Is Covid-19 Impacting You, Your Carving or Your Local Mtn.?

[lowrider]

Jack yes you are correct USA not the worst in the world just my world, North America . In Canada we are seeing recalls on masks and volunteers are sewing new elastics on old stock masks. Things you don't expect in North America. Luckily we have resources to deal with hiccups like this. Work is underway to make 30,000 respirators and if were lucky enough not to need them they will be available for those that do. Stretching out exposure is the best of a bad plan . Making sure the medical community has the best equipment should be everyone's priority.  building capacity in the system is the main drive now by the Government. Workplace inspections are on the increase to protect workers concerned with health and safety. Farm workers still in short supply with an early spring in Ontario. Doctors are telling people not to do risky sports because orthopedics have limited access to operating rooms and beds. Ontario Premier is calling for more  testing, testing, needs to be the priority 13,000 a day has to be the goal. Presently  doing 1300 to 1500 per day.                                                   Anyone out there hiking for turns would be nice to see. Found some snow in the manure pile  today would have been nice to play in but was a little too yellow !                   Jack I wonder if Sweden's numbers are a factor of an older healthier demographics, Nursing home deaths are the main ones here at least for now. I wonder how the numbers would look if we subtracted average seasonal flue deaths.

[big mario]

Don't know 'bout the rest of y'all, but I've been doing a lot more day drinkin' since I've been furloughed...

[lowrider]

8 minutes ago, big mario said:

Don't know 'bout the rest of y'all, but I've been doing a lot more day drinkin' since I've been furloughed...

To get away from the day drinking (was thinking of starting a cocktail hour and my  wife agreed ) perhaps volunteering for that trip to Mars wouldn't be as isolating as previously thought . 

[dredman]

@big mario I see your Montucky Cold Snack!

[big mario]

47 minutes ago, dredman said:

@big mario I see your Montucky Cold Snack!

That was just for you Dave!

[John Gilmour]

20 hours ago, lowrider said:

John hyperbaric chamber is not the kind of device that's going to help more than 10 people in the USA given the limited number that exist are you suggesting we all go live in a submarine ? If you want to sit at the bottom of the harbor I have a half dozen scuba tanks you are welcome to ! Nice that you are using your life experiences to rationalize what's going on. You have a knack for writing interesting tales and I would buy your book if you ever decide to write one but I would consider it entertainment  you certainly  have had some colourful experiences not so much science and fact.

I never implied  ideas were practical.... haha.

 

I'm saying for those travelers who  COVID-19 at high altitudes- they should probably return to sea Level ASAP to increase the O2 for their lungs . It isn't practical to use byperbaric chambers or submarines for a number of reasons like quick  access by medical personnel. Though in some cases, it might be a better alternative. And I'm not saying everyone should go on Nuclear submarines with medical crews- and if you want to stay under for weeks at a time. haha.

But they do make some pressure bags, that they use for people that need a portable hyperbaric chamber for AMS. Covid-19 is  a weird disease that might need unconventional treatment for a minority of some of threatened  02 compromised patients to have better outcomes since ARDSnet isn't working out so well for a lot of the patients. Different therapies for different patients who present with different symptoms , not one size fits all. I could say if a hyperbaric bag were an option and I could avoid a vent, I'd probably go for the bag.. less chance to damage alveoli . Plus you have the benefit of being able to move a patient around without infection to others,  as you can control and filter provided that the patient looks stable .

http://hbot-therapy.com/durable-easy-to-set-up-compact-hbot-chambers-by-oxyhealth-llc/

 

https://www.chinookmed.com/06001/gamow-bag-hyperbaric-chamber-civilian-model.html

 

[John Gilmour]

19 hours ago, FrankNBeans said:

For sure. It seems you've made quite to flip-flop from encouraging people to share a condo with you in Brian Head as you left one cluster in Colorado and traveled through several rural communities in western Colorado and Utah:

John Gilmour

Trench Digger

Posted March 18

...ikon and epic pass holders get a discount along lift tickets about $35. Furthermore the base elevation in Brian ahead is the highest in Itah making corn snow and mashed potatoes A non issue at the bottom or simply a better ratio of packed powder to slush at the bottom .

lodging around that area is very affordable- and I am considering splitting costs near the mountain and making a carving condo. 
text me at 347-263-7238

 

I'm sure you're a nice guy, but being born on third doesn't mean you've hit a home run.

