COVID-19 POCUS – Day 15, Thoughts About The Pandemic

Point Of Care UltraSound & COVID-19  

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

Image: common findings in patients with COVID-19 pneumonia. Adapted from Peng et al 2020.


POCUS with focus on lung ultrasound is a great additional diagnostic tool for us at the ER and ED to help diagnose and monitor the development of our patients with COVID-19 pneumonia.

First, look at the pleural line, and do it systematically.

zones
Image: one example of dividing the thorax into different zones for point of care lung examination with ultrasound. From Arbelot C et al 2020.  


It doesn’t matter what numeric zone standard you use, what matters is that you are consistent and systematic.

Once you start looking at the lungs apically in a healthy lung you’ll see the following:

A - Lines - Normal Lung
Image: healthy lung. 


The pleural line is visualized at top of the image as a thin & regular white line (no sign of inflammation/infection), there is movement/lung sliding (no sign of pneumothorax), and there is a-lines (the second horizontal white line below the the top one – a sign of a “dry” lung”).

In a COVID-19 pneumonia what you’ll (sometimes) get is the following pleural line:

Day 4

Image: day 4 after symptoms, in a patient developing a COVID-19 pneumonia. 


The pleural line above is irregular, there is a bump in the pleura (sign of a infection/subpleural consolidation), and b-lines following that bump (the moving vertical line, sign of a “wet” lung).

Day 5
Image: day 5 after symptoms, in a patient developing a COVID-19 pneumonia. 


Between the pleural line in the image to the left above and the thorax wall there is now fluid/edema shown as black (fluid becomes black with ultrasound). There are also several b-lines (signs of a “wet” lung, in other words: interstitial fluid) in each of the two captured images above, initially my experience is that these are seen more peripherally in some patients while they can maintain a-lines central/apical (COVID-19 seems, radiologically, to affect the lungs more peripheral/lower parts/subpleural *).

 

Pleural Findings in COVID-19
Image: pleural findings in a more advanced COVID-19 pneumonia.


Presumably a (radiologically) more severe pneumonia seen in the image above, with shredding (a highly irregular/inconsistent pleural line), several bumps indicative of infection/subpleural consolidation, and more prouncanced amount of fluid/edema between the pleural line and the thoracic wall.

Classic Findings in Pneumonia
Image: plural findings in a patient with bacterial pneumonia.


The patients with COVID-19 can also get a secondary bacterial infection as an addition to their COVID-19 pneumonia. In the image above signs of a larger subpleural irregularity is seen in the middle of the pleura line with consolidation (signs of a collapsed piece of lung) and within it: static air bronchograms (air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white), it is almost always caused by a pathologic airspace/alveolar process, in which something other than air fills the alveoli *). Keep in mind that static airbronchograms do not rule in bacterial pneumonia, they can also be a feature of just a COVID-19 pneumonia – a sign of resorptive atelectasis. You’ll need to look at the clinic and lab results for additional guidance as (almost) always with POCUS.


The COVID-19 pneumonia does not seem to produce large amounts of pleural effusion, however small amounts can be seen, sometimes also alongside with posterior/diafragmal/lower lung b-lines.

Sources: 

COVID-19 Numbers Sweden 2020-04-08 *

  • 687 deaths nationally
    • 419 of them in Stockholm
  • 8 419 confirmed cases nationally
    DEATHS [SWE]
    8fhmd
    New confirmed deaths daily in Sweden. 

    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    ICU [SWE]
    8fhmi
    New Covid-19 patients Being Treated at the ICU in Sweden. 

    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    NEW CONFIRMED CASES [SWE]  
    8fhm
    New confirmed cases daily in Sweden.
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    TOTAL CONFIRMED CASES [SWE]  
    8fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 681 COVID-19 confirmed patients treated in the ICU in total so far
    • 10,2 days from symptoms to ICU
    • 24,4 % women
      7sir
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week for the first 4 weeks. From week ten: 5 →  24  → 130 → 420 → 743 → (856 this week up until now, however since it’s only wednesday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-08 at 14:00 CET) *

  • 79 385 confirmed deaths
  • 1 356 780 confirmed cases
  • 6 695 new deaths, daily change: 33,37%

Image: Denver Health & The POCUS Altas on COVID-19 findings with lung ultrasound *

Denver Health COVID US lung

That’s it until tomorrow, keep calm and stay safe!

