# Coronavirus Discussion Thread



## Akulahawk (Feb 2, 2020)

One of the difficulties of this virus is that we're still learning about it and it's still very early on that we don't quite yet know everything about it. One thing to watch out for is that it appears that infected people are quite infectious during their prodromal period and are still shedding a lot of virus even after the symptoms have subsided. I don't think we know yet exactly how long people are actually infectious. Hopefully this stuff isn't a weaponized virus that found a way into the wild. The good news, if any, is that because there are infected people now outside China, western health agencies (and governments) will have this stuff genetically sequenced fairly quickly and therefore should be able to determine if it's weaponized or if it's "just" a virulent coronavirus. Either way, good early containment should allow this to burn out...


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## Summit (Feb 2, 2020)

It's already sequenced and we had the sequence before it was seen outside. Assuming the Chinese weren't lying.

What will be interesting to see is how much it mutates. It is a RNA virus.


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## Akulahawk (Feb 2, 2020)

Summit said:


> It's already sequenced and we had the sequence before it was seen outside. *Assuming the Chinese weren't lying*.
> 
> What will be interesting to see is how much it mutates. It is a RNA virus.


Trust but verify... If they're not lying about it... great. However as an RNA virus, it can quickly mutate. I just hope it burns itself out before it mutates into something really bad!


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## Summit (Feb 2, 2020)

Akulahawk said:


> Trust but verify... If they're not lying about it... great. However as an RNA virus, it can quickly mutate. I just hope it burns itself out before it mutates into something really bad!


Sometimes zooinotics mutate to be less deadly over generations like Ebola (seriously) and sometimes they become more deadly like Spanish Influenza did.


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## FiremanMike (Feb 3, 2020)

I've worke


DesertMedic66 said:


> This. It’s not Ebola



According to the CDC, it's not.. Then my state came out and said to use all the ebola precautions.


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## Summit (Feb 3, 2020)

FiremanMike said:


> I've worke
> 
> 
> According to the CDC, it's not.. Then my state came out and said to use all the ebola precautions.



Including trained observer doffing in the kiddie pool vat??? What state says that? That isn't what CDC nor CO says.


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## FiremanMike (Feb 4, 2020)

Summit said:


> Including trained observer doffing in the kiddie pool vat??? What state says that? That isn't what CDC nor CO says.



I apologize, Im not sure it mentioned decon, but it did call for Ebola level ppe..


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## Phillyrube (Feb 4, 2020)

You know, this isn't new.   It's printed on a can of Lysol I've had lying around my shop the past few years.


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## johnrsemt (Feb 5, 2020)

The news this morning has a Cruise ship with 4000+ passengers and 1100+ employees are quarantined off of Japan with 11 people with Coronavirus.  1 person left the ship after 5 days (11 day voyage) sick, and when they realized what he had the Japanese officials checked everyone else; found 11 more people with the virus; and I think pulled them off to treat them.
The rest get to stay on board for an additional 14 days, but are to stay in their cabins.  Worse ways to be quarantined.  

I wonder if the Cruise line company will tell everyone scheduled for future cruises what happened on this one.


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## Grant Brown (Feb 26, 2020)

I just registered today on here so i could see what everyone is seeing precaution wise for the corona-virus. i did find this from john hopkins and was curious on every bodies opinion on it. The death number compared to the recovered number is very surprising especially since thats no a number you hear in the news. But we all know fear sells!!





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						ArcGIS Dashboards
					

ArcGIS Dashboards




					www.arcgis.com


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## Summit (Feb 26, 2020)

Grant Brown said:


> I just registered today on here so i could see what everyone is seeing precaution wise for the corona-virus. i did find this from john hopkins and was curious on every bodies opinion on it. The death number compared to the recovered number is very surprising especially since thats no a number you hear in the news. But we all know fear sells!!
> 
> 
> 
> ...



Recovery lags deaths lags diagnosis

I'm not sure if you are saying that it is unusually high deaths, in which case, remember: recoveries will go up.

Or are you saying a calculated CFR of 3.4% doesn't scare you because that is BAD.

CFR will rise because deaths lag diagnosis and we are early in the growth curve. It has been steadily rising. It was 2% a month ago.


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## FiremanMike (Feb 28, 2020)

Summit said:


> Recovery lags deaths lags diagnosis
> 
> I'm not sure if you are saying that it is unusually high deaths, in which case, remember: recoveries will go up.
> 
> ...



That's a far cry from the 10% that was being claimed early on..


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## RedBlanketRunner (Feb 28, 2020)

Summit said:


> But sonE tricks of ventilation engineering and I can make extra neg rooms or make an entire ward neg.


If your hospital is JCAH certified, all patient rooms are negative pressure. Or rather, the hallways are positive pressure. A magnehelic must be placed in every hallway ventilation system and X reading maintained. etc etc.

Meanwhile, our municipality (Maejo -Chiang Mai) had it's first case yesterday, and it's a community sourced.

Stay safe out there people. Maybe a little review of infection control P&Ps is in order. So easy to miss things or become a vector.


PS Weird shopping list: 50 kg of H2O2 50%, 500 kg isopropyl alcohol 70%. Sourced from chemical supply house, $145.


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## Kavsuvb (Feb 29, 2020)

Anyone want to hit the Panic Button

*Person dies from coronavirus in Washington state, first in the US, health officials say








						Person dies from coronavirus in Washington state, first in the US, health officials say
					






					www.foxnews.com
				



*


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## Kavsuvb (Feb 29, 2020)

Here's the Latest update from the CDC's HAN




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						HAN Archive - 00428 | Health Alert Network (HAN)
					

Health Alert Network (HAN). Provided by the Centers for Disease Control and Prevention (CDC).




					emergency.cdc.gov


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## Kavsuvb (Feb 29, 2020)

*BREAKING: First Confirmed Coronavirus Death In U.S. Occurs








						BREAKING: First Confirmed Coronavirus Death In U.S. Occurs | The Daily Wire
					






					www.dailywire.com
				




Department of Health confirms first coronavirus death in Washington state









						Department of Health confirms first coronavirus death in Washington state
					






					www.kiro7.com
				



*


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## Jim37F (Feb 29, 2020)

And 4,800 people in the US have also died from regular flu this year already. Yet no one is hitting any panic buttons over that...


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## Summit (Feb 29, 2020)

The market will panic. 

People need to get ahold of themselves and show dignity in the face of adversity.


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## CCCSD (Feb 29, 2020)

And in other news...kids drown in swimming pools, drunk drivers kill thousands each year...


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## SandpitMedic (Feb 29, 2020)

You don't need to post the same information in separate threads @Kavsuvb

COVID-19 is a big nothing burger. The panic is unnecessary. We have been through SARS, Ebola, AIDS, MERS, Bird Flu, Swine Flu, Zika, West Nile, etc etc etc..... each one was supposed to wipe out the planet. COVID-19 is in a family of viruses that include the common cold; while it is a new mutant virus (novel) there is no need for all the hooplah. We will go on- we will survive...."Life...uhhh... finds a way."

This *will* spread, just like the flu and the cold. The mortality rate is very low.  It has only been lethal in older patients with compromising comorbidites, unlike the flu which kills many thousands per year, both young and old, as others have stated in the other thread. It will just be a regular old flu like illness that people get during the corona season (not summer.)

Wash your hands, keep your hands off your face, buy some little saniwipes and wipe down public spaces you're utilizing, and avoid sick people. Simple.


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## CCCSD (Feb 29, 2020)

Bazinga!


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## Summit (Feb 29, 2020)

I don't think this is a nothing. It's possible that it could simply go away. It's possible that the effect could be minor. But the disease is much more severe than influenza oh, there is no vaccine, and there is no treatment. This leaves not just a significantly higher mortality rate than influenza, but the potential to overwhelm an already overburdened Healthcare System putting it into a triage mode. Disruption of supply chain and the economy are also potential major consequences of this disease. the world will not end. Life Will Go On. It did so in 1918 1919, but the was much tragedy, suffering, and death.


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## NomadicMedic (Feb 29, 2020)

It's treated the same way we treat flu. Supportive care. It'll kill a bunch of immunocompromised people and make a lot of people sick. 
It's already far and wide in Washington with 50+ people who were in contact with staff and residents at the LTAC in Kirkwood sick or hospitalized with respiratory symptoms. 

This is going away anytime soon. It's in no way a "nothing burger". If it continues to spread, it may very well incapacitate large areas of the US.


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## Phillyrube (Feb 29, 2020)

I'm more worried about norovirus I may run into on the cruise I'm on next week.


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## SandpitMedic (Feb 29, 2020)

Well. I guess we will see.
It'll go the way of H1N1, in my opinion.

Novel viral status= People will wig out. People will get sick. The young, old, and immunocompromised will be hit the hardest. And then it will just be another waxing/waning seasonal illness.

Vaccines are in the works on multiple fronts.

Wake me up when it starts killing normal healthy people at high rates.


