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Direct Link To This Post Posted: 03/26/2020 at 5:01pm
Originally posted by NextLevel NextLevel wrote:


IF you wouldn't go as far as 100X and you know that 1-5% of people who get the disease get critically ill (which invokes a multiplier of 20x - 100x), where do you get 10x from?  Just curious.
I'm not following you here.  We're talking about reported or estimate infections, and sometimes we talk about deaths.  Neither links to "critically ill."  And if you did have an estimate number like
1% get critically ill," that assumes you have an accurate measure of the overall infection number (same for death rates expressed as %), which we don't.
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Direct Link To This Post Posted: 03/26/2020 at 5:41pm
The truth is probably that a lot more people are getting infected (N) and substantially smaller percentage of those (k) are actually getting critically ill.  But the product of those two numbers (Nk) is still a sufficient number of people to completely destroy our healthcare system -- and we are seeing that even if we aren't sure what the exact values are for N and k. Plus, anyone who has the bad luck to have a critical case of influenza that attacks their lungs such that they also need an ICU are also screwed.

Bear in mind that healthcare providers seem to be getting sick at a higher rate, which makes sense because they are exposed to a higher initial "dose" of the virus (and possibly even multiple variants).  That dose is part of what determines the clinical course because it affects whether your immune system can stop at an early stage.  If only a few cells take up the virus at the start, you will probably beat it without a massive inflammatory response.


Edited by Baal - 03/26/2020 at 5:44pm
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Direct Link To This Post Posted: 03/26/2020 at 9:32pm
Originally posted by obesechopper obesechopper wrote:

Originally posted by Baal Baal wrote:

Originally posted by Egghead Egghead wrote:

Originally posted by Baal Baal wrote:

I think those criteria have been relaxed in Houston area now because most of the spread is now community.  The problem is there simply aren't test kits available.

This is utterly insane. 

Our nation had a bunch of weeks to get ready for this and clearly did nothing. 

Starting midnight tonight there is a stay-at-home order in Houston and surrounding area.  Also in Dallas, Austin and San Antonio.  It's not like Italy where the cops will arrest you if they see you -- not yet.

3 weeks before the shxt storm hit N.A., and the test kit was in shortage supply already because some of the medical ingredients from germany almost ran out. 

Anyway, do we know US using the 15 mins new kits now or the 4 hours test kits at the drive thru?


Whatever local authorities can get

My doctor said it's taking him... 6 days!! To get the results back.

15 mins and 4 hours!? 
Those are the test processing time
You need to count the administration and transfer (not all labs can do the testing) too.
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Direct Link To This Post Posted: 03/26/2020 at 10:39pm
I've scarcely been able to speak with anyone who HASN'T thought they'd had the covid in the last few weeks or days. Going by general public opinion and zero testing, you'd think literally EVERYONE was already infected! LOL 

We just had a case of the flu sweep through our household... and yes, you can be damn sure I thought it was COVID! Got swabbed and found it was Flu. However... if you test positive for flu they won't covid test you as well. So it only moderately reduced my fears Confused
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Direct Link To This Post Posted: 03/27/2020 at 10:23am
Its possible to use cell phone location data to indirectly track how the virus spreads.  NYC and New Orleans are huge hot spots and south Florida will soon join them.  Thanks ib part to to Mardi Gras and Spring Break, the virus is definitely coming to a place near you.

Texas Governor Abbott esterday announced a mandatory 14 day quarantine to anyone who passed through an airport in NYC, NJ, Connecticut, or New Orleans, monitored by law enforcement t. Of course, I-10 goes straight from New Orleans to Houston, about a 6 hr drive.  But he refuses to insist on statewide lockdown.  

Several local governments (Dallas, Houston, Austin, San Antonio, Waco, Corpus Christie, etc.) have made shelter-in-place orders, but as far as I can tell, NOT in Beaumont or Port Arthur, which are oil and refining cities along the Louisuana border.  Those poor people are going to be hosed.

Meanwhile some GOP members in the Texas legislature are complaining that Texas cities and counties ought not be allowed to make such orders.  They dont understand that this is a war.  I'm sure British people in WW2 find blackout rules inconvenient too.



Edited by Baal - 03/27/2020 at 10:34am
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Direct Link To This Post Posted: 03/27/2020 at 1:17pm
Originally posted by Baal Baal wrote:

Its possible to use cell phone location data to indirectly track how the virus spreads.  NYC and New Orleans are huge hot spots and south Florida will soon join them.  Thanks ib part to to Mardi Gras and Spring Break, the virus is definitely coming to a place near you.

