COVID-19

[Irish2155]

Hate to tell you, but Harry & Izzy’s is no more.

You sure about that? I just ate at H&I in the airport about a month ago.

 

[Irish YJ]

Hate to tell you, but Harry & Izzy’s is no more.

My cuz was there right before the Covid closing. Not sure which one of the 3 he was at, but I don't think they are permanently closed. Just Covid related.

 

[BobbyMac]

It just got real.

Scareface got the Cov..

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[Whiskeyjack]

It just got real.

Scareface got the Cov..

The what now? You mean the 'Rona?

 

[Irish2155]

It just got real.

Scareface got the Cov..

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Oh no. Bushwick dies and now Scarface has COVID. Take it easy Willie D.

 

[Circa]

• The reports are that the truckers are getting supplies to the stores.
• People are stocking the shelves all night and letting old people shop first.
• Carnival Cruise line told Trump “We can match those big Navy Hospital ships with some fully staffed cruise ships”
• GM said hold our cars and watch this; we can make those ventilators where we were making cars starting next week.
• Women and children are making homemade masks and handing out snacks to truckers.
• Restaurants and schools said, We’ve got kitchens and staff; we can feed kids.”
• Churches are holding on-line services and taking care of their members and community.
• NBA basketball players said, “Hold our basketballs while we write checks to pay the arena staff.”
• Construction companies said, “Here are some masks for the medical staff and doctors”.
• Breweries are making sanitizer out of the left-over ingredients.
• We thought we couldn’t live without Baseball, NASCAR, NBA or going to the beach, restaurants or a bar. Instead, we’re trying to keep those businesses open by ordering take-out.

You’ve got two Democrat Governors getting told “We will make it happen” by a Republican President who has fought with them for three and half years. While the media keeps repeating itself, “We are a nation divided.”

What communist China didn't count on was America saying "Hey, sit back and watch this."

I think a Japanese Admiral in the middle of the Pacific said it best in 1941, "I think we have awakened a sleeping giant."

Give us a few more weeks (maybe months) and we will be doing much better! And stop listening to the hysterical media!!

Sharing this from another FB friend. We have wonderful country and an amazing God.

I know we will be ok

#unitedwestand

You bet.My Grandfather who flew as a tailgunner on B25 missions In the South Pacific was the first to tell me about that.
We'll be ok. Just clam up and protect yourself/family.
I've got a friend that works construction (essential) downtown NYC, and he says It's empty. Never seen before type of atmosphere.

 

[BobbyMac]

The what now? You mean the 'Rona?

I'm thinkin more like the Clap or the Croup.

Been locked in my house for too long, losing my sense of humor and all creativity.

But on an AZ note, former employer called me at 5am this morning and asked how I got the computer system back on line last time it went down. I told them and they then asked me if I could go there and do it. (I'm talking to an operations guy in the San Fran. I said sure, give me the code and I'll get over there today or tomorrow. His repsonse? "We open at 10am."

I'm like.... Wuuut??? A furniture store is open and I've left my house once in 9 days???

I told him, I'll have to pass. Can't risk it out there with the flu zombies. The real reason I didn't go? They have no business being open.

 

[ACamp1900]

So COVID isolation day five: wife and I agree I would have made a GREAT Medieval English king,... property rights for all who work for it,... great bank of Scotland,... Public Universities,... and I’d fuck half of London,... Long Live.

There’s no telling where this rabbit hole will go given a few more weeks,......

 

[GATTACA!]

So COVID isolation day five: wife and I agree I would have made a GREAT Medieval English king,... property rights for all who work for it,... great bank of Scotland,... Public Universities,... and I’d fuck half of London,... Long Live.

There’s no telling where this rabbit hole will go given a few more weeks,......

Hear yee, hear yee! As the first order of his holiness Aaron I of the house ACamp, Baltimore is hereby annexed. A shit hole city that is home to thieves knows no home within our realm.

 

[ACamp1900]

Nuking the entire province sounds a most prudent and godly venture.

 

[ulukinatme]

This lockdown has people going crazy. Those of us that are video gamers...

 

[SonofOahu]

You strung the sentences together. I just highlighted the irony. A politician is supposed to have all the answers when the professionals weren't prepared.


Yes, I'd like to see a healthcare poll on the incompetence of hospital administrators, Hospital Boards of Trustees, State Hospital Governing Boards, AMA, EMAs, etc, etc, who didn't prepare for an emergency.