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## NomadicMedic (Feb 29, 2020)

It doesn't have to kill a lot of people to really f up the economy and seriously impact the infrastructure we all take for granted.


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## CCCSD (Feb 29, 2020)

NomadicMedic said:


> It doesn't have to kill a lot of people to really f up the economy and seriously impact the infrastructure we all take for granted.



That’s The Stupid being acted on. I hear Test Vaccine 93-B71 is looking pretty good...


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## SandpitMedic (Mar 1, 2020)

Des


NomadicMedic said:


> It doesn't have to kill a lot of people to really f up the economy and seriously impact the infrastructure we all take for granted.


Destabilization.... that’s what you’re talking about.
It isn’t the zombie virus.... it’s a flu like illness. When you get it, you get a flu like symptoms, and then you get better.
One woman in Japan got it _twice_.


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## Peak (Mar 1, 2020)

SandpitMedic said:


> The young, old, and immunocompromised will be hit the hardest.



To my knowledge there haven't been any deaths in school aged or younger. 

Even among the old adults mortality is heavily weighed on those with comorbid disease.


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## SandpitMedic (Mar 1, 2020)

Peak said:


> Even among the old adults mortality is heavily weighed on those with comorbid disease.


Exactly.
That’s what I’m saying.

As it progresses past direct contact with infected Chinese and nosocomial infections and begins its community spread kids will probably be hit as well. Hopefully not as hard.


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## Peak (Mar 1, 2020)

SandpitMedic said:


> Exactly.
> That’s what I’m saying.
> 
> As it progresses past direct contact with infected Chinese and nosocomial infections and begins its community spread kids will probably be hit as well. Hopefully not as hard.



There have been younger kids infected, just no deaths.


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## SandpitMedic (Mar 1, 2020)

Peak said:


> There have been younger kids infected, just no deaths.


Hope there aren’t, but we will see in time.
Flu can be devastating for young hosts. It is good news that there have no infected children who have succumb to COVID-19.


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## Summit (Mar 1, 2020)

The morbidity of this disease in healthy adults is higher than influenza.

It is also significantly more contagious than influenza.

The PPE and isolation considerations are more complex than influenza and a major capacity bottleneck for healthcare. Failures in PPE and isolation have resulted in ENORMOUS rates of hospital acquired infection AND HEALTHCARE WORKER INFECTIONS with severe morbidity and notable mortality. Thousands of HCWs have been infected, and not just in China. But done correctly, the outcomes are good.

You had better take it seriously, because systemically EMS systems are going to be utilized to collect COVID-19 lab testing on non-critical patients at home rather than taking them to overburdened ERs.

"I don't have a protocol for that." You likely will shortly.

Practice with you PPE and turn your "Community EMS" switch to WAR






EMS will also transfer early patients from outlying facilities to hospitals with special disease units... then after the initial stages of the outbreak EMS will find itself transferring patients from facilities without adequate airborne rooms to facilities with adequate rooms. EMS will also transfer critical COVID-19 cases from small hospitals and overburdened hospitals to hospitals with ICU capacity (and ECMO when one opens up).


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## VFlutter (Mar 1, 2020)

Apparently hits very hard on current/prior smokers. Wonder if that will be true for all the Vapers too

Italy has a decent sized outbreak and is trialing early ECMO for high risk cases however not really feasible large scale.

And rumor has it that N95s are not effective which is why we are seeing healthcare worker acquired. N99 or PAPR is probably the safest bet.


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## Summit (Mar 1, 2020)

VFlutter said:


> And rumor has it that N95s are not effective which is why we are seeing healthcare worker acquired. N99 or PAPR is probably the safest bet.



This indicates N95s work fine with proper procedure and good hand hygiene: https://www.medrxiv.org/content/10.1101/2020.02.18.20021881v1.full.pdf

Theoretically as well, N95s should be just fine.

We use N95s against similarly sized airborne viruses with great effect.

The problem is people such at their PPE technique, they self contaminate when doffing. A better filter won't do anything for that.

The word of the year is Fastidious.
adj.
very attentive to and concerned about accuracy and detail.

BE FASTIDIOUS WITH YOUR PPE.


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## akflightmedic (Mar 1, 2020)

Phillyrube said:


> I'm more worried about norovirus I may run into on the cruise I'm on next week.


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## RedBlanketRunner (Mar 2, 2020)

2.3% mortality rate is not a 'nothing burger'.


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## RedBlanketRunner (Mar 2, 2020)

Most have heard the old paradoxymoron, 'A Chrisitan Scientist with a hot appendix'.
Looks quite likely we will get a new one: Contracting Covid19 at a Trump rally.'


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## SandpitMedic (Mar 2, 2020)

RedBlanketRunner said:


> Most have heard the old paradoxymoron, 'A Chrisitan Scientist with a hot appendix'.
> Looks quite likely we will get a new one: Contracting Covid19 at a Trump rally.'


I haven’t. Care to explain...


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## RedBlanketRunner (Mar 2, 2020)

Jim37F said:


> And 4,800 people in the US have also died from regular flu this year already. Yet no one is hitting any panic buttons over that...


'Normal' flu is pandemic, fully established, in the wild. It's mortality rate is <.1%
Covid19 mortality rate is presently 2.27%

Covid19 was only reported in Wuhan China 2 months ago. At present it is in:

China
Hong Kong
Macau
Taiwan
Afghanistan
Algeria
Australia
Austria
Azerbaijan
Bahrain
Belarus
Belgium
Brazil
Cambodia
Canada
Croatia
Denmark
Estonia
Egypt
Finland
France
Georgia
Germany
Greece
Iceland
India
Iran
Iraq
Israel
Italy
Japan
Kuwait
Lebanon
Lithuania
Malaysia
Mexico
Monaco
Nepal
Netherlands
New Zealand
Nigeria
North Macedonia
Norway
Oman
Pakistan
Philippines
Romania
Russia
San Marino
Singapore
Spain
Sri Lanka
Sweden
Switzerland
Thailand
The Republic of Korea
United Arab Emirates
United Kingdom
United States
Vietnam



SandpitMedic said:


> I haven’t. Care to explain...


A paradoxymoron is something that cannot possibly happen but inevitably will.


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## RedBlanketRunner (Mar 2, 2020)

1918 Spanish flu. Mortality rate, 2.3% 
Covid-19 Mortality rate: 2.3%
Population density is many times greater today and we presently have 83,000 airline flights per day.


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## SandpitMedic (Mar 2, 2020)

RedBlanketRunner said:


> 1918 Spanish flu. Mortality rate, 2.3%
> Covid-19 Mortality rate: 2.3%
> Population density is many times greater today and we presently have 83,000 airline flights per day.


I think it is wise to be prudent.
An alarmist, not so much.

It is far too early to be comparing the Spanish Flu with COVID-19. The Spanish Flu infected 500 million people, meanwhile this virus has infected roughly 80,000 (of whom many are unverified).

Furthermore, the mortality associated with COVID-19 is (so far) exclusive to older folks with preexisting cardiac or pulmonary conditions.

Even furthermore, advancements in medical science and the mad dash to create a vaccine in 2020 vs what they had in 1918 make it far less likely that COVID19 will reach the scale of the Spanish Flu.

While we may disagree on the matter- and I hope I am right and it turns out to be a big nothing burger that we just add to our list of seasonal ailments, I am sure we can agree on my final point: Wash your hands.


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## GMCmedic (Mar 2, 2020)

Meh, the mortality rate will begin to trend down as we learn more and begin to control the current outbreak. Still less lethal than Ebola and we survived that.


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## DrParasite (Mar 2, 2020)

*Feeling panicked about coronavirus? Media coverage of new epidemics often stokes unnecessary fear*

By the way, CDC estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010, including an estimated 61,000 during the 2017-2018 flu season


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## SandpitMedic (Mar 2, 2020)

Can we merge threads into just Coronavirus as a title?


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## VentMonkey (Mar 2, 2020)

SandpitMedic said:


> Can we merge threads into just Coronavirus as a title?


I’d prefer a “fear mongering” title, it’s all inclusive. Then you could put next years virus/ subjective killer, and then the next, and so on and so forth.


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## Chimpie (Mar 2, 2020)

SandpitMedic said:


> Can we merge threads into just Coronavirus as a title?


*Moderator Note: *I've merged similar posts from the other thread to this one and changed the title to "Coronavirus Discussion Thread". 

To discuss *specifically* EMS's response to the Coronavirus, go here:




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						EMS Response to the Coronavirus outbreak
					





					emtlife.com
				




Thanks!


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## RedBlanketRunner (Mar 2, 2020)

SandpitMedic said:


> I think it is wise to be prudent.
> An alarmist, not so much.


Interesting quote considering your title on this forum. 


Those of us who work in and around the medical profession should feel a sense of obligation to avoid media sensationalism. Stick to the facts, statistics, citing credible sources. Not always that easy to do considering the time it sometimes takes for a morbidity report to come out but...