Texas Governor Abbott esterday announced a mandatory 14 day quarantine to anyone who passed through an airport in NYC, NJ, Connecticut, or New Orleans, monitored by law enforcement t. Of course, I-10 goes straight from New Orleans to Houston, about a 6 hr drive.  But he refuses to insist on statewide lockdown.  

Several local governments (Dallas, Houston, Austin, San Antonio, Waco, Corpus Christie, etc.) have made shelter-in-place orders, but as far as I can tell, NOT in Beaumont or Port Arthur, which are oil and refining cities along the Louisuana border.  Those poor people are going to be hosed.

Meanwhile some GOP members in the Texas legislature are complaining that Texas cities and counties ought not be allowed to make such orders.  They dont understand that this is a war.  I'm sure British people in WW2 find blackout rules inconvenient too.

I am not saying those old GOPs are right. However, I understood Trump and GOPs points now. As a country as a whole, we need to start rethinking the whole situation now. If the virus don't die in the late spring, what shall we do?
Such as, China gov't who has great leap forward and 8964 in their resume could not successfully reopen the factoies in mid-feb. What can we do?
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Direct Link To This Post Posted: 03/27/2020 at 1:23pm
Originally posted by obesechopper obesechopper wrote:

I've scarcely been able to speak with anyone who HASN'T thought they'd had the covid in the last few weeks or days. Going by general public opinion and zero testing, you'd think literally EVERYONE was already infected! LOL 

We just had a case of the flu sweep through our household... and yes, you can be damn sure I thought it was COVID! Got swabbed and found it was Flu. However... if you test positive for flu they won't covid test you as well. So it only moderately reduced my fears Confused
Tell me about it, now, my parent have cough, and I have sore throat and cough; i'm freaking out DeadDeadDeadDeadDead
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Direct Link To This Post Posted: 03/27/2020 at 5:23pm
Originally posted by Egghead Egghead wrote:

Originally posted by Baal Baal wrote:

Its possible to use cell phone location data to indirectly track how the virus spreads.  NYC and New Orleans are huge hot spots and south Florida will soon join them.  Thanks ib part to to Mardi Gras and Spring Break, the virus is definitely coming to a place near you.

Texas Governor Abbott esterday announced a mandatory 14 day quarantine to anyone who passed through an airport in NYC, NJ, Connecticut, or New Orleans, monitored by law enforcement t. Of course, I-10 goes straight from New Orleans to Houston, about a 6 hr drive.  But he refuses to insist on statewide lockdown.  

Several local governments (Dallas, Houston, Austin, San Antonio, Waco, Corpus Christie, etc.) have made shelter-in-place orders, but as far as I can tell, NOT in Beaumont or Port Arthur, which are oil and refining cities along the Louisuana border.  Those poor people are going to be hosed.

Meanwhile some GOP members in the Texas legislature are complaining that Texas cities and counties ought not be allowed to make such orders.  They dont understand that this is a war.  I'm sure British people in WW2 find blackout rules inconvenient too.

I am not saying those old GOPs are right. However, I understood Trump and GOPs points now. As a country as a whole, we need to start rethinking the whole situation now. If the virus don't die in the late spring, what shall we do?
Such as, China gov't who has great leap forward and 8964 in their resume could not successfully reopen the factoies in mid-feb. What can we do?


What you do is take steps as much as you can to make sure that this thing is diminished as much as possible by late spring.  You don't complain about the steps that are ESSENTIAL NOW if you want that to happen.  You don't call it a hoax.  You don't tell people they have a duty to die.
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Direct Link To This Post Posted: 03/27/2020 at 5:45pm
Originally posted by Baal Baal wrote:

Originally posted by Egghead Egghead wrote:

I am not saying those old GOPs are right. However, I understood Trump and GOPs points now. As a country as a whole, we need to start rethinking the whole situation now. If the virus don't die in the late spring, what shall we do?

Such as, China gov't who has great leap forward and 8964 in their resume could not successfully reopen the factoies in mid-feb. What can we do?


What you do is take steps as much as you can to make sure that this thing is diminished as much as possible by late spring.  You don't complain about the steps that are ESSENTIAL NOW if you want that to happen.  You don't call it a hoax.  You don't tell people they have a duty to die.
Don't play strawman here Wink

I don't like trump. However, I will hear what he said and think about ahead of time because, at the end of the day, he is POTUS.