I'm not talking 2015 although that is fair game for why hospitals aren't prepared from coast to coast. Why State EMA's weren't prepared when the reports first came out of China and thousands of Chinese got on planes and left the country? Why was it a shock when cruise ships had so many sick but weren't quarantined and isolated? Hello, Seattle!

Why the Governor of NY was quick to tell POTUS AND the Mayor of NYC. "Don't tell me what to do, I'm in charge." The GOVERNORS are the only one with the authority in our republic. Why were hospitals in all 50 States so under prepared. In 1918 they didn't have the 24/7 news, TV, internet, cell phones, fax machines. They had a reason to be unprepared. No so today.

Instead of lamenting lack of PPE today (I have neighbors sewing masks at home to fill local needs) why weren't administrators on the phone to 3M, et al, in December ordering PPEs for their people instead of waiting until March?

So let's all point the finger at POTUS (of any party) for why the medical facilities from 50 sovereign states were so woefully unprepared and despite Wuhan's problem in December waited until March for the Federal Government to bail out those 50 States medical facilities AND their industries.

By way of disclosure, my extended family includes 12 MDs, 2 PAs, 6 RNs, including 2 Hospital Nursing Administrators, 2 Pharm.D, 2 PT.D, and a pharmaceutical rep. It was a topic around our dinner tables and in communications (they're located in 7 states) but they expressed real concern that the higher ups mantra was uniform, there's no funds budgeted to start preparing now.

I enjoy the posts you and are member MDs put up here enlightening many. But keep in mind this thread was supposed to be for the medical side, how are we doing, how people are coping, etc. There is a POLITICAL Thread for grinding your axe. Put it there.

Best wishes to you, your family, and your staff. Be safe.

My friend, I must have sounded like the tinfoil-hat-wearing prepper for the last few months. I was one of the first to sound the alarm about this, but it's hard to make moves when you don't have the funding nor supplies to do anything about it. I know you want to separate the politics from the discussion, however when the analyses about this situation are written, the five-why is going to point to one thing: Trump is a terrible CEO, and he really sunk us when he failed to prepare and then downplayed (mocked, even) the threat.

Hospitals are like colleges in the NCAA. Not everyone has the money of an ND, Texas, or Alabama. My hospital is tiny and poor. I laughed at a recent Becker's article on 5 Washington hospitals who were potentially going to close. They have 45 days cash on hand. You know how much we have? Like, 4. So tell me how we're supposed to stockpile equipment, when I can't even stock Coca Cola products? How do you buy stuff when you're on credit lock?

Our situation is not unique. I don't remember the exact count, but rural hospitals all over the US close on a monthly basis. They can't keep up with the Joneses...es. But even the wealthy systems don't have the capital to keep the amount of items needed for this pandemic. Even if they did, China cut off the supply well before anyone had the opportunity to start purchasing more.

The problem isn't that the hospitals didn't prepare for the end of the world. The problem is that our nation has more than enough help, both internally and from its "leaders," to push us right to that day. I wish your family good fortune in the wars to come. I found out, yesterday, that I am already potentially exposed. At least our hospitals are empty. We're in the calm before the storm.

 

[Legacy]

Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies (Kaiser Health)

Where The ICU Beds Are
More than half of counties have no hospital ICU beds, a growing concern as the novel coronavirus spreads throughout the nation. This map shows counties with no hospitals, counties with hospitals but no ICU beds, and counties that do have ICU beds. You can scroll over the map or, better yet, do a more comprehensive search on KHN’s interactive table, where you can search by either county or state.

(Interactive graphic by county - number of Hospitals with ICU beds, without ICU beds, and no hospitals)

More than half the counties in America have no intensive care beds, posing a particular danger for more than 7 million people who are age 60 and up ― older patients who face the highest risk of serious illness or death from the rapid spread of COVID-19, a Kaiser Health News data analysis shows.

Intensive care units have sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and ventilators to help them breathe. Even in communities with ICU beds, the numbers vary wildly ― with some having just one bed available for thousands of senior residents, according to the analysis based on a review of data hospitals report each year to the federal government.

DOWNLOAD THE DATA
Download the ICU Beds By County Data (.zip)
Consider the homes of two midsize cities: The Louisville area of Jefferson County, Kentucky, for instance, has one ICU bed for every 442 people age 60 or older, while in Santa Cruz, California, that number stands at one bed for every 2,601 residents.

Differences are vast within each state as well: San Francisco, with one bed for every 532 older residents, and Los Angeles, with 847 residents per bed, both have greater bed availability than does Santa Cruz.