Personally, I gave up lamestream media in 1990 when half the crap on the stupid tube was politicians vying for attention. I found the best sources of information come from signing on to various medical info sites, getting the daily load in emails. Then simply scan the emails looking for the numbers, statistics, and forming my own opinions. It goes without saying to avoid quoting anything that has questionable sources. We owe that to our fellow health care workers. My quotes on this forum are from CDCs, Walter Reed, Mayo, WHO and so on and some insider info from the likes of MSF, ICRC, Stan. Med. etc and I offer it as a heads up, not to be taken as gospel but for others to check and reach their own conclusions.

My concern of course is as a health care advisor in the third world where keeping abreast of events is crucial.  What I find extremely disconcerting, tragically ironic, is how close in understanding basic health care and disease prevention the modern family in the US and Europe is to the average persons in outlying villages where livestock free ranges right into peoples homes.

This present epidemic is much the same as other recent outbreaks the denial/misinformation crowd is citing, but the prevalence, rapid transmission, and mortality rate is disconcerting. Extremely disconcerting considering our last line of defense, quarantine and isolation, is given the same short shrift by the poorly educated as it is by the people who get most of their information from biased pseudo news - propaganda sources, be it the evening news or the village to village coconut wireless (Gossip).

Let's stick to the facts. The statistics. The credible reputable sources.


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## RocketMedic (Mar 2, 2020)

You know, RedBlanketRunner has some extremely serious credibility issues, but I think that blind squirrel found a nut after all. Spanish flu hit an estimated 500 million people, over 3 years, and the peak affects were spaced over about six months. This is in a society revolving from war, with less travel and less contact with others in most cases, and weaker reporting and testing systems.

I think Covid-19 is shaping up in the same mold.


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## CCCSD (Mar 2, 2020)

He lost his Street Creds long ago.


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## SandpitMedic (Mar 2, 2020)

That was a very articulate way of saying we’re all a bunch of gaboons. 
Okay then...

I only have one question: I have a title on this forum?!?


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## RedBlanketRunner (Mar 2, 2020)

CCCSD said:


> He lost his Street Creds long ago.


Considering the source, praise indeed.



SandpitMedic said:


> I only have one question: I have a title on this forum?!?


*Crowd pleaser*
You know, like that guy with over 15,000 documented lies, half truths and misinformations to his credit at his poop rallys.


Seriously, something like this virus should be taken in the most serious vein possible. If dead wrong, chagrin and lots of sighs. If real and present danger, misinformation or making light of the problem only exacerbates it.


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## SandpitMedic (Mar 2, 2020)

RedBlanketRunner said:


> *Crowd pleaser*
> You know, like that guy with over 15,000 documented lies, half truths and misinformations to his credit at his poop rallys.


What? Take your meds dude. Don’t derail this thread with your politics.


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## CCCSD (Mar 2, 2020)

Like I said...


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## SandpitMedic (Mar 3, 2020)

CCCSD said:


> Like I said...


Nailed it


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## RocketMedic (Mar 3, 2020)

Coronavirus!


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## RedBlanketRunner (Mar 3, 2020)

Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, instantly corrected Trump: “Let me make sure you get the ... information.” A vaccine could be ready “at the earliest [in] a year to a year-and-a-half, no matter how fast you go,” said Fauci, noting: “Like I’ve been telling you, Mr. President.” 

Fauci also corrected Trump after his first news conference on the coronavirus last Wednesday, when the president insisted a vaccine was “very close.” Fauci later said a coronavirus vaccine could take up to two years.


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## ExpatMedic0 (Mar 3, 2020)

Hand sanitizer and some food items completely ransacked in stores here. Amazon is even out of stock. So what did I do? After I realized I couldn't buy hand sanitizer I got a little nervous. Went to a different store. I saw that Glocks are still in stock at the local gun store. Did you guys know we get a "blue label" discount? Pretty funny I went from lack of hand sanitizer to deadly force. Whoops. Anyway didn't buy a gun. I'm more worried about how society reacts to this than I am the actual virus.


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## RedBlanketRunner (Mar 3, 2020)

Hand sanitizer is just isopropyl alcohol sometimes with hexachlorophene and other gunk. Go buy a gallon for a $10-$20 and go nuts with it. Lots cheaper than a Glock. 
Handy trick: Wear a pair of those cheap cotton gloves. Soak them in alcohol then take a casual walk around your home, vehicle and workplace, rubbing everything that you normally would touch. It's amazing some of the places we touch as we go about our daily lives that get missed when you go on a sanitizing binge.


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## NomadicMedic (Mar 3, 2020)

Things are getting interesting. My friends in Washington State are nervous. 12 firefighters are now quarantined after the nursing home debacle.

Even if they're NOT sick, the quarantine will have a big impact on staffing.

If I had to quarantine 12 EMTs at my service, we would have to go out of service. It would have a huge impact on staffing


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## Akulahawk (Mar 4, 2020)

One interesting effect that COVID-19 has had on hospital operations (at least where I work) is that it's forcing us to create (temporarily) rooms that can be used for respiratory isolation. These include anterooms for donning/doffing PPE. It's also ensuring that healthcare personnel are actually gaining experience in conducting healthcare activities while wearing various PPE. Expect, in the short term, occasional shortages in this stuff as hospitals begin to realize that their stores of PPE won't last all that long in practice. It's one thing to have a patient that needs airborne isolation every once in a while but if you have 6 or 10 all at once, that can be a problem. 

Please do note that I'm NOT referring to tertiary facilities that get "isolation" cases as nearly a routine matter. Those facilities are going to be set up for this. I'm referring to community/local facilities. They're going to get hammered pretty badly if COVID-19 turns out to be a particularly bad bug.


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## Summit (Mar 4, 2020)

Akulahawk said:


> One interesting effect that COVID-19 has had on hospital operations (at least where I work) is that it's forcing us to create (temporarily) rooms that can be used for respiratory isolation. These include anterooms for donning/doffing PPE. It's also ensuring that healthcare personnel are actually gaining experience in conducting healthcare activities while wearing various PPE. Expect, in the short term, occasional shortages in this stuff as hospitals begin to realize that their stores of PPE won't last all that long in practice. It's one thing to have a patient that needs airborne isolation every once in a while but if you have 6 or 10 all at once, that can be a problem.
> 
> Please do note that I'm NOT referring to tertiary facilities that get "isolation" cases as nearly a routine matter. Those facilities are going to be set up for this. I'm referring to community/local facilities. They're going to get hammered pretty badly if COVID-19 turns out to be a particularly bad bug.


We have figured out how to turn a whole ward negative. FYI anterooms are not a requirement and add engineering difficulties. We are not doing those.


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## KingCountyMedic (Mar 4, 2020)

NomadicMedic said:


> Things are getting interesting. My friends in Washington State are nervous. 12 firefighters are now quarantined after the nursing home debacle.
> 
> Even if they're NOT sick, the quarantine will have a big impact on staffing.
> 
> If I had to quarantine 12 EMTs at my service, we would have to go out of service. It would have a huge impact on staffing



It's more like 50 if you include Firefighters, Paramedics and Private Ambulance folk. Most are in quarantine some have moved to isolation showing some mild symptoms. All of the deaths and super sick folks have been elderly with lots of bad heart/lung disease to begin with. The exact same folks that regular old fashioned flu kills by the thousands every year. Your Washington State friends that are nervous should wash their hands, stop touching their face, use their PPE, follow proper donning/doffing procedures and not listen to the news media.


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## FiremanMike (Mar 4, 2020)

NomadicMedic said:


> Things are getting interesting. My friends in Washington State are nervous. 12 firefighters are now quarantined after the nursing home debacle.
> 
> Even if they're NOT sick, the quarantine will have a big impact on staffing.
> 
> If I had to quarantine 12 EMTs at my service, we would have to go out of service. It would have a huge impact on staffing



That makes me want to get exposed to coronavirus.. 2 week vacation?? Sounds great!


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## Akulahawk (Mar 4, 2020)

Summit said:


> *We have figured out how to turn a whole ward negative*. FYI anterooms are not a requirement and add engineering difficulties. We are not doing those.


Not easy to do to an ED... Much easier to do to inpatient wards.


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## NomadicMedic (Mar 4, 2020)

KingCountyMedic said:


> It's more like 50 if you include Firefighters, Paramedics and Private Ambulance folk. Most are in quarantine some have moved to isolation showing some mild symptoms. All of the deaths and super sick folks have been elderly with lots of bad heart/lung disease to begin with. The exact same folks that regular old fashioned flu kills by the thousands every year. Your Washington State friends that are nervous should wash their hands, stop touching their face, use their PPE, follow proper donning/doffing procedures and not listen to the news media.



It’s not that they are concerned about dying. They’re concerned about a 2 week quarantine.


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## Summit (Mar 5, 2020)

Akulahawk said:


> Not easy to do to an ED... Much easier to do to inpatient wards.


