Brian Kimble

Listening to this in memory of my friend who killed himself 5 years ago. I miss you Steve <3. Half of the views are from me lol! Love this song... Merry xmas loners, here's one to you-Cheers. My Daddy was there Tempe Az 1981,Rolling stones were his absolute favorite band. My dad passed away October 17th, 2017 At the age of 69. Looking at these videos means more to me now. I know he's wearing a white cowboy hat at the concert He showed me once where he was. I know he has the movie on vhs., I miss him more than words can you sure lived a Rock N Roll life. I'll Always be your little girl.
Never leave your pizza. Download Full burdens. [NEW: As requested, a downloadable PDF version of this document is now available to email to relatives] If you just want to learn how to reduce your risk of catching COVID-19, scroll down to the "Risk Reduction" section. However, to appreciate the full scope of the challenge ahead, you are encouraged to carefully read this entire document, which will be updated regularly as long as it stays on the front page of your sub. The aim of this document is simple: it's best to walk into something knowing what you're about to face. It also aims to reduce anxiety, panic, and misinformation by arming you with key sourced information, all without downplaying the risks of COVID-19. The document has gone through hundreds of iterations thanks to global community feedback, including from places such as Seattle, LA, Australia, and Canada. Although all facts are meticulously sourced from experts in their fields, you are responsible for your own health and your own research. Further, contextualization of information remains an ongoing challenge, as does keeping up with a fluid situation. Final word will always belong to the health authorities, as well as the mods of this subreddit. Now brace yourself, because this is going to suck a little bit. CONTEXT: A recent in-depth study has shown just how incredibly infectious COVID-19 is. Unfortunately, its spread has not slowed, and the virus has only been halted through stringent physical distancing measures. In other words, and as the Director of the WHO himself has said, this is not a drill. The bad news: There are currently over half a million global confirmed cases of COVID-19, and the WHO has classified it as a pandemic. Now it seems that it has arrived upon your doorstep, which means there is likely exponential and silent human-to-human transmission in the community. The good news: knowledge is a weapon that defeats these things. It worked in 1918 against the Spanish Flu, when we essentially stopped the medieval practice of blood-letting (you know when they drained you of blood because they thought that would cure whatever ailed you? Or leeching? ). And it worked against many other outbreaks since: Smallpox, MERS, SARS, Ebola, etc. The WHO's tackling of Smallpox alone was nothing short of scientific heroism. And so, a hundred years after 1918, here we are again, facing perhaps the greatest test of our generation. The problem is that these days we're inundated with so much information that, when a real threat comes along, it's buried under a mountain of clutter. And although this document is not all-encompasing by any means, hopefully it will help you see through some of that clutter, as well as give those new to the threat an opportunity to hit the ground running. So go ahead and meet your foe. Do not underestimate it. Now prepare to go to war. IMPORTANT: The main mode of transmission is via respiratory droplets: coughing, sneezing, and breathing. But you can also get it through shaking hands, kissing somebody who is sick, or touching a contaminated surface (droplet dispersion; think of a cough plume settling). This can include handrails, doorknobs, elevator buttons, and surfaces prone to a droplet dispersion cloud. "Cough dispersion" basically means anytime a sick person coughs, they're dispering a plume of droplets over a given area. The viral particles within those droplets then settle on ordinary surfaces. People touch those surfaces then touch their phones or their faces, which in turn lead to contact with their eyes, mouth, or nose, inducing infection. Therefore it is best to keep a 6 ft "coughing distance" from people, and treat everything you touch in public as if it's been contaminated (see the "Risk Reduction" section below). Here's an excellent short video on the topic. Read a little more on the subject here. [AWAITING PEER REVIEW, BUT IS GAINING ACCEPTANCE IN THE SCIENTIFIC COMMUNITY] There now appears to be evidence the virus can spread through breathing. Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota: "The findings [of the study] confirm that COVID-19 is spread simply through breathing, even without coughing. Don't forget about hand washing, but at the same time we've got to get people to understand that if you don't want to get infected, you can't be in crowds. Social distancing is the most effective tool we have right now. " Source. (Crucial to understand: the research specifies patients who are symptomatic, and makes no claims about asymptomatic transfer. ) UPDATE: Dr. Osterholm just went on the Joe Rogan show to explain the situation. Although the show itself has been known to be controversial, the Doctor's credentials speak for themselves. [AWAITING PEER REVIEW] A new study indicates COVID-19 can survive in the air for up to 3 hours, and several days on surfaces, depending on the surface (up to 3 days on plastic, up to 2 days on metal, up to 1 day on cardboard). ( Article | Study). Here's a shadowgraph imaging of people breathing ( source). Unfortunately it is a bit misleading as it does not show drop dispersion, but gets the point across. [AWAITING PEER REVIEW] New analysis seems to indicate infected people without symptoms might be driving the spread of coronavirus more than we realized (CNN link, with links to multiple studies in the article). This is corroborated by Dr. Norman Swan on March 14th, via ABC Australia, who says "you are infectious before the symptoms come out, there's no question about that. " The WHO says you are infectious for about 48 hours prior to showing first symptoms. (Source 1: Dr. Swan: see minute mark 4:02 in this health alert video), ( Source 2). ALERT: It is now generally believed that this is the reason the virus is taking so many communities by surprise: it spreads during that crucial asymptomatic/low-symptom stage. WARNING: March 16th Article, based on fresh research: "80% of COVID-19 spreads from people who don't know they are sick" ( Article | Study | Discussion 1 | Discussion 2) WARNING: We are past containment. It is now vital to flatten the curve and implement physical distancing measures. A short GIF on how we stop the virus from spreading. Up to 1 in 5 infected people may require hospitalization source 1, source 2. But this is an oversimplification as the metric skews toward the elderly and those with comorbidities (see the Mortality/Comorbidities section below). Plus the metrics differ based on region and testing capacity. Excellent short video on the topic. Here's a breakdown of the above: Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases. 13. 8% have had severe disease requiring hospitalization, and 6. 1% were critical, requiring the ICU (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). (These numbers are as of Feb 20, 2020, based on 55, 924 laboratory confirmed cases in China, from the WHO report. ) Update: European Society of Intensive Care Medicine is reporting a 10% ICU rate, and has issued a word of warning. Due to the highly infectious nature of COVID-19, the danger is not just the mortality rate for the vulnerable, but the possibility of overwhelming the health infrastructure, which in turn causes unnecessary fatalities. As it stands, it wouldn't take much to overwhelm hospitals, hence why it's important to start taking preventative measures now (outlined in the Risk Reduction section below)?especially because hospitals are already burdened with a heavy flu season (in the Northern hemisphere, that is). For example, if only 10 out of every 1000 people required a bed, we'd already be coming up short, as in the USA there are only 2. 77 beds for every 1000 people, and 2. 58 in Canada. Why is this important? In South Korea, 4 in 22 deaths happened while waiting to be hospitalized ( source in Korean, as well as a discussion about it), and that's from South Korea, who is #2 in the world bedcount-wise with 12. 27 beds per 1000 people. And of course many beds will already be occupied for regular patients. Toronto Star soberly warns hospitals can’t cope if coronavirus outbreak worsens in Canada: March 6th. A surgeon working in the heart of Italy's outbreak gives a harrowing testimony and urges everyone to heed the warning that it can easily overwhelm hospitals ( translation / Original). This is a "novel" virus, which means the immune system has never been exposed to it and therefore everyone is susceptible. There is no vaccine, nor do authorities expect one for some time. A superb short video by Kurzgesagt on how the virus works, among other thigns of note. People are thought to be most contagious when they are most symptomatic (the sickest). (Source: CDC) Update: March 18th: Young people are getting extremely sick from coronavirus, according to new evidence ( article | discussion). A young person's dire warning. Update: March 17th: "Prepare to see COVID-19 cases rising. That doesn't mean social distancing has failed: Impacts won't be apparent for at least two weeks and probably longer, experts say" ( source) Update: "Coronavirus: Why You Must Act Now | Politicians, Community Leaders and Business Leaders: What Should You Do and When? " ( link) Update: Excellent quick read on how normalcy lulls and how quickly this thing can hit, by The Washington Post: "When a danger is growing exponentially, everything looks fine until it doesn’t" ( link | archive link) Update: CNN: "Take this seriously. Coronavirus is about to change your life for a while" ( link) Update: WHO director: "We are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction. " ( link) Update: "Any country that looks at the experience of other countries with large epidemics and thinks that it won’t happen to us is making a deadly mistake, " warned the WHO. Update: "People