To answer that, at first I didn't believe it affected people at altitude like I do now. I also thought at ski resorts where you could ride alone on lifts WITHOUT gondolas you would be as safe as playing golf. I was still going to self quarantine in my car for 5 days before sharing any space as I had already self quarantined several days in my car in Aspen  . I was looking for just 1-2 other people to join my GF and her son (they aren't car campers)  who had already quarantined for 10 days . And we didn't know the high asymptomatic rate at that time. I self quarantined for an additional  7 days in my car when I arrived back in the Orange County  and got tested as soon as they could take me a few hours after I woke up.

I did not end my quarantine until I got a negative test result- just stayed in the driveway, not fun. My exposure in Colorado was almost zero because my turtles were banned this year from Apres ski. I was living in my car for every single night in Colorado and did not eat in any restaurants in town (very low budget this season-camping stoves etc.)  and only ate a single dinner at a friends house . SO compared to other snowboarders in Aspen my exposure was about the least possible. But I still don't take chances. I even bag my footwear in the car and spray it.

Having the typical  western 50-200 feet between skiers in the open air, while you ski with a Ski face mask (maybe a mask under that)  and goggles and gloves and you wipe down everything with sanitizer before you go in your car IMHO, probably not that risky. Watch out for kids wiping  snot on the chairlift bar.

Being on third? Not even close... behind in EVERY possible bill like the rest of America...COVID-19 totally screwed me including my off season income.

Edited April 9, 2020 by John Gilmour

[philw]

18 hours ago, Jack M said:

We shall see.  One thing I find puzzling is Sweden.  They have taken a unique and cavalier approach to dealing with the situation, with  minimal restrictions.  Personally I disagree with this, but their case rate is lower than ours - 834 cases per million vs 1210.  However their mortality rate is considerably higher, 8.2% vs 3.2%.  I wonder how this is.

Apologies if it's already in the thread, but it kind of depends quite a lot on how you define "mortality rate".

The percentage of all deaths in which the virus is subsequently found would be one metric. Another could be the percentage of people you tested who subsequently died. It's easy to see that these will produce vastly different answers depending on a nation's specific approach and circumstances.

Without considerably more sophistication you're not going to be able compare different metrics gathered in different ways. I'd be more interested in looking at trends in specific country metrics, where you know that a country has or has not changed methodology (of data collection or process). Comparing the rates of change in different countries is probably more useful than comparing absolute numbers too.

[Jack M]

3 hours ago, philw said:

Apologies if it's already in the thread, but it kind of depends quite a lot on how you define "mortality rate".

I'm looking at this:

https://www.worldometers.info/coronavirus/#countries

And dividing total deaths by total cases.  I know there are all kinds of flaws with this, including selection bias, because tests are relatively scarce and are only being administered to people who have more significant symptoms.  Or at least they were.

4 hours ago, John Gilmour said:

I did not end my quarantine until I got a negative test result

How did you get tested?  Did you have symptoms?  My daughter and I flew home from CO on 3/16, and she developed a persistent cough.  They wouldn't test her because she didn't have a fever, and was not deemed at risk.

 

19 hours ago, lowrider said:

I wonder how the numbers would look if we subtracted average seasonal flu deaths

normal seasonal flu numbers aren't in the COVID numbers, or did I not understand you?

[TVR]

I would like to see the test for the Antigen released as soon as possible. Once we know who has the antibodies, we can know when we can get back to normal. People who are immune don't spread it, nor if exposed are they susceptible, so it makes sense when we pass a threshold of immune individuals, life can get back to normal.

The reality is, most people are not presenting with symptoms. Those individuals form an immunity, and never present any visible signs to show they were exposed. Once we have a way to determine you have been exposed, and have the Antigen, this will all be behind us. Right now, as the test exists, it is only a matter of the FDA to allow the test to be used. 

On a side note, think how much good the test could also do for those in the first responder role? If you are immune, your main concern is then to not spread the transmission, and less on self preservation, and mental toll relief would be immense. Additionally, autopsy's could be done again as currently they are not being performed due to the risk or particulates.

[lowrider]

I was wondering about the reliability of data and how the initial  covid 19  numbers compare to season flue deaths. Those susceptible to death from flue are  virtually the same or similar to those who die from covid 19 ( massive generalization on this point )  It will be many months before verified analysis will be able to make heads or tales  of the stats being collected. And then the obvious spin that will be used to argue afterward. Verifying cause of death for each case is important to have confidence in data and analysis moving forward. 

[Jack M]

12 minutes ago, lowrider said:

I was wondering about the reliability of data and how the initial  covid 19  numbers compare to season flue deaths.

As far as I can tell the mortality rate for COVID is about 10 times higher than the common flu in the US.

