Question about Viruses

[TehLlama]

So if we go with bacteria is a alive and a virus exist on a surface. What exactly are we doing to it as we try to remove it from a surface? Could we liken it to say an ink dot on our hand. Wash with alcohol or soap and we no longer have a dot or a stain. We are basically just ripping it up or dissolving it into something non-virus? Like maybe a dried leaf from a tree. We still call it a leaf until it's ground to dust and not likely you could reassemble a spoon of dust into a leaf.

What about putting food in your freezer? Can the cold preserve the virus regardless of the surface it's on?

Basic answer is that you're doing what you can to denature the proteins the virus needs to actually bind to a cell and infect it, or otherwise cause key elements of the capsid to break up or become useless for the infection phase, and you have prevented that instantiation of the virus from reproducing (it's basically just dead protein and genetic material at that point).

Physical capture is hard, and you need airflow in HVAC systems to the point where filters arbitrarily large aren't that workable. UV will denature things, but again power to throughput ratio makes that pretty hard to fully disinfect things... but decent filtration will capture a lot of the aersol-borne virus particles that are hitching a ride in water droplets and airborne sputum.

[ramairthree]

That’s a way more complicated question than it seems and no black and white direct answer. Sort of like trying to come up with a single definition for a species, why some bacteria act like a fungus, where to draw the line at a lichen, etc.

Presumably you’re asking because of the current virus furor.

Overall odds are good.

f you go into this with, it’s nothing but the flu, you won’t objectively evaluate it.
If you go into this with, it’s the big one, you won’t objectively evaluate it.

It’s not a discrete Newtonian equation.
It’s an overlapping circles of conditional probability quantum estimate that is half gestalt/pattern recognition and half math.
That’s something that drives people mad about medicine. And people trying to plan for responses and resources even madder. It is what it is. When you find out grandma has cancer you want to know how long she has. You only know statistically and a range and an average. And that’s if she doesn’t have a heart attack and die next week instead of her average 8 months to live. Or if she will be miserable and suffering still 18 months from now.

Yet everyone without math beyond what even used to be freshman high school algebra, let alone the basic first year of calc or grad/doctoral level biostatistics thinks they know what they are looking at when the news shows the start of exponential growth on a linear scale graph. In real life that would be like graphing your fat loss, muscle gain, and Personal bests when you first start a killer diet and workout regimen and thinking it would keep doing that.

60k to 600k is a nice tight estimate for a population of 330 million people plus running around America.
With an impact zone right in the middle of old, frail, multiple pre-existing, and poorly controlled conditions population.
With some minimal collateral damage outside of the impact zone. That was the hand dealt.

An impossible compression of spread time and resource limitations would drive it towards the high end. Mainly because without the insight to rationally assign and limit resources away from futile care a lot of the capacity would have been wasted. With the greatest impact on resources being that people that were going to die in the next few months would be shifted into dying sooner. Sort of like everyone wanting a new boat or convertible in the summer. Only not as fun.

The steep grade of diminishing returns means relatively low impact to control spread measures are about 90% + as effective as very drastic measures to control spread. Why did we go so drastic? By all indications the Oval Office and team were going let it ride and to do some basic border control, etc. while everyone else was calling them racists and telling people to go kiss gay Chinese people and other people of color and immigrants and refugees at parades and stuff. Then the media starting fanning the flames. Whether unintentional in search of ratings or calculated to political goals, it spun the public into a panic demanding something, anything, everything, be done.

We got the response. People wanted to know worst case scenario, beyond reason, and everything possible done. They got it.

This should have been a pretty standard threat eval and response.
With some pretty basic recommendations, and plans for amelioration.
That’s not what happened. The media fueled a public demand for more. With zero perspective.

Now the public and the media want to blame leaders and experts for giving them a worst case scenario and doing everything possible.

As for the virus itself and the infected.
Not every infection is the same. Not every patient is the same.

Some people get a massive viral load and their body is overwhelmed even if they are young and healthy.
Some people get a minimal or average load but their luck and their body turn on them and also end up bad off.
Some people have a course different than others.
Some people are already in such rough, frail shape it does not matter if they had the infection or not, their time was upon them. Others get a little speed boost and a slightly quicker arrival to their time.