Edited by Egghead - 03/27/2020 at 5:49pm
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Direct Link To This Post Posted: 03/27/2020 at 6:56pm
HI,

As of today, Friday, March 27th, the country that gets the (on-going) award for the virus's patient treatment is Germany.  Their cases are over 42,000; their deaths are only 253, by far the best ratio by country.

Germany42,288253
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Direct Link To This Post Posted: 03/27/2020 at 8:12pm
The best ratio within Canada is Quebec (2,021 - 18), and the worest is BC (725 - 14)

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Direct Link To This Post Posted: 03/27/2020 at 8:32pm
That's a pretty impressive statistic in Germany but without some more information it's hard to tell if it reflects a broader amount of testing that is identifying more people who have minimal symptoms, or if it is something different they are doing in their hospitals, or some other factor.

What I would really like to know in various places is survival rate among patients who are admitted to hospitals.  That will be higher if the hospitals aren't overwhelmed. 
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Direct Link To This Post Posted: 03/27/2020 at 8:42pm
Comparing ratios is meaningless at this point.

The numbers are highly skewed depending on testing volume. Germany has done a lot more testing than many countries, 500,000 per week, so they have found many asymptomatic people. Asymptomatic people don't require any treatment so no one can really say Germany "treats" patients better than anywhere else.

https://bgr.com/2020/03/26/coronavirus-testing-explains-germanys-low-covid-19-fatality-rate/
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Direct Link To This Post Posted: 03/27/2020 at 9:01pm
Originally posted by qpskfec qpskfec wrote:

Comparing ratios is meaningless at this point.

The numbers are highly skewed depending on testing volume. Germany has done a lot more testing than many countries, 500,000 per week, so they have found many asymptomatic people. Asymptomatic people don't require any treatment so no one can really say Germany "treats" patients better than anywhere else.



That was what I was thinking too.  I didn't know how many people they had tested. 

The article you linked to has useful information but seems to make some strange conclusions unless I'm misreading it.  They refer to the testing as German's "secret weapon" against the virus.  But asymptomatic people were never going to die regardless of whether they were tested or not!  The case fatality rate is what it is either way.  It is just that their estimate is closer to reality. 

Testing does let you quarantine positive people so they don't spread it to other people (or are less likely too).  And that is a key thing but hardly a secret. 


Edited by Baal - 03/27/2020 at 9:07pm
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Direct Link To This Post Posted: 03/27/2020 at 11:48pm
Is there strong evidence that putting people on ventilators makes a big difference to their survival odds?  Just thinking out loud.
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Direct Link To This Post Posted: 03/28/2020 at 12:13am
Originally posted by NextLevel NextLevel wrote:

Is there strong evidence that putting people on ventilators makes a big difference to their survival odds?  Just thinking out loud.

I read somewhere the mortality rate at this one hospital for + covid pts that were intubated on a ventilator was 85%. Idk how accurate that number is but from what ive seen at my hospital the ones that ended up being intubated on the ventilator were the really sick pts with other serious comorbidities. 


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Direct Link To This Post Posted: 03/28/2020 at 6:18am
There are multiple reasons for Germany having lower mortality rates. The most important one is the testing that was mentioned before - Germany has tested a lot more, allowing earlier detection and self-isolation. However, as often in epidemiology, there is rarely such a simple answer and with regards to Germany there may be a couple of other reasons. 

Firstly, Germany has a very good healthcare system with a lot more ICU beds than most other countries - IIRC about 30 per 100,000, while that is about 6-7/100,000 for the UK. Not sure what the number is in eg Italy or Spain, but there they have to choose patients who gets put in an ICU, and who doesn't. Although indirect, it might answer the question of Nextlevel on whether ventilators do make a difference or not (I'm pretty sure it does make a difference, but I'm not a clinician and have not checked whether there is any data on this)

Secondly, the German wave of infection mainly originated from people skiing in northern Italy - and they were, on average, reasonably young and fit. Not sure whether this had much of an big impact - possibly early yes, but now probably does not make such a difference anymore.
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Direct Link To This Post Posted: 03/28/2020 at 8:21am
' Is there strong evidence that putting people on ventilators makes a big difference to their survival odds?  Just thinking out loud.' - nextlevel

Doctors everywhere, including those in the US, are in desperate need for medical equipment especially ventilators. I do not even want to think about it. If you are in the position to, it is a better option you start a donation drive here and buy some for the doctors; even if it is one ventilator.
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Direct Link To This Post Posted: 03/28/2020 at 8:38am
Sorry guys, Germany probably has close to the same death rate as everywhere else.  Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  

Edited by WeebleWobble - 03/28/2020 at 8:44am
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Direct Link To This Post Posted: 03/28/2020 at 8:42am
Originally posted by WeebleWobble WeebleWobble wrote:

Sorry guys, Germany probably has the same death rate as everywhere else.  Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  

And what is your evidence for that?
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Direct Link To This Post Posted: 03/28/2020 at 8:49am
Originally posted by kuifje kuifje wrote:

Originally posted by WeebleWobble WeebleWobble wrote:

Sorry guys, Germany probably has the same death rate as everywhere else.  Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  

And what is your evidence for that?

