corona virus alerts - Latest cruising Information for vessels/locations/rules

[DeepFrz]

Originally Posted by zeehag

this is a generally trusted site for medical folks to see the development iof this issue nation by nation and worldwide....comes from johns hopkins

https://www.arcgis.com/apps/opsdashb...23467b48e9ecf6

Yes it is a trusted site but slow at updates. The "worldometers" site is updated more often during the day. the two sites seem to come together later in the evening (CDT).

[Montanan]

First there was a shortage of TP, then SARS-CoV-2 tests, then personal protective equipment, now a pending condom shortage. Okay, not a reason to go buy out the neighborhood store, grant you. Please don't be a prick or a dick and hoard condoms. The memes for this will soon be going viral.

A global shortage of condoms is looming, the world's biggest producer said, after a coronavirus lockdown forced it to shut down production. Malaysia's Karex Bhd makes one in every five condoms globally. It has not produced a single condom from its three Malaysian factories for more than a week due to a lockdown imposed by the government to halt the spread of the virus. That's already a shortfall of 100 million condoms, normally marketed internationally by brands such as Durex, supplied to state healthcare systems such as Britain's NHS or distributed by aid programs such as the UN Population Fund.

[hpeer]

Originally Posted by Lake-Effect

There's some confusion and misquoting in the info given to the public, for sure. But the stats and predictions must have been pretty convincing for the majority of world governments, for them to get with the program so hard.

Honest predictions are necessary for being properly prepared, and as a benchmark for judging the success of our prevention and mitigation strategies.

Hope for the best, but be prepared for the worst.

LAKE,

The agree that there are meaningful stats. And you can find them if you look. And hopefully government experts advising the President and Governors and Mayors can sort this stuff out. Although in some cases that is not evident.

I explained above sheikh numbers I thought were meaningful and why.

Deaths PER MILLION and the CHANGE in deaths per day for some reasonably defined region.

Take for example the numbers for Italy. I may have made a mistake. Virus has not effected the entire country yet, but the deaths per million includes the entire population. To the final number may well be 500 to 700 deaths per million. Then that would fit well with Fauci’s 100,000 - 200,000 SAWG for the USA.

[smbdyiam2]

Originally Posted by Montanan

March 29

THE Philippine health ministry on Sunday reported 343 new coronavirus cases, marking the country's largest daily increase in infections, and three additional deaths.

That raised the total number of known infections in the country to 1,418, while the death toll has reached 71, it said. Seven more patients have recovered, however, bringing the total number of recoveries to 42.

trying to understand numbers
1418 sick
71dead
42 recoveries
so out of 113 --71 dead-- 41 recovered does not sound good for the remaining--1418-- sick --or maybe 1305 sick either way does not sound good
Sick going to recover or die or just stay sick?
125,000 sick now in US

[Pelagic]

Originally Posted by delmarrey

It seems the Philippines here have peaked at 803. No new cases in the past day. We’ll see tomorrow!
54 deaths as of right now.

The Philippines are way behind in testing and some of the Chinese test kits are being reported as faulty.

The real level of contamination will come after the fact when symptoms appear .

My hope for Filipinos is that due to their seasonal issues with Denge and Malaria, some helpful antibodies may already be in place.

Here inside Subic, the SBMA enforced restrictions are becoming more draconian as fear sets in.

Latest updates

NOTICE TO ALL RESIDENTS

In view of the presence of COVID-19 positive cases in Zambales and Bataan, there is a pressing need to implement stricter measures to protect the stakeholders of the Subic Bay Freeport Zone from the risk of transmission.

Efforts are under way to convert the Subic Gym, and additionally, the former Leciel Hotel as a care and isolation facility for PUIs with mild to moderate symptoms in order to preserve the limited capacity of Baypointe Hospital for PUIs with severe symptoms / with comorbidities and COVID-19 positive patients.

In addition thereto, the SBMA shall be implementing stricter border control measures.

