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RacingRodent
Consul
Wearing a wig?
twonines
LIMERICUS
Social distance, I didn`t get that close.
RacingRodent
Consul
I only manage to get by with my telephoto lenses.
malins
Stumbling Seeker
There's one simple and sad fact not covered here ....
... while in the objective sense, testing is not that great in Germany, it's been better than in many other countries.
This means that there is, relatively, a higher proportion of cases that are picked up early in the course of the disease.
Deaths usually happen after 2 weeks or more of the disease. That means that at any point in time the deaths are coming from the set of infected people 2 or more weeks prior (averaged) So long as new cases discovered expand rapidly, and they are discovered early, the number of deaths will lag significantly just because all those new cases have had no time to resolve to an outcome (mostly, and hopefully, recovery, ... but sometimes death).
If all infections were stopped right now, deaths would continue to slowly creep up over several weeks until settling in at a final case fatality rate that will seem much more typical.
Silent_Water
Tribune
Correct. In any case, this disease can become terrible for everyone and there was two days ago an article in the German newspaper "Die Zeit" with the most detailed description of serious cases I have read up to now by a Dr. Clemens Wendtner in Munich who has treated the very first case and now also the most severe cases of the coronavirus in Germany.
This is not an illness, which you can easily compare with the influenza virus because it depends very much on the question if the virus really gets deep into your lungs or not.
If it is in the lungs, it is faster and deadlier than most other diseases this doctor has ever seen before:
(Link down below, translation via Google, so: sorry for possible mistakes!)
...
ZEIT ONLINE: How are the patients who come to you?
Wendtner: It depends on when you come. Usually people come with a fever, which does not really decrease on the ward. Your breathing gets worse, even though we supply it with oxygen through a mask. Then we have the option to increase the oxygen supply, up to twelve liters per minute. Two to four liters are usual on a normal ward. If there is still not enough oxygen in the human blood, we have to intubate and ventilate using the machine.
ZEIT ONLINE: Are there any sick people who have to go straight to the intensive care unit?
Wendtner: Absolutely. We also have to provide artificial respiration to young people. They are in their twenties and thirties and had to be intubated after a few hours in the emergency room. Hence the warning: Young people are not invulnerable! Some weigh themselves in a security that does not exist.
ZEIT ONLINE: Are there young people with no previous illness?
Wendtner: Yes. Some of the young patients we treat were in Ischgl or St. Anton skiing. Ischgl seems to have been a real transshipment point for the virus. So many people celebrating in a confined space, it's easy to get infected - even without previous illness. And some of them just got seriously ill.
ZEIT ONLINE: What do you see in these patients?
Wendtner: In many patients with Covid pneumonia, huge areas of the lungs are infected. We call it frosted glass. These areas appear whitely cloudy on the X-ray image, just like milk glass. The lung tissue there is denser than elsewhere. It is a sign of inflammation. You can hardly see it as clearly as with Covid-19 in classic bacterial pneumonia. One lung segment is affected in classic pneumonia, but never the whole lung as with Covid-19. This is a very massive event.
ZEIT ONLINE: How does that happen?
Wendtner: Directly through the virus: In comparison, Sars-CoV-2 destroys the lung cells, they die. As the infection progresses, less functional lung tissue remains available for breathing, which naturally makes breathing difficult.
In addition with Covid-19, in many cases we see an excessive response from the immune system, a cytokine storm, as we call it. Put simply, inflammatory cells shoot into the lungs. This severely restricts the function of the alveoli and the gas exchange cannot work. We see such a reaction at some point in the majority of patients who come to the intensive care unit. The only question is whether you can recognize and treat this early enough or whether the reaction has already taken place so that you are late. If so, you often already have a lot of destroyed lung tissue that you can no longer save. Then the fire is almost over and the chances of survival decrease significantly.
ZEIT ONLINE: How do you try to interrupt this cascade?
Wendtner: The idea is to use a drug to dampen the immune response. One approach to this is the rheumatism drug Tocilizumab. Studies are currently starting with the active ingredient, in which our clinic will also participate. However, this is not a panacea. For example, some patients get an infection with bacteria in addition to their Covid pneumonia. We have to treat them with classic antibiotics. And of course you shouldn't inhibit the immune system in such patients.
ZEIT ONLINE: What about other drugs?
Wendtner: These days we are starting two phase 3 studies with the antiviral active ingredient Remdesivir, on which there are high hopes. It is currently being tested in clinical trials worldwide. In Germany, in addition to our clinic, one in Düsseldorf and one in Hamburg are participating. We'll see what the results are. The most important measure in severe cases remains ventilation.
