Coronaviruset i verden: Nyheter og diskusjon

[Camlon]

17 minutes ago, Mr_Spock said:

Nå var det jeg som trollet - men kanskje du skulle bli litt flinkere til å bruke "Jeg tror" og "Jeg synes" foran mye av det du skriver - så blir det mer interessant å diskutere med deg.

Du skriver ikke "Jeg tror" eller "Jeg synes" foran det du skriver. Kanskje fikse dine egne innlegg før du klager på andre?

Og du vet at trolling er imot retningslinjene?

 

[G]

Washington Post 6. april

Sitat

The dark side of ventilators: Those hooked up for long periods face difficult recoveries

Although the machines can mean the difference between life or death, they often cause other complications.

Medical staff, wearing protective suits and face masks, work at the intensive care unit for coronavirus disease patients at Ambroise Pare clinic in Neuilly-sur-Seine, near Paris. (Benoit Tessier/Reuters)

By 

Carolyn Y. Johnson and 

Ariana Eunjung Cha 

April 6, 2020 at 7:25 p.m. GMT+2

 

For people desperately ill with covid-19, getting hooked up to a mechanical ventilator can mean the difference between life and death. But despite officials’ frantic efforts to secure more of the machines, they are not a magic bullet.

Many attached to the scarce machines will not make it out of the hospital. Data from China, Italy and the U.S. suggest that about half of those with covid-19 who receive ventilator support will die.

“They’re called life support for a reason — they just keep people alive while typically buying time for something else to heal the lungs,” said Scott Halpern, a bioethicist at the University of Pennsylvania. But with covid-19, the disease caused by the novel coronavirus, “we don’t have a treatment for the underlying insult.”

For those who manage to defeat the virus and come off ventilators, the really hard part begins. Many will suffer long-term physical, mental and emotional issues, according to a staggering body of medical and scientific studies. Even a year after leaving the intensive care unit, many people experience post-traumatic stress disorder, Alzheimer’s-like cognitive deficits, depression, lost jobs and problems with daily activities such as bathing and eating.

 

“I think what we’re going to see is a wave, about six weeks after the initial illness,” said Samuel Brown, director of the Center for Humanizing Critical Care at Intermountain Healthcare in Utah. “One to three weeks to get off the ventilator, and a couple of weeks to get their sea legs back to get home — and then to finally realize: What happened? What did I just survive? And how desperately frightening that experience was for a wave of survivors who are going to have really difficult psychological symptoms.”

Although the vast majority of people with covid-19 experience mild cases of infection, about one in six known cases develop severe shortness of breath. About half of those become critically ill, as people’s damaged lungs fill with fluid, staying alive only with the help of a mechanical ventilator, according to evolving data.

By the end of the pandemic, hundreds of thousands of Americans who have survived severe cases of covid-19 are likely to seed the next health-care crisis as many struggle with the physical and psychological effects of long hospital stays, say epidemiologists.

Patients with covid-19 typically stay on ventilators for prolonged periods which increases the likelihood of long-term complications. The risk of infection also means they are cut off from human contact, which also increases the risk of psychological issues.

“We normally kneel at their bedside and hold their hand and ask them, ‘How are you’ and tell them, ‘It is my privilege to help you.’ Instead what they are getting is someone in spacesuit garb with very little time to spend with them,” said E. Wesley Ely, a professor at Vanderbilt University in Nashville.

 

He recounted how a medical resident recently came to him in tears.

“I don’t feel like I’m a doctor,” the resident told Ely. “The first time I really sat with that patient was to pronounce him dead.”

 

Nic Brown scribbled this message to health-care workers at Cleveland Clinic who cared for him while he was hospitalized for covid-19: “I think you are all rock stars. … Today I leave this ICU a changed person, hopefully for the better." (Courtesy Cleveland Clinic)

ICU Survivors

The ranks of covid-19 survivors are just beginning to expand in the United States, but acute respiratory distress syndrome — the lung failure that kills patients — is also caused by other infections, giving doctors a deep reservoir of knowledge about what happens to such people after they leave the hospital. Each year, there are about 200,000 people with acute respiratory distress in the United States, and about 60 percent of them live. Many of these survivors have been watching the unfolding pandemic in the United States with an unsettling sense of foresight and empathy.