Can't do it to m open Ed bays, but you can convert individual rooms with minimal work on a crisis basis



			https://www.health.state.mn.us/diseases/hcid/negpressure.pdf


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## PotatoMedic (Mar 5, 2020)

https://www.nejm.org/doi/full/10.1056/NEJMe2002387?query=recirc_curatedRelated_article
		


An interesting read.


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## johnrsemt (Mar 5, 2020)

2 week vacation?  When I worked busy services, I would have gotten exposed just for 2 weeks of sleep


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## RedBlanketRunner (Mar 5, 2020)

It's okay to go to work with...
Typhoid Mary, meet #CovidDonald.


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## Akulahawk (Mar 5, 2020)

Summit said:


> Can't do it to m open Ed bays, but* you can convert individual rooms with minimal work on a crisis basis*
> 
> 
> 
> https://www.health.state.mn.us/diseases/hcid/negpressure.pdf


Which is what we've done. My ED already has two neg pressure rooms and they've converted a couple more rooms using techniques described in that PDF. Fortunately for us, most of our ED is set up as individual rooms vs open bays, so we could convert 20+ rooms additionally within the ED. What that would do to staffing requirements is an entirely different matter.


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## RocketMedic (Mar 6, 2020)

NomadicMedic said:


> It’s not that they are concerned about dying. They’re concerned about a 2 week quarantine.


Exactly. It’s not even if they get sick or not- the nature of EMS means that an infected/asymptomatic or mild case that doesn’t bother us at all can still provide a lethal infection to someone we encounter. Ergo, we can’t safely work or provide care without some significant PPE investments. We are literally threats to our patients if we’ve been exposed and are carrying Covid-19.

Are they being paid?


----------



## VFlutter (Mar 9, 2020)

St. Louis is primed to turn into Washington. A college student returning from Italy tested positive and was told to quarantine and home along with her entire family. The father and younger daughter broke the quarantine and attended a father-daughter dance, house party, and visited multiple stores. People really are insanely ignorant. Now reports of multiple presumtive positvie tests in the area.


----------



## VentMonkey (Mar 9, 2020)




----------



## RedBlanketRunner (Mar 10, 2020)

In a clinical environment it's so easy to forget PPE is only half the battle. Out in the field it's actually only a small fraction. Once you've attended to someone you become a potential vector, for both yourself, others around you, and your work in the next house or village. There is no convenient sink and changing station. You have to free form decontaminating yourself then figure out what to do with the contaminated protections then decontaminate the container, then your vehicle. Then wash, rinse, repeat, sometimes 10-20 times a day. And don't forget to have side trips planned to the commercial hog farms if available just so you can drive through their wheel decontamination baths. Freaking nightmare.


----------



## KingCountyMedic (Mar 11, 2020)

I'm really curious how we will deal with our "Urban Camper" problem here.

You really think the guy that just shot up black tar heroin, tossed his dirty needle on the ground and proceeded to poop on the sidewalk before robbing you at knife-point is going to self quarantine?!?


----------



## Phillyrube (Mar 11, 2020)

DrParasite said:


> *Feeling panicked about coronavirus? Media coverage of new epidemics often stokes unnecessary fear*
> 
> By the way, CDC estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010, including an estimated 61,000 during the 2017-2018 flu season
> 
> View attachment 4785


2021......zombies formed from failed attempts at a coronavirus vaccine are gonna kill us all.


----------



## FiremanMike (Mar 11, 2020)

On the lighter side of things - my blended physiology class will have the next 2-3 labs done from home with made up data, and our exam next week is now to be done at home and is open note.. 

So that rocks


----------



## Phillyrube (Mar 12, 2020)

Interesting thought....I was reading some of the course stuff I got from DMAT training at Ft Detrick.   Any thoughts this wuhan flu is actually a beta test for something stronger, seeing as it came from the area of a bioweps lab?


----------



## GMCmedic (Mar 12, 2020)

This coronavirus thing is getting really old.


----------



## mgr22 (Mar 12, 2020)

GMCmedic said:


> This coronavirus thing is getting really old.



Yet it's the biggest news story of the year with major social, financial, educational, political, cultural, professional, and recreational implications for many of us.


----------



## GMCmedic (Mar 12, 2020)

mgr22 said:


> Yet it's the biggest news story of the year with major social, financial, educational, political, cultural, professional, and recreational implications for many of us.


And most importantly, suspending baseball!!!!!!!


----------



## mgr22 (Mar 12, 2020)

GMCmedic said:


> And most importantly, suspending baseball!!!!!!!



I'm more upset about hockey. I'll have to find something else to watch that doesn't involve politics, talent shows, or real housewives.


----------



## akflightmedic (Mar 12, 2020)

Yay...Maine got its first case today.

Spring break has been extended an extra week for now while they decide what to do next. They are most likely going online for remainder of semester.


----------



## FiremanMike (Mar 12, 2020)

I saved about $160 on my August cruise this week thanks to price drops..


----------



## CCCSD (Mar 12, 2020)

Phillyrube said:


> Interesting thought....I was reading some of the course stuff I got from DMAT training at Ft Detrick.   Any thoughts this wuhan flu is actually a beta test for something stronger, seeing as it came from the area of a bioweps lab?



It’s been and being discussed.


----------



## johnrsemt (Mar 12, 2020)

FiremanMike;  You may want to check;  2 major cruise lines cancelled all cruises for at least 60 days.


----------



## CCCSD (Mar 12, 2020)

I wonder if this will resurrect the Cruise Line Medic thread...


----------



## FiremanMike (Mar 13, 2020)

johnrsemt said:


> FiremanMike;  You may want to check;  2 major cruise lines cancelled all cruises for at least 60 days.



My cruise is in August, but thanks for the heads up, I appreciate it


----------



## Phillyrube (Mar 13, 2020)

Got back from Bahamas last Friday.  Saturday I had a throat tickle sort of cough, which got worse.   Saw the doc Monday, ended up with steroids and Zpack.  No temp at all.   Not blowing green.  That is on decline.  Wife wakes up this morning with low grade fever and cough.   We only live together.   AND, I pick up my niece and two girlfriends from their cruise this am.   
Rode my bike through UCF yesterday, it's spring break but place is like a ghost town.  Had my coffee with no one to look at.
Stay safe, everyone.


----------



## cruiseforever (Mar 13, 2020)

We just got kicked out of a fire station we are based at.  They saw us as a risk to their health.


----------



## CCCSD (Mar 13, 2020)

Do you have a contract or MOU? Your company might get some $$$. You can always refuse to respond to the station if called due to a “risk to your health”...


----------



## RocketMedic (Mar 13, 2020)

CCCSD said:


> Do you have a contract or MOU? Your company might get some $$$. You can always refuse to respond to the station if called due to a “risk to your health”...


I actually makes a lot of sense to isolate risky people


----------



## KingCountyMedic (Mar 13, 2020)

Our State is closed now pretty much. TP is more valuable than cigarettes in prison for some reason.


----------



## OG EMT (Mar 13, 2020)

I predict a baby boom around next Christmas time.


----------



## SandpitMedic (Mar 13, 2020)

OG EMT said:


> I predict a baby boom around next Christmas time.


We’re going to need it when this thing is done with the elderly (according to the statistics).

I still think this panic and overreaction is way out of proportion. This isn't planning and prudence- it is absolute madness.


----------



## RocketMedic (Mar 13, 2020)

SandpitMedic said:


> We’re going to need it when this thing is done with the elderly (according to the statistics).
> 
> I still think this panic and overreaction is way out of proportion. This isn't planning and prudence- it is absolute madness.


I heard it called the Boomer Remover and it seems apt.


----------



## CCCSD (Mar 13, 2020)

RocketMedic said:


> I actually makes a lot of sense to isolate risky people



How are they any “riskier” than anyone else? 
If there is a signed contract, you can’t just break it because you’re scared. This is a FLU, not Ebola. Jesus, The Stupid is rampant!


----------



## NomadicMedic (Mar 13, 2020)

RocketMedic said:


> I heard it called the Boomer Remover and it seems apt.



I find that incredibly callous.


----------



## Jim37F (Mar 13, 2020)

Well my FD just put this out:



> Due to the Coronavirus disease (COVID-19) outbreak, the Honolulu Fire Department will not participate in community events, provide fire safety presentations, or host museum tours until further notice.  For those with an already scheduled event you will be contacted.



Last I heard there were still only 2 confirmed cases, both in isolation...


----------



## RocketMedic (Mar 13, 2020)

NomadicMedic said:


> I find that incredibly callous.


Well yeah, that’s the point...pandemic that primarily affects the elderly while oddly sparing the young is going to get some salty nicknames. Youth naming things are rarely sensitive, and the fact that so many Boomers are willfully ignorant of the danger brings it home.


----------



## E tank (Mar 13, 2020)

Sheesh...they'll be shutting off the water to avoid transmission at this rate....