You can sort of get an idea here: https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

Looks like about 0.1% mortality rate.

But those are estimates.  When you do similar estimations for COVID, the mortality rate is closer to 1% in the US as of March 30:

https://www.cnn.com/2020/03/30/health/coronavirus-lower-death-rate/index.html

[BobD]

3 hours ago, lowrider said:

I was wondering about the reliability of data and how the initial  covid 19  numbers compare to season flue deaths. Those susceptible to death from flue are  virtually the same or similar to those who die from covid 19 ( massive generalization on this point )  It will be many months before verified analysis will be able to make heads or tales  of the stats being collected. And then the obvious spin that will be used to argue afterward. Verifying cause of death for each case is important to have confidence in data and analysis moving forward. 

I think the view on that has changed  'All our ICU patients are in their 50s or younger' 

 

 

 

[SunSurfer]

@Jack M

https://fivethirtyeight.com/features/coronavirus-case-counts-are-meaningless/

Case counts between countries, and even states of the US are almost certainly not comparable due to differences in the availability of testing and who is able to be tested. Ratios of diagnosed cases to admissions to hospital and to Covid deaths (again method for determining death caused by Covid varies) vary very widely. As an an example at one extreme New Zealand has widely available testing, active tracking testing and isolation of all known close case contacts, is diagnosing Covid both clinically (suspected cases) and as test positive (confirmed cases), has 1239 cases total (suspected + confirmed), less than 20 people in hospital with Covid, 4 patients in ICU care across the whole country, and 1 death so far. Most of our ongoing new cases have been in identified contacts who were already isolated before clinical symptoms developed.

That suggests that in many countries the actual number of cases are vastly under reported, cases are unrecognised, and as a result spread is likely to continue because of failure to adequately isolate infected people.

@John Gilmour Apologies for me losing my rag. I took a day off from here afterwards to cool off. The explanation below is pitched for the general reader, not for someone who has any formal training in human physiology.

Lots of critical care docs have thought very hard, for a very long time, about how to deal with the impact of disease processes on the lungs. Adult Respiratory Distress Syndrome (ARDS) is an end point for a wide range of illnesses in terms of their impact on the lungs. Patients with lung infections, generalised infection (sepsis), traumatic injury, burns, illnesses like pancreatitis can all end up with ARDS. I've treated lots of patients with ARDS.

Oxygen is one of the things that keeps us alive. Our lungs allow us to extract oxygen from the air we breathe, get it into our blood, and then our red blood cells carry it to our tissues were it diffuses through to the energy factories in our cells called mitochondria. Red blood cells don't use the oxygen they carry, just one of the body's bits of fine tuning.

For the system to work there has to be enough oxygen in the air that we breathe. At high altitude the low barometric pressure doesn't change the proportion of oxygen in the air, it's still 21%, but it does decrease the absolute pressure of oxygen. At sea level barometric pressure is 760mmHg, so that the oxygen pressure is 760 x 0.21 =  approx. 150mmHg. At 2500 metres altitude, roughly the altitude in Aspen, the barometric pressure is approx 550mmHg so that the actual oxygen pressure is now 550 x 0.21 = approx. 110 mmHg.
A Gamow bag is used to treat severe altitude sickness on the mountain by increasing the barometric pressure around the sufferer, and results in an increase in the absolute oxygen pressure available without needing to use an oxygen cylinder.

Too much oxygen in the air that we breathe is also possible. Higher than 21% concentrations cause a range of problems, but higher than 450 mmHg absolute pressure causes direct toxicity to the very thin walled cells (Type 1 alveolar cells) in the air sacs (alveoli) in our lungs that allow the movement of oxygen from the air into our blood. The body replaces the damaged cells with cells that are much thicker which makes it much harder to get oxygen into the blood. You can easily raise the oxygen concentration up that level without needing a hyperbaric chamber.

To get effective transfer of oxygen from the air to the blood you need good matching of air in the air sacs of the lungs to the flow of blood through the lungs. If air sacs collapse, or are filled with fluid and secretions as a result of infection, or other reasons, then blood continues to flow past those air sacs but doesn't get to pick up oxygen, or get rid of the carbon dioxide the body has been producing when it burned fuel using the oxygen. In ARDS there are lots of flooded and/or collapsed air sacs in the lungs.

All of your blood flow goes through the lungs all the time. The other organs in your body only get a share of the total blood flow. If more than 25% of your total blood flow through the lungs doesn't get to pick up oxygen, then no matter how high the oxygen pressure goes, the oxygen level in the blood carrying oxygen to the rest of the body will be lower than normal. The normal level can only be restored by opening up some of the collapsed or flooded air sacs. That's where ventilators and endotracheal tubes come in.