If you just want to learn how to reduce your risk of catching COVID-19, scroll down to the "Risk Reduction" section. However, to appreciate the full scope of the challenge ahead, you are encouraged to carefully read this entire document. The aim of this document is simple: it's best to walk into something knowing what you're about to face. It also aims to reduce anxiety, panic and misinformation by arming you with sourced knowledge, all without downplaying the risks of COVID-19. The document has gone through hundreds of iterations thanks to global community feedback, including from outbreak zones such as Seattle, Australia, and the LA area. Although all facts are meticulously sourced from experts in their fields, you are responsible for your own health and your own research. Further, contextualization of information remains an ongoing challenge, as does keeping up with a fluid situation. Final word will always belong to the health authorities, as well as the mods of this subreddit. Now ready yourself, because this is going to suck a little bit. CONTEXT: A recent in-depth study has shown just how incredibly infectious COVID-19 is. Unfortunately, its exponential spread has not slowed, and the virus has only been halted in China through Herculean efforts. In other words, and as the Director of the WHO himself has said, this is not a drill. The bad news: There are currently over 100, 000 global confirmed cases of COVID-19. Now it seems that it has arrived upon your doorstep. That means there is likely silent human-to-human transmission in the community. The good news: knowledge is a weapon that defeats these things. It worked in 1918 against the Spanish Flu, when we essentially stopped the medieval practice of blood-letting (you know when they drained you of blood because they thought that would cure whatever ailed you? Or leeching? ). And it worked against many other outbreaks since: Smallpox, MERS, SARS, Ebola, etc. The WHO's tackling of Smallpox alone was nothing short of scientific heroism. And so, a hundred years after 1918, here we are again, facing perhaps the greatest test of our generation. The problem is that these days we're inundated with so much information that, when a real threat comes along, it's buried under a mountain of clutter. And although this document is not all-encompasing by any means, hopefully it will help you see through some of that clutter, as well as give those new to the threat an opportunity to hit the ground running. IMPORTANT: The main mode of transmission is via respiratory droplets: coughing, sneezing, and breathing ( NEW). But you can also get it through shaking hands, kissing somebody who is sick, or touching a contaminated surface (droplet dispersion; think of a cough plume settling). This can include handrails, doorknobs, elevator buttons, and surfaces prone to a droplet dispersion cloud. "Cough dispersion" basically means anytime a sick person coughs, they're dispering a plume of droplets over a given area. The viral particles within those droplets then settle on ordinary surfaces. People touch those surfaces then touch their phones or their faces, which in turn lead to contact with their eyes, mouth, or nose, inducing infection. Therefore it is best to keep a 6 ft "coughing distance" from people, and treat everything you touch in public as if it's been contaminated (see the "Risk Reduction" section below). Here's an excellent short video on the topic. Read a little more on the subject here. UPDATE: There now appears to be evidence the virus can spread through breathing as well. Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota: "The findings [of the study] confirm that COVID-19 is spread simply through breathing, even without coughing. Don't forget about hand washing, but at the same time we've got to get people to understand that if you don't want to get infected, you can't be in crowds. Social distancing is the most effective tool we have right now. " Source. (Crucial to understand: the research specifies patients who are symptomatic, and makes no claims about asymptomatic transfer. ) Up to 1 in 5 infected people may require hospitalization source 1, source2. But this is an oversimplification as the metric skews toward the elderly and those with comorbidities (see the Mortality/Comorbidities section below). Here's a breakdown of the above: Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases. 13. 8% have had severe disease requiring hospitalization, and 6. 