A common complication of prolonged stays in intensive care units is something called “ICU delirium,” in which patients become severely confused and may have nightmarish hallucinations — which could be worse if people never see their caregivers’ faces and don’t have family there to help them understand what really happened.

Nic Brown, a 38-year-old information technology manager, spent 18 days at the hospital — seven on a ventilator. He was Cleveland Clinic’s first covid-19 patient and said he has more memories of the ICU than he cares to remember.

“I had these horrible dreams and it was night after night of torment,” he said in an interview. “There was a point I wanted to ask them to pull the plug. I couldn’t do it.”

 

Brown was lucky. His condition improved after doctors treated him with a variety of experimental medications, and he was discharged last week. His lungs are still struggling to recover, and when he does ordinary things like stand up to check his computer printer, he gets winded. He also said he’s experienced some vision issues and, earlier on, confusion. He would write something down, but it wouldn’t match the message he intended to convey.

“When you typically get out of the ICU at the hospital, you get all this support like physical therapy and speech therapy but when you are a covid-19 patient, you get none of that,” he said.

With the risk of infection and social distancing orders in place, doctors say, many rehabilitation services have not been accepting patients recovering from the virus.

 

Michelle and Ken Bryden of Ellicott City, Md. A year ago, Michelle Bryden spent four days on a ventilator because of acute respiratory distress syndrome, which also occurs in covid-19. (Courtesy of Michelle Bryden)

Michelle Bryden, a 49-year-old engineer from Ellicott City, Md., was able to take advantage of that kind of support after her hospitalization for bacterial meningitis and sepsis left her on a ventilator for four days. She has been thinking about people recovering from covid-19 as she approaches the first anniversary of her hospitalization, imagining what her path through the medical system would have been like if she had been alone.

 

Bryden’s husband, Ken, was with her constantly in the hospital and has helped her fill in the gaps in her memory from when she was sedated and had no idea what was happening. But when he left the hospital to shower or sleep, the isolation was difficult, even though she knew he would soon return.

“Having him there was important, and I think not having visitors in the hospital would be so hard,” Bryden recalled. “I found the nights to be very scary.”

Eileen Rubin, now 57, who spent eight weeks on a ventilator due to acute respiratory distress syndrome caused by sepsis when she was 33, said that she isn’t sure she would have survived without her family’s presence and support.

 

“I cry for them [covid-19 patients], really, because they don’t have that support that is really so significant and meaningful, and there’s no way to change that,” Rubin said. “It’s a feeling you have that you carry with you. … You know somebody is fighting for you when you can’t fight for yourself.”

Health-care teams are finding ways to alleviate patients’ isolation, knowing that even small changes could mean the difference between a person who survives and one who is better-equipped to recover. Some health-care workers have put their photos in patients’ rooms so that when they come in covered in a mask and gown, they can point to the photo and say, “I’m that person.”

Others are communicating with telehealth apps from inside the hospital, so that they can at least have some face-to-face interactions, albeit on screen. Still others have used their private cellphones covered in zip-top bags to bring family members to the bedside with video chat. The Mayo Clinic recently brought up video chat on iPads to make sure that patients can see their families as they fight the virus alone.

Psychological risks

Even when people survive the illness, they will likely reenter a world where much of their support network simply can’t give them a hug due to social distancing guidelines — and where fear of contagion could create stigma, too.

“I think that’s a dynamic you can’t overemphasize — that it is always bad to be in the ICU, but it’s probably doubly bad to be in the ICU during a pandemic, because of the anxiety that is just fomenting,” said James Jackson, a psychologist at Vanderbilt University. “It’s in the air, if you will. And that all adds to the psychological burden.”

Just as combat veterans may not want to ever return to the battlefield, people who recover from critical illness may not even want to drive by the hospital, Jackson said — and that means that post-traumatic stress disorder could compound other medical problems, impeding people’s ability to seek the medical support they need.