 

WORK EAT SLEEP – REPEAT – Day 14, Thoughts About The Pandemic

ROUTINES  

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 


12 hour shifts on repeat.


The game is catch up in between, trying to get enough rest and nutrition to do it all over.


Trying not to get sick.


Everything none essential is on hold.


Life is on paus.


What matters is making it through to the next shift.


And repeat.

COVID-19 Numbers Sweden 2020-04-07 *

  • 640 deaths nationally
    • 381 of them in Stockholm
  • 7 693 confirmed cases nationally
    DEATHS [SWE]
    7fhmd
    New confirmed deaths daily in Sweden. 

    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    ICU [SWE]
    7fhmi
    New Covid-19 patients Being Treated at the ICU in Sweden. 

    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    NEW CONFIRMED CASES [SWE]  
    7fhmfall
    New confirmed cases daily in Sweden.
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    TOTAL CONFIRMED CASES [SWE]  
    7fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 645 COVID-19 confirmed patients treated in the ICU in total so far
    • 10,2 days from symptoms to ICU
    • 23,7 % women
      7sir
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week for the first 4 weeks. From week ten: 5 →  24  → 130 → 420 → 739 → (813 this week up until now, however since it’s only tuesday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-07 at 20:00 CET) *

  • 77 776 confirmed deaths
  • 1 282 931 confirmed cases
  • 5 022 new deaths, daily change: 4,39%

That’s it until tomorrow, keep calm and stay safe!

War-like Scenes in the ER – Day 13, Thoughts About The Pandemic

WE ARE ALL IN THIS TOGETHER 

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

1cnn

I’m in between night shifts working in the Emergency Department at of one the major emergency hospitals in Stockholm, Sweden. The article * above, published today, also describes the scenes in the ER of our hospital. The same thing that is happening in NY is happening in Stockholm.

It’s not chaos to them, but to an onlooker, it seems like hell.

“They’re so sick you lose them in a heartbeat, they’re that sick,” respiratory therapist Julie Eason told CNN. “They’re talking to you and then a few minutes later you’re putting a tube down their throat and you’re hoping that you can set the ventilator in such a way that it actually helps them.”

This is the truth of what coronavirus is doing to thousands of Americans, and likely will to many thousand more. It has been largely unseen because visitors are not allowed to be in hospitals, and everyone else is staying home.

This has become our reality, unseen by civilians due to visiting restrictions.

The volume of people coming to the ER is lower than before the virus, but because they are all suffering from Covid-19, the patients are sicker and the death rate is high. Nearly 25% of the patients admitted to the hospital with the virus have died.

“It’s not the hospital it’s the nature of the disease,” Dr. Lorenzo Paladino, an emergency medicine physician, told CNN.

There are no broken bones or stomach viruses these days. These doctors are only seeing people who are struggling to breathe because they’ve contracted the virus that’s caused a pandemic across the globe and is now heading to a peak in New York City, according to some scientists.

More and more patients are coming to SUNY Downstate by the day, its doctors said.

“It’s relentless,” Paladino said.

And there is no time for rest. CNN reporters saw a health care worker wrap the body of a deceased patient. Within 30 minutes, the body was gone, the space was sanitized and there lay a critically ill man, coughing, with an oxygen mask on his face.

The amount of really critical patients is overwhelming and me and my colleagues struggle to keep up.

Except we can’t.

It’s overwhelming.

It is truly relentless at this point.

 

And it will only get worse.

Of the nearly 400 people admitted for Covid-19 treatment at the hospital, 90% of them are over the age of 45, and 60% are older than 65, staff said. But it’s not only an affliction for the old. Their youngest patient was a toddler, age 3.

“We have some young people in there in their 20s, not used to seeing this and some had a thousand-mile stare, just crying,” Paladino said of patients seeking treatment for coronavirus in the emergency room.

Many of the patients we are seeing are not old with multiple underlying diseases.

They are middle aged.

And they are in severe respiratory distress.
2cnn

What’s happening in NY is happening in Stockholm is happening in all the major ED’s and ER’s in the world.

We are all in this together.

We will get through this together.

COVID-19 Numbers Sweden 2020-04-06 *

  • 477 deaths nationally
    • 303 of them in Stockholm
  • 7 206 confirmed cases nationally
    DEATHS [SWE]
    6fhm
    New confirmed deaths daily in Sweden. 

