COVID-19

[Irishize]

We've been to a few DOAs this past week (a little more than normal). Keep in mind, my department covers a city of 45,000 (not exactly NY). I'm assuming people are just afraid to leave the house and it's not COVID related. Medics say the hospitals are actually slower than normal. Think my whole county has 25 or so confirmed cases out of 100,000+.

Obviously New York is dealing with the virus more than everyone else so many of these are probably virus related.

I know of a physician who had a patient in need of a heart procedure but since it was considered elective, they had to put on hold. He unfortunately passed away last week. The physician believes the procedure would’ve likely saved him.

Other elective procedures being on hold could prevent cancers or other issues found during a procedure (i.e., colonoscopy).

 

[PerthDomer]

Until this improves we won't have the vents or sedatives needed to do elective procedures. You need PPE or rapid testing for all cases. They had a few orthopedic surgeons get ill from being in the OR with asymptomatic people who showered the room on intubation. We're rationing Propofol, Fentanyl, benzos, and paralytics at baseline now...

 

[TorontoGold]

Does anyone have a link to a model that shows the impact of the travel restrictions put in place against China? Curious to see the impact.

 

[Sea Turtle]

Ok, I dont want to come across abrasive but do you understand the crisis NY is in right now? People keep obsessing over these models. But in real life NYC is struggling! FDNY just shared some statistics about the staggering number of people dying in their homes and at the scene when EMS arrive. If we allowed business to go on as usual NY would be seeing a continued exponential increase in deaths and cases until they reached that herd immunity. But herd immunity doesn't kick in until around 50-70% of the population has acquired the disease or asympomatically developed an antibody response.

Even if the mortality rate is 0.5% which is the absolute lowest rate I have seen quoted, that's still 750k dead bodies and 4-5 x that would need hospital care across the country, and this doesn't even take into account the number of those that would need ICU care or the meds to keep them paralyzed or the nurses or RTs to care for them. And this best case scenario mortality rate is assuming we can care for all those needing hospitalized and they wont die without proper care. But that's absurd to think we could create an additional 400% capacity of hospital beds and an additional 1000% capacity in ICU beds to properly care for everyone simultaneously. We have around 1 million hospital beds and a little over 100k ICU beds in this country. Play with the numbers to get it to work. It wont. Unless you assume something like 90% asymptomatic rate. Maybe once this is behind us and the numbers are calculated in total this will be the case. But this is an incredibly dangerous assumption that nobody can make or calculate at this time.

But I understand our country is very diverse demographically so it's absolutely right to say that most states are not going to be like NY. But how do you tell Ohio or Arizona or Arkansas to just go about their business as usual because "Well, we dont think it will happen to you."

Bottom line. As we get more information the picture becomes clearer. Until we are really damn sure we know what we are dealing with, nobody in the medical field is going to back down from protecting people from themselves. And I hope the extent of this is far, far less severe than the current projections. Everyone wins in that case.

You aren't abrasive. And I appreciate your posts. I know that you have to look at it through another lens.
I have been saying for awhile now that this is a New York and New Jersey crisis due to population, mass public transit, being an international city and other factors.

We had people saying 240,000 deaths in our country alone(the world is at like 80,000)and millions of hospitalizations. And people believed it. We very well may not even reach the 25,000 deaths of Swine Flu of 2009. And even the deaths of this Covid 19, over 80% had other health problems. And we Certainly aren't going to match the millions of hospitalizations from Swine Flu.

 

[Circa]

You aren't abrasive. And I appreciate your posts. I know that you have to look at it through another lens.
I have been saying for awhile now that this is a New York and New Jersey crisis due to population, mass public transit, being an international city and other factors.

We had people saying 240,000 deaths in our country alone(the world is at like 80,000)and millions of hospitalizations. And people believed it. We very well may not even reach the 25,000 deaths of Swine Flu of 2009. And even the deaths of this Covid 19, over 80% had other health problems. And we Certainly aren't going to match the millions of hospitalizations from Swine Flu.

It's amazing how many people can act like a cat in the hat and not really understand....
<iframe src="https://giphy.com/embed/ORMj1QFzBF840" width="480" height="346" frameBorder="0" class="giphy-embed" allowFullScreen></iframe><p><a href="https://giphy.com/gifs/lol-spider-toy-ORMj1QFzBF840"

 

[loomis41973]

Was never a huge fan of Mike Pence as VP but he's doing damn good work on the China Virus task force. Good grooming going on.