 

How ventilators work and why we need them to fight covid-19

 

 

Coronavirus may cause a shortage of ventilators, and U.S. health-care workers are worried there won't be enough of them to serve covid-19 patients. (Daron Taylor/The Washington Post)

Centers to support ICU survivors are not at every hospital, and delivering additional care for a person’s physical, cognitive and mental health during a pandemic will be harder. Recovery may also be affected by the absence of family members in the hospital, as people trying to support their loved one may have little idea what they experienced.

“So now you have the family member who survived, and they’ve been through war. But no one really knows what that war experience was like,” said Michael Wilson, a pulmonary intensive care unit physician at Mayo Clinic.

It’s at home, after the first few weeks of convalescence, when people begin to try to bathe themselves or feed themselves that most people begin to grapple with limitations they may not have recognized in the hospital. They begin to reconstruct the lost time, piecing together fragments of memories. People may feel depressed as they realize that they have left the hospital — only to navigate a new set of problems that often last six months to a year.

“When someone is critically ill and so sick they require life support, such as a mechanical ventilator, most patients do not return to that former state when the life support is discontinued — particularly in the context of covid” where they may be on ventilators for long periods, said Dale Needham, professor of pulmonary and critical care medicine at Johns Hopkins University School of Medicine.

Bryden, for example, knows that she’s considered to be a “good” recovery case and is glad, because she’s not sure she could have handled worse. She lost 20 pounds of muscle. She had to learn how to get out of bed and use a walker, although she had once exercised every morning. She was cleared to eat food, but she tried eating rice, and the simple act of coordinating the movement of her mouth to chew and push food into her throat was impossible at first.

Bryden was able to return to work in six weeks, walking with a cane, and by six months, she says, she began to feel like herself.

“I would just emphasize that it is hard, and the fact you’ve gotten out of the ICU or the hospital is really only half the battle,” Bryden said, of the advice she would give people recovering from the worst cases of covid-19. “From the patient perspective, it was harder after I got out.”

Julie Tate contributed to this report.

https://www.washingtonpost.com/health/2020/04/03/coronavirus-survivors-recovery/

Endret 8. april 2020 av Uderzo
rettet opp formatering for mobil brukere

[Mr.M]

Jarmo skrev (1 time siden):

https://www.vg.no/nyheter/meninger/i/wPGVKn/ekspertene-og-erna-er-ikke-enige

så vi rakk knapt få ei natt rolig søvn, i håp om at landet er på rett kurs, føre uenigheten kom til overflaten.

Egentlig burde jeg visst det, for det har murret under overflaten fra det hele startet, at FHI egentlig mener noe annet om håndteringen enn regjering, men har høflig holdt lav profil. (FHI anbefalte f.eks. ikke stenging av barnehaver, skoler, eller riksgrensa, det kom frem fra et lukket møte

https://www.aftenposten.no/norge/i/lA5k3y/slik-var-spillet-om-de-mest-dramatiske-tiltakene-i-norge-siden-krigen

Nå hevder altså FHI at det verste faktisk ligger foran oss, mens Bent Høie sier "vi har vært på (fjell) toppen, og nå på vei ned."

Ikke lett å vite hvem man skal tro mest på, fagmyndighetene eller politikerne...

[ok67]

Var ein tur på den lokale post i butikk og henta ein pakke, der var det lite folk og god plass. Planen var etterpå å ta turern innom OBS Bygg for å kjøpe eit spann med maling, der var parkeringsplassen full, så eg stod over den. Tilsvarande på parkeringsplassen på City Cyd, den var også stappfull. Så virkar som at folk begynner å ta litt lett på det. Så fryktar vi må vil sjå eit oppsving i smitten etter påske, omtrent samtidig som barnehagane åpnar igjen...

[G]

2 hours ago, Jarmo said:

https://www.vg.no/nyheter/meninger/i/wPGVKn/ekspertene-og-erna-er-ikke-enige

Igjen spores pessimismen om at en vaksine ikke kommer. Den vil jo komme en gang. Og det er nok beintøff kamp om å komme først over målstreken med det også, for å sikre seg store salg.

 

Media har ihvertfall hengt seg på og henger ut Trump:

Quote

Trump truer med å holde tilbake penger til WHO

President Donald Trump sier han vurderer å holde tilbake den økonomiske støtten til Verdens helseorganisasjon (WHO) fordi den mislyktes i å stanse pandemien.