    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    ICU [SWE]
    6fhmi
    New Covid-19 patients Being Treated at the ICU in Sweden. 

    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    NEW CONFIRMED CASES [SWE]  
    6fhmd
    New confirmed cases daily in Sweden.
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    TOTAL CONFIRMED CASES [SWE]  
    6fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 601 COVID-19 confirmed patients treated in the ICU in total so far
    • 10,2 days from symptoms to ICU
    • 24,3 % women
      6sir
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week for the first 4 weeks. From week ten: 5 →  24  → 130 → 420 → 730 → (744 this week up until now, however since it’s only tuesday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-06 at 14:00 CET) *

  • 67 666 confirmed deaths
  • 1 221 214 confirmed cases
  • 5 799 new deaths, daily change: -12,98%

Image: COVID-19 Case Comparison by WHO region *

casecomp

That’s it until tomorrow, keep calm and stay safe!

Another Night Shift – Day 12, Thoughts About The Pandemic

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

Starting yet Another 12,5 hour nightshift in 30 minutes, scheduled for six of them in the upcoming week.

Don’t have time for a full post, so here goes my thoughts before my night shift.

This weekend from the thoughest yet.

We are at the edge of the brink and our ICUs are now very close to maximum capacity.

What comes next is unprecedented for Swedish healthcare, what comes next is trying to save as many as possible with limited resources.

 

Amat Victoria Curam – Day 11, Thoughts About The Pandemic

Preparation

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

Amat victoria curam‘ – its latin for ‘Victory Loves Preparation‘.

Long after the COVID crisis is over there is considerable amount of data review and analysis left to do for the NGOs and global governments to help us be prepared for the next virus.

Because this will happen again.

This graph of number of critical care beds in Europe paints the picture, Sweden ranks in the bottom: *

Numbers of critical care beds corrected for size of population (per 100,000 inhabitants) for European countries  

Prior Preparation Prevents Poor Performance – also called the five P’s, is an idiom that was our mantra during my military service.

There is sometimes a sixth ‘P’ added to the idiom above: Prior Preparation Prevents Piss Poor Performance.

There is no doubt that our performance in Sweden been piss poor due to the lack of good preparation.

This graph of number of total hospital beds in Europe paints the picture, Sweden ranks, again, in the bottom: *

Chart: Germany Leads Europe In Hospital Bed Capacity | Statista

For years politicians, against the the alarms and opposition of the healthcare profession, have been dismantling our hospitals, our emergencies, and our intensive care units.

One can hope that they will do their risk-analysis properly this time around.

One can hope the era of just in time is partially over and the value of just in case again becomes apparent.

We MUST be better prepared next time.

Amat Victoria Curam.

COVID-19 Numbers Sweden 2020-04-04 *

  • 373 deaths nationally
    • 230 of them in Stockholm
  • 6 443 confirmed cases nationally
    DEATHS [SWE]
    4fhmdNew confirmed deaths daily in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    ICU [SWE]
    4fhmi
    New Covid-19 patients Being Treated at the ICU in Sweden. 

    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    NEW CONFIRMED CASES [SWE]  
    4fhm
    New confirmed cases daily in Sweden.
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    TOTAL CONFIRMED CASES [SWE]  
    4fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 520 COVID-19 confirmed patients treated in the ICU in total so far
    • 10,0 days from symptoms to ICU
    • 24,8 % women
      3sir
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week for the last 4 weeks, 5 →  24  → 130 → 421 → (641 this week up until now, however since it’s only saturday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-04 at 10:00 CET) *

  • 56 985 confirmed deaths
  • 1 051 635 confirmed cases
  • 207 countries, areas or territories with cases

Image: Projection of COVID-19 Deaths in USA by August 4th (With Interventions) *

modelusa

That’s it until tomorrow, keep calm and stay safe!

COVID-19 is NOT a Black Swan – Day 10, Thoughts About The Pandemic

NOT a Black Swan

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

A Black Swan event is, according to Nassim Nicholas Taleb in his book published in 2007, defined by 3 criteria: *

  1. They are hard to predict.
  2. They have high consequences.
  3. They are retrospectively predictable because of psychological bias.

The COVID-19 pandemic is NOT a black swan.