 

[Irish YJ]

Was never a huge fan of Mike Pence as VP but he's doing damn good work on the China Virus task force. Good grooming going on.

I never really liked him (still don't) except for his tax cuts, but he's doing a good job. Doesn't matter how good he does though, he'll always get piled-on by those for his beliefs.
#TolerateOnlyWhatYouAgreeWith

 

[Sea Turtle]

Was never a huge fan of Mike Pence as VP but he's doing damn good work on the China Virus task force. Good grooming going on.

I agree. He's doing a great job. He has to be exhausted and thick skinned from every Monday morning qb in the press and medical community.

 

[Sea Turtle]

I never really liked him (still don't) except for his tax cuts, but he's doing a good job. Doesn't matter how good he does though, he'll always get piled-on by those for his beliefs.
#TolerateOnlyWhatYouAgreeWith

Yep

 

[InKellyWeTrust]

You aren't abrasive. And I appreciate your posts. I know that you have to look at it through another lens.
I have been saying for awhile now that this is a New York and New Jersey crisis due to population, mass public transit, being an international city and other factors.

We had people saying 240,000 deaths in our country alone(the world is at like 80,000)and millions of hospitalizations. And people believed it. We very well may not even reach the 25,000 deaths of Swine Flu of 2009. And even the deaths of this Covid 19, over 80% had other health problems. And we Certainly aren't going to match the millions of hospitalizations from Swine Flu.

I appreciate it. I think when we look back we will question some of the decisions. I also think this is why the federal government has not issued a country wide shelter in place because its so difficult to generalize over a diverse population. But I also believe you have to listen to the epidemiologists whose careers are decidated to this very scenario. If they overshoot it's because they are trying to protect human life. And there are definite consequences to shutting down the economy, I would never deny that. We can all agree on the media's tendency to sensationalize. I think I'm getting a little heated because I already see how they will grab ahold of any mis-projections and cast blame on experts who were predicting as best they could with the information available. And for the record, I am not one of those experts. I know medicine but cant claim epidemiology. Though I think we've all learned more about epidemiology than we ever thought we would thanks to C19.

 

[NDLS_USMC]

Been lurking since February and finally have contribution/question.

Any of your medical-types have critique points?

covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-

http://web.archive.org/web/20200405...ht-have-finally-found-its-secret-91182386efcb

 

[GoldenToTheGrave]

You aren't abrasive. And I appreciate your posts. I know that you have to look at it through another lens.
I have been saying for awhile now that this is a New York and New Jersey crisis due to population, mass public transit, being an international city and other factors.

We had people saying 240,000 deaths in our country alone(the world is at like 80,000)and millions of hospitalizations. And people believed it. We very well may not even reach the 25,000 deaths of Swine Flu of 2009. And even the deaths of this Covid 19, over 80% had other health problems. And we Certainly aren't going to match the millions of hospitalizations from Swine Flu.

When they say "people with other health problems", that includes 78 million people that have high blood pressure, 30 million diabetics, and 25 million with asthma.

 

[NorthDakota]

I never really liked him (still don't) except for his tax cuts, but he's doing a good job. Doesn't matter how good he does though, he'll always get piled-on by those for his beliefs.
#TolerateOnlyWhatYouAgreeWith

Was actually talking about him today with my bro-in-law.

I've never given two shits about Mike Pence but the dude has been a pro when it comes to this stuff as far as his method of communication alone. I could easily be convinced he's the best VP since Bush 41....though I have a soft spot for Dick as a fellow Flyover.

I'm going to trolololol so hard if the USA comes in under the models of deaths.

Btw....Joe Diffie was taken from us. If Donald wants to go down as the greatest American president of all time, he gets Congress to declare war so we can have Marines raising the US flag in the Forbidden City while "Prop Me Up Beside the Jukebox" is blaring.

 

[Irish YJ]

Been lurking since February and finally have contribution/question.

Any of your medical-types have critique points?

covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-

http://web.archive.org/web/20200405...ht-have-finally-found-its-secret-91182386efcb

I've read a few similar things about the impact to red blood cells, and the impact of ventilators. I'm no doc, so really would love to hear one way in.

