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Jonathan Kay
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The problem with respiratory impairment is that any illness will finish you off.

That's the risk. The most common relevant medical concept is that of "reserve". 

I suspect that no-one is dying of coronavirus but it is hastening the demise of people suffering from existing respiratory issues or what used to be recorded on death certificates as senility. 

From what I can tell and from other viral diseases there will be deaths in people with no known underlying condition as well as those with eg COPD. This is partly a matter of what actually happens and partly of language and partly of concept. It's necessary to separate cause from process from clinical effects. A concept such as "... dying of coronavirus" doesn't fit into that model. Someone with no known underlying condition might get several different disease processes caused by the virus eg bronchitis or pneumonia. That pneumonia might be primarily inflammation directly caused by the virus or involve bacterial infection along the way. NB there are two different uses of the term pneumonia: bronchopneumonia (the old man's friend) and lobar pneumonia (the dramatic disease with a crisis beloved of fiction writers).

There's been a trend over the last few years to move away from traditional classifications based on disease processes and you'll now see much more generic terms such as "upper respiratory tract infection" and "lower respiratory tract infection". That goes with the knowledge that in most cases you can't actually tell from clinical examination what is going on.  And with the addition of "community acquired" or "hospital acquired" that model works well with guidance on how to manage them, including decisions about antibiotics.

Jonathan

PS: Wikipedia is excellent on all of this. It's now a major resource for your doctors of the future so I wouldn't worry about relying on it.

Jonathan Kay
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I was conversing with an old work colleague the other day and we were both struck by the fact that in all the TV images of either real or suspected Coronavirus patients in the Far East, all the Health Staff are dressed in full Bio-Hazard Gear. Whereas in the UK, the Coach Drivers transporting the suspected sufferers were wearing ordinary clothes and no masks.

How interesting. I rarely watch TV news and hadn't spotted that. My immediate thoughts were:

  1. Face masks are much more common in ordinary times in the Far East, so it would be upsetting for people familiar with that to see staff not wearing them.
  2. TV editors select exciting rather than typical clips.

Then I went to see the official UK advice:

and the latter says:

"4.4 Facemasks
Staff are not recommended to wear respiratory masks. They do not provide protection from respiratory viruses. Respiratory masks are only recommended to be worn by symptomatic passengers to reduce the risk of transmitting the infection to other people.
PHE recommends that the best way to reduce any risk of infection is good hygiene and avoiding direct or close contact (closer than 2 metres) with any potentially infected person. Any member of staff who deals with members of the public from behind a screen will be protected from airborne particles."

Jonathan

Blue7
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It looks like it will be with us soon so best be prepared and buy some appropriate equipment Whistle

anthonym
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The most common relevant medical concept is that of "reserve". 

 

That SOUNDS like this, in short a measure of frailty or the lack of it:

https://oxfordmedicine.com/view/10.1093/med/9780199653461.001.0001/med-9780199653461-chapter-28

Chapter:
Physiological Reserve and Frailty in Critical Illness

Author(s):

Robert C McDermid
 and Sean M Bagshaw

DOI:
10.1093/med/9780199653461.003.0028

Physicians have long sought to define a ‘physiologic age’ distinct from chronologic age which might account for some of the variance in response to critical illness and injury. This has led to the concept of ‘physiologic reserve’ which might represent a major driver of outcome in patients requiring intensive care. The human body is a complex system that adapts to a multitude of external stressors; however, senescence or illness can reduce inherent adaptive mechanisms, reducing complexity and reducing the threshold for decompensation (i.e. acute illness or injury). This theoretical critical threshold can be considered ‘physiologic reserve’. The phenotypic expression of this process is frailty. Frailty is a condition in which small deficits accumulate which individually may be insignificant but collectively produce an overwhelming burden of disease and heightened vulnerability to adverse events. Frail patients expend a greater proportion of their reserve simply to maintain homeostasis, and seemingly trivial insults can contribute to catastrophic decompensation. While frailty has generally been described among older populations, the concept of frailty as a surrogate of physiologic reserve may have relevance to critically ill patients across a wide spectrum of age. Research is needed to characterize the biological underpinnings of frailty, optimal ways to measure it, and its importance in determining survival and functional outcomes after critical illness. The utilization of ICU resources by older patients is rising, and the prevalence of frailty in those admitted to the ICU is likely to increase.

Tony Whitley
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It was a local bus company that transported the COVID-19* patients, they pointed out that trying to drive a bus  in full hazmat gear was many times more likely to kill the patients than the virus.  Instead the drivers had agreed to be kept in isolation for two weeks afterwards.

* COVID-19... COVID... I have been wondering if crows were involved in this "Bird flu" epidemic Scratchchin

Jonathan Kay
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* COVID-19... COVID... I have been wondering if crows were involved in this "Bird flu" epidemic

Are you getting your Rs confused with...

;-)

Jonathan

anthonym
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who me? Carlsberg. It's your domain not mine.

Tony Whitley
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Dear Parents,
During the past 24 hours you may have seen Horseman Coaches mentioned within the media helping to safely transport British citizens who have returned from China.
I wanted to personally write to you to let you know that without doubt there is no risk to any of our staff or customers by helping individuals returning from China. I also wanted to assure you there will be no disruption or change to the usual service you receive from Horseman Coaches.
Background Information:
On Thursday afternoon, Horseman Coaches was contacted on behalf of the British Government to assist with the repatriation of British citizens from China. 83 Britons returned to RAF Brize Norton on Friday 31st January 2020. Five of our coaches from a fleet of 62 were dispatched to transport the individuals to Arrowe Park Hospital in Wirral.
Safety Comes First:
Public Health England (PHE) has formally confirmed that all vehicles used will remain locked in a secure lock up facility for a minimum of 10 working days and will be subject to a military-grade cleansing process.
The team at Public Health England (PHE) has also confirmed that there will be no risk to any future passengers travelling or using these coaches in future.
As an additional measure all drivers will be released from Arrowe Park Hospital in the next few days to return, and remain at home for a further 10 working days under quarantine conditions which will be overseen by the Department for Health and Public Health England as an additional precautionary measure.
Due to a number of misleading media reports surrounding the safety of our drivers and passengers, I wanted to share with you the following insight:
  • Horseman Coaches had provided PPE (Personal Protective Equipment) equipment for all drivers involved in the successful repatriation of 83 Britons. Regrettably this was not accurately reported by the media.
  • Military personnel medics and government officials told our drivers that PPE equipment was not necessary due to the precautions already taken by the Department for Health and Public Health England.
  • Government officials confirmed that drivers wearing PPE equipment while driving posed a greater risk to the safety of passengers. This was a governmental decision based on a risk assessment conducted by the Department for Health and Public Health England.
  • Public Health England have confirmed that the virus can only be contracted from someone displaying symptoms. Public Health England have confirmed that none of the 83 Britons displayed any symptoms throughout their repatriation.
  • The photographed individual wearing a PPE suit seen in the media was in direct contact with each of the 83 Britons, hence the need to wear protective clothing
  • The individuals repatriated have not had direct contact with any of our Drivers, who were kept at the correct distance required during transportation. Officials from PHE (Public Health England) have been present to supervise and manage the situation at all times.
  • PHE has confirmed all drivers may return to work immediately, however Horseman Coaches has asked all drivers to remain at home on full pay and benefits for the next 10 working days under quarantine conditions as an additional precautionary measure.
TomB
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My sisters school in Oxfordshire is sending pupils home after one came back from Italy apparently unwell.  They are closing for a deep clean, cant see anything in the news yet....

Jonathan Kay
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Oxford Mail.

Jonathan