På den daglige pressekonferansen tirsdag kveld sa Trump at han ville «holde kraftig tilbake» på finansieringen av FN-organet. USA er den største enkeltgiveren til WHO.

– De gjorde en feil, de glapp, sa Trump om WHOs håndtering. Les mer her.

(NTB)

Sigurd Bjørnestad

https://www.aftenposten.no/koronaviruset

Trump synes det er best å true alle til å danse hans dans! Trump i et nøtteskall.

Endret 8. april 2020 av G

[G]

1 hour ago, Mr_Spock said:

Et par tiltak man kan passe på i disse tider - blant annet å trene lungene:

https://www.aftonbladet.se/nyheter/a/Vb8a1W/sa-kan-du-hejda-corona--och-avlasta-varden

 

LOL, det er ikke alltid like enkelt å få i seg denne væsken under og etter diare. Noen som opplever diare må av og til ha intravenøst. Dette har man tidligere sett i e.coli epidemier, bare for å sammenlikne med noe:

Quote

De flesta coronapatienter som kommer till intensivvården har dubbelsidig lunginflammation, är svårt uttorkade och har haft hög feber och diarréer i en vecka.

Läkare och sjuksköterskor uppmanar nu de som smittats att ta bättre hand om sig i ett tidigt skede – för att avlasta vården.

– Du ska dricka mycket och träna lungorna, säger Johan Styrud, överläkare på Danderyds sjukhus.

 

[G]

45 minutes ago, BadCat said:

Samfunnet kommer til å bli endret for lang tid. Kan ikke ha åpne grenser igjen siden det kan komme inn virus.  All gammel tankegang og Schengen-området må erstattes. Vær også klar for fremtidig nedstengning av samfunnet siden den terskelen nå er overskredet.

 det var da svært mørke tanker.

Løsningen er å følge bedre med, og så ha et apparat som kan strupe inn grensene til Norge veldig kjapt ved behov.

[Mr_Spock]

G skrev (1 minutt siden):

LOL, det er ikke alltid like enkelt å få i seg denne væsken under og etter diare. Noen som opplever diare må av og til ha intravenøst. Dette har man tidligere sett i e.coli epidemier, bare for å sammenlikne med noe:

 

Jeg tenkte mest på det å trene lungene med den enkle øvelsen - derfor jeg poengterte det - kanskje en anbefaling som burde gis til gamle/sykehjem osv. Eller for alle.

[G]

Før i tiden husker jeg de hadde et slikt program som het Trim for eldre på Nrk:

 

[helsten2]

1 hour ago, Mr_Spock said:

Nå var det jeg som trollet - men kanskje du skulle bli litt flinkere til å bruke "Jeg tror" og "Jeg synes" foran mye av det du skriver - så blir det mer interessant å diskutere med deg.

Det gjelder vel oss alle.

For å sitere Anders Tegnell: "Før Corona-krisen var det veldig få smittevernseksperter. Nå er plutselig alle eksperter!"

Må vel gi han litt rett der....

[Benbjo]

26 minutes ago, Mr.M said:

så vi rakk knapt få ei natt rolig søvn, i håp om at landet er på rett kurs, føre uenigheten kom til overflaten.

Egentlig burde jeg visst det, for det har murret under overflaten fra det hele startet, at FHI egentlig mener noe annet om håndteringen enn regjering, men har høflig holdt lav profil. (FHI anbefalte f.eks. ikke stenging av barnehaver, skoler, eller riksgrensa, det kom frem fra et lukket møte

https://www.aftenposten.no/norge/i/lA5k3y/slik-var-spillet-om-de-mest-dramatiske-tiltakene-i-norge-siden-krigen

Nå hevder altså FHI at det verste faktisk ligger foran oss, mens Bent Høie sier "vi har vært på (fjell) toppen, og nå på vei ned."

Ikke lett å vite hvem man skal tro mest på, fagmyndighetene eller politikerne...

Det kommer til å blusse opp igjen. Det er 100% sikkert. 