The hydroxychloroquine narrative,,,,. If you're being pragmatic, it's a real option. The politics around it are silly. I certainly understand the desire for a years testing, etc., but folks don't have a year, and it's mature drug that's cheap and widely available. You're not risking a lot by using it. I'm sure the drug companies hate it.

As far as China is concerned. Fuck them. Anyone with half a brain looking at the timeline and actions can, in no way, defend them.

 

[Irish YJ]

Was actually talking about him today with my bro-in-law.

I've never given two shits about Mike Pence but the dude has been a pro when it comes to this stuff as far as his method of communication alone. I could easily be convinced he's the best VP since Bush 41....though I have a soft spot for Dick as a fellow Flyover.

I'm going to trolololol so hard if the USA comes in under the models of deaths.

Btw....Joe Diffie was taken from us. If Donald wants to go down as the greatest American president of all time, he gets Congress to declare war so we can have Marines raising the US flag in the Forbidden City while "Prop Me Up Beside the Jukebox" is blaring.

He's definitely putting in the work. I know libs hate him, but his work here has nothing to do with his Christian views. So is everyone IMO (working hard), including Trump. I don't care for everything he's done/said, but there's no doubt he's putting in the effort and trying to do what's best.

I won't laugh if the models come in under, I'll rejoice. I think the Monday morning QBs though were almost hoping for a much worse case just so they could have another excuse to bash him. Some of the gleeful stuff I've seen is pretty disgusting. It's pretty sad to see all the anecdotal criticism that simply lacks any comparison, fact, context, etc... I'm already giggling a bit every time another country, doctor, or patient comes out speaking positively about hydroxychloroquine. Folks should be praying for it to work, instead of using it as a political battle cry. The Mich Dem State Rep situation is hilarious given all the incredibly partisan BS Whitmer has spouted off about.

 

[IrishLax]

Is the AG talking out of his ass then or what? I’m pretty sure he said this week was going to be the worst week, but it also feels like they’ve been saying that for 2 weeks now. It sucks that we haven’t seen the peak yet when most states have had travel bans and quarantined for 2+ weeks now. Maybe the social distancing idea was too good to be true.

I've found this to be generally accurate in terms of aggregating the data and giving realistic projections -- https://covid19.healthdata.org/united-states-of-america

It's constantly updated, and it looks like April 12th to the 18th will be "peak week" in terms of daily deaths. By May we'll a couple weeks into daily decline and by June it should be mostly isolated. The scare is a resurgence in June when people go away from social distancing.

 

[SonofOahu]

Excellent find. Kudos.

Not a lawyer myself, either. I'd hazard a guess that the "liability protections for pandemic" actions depends on the definition of "covered persons".



link provided for "covered person":


Does Trump declaring a National Emergency of HHS declaring a Public Health Emergency protect entities like ambulance services, hospitals, etc from liability?

I have no idea.

I found out in a conference call, yesterday, that our healthcare association is creating a unified triage plan which all the hospitals will follow. This effort is under the guidance of HDOH and HI-EMA, so it's a State-led effort. I think this provides all of us with the cover (legally, ethically, etc.) granted by the proclamation/declaration.

 

[SonofOahu]

This is a very interesting read. It sounds like the medical field within the last few days has really figured out how the virus targets the body and is now better equipped to deal with it. According to the author, it had them fooled originally.

http://web.archive.org/web/20200405...ht-have-finally-found-its-secret-91182386efcb

Been lurking since February and finally have contribution/question.

Any of your medical-types have critique points?

covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-

http://web.archive.org/web/20200405...ht-have-finally-found-its-secret-91182386efcb

I wouldn't just take this with a grain of salt, I would take the whole salt shaker. I'm not a physician, but this flies in the face of a lot of established knowledge. Remember, corona viruses are not new. This particular virus is a novel one, but that doesn't make it totally unique.

One of the theories about why the malaria drug may work is that it shuts down the cytokine storm. The cytokine storm is what's causing people to crash. There's still way too little literature out there to know what the answer is.

This isn't an episode of "House", we're not going to have miraculous answers in an hour.

 

[SonofOahu]

Nobody thinks that. People do think, however, that the media has been hysterical about this. Once that happened, society and businesses freaked out because of fear of shortages and litigation fears

Also, this mortality rate is not a true number, which I'm sure you know. So many people have this and are asymptopatic. So many people will get this and never even know they had it.

As these models become more and more absurd and things calm down, I really think some people just don't want to believe that they bought this at face value, were taken by bad info and panicked. They want to feel justified. Which is understandable.