The tube seals off the lungs, allowing complete control over the oxygen pressures and the pressures applied to the lungs. A modern ICU ventilator allows the patient to be breathed for, but even more importantly is able to sense when the patient is trying to breathe for themselves and to effectively assist them to do so.
The breathing tube allows suction tubes to be put down, clearing out fluid just as you would use a vacuum cleaner to clean your house.
Amongst the things that critical care doc do is to carefully apply a constant distending pressure to the lungs between breaths (positive end expiratory pressure or PEEP), trying to open up those collapsed air sacs to allow the lungs to better exchange oxygen between gas and blood.
They may also put the patient into different positions, on their sides, or even face down, to change the traction effect of gravity upon the lung tissues and so help to open up air sacs that were previously at the effective "bottom" of the lung and so kind of squashed, by now putting them at the top where gravity effectively pulls them open.

When the lungs get really gunked up and even these treatments are not sufficient to sustain the oxygen supply, then there is one more strategy available. Extra corporeal membrane oxygenation (ECMO). Basically a machine is used to replace the lungs and to transfer the needed oxygen into the patient's blood. Critical care docs in first world countries have got better at utilising ECMO in recent years, but it remains an incredibly invasive treatment needing lots of skilled staff to make it work.

Intensive care doesn't cure anything. Instead it helps to keep the patient alive while other treatments and the body's immune system cure the underlying illness.

 

Edited April 10, 2020 by SunSurfer

[philw]

16 hours ago, BobD said:

I think the view on that has changed  'All our ICU patients are in their 50s or younger' 

I'd be a bit careful with that quote, which can be misleading without significant qualification.

Spiegelhalter has a good summary including UK stats on risk versus age from ICL. I have worked with them and their data is NHS, absolutely everyone' in the country is included.

https://medium.com/wintoncentre/how-much-normal-risk-does-covid-represent-4539118e1196

If your point is that no one's guaranteed to survive, that's certainly true. However that risk increases with age, and this has not changed. Spiegelhalter points out that the ICL risks are "averages". So for example if you're on the Long Term Conditions register, your risk is significantly higher, which is why those 1.5M people are getting special care at present.

Unless something changes, sooner or later we're all going to get it, but the risks are not the same for everyone.

[lowrider]

Looking forward to the day when we can be tested to see if we have been exposed .

[pow4ever]

This seems interesting:

https://www.tillett.info/2020/04/05/a-solution-to-covid-19/

Find a weaker but similar strand virus.

[softbootsurfer]

Yes it Is !!

Colorado is and has been basically closed, for a month...that has been the Intent anyway...

Colorado has a population of 5,759,000

as of today, 37,000 have been tested with 7,300 confirmed

One of my Friends has died from it...5 other Friends, in our approximate age group ( over 70 ) have had it and recovered

I predict the closure, is too much of a hardship, on the general population and things will open backup,  starting around the 1st of May 

We will see...I am not assigning any BLAME in this post

 

[BobD]

On 4/10/2020 at 6:35 AM, philw said:

I'd be a bit careful with that quote, which can be misleading without significant qualification.
 

Obviously this is just one hospital. The quote is given in that context. I think the value of the quote and the video is that people of all ages are ending up in ICU with severe respiratory problems, but it is the very old who  are less likely to recover.

[philw]

15 hours ago, BobD said:

Obviously this is just one hospital. The quote is given in that context. I think the value of the quote and the video is that people of all ages are ending up in ICU with severe respiratory problems, but it is the very old who  are less likely to recover.

It's a selective and unrepresentative anecdote.

If you're familiar with the NHS in Wales, then you'd know that hospitals don't work individually. Here's the top level data. The NHS's advice (see below, my bold) suggests those who are most at risk. Individual NHS clinicians aren't statisticians and they will only see patients triaged into their care, which is why we collect and use data.

If I sound like I care then possibly that's because my software collects and collates some of these data.
 

Quote

 

"...those who are at increased risk of severe illness from coronavirus (COVID-19)... includes those who are:

• aged 70 or older (regardless of medical conditions)
• under 70 with an underlying health condition listed below (ie anyone instructed to get a flu jab as an adult each year on medical grounds):
• chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
• chronic heart disease, such as heart failure
• chronic kidney disease
• chronic liver disease, such as hepatitis
• chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
• diabetes
• problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
• a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
• being seriously overweight (a body mass index (BMI) of 40 or above)
• those who are pregnant

 

source

[John Gilmour]

Oh Jack, Laguna Beach currently has test results with the highest per capita rate in Orange County positive COVID-19 rate in part because a higher percentage of people were tested, and tests were free. 

