Corona virus, Port and the AFL.

[OneGreatClub]

A female passenger from the Ruby Princess cruise ship has become South Australia’s second coronavirus death, SA Health has announced.
The Adelaide woman, 62, died in the early hours of Wednesday after losing her battle in the Royal Adelaide Hospital’s intensive care unit.

That Ruby Princess must have housed a nasty strain or a large load of of the virus.

 

[EskimoPAFC]

Lockdown works, the big risk is lifting it too quickly!

Yep.

Just to clarify, Im referring to the lockdown in Italy with this post. I havent looked at the Australian numbers to the same level of detail.

 

[Established1870]

Trump removes independent watchdog tasked with overseeing coronavirus emergency funds

President Donald Trump has removed the acting inspector general for the Defense Department, Glenn Fine, from his post -- a decision that means Fine will no longer chair the Pandemic Response Accountability Committee tasked with overseeing $2 trillion in emergency coronavirus funding.

edition.cnn.com

President Donald Trump has removed the acting inspector general for the Defense Department, Glenn Fine, from his post -- a decision that means Fine will no longer chair the Pandemic Response Accountability Committee tasked with overseeing $2 trillion in emergency coronavirus funding.
Late last month, a group of independent federal watchdogs tapped Fine, a career official, to lead the group tasked with preventing "waste, fraud, and abuse" in the use of coronavirus relief money.

 

[pastmyprimus]

I’m starting to see more and more stories about there being an unusual drop off in heart attacks and pneumonia cases as these cases are now COVID-19 cases (patients may also be delaying seeking treatment due to fear of the virus leading to poorer health outcomes). This seriously skews the data as patients have some very consequential co-morbidities that is getting lost in the COVID-19 reporting. It helps to explain why COVID-19’s impact is greater in older people as they tend to have underlying age related issues.

There’s also the issue of clinical coding. It looks like hospitals are incentivised to code for COVID-19 as there is more funding readily available. Bottom line is that the number of COVID-19 hospitalisations may not be representative of actual COVID-19 cases due to clinical coding.

Where Have All the Heart Attacks Gone? (Published 2020)

Except for treating Covid-19, many hospitals seem to be eerily quiet.

www.nytimes.com

I work in a Victorian hospital and this is not true. There's no extra funding for covid-19 patients. Maybe different in SA though

 

[_VXV]

Yep.

Just to clarify, Im referring to the lockdown in Italy with this post. I havent looked at the Australian numbers to the same level of detail.

Mentioned earlier in this thread Planet America reported a couple of weeks ago the spike in Spanish flu cases once isolations were relaxed but couldn’t find data to back this up. I’ve since found a graph of St Louis related to this time which illustrates the spike when everyone relaxed & started going out again


I wouldn’t be returning to normal just yet.

 

[PowerBaz]

Please explain to me the difference between being on a cruise ship for 14 days and being in a hotel room for the same amount of time.

The salt water perhaps?

Are you talking before or after the outbreak....

 

[Interstater]

Are you talking before or after the outbreak....

I'm talking generally, I have a theory on this but would like to hear others opinions before I mention mine.

 

[RussellEbertHandball]

Leigh Sales last night on 7.30 spoke to Hugh Montgomery, Professor of Intensive Care at University College London, and they aslo spoke to him on 26th March.

Last night the prof said evidence in UK has suggested it is a blood and blood vessel disorder more than respiratory disease.

The good prof suggests that, as I worked out about 10 days ago, when a health system is stressed, if you need to be hospitalised and need heavy medical assistance you have about 50% chance of surviving as mortality rates are that high, ie you don't have time to do wide testing and find the 80% mild cases, you basically only test the more severe cases, put them in hospital and treat them.

You get to that stage and data mortality levels are useless stats, a bit like the stats of taking marks from chip kicks in the backline killing the last couple of minutes of the game.

7.30

www.abc.net.au

LEIGH SALES, PRESENTER: Professor Montgomery, I don't want you to speculate on the condition of the Prime Minister but can we talk generally about the way that COVID-19 plays out? When you get to day 10 or so of the infection and your condition is such that you require admission to an ICU, what is going on with your body?