I know you're probably not all there, but you realize that the only reason we're sitting here talking about numbers coming down is because just about the entire world stopped, right? I don't think people truly appreciate that fact, at this point. Also, you should notice that the people who are the most concerned, insightful, and productive in this discussion are the physicians, first responders, and other healthcare professionals.

The ones who are the least useful are the ones working at Dairy Queen and ESPN.

 

[SonofOahu]

The hydroxychloroquine narrative,,,,. If you're being pragmatic, it's a real option. The politics around it are silly. I certainly understand the desire for a years testing, etc., but folks don't have a year, and it's mature drug that's cheap and widely available. You're not risking a lot by using it. I'm sure the drug companies hate it.

If you're a provider and you order an unproven drug that ends up killing your patient, there's not much room for pragmatism and you are risking a lot. It may be a real option, but there is always a risk/reward calculation involved.

 

[Irish YJ]

I wouldn't just take this with a grain of salt, I would take the whole salt shaker. I'm not a physician, but this flies in the face of a lot of established knowledge. Remember, corona viruses are not new. This particular virus is a novel one, but that doesn't make it totally unique.

One of the theories about why the malaria drug may work is that it shuts down the cytokine storm. The cytokine storm is what's causing people to crash. There's still way too little literature out there to know what the answer is.

This isn't an episode of "House", we're not going to have miraculous answers in an hour.

Pragmatically speaking (about hydroxychloroquine), and I stress pragmatically, is there not enough rough and anecdotal evidence out there to reduce the salt a bit. I can certainly understand the desire to have this wrapped in a bow, but it's not like this is an episode of FDA Perfect Red Tape either.

This may not be the ultimate example of desperate times, but it's desperate times for many individuals. Utilizing a drug that has been around for a long time that has clear "knowns" is not like stepping up to the craps table and betting on an experimental never used before treatment.

If myself, or a family member, was in need, I absolutely hope for access. You wouldn't?

 

[Irish YJ]

If you're a provider and you order an unproven drug that ends up killing your patient, there's not much room for pragmatism and you are risking a lot. It may be a real option, but there is always a risk/reward calculation involved.

Waiver....
I'd do a waiver than to sit in a bed, get worse, only to be put on a ventilator and hope.

What is your opinion on the leading French epidemiologist (if not leading European) saying it's unethical to withhold?

 

[SonofOahu]

Pragmatically speaking (about hydroxychloroquine), and I stress pragmatically, is there not enough rough and anecdotal evidence out there to reduce the salt a bit. I can certainly understand the desire to have this wrapped in a bow, but it's not like this is an episode of FDA Perfect Red Tape either.

This may not be the ultimate example of desperate times, but it's desperate times for many individuals. Utilizing a drug that has been around for a long time that has clear "knowns" is not like stepping up to the craps table and betting on an experimental never used before treatment.

If myself, or a family member, was in need, I absolutely hope for access. You wouldn't?

For me? Honestly, I don't know. I have a heart history, so I'd have to make sure that was addressed. If there are alternatives, maybe those first.

If I'm crashing that hard, I'd probably rather just go. I don't want to go on a vent, it's 50/50 at best.

 

[Irish YJ]

For me? Honestly, I don't know. I have a heart history, so I'd have to make sure that was addressed. If there are alternatives, maybe those first.

If I'm crashing that hard, I'd probably rather just go. I don't want to go on a vent, it's 50/50 at best.

Ok, minus your heart history (which is the biggest fear of the treatment)

What are the current alternatives? None that I know of.

 

[Sea Turtle]

I know you're probably not all there, but you realize that the only reason we're sitting here talking about numbers coming down is because just about the entire world stopped, right? I don't think people truly appreciate that fact, at this point. Also, you should notice that the people who are the most concerned, insightful, and productive in this discussion are the physicians, first responders, and other healthcare professionals.

The ones who are the least useful are the ones working at Dairy Queen and ESPN.

You don't need to insult people to make a point. If you disagree, that's fine but you don't need to make childish snarky comments about Dairy Queen and not being all there because I disagree with you.

240,000 people were supposed to die in our country . Millions of hospitalizations. And that was with social distancing, etc. Some knew that was absurd. Many panicked. Now it's 140,000. Right.