The COVID-19 pandemic does not qualify as a black swan because it was not hard to predict, in fact many people have warned against the inevitability of a virus pandemic years before. One of them was Nassim Taleb, who also wrote this in his 2007 book:

“As we travel more on this planet, epidemics will be more acute — we will have a germ population dominated by a few numbers, and the successful killer will spread vastly more effectively. I see risks of a very strange acute virus spreading throughout the planet.”

Among yet others, Bill Gates also warned against pandemics in his TED Talk 2015, saying that we needed to get better prepared for such an inevitable event:

The COVID-19 pandemic was not a black swan, it was a white swan in plain sight.

We have passed 50 000 COVID-19 deaths globally this week. *

The global community should of been considerably more prepared, and this pandemic could of been avoided or at least mitigated to a large extent.

COVID-19 Numbers Sweden 2020-04-03 *

  • 333 deaths nationally
    • 206 of them in Stockholm
  • 6 078 confirmed cases nationally
    3fhm
    New confirmed cases daily in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    3fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 461 COVID-19 confirmed patients treated in the ICU in total so far
    • 9,9 days from symptoms to ICU
    • 24,3 % women
      3sir
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week, 5 →  24  → 130 → 421 → (623 this week up until now, however since it’s only friday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-03 at 18:00 CET) *

  • 50 489 confirmed deaths
  • 976 249 confirmed cases
  • 206 countries, areas or territories with cases

Image: COVID-19 Deaths in Each Age Group in Sweden (Updated 2020-04-03) *

3fhmd

That’s it until tomorrow, keep calm and stay safe!

The Curve – Day 9, Thoughts About The Pandemic

Death Toll Still Rising in Most Countries

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

Woke up 30 minutes ago, it’s 20 pm here and I’m off to my fourth night shift in a row at the ER. Since I’m short on time for writing today’s post, this one is a short post with some take home messages from Financial Times page on the latest numbers on Covid-19: *

  • The human costs of the coronavirus outbreak continue to mount, with more than 917,000 people infected globally. The number of people confirmed to have died from the virus has now surpassed 46,000. 

  • More than ten countries are now seeing weekly death tolls in the hundreds or even thousands, and in all but a handful of cases those numbers are still going up.

  • The world’s new urban epicentre is New York, where each day brings more coronavirus deaths than the last. The state’s death toll is rising faster than in any other subnational region at this stage of its outbreak.

For Europe and the US the worst seems yet to come.

COVID-19 Numbers Sweden 2020-04-02 *

  • 282 deaths nationally
    • 164 of them in Stockholm
  • 5 466 confirmed cases nationally
    2fhm
    New confirmed cases daily in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    2fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 445 COVID-19 confirmed patients treated in the ICU in total so far
    • 9,8 days from symptoms to ICU
    • 24,5 % women
      1SIR
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week, 5 →  24  → 130 → 418 → (558 this week up until now, however since it’s only thursday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-02 at 10:00 CET) *

  • 45 526 confirmed deaths
  • 896 450 confirmed cases
  • 205 countries, areas or territories with cases

Financial Times New Deaths Per Day Selected Countries (updated yesterday 2020-04-01 at 19:00 GMT) *

2ft

Image: Death Tolls are Still Accelerating in Most Countries (Updated 2020-01-01) *

1ftaccel

That’s it until tomorrow, keep calm and stay safe!

Covid-19 & Damage Control – Day 8, Thoughts About The Pandemic

Who Gets Critical Care when Resources are Scarce? 

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

There are no margins left.

We are at maximum capacity.

Weeks of preparation and mobilisation and we’re already at the brink.

Our ICUs have almost filled up.

Our emergency wards keep filling up but soon there will be no beds or respirators left at the ICU to move the critical Covid-19 patients to from our wards.

Most of my colleagues are exhausted after their shifts.

Many of my colleagues have called in sick, presumably infected with Covid-19.

A few of my colleagues are being treated in the ICU for their Covid-19 pneumonia, presumably with severe ARDS.

This is the closest Sweden has gotten to wartime medicine in modern times.

Our resources are almost depleted.

What comes next is damage control.

What comes next is also choosing who should get intensive care, not only who needs it.

What comes next is a kind of prioritization of resources most of us never been forced to do before (notwithstanding those who worked in certain areas outside of Sweden or in warzones).

To help guide clinicians, The National Board of Health and Welfare (Socialstyrelsen), has created ethical guidelines to help us decide who gets the finite resource of intensive care. *

The guidelines are titled:

National principles for prioritization in intensive care under extraordinary circumstances.