I've read it a few times but not sure where.  Also I've read they don't do postmortem tests.



Another theory I've read is that Germany consumes tons of sauerkraut, which like kimchi, is loaded in probiotics which could be a huge boost to their immune system.
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Direct Link To This Post Posted: 03/28/2020 at 8:54am
Originally posted by WeebleWobble WeebleWobble wrote:

Originally posted by kuifje kuifje wrote:

Originally posted by WeebleWobble WeebleWobble wrote:

Sorry guys, Germany probably has the same death rate as everywhere else.  Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  

And what is your evidence for that?

I've read it a few times but not sure where.  Also I've read they don't do postmortem tests.



Another theory I've read is that Germany consumes tons of sauerkraut, which like kimchi, is loaded in probiotics which could be a huge boost to their immune system.

Yep, that's  the evidence - "I  read it somewhere". Typical, which is why I don't post much here (I am a microbiologist so could post a lot more - but I won't).
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Direct Link To This Post Posted: 03/28/2020 at 9:21am
Originally posted by kuifje kuifje wrote:

There are multiple reasons for Germany having lower mortality rates. The most important one is the testing that was mentioned before - Germany has tested a lot more, allowing earlier detection and self-isolation. However, as often in epidemiology, there is rarely such a simple answer and with regards to Germany there may be a couple of other reasons. 

Firstly, Germany has a very good healthcare system with a lot more ICU beds than most other countries - IIRC about 30 per 100,000, while that is about 6-7/100,000 for the UK. Not sure what the number is in eg Italy or Spain, but there they have to choose patients who gets put in an ICU, and who doesn't. Although indirect, it might answer the question of Nextlevel on whether ventilators do make a difference or not (I'm pretty sure it does make a difference, but I'm not a clinician and have not checked whether there is any data on this)

Secondly, the German wave of infection mainly originated from people skiing in northern Italy - and they were, on average, reasonably young and fit. Not sure whether this had much of an big impact - possibly early yes, but now probably does not make such a difference anymore.

Thank you very much for your well-reasoned, intelligent, and knowledge-based posting here.  It is of high value, is appreciated, and contributes significantly to our understanding.

Thanks.
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Direct Link To This Post Posted: 03/28/2020 at 10:17am
Originally posted by penholderxxx penholderxxx wrote:


Doctors everywhere, including those in the US, are in desperate need for medical equipment especially ventilators. I do not even want to think about it. If you are in the position to, it is a better option you start a donation drive here and buy some for the doctors; even if it is one ventilator.
You may be right. However, can someone find out do they take med to relieve the symptoms beside the ventilator (I cannot find it)? I remember that they do in SARS. Now, all doctor are talking on how to find to the cure.
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Direct Link To This Post Posted: 03/28/2020 at 10:24am
Originally posted by WeebleWobble WeebleWobble wrote:

Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  


Sorry, WeebleWobbble, but this is 100% untrue, at least according to the Robert-Koch-Insitut (it is a federal goverment agency and subordinate of the Ministry of Health in Germany; it gives scientific advise to the german government). In one of the press conferences from this week one of the journalists actually asked Prof. Dr. Lothar Wieler (head of the RKI) about this and he clearly said that people who are corona-positive and having comorbidities and eventually die are counted as a victim of corona!
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Direct Link To This Post Posted: 03/28/2020 at 10:28am
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Direct Link To This Post Posted: 03/28/2020 at 10:34am
Originally posted by WeebleWobble WeebleWobble wrote:

Originally posted by kuifje kuifje wrote:

Originally posted by WeebleWobble WeebleWobble wrote:

Sorry guys, Germany probably has the same death rate as everywhere else.  Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  

And what is your evidence for that?

I've read it a few times but not sure where.  Also I've read they don't do postmortem tests.



Another theory I've read is that Germany consumes tons of sauerkraut, which like kimchi, is loaded in probiotics which could be a huge boost to their immune system.