Effective April 1, 2020, SBFZ Residents who shall exit the Subic Bay Freeport Zone (SBFZ) shall be required to surrender their SBMA ID and Quarantine Pass, thereby preventing their re-entry into the SBFZ. Exceptions to this rule are the following:

1. Government officials / employees going to and from their official work stations or on official business.

2. Residents who own / are employees of establishments outside the SBFZ that are allowed to continue to operate based on the IATF Guidelines. Provided, that they present a document from the concerned local government unit that the establishment they will travel to is authorized to continue to operate.

3. Residents who are seeking medical treatment, medicines or medical supplies that are not available inside the SBFZ. Provided, that they first obtain a Travel Pass from the Office of the Deputy Administrator for Public Health and Safety.

4. Residents seeking emergency medical treatment. Provided that, upon re-entry, they present a medical certificate from the hospital that they obtained treatment from.

5. Residents involved in relief distribution and other humanitarian efforts, provided they present a Travel Authority or Travel Pass from the PNP or from a local government unit.

For your information and compliance.

[Montanan]

Very unlikely that there would be any immunity to SARS-CoV-2 due to having previously had dengue or malaria. There is no similarity and the new coronavirus is novel so the population is naive to it which accounts for its rapid spread.

The dengue virus has five types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type greatly increases the risk of truly severe complications - the development of severe dengue, also known as dengue hemorrhagic fever.

Malaria is an intermittent and remittent fever caused by a protozoan parasite that invades the red blood cells. The parasite is transmitted by mosquitoes in many tropical and subtropical regions. There is no virus with malaria.

If anything one is likely to have greater complications with COVID-19 if one is weakened by dengue or malaria.

Stay safe as best you can.

[letsgetsailing3]

Current social distancing guidelines in the U.S. have been extended to April 30.

[S/V Adeline]

When you factor in that many states have exempted just about everyone except bars, hair salons, massage parlors, restaurants, etc...it's really a big sad joke.
Closing waffle house means it's serious, but leaving pet supply stores open makes it a joke. Lowes was so crowded yesterday you had to turn sideways to pass in the aisle. I had a busted sewer line, but the entire family of 5 browsing color swatches....WTF?
Our governor refused to allow any who self quarantine to claim benefits.
Work - expose yourself to sickness/possible death
Or
Lose Job, Income, Subject your family to poverty, starvation, and homelessness.

Wonderful choice isn't it?

Originally Posted by letsgetsailing3

Current social distancing guidelines in the U.S. have been extended to April 30.

[Montanan]

The surge of coronavirus cases in California that health officials have warned was coming has arrived and will worsen, Gov. Gavin Newsom said Friday, while the mayor of Los Angeles warned that by early next week his city could see the kind of crush that has crippled New York.

“We are now seeing the spike that we were anticipating,” Newsom declared while standing in front of the 1,000-bed Navy hospital ship Mercy that arrived in the Port of Los Angeles. It will take non-virus patients to free up rooms at hospitals for infection cases.

Newsom said California's cases grew 26% in one day even with the results of 65,000 tests still pending. Johns Hopkins University tallied more than 4,700 California cases Friday, with at least 97 deaths.

After a slow start, testing has accelerated rapidly, from about 27,000 on Tuesday to 88,000 on Friday.

In Los Angeles County — the nation's most populous with more than 10 million residents — there were 678 new cases in the past two days for a total of nearly 1,500. Los Angeles Mayor Eric Garcetti said if the trend continues, the city's cases could double every two days. That would put Los Angeles on par with New York City's outbreak in five days.

“We will be where they are," Garcetti said. “We will have doctors making excruciating decisions. We will be trying to figure out what we do with that surge, how to get ventilators, where to find beds."

New York City has more than 26,000 cases and at least 366 deaths.

Newsom has said the state could need 50,000 additional hospital beds. Since the crisis started. the state's 416 hospitals have been able to find space for 30,000 more patients in their facilities. State and local officials have scrambled to find other locations.

Newsom obtained emergency funding from the state Legislature to lease room for more than 500 patients at two hospitals, one in the San Francisco Bay Area that is bankrupt and a Los Angeles facility that closed in January. Beyond the Mercy hospital ship, the military is providing eight field hospitals with room for 2,000 patients.