Even counties that rank in the top 10% for ICU bed count still have as many as 450 older people potentially competing for each bed. (cont)

 

[SonofOahu]

I had gotten the same message from John Engemann who I have known for many years as our daughters are classmates. He set me straight on a few details I was struggling with - namely the tests are catching this actual COVID19 and not just coronavirus generally. Amazing to me those tests can be developed so quickly. Part of the hang up is the US regulations, part wanting a more accurate test - he agrees with most normal humans that a flawed test is better than no test. He was an early mover on TP hoarding. The reality is, lots of people will get it and lots of people will die, not that different than the flu. Slowing it down gives time for better treatment and capacity utilization.

It of course makes sense that UM would have a lot of infectious disease specialists. Michigan still sucks.

There are usually three tests run, in this order:

Flu A and B
Respiratory Virus Panel (colds, basically)
COVID-19 specific

Most people are stopping at positive flu. ED doc in NOLA said Flu and COV-19 have been onboard at the same time (like I hypothesized in my first post) and the patients are suuuuuper messed up. You ain't coming back from that.

This is not like the flu, it's much worse. Flu seasons can get gnarly, but not like this. Certainly not like this.

 

[Legacy]

American Hospital Capacity And Projected Need for COVID-19 Patient Care (Health Affaris)

Excerpt:

The 2019 coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading throughout the world. In the United States, the disease is expected to infect 20-60 percent of the population before the pandemic finishes its course. The recent experience in Italy has highlighted the critical need to ensure adequate capacity of inpatient and intensive care beds for what is likely to be a surge of seriously ill patients.

To assess the capacity of U.S. hospitals to care for the impending number of hospitalized patients, we merged hospital infrastructure data from the 2018 American Hospital Association (AHA) Annual Survey and the American Hospital Directory to estimate inpatient and intensive care unit bed capacity in non-federal acute-care hospitals overall in the US and in each of the 306 hospital referral regions. We calculated average inpatient and ICU occupancy rates from annualized inpatient bed days. We used population estimates from the U.S. Census American Communities Survey to project likely numbers of infected patients, hospitalization rates and ICU utilization rates based on existing data from recently published reports. We adjusted these rates across communities by proportion of people who were age 65 or over, as data suggests that hospitalization rates vary by age.

Based on work by Lispsitch and colleagues, we used a middle-level estimate of COVID-19 infection rate of 40 percent. We assumed lengths of stay based on published studies. We calculated the capacity gap between current bed occupancy and anticipated COVID-19 demand assuming six, 12 and 18 month transmission curves. In our primary model, we made the very aggressive assumption that 50 percent of currently occupied beds could be freed up to care for COVID-19 patients.

Nationally, based on 40 percent prevalence of COVID-19 over the course of the pandemic, we estimate that 98,876,254 individuals will be infected, 20,598,725 individuals will likely require hospitalization and 4,430,245 individuals will need ICU-level care. We found that inpatient and ICU bed capacity to handle expected patient volumes varied significantly by Hospital Referral Region (See exhibits 1 and 2).

If the infection curve is not flattened and the pandemic is concentrated in a 6-month period, that would leave a capacity gap of 1,373,248 inpatient beds (274 percent potentially available capacity) and 295,350 ICU beds (508 percent potentially available capacity). If the curve of transmission is flattened to 12 months, then the needed inpatient and ICU beds would be reduced to 137 percent and 254 percent of current capacity. However, if hospitals can indeed reduce current bed occupancy by 50 percent and flatten the transmission curve to 18 months, then the capacity needed would be reduced to 89 percent of inpatient and 166 percent of ICU beds. If the infection rate is only 20 percent (low end of current estimates), we would largely be able to meet the needs for inpatient care if we flatten the curve to 12 months.

Finally, we observed large variations in availability of both regular and ICU beds across communities (see exhibits 1 and 2). Some rural communities have adequate numbers of regular beds but often large shortfalls of ICU beds, whereas many more-populous communities have inadequate number of total beds but smaller shortfalls of ICU beds. Our findings clearly illustrate the public health imperative to both flatten the curve of transmission and recruit additional capacity of both regular and ICU beds. (cont)

This article is from March 17th, projecting need from that time, concluding

We are at an inflection point and clearly do not have the capacity to care for our population of COVID-19 patients if the infections occur quickly and there is a spike in acutely ill patients. However, spreading the disease out, and providing new strategies to expand the number of beds and the workforce, can help ensure that we get through this difficult period.