As for vents. There are only so many people that can manage a patient on a vent. Making a bunch of vents does not increase that. People end up on a vent for different reasons. They get too tired to breath on their own. Their mental status is too poor to maintain their airway. Their lungs are full of fluid, or pneumonia, or they have bad reactive airways symptoms and are getting hypoxia. They are getting enough oxygen but are not ventilating and getting too hypercaepnic. These are issues people show up to the hospital with all the time, sometimes several times a year. The complications from being on a ventilator are not unique to this virus. Reports are mixed, but overall, the age, medical conditions, and severity of those conditions seem to have the same outcome in negative and positive patients.


As for meds, Some meds may be of benefit. Right now you can find evidence some make things worse, some do nothing, or it helps. This kind of process takes months if not years to sort out.

Some people have a myocarditis and heart failure component. This is not unique to this virus.

Some people may have competitive O2 binding. This is not a new medical concept.

Some people may develop a hypercoagulable state. Neither hyper nor hypo coagulable states are new medical concepts.

Now, I was firmly in the classic jumped a host to people virus naturally occurring virus. It is, after all, 85 to 90% identical code to a related naturally occurring virus.

I’m not going to go full tinfoil and say this virus had some help, but’s it’s propensity to do and combination of the above is a little atypical. It’s sort of like a 5’11” white guy dunking a basketball or a 175 lb. guy benching 400 pounds. Some do. But not what your first thought would be. It still could be entirely natural.

And the elephant in the room. There is no guarantee having it means you are immune, let alone long term. This is likely going to be endemic and seasonal. You can be an asymptomatic carrier. Likely 85% of people with it have either no or such mild symptoms they don’t seek care. This means the 400k plus positive tested population is not the normal. Many were admitted and treated presumptively. Many were sent home presumptively without tests. Many never sought care. There are very likely millions of People in America with this virus.

“Flattening the curve” means a smaller peak in resources and less outpacing of resources. (Totally forgetting the concept a bunch of those resources would be tied up in futile care and should not be tied up). Everyone has quoted that concept. Less well discussed is what that means in terms of prolonging the outbreak and decreasing herd immunity. There is no guarantee their will be a vaccine or highly effective specific medical therapy. This may rear it’s head seasonally every year.

But, instead of ending on a bad note,
If this truly had a high death rate like everyone was running around crazy about,
There are vulnerable parts of the population this would have already burned through like kindling,
That are not really amenable ro self quarantine and social distancing. This has not happened.

Ok, went way longer than planned, but the gist was supposed to be,
No matter what steps you take today to not get infected with this virus, it will likely be there next week, next month, and next year.

[jsbhike]

Also have over cloth disposable booties, escapes me why I purchased these booties.

Read that and started laughing since I make a similar statement at least once or twice a year.

Any chance of insect transmission? Ticks or mosquitos?

[Life's a Hillary]

ramairthree, apologies for not knowing this before but what is your profession? You seem to be really knowledgeable on this so I’m just curious as to your background to give it a little more context.

[ramairthree]

ramairthree, apologies for not knowing this before but what is your profession? You seem to be really knowledgeable on this so I’m just curious as to your background to give it a little more context.

I'm not going to AROCK myself totally.

Yes I started out as an E1 11B in Ranger Bn.

I do have an undergrad brick and mortar degree from a school that was around over a couple of hundred years old before I graduated from it in applicable sciences.
I do have a doctorate from a real you go there brick and mortar school with applicable background.

I do have over a decade in time in other SOF units. With several years related to applicable stuff plus time on target in direct support during TICs. The last several years I was in before retiring involved direct one on one interaction GO/FOs, in both command and staff roles. With some of my recommendations and programs being theater / nation wide.

From the late 1990s until about 2010 when I was otherwise engaged I had about a dozen and a half publications in peer reviewed real paper journals about half of which involve viruses and febrile disease. And some of which involve information from massive disease/medical databases.

Plus another half dozen published abstracts. And about another half dozen presentations at national conferences.

My role since retiring from the military gives me insight into about 6000 trauma, critical care, and emergency data points per year. With additional information on more. Not near as much as when I was doing research.

I'm not the guy who is going to come up with a vaccine, research novel applications of medications, develop new medications, or manage people in the ICU.
No more than I'm the guy that was going to extract DNA and hatch dinosaurs in Jurassic Park or fly the ship that defeats the aliens in Independence Day.
I'm more like the Jeff Goldblum dude in both movies people don't like hearing what they need to hear, not what they want to hear from.