PROFESSOR HUGH MONTGOMERY, PROFESSOR OF INTENSIVE CARE, UCL: That's a very good question and in many ways we don't actually know.

So, this is being presented like bad flu and it really isn't. This is as different from flu as Ebola is from an ingrown toenail. This is a very, very different disease.

You might feel like you have got flu - achy, breathless and so forth - but this is not the same thing.

Most people get infected, don't get many symptoms. If they do they are quite mild or they feel like they have got flu and they get better.

Some, however, it is around day 10 to 12 in the majority - sometimes later, sometimes earlier - will get progressively short of oxygen. So the oxygen levels in their blood will fall.

They have a very profound drive to breathe which seems way beyond that that would be driven just by the low oxygen and sometimes those patients are aware of that air hunger and breathlessness and sometimes they are just not and we see them blue and panting and they are unaware they are even unwell at all.

Now some of those just need a little supplemental oxygen and will get better but some will progressively worsen. They will go on to a tight-fitting mask that helps inflate the lungs a little bit and deliver more oxygen.

They lay down on their tummies to help improve oxygen for other reasons but then they would end up needing to be intubated and air blowing in and out of lungs.

Now normally, if this was a viral pneumonitis or a viral infection of the lung or a bacterial infection of the lung, the problem is little air sacs getting inflamed and the air sacs getting full of gunk and nasty pussy tissue and that is not what is happening here at all.

The low oxygen levels and the very high carbon dioxide levels we're seeing, seems to be due to something wrong with the blood vessels in the lung.

So blood essentially is coming into the lung full of carbon dioxide and without much oxygen and it is transiting the lung to the arterial side in exactly the same state that it came in.

So a lot of this problem seems to be vascular and indeed when we measure clotting in the blood, it is off the scale abnormal.

There are things called D-Dimers that break down clot and those would be up a little bit if you had a clot. These are stratospheric levels.

So this seems to be a blood and blood vessel disorder.

LEIGH SALES: Given how unusual this is, once you reach a stage where you require intubation, what are your chances at that point of survival?

HUGH MONTGOMERY: Well, depends really on what data. We can only start reporting on our own because each healthcare system is different and they are overwhelmed to different degrees and the level of which you are overwhelmed will clearly determine outcome.

We've not got enough through to know at the moment but roughly at the moment, we would be expecting around 50 per cent of our patients to die, and 50 per cent to survive.

It could be worse than that. I doubt that it will be substantially better.

26th March interview he talked about the stress on the hospital system.

7.30

www.abc.net.au

LEIGH SALES: And what is the situation in Britain at the moment regarding the hospital's capacity to meet the demand for treatment?

HUGH MONTGOMERY: Well, we're trying and at the moment we're largely coping but we're on this exponential function of cases. So to put simply, once one is infected it takes about six days to develop symptoms and one can be spreading the disease for between four and six days of that time.

And to become critically unwell people tend to present between six to 10 days of illness.

So this massive rise you're getting in Australia, and we've had here, will be followed some time six to 10 days down the pipeline by the same exponential rise in hospitalised cases and intensive care cases and that's what we're hitting about now.

We're told by our Department of Health that London might run out of intensive care beds by the 28th, that's two days' time because of this exponential function which I can explain if you're interested about how that works.

LEIGH SALES: Please do.

HUGH MONTGOMERY: Well, put simply, if you get ordinary flu, you pass that on average to 1.4 people, if you could do such a thing, which means that if they then pass it on to their 1.4 each, by the time 10 cycles of infection have happened, you have been responsible for 14 cases of flu which is pretty bad. If the coronavirus at its worst, you could infect three people. By the time you get to the 10th cycle, that 10th wave has infected another 59,000 people on its own and overall, you have been responsible for 78,000 cases of this disease.

Now if only 10 per cent of those need to go to hospital and half of those to an intensive care unit, you can do your own maths. Britain only had 1,000 adult intensive care beds a few weeks ago and we're looking as if we are going to have 17,000 intensive care cases within the next few weeks to contend with.