ZEIT ONLINE: What does it look like? On television pictures from Italy you can often see that the patients are ventilated in the prone position.
Wendtner: It's the same with us, but not all the time. Greater pressure is exerted by the body weight on the lung sections on which the patient lies. This compresses the lung tissue, it is poorly supplied with blood and also poorly ventilated. By turning the patient upside down, the aim is to ensure that the air from the ventilator can flow down to these lowest parts of the lungs. We have so-called turning teams that turn the patients on a regular basis, because it is also not good if they are lying on their stomach all day.
ZEIT ONLINE: Is ventilation difficult?
Wendtner: It's not trivial with Covid-19. The problem is that the inflammation causes the lung tissue to swell a lot. This means that you need a fairly high pressure when breathing to get enough air into your lungs. Unfortunately, this can also lead to long-term damage. Even if the patients survive, their lung tissue may become stiff afterwards because they had to be ventilated with high pressures for a long time. Some of them may even be dependent on oxygen in everyday life.
And yes, this can also happen to young people.
ZEIT ONLINE: How long do patients have to be ventilated?
Wendtner: We have patients here who have been attached to the machine for two or three weeks. With classic pneumonia, it doesn't take that long, so you might have to ventilate as a support in between. But with Covid, it's a long, tough business. You also have to take this into account when calculating intensive care beds, which are not released as quickly for patients who are moving up. In Italy, this leads to the ethically very difficult situation that young people are in intensive care beds because they presumably still have a higher chance of surviving while older people are no longer able to get a bed. Fortunately, that's not the case with us. So far, we have only had one death in our clinic: an older patient with previous illnesses. But if we speak again in two weeks, the situation can of course be different.
ZEIT ONLINE: Do you feel well prepared with your clinic for what could come?
Wendtner: Yes. We have several crisis teams here every day, and the management also supports us wherever they can. If we want something, it will be implemented. We currently have no problem in Munich. Here the patients can choose which center to go to. I'm more worried about the peripheral clinics. Many of them do not have these resources or knowledge, and yet sick patients will get there just as seriously. We really have to try everything so that we don't get a tsunami regarding the rush of patients, but a dosed wave that we can master well.
This is not an illness, which you can easily compare with the influenza virus because it depends very much on the question if the virus really gets deep into your lungs or not.
If it is in the lungs, it is faster and deadlier than most other diseases this doctor has ever seen before:
(Link down below, translation via Google, so: sorry for possible mistakes!)
...
ZEIT ONLINE: How are the patients who come to you?
Wendtner: It depends on when you come. Usually people come with a fever, which does not really decrease on the ward. Your breathing gets worse, even though we supply it with oxygen through a mask. Then we have the option to increase the oxygen supply, up to twelve liters per minute. Two to four liters are usual on a normal ward. If there is still not enough oxygen in the human blood, we have to intubate and ventilate using the machine.
ZEIT ONLINE: Are there any sick people who have to go straight to the intensive care unit?
Wendtner: Absolutely. We also have to provide artificial respiration to young people. They are in their twenties and thirties and had to be intubated after a few hours in the emergency room. Hence the warning: Young people are not invulnerable! Some weigh themselves in a security that does not exist.
ZEIT ONLINE: Are there young people with no previous illness?
Wendtner: Yes. Some of the young patients we treat were in Ischgl or St. Anton skiing. Ischgl seems to have been a real transshipment point for the virus. So many people celebrating in a confined space, it's easy to get infected - even without previous illness. And some of them just got seriously ill.
ZEIT ONLINE: What do you see in these patients?
Wendtner: In many patients with Covid pneumonia, huge areas of the lungs are infected. We call it frosted glass. These areas appear whitely cloudy on the X-ray image, just like milk glass. The lung tissue there is denser than elsewhere. It is a sign of inflammation. You can hardly see it as clearly as with Covid-19 in classic bacterial pneumonia. One lung segment is affected in classic pneumonia, but never the whole lung as with Covid-19. This is a very massive event.
ZEIT ONLINE: How does that happen?
Wendtner: Directly through the virus: In comparison, Sars-CoV-2 destroys the lung cells, they die. As the infection progresses, less functional lung tissue remains available for breathing, which naturally makes breathing difficult.