----------



## GMCmedic (Mar 13, 2020)

E tank said:


> Sheesh...they'll be shutting off the water to avoid transmission at this rate....


Dont give them any ideas


----------



## Summit (Mar 13, 2020)

NREMT extended due dates for this cycle to end of June. You can do all CE remote/online.


----------



## CCCSD (Mar 13, 2020)

RocketMedic said:


> Well yeah, that’s the point...pandemic that primarily affects the elderly while oddly sparing the young is going to get some salty nicknames. Youth naming things are rarely sensitive, and the fact that so many Boomers are willfully ignorant of the danger brings it home.



How are we ignorant? We’re just not panicking like all the millennials et al. We’re smart.


----------



## akflightmedic (Mar 14, 2020)

We have 3 cases in Maine. The colleges have closed for remainder of semester. Schools are closing. All public events have been cancelled including a concert I have tickets for next weekend. City hall meetings cancelled. The nursing homes have stopped ALL visitors. The hospitals have stopped visitors. 

Nursing school clinicals cancelled. The casinos will be closing soon. Especially since Foxwoods announced they are closing. Encore Boston is next. And then all the smaller ones.


----------



## RedBlanketRunner (Mar 14, 2020)

My wife and I caught it thanks to immigration department waiting room jamb packed with Chinese tourists. Acts a little strange; slight sore throat for a day then straight to the lungs. Non OTC expectorant and broncodilator has it covered  I can see it hammering chest breathers and sedentary low exercise people hard.


----------



## RedBlanketRunner (Mar 14, 2020)

Addendum. It's pretty obvious why this went pandemic. If average person contracts this they will likely write it off as a cold of seasonal flu. I did until my wife caught it and developed SOB. So I wouldn't be surprised if reported cases is around 5% - 10%.
Let's keep in mind it was in the wild in China from the first of the year and they had their new years celebration which very often involves travel. From Jan. 1st through the end of Feb. every cut rate airline in SE Asia gets booked solid.


----------



## mgr22 (Mar 14, 2020)

RocketMedic said:


> I heard it called the Boomer Remover and it seems apt.



We'll try not to inconvenience the rest of you on our way out.


----------



## Sled Driver (Mar 14, 2020)

Summit said:


> NREMT extended due dates for this cycle to end of June. You can do all CE remote/online.



Does NR offer any CME classes directly from their own web site ?


----------



## GMCmedic (Mar 14, 2020)

RedBlanketRunner said:


> Addendum. It's pretty obvious why this went pandemic. If average person contracts this they will likely write it off as a cold of seasonal flu. I did until my wife caught it and developed SOB. So I wouldn't be surprised if reported cases is around 5% - 10%.
> Let's keep in mind it was in the wild in China from the first of the year and they had their new years celebration which very often involves travel. From Jan. 1st through the end of Feb. every cut rate airline in SE Asia gets booked solid.


Yep, this is why weve been saying its too early to let the mortality rate drive fears.


----------



## RocketMedic (Mar 14, 2020)

RedBlanketRunner said:


> My wife and I caught it thanks to immigration department waiting room jamb packed with Chinese tourists. Acts a little strange; slight sore throat for a day then straight to the lungs. Non OTC expectorant and broncodilator has it covered  I can see it hammering chest breathers and sedentary low exercise people hard.



So, 90% of our patients.


----------



## SandpitMedic (Mar 14, 2020)

If you waited until literally 2 weeks before your recert was due to start your CME/recert..... you’re a donkey. We have *2* years! If that’s anyone here- stop being such a damn procrastinator.

NREMT is a damn clown show. Extending recert deadline 2 weeks before D-Day after 2 years to complete is just doing something just to do it... “Best Buy and Bank of America are sending out emails for COVID so I guess we should too.” Durrrr.

Doesn’t affect me, but damn it makes me hot.


----------



## Summit (Mar 14, 2020)

I think the South Korean dataset is the most informative as their broad testing captured asymptomatic cases and the CFR is about 1%.

The US is testing people better than Iran. That's all I can say and it isn't much...


----------



## RocketMedic (Mar 14, 2020)

Summit said:


> I think the South Korean dataset is the most informative as their broad testing captured asymptomatic cases and the CFR is about 1%.
> 
> The US is testing people better than Iran. That's all I can say and it isn't much...


Would you even want to be tested by an Iranian government, given the potential locally-acceptable responses and consequences?


----------



## RocketMedic (Mar 14, 2020)

Silly question here: 24-hour shift patterns are well known to destroy sleep cycles and result in chronic immunocompromise, not to mention exposure to large numbers of people without consistent or frequent uniform changes and the effects of fatigue on cleaning/resetting.
Does this matter in the context of COVID-19? Like, would it be wise to pull trucks and crews down at intervals for required Decon and reset?


----------



## Jim37F (Mar 14, 2020)

Out Training Bureau has a few people trained explicitly in NREMT renewal. We also use mandatory online training (Target Solutions) in addition to mandatory in person trainings, Training logs everything, and medical refresher training is scheduled explicitly to match NR renewal requirements...

So like in December they sent their guys out to pretty much every station and basically hand held everyone thru recerting NREMT


----------



## akflightmedic (Mar 14, 2020)

Has anyone let the Amish know whats going on yet?


----------



## cruiseforever (Mar 14, 2020)

CCCSD said:


> Do you have a contract or MOU? Your company might get some $$$. You can always refuse to respond to the station if called due to a “risk to your health”...



Not sure if there is anything like that in the contract.  The best thing that can happen is that we will never be stationed there again.  It felt like we being judged constantly.


----------



## NomadicMedic (Mar 14, 2020)

akflightmedic said:


> Has anyone let the Amish know whats going on yet?



Trust me. They know.

The Amish know everything


----------



## Phillyrube (Mar 15, 2020)

It's getting bad.  Closing the liquor stores.









						Bucks, Montgomery County wine & spirit stores to close
					

Whether you’re social distancing, self-quaranting or just keeping your hands washed, some may like a little drink to help during these unprecedented




					www.theintell.com


----------



## akflightmedic (Mar 15, 2020)

Thats why I loaded up yesterday....plenty of booze on hand.


----------



## Phillyrube (Mar 15, 2020)

Navy handwashing techniques.....


----------



## cruiseforever (Mar 15, 2020)

Looks like Minnesota is dumping all regulations on it's ambulances if things get bad.









						Minnesota issues ‘5-day Emergency Suspension of Ambulance Services’ memo
					

Ambulance services asked to maintain normal operations during COVID-19 pandemic but are given exceptions to staffing, equipment and drug requirements




					www.ems1.com


----------



## CCCSD (Mar 15, 2020)

Utter carnage will result in that ruling. Welcome to Third World EMS.


----------



## RocketMedic (Mar 15, 2020)

That seems like prudent preparation for the dead body cart


----------



## RocketMedic (Mar 15, 2020)

CCCSD said:


> Utter carnage will result in that ruling. Welcome to Third World EMS.


The CNA students and an EMT-B in a QRV lol


----------



## DesertMedic66 (Mar 15, 2020)

I have absolutely no idea how busy our local 911 system has been but I will not be surprised if we stop responding to low level calls.


----------



## cruiseforever (Mar 15, 2020)

Ohio and Illinois closing restaurants and bars.  I don't thing there is any way the country can avoid recession with so many people not getting paid.









						Illinois, Ohio closing all bars, restaurants in response to coronavirus
					

Illinois and Ohio announced on Sunday they would close all restaurants and bars in response to the growing COVID-19 pandemic. “We will be issuing an order closing all bars and restaurant…




					thehill.com


----------



## Jim37F (Mar 15, 2020)

Dang, our Dept is cancelling virtually all upcoming training classes, seminars, etc. Even the Captains promotion is no more, my PHTLS class is "postponed indefinitely", same for a handful of other various training stuff 🙁


----------



## Carlos Danger (Mar 15, 2020)

cruiseforever said:


> Ohio and Illinois closing restaurants and bars.  I don't thing there is any way the country can avoid recession with so many people not getting paid.
> 
> 
> 
> ...


There is no way to avoid a recession at this point. The market is way down in spite of the feds pulling all the strings available to them and lots of businesses are already hurting and many products that we rely on from China are already hard to get, and we are only at the leading edge of the thing.

I think our near future probably holds widespread "stay home unless you are medical or public safety" orders and martial law.  

Our reaction to this thing is going to cause WAY more damage than the virus itself.


----------



## Gurby (Mar 15, 2020)

Remi said:


> Our reaction to this thing is going to cause WAY more damage than the virus itself.



You work in a hospital right?  Is your facility not being affected by this?

How do you think the US government should respond?


----------



## DrParasite (Mar 15, 2020)

Remi said:


> There is no way to avoid a recession at this point. The market is way down in spite of the feds pulling all the strings available to them and lots of businesses are already hurting and many products that we rely on from China are already hard to get, and we are only at the leading edge of the thing.