[Nopros]

ok67 skrev (24 minutter siden):

Var ein tur på den lokale post i butikk og henta ein pakke, der var det lite folk og god plass. Planen var etterpå å ta turern innom OBS Bygg for å kjøpe eit spann med maling, der var parkeringsplassen full, så eg stod over den. Tilsvarande på parkeringsplassen på City Cyd, den var også stappfull. Så virkar som at folk begynner å ta litt lett på det. Så fryktar vi må vil sjå eit oppsving i smitten etter påske, omtrent samtidig som barnehagane åpnar igjen...

Stygt redd for at du har helt rett. Vet at den lokale OBS Bygg satte omsettingsrekord i går.

[G]

Just now, Nopros said:

Stygt redd for at du har helt rett. Vet at den lokale OBS Bygg satte omsettingsrekord i går.

Nordmenn elsker jo å pusse opp hus og få det fint i hagen.

[Benbjo]

24 minutes ago, G said:

Igjen spores pessimismen om at en vaksine ikke kommer. Den vil jo komme en gang. Og det er nok beintøff kamp om å komme først over målstreken med det også, for å sikre seg store salg.

Åpenbart så vet FHI noe om vaksineforsøkene til nå - derav pessimismen. Det er jo ikke gitt at det er mulig å finne en vaksine mot dette og jo lenger tid det tar og flere blir smittet jo mindre sannsynlig er det at vaksinasjon er mulig (pga mutasjoner). 

[G]

Just now, Benbjo said:

Åpenbart så vet FHI noe om vaksineforsøkene til nå - derav pessimismen. Det er jo ikke gitt at det er mulig å finne en vaksine mot dette og jo lenger tid det tar og flere blir smittet jo mindre sannsynlig er det at vaksinasjon er mulig (pga mutasjoner). 

Du tenker på at viruset vil forandre seg så mye på så kort tid at vaksinen kommer til å henge etter i å kunne gi immunitet?

[Benbjo]

8 minutes ago, G said:

Du tenker på at viruset vil forandre seg så mye på så kort tid at vaksinen kommer til å henge etter i å kunne gi immunitet?

Ja. Bare på lille Island er det flere titalls varianter. På verdensbasis er det sikkert tusentalls. Når vi er ferdige med dette så er det kanskje millioner av varianter. 

Mener jeg leste at for hver 10 smittede muterer det 1 gang, men nå er jeg på litt tynn is. 

Spørsmålet er jo hvor mye viruset endrer seg hver gang ift hvor effektiv en vaksine eventuelt vil være. Og det er dersom det i det hele tatt er mulig å vaksinere mot dette. 

De er jo ikke sikre på at man blir immun engang etter sykdommen eller hvor lenge. 

Endret 8. april 2020 av Benbjo

[Mr.M]

Benbjo skrev (4 minutter siden):

Det kommer til å blusse opp igjen. Det er 100% sikkert. 

ikke kun av den grunn du mener, tror jeg (altså, vil blusse opp pga. barnehager og skoler?

nei, FHI mener det nærmest er en naturlov, at smitte-forekomsten vil øke, fordi vi ikke vil greie å gjemme oss unna på lang sikt. Dette uavhengig om barnehage/skoler hadde åpne 4 uker senere, eller hva som helst. Fordi en dag "må vi ut i lyset" alle mann.

Så vi er i grunn tilbake til utgangspunktet og det "ideologiske" skillet, som kan illustreres med håndteringen Norge vs Sverige, og kampen mellom fageksperter og politikere.

[Simen1]

helsten2 skrev (13 minutter siden):

For å sitere Anders Tegnell: "Før Corona-krisen var det veldig få smittevernseksperter. Nå er plutselig alle eksperter!"

Må vel gi han litt rett der....

Folk har av egen interesse lest seg opp og kurset seg selv intensivt i nettopp smittevern som aldri før. Menneskeheten har aldri hatt i nærheten av så god kunnskap om smittevern som nå, ute blant folk flest. Jeg synes ikke man skal prate nedlatende om det.

[Benbjo]

3 minutes ago, Mr.M said:

ikke kun av den grunn du mener, tror jeg (altså, vil blusse opp pga. barnehager og skoler?

nei, FHI mener det nærmest er en naturlov, at smitte-forekomsten vil øke, fordi vi ikke vil greie å gjemme oss unna på lang sikt. Dette uavhengig om barnehage/skoler hadde åpne 4 uker senere, eller hva som helst. Fordi en dag "må vi ut i lyset" alle mann.