 

I called one place at Caldeus 333 Thalia Laguna Beach at a time when there were only 17 cases in OC. I explained I could not stay in Aspenany longer and was returning to Orange Country (6th most populated county in the USA) from a Colorado Cluster Area and was going to stay away from housemates for 7 more days but wanted to know if I should take more extreme measures if I were tested  Positive (like not going out at all- having others shop for food for me etc. ) . With Orange County wanting to do as much as they could to identify positive cases and quarantine (this was well before Shelter in place) they also felt it was worth testing me as the Aspen Cluster was the biggest in Colorado. I also wore masks starting on March 13th and people looked at me like I was nuts and continued to wear them after March 20 even though I was Negative . Now everyone wears masks.

 

 

BTW- this is a ridiculous small sample size- normally if results were mixed I'd disregard it entirely... however all the results skew one way and by a good amount.

 

Again just looking at the fate of the National Brotherhood of Skiers.In that most were shorter domestic flights but again, these flights are pressurized to 5000-8000 feet more to the high end.

 

https://www.powder.com/stories/news/are-ski-areas-responsible-for-the-spread-of-covid-19/

As if March 19 40% of Norways cases can be traced to this resort" (Ischgl)  a high one well over 14,000 feet. So you fly in pressurized to 8000 feet and then ski over 14,231 feet. That would completely destroy my ability to breathe without slow acclimatization ...whcih is why I find Aspen's 4 separate areas manageable incrementally.

For me arriving in Aspen  I ski Buttermilk the first day 9,900 feet , then Aspen AJAX 11,212 for a week or more before considering Aspen Highlands 11,675 chair access ...top of bowl 12,392 feet and lastly Snowmass at over 14,098 feet. It might not seem like huge difference but physiologically it is. For me its the difference between staying in Aspen or taking the next direct flight to Phoenix or LAX to stop my altitude sickness from becoming HAPE.

You pass a threshold and suffer. I think Covid-19 likes what altitude does to a non acclimatized person and people with genetics that react to altitude differently. 

I'm not going to blame it all on ski resorts, but you  might think that those with larger capacity Gondolas might have more transmission but Sun Valleys gondola is not bigger than Aspens. However Ischgl has a much bigger gondola like  Squaw Valleys.

Just saying that non acclimatized people under altitude duress even if mild might be more likely to contract and suffer from Covid-19 which will infect a weaker immune system (yes we have no immunity for this, but likely there is a viral load threshold for infection that could be lower for those under altitude duress )  and possibly propagate faster and shed more virus as a result.  Drinking isn't likely to help as AMS and HAPE are easier to get if you drink, and the prevalence of smoking in European resorts with deep inhalation probably kicked it up a notch .Lots of smoking in many Asian countries too. Smoking and drinking go hand in hand.

My concern is:

IF high altitude ski resorts do prove to have more transmission....and COVID-19 (which apparently has already mutated) is something you can get next year in a new strain.... oh shit.

 

 

Edited April 15, 2020 by John Gilmour

[softbootsurfer]

top of Snowmass 12,510 ft. for clarification

also, isn't the Post, about the CIA, saying China, is misrepresenting info, a Political Statement? 

[SunSurfer]

@John Gilmour

https://www.theguardian.com/world/2020/may/03/pharma-giant-roche-gets-us-go-ahead-for-covid-19-antibody-test

Seriously now, the linked article explains why initially every man and his dog were able to market Covid-19 antibody tests in the USA. The test Roche have just had approved by the FDA sounds like it's pretty reliable, as in it's highly likely to detect the antibody if you have it, and relatively unlikely to give you a false positive result. The other major manufacturers approved by the FDA will presumable have similar reliability stats.

[SunSurfer]

NZ signalled a move to a lower level of social restriction today that will allow travel within the country. Single digit new case diagnoses for the last 10 days or so, with all new cases in isolation prior to diagnosis because of links to prior cases. Some of these cases have been completely without symptoms and only detected by routine testing prior to return to work.

But, if we can stay at this level or lower, in 3 months exactly I will be in Central Otago with 4 boards and 3 weeks to carve them. Fingers crossed.

 

[philw]

I'd fly out there to play, but I suspect the logistics of that may be practically impossible, in terms of getting out of my country, transit somewhere or other, and then getting into a virus-free country.

I think the world noticed before that Jacinda Ardern isn't daft.