In addition with Covid-19, in many cases we see an excessive response from the immune system, a cytokine storm, as we call it. Put simply, inflammatory cells shoot into the lungs. This severely restricts the function of the alveoli and the gas exchange cannot work. We see such a reaction at some point in the majority of patients who come to the intensive care unit. The only question is whether you can recognize and treat this early enough or whether the reaction has already taken place so that you are late. If so, you often already have a lot of destroyed lung tissue that you can no longer save. Then the fire is almost over and the chances of survival decrease significantly.
ZEIT ONLINE: How do you try to interrupt this cascade?
Wendtner: The idea is to use a drug to dampen the immune response. One approach to this is the rheumatism drug Tocilizumab. Studies are currently starting with the active ingredient, in which our clinic will also participate. However, this is not a panacea. For example, some patients get an infection with bacteria in addition to their Covid pneumonia. We have to treat them with classic antibiotics. And of course you shouldn't inhibit the immune system in such patients.
ZEIT ONLINE: What about other drugs?
Wendtner: These days we are starting two phase 3 studies with the antiviral active ingredient Remdesivir, on which there are high hopes. It is currently being tested in clinical trials worldwide. In Germany, in addition to our clinic, one in Düsseldorf and one in Hamburg are participating. We'll see what the results are. The most important measure in severe cases remains ventilation.
ZEIT ONLINE: What does it look like? On television pictures from Italy you can often see that the patients are ventilated in the prone position.
Wendtner: It's the same with us, but not all the time. Greater pressure is exerted by the body weight on the lung sections on which the patient lies. This compresses the lung tissue, it is poorly supplied with blood and also poorly ventilated. By turning the patient upside down, the aim is to ensure that the air from the ventilator can flow down to these lowest parts of the lungs. We have so-called turning teams that turn the patients on a regular basis, because it is also not good if they are lying on their stomach all day.
ZEIT ONLINE: Is ventilation difficult?
Wendtner: It's not trivial with Covid-19. The problem is that the inflammation causes the lung tissue to swell a lot. This means that you need a fairly high pressure when breathing to get enough air into your lungs. Unfortunately, this can also lead to long-term damage. Even if the patients survive, their lung tissue may become stiff afterwards because they had to be ventilated with high pressures for a long time. Some of them may even be dependent on oxygen in everyday life.
And yes, this can also happen to young people.
ZEIT ONLINE: How long do patients have to be ventilated?
Wendtner: We have patients here who have been attached to the machine for two or three weeks. With classic pneumonia, it doesn't take that long, so you might have to ventilate as a support in between. But with Covid, it's a long, tough business. You also have to take this into account when calculating intensive care beds, which are not released as quickly for patients who are moving up. In Italy, this leads to the ethically very difficult situation that young people are in intensive care beds because they presumably still have a higher chance of surviving while older people are no longer able to get a bed. Fortunately, that's not the case with us. So far, we have only had one death in our clinic: an older patient with previous illnesses. But if we speak again in two weeks, the situation can of course be different.
ZEIT ONLINE: Do you feel well prepared with your clinic for what could come?
Wendtner: Yes. We have several crisis teams here every day, and the management also supports us wherever they can. If we want something, it will be implemented. We currently have no problem in Munich. Here the patients can choose which center to go to. I'm more worried about the peripheral clinics. Many of them do not have these resources or knowledge, and yet sick patients will get there just as seriously. We really have to try everything so that we don't get a tsunami regarding the rush of patients, but a dosed wave that we can master well.
Last edited:
Crux-Emperor Baracus X
Rectidolor
BREAKING NEWS:
The Prime Minister of the U.K,Boris Johnson has been tested positive for Covid 19.
Worrying times indeed.
The Prime Minister of the U.K,Boris Johnson has been tested positive for Covid 19.
Worrying times indeed.
old slave
FELIS RESPICIENS
I can't help thinking many people will be saying "His advice to us all on how to behave must be pretty useless!" and they will try to return to normal too soon. Meanwhile, I'm staying in and chatting on CF, the last available outdoor entertainment in Leeds has closed down:
Holbeck managed zone shut down as police stop all street sex work in Leeds
Leeds City Council has confirmed its managed zone, dubbed Britain’s first legal red light district, has been suspended, with no soliciting allowed at any time during the coronavirus lockdown.
twonines
LIMERICUS
The only thing to be learned from this is that the skeleton staff that are still trying to carry on to ensure that life continues, even in a truncated form, are as vulnerable as the rest of us.I can't help thinking many people will be saying "His advice to us all on how to behave must be pretty useless!" and they will try to return to normal too soon. Meanwhile, I'm staying in and chatting on CF, the last available outdoor entertainment in Leeds has closed down:
Holbeck managed zone shut down as police stop all street sex work in Leeds
Leeds City Council has confirmed its managed zone, dubbed Britain’s first legal red light district, has been suspended, with no soliciting allowed at any time during the coronavirus lockdown.www.yorkshireeveningpost.co.uk
The sad part is that certain morons are attempting to make short term political capital out of his and the Chief Medical Officer`s infection.
old slave
FELIS RESPICIENS
I agree.