So this is a tsunami. We're in unchartered territory. We're coping at the moment but it will, it will be a test of our resilience really, about how we all pull together to get through this.

Since that interview which would have been around lunchtime on the 26th UK time their new case and deaths per day have been

26/3 2,129 new cases / 115 new deaths
27/3 2,885/ 181
28/3 2,546 / 260
29/3 2,433 / 209
30/3 2,619 / 209
31/3 3,009 / 180
1/4 4,324 / 563
2/4 4,244 / 569
3/4 4,450 / 684
4/4 3,735 / 708
5/4 5,903 / 621
6/4 3,802 / 439
7/4 3,634 / 786

In the first 2 quarters of 2019 the UK recorded 253,185 deaths from all causes, ie an average of 1,398 people per day.

Quarterly mortality report, England - Office for National Statistics

Provisional death registration and death occurrence data for England, broken down by sex and age.

www.ons.gov.uk

Yesterday in the UK the number of people that died of COVID-19 was more than 50% of the daily death toll in first half of 2019.

And the first 7 days of April 2020, basically the number of people died from COVID-19 in the UK was the equivalent of 45% of people died in the the UK for the first 7 days of April 2019. Now people didn't stop dying from all the other things the last 7 days.

That's why mortality stats are useless when a health system gets swamped and you are a healthcare worker having to save people's life from this, you can't and then you have to wheel the body out and stack it into those Refrigerated Trailer Trailers where the temporary morgue in the hospital parking lot is set up.

 

[Burningleviathan]

I’m starting to see more and more stories about there being an unusual drop off in heart attacks and pneumonia cases as these cases are now COVID-19 cases (patients may also be delaying seeking treatment due to fear of the virus leading to poorer health outcomes). This seriously skews the data as patients have some very consequential co-morbidities that is getting lost in the COVID-19 reporting. It helps to explain why COVID-19’s impact is greater in older people as they tend to have underlying age related issues.

There’s also the issue of clinical coding. It looks like hospitals are incentivised to code for COVID-19 as there is more funding readily available. Bottom line is that the number of COVID-19 hospitalisations may not be representative of actual COVID-19 cases due to clinical coding.

Where Have All the Heart Attacks Gone? (Published 2020)

Except for treating Covid-19, many hospitals seem to be eerily quiet.

www.nytimes.com

While i can get past the NYT paywall to read the article, they are most likely dying at home as there has been a huge surge of the in NYC. I only had a quick skim read but it did mention far more callouts for heart attacks. It would suggest people aren't going to the ER.

Staggering Surge Of NYers Dying In Their Homes Suggests City Is Undercounting Coronavirus Fatalities

Deaths at home hit record numbers, but they’re not all counted in the official coronavirus toll.

gothamist.com

 

[RussellEbertHandball]

While i can get past the NYT paywall to read the article, they are most likely dying at home as there has been a huge surge of the in NYC. I only had a quick skim read but it did mention far more callouts for heart attacks. It would suggest people aren't going to the ER.

Staggering Surge Of NYers Dying In Their Homes Suggests City Is Undercounting Coronavirus Fatalities

Deaths at home hit record numbers, but they’re not all counted in the official coronavirus toll.

gothamist.com

Last night on 7.30 they had a story on New York and reporter David Lipson spent a day talking with an ambulance worker and others.

She had just completed a 93 hour week, she says day shifts are blurring into night shifts and sleeps at work.

MEGAN PFEIFFER, PARAMEDIC: Days are very long, they are very busy. We're seeing a lot of very, very sick people.

Last week alone I did 93 hours, I worked. So we are now on our way to a cardiac arrest.

DAVID LIPSON, REPORTER: For New York City paramedic, Megan Pfeiffer, day and nightshift have merged.

MEGAN PFEIFFER:
So busy, we're currently not getting BLS back-up either. It is like battlefields triage out there right now.

DAVID LIPSON: In the fight against COVID-19, the city that never sleeps has taken on new meaning.

MEGAN PFEIFFER:
I haven't been home in over a week now; I think probably closer to two. I have lost track. I was sleeping in the station. There are several who are sleeping in their cars.