[WillBrink]

“Flattening the curve” means a smaller peak in resources and less outpacing of resources. (Totally forgetting the concept a bunch of those resources would be tied up in futile care and should not be tied up). Everyone has quoted that concept. Less well discussed is what that means in terms of prolonging the outbreak and decreasing herd immunity. There is no guarantee their will be a vaccine or highly effective specific medical therapy. This may rear it’s head seasonally every year.
.

That's the position here, and as expected, he's taking a lot of heat for it. I posted article and vid on Dr. Knut Wittkowski - who was head of the Department of Biostatistics, Epidemiology, and Research Design at the Rockefeller University - RE, his position our approach to Covid was counter productive. For those who have the epi/bio stats background to wade through it, here's his full paper:

The first three months of the COVID-19 epidemic: Epidemiological evidence for two separate strains of SARS-CoV-2 viruses spreading and implications for prevention strategies

Two epidemics of COVID-19

KNUT M.WITTKOWSKI1

Abstract

About one month after the COVID-19 epidemic peaked in Mainland China and SARS-CoV-2 migrated to Europe and then the U.S., the epidemiological data begin to provide important insights into the risks associated with the disease and the effectiveness of intervention strategies such as travel restrictions and social distancing. Respiratory diseases, including the 2003 SARS epidemic, remain only about two months in any given population, although peak incidence and lethality can vary. The epidemiological data suggest that at least two strains of the 2020 SARS-CoV-2 virus have evolved during its migration from Mainland China to Europe. South Korea, Iran, Italy, and Italy’s neighbors were hit by the more dangerous “SKII” variant. While the epidemic in continental Asia is about to end, and in Europe about to level off, the more recent epidemic in the younger US population is still increasing, albeit not exponentially anymore. The peak level will likely depend on which of the strains has entered the U.S. first. The same models that help us to understand the epidemic also help us to choose prevention strategies. Containment of high-risk people, like the elderly, and reducing disease severity, either by vaccination or by early treatment of complications, is the best strategy against a respiratory virus disease. Social distancing or “lockdowns” can be effective during the month following the peak incidence in infections, when the exponential increase of cases ends. Earlier containment of low-risk people merely prolongs the time the virus needs to circulate until the incidence is high enough to initiate “herd immunity”. Later containment is not helpful, unless to prevent a rebound if containment started too early.

Cont:

https://www.medrxiv.org/content/10.1...715v2.full.pdf

[ramairthree]

It would be sweet if it dropped down and away. Even something like MERS lingers around with a couple hundred cases a year. I am very suspicious of what lingering amount of SARS and related my have been lingering about China the past 17 years.

[tb-av]

Thank you for the thorough insight. Would you object to my posting your reply #42 above in another small semi-private forum? I know a few people that are looking for some qualified insight. Some are worried about a Typhoid Mary type situation which I think your post basically covers as well.

Completely understand if you rather it not be placed elsewhere.

thanks,

TB

[ramairthree]

Thank you for the thorough insight. Would you object to my posting your reply #42 above in another small semi-private forum? I know a few people that are looking for some qualified insight. Some are worried about a Typhoid Mary type situation which I think your post basically covers as well.

Completely understand if you rather it not be placed elsewhere.

thanks,

TB

Sure. No prob.

Thirty days ago I did a model using an impossible 100% infection rate over an impossible four month period. This was about 60k to 600k with the high end because of not enough critical care resources. Divide by five over eight months, divide by ten over 12 months. But.... the vast majority of the resources would be tied up in futile, end of life care among patients most likely to be among the 250k average deaths per month without COVID we would have expected this year. Virtually all among those likely to die this year. And that reasonably appropriate levels of resources would be available if we focused on outliers and took a different approach to resource use in futile, end of life care. This was posted a few days after I calculated it in the COVID thread and seems to have been extremely unpopular. I predicted millions of lost jobs, hundreds of thousands of ruined retirement accounts, and thousands of lost businesses. And that the long term impacts of the panic were more harmful than less drastic measures saving those that would not be expected to soon die if they were not infected, but providing easement and comfort to those who would be expected to die soon even without infection. As I said, very unpopular. But the virus is not going to magically disappear in two weeks, three weeks, etc. and taking the hit with trying to glance it off was a good option vs. jumping off a cliff to avoid taking the hit was not a good option. The true impact of COVID had to be taken in perspective with our baseline death rate, who was in line to die this year without it, and who would likely only die this year if they were an outlier. I seem to have failed at conveying any perspective to most.