This is a time of extraordinary circumstances.

This is not a drill, it’s not a dream, and it’s not an April fools’ joke.

This is a global emergency.

This is happening right now, it’s happening to us, it’s happening to our jobs and financial systems, it’s happening to our loved ones, it’s happening to our health care workers – it’s happening to you.

We are at the point of damage control and we must do all we can to mitigate that damage in the best way we can.

As emergency physicians this is no different from what we have always done, what we have trained for, only now it’s more critical and in a larger scale than it has ever been in our lifetime.

The state of play has changed and now we must change the state of play.

COVID-19 Numbers Sweden 2020-04-01 *

  • 239 deaths nationally
    • 148 of them in Stockholm
  • 4 947 confirmed cases nationally
    1fhm
    New confirmed cases daily in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    1fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 402 COVID-19 confirmed patients treated in the ICU in total so far
    • 9,3 days from symptoms to ICU
    • 25,0 % women
      1SIR
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week, 5 →  24  → 130 → 413 → (501 this week up until now, however since it’s only weednesday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-01 at 10:00 CET) *

  • 37 203 confirmed deaths
  • 783 360 confirmed cases
  • 205 countries, areas or territories with cases

Financial Times New Deaths in the Past Week Selected Countries (updated yesterday 2020-03-31 at 19:00 GMT) *

1ft

New Resources Added to ※ CTSOP

Image [SWE]: Number of COVID-19 Deaths in Sweden Daily in March *

31death

That’s it until tomorrow, keep calm and stay safe!

COVID-19 & ARDS, – Day 7, Thoughts About The Pandemic

COVID-19 & ARDS (Acute Respiratory Distress Syndrome)

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

What we noticed at the hospitals is that it’s not just older people with underlying diseases that can get critically ill from COVID-19, there is another group of 30 to 70 year old (men) who smoke with hypertension that are also at risk of ending up at the ICU.

What we noticed is that even people in their twenties and thirties, men and women, can also get severe pneumonia with ARDS (although an even smaller sample than the one above – yet not an insignificant number however).

Even though the fatality rate is exceedingly low for people below 70 years of age with few underlying comorbidities, they still represent their fair share of patients treated at the ICU.

So far, of the 416 COVID-19 patients treated at the ICUs in Sweden we have the following numbers (unfortunately just age included in these numbers and not comorbidity/underlying diseases): *

  • 20-29 yrs: 3,4% (15 patients)
  • 30-39 yrs: 3,8% (16 patients)
  • 40-49 yrs: 10,6%  (44 patients)
  • 50-59 yrs: 25,2% (105 patients)
  • 60-69 yrs: 30,5% (124 patients)
  • 70-79 yrs: 22,3% (93 patients)
  • 80-89 yrs: 4,6% (19 patients)

Data above taken from SIR (Swedish Intensive Care Registry):

SIR31mars

Similar numbers has been seen in other countries such as in USA: *

cdc icu

I can’t find any numbers/studies on ICU admission, age, AND comorbidity. But at my clinic and from the case-reports from other countries, many of the younger COVID-19 patients being admitted to the ICU don’t have any serious underlying diseases.

Sources: 

COVID-19 Numbers Sweden 2020-03-31 *

  • 180 deaths nationally
    • 103 of them in Stockholm
  • 4 435 confirmed cases nationally
    31fhm
    New confirmed cases daily in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    29fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 358 COVID-19 confirmed patients treated in the ICU in total so far
    • 9,1 days from symptoms to ICU
    • 24,9 % women
      31sir
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week, 5 →  24  → 130 → 413 → (464 this week up until now, however since it’s only tuesday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-03-31 at 10:00 CET) *

  • 33 673 confirmed deaths
  • 719 758 confirmed cases
  • 202 countries, areas or territories with cases

Financial Times Cumulative Number of Deaths Selected Countries (updated yesterday 2020-03-30 at 19:00 GMT) *

31ft

New Resources Added to ※ CTSOP

Image [SWE]: Cheat Key for Patients With ARDS by Karolinska *

That’s it until tomorrow, keep calm and stay safe!