DAVID LIPSON: The city's health system is so overwhelmed, the once unthinkable is now common practice.

MEGAN PFEIFFER: We are no longer transporting if we're not able to get a heartbeat back.

Now at this point, we're, they are going to be pronounced if we cannot get them revived after about 20 minutes or so. It's the amount of people sick and dying around us, it's really difficult.

DAVID LIPSON: All over New York, open spaces have been converted into field hospitals but with an increasing number of front-line health workers now off sick, their patients can't always get the help they need.

MEGAN PFEIFFER: Even last night, it happened in a hospital, where there was a patient on the bed who was turning blue. They were cyanotic from the lack of oxygen and having trouble breathing.

One of our EMS crews had to like jump in and start helping breathe for this patients with our own supplies and our own oxygen until the nurses and staff there were able to get to them because they were just, they basically were just sitting there in the corner dying.

JUDY GONZALEZ, ER NURSE: We have many people that don't survive. We have 10, 15 cadavers a day that we're shipping out Oh, it's incredibly traumatic.
......
Read on, it gets worse

7.30

www.abc.net.au

 

[Forzaport]

I work in a Victorian hospital and this is not true. There's no extra funding for covid-19 patients. Maybe different in SA though

I don’t know the exact funding amounts but I’d be surprised if COVID-19 clinical codes didn’t attract higher dollars compared to flu for example.

I’ve done a little extra reading - you don’t need laboratory confirmation to use COVID-19 codes in hospitals and this would apply Australia wide.

https://www.ihpa.gov.au/sites/default/files/icd-10-am_achi_acs_eleventh_edition_errata_3_effective_1_january_2020.pdf

And some general info - from WA but would apply nationally:

Western Australian Clinical Coding Authority (WACCA)

Clinical Coding within Western Australia incorporates the Australian Coding Standards and Western Australian Coding Rules as passed by the WA Clinical Coding Advisory Group.

ww2.health.wa.gov.au

What is clinical coding information used for?

Activity Based Funding (ABF) and reimbursement.
Each inpatient episode's codes and patient data items are processed by grouper software to determine an Australian Refined - Diagnosis Related Group (AR-DRG) for the inpatient episode of care, which informs funding and reimbursement. The AR-DRG classification enables hospital episodes to be grouped into meaningful categories, helping us to better match patient needs to health care resources.

 

[Del165198]

 

[Del165198]

Last night on 7.30 they had a story on New York and reporter David Lipson spent a day talking with an ambulance worker and others.

She had just completed a 93 hour week, she says day shifts are blurring into night shifts and sleeps at work.

MEGAN PFEIFFER, PARAMEDIC: Days are very long, they are very busy. We're seeing a lot of very, very sick people.

Last week alone I did 93 hours, I worked. So we are now on our way to a cardiac arrest.

DAVID LIPSON, REPORTER: For New York City paramedic, Megan Pfeiffer, day and nightshift have merged.

MEGAN PFEIFFER:
So busy, we're currently not getting BLS back-up either. It is like battlefields triage out there right now.

DAVID LIPSON: In the fight against COVID-19, the city that never sleeps has taken on new meaning.

MEGAN PFEIFFER:
I haven't been home in over a week now; I think probably closer to two. I have lost track. I was sleeping in the station. There are several who are sleeping in their cars.

DAVID LIPSON: The city's health system is so overwhelmed, the once unthinkable is now common practice.

MEGAN PFEIFFER: We are no longer transporting if we're not able to get a heartbeat back.

Now at this point, we're, they are going to be pronounced if we cannot get them revived after about 20 minutes or so. It's the amount of people sick and dying around us, it's really difficult.

DAVID LIPSON: All over New York, open spaces have been converted into field hospitals but with an increasing number of front-line health workers now off sick, their patients can't always get the help they need.

MEGAN PFEIFFER: Even last night, it happened in a hospital, where there was a patient on the bed who was turning blue. They were cyanotic from the lack of oxygen and having trouble breathing.