I agree, however once the virus is under control, everything will bounce back.

Yes, the stock market is (understandably) down, and businesses will be hurting for at least a month; but in a few months, everything will bounce back up.  Retails supermarkets are making money, cleaning companies are making $$$$, big pharma is getting millions.... 

Things will slow down, but they will catch up pretty quickly; we just need to get this virus under control, and all the chicken little's in the news media to stop panicking the public by saying the sky is falling.


----------



## Summit (Mar 15, 2020)




----------



## DragonClaw (Mar 15, 2020)

I've been to hospitals with corona virus pts. Our PCRs now have options to select the CC as "CONFIRMED CORONA VIRUS" and it's the only one in all caps.


----------



## Aprz (Mar 15, 2020)

cruiseforever said:


> We just got kicked out of a fire station we are based at.  They saw us as a risk to their health.


We haven't been kicked out, but some of the fire departments have hand sanitizer wipes and spray by the entrance, a sign in sheet, and we are suppose to utilize those as we walk in.

Oddly enough, I ran an airport call today, and the firefighter told me the stupidest plan ever to minimize contact. First, they asked if they could use our gear instead. Okay? They didn't want to bring in their own equipment. Walking to the gate, he was saying "here is how it is going to be... to minimize contact" speech. His plan was that he'd go on the plane to extricate the patient and move the patient to our gurney to minimize exposure/contact, and then I'll take over/transport from there. To me, I just didn't get it... My equipment. So you are going to contaminate my equipment. On top of that, if the patient is going to be transported, no matter what, I'll be exposed to him. Why don't I make patient contact and you just wait outside? All he was doing was risking exposure to one more person, himself. LOL. I don't know how he thought that through. I just told him OK because I am super passive, but when we showed up, the patient was already off the plane, and I made first contact anyways and cancelled them.

I've been hearing places of firefighters not responding to calls or waiting outside while EMS goes inside. I think that's how it should be. Non transport firefighters going inside is just adding more potential for exposure for a call that is unlikely to be super critical requiring their help. Even on critical calls, at least in my area, I feel like they are more of a burden than helpful (eg them wanting to put a traction splint on a traumatic arrest is my most famous example of being a burden rather than helpful on a critical call...), and I rather cancel them anyways even if I do need an extra hand.


----------



## CALEMT (Mar 15, 2020)

akflightmedic said:


> Thats why I loaded up yesterday....plenty of booze on hand.



Looks like I picked the wrong lent season to give up liquor...


----------



## Aprz (Mar 16, 2020)

I just found out one of our local firefighters was infected with COVID19 ended up on a ventilator. It sounds the rest that have been infected with it are doing okay.


----------



## RocketMedic (Mar 16, 2020)

Aprz said:


> I just found out one of our local firefighters was infected with COVID19 ended up on a ventilator. It sounds the rest that have been infected with it are doing okay.


That sounds extra-aggressive. Hope he pulls through.


----------



## Jim37F (Mar 16, 2020)

Yeah. Wonder why 1 guy is critical, but the others aren't, they were most likely exposed to the same strain. Prob has to do with individual medical history and suseptibilities...

They've officially announced a total of 7 confirmed COVID-19 cases here in Hawaii, all believed to be travel related exposures vs community spread. 









						Seven total COVID-19 cases in Hawaii
					






					www.kitv.com


----------



## DesertMedic66 (Mar 16, 2020)

On of our local hospitals has a decent number of positive patients are they have been internally reporting that they have a couple of criticals in the 40 year old age range.


----------



## Peak (Mar 16, 2020)

So one of the area services brings me a kid last night, zero symptoms of any communicable disease let alone covid 19.

They are wearing tyvek suits and have a particulate mask on. After they are done with report I asked them why they are dressed like glow worms, apparently they are wearing their type c suits to every call. In this whole thing all of them have touched their face at least once and haven't cleaned their hands a single time. 

It's one thing to be cautious, but what they are doing has zero effectiveness.


----------



## Sled Driver (Mar 16, 2020)

Guys great info being put out. 
Since the Account profiles do not give locations, it would be helpful to know which Hospital, The State, The City or Dept. as allowable, or that you are comfortable providing some detail as to where these things are going on to give some context. Thanks.
Be Safe.


----------



## Carlos Danger (Mar 16, 2020)

Gurby said:


> You work in a hospital right?  Is your facility not being affected by this?
> 
> How do you think the US government should respond?


I do work in a hospital. We have not yet been affected by this at all, though we fully expect to be in the not-too-distant future.

I'm not sure what the feds should do, but the constant drumbeat of apocalyptic predictions from the media are not helping at all, nor is the lack of coherent leadership at the federal level. The anxiety over this is already palpable and probably going to get much worse, and it's largely unnecessary and potentially very harmful.



DrParasite said:


> I agree, however once the virus is under control, everything will bounce back.
> 
> Yes, the stock market is (understandably) down, and businesses will be hurting for at least a month; but in a few months, everything will bounce back up.  Retails supermarkets are making money, cleaning companies are making $$$$, big pharma is getting millions....
> 
> Things will slow down, but they will catch up pretty quickly; we just need to get this virus under control, and all the chicken little's in the news media to stop panicking the public by saying the sky is falling.


I hope you are right, but I am not so optimistic. This isn't just about the market tanking and then recovering a few months later. There's a lot more at work here, financially and economically speaking. The economic impact of this could easily be at least as bad as the crash in 2008, and potentially much worse. In a few days we just added $1T more to our already insane national debt, all the major national banks have dropped interest rates to zero and flooded the market with cash, many individuals who live paycheck to paycheck are already out of work or about to be, and businesses large and small are already being negatively affected. And this thing hasn't even really begun yet.


----------



## GMCmedic (Mar 16, 2020)

Well all dine in wating has been closed through the end of the month in Indiana and surrounding states. Can still do take out or delivery for the time being. We also had our first Covid death today. Didnt say where but I assume it was the Indianapolis area since there have been no confirmed cases south of there.


----------



## KingCountyMedic (Mar 16, 2020)

Lot's of our folks are sick, lot's in quarantine or isolation. We are shutting down everything here. I think one of our biggest issues going forward is the rate we are burning through our PPE. If we keep going like this we will run out of gowns and masks etc. I have plenty of TP and Corona so I'm good. A trip to Costco is quite the adventure now. I don't think COVID 19 is the biggest threat facing us though, I think it's social media. Covid does definitely suck from what our sick peeps have told us though.


----------



## Aprz (Mar 16, 2020)

I was just told by other crews that people in the county are suppose to shelter in place, and supposedly violators can get a misdemeanor? I haven't been officially told yet or know the details, but it is on the news online.





__





						Redirect Notice
					





					www.google.com


----------



## CALEMT (Mar 16, 2020)

KingCountyMedic said:


> Lot's of our folks are sick, lot's in quarantine or isolation. We are shutting down everything here. I think one of our biggest issues going forward is the rate we are burning through our PPE. If we keep going like this we will run out of gowns and masks etc. I have plenty of TP and Corona so I'm good. A trip to Costco is quite the adventure now. I don't think COVID 19 is the biggest threat facing us though, I think it's social media. Covid does definitely suck from what our sick peeps have told us though.



Social media and/or news media will be the downfall to our society.


----------



## CCCSD (Mar 16, 2020)

Aprz said:


> I was just told by other crews that people in the county are suppose to shelter in place, and supposedly violators can get a misdemeanor? I haven't been officially told yet or know the details, but it is on the news online.
> 
> 
> 
> ...



Since it’s a misdo, don’t sweat the ticket.  No court for theft or battery, this won’t go far. They MUST allow people to shop.


----------



## NomadicMedic (Mar 16, 2020)

KingCountyMedic said:


> Lot's of our folks are sick, lot's in quarantine or isolation. We are shutting down everything here. I think one of our biggest issues going forward is the rate we are burning through our PPE. If we keep going like this we will run out of gowns and masks etc. I have plenty of TP and Corona so I'm good. A trip to Costco is quite the adventure now. I don't think COVID 19 is the biggest threat facing us though, I think it's social media. Covid does definitely suck from what our sick peeps have told us though.



Are you still running EMS services? Do you have enough people to staff the system?  When you say "shutting everything down" you mean stores and restaurants... Like we're doing here in PA?


----------



## KingCountyMedic (Mar 16, 2020)

NomadicMedic said:


> Are you still running EMS services? Do you have enough people to staff the system?  When you say "shutting everything down" you mean stores and restaurants... Like we're doing here in PA?


Yes, shutting down most businesses etc.
Our EMS system is going strong.


----------



## RocketMedic (Mar 16, 2020)

I’m curious as to what our PPE plan is. Are we going to be expected to run calls without it?


----------



## Tigger (Mar 16, 2020)

Some of my jobs are asking that we reuse PPE from calls where there is not a high suspicion of COVID exposure. If there are decon procedures I suppose that's fine but generally speaking I'm not wearing an N95 or gown unless there is suspicion anyway...