The massive Los Angeles Convention Center also is being readied to serve as a location for patients. Meantime, state officials are trying to find 10,000 ventilators, and so far have 4,095. Newsom said the only federal help has been 130 ventilators sent to Los Angeles.

[lateral]

Originally Posted by zeehag

sent to a nurse friend from her friends nurse anesthetist friend from front lines:



"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this *** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."
��

A friends daughter who a nurse anesthetist sent this to me

Excellent, thanks.
Any news on TAS article on efficacy of hydroxychloroquine/ azithromycin supposedly being used with success in NY hospitals? Propaganda? As Fauci did not appear enthusiastic.
https://spectator.org/the-game-chang...ump-was-right/
OK, so source is new to me.
Factual Reporting: MIXED
Country: USA
World Press Freedom Rank: USA 48/180

[wingssail]

Mexican ports have been closed. As of today, March 29, 2020 the Secretary of Marina directed all Capitanias de Puerto del Pais (Port Captains in the whole country) to not issue despachos y salidas (zarpe or exit permits) for any vessels in any port.

This closure is due to Mexican efforts to contain the Corona virus.

We got this news from a marina security guard as we were preparing to depart onboard Wings for a 2-3 month cruise in the Sea of Cortez. Two hours later and we'd have already been gone. The boat is provisioned and ready. A little later Lupe (Guadalupe Del Carmen Dipp) posted the document.

We typically cruise during these months and this year it had a dual purpose: pleasure and corona virus avoidance.

We are now awaiting clarification and if possible we will seek a dispacho from our Capitania de Puerto tomorrow. Other wise I guess we'll stay in port.

Update: It seems that private vessels not engaged in tourism or day trips with guests may be permitted to depart ports, the notice is directed to tourism and social events on boats. Information via Mike Danielson, PV Sailing

[zeehag]

Originally Posted by wingssail

Mexican ports have been closed. As of today, March 29, 2020 the Secretary of Marina directed all Capitanias de Puerto del Pais (Port Captains in the whole country) to not issue despachos y salidas (zarpe or exit permits) for any vessels in any port.

This closure is due to Mexican efforts to contain the Corona virus.

We got this news from a marina security guard as we were preparing to depart onboard Wings for a 2-3 month cruise in the Sea of Cortez. Two hours later and we'd have already been gone. The boat is provisioned and ready. A little later Lupe (Guadalupe Del Carmen Dipp) posted the document.

We typically cruise during these months and this year it had a dual purpose: pleasure and corona virus avoidance.

We are now awaiting clarification and if possible we will seek a dispacho from our Capitania de Puerto tomorrow. Other wise I guess we'll stay in port.

Update: It seems that private vessels not engaged in tourism or day trips with guests may be permitted to depart ports, the notice is directed to tourism and social events on boats. Information via Mike Danielson, PV Sailing

info for the aviso from the port captains is that the party boats and day trippers are not to go anywhere, we as cruisers are allowed to move about. as we donot need despachos for travelling within mexico we are good., in and out of mexico maybe disturbed as those need despachos.
stay safe donot get sick and donot expose an old fart to this issue.
stay healthy and whole.

[DeepFrz]

Want to know why this disease is spreading so fast? Here is link to a newspaper article quoting an MIT study.

The MIT study says that after coughing the airborne droplets can be spread up to 7 to 8 meters and "The researchers also warn that droplets can stay suspended in the air for hours, moving along airflow patterns imposed by ventilation or climate-control systems. "

https://www.independent.ie/world-new...-39083182.html

Note: I looked for but could not find the release of the actual study.

[s/v Jedi]

Here’s the latest from that NYC MD curing patients with his cocktail of medications: https://techstartups.com/2020/03/28/...-z-pak-update/

[Lake-Effect]

Originally Posted by s/v Jedi

Here’s the latest from that NYC MD curing patients with his cocktail of medications: https://techstartups.com/2020/03/28/...-z-pak-update/

I sure hope it's as good as implied.

Our current isolation and social-distancing is buying time for breakthroughs like this.