One of our EMS crews had to like jump in and start helping breathe for this patients with our own supplies and our own oxygen until the nurses and staff there were able to get to them because they were just, they basically were just sitting there in the corner dying.

JUDY GONZALEZ, ER NURSE: We have many people that don't survive. We have 10, 15 cadavers a day that we're shipping out Oh, it's incredibly traumatic.
......
Read on, it gets worse

7.30

www.abc.net.au

bUsInEsS aS uSuAl

 

[edgie]

The situation has changed. Going to get swabbed.

Sent from my Nokia 7.2 using Tapatalk

 

[Canoogs]

That Ruby Princess must have housed a nasty strain or a large load of of the virus.

I find it more likely that the demographics of cruise passengers shares some strong correlations with those who are more vulnerable to Covid-19.

 

[Magus]

Quarterly mortality report, England - Office for National Statistics

Provisional death registration and death occurrence data for England, broken down by sex and age.

www.ons.gov.uk

Yesterday in the UK the number of people that died of COVID-19 was more than 50% of the daily death toll in first half of 2019.

And the first 7 days of April 2020, basically the number of people died from COVID-19 in the UK was the equivalent of 45% of people died in the the UK for the first 7 days of April 2019. Now people didn't stop dying from all the other things the last 7 days.

NEGAN

 

[Interstater]

Makes me wonder if any hemophiliacs have died of Covid-19.

 

[raptalia]

I just heard a young woman on ABC News say, 'there are now close to 6,000 cases of corona virus across Australia'. That is not true as that is a cumulative total. Some 2547 cases have been classified as recovered so we have 3,441 active cases across Australia.

What is it with the hate here? Do you think he just pulled the drug out of his ass as one to use? No, around the world doctors have been trying everything and across multiple disparate studies they had been finding promising results. Of course as soon as he said hew as for it and wanting trials in America to see if it works suddenly everyone who hates him was against it. Some governors had to backtrack on their political banning of it, read up on the Michigan politician who is praising the use of it in helping her recovery. It's being looked at as a preventative and a aid if given early enough in treatment with the benefit being it's a really old drug and cheap. No Donald doesn't own the company otherwise he wouldn't have had to ring India to ask for supply, India who happen to be keeping it for themselves as they themselves also believe that it is effective in both preventative and infected care.

Here's India:
Donald made them use it?

Feel free to look up the French etc as well. I don't understand the hate when someone wants a cure because of the person who suggested it, if it works then it's a fantastic solution. I'd be more wary of government health officials from around the world pushing solutions that they have a commercial interest in or relationship with instead of being open to all possible ones even if there's no money in it for them.

I for one hope we are also studying some trials with this drug and it's effectiveness, if it does work in combination with Zinc or whatever else then with our low numbers maybe we could really put our foot on the virus fast, wouldn't that be good? This means virus beaten = AFL = happy forum

I don't like Gladys Berejiklian or Brad 'Health' Hazzard either so it isn't just a, I don't like Donald thing.

 

[Interstater]

I find it more likely that the demographics of cruise passengers shares some strong correlations with those who are more vulnerable to Covid-19.

My theory is that the crew are the issue.
They share close quarters with each other and have no opportunity to be taken out of the situation if they are sick.
Compare the size of the accommodations of the crew with that of the passengers.

If you look at a hotel situation, the staff are not crowded together when not at work, and if they are sick they can be removed from the situation.

 

[pastmyprimus]

I don’t know the exact funding amounts but I’d be surprised if COVID-19 clinical codes didn’t attract higher dollars compared to flu for example.

I’ve done a little extra reading - you don’t need laboratory confirmation to use COVID-19 codes in hospitals and this would apply Australia wide.

https://www.ihpa.gov.au/sites/default/files/icd-10-am_achi_acs_eleventh_edition_errata_3_effective_1_january_2020.pdf

And some general info - from WA but would apply nationally:

Western Australian Clinical Coding Authority (WACCA)

Clinical Coding within Western Australia incorporates the Australian Coding Standards and Western Australian Coding Rules as passed by the WA Clinical Coding Advisory Group.

ww2.health.wa.gov.au

What is clinical coding information used for?