I will add that post below. A month after my initial hobby, napkin math assessment, - the official evaluations are starting to look a lot like my numbers vs. the initial super scary numbers they were giving.

I am only one guy with no say in national policy and no role in anything significant these days.
With an educated opinion but still just one man’s opinion.

From one month ago-

For starters,
Exponential growth, doubling time, etc. does not work out in real life like it does with pure math, out side of a lab, etc.
Some basic, less economically devastating, educationally interrupting, societal interrupting, business destroying measures could have spread the curve.

You see a lot of sensationalist news about ICUs being full.


Ummm....
At most hospitals on any given day the ICU is at or near 100% capacity.

This is like saying,
Oh my God! With COVID I can’t find a single bottle of Pappy or Blantons near me! Well good luck with finding one pre COVID.


My point is that “The ICUs are 100% full!!!!” Is business as usual.
It is not because of C19.

Everyday, there are people that die of their heart attack because the cath lab was occupied and in use before they could make it there, the CT team was tied up with another case, waiting hours for transfer to a place with neurosurgery, both the trauma OR and backup OR are running and someone is dying of internal bleeding with no OR or surgeon available.

Most people don’t feel or know about it. That concept is hitting home to a lot of people right now.

You see a lot of graphs and curves about exceeding capacity because of C19.


Again, the point was that is a problem in medicine without C19 issues.
It is not caused by C19.

A bunch of people are running around acting like full ICUs, full ER beds, long ER wait times, etc, are because of COVID.

That is business as usual.

If C19 doubles the number of people needing to be in the ER, hospital, or ICU on a vent-
There is no magical Elysium supply of medical care, equipment, and people.

The majority of those beds are already filled with a 94 year old non verbal, bed ridden, patient that had a head bleed and aspiration pneumonia and the family wants everything done. Or a septic IV heroin user with sepsis, endocarditis, epidural abscess, etc. Or a 400 pound 35 year old HIV positive patient with a huge saddle embolus that has spent the last three weeks in rehab from a stroke. Or a 50 year old heart failure, dialysis patient that does not take his meds and skips dialysis because they would rather keep doing cocaine. Or a 66 year old that rolled over his truck with an alcohol level of 300, COPD, cardiac stents, and has already had his license taken away years ago. Or the illegal alien that just had a massive anterior MI. Or the terminal, metastatic cancer patient that was supposed to be on hospice and comfort care. Or the 300 pound septic shock, chain smoking diabetic with peripheral vascular disease and limb infections. Or the psyc patient on their 87th visit to the hospital but this time they did their research and overdosed on Tylenol and lithium. None of them are long for this world. They are going to die in the next few days, or in the next few months, or this year with a ton of time spent in and out of the hospital.


The point is critical and emergency medical services, in the complete absence of COVID, are typically at or near full capacity.

About three million people die in America every year. About a quarter from heart disease, a fifth from cancer, about 5% each from lung disease, strokes, dementia/old age, and trauma. Throw in diabetes, kidney disease, and suicide for another 5%. Note how interrelated and coexistent many of these are.
Then throw in recreational overdoses, autoimmune disorders, and everything else into the other 25 percent.

Could masks, no shaking or hugging, gloves handling money and items between people, and copious hand sanitizer had the same impact as a hard stop destroying the economy, businesses, retirement, jobs, of a massive portion of the population?

Could reasonable, sane news broadcasts accomplished similar instead of fan flaming led to a less panicked, more in depth planned response?

Could a plan to increase capacity by avoiding futile care been more reasonable?
This is a harsh question.
How many vents would be free if-
No inoperable head bleeds get vents.
No metastatic/palliative chemo/xrt cancer patients on vents.
No LVAD, EF below 20%, or septic endocarditis patients on vents.
No self ingested overdoses on vents.
No intentional self inflicted gunshot wounds on vents.
No BMI >50 on vents.

I won’t even get into the severely senile and demented who don’t know who they are, are non verbal, have PEG tubes because they won’t eat or drink, etc.


Should people that were going to die anyway in a few days or this year be allowed on a vent when someone that would have a long, normal life after recovery ?

Ok, now let’s add in some C19.