----------



## CALEMT (Mar 16, 2020)

Tigger said:


> Some of my jobs are asking that we reuse PPE from calls where there is not a high suspicion of COVID exposure.



10 times for low risk. 1 and done for high risk patients.


----------



## Aprz (Mar 17, 2020)

To me, reusing the mask doesn't make sense. The front of the mask is contaminated. If you are using it because it is possible the patient has something, how do you know if they did or didn't have something, and that when you reuse it, how are you avoiding cross contamination? Wherever you put it, you are contaminating something. Back in your pocket? Contaminated. Plastic bag? Contaminated. Touch the front with your hand? Contaminated? It seems pretty impossible to not cross contaminate, if you are reusing it. I feel like reusing it just leads to a false sense of security.





__





						This Page is No Longer Available
					

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”).




					www.cdc.gov
				




Scroll down to the bottom where it says is titled in bold "Risksof Extended Use and Reuse of Respirators". The whole page talks about how it is past practice to reuse, but the problems associated with reuse. To me, it seems like a circle jerk. We are short mask, reuse it to conserve mask, but the mask is contaminated.


----------



## VFlutter (Mar 17, 2020)

Anyone using half-face respirators instead of disposable n95s? Any recommendations 3M, Scott, MSA, etc? Not that you can get any masks currently but it seems that you can still easily get N95/P100 filters in bulk for reusable masks  compared to the minimal availability of cheap N95s. May be something we look into getting for the future


----------



## Sled Driver (Mar 17, 2020)

I am running 3M Half Respirator, size Medium fits most. I ordered a large pile of P-100 filters moments before the current madness hit. I carry the mask and extra filters in a Blackhawk gas mask carrier with anti microbial wipes in the case leave it in my truck. I have worn it for long periods of time and it is comfortable enough. I think you will be happy with it, don't forget to shave. The way things are going around here I may need it for food shopping.


----------



## Summit (Mar 17, 2020)

There is guidance on reuse of masks. Are you saying you're actually reusing gowns? What's a recipe for self contamination? That is.


----------



## Tigger (Mar 17, 2020)

Summit said:


> There is guidance on reuse of masks. Are you saying you're actually reusing gowns? What's a recipe for self contamination? That is.


Many texts from AMR saying to reuse gowns if you wore it but the patient was not suspicious for COVID. Also folks need to be wearing full PPE if participating in the decon process so unless the sole provider with contact also does the decon (takes forever), I am not sure how we will not have both ambulance crew members in full PPE.


----------



## GMCmedic (Mar 17, 2020)

Seems current home management recommendations(at least local to this state), are Zinc, Vitamin C and Tylenol for fever.

Avoid Elderberry, NSAIDs, and steriods.


----------



## CALEMT (Mar 17, 2020)

GMCmedic said:


> Tylenol



If its good enough for Clark Griswold, then its good enough for us all.


----------



## KingCountyMedic (Mar 17, 2020)

Anyone changing their airway practices? We are going to the iGel for Covid and full PPE required for any CPR or intubation regardless of situation.


----------



## Kavsuvb (Mar 17, 2020)

I wonder how many EMT's, Paramedics, PA's, NP's, DO's and MD's do we have that can sustain this Pandemic in this country. I know we have some EMT's and Paramedics that are not affiliated with a EMS service or Vol EMS squad.

I have heard rumblings within DHS, HHS and DoD that they may activate the Military medical companies including the already PHS Commissioned Corp already on scene in Washington State. That means DMAT teams, US Army Corp of Engineers, State's National Guard and State Militias. 

If many of you don't know what the PHS Comissioned corp, here's info




__





						Home | Commissioned Corps of the U.S. Public Health Service
					

The Commissioned Corps of the U.S. Public Health Service works on the front lines of public health.




					usphs.gov
				




*What is the USPHS and what does it do?*








						What is the USPHS and what does it do?
					

If you watched the White House press briefing on COVID-19 today, you might have wondered what the Coast Guard folks were doing on tv for a Presidential Address about a global pandemic. And then, upon further inspection of their uniforms and seeing t…




					www.wearethemighty.com


----------



## mgr22 (Mar 17, 2020)

GMCmedic said:


> Seems current home management recommendations(at least local to this state), are Zinc, Vitamin C and Tylenol for fever.
> 
> Avoid Elderberry, NSAIDs, and steriods.



What's the concern about NSAIDs?


----------



## GMCmedic (Mar 17, 2020)

mgr22 said:


> What's the concern about NSAIDs?


Cytokine response


----------



## DesertMedic66 (Mar 17, 2020)

KingCountyMedic said:


> Anyone changing their airway practices? We are going to the iGel for Covid and full PPE required for any CPR or intubation regardless of situation.


As of yet we have not changed any of our airway practices aside from placing a HEPA filter on BVMs and not just our ventilators. CPAP/BPAP/Intubation/etc are all still approved.


----------



## cruiseforever (Mar 17, 2020)

Now the cops are told to avoid EMS in my area.  There has only been one case in our county.   One would would think we have been rolling around in Fentanyl.  We have always had a very positive relationship with them.  But that is quickly heading down the tubes.


----------



## Jim37F (Mar 17, 2020)

I saw a post on Facebook, apparently San Bernadino Co is rolling to every EMS call in full gowns and masks, regardless? 

I'm honestly more worried about the idoitic panic buying people more than the virus itself... but now the Wall St people panicking is worrying me more than the people getting into first fights over TP, which is still more worrisome to me than the dang virus itself


----------



## Kavsuvb (Mar 17, 2020)

Here's the Guidelines from the CDC for EMS

Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States








						COVID-19 ARCHIVED WEBPAGE
					

This historical page is not up to date. Find the latest on COVID-19.




					www.cdc.gov
				




They include the EMS Infectious Disease Playbook. https://www.ems.gov/pdf/ASPR-EMS-Infectious-Disease-Playbook-June-2017.pdf


----------



## KingCountyMedic (Mar 17, 2020)

DesertMedic66 said:


> As of yet we have not changed any of our airway practices aside from placing a HEPA filter on BVMs and not just our ventilators. CPAP/BPAP/Intubation/etc are all still approved.


Yea, we have the filters too. I have heard a bit of talk about those with transport vents potentially loaning them out to hospitals if the need arises but it's just beanery table talk. I don't know of anyone doing so yet. As of right now we are seeing a ton more cases but it's just because we have the tests now. Death toll is rising but it's still just the very old/sick folks. I do know people that have it and they have said it is horrible but they haven't had to use any more TP than usual. 

Love to hear others approach to running out of PPE. Stay safe everyone


----------



## SandpitMedic (Mar 17, 2020)

I too have heard of the cytokine storm in young people who use NSAIDs for their COVID symptoms.
Looking for more data on that.


----------



## CCCSD (Mar 17, 2020)

Post a link to that medical advice?


----------



## jgmedic (Mar 17, 2020)

Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists
					

Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of covid-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.  The minister, Oliver Veran, tweeted on Saturday 14 March that...




					www.bmj.com


----------



## mgr22 (Mar 17, 2020)

SandpitMedic said:


> I too have heard of the cytokine storm in young people who use NSAIDs for their COVID symptoms.
> Looking for more data on that.



I thought NSAIDs such as ASA and ibuprofen were ineffective at preventing cytokine storms, as opposed to causing them. If that's the case, NSAIDS may still be more effective than APAP at treating mild s/s of COVID in some people. Here's a reference:









						An Effective Treatment Strategy for Cytokine Storm in Severe Influenza
					

Despite the use of vaccines and antiviral therapies such as oseltamivir, severe influenza kills thousands to tens of thousands of Americans each year.



					www.americanlaboratory.com
				




I'm no expert on this. Any thoughts?


----------



## GMCmedic (Mar 17, 2020)

CCCSD said:


> Post a link to that medical advice?


Not advice, just education. JG posted the link on NSAIDs that ACEP just shared, the rest came from the Indiana State Medical Director via facebook, including avoiding NSAIDs


----------



## CCCSD (Mar 17, 2020)

Ok. Wanted to confirm it’s actual medical information that is vetted.


----------



## Tigger (Mar 17, 2020)

Peak said:


> So one of the area services brings me a kid last night, zero symptoms of any communicable disease let alone covid 19.
> 
> They are wearing tyvek suits and have a particulate mask on. After they are done with report I asked them why they are dressed like glow worms, apparently they are wearing their type c suits to every call. In this whole thing all of them have touched their face at least once and haven't cleaned their hands a single time.
> 
> It's one thing to be cautious, but what they are doing has zero effectiveness.


Please tell me this is WM and not another agency already following suit.

As for airway procedures, we are not to intubate patients "at risk," and use iGels instead, this includes RSI. If you do any sort of airway procedure it's supposed to be with an N95 and other PPE, with the doors of the ambulance open and the exhaust vents on. I am ordering filters now because well, what a time to suddenly be in charge or ordering.