On March 17, the U.S. had 3500 Covid 19 patients. On March 26th, the CDC reports that we have 68,440.

Cumulative stats from Jan 22nd to March 25 (Interactive graph by date)

 

[SonofOahu]

I dont think people will get it until they are hauling away 1000s of bodies per day in refrigerated semis.

Dude, I legit have to figure out if we need a full 40, or if we can get away with a 24. My morgue fits 7, 14 if we lay them on their sides.

 

[GATTACA!]

Nuking the entire province sounds a most prudent and godly venture.

Shock and awe. I like it. Put Pittsburgh and Cincinnati on notice.

 

[Legacy]

Kentucky mayor's coronavirus warning pulls no punches: 'Listen up dipsh--s' (Fox)

 

[Legacy]

I dont think people will get it until they are hauling away 1000s of bodies per day in refrigerated semis.

Undoubtedly. Numbers and graphs get you so far.

The coronavirus may be deadlier than the 1918 flu: Here’s how it stacks up to other pandemics
(CNBC)

Three months after the coronavirus emerged in China, it has quickly spread to nearly half a million people across the globe, killing more than 22,000 people and bringing the world economy to a near-grinding halt.

Some scientists estimate that millions will ultimately die before COVID-19 runs its course. There’s a lot that infectious disease specialists and scientists still don’t know about the virus. Exactly how deadly and contagious COVID-19 is, is still a matter of debate.

We break down what we know about the virus and how it compares with some of history’s deadliest pandemics and diseases. (cont)

 

[Irish#1]

You sure about that? I just ate at H&I in the airport about a month ago.

My cuz was there right before the Covid closing. Not sure which one of the 3 he was at, but I don't think they are permanently closed. Just Covid related.

My mistake. It's Ike's & Jonesy's that closed.

 

[IrishLion]

Shock and awe. I like it. Put Pittsburgh and Cincinnati on notice.

You may not like the sports teams, but Cincinnati will be a valuable territory to control when the world ends.

Pittsburgh is just trash all around.

 

[BleedBlueGold]

Interesting to read about the local facilities per each poster...

At my hospital, we have 10 vents and last I knew, 8 or 9 are in use. In my specific department, we have 1 box of masks and a total of 5 N95 masks. The main ER nurse has it and is on a vent. Policy-wise, our hospital has been about a week behind all the others in terms of lock downs, no visitors, temp checks, etc. Just in the last 7 days, there's been a small "boom" of patients. Going from "one, but he's currently in Florida," to "we just scanned 6 people with symptoms in the last hour."

I've been up my bosses' asses the last three weeks about this stuff and they still won't set non-essential staff up with remote capabilities. It's "all hands on deck" until further notice.

Locally, in my neighborhood (northside of Indy), kids and at-home parents are treating this like summer break. They're out everywhere, playing, drinking beers, socializing (nowhere near the recommended 6+ feet apart). It's unreal.

 

[Irish2155]

Interesting to read about the local facilities per each poster...

At my hospital, we have 10 vents and last I knew, 8 or 9 are in use. In my specific department, we have 1 box of masks and a total of 5 N95 masks. The main ER nurse has it and is on a vent. Policy-wise, our hospital has been about a week behind all the others in terms of lock downs, no visitors, temp checks, etc. Just in the last 7 days, there's been a small "boom" of patients. Going from "one, but he's currently in Florida," to "we just scanned 6 people with symptoms in the last hour."

I've been up my bosses' asses the last three weeks about this stuff and they still won't set non-essential staff up with remote capabilities. It's "all hands on deck" until further notice.

Locally, in my neighborhood (northside of Indy), kids and at-home parents are treating this like summer break. They're out everywhere, playing, drinking beers, socializing (nowhere near the recommended 6+ feet apart). It's unreal.

We took the dog for a walk around the neighborhood yesterday and it was like a big block party...music screaming from every direction, drinking, socializing, etc...looked fun but I kept my distance. I've never seen so many people out around here at one time. Spring fever is in overdrive...

 

[tussin]

Undoubtedly. Numbers and graphs get you so far.

The coronavirus may be deadlier than the 1918 flu: Here’s how it stacks up to other pandemics
(CNBC)

It's unclear how much of the growth in confirmed cases is due to increased testing versus disease spread.

 

[Irish YJ]

My Pillow has converted all their factories in 3 days to make PPE. Making 10k masks/day and will be up to 50k per day.