Say all 330 million people in America magically catch the virus in March, April, May, and June. There would normally be about 12 million hospital admissions during a four month period in America.) 100% exposure and infection is not possible. But we are going to paint the worst case scenario. On a graph with a 4 day doubling time, you could go from a few hundred cases to the entire population in about three weeks. Humans are not bacteria on a medium in a culture. There are shut ins, closed social circles, geographic barriers, closed loop repeat interaction circles, etc. even the four months I am using is crazy compressed but go with it.

Over 283.5 million people are not going to have any significant symptoms, go to a doctor, or have any issues.

About 49.5 million people will feel sick.

Let’s say About 7.5 million will be severe and need to be in the hospital.

And 750,000 of those are going to buy ten days on a vent.

I am being very, very generous with the doom percentages.

(There are over 36 million hospital admissions in over 6000 hospitals in America each year. With about 2% of patients accounting for 10% of costs, and about 1/3 of patients accounting for multiple admissions.)

This is not 7.5 million people admitted to the hospital on top of 12 million people normally admitted to the hospital during that four months.


It’s probably about 8 million people being admitted once or more than once, for a total of 12 million admissions.
And the vast majority of the 7.5 million people that will need to be admitted for COVID are the same old, sickly, poor health, multiple medical problem, way above average disease for their age, etc. patients that were already among those getting admitted.


Anyways, let’s say we range from 75,000 to 600,000 of those admitted patients die.


And most are from the categories of the 3 million people that were going to die this year anyway.

Yes, it’s worse than the flu.
Yes, it will strain the system.
Yes, some alleviating, flattening, procedures needed to occur.
But it is not a death sentence. We are talking 8% death rate with average age of 80 in a second world health care system with way less ICU and vent capacity.

We have destroyed a nation’s economy and way of life, ruined tons of businesses, put millions out of jobs, etc. in order to save elderly, sick, and unhealthy people from dying from COVID that were already going to die from other medical conditions at the same time or later this year.

Now let’s look at little kids under the age of 5.
Let’s pick one single other virus.
RSV. Each year,
About half a million will show up in the ER. About 50,000 will be admitted to the hospital.
About 500 will die. Add in flu. Add in other organisms for pneumonia.
That’s thousands of little kids dying every year from pneumonia with zero media attention.
The kids susceptible to the above are the same that would be susceptible to C19.
Little kids dying is sad. The only good news is they can’t die twice from two different things.


And this goes for older kids and young adults.

I have painted the worse case scenario I can.

You will need to form your own opinion regarding the media, politicians, the public, the response, the current impacts, the long term impacts.

Was your 88 year old grandmother with dementia, heart disease, AFIB, falls, head bleeds, and bleeding ulcers that was going to die this year worth keeping alive a few more months not getting corona virus a fair trade for hundreds of men that worked for decades but have had their retired accounts shattered and will have to keep working? Was your beloved child with severe CF not being exposed to corona virus and making it another year before succumbing to another infection worth a dozen local businesses folding and hundreds of people losing jobs? Did saving the chain smoking alcoholic repeat accident drunk driver from getting C19 and dying next week so he can die from his variceal bleeding next month warrant thousands of kids having their education, lives, and futures interrupted and delayed? Was watching your everything to you wife spend another month or two miserable on palliative chemo therapy worth also losing your home, job, and the same for dozens of other people? We have bought a non compliant, crack fiend self inflicted heart failure, LVAD, dialysis, 40 year old that has never had a job and never supported his bastard children and been in and out of jail another month or two of life at significant expense and sacrifice to dozens of other people, was it worth it?


The questions are meant to be very harsh and soul searching.

[TexasGunNut]

The questions are meant to be very harsh and soul searching.

Regardless of how you feel, this post and the vast majority of what this man says on this subject is gospel.

Triage occurs daily in all therapeutic settings; always has and always will. Thank God most people aren’t privy to the hallway decisions health care people HAVE to make. That is a cold hard fact. I’ve seen it destroy and consume men and women who can’t see past their intrinsic nature to save everyone.
Excess capacity is a myth; good people bleed out because there was only one MD on shift when five ambulances and two packed cars pulled in. Then add in the knowledge that a bureaucrat cut two MD’s weeks before that school bus crash.
The majority of health care resources are wasted on people that do not need or deserve to live, and in my 60 years I still haven't figured out any better way. It’s easy to play god and awfully hard to be proficient at it. The slippery slope part sneaks up on you.
I would much rather live with pulling the plug on my own father than have a government agency telling me he did not check the right boxes to justify care.

As the man says...these are the harsh and soul searing questions that may have no good solutions.