People thought this was going to be The Stand. Stephen King had to calm some people down because they thought this was the end. People dumped their stock trying to salvage something before it all crashed and burned. I never said this wasn't a problem. It is. It's a crisis in NYC. But in my opinion, and many others, this wasn't worth shutting the world down, costing trillions of dollars and sending the country into double digits unemployment which is the start of a Depression. People you and I know will be out of work months from now because the media went hysterical.

Now, I'm sure you are all there and a smart guy and probably have a fine career, but we can agree to disagree. See how easy that is?

 

[Irish YJ]

You don't need to insult people to make a point. If you disagree, that's fine but you don't need to make childish snarky comments about Dairy Queen and not being all there because I disagree with you.

240,000 people were supposed to die in our country . Millions of hospitalizations. And that was with social distancing, etc. Some knew that was absurd. Many panicked. Now it's 140,000. Right.

People thought this was going to be The Stand. Stephen King had to calm some people down because they thought this was the end. People dumped their stock trying to salvage something before it all crashed and burned. I never said this wasn't a problem. It is. It's a crisis in NYC. But in my opinion, and many others, this wasn't worth shutting the world down, costing trillions of dollars and sending the country into double digits unemployment which is the start of a Depression. People you and I know will be out of work months from now because the media went hysterical.

Now, I'm sure you are all there and a smart guy and probably have a fine career, but we can agree to disagree. See how easy that is?

While I don't condone the snark, some of his points ring absolutely true. We are better off than models because of an early travel cut off, social distancing, out technology, and because the world has literally shut down.

Pardon any snark from me, but this is not the flu. To say so is pure idiocy. The entire world is treating this differently for a reason. I've had healthy friends thus far go into ICU, others with worsening symptoms struggle to get tested, and I'm terrified that a family member who has pre-existing conditions get a whif of this stuff.

Don't be the dip shit on one of the extreme sides.

 

[InKellyWeTrust]

Been lurking since February and finally have contribution/question.

Any of your medical-types have critique points?

covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-

http://web.archive.org/web/20200405...ht-have-finally-found-its-secret-91182386efcb

Yeah, this is bunk. I read this somewhere else too. I believe it's based off an opinion piece by a NY ICU physician. There is nothing in the literature to support it. This would fly in the face of all the evidence and standard of care for ARDs in general and prior coronavirus outbreaks MERs and SARs.

 

[Irish#1]

Spoke to my neighbor yesterday. He's a policeman and patrols an area with a high crime rate. He said a couple of weeks ago, the streets were pretty empty and the vast majority were practicing social distancing. Now many are back to their normal routines and not practicing distancing. Also crime jumped back up to it's normal level in the ares he parols. People just don't get that this is a sneaky killer. I suppose if someone dropped dead in front of them, it might wake them up, but then again maybe not.

 

[IrishLion]

Was actually talking about him today with my bro-in-law.

I've never given two shits about Mike Pence but the dude has been a pro when it comes to this stuff as far as his method of communication alone. I could easily be convinced he's the best VP since Bush 41....though I have a soft spot for Dick as a fellow Flyover.

I'm going to trolololol so hard if the USA comes in under the models of deaths.

Btw....Joe Diffie was taken from us. If Donald wants to go down as the greatest American president of all time, he gets Congress to declare war so we can have Marines raising the US flag in the Forbidden City while "Prop Me Up Beside the Jukebox" is blaring.

This is what I don't understand from people, especially a media dude like Clay Travis who originally said "I'll be surprised if the US has more than 3500 deaths from this."

If we come in under projection, doesn't it mean the social distancing likely worked in flattening the curve? We're dealing with it longer via quarantine and restrictions, but the projected death tolls don't reach the potential peaks that were theorized.

Some states aren't in lockdown, but that doesn't mean the overall effort hasn't been effective, especially in places where it's been taken seriously. My friends in public service in Cincy are worried that isolation will be relied on for TOO long, but won't deny that the lockdown prevented a crisis in Cincinnati hospitals just based on people that would have had to be brought in with respiratory issues, had it spread unchecked with no social effort to curb the virus.

I guess I don't get people that want to celebrate the projections being "wrong" when the whole point of everything is to make sure they ARE wrong.

There are people out there who originally said "this is all dumb and unecessary"... 10 million people could die, and certain people would crow about being right or vindicated because the total wasn't 11 million.

 

[wizards8507]

So uh.

https://twitter.com/johncardillo/status/1247859223184244736?s=19