Activity Based Funding (ABF) and reimbursement.
Each inpatient episode's codes and patient data items are processed by grouper software to determine an Australian Refined - Diagnosis Related Group (AR-DRG) for the inpatient episode of care, which informs funding and reimbursement. The AR-DRG classification enables hospital episodes to be grouped into meaningful categories, helping us to better match patient needs to health care resources.

I’m well across those documents plus more on the subject as that’s part of my job.

The AR-DRG drives the payment a hospital receives, and that's largely determined by the principal diagnosis. Other variables are also involved.

You’d expect a flu case to fall into an AR-DRG that pays less than a covid-19 case, just as you'd expect a tonsillectomy patient to fall into a AR-DRG that pays a lot less than the AR-DRG for a hip replacement. Hospitals across Australia run costing studies each year to help to determine the AR-DRG payments.

IHPA did a good job in releasing guidelines for coding covid-19 so quickly. They provide good guidance for our coders.

On the incentives to code covid-19 instead of the something like the flu. Most health departments I know of run independent coding audits. One aim is to check the quality of the coding. Covid-19 would be a good condition to target.

I was working in SA Health 5 years ago, and it's funding model provided little incentive to game coding. Hospitals were set weighted activity targets to achieve, and received no extra funding if they went over. Metro hospitals always achieved their targets, so had little financial incentive to game

 

[El Zorro]

I work in a Victorian hospital and this is not true. There's no extra funding for covid-19 patients. Maybe different in SA though

So, fake news. How surprising...

 

[pastmyprimus]

So, fake news. How surprising...

Yes there is. On the plus side I've come across useful info. on this thread.

 

[raptalia]

Just heard a woman on the ABC arguing for international students to be given JobKeeper. The scheme we have is going to cost $130 billion and this silly cow wants to spend billions more on people who are not even Australian citizens.

 

[Forzaport]

I’m well across those documents plus more on the subject as that’s part of my job.

The AR-DRG drives the payment a hospital receives, and that's largely determined by the principal diagnosis. Other variables are also involved.

You’d expect a flu case to fall into an AR-DRG that pays less than a covid-19 case, just as you'd expect a tonsillectomy patient to fall into a AR-DRG that pays a lot less than the AR-DRG for a hip replacement. Hospitals across Australia run costing studies each year to help to determine the AR-DRG payments.

IHPA did a good job in releasing guidelines for coding covid-19 so quickly. They provide good guidance for our coders.

On the incentives to code covid-19 instead of the something like the flu. Most health departments I know of run independent coding audits. One aim is to check the quality of the coding. Covid-19 would be a good condition to target.

I was working in SA Health 5 years ago, and it's funding model provided little incentive to game coding. Hospitals were set weighted activity targets to achieve, and received no extra funding if they went over. Metro hospitals always achieved their targets, so had little financial incentive to game

This is consistent with what I’ve heard. The auditing prevents blatant gaming of the system but there’s a fair amount of grey area to nudge things, enough to give a little artificial bump to the COVID-19 hospitalisation figures. You’re not suspicious that metro hospitals always reach their targets? As the COVID-19 codes are so new, there likely isn’t much in the way of targets at the moment. This will change over time but I’d be surprised if hospitals have targets on something where there isn’t any reliable historical data.

Another issue would be those hospitalised under suspicion of COVID-19 as it appears they count as a hospitalisation under the coding rules.

 

[manureid]

This is consistent with what I’ve heard. The auditing prevents blatant gaming of the system but there’s a fair amount of grey area to nudge things, enough to give a little artificial bump to the COVID-19 hospitalisation figures. You’re not suspicious that metro hospitals always reach their targets? As the COVID-19 codes are so new, there likely isn’t much in the way of targets at the moment. This will change over time but I’d be surprised if hospitals have targets on something where there isn’t any reliable historical data.

Another issue would be those hospitalised under suspicion of COVID-19 as it appears they count as a hospitalisation under the coding rules.

I know from my own experience in a Health Unit, that targets were always reached because they were never set to a level you could not meet. A lot of work is done unfunded as you always reach the targets set by the department.