CEO says Trump has asked them, as well as the many private sector companies jumping into to this situation, to strongly look at replacing China long term for the manufacturing of all of these items.

 

[zelezo vlk]

Dude, I legit have to figure out if we need a full 40, or if we can get away with a 24. My morgue fits 7, 14 if we lay them on their sides.

I think I read that in Madrid their National Guard took over an ice rink to use as a temporary morgue.

 

[Irish YJ]

Nuking the entire province sounds a most prudent and godly venture.

As a king, you don't need my vote, but I pledge fealty to anyone who smites the entire DC kingdom.

As far as you're other comments about being king,,,,,,

It's unclear how much of the growth in confirmed cases is due to increased testing versus disease spread.

I'm sure it's both, but far more due to increased testing. Everyone has predicted the testing spike. And we'll still never know the self corrected volumes which is projected to be a majority of infected.

My mistake. It's Ike's & Jonesy's that closed.

I was surprised I&J lasted so long. It preceded this old man and I can remember cougar shopping there back in the day. I'm pretty sure H&I is doing very well. A HS bud of mine is running one, or part of one, and has been a part of the SE's brand since the 90s. Another buddy eats at H&I weekly and says it's always got good business.

My friend, I must have sounded like the tinfoil-hat-wearing prepper for the last few months. I was one of the first to sound the alarm about this, but it's hard to make moves when you don't have the funding nor supplies to do anything about it. I know you want to separate the politics from the discussion, however when the analyses about this situation are written, the five-why is going to point to one thing: Trump is a terrible CEO, and he really sunk us when he failed to prepare and then downplayed (mocked, even) the threat.

Hospitals are like colleges in the NCAA. Not everyone has the money of an ND, Texas, or Alabama. My hospital is tiny and poor. I laughed at a recent Becker's article on 5 Washington hospitals who were potentially going to close. They have 45 days cash on hand. You know how much we have? Like, 4. So tell me how we're supposed to stockpile equipment, when I can't even stock Coca Cola products? How do you buy stuff when you're on credit lock?

Our situation is not unique. I don't remember the exact count, but rural hospitals all over the US close on a monthly basis. They can't keep up with the Joneses...es. But even the wealthy systems don't have the capital to keep the amount of items needed for this pandemic. Even if they did, China cut off the supply well before anyone had the opportunity to start purchasing more.

The problem isn't that the hospitals didn't prepare for the end of the world. The problem is that our nation has more than enough help, both internally and from its "leaders," to push us right to that day. I wish your family good fortune in the wars to come. I found out, yesterday, that I am already potentially exposed. At least our hospitals are empty. We're in the calm before the storm.

Not going to go down the political rabbit hole too far, but disagree with paragraph one. I've read way too much (strictly factual and scientific) on this situation globally, and all the different inputs/outputs to and from, and responses by country. A deep look at the testing debacle is likely easiest at this point, but the facts point to very specific issues that have zero to do with the current administration. In addition, the so called models of response thus far have been either authoritarian in nature, or countries who have close partnership/reliance on the private sector and less reliance on bodies like the FDA. And lastly, the issues with model and funding at hospitals in general here in the US, precedes this administration, and is a very complex discussion that includes far more than just federal funding.

Hope you are doing well my friend. Most important, be safe. Prayers for you.

 

[Irish2155]

I was surprised I&J lasted so long. It preceded this old man and I can remember cougar shopping there back in the day. I'm pretty sure H&I is doing very well. A HS bud of mine is running one, or part of one, and has been a part of the SE's brand since the 90s. Another buddy eats at H&I weekly and says it's always got good business.
.

I've probably been laid out of Ike and Jonesy's more than any other bar in my life. Either there or Piere's up in Fort Wayne. Cougar hunting at it's finest for this young lad back in the day. Loved Ike's even though it was always packed like sardines and the music sucked.

 

[Irish YJ]

I've probably been laid out of Ike and Jonesy's more than any other bar in my life. Either there or Piere's up in Fort Wayne. Cougar hunting at it's finest for this young lad back in the day. Loved Ike's even though it was always packed like sardines and the music sucked.

Back in my day they had a pretty decent band IIRC. And I really wasn't there for the music to be honest . Cheap beer and target rich.

 

[GATTACA!]

You may not like the sports teams, but Cincinnati will be a valuable territory to control when the world ends.

Pittsburgh is just trash all around.

I don't really even dislike the Bengals. I think of them more as our plucky little brother. Which is kind of incredible since the Browns have been the worst team in the league basically my entire life.