Så vi er i grunn tilbake til utgangspunktet og det "ideologiske" skillet, som kan illustreres med håndteringen Norge vs Sverige, og kampen mellom fageksperter og politikere.

At barnehage og skole åpner er 1 faktor. Det er ingenting som tilsier at barn ikke smitter hverandre eller andre. Så dette er et eksperiment med potensielt fatale konsekvenser. 

Den andre faktoren er at Høie og co har gått ut og sagt at alt er under kontroll. Da slipper folk guarden og gjør mer eller mindre som før. I Oslo i dag har det flere titalls meter med kø for å komme inn på polet f.eks. 

Den eneste måten å hindre at dette går amokk på er å få antall nysmittede per dag ned på 0, så åpne opp og teste, teste, teste. Isolere, isolere, isolore. Spore, spore, spore. Men det er det ikke ressurser til i Norge.

[G]

Det har vel vært snakk om at når de får til universal flue vaccine, så kan dette kanskje også ha god nytte på andre typer virus. Kanskje også COVID-19, men akkurat det der tar jo tid. Var vel et selskap som har blitt halvveis promotert via dokumentarfilm på Netflix, som jobber med denne universelle vaksinen for influensa. Så kanskje en universell coronavirusvaksine også er mulig om en gir det noen års tid.

https://en.wikipedia.org/wiki/Influenza_vaccine#Universal_flu_vaccines

Quote

Around the world, more than 40 teams are working on a vaccine for Covid-19. We followed one doctor in the most urgent quest of his life.

<snip></snip>

Already, the temptation to accelerate the trials of Covid-19 vaccines is becoming apparent. Earlier this month, Donald Trump suggested using “a solid flu vaccine … on corona”. Not possible, scientists informed him. When he declared that a vaccine would be available within a few months, he had to be told that, in that time, vaccines would only be ready for testing. Ordinarily, human trials come after many phases of animal testing, but at least two companies – one of them Moderna – have decided to do both in parallel. The scientists I spoke to, though, kept telling me that testing couldn’t be rushed. “There will be many trials, and we need to be ready for some failures,” Heeney said. He leaned in towards his webcam as if to push his point physically through the internet to me. “We have to avoid overpromising, because if there’s an accident with one of those first vaccines – if someone gets ill and it gets into the Daily Mail, ‘New vaccine threatens survival’ or some ridiculous headline – then people won’t want to take even the later vaccines that do work. It’s a razor’s edge we’re walking here.”

<snip>

If huge swathes of society become infected before the vaccine is ready to test on humans, the trials will be difficult to conduct, said Sarah Gilbert, an immunologist at the University of Oxford’s Edward Jenner Institute for Vaccine Research. Gilbert’s team also has a vaccine candidate for Covid-19, based on an earlier vaccine it had devised for Middle East respiratory syndrome, or Mers, another coronavirus disease. In mid-March, Gilbert had to put an auto-response on her email. When her team was ready to recruit subjects for vaccine trials, it would be advertised on the website, she wrote. “Please do not contact me about volunteering.”

Gilbert’s worry is that, at the peak of infection, the virus will be bouncing so frantically around the population that “you can’t screen your volunteers. By the time you get their results back, they may have been exposed.” Organising trials after the peak subsides presents another problem, because so many people will have cultivated a natural immunity by then. Transmission will have dropped as well, Gilbert said – it’s hard to know how well a vaccine trial is going if the subjects aren’t being exposed to the virus at all. “This is herd immunity – good for the population, but it makes testing a vaccine more difficult,” she explained.

The best possible scenario involves delaying the pandemic’s peak – pushing it through the summer towards August, to buy scientists a few extra months to run their trials. “So we’d really be pleased,” Gilbert said sternly, “if everyone will just do what they’re being told and stay at home.”

https://www.theguardian.com/world/2020/mar/27/inside-the-race-to-develop-a-coronavirus-vaccine-covid-19

Endret 8. april 2020 av G