But to far more important matters: Harry, Megan & Archie have moved to California permanently, just before the borders closed. Is the coffee better there than BC?
windar
Teller of Tales
I do hope the workers will be eligible for unemployment insurance until they can get back on their backs againI can't help thinking many people will be saying "His advice to us all on how to behave must be pretty useless!" and they will try to return to normal too soon. Meanwhile, I'm staying in and chatting on CF, the last available outdoor entertainment in Leeds has closed down:
Holbeck managed zone shut down as police stop all street sex work in Leeds
Leeds City Council has confirmed its managed zone, dubbed Britain’s first legal red light district, has been suspended, with no soliciting allowed at any time during the coronavirus lockdown.
old slave
FELIS RESPICIENS
I do hope the workers will be eligible for unemployment insurance until they can get back on their backs again
Only if they completed their tax returns accurately and have three years data. Newbies need not apply in UK.
What's this new app just available?
Whorber.
Thank goodness for technology.
Poor Old Slave!
Praefectus Praetorio
R.I.P. Brother of the Quill
On a lighter note, a question and answer on Quora
Why do people in Canada pronounce “lieutenant” like Americans instead of the proper “leftenant”? I’ve only seen it pronounced right by people with military backgrounds or cadets.
Hmm. Yes. This is one of those embarrassing situations where Hank actually got it right and we didn’t.
Lieu Tenente means “in place of a captain” and the first bit is supposed to be said as loo. British eyes saw that u as a v and we anglicised it to lev.
But Hank can bugger off because now it’s a tradition and the fact that we got it wrong is completely and utterly irrelevant and, by our own measures, we’re doing it right and they’re doing it wrong. Even if it isn’t.
Because sheer, stubborn bloody-mindedness is 85% of what being an Englishman is about. Closer to 93% if you’re a Scot. Very nearly infinite if you’re from Northern Ireland. Only about 70% if you’re Welsh, though, they’re quite laid back about things, still, good enough.
Leftenant it is then. Stuff the rest of the world. Who bloody well won the Battle of Waterlef?
The answer explains a lot of what I've been trying to figure out about the British (and don't even get me started on the Scots or Ulsters!)
Why do people in Canada pronounce “lieutenant” like Americans instead of the proper “leftenant”? I’ve only seen it pronounced right by people with military backgrounds or cadets.
Hmm. Yes. This is one of those embarrassing situations where Hank actually got it right and we didn’t.
Lieu Tenente means “in place of a captain” and the first bit is supposed to be said as loo. British eyes saw that u as a v and we anglicised it to lev.
But Hank can bugger off because now it’s a tradition and the fact that we got it wrong is completely and utterly irrelevant and, by our own measures, we’re doing it right and they’re doing it wrong. Even if it isn’t.
Because sheer, stubborn bloody-mindedness is 85% of what being an Englishman is about. Closer to 93% if you’re a Scot. Very nearly infinite if you’re from Northern Ireland. Only about 70% if you’re Welsh, though, they’re quite laid back about things, still, good enough.
Leftenant it is then. Stuff the rest of the world. Who bloody well won the Battle of Waterlef?
The answer explains a lot of what I've been trying to figure out about the British (and don't even get me started on the Scots or Ulsters!)
M
montycrusto
Guest
Luckily our American friends provide a shining example of self-effacing modesty for us to look up to
(hey I’m KIDDING, don’t get triggered
)
Praefectus Praetorio
R.I.P. Brother of the Quill
Thank You!Luckily our American friends provide a shining example of self-effacing modesty for us to look up to
(hey I’m KIDDING, don’t get triggered
I have to work very hard to be this modest!
Luckily our American friends provide a shining example of self-effacing modesty for us to look up to
(hey I’m KIDDING, don’t get triggered
True, but let’s not name names
Thanks for this. I was always mystified as to why Lieutenant Hardcastle always came off as Leftenant Hardcastle. Now I know. CF is so educational!
M
montycrusto
Guest
And don’t forget when visiting the UK to drive on the Lieut
And don’t forget when visiting the UK to drive on the Lieut
Or be crucified on the town Green?