1% were critical, requiring the ICU (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). (These numbers are as of Feb 20, 2020, based on 55, 924 laboratory confirmed cases in China, from the WHO report. ) Update: European Society of Intensive Care Medicine is reporting a 10% ICU rate, and has issued a word of warning. Due to the highly infectious nature of COVID-19, the danger is not just the mortality rate, but the possibility of overwhelming the health infrastructure, which in turn causes unnecessary fatalities. As it stands, it wouldn't take much to overwhelm hospitals, hence why it's important to start taking preventative measures now (outlined in the Risk Reduction section below)--especially because hospitals are already burdened with a heavy flu season (in the Northern hemisphere, that is). For example, if only 10 out of every 1000 people required a bed, we'd already be coming up short, as in the USA there are only 2. 77 beds for every 1000 people, and 2. 58 in Canada. Why is this important? In South Korea, 4 in 22 deaths happened while waiting to be hospitalized ( source in Korean, as well as a post about it), and that's from South Korea, who is #2 in the world and has 12. 27 beds per 1000 people. And of course many beds will already be occupied for regular patients. Toronto Star soberly warns hospitals can’t cope if coronavirus outbreak worsens in Canada: March 6th. A surgeon working in the heart of Italy's outbreak gives a harrowing testimony and urges everyone to heed the warning that it can easily overwhelm hospitals ( translation / Original). This is a "novel" virus, which means the immune system has never been exposed to it and therefore everyone is susceptible. There is no vaccine, nor do authorities expect one for some time. PSYCHOLOGY: Do not panic, but give yourself permission to feel fear. Fear gets you prepared. As for panic, all one has to do is look at the crowded halls of Wuhan hospitals during the early phases of the outbreak to understand how panic worsens problems. A jolt of fear is all right, as it gets you moving in the right direction. After that point, however, you must turn to thinking clearly, level-headedly, and listen to your local health authorities. Follow the streps in the "Risk Reduction" section below. Normalcy bias plays a factor. So does denial. You may hear things like "it's just a flu, nothing to worry about. " Facing the threat will help you prepare for it while denial puts you and your loved ones at risk. People in denial may take foolish risks like attend crowded events during an active outbreak, or fail to take precautionary measures, thereby accidentally passing the virus on to others. Denial also slows community response. Here is an excellent Harvard piece on reactions and overreactions, denial versus panic, and the five principle bulwarks against denial. It is short and absolutely worth your time. For officials, crisis management teaches us that it is important not to downplay a threat, otherwise you may lose the public's trust. Do not fear inducing a panic (see the aforementioned paper). The public needs you to be clear, informative, competent, and proactive. Studies such as this one about the 1918 pandemic have shown just how effective a proactive approach can be on the part of leadership. But look what can happen on the other end of the spectrum. If you're experiencing distress regarding this epidemic, please consider visiting COVID-19 mental health support. RISK REDUCTION: Think of those in your life who are vulnerable (see the Comorbidities section). If not for yourself, do it for them. Practice social distancing. Do not touch your face (practice this one at home, as it's harder than you think). After every outing, wash your hands and disinfect your phone (the virus can likely live up to 96 hours on phone screens). And you're probably washing your hands wrong. Here's a short 1. 5 minute tutorial by the WHO. Carry disinfectant with you. Do not shake hands. While in public, try to keep a coughing distance from people, which is at least 6 feet. Treat everything you touch in public as a contaminated surface. If you use a travel mug, be sure to disinfect it after every outing. Disinfect doorknobs and often-touched places, especially keyboards and phones. Take initiative and disinfect doorknobs and elevator buttons in your building. Do not wait for management to do it for you. Keep disinfectant by every entrance to your house. Avoid anyone who is coughing, and stay away from poorly ventilated places. Stay away from crowds. Cough into your elbow, or preferably into a tissue that is disposed of into the trash. While in public, only touch things with your knuckle, a glove, or your sleeve. Touch elevator buttons with the tip of your key. Ask your boss to work from home as many transmissions happen at work. If you have extra face masks, consider donating some to senior care facilities and hospitals, as there is a global shortage and they will desperately need them in the coming months. Masks in the right hands is to your benefit, as they slow the spread. Hoarded masks are actually detrimental to the community. If you have extra bottles of hand-sanitaizer, please consider sharing them with those who do not have any. This is about working together, and minimizing community spread helps everyone
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