanation....

I guess my question if I was a journalist would be...."Are all our 500 ICU beds equiped with ventilators, and do we have appropriately trained staff to run them? If we do not, how many ventilators do we have, that staff are trained to use?"

Naos

macmahon wrote: »

Thankyou. But so far this isn't and it seems to be going on for a long time. I was up at the CUH today for an appointment and everything was quiet? Never seen the place so quiet!

It isn't (overrunning our health system currently) because of the measures we've put in place and the majority of people are adhering too.

Beasty

Strazdas wrote: »

They are in fact : Dr Holohan says they are recording all nursing home deaths

But that has to be caveated. They are only recording those "diagnosed" with Covid-19. We do not know if they are testing everyone in nursing homes

froog

Christ trump has his lizard vampire of a son in law heading up the supply chain team. They are super ****ed.

BanditLuke

Beanybabog wrote: »

How long do people think the ban on family visits will be?

I'd say July at the earliest and then another shutdown in October for longer this time with the much more letal second wave.

igCorcaigh

bekker wrote: »

Not shorthand, sloppy.

Sloppy language leads to sloppy thinking, and there's enough of that are around already.

Thinking COVID-19 = coronavirus negates the ability to correctly filter memes on coronavirus.

Misinformation has an R0 of >10k.

I know.

At least it's not a novel rhinovirus we're dealing with. Those poor creatures have it tough already.

macmahon

BanditLuke wrote: »

Imagine RTE doing a piece like that.


Nah me neither.

They did didn't they?...yvonne kinsella rte...google it!

amadangomor

10000maniacs wrote: »

How many people in that photo can you picture hooked up to a ventilator? Three at least. That guy with the beard stuffing his face, was it worth it?

They should be branded with an idiot stamp on their foreheads and not allowed to take an ICU bed if they need one.

Beasty

Logan Roy wrote: »

That line is orange not red

I don't want to worry you, but mixing up orange and red is one of the symptoms of....







...colour blindness (not to be confused with coronavirus)

stephenjmcd

BanditLuke wrote: »

I'd say July at the earliest and then another shutdown in October for longer this time with the much more letal second wave.

Thats complete scaremongering, nobody can say about a more lethal wave.

At some point a decision will be taken to get back to as close as possible to every day life. Be it June, July whenever. But you can't come out and say a more lethal wave as nobody has any proof of that

Strazdas

Beasty wrote: »

But that has to be caveated. They are only recording those "diagnosed" with Covid-19. We do not know if they are testing everyone in nursing homes

Well they have no reason to do a test on anyone in a nursing home not displaying Covid symptoms, so it's as good a method as any I guess.

kenmc

MadYaker wrote: »

No cases in North Korea?? What’s their secret?!

Shoot on sight. If there's a person carrying the virus at the time, oopsie.

Martina1991

UrbanFret wrote:

Can the labs that usually test for the veterinary world help I wonder?

igCorcaigh wrote:

Wouldn't think so. It's the lack of reagent that seems to be the issue.

sadie1502 wrote:

Of course why not. They are labs. They can test the swabs.

y0ssar1an22 wrote:

a proprietary reagent i think? i wonder could they make it if free to do so?

sadie1502 wrote:

Well they can test once they have the reagents.

Just because a facility has a laboratory does not mean it can perform diagnostic testing.

Just because reagents can be bought from suppliers does not mean they can perform diagnostic testing.

Testing is carried out by Medical Scientists. These professionals have to have a BSc in Biomedical Science that is accredited by the Academy of Medical Laboratory Scientists. It is estimated ~70% of the profession have also obtained their MSc.

There are ~2,000 Medical Scientists employed in Ireland working in public and private hospitals.

This profession is specifically trained and qualified to perform high complexity diagnostic testing. It cannot be just open to any place or anyone.

gmisk

The cause of coronavirus according to a dup councillor....gay people and abortion...I should have guessed!
https://www.irishtimes.com/news/ireland/irish-news/dup-politician-did-not-intend-to-cause-hurt-when-linking-coronavirus-to-abortion-law-1.4219288

tuxy

kenmc wrote: »

Shoot on sight. If there's a person carrying the virus at the time, oopsie.

No need to do that. Info does not get in or out of the country.
Some poor countries could even welcome the increased production from the death of people too old to work.

igCorcaigh

macmahon wrote: »

Thankyou. But so far this isn't and it seems to be going on for a long time. I was up at the CUH today for an appointment and everything was quiet? Never seen the place so quiet!

Lots of non urgent things have been cancelled.

macmahon

Popeleo wrote: »

Because of the exponential growth that is like nothing else we have experienced in several generations.

When the capacity of the hospital ICUs etc. is reached, the death rate can go from c. 1% to c. 10%. and it won't be just the old and frail that cannot be saved.

Thankyou. I understand your last sentence but not your first! Where is this exponential growth?

1800_Ladladlad

Thank fook we're all not famous or we'd all have that Covid19 by now .... or even worse, a fatality.

Bobtheman

I was a bit surprised at the Department of education being so adamant that they will run the LC somehow in June. By hook or by crook. They said. Reminds me of the promise that the bank bailout would be only 8 billion . Ah the memories. Great times.

igCorcaigh

Martina1991 wrote: »

Just because a facility has a laboratory does not mean it can perform diagnostic testing.

Just because reagents can be bought from suppliers does not mean they can perform diagnostic testing.

Testing is carried out by Medical Scientists. These professionals have to have a BSc in Biomedical Science that is accredited by the Academy of Medical Laboratory Scientists. It is estimated ~70% of the profession have also obtained their MSc.

There are ~2,000 Medical Scientists employed in Ireland working in public and private hospitals.

This profession is specifically trained and qualified to perform high complexity diagnostic testing. It cannot be just open to any place or anyone.

Exactly. And any qualified biomedical laboratory has statistical metrics that are monitored. It's not like anyone with the right equipment can just open shop.

bekker

Strazdas wrote: »

In fairness, very little was known about the virus and transmission at that stage. There was talk from scientists you would need to spend around 15 minutes with a person before you could catch Covid from them.

'Talk from scientists', what scientists? what forum? what specialities? etc. etc.

Microdroplet transmission, expiration etc has been in the frame from the beginning.

eagle eye

stephenjmcd wrote:

At some point a decision will be taken to get back to as close as possible to every day life. Be it June, July whenever. But you can't come out and say a more lethal wave as nobody has any proof of that

The simple solution is complete lockdown which means a temporary border with NI, nobody in or out of the country, unless out means you stay gone, and we'll be clear of this thing before June.
Of course that sorts this country out and not the rest of the world. We need to maintain the lockdown as far as entry to the country is concerned until the rest of the world is clear of it.

We can all be back at work by June though if they do things right.