The primary reason that Italy has had so many deaths is NOT because of an older population.
The primary reason for the high mortality rate is that the healthcare system is overwhelmed and so patients die who would have lived but there is no ventilator available or no ICU bed.
With a functioning healthcare system mortality rate is likely 1%, but without it more like 4%.
https://nyti.ms/2wtYUqA via'Brace Yourself': How Doctors in Italy Responded to Coronavirus @nytvideo
As of today this is VERY likely to occur in the US (at least in some states) because of federal incompetence in making testing widely available so that case contact tracking and testing can occur (and in mandating significant social distancing efforts).
In most parts of the country we are not even testing all symptomatic patients unless they are hospitalized. Current wait times for results from one of the largest labs doing the testing is 8-9 days in Southern California (Quest) although nationally they say turnaround time is 5 days (this for a test that takes 3 ½ hours to run on the lab machine).
Check out this piece in Medium.
I don't agree with all the numbers but it is directionally correct and very well supported scientifically.
And it makes me want to apologize the entire public health community. This problem started with inadequate follow up after SARS in the late 2000s and was exacerbated by dismantling by the current administration of the office most intimately knowledgeable about pandemic response (there has been a LOT of planning for pandemic flu, which is very much like the current crisis).
There's a petition at the end to get the government to act in a way that will intelligently control this virus – difficult, painful, but the experiences in China, South Korea, Singapore show that it can be done and the initial difficult phase can be done in a few weeks (not months).
And we must get to a position where we can do widespread testing or we'll have to be in this economic shutdown catastrophe for months to have any hope of preventing millions of deaths in this country.
-------- Ben Broder, MD, PhD, CPPS (he/him/his) Regional Assistant Medical Director of Quality and Clinical Analysis (Regional Offices), Diplomate in Clinical Informatics, Hospitalist, KFH Baldwin Park
Kaiser Permanente / Southern California Permanente Medical Group, 393 E Walnut St 3rd Flr NW, Pasadena, CA 91188-8034
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Here is a link to a paper published in JAMA today about the high case fatality rate in Italy.
Hi Ed, Hi everybody,
Nasal congestion is an early symptom in many cases. The anosmia could be as simple as that. I've attached a few papers that may be helpful to the clinicians on this list, with regard to the reported symptom cluster, treatment approaches and diagnostic criteria.
Also have attached an "Action Paper" from the MIT/MITRE group, which was commissioned by DoD and is based on data as current as last Thursday.
All the best,
Michael A. Bruno, M.D., M.S., F.A.C.R. Professor of Radiology & Medicine
Vice Chair for Quality & Patient Safety
Chief, Division of Emergency Radiology
Penn State Milton S. Hershey Medical Center ( (717) 531-8703 | 6 (717) 531-5737