COVID-19 Timeline – Day 6, Thoughts About The Pandemic

A timeline of the COVID-19 pandemic (Last updated 2020-04-09)

  • April 9, 2020 – Total confirmed COVID-19 cases in the world 1 506 936, total deaths world wide 89 931, number of deaths in Sweden are now 793. (4
    MARCH 2020
  • March 31, 2020 – Total confirmed COVID-19 cases in the world 809 608, total deaths world wide 39 545, number of deaths in Sweden are now 180(4
  • March 26, 2020 – US Senate passes $2 trillion COVID-19 aid package. (3
  • March 26, 2020 – Total confirmed cases in the US reach 82,404 — the highest in the world — surpassing China’s 81,782 and Italy’s 80,589.
  • March 26, 2020 – Roughly 1 in 2 Americans go on lockdown as 22 states issue stay-at-home orders.
  • March 23, 2020 – New York City confirms 21,000 cases, making it the biggest epicenter of the outbreak in the US.
  • March 22, 2020 – About 1 in 3 Americans are under lockdown as 12 states issue stay-at-home orders.
  • March 21, 2020 – Unemployment insurance claims rose by over 3M from March 7-21, reaching their highest level yet. (2)
  • March 20-21, 2020 – Italy reports the two highest single-day death tolls for any country: 627 on March 20 and 793 on March 21.
  • March 11, 2020 [SWE]Sweden records its first death.  
  • March 8, 2020 – Italy places all 60 million residents on lockdown.
    FEBRUARY 2020
  • February 29, 2020US reports first death on American soil.
  • February 21, 2020Italy outbreak begins. 
  • February 19, 2020Iran outbreak begins. 
  • February 12, 2020Coronavirus cases start to spike in South Korea.
  • February 11, 2020 [WHOWHO announces that the new coronavirus disease will be called “COVID-19.”
  • February 9, 2020Death toll in China surpasses that of the 2002-2003 SARS epidemic, with 811 deaths recorded.
  • February 7, 2020Chinese whistleblower Li Wenliang dies.
  • February 2, 2020First death outside China is recorded in the Philippines.
    JANUARY 2020 
  • January 31, 2020President Trump bans foreign nationals from entering the US if they were in China within the prior two weeks.
  • January 31, 2020 [SWE]First confirmed COVID-19 case in Sweden, a 20-something woman who traveled home from Wuhan.   
  • January 30, 2020 [WHO]WHO declares a global public-health emergency. 
  • January 23, 2020Wuhan is placed under quarantine, Hubei province follows within days.
  • January 20, 2020First US case is reported: a 35-year-old man in Snohomish County, Washington.
  • January 13, 2020First coronavirus case outside of China is reported in Thailand.
  • January 12, 2020China shared the genetic sequence of COVID-19. (6)
  • January 11, 2020China records its first death.
  • January 7, 2020Chinese authorities identify a new type of coronavirus (called novel coronavirus or nCoV). 
  • January 1, 2020Huanan Seafood Wholesale Market close
  • January 1, 2020 [WHOSets up the IMST (Incident Management Support Team) across the three levels of the organization: headquarters, regional headquarters and country level, putting the organization on an emergency footing for dealing with the outbreak. (6)
    DECEMBER 2019
  • December 31, 2019Chinese Health officials inform the WHO about a cluster of 41 patients with a mysterious pneumonia. Most are connected to Huanan Seafood Wholesale Market.

Sources: 

      1. Business Insider
      2. Visual Capitalist
      3. BBC
      4. John Hopkins Coronavirus Resource Center
      5. FHM
      6. WHO

COVID-19 Numbers Sweden 2020-03-30 *

  • 146 deaths nationally
    • 88 of them in Stockholm
  • 4 028 confirmed cases nationally
    30fhm
    New confirmed cases daily in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
    30fhmk
    New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 311 COVID-19 confirmed patients treated in the ICU in total so far
    • 9,4 days from symptoms to ICU
    • 26,4 % women
      30sir
      Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week, 5 →  24  → 127 → 387 (397 this week up until now, however since it’s only monday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-03-29 at 18:00 CET) *

  • 30 039 confirmed deaths
  • 638 146 confirmed cases
  • 202 countries, areas or territories with cases

Financial Times Cumulative Number of Deaths Selected Countries (updated yesterday 2020-03-29 at 19:00 GMT) *

30FT

New Resources Added to ※ CTSOP

Image: Timeline SARS vs COVID-19 *

CORONAVIRUS TIMELINE: Comparison of the SARS and new coronavirus outbreak over time.

That’s it until tomorrow, keep calm and stay safe!