I'm back

Its  been 11 years since I last posted.   I am no longer a dialysis tech working in a hospital.  I now engineer, design, build and test new technology for dialysis full time at a tech startup.

The test equipment I had and the prototypes of home built ventilators that my son and I made when the H1N1 virus was of concern sat for a long time in my basement collecting dust.  Ironically, I cleaned out that room in December 2019 and threw out most of it.

Years came and went and no major pandemic ever appeared.  H1N1 was much less lethal than many expected, and MERS was largely contained.  I was happy for that.  Although I warned 11 years ago of the risks of not having enough ventilator surplus capacity to deal with a serious problem, I was happy that no serious emergency ever occurred.  I thought we were safe.  I hope we still are safe, and I pray that all the reports we hear are drastically exaggerated and nothing bad will happen.

So now we have a new coronavirus now called SARS-CoV-2, causing the disease Covid-19.

A lot of people are concerned.  The stock market certainly seems to be concerned at the end of February.  And suddenly there is a large spike in traffic on this blog again.  So how do we know if this will be severe or if it will turn out to be nothing?  First we look at what the experts have to say:

Here is a good article from the New England Journal of Medicine.
https://www.nejm.org/doi/full/10.1056/NEJMp2002125

• Basically they are concerned but it is still too early to say how bad it will be.  
• They say that the estimated case fatality ratio among medically attended patients so far is approximately 2%.

Here is an article on estimating the demand for mechanical ventilators in a pandemic. 
https://doi.org/10.1093/cid/civ089

• The highest  estimated case fatality ratio they considered was 0.5%
• They used an estimate of a clinical attack rate of between 20% to 30%.
• Two of the experts in the list below predict a clinical attack rate of 60% or even 70%.  I hope it is not that high or we will have a lot of excess deaths due to lack of basic ventilator support.

Among other factors, epidemiologists are interested in the severity of the outbreak and what is known as the virus’ “attack rate.” The attack rate means the percentage of people who will develop the disease if it spreads.  With seasonal influenza, the Centers for Disease Control and Prevention estimates between 3% and 11% of people become sick with flu every year. But immune systems have experience with influenza; the attack rate might be higher with a virus such this that is wholly new to humans.



So, have hospitals stockpiled enough ventilators to deal with this risk?
Here is an article from th Baltimore Sun in 2016 that deals with this issue:
https://www.baltimoresun.com/news/investigations/bs-md-sun-investigates-ventilators-20160116-story.html

• "Maryland's attorney general issued an opinion in December that found that the Catastrophic Health Emergencies Act of 2002 gives the governor the authority to ration the machines that support breathing in flu patients suffering respiratory complications."   "The flu typically sickens and kills thousands in the United States every year, but pandemics remain uncommon. During the last one, in 2009, a vaccine hurried into production was credited with stemming a virus that led to about 12,000 deaths."
• That 2009 one was the one that was worrisome when I started the Pandemic Ventilator Project.
• "A severe pandemic like the Spanish flu of 1918, which led to more than 500,000 U.S. deaths, likely would necessitate rationing.  A severe pandemic today could sicken 90 million people and lead to 1.9 million deaths, the planners estimated. Some 740,000 ventilators could be needed."
• That death rate of 2% is very similar to current projections for COVID-19.  That number is for a clinical attack rate of 30%.  Some experts predict a clinical attack rate of 60% for COVID-19.  so the death rate and ventilator need could then be twice that number.
• "Studies show U.S. hospitals have about 70,000."
• Not good news.
• "Fortunately, we have not experienced a pandemic event that has resulted in a ventilator shortage in the U.S," said Alan C Regenberg, director of outreach and research support at Hopkins' Berman Institute of Bioethics.  But "even a more moderate event would push our current capacity to its limits," he said, "and a severe event would leave us with major mechanical ventilation shortages."

Here are a few more collected expert opinions on the coronavirus outbreak

 The director general of the WHO has recently spoken of a narrowing of the window of opportunity to control the current epidemic. The tipping point - after which our ability to prevent a global pandemic ends - seems a lot closer after the past 24 hours
Prof. Paul Hunter
Professor of Health Protection
University of East Anglia
Feb. 23, 2020

 The number of reports from multiple different countries in the past 36 hours showing what is most likely community human to human spread of SARS-CoV-2 confirms fears that the virus is on its way to causing a pandemic
Prof. Dr. Benhur Lee, MD
Professor of Microbiology
Icahn School of Medicine at Mount Sinai (ISMMS)
Feb. 21, 2020

 All predictions are important. Most predictions are wrong. And I think we must be careful with that.
[asked about prediction that Covid-19 could affect 2/3 of world's population]
Dr. Michael Ryan
Executive Director
WHO Health Emergencies Programme
Feb. 17, 2020

 I think it is likely we will see a global pandemic. If a pandemic happens, 40% to 70% of people world-wide are likely to be infected in the coming year. What proportion is asymptomatic, I can't give a good number
Prof. Marc Lipsitch
Prof. of Epidemiology, Harvard School of Public Health
Head, Harvard Ctr. Communicable Disease Dynamics
Feb. 14, 2020

 I think this virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we'll get community based transmission and you can start to think about it like seasonal flu. The only difference is we don't understand this virus
Dr. Robert Redfield
Director, CDC
US Centers for Disease Control and Prevention
Feb. 13, 2020

This is really a global problem that’s not going to go away in a week or two.
What makes this one perhaps harder to control than SARS is that it may be possible to transmit before you are sick.
I think we should be prepared for the equivalent of a very, very bad flu season, or maybe the worst-ever flu season in modern times.
Prof. Marc Lipsitch
Prof. of Epidemiology, Harvard School of Public Health
Head, Harvard Ctr. Communicable Disease Dynamics
Feb. 11, 2020

 I hope this outbreak may be over in something like April
Prof. Nanshan Zhong
Leading epidemiologist, first to describe SARS coronavirus
Feb. 11, 2020

 It could infect 60% of global population if unchecked
Prof. Gabriel Leung
Expert on coronavirus epidemics
Chair of Public Health Medicine
Hong Kong University
Feb. 11, 2020

 It’s a new virus. We don’t know much about it, and therefore we’re all concerned to make certain it doesn’t evolve into something even worse
Prof. W. Ian Lipkin
Epidemiology Director
Columbia University
Feb. 10, 2020

 We are estimating that about 50,000 new infections per day are occurring in China. [...] It will probably peak in its epicenter, Wuhan, in about one month time; maybe a month or two later in the whole of China. The rest of the world will see epidemics at various times after that.
Prof. Neil Ferguson
Director, Institute for Disease and Emergency Analytics
Imperial College, London Feb. 6, 2020
 This looks far more like H1N1’s spread than SARS, and I am increasingly alarmed
Dr. Peter Piot
(Director, The London School of Hygiene and Tropical Medicine)
Feb. 2, 2020

 It sounds and looks as if it’s going to be a very highly transmissible virus [...] This virus may still be learning what it can do, we don’t know its full potential yet.
Robert Webster
(Infectious disease and avian flu expert at St. Jude Children’s Research Hospital)
Feb. 2, 2020

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