I've read it a few times but not sure where. LOLLOLLOL Also I've read they don't do postmortem tests.ConfusedConfusedConfused  I suppose you are joking...



Another theory I've read is that Germany consumes tons of sauerkraut, which like kimchi, is loaded in probiotics which could be a huge boost to their immune system.   Confused Another joke perhaps? I for myself do eat sauerkraut, maybe 5 times...per year. And even hardcore-bavarians do not eat that stuff every day (maybe a few times per month). So the notion that sauerkraut helps in a sigfnificant way against corona is a stretch.


Edited by Skynet - 03/28/2020 at 10:35am
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Direct Link To This Post Posted: 03/28/2020 at 10:37am
Originally posted by Skynet Skynet wrote:

Originally posted by WeebleWobble WeebleWobble wrote:

Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  


Sorry, WeebleWobbble, but this is 100% untrue, at least according to the Robert-Koch-Insitut (it is a federal goverment agency and subordinate of the Ministry of Health in Germany; it gives scientific advise to the german government). In one of the press conferences from this week one of the journalists actually asked Prof. Dr. Lothar Wieler (head of the RKI) about this and he clearly said that people who are corona-positive and having comorbidities and eventually die are counted as a victim of corona!

Thanks for the reference - I was wondering about this as well (yes, I've read it 'somewhere'). With anything data related, how one collects and labels it is VERY important, that's why the comment above about how one records cause of death was actually quite reasonable, when discussing mortality rates.
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Direct Link To This Post Posted: 03/28/2020 at 11:07am
Originally posted by NextLevel NextLevel wrote:

Is there strong evidence that putting people on ventilators makes a big difference to their survival odds?  Just thinking out loud.


Ventilation is the standard treatment for anyone with acute respiratory distress syndrome (ARDS) which is generally what makes people die from a cornonavirus (or influenza). 

During ARDS the type-2 pneumocytes stop making something called pulmonary surfactant, which has two effects:  gas exchange between little air sacs and capillaries carrying blood is reduced, and mechanical properties of the airways are badly altered, requiring more mechanical force (negative pressure) to fill them with air.  At that point, without artificial ventilation, the patient will usually die.  There are many other aspects too.  There is an immune-mediated inflammatory response in the lungs causing the little air sacs to fill up with fluid, and the resulting release of cytokines from a variety of immune cells that live in the lung affects numerous other organ systems. The fluid filled air sacs (alveoli) are pretty much out of action.  It is known that it is important to ventilate at low tidal volume but higher frequency (other wise you actually make the inflammation worse).  Often the ventilation works better if the patient is placed on their stomach.  And it is often necessary to place the patient into an artificial coma so that they don't try to breathe on their own and fight the machine.  In really bad cases, they can try to put the blood into another type of machine to add the gas to the blood that way.  In the mean time, they may also need to do temporary hemodialysis to maintain blood electrolytes.

I remember reading that survival of ARDS patients caused by viral infection who need a ventilator is somewhat better than a coin toss, at least in ideal ICU conditions.  But without it, chances of surviving approach zero.

Other problems are that that the cytokine storm in ARDS and other factors have a tendency to cause failure of other organs, especially the kidneys.  The patients are almost always acidotic due to elevated blood pCO2 which can quickly become lethal if kidneys fail.  There is almost always a hypokalemia (low blood K+) that is hard to manage also.  Consequences often lead to cardiac aryhthmias, often fatal.

I don't have time to put links to all of these things, but this is what we teach in medical school and you can find information on this all over the internet. 


Edited by Baal - 03/28/2020 at 11:09am
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Direct Link To This Post Posted: 03/28/2020 at 11:30am
Originally posted by kuifje kuifje wrote:

Originally posted by WeebleWobble WeebleWobble wrote:

Originally posted by kuifje kuifje wrote:

Originally posted by WeebleWobble WeebleWobble wrote:

Sorry guys, Germany probably has the same death rate as everywhere else.  Supposedly if someone has a comorbidity they list that as the cause of death.  So if they get corona and die but had asthma then they died from asthma.  

And what is your evidence for that?

I've read it a few times but not sure where.  Also I've read they don't do postmortem tests.



Another theory I've read is that Germany consumes tons of sauerkraut, which like kimchi, is loaded in probiotics which could be a huge boost to their immune system.

Yep, that's  the evidence - "I  read it somewhere". Typical, which is why I don't post much here (I am a microbiologist so could post a lot more - but I won't).


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