----------



## RocketMedic (Mar 17, 2020)

Tigger said:


> Please tell me this is WM and not another agency already following suit.
> 
> As for airway procedures, we are not to intubate patients "at risk," and use iGels instead, this includes RSI. If you do any sort of airway procedure it's supposed to be with an N95 and other PPE, with the doors of the ambulance open and the exhaust vents on. I am ordering filters now because well, what a time to suddenly be in charge or ordering.


Same here, but we don’t yet have the HEPA cartridges for the BVMs.


----------



## Mufasa556 (Mar 17, 2020)

Yesterday I watched an AMR crew try and staple their N95 back together since they’re only getting 1 a shift. Seems like things are going well out there.


----------



## SandpitMedic (Mar 18, 2020)

So here is a news article of the WHO “officially” recommending a stop on NSAIDs for COVID patients. Apparently it was based on the French Health Ministry guidelines which were based on a study or article in the _Lancet._

I was unable to corroborate the information on the WHO website.





__





						Updated: WHO Now Doesn't Recommend Avoiding Ibuprofen For COVID-19 Symptoms
					

Editor's note (19 March 2020): Since the publication of this article, the World Health Organization has updated its advice on the official Twitter account: "Based on currently available information, WHO does not recommend against the use of ibuprofen."...




					www.sciencealert.com


----------



## RocketMedic (Mar 18, 2020)

Mufasa556 said:


> Yesterday I watched an AMR crew try and staple their N95 back together since they’re only getting 1 a shift. Seems like things are going well out there.


Yeah I’m not sure how we’re supposed to recycle them


----------



## Gurby (Mar 18, 2020)

I wonder if you guys believe this is real yet?

My small, rural hospital is absolutely getting smashed, and half of our nurse+physician staff is out on quarantine for possible exposures.  We have only had a couple confirmed positive patients so far and it's already a mess.  There aren't enough negative pressure rooms to put people in while we rule patients in/out, and donning/doffing PPE every time you need to go into a room really slows down the day when we're already understaffed.  I can't imagine what it must look like in NYC where they've essentially tripled their number of cases in 3 days.


----------



## Tigger (Mar 18, 2020)

Gurby said:


> I wonder if you guys believe this is real yet?


I hope that there aren't people out there pretending this isn't real.

I transported a symptomatic patient with several immunocompromising diseases already...she went to triage because the the ED is slammed.


----------



## NomadicMedic (Mar 18, 2020)

Tigger said:


> I hope that there aren't people out there pretending this isn't real.
> 
> I transported a symptomatic patient with several immunocompromising diseases already...she went to triage because the the ED is slammed.



there are plenty of people who believe this is a media scare tactic. The DOH confirmed the first death in PA today and a slew of social media comments were about how “you can’t trust the media”.

all I can do is shake my head.


----------



## Sled Driver (Mar 18, 2020)

475 people Italy died just today alone.

As of 17:40 EST in NYC there are 1,841 confirmed cases, which is more than 3x the number from just 72 hours ago and 11 deaths in NYC alone.


----------



## FiremanMike (Mar 18, 2020)

NomadicMedic said:


> there are plenty of people who believe this is a media scare tactic. The DOH confirmed the first death in PA today and a slew of social media comments were about how “you can’t trust the media”.
> 
> all I can do is shake my head.



I believe this is a real pandemic

I also believe the media is intentionally using words to cause what can only be described as a frenzied panic of epic proportions.

As of this morning, there are 200,000 confirmed cases worldwide.. So we can accept that not a lot of people are getting tested, so lets say the number is closer to 2,000,000 infected patients WORLDWIDE, which includes the areas where this disease ran UNCHECKED for 3 months.

That is 2 tenths of 1 percent of the worlds population...


----------



## Carlos Danger (Mar 18, 2020)

KingCountyMedic said:


> Anyone changing their airway practices? We are going to the iGel for Covid and full PPE required for any CPR or intubation regardless of situation.


Avoid hi flow 02, CPAP/BIPAP, manual ventilation, RSI everyone, ETT’s only - no LMA’s. Also, all intubations are to be performed by anesthesia personnel wearing a PAPR and full garb whenever possible.


----------



## Carlos Danger (Mar 18, 2020)

NomadicMedic said:


> there are plenty of people who believe this is a media scare tactic. The DOH confirmed the first death in PA today and a slew of social media comments were about how “you can’t trust the media”.
> 
> all I can do is shake my head.


Well the reality is that you CAN’T trust the media.

the media’s general lack of credibility is why so many folks are so skeptical.


----------



## Jim37F (Mar 18, 2020)

Starting Friday, all restaurants on Oahu will be pickup, curbside, or delivery only


----------



## FiremanMike (Mar 18, 2020)

Remi said:


> Well the reality is that you CAN’T trust the media.
> 
> the media’s general lack of credibility is why so many folks are so skeptical.



And for me, it might be the "boy who cried wolf" syndrome.. I've lived in EMS through SARS, H1N1, ebola, swine flu, zika virus, and I'm sure I'm missing a few (started in 1998)..  Each of those were going to be crisis pandemics that would kill millions, and each of them panned out to be pretty much nothing like the frenzy.


----------



## GMCmedic (Mar 18, 2020)

I think that at least in healthcare, we recognize the seriousness of the situation, but also recognize that the media has also created a panic. 

In other news, hadnt seen this posted so in case you havent seen it.


----------



## RedBlanketRunner (Mar 18, 2020)

GMCmedic said:


> Yep, this is why weve been saying its too early to let the mortality rate drive fears.


From the medical head honcho of our NGO cooperative: "To answer all your questions, in a nutshell, we don't know anything. All our data right now involves assumptions, guesses, and close comparisons. Thoroughly tested clinical analysis is weeks, months or even years off. "


RocketMedic said:


> So, 90% of our patients.


OUCH. 


Seriously, if you wanted to put a serious dent in the infection rate in the US it's quite simple. Trump makes a public announcement that virtually everything he has said about the virus up to a few days ago is misinformation or outright lies. 
As long as there are deniers and naysayers we have an active viral pool and he's got millions of head-in-the-sand followers.


----------



## SandpitMedic (Mar 19, 2020)

GMCmedic said:


> I think that at least in healthcare, we recognize the seriousness of the situation, but also recognize that the media has also created a panic.
> 
> In other news, hadnt seen this posted so in case you havent seen it.
> 
> ...


This is fantastic. Thank you.


----------



## SandpitMedic (Mar 19, 2020)

RedBlanketRunner said:


> Seriously, if you wanted to put a serious dent in the infection rate in the US it's quite simple. Trump makes a public announcement that virtually everything he has said about the virus up to a few days ago is misinformation or outright lies.
> As long as there are deniers and naysayers we have an active viral pool and he's got millions of head-in-the-sand followers.


Will you get off the Trump BS dude. You're trolling!

The discussion of distrust of the severity of this has more to do with the *media* than the president, as has been discussed here. I promise you, the MAGA people are paying attention to this.


----------



## SandpitMedic (Mar 19, 2020)

This is the Imperial report from 3/16/2020. It's why the tone has changed and politicians are enacting these policies of everything closing down big and small. Can you believe Las Vegas is closed?! It has NEVER happened before. The entire city, as is the rest of NV... Like many other cities...

This research indicates that within 3 months the _best_ likely outcome of this in the US is 1.1-1.2 million dead and 250,000 deaths in the UK. That is if social isolation and closures work. Without all the shut downs in the US we are looking at 4 mil dead and globally 90 mil dead _POTENTIALLY. _

This is evolving rapidly. I am not so sure it will be the apocalypse the media says, but I think I may find myself retracting my nothing burger statements from last week. Time will tell, and I hope I am wrong._ There is a lot of conflicting data out there. There is a lot of unknown out there. There is a lot of speculation out there. And there is a lot of "let's just air on the side of caution" out there....Which is what we are doing. _

I don't know that these data will come to fruition, because this is unprecedented in the modern world and no one has a crystal ball. Either way, the economic consequences are going to be devastating even if this turns out to be a nothing burger flu-like-illness or the real reset button.  



			https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf


----------



## RedBlanketRunner (Mar 19, 2020)

SandpitMedic said:


> Will you get off the Trump BS dude.


I will certainly avoid any BS. What I stated stands and is a fact. Deniers in red silly hats all over the midwaste.
Do you have a problem with the president fessing up, being honest, and confronting this impending disaster head on? Our ONLY line of defense right now is complete transparency and total cooperation.


----------



## FiremanMike (Mar 19, 2020)

SandpitMedic said:


> This is the Imperial report from 3/16/2020. It's why the tone has changed and politicians are enacting these policies of everything closing down big and small. Can you believe Las Vegas is closed?! It has NEVER happened before. The entire city, as is the rest of NV... Like many other cities...
> 
> This research indicates that within 3 months the _best_ likely outcome of this in the US is 1.1-1.2 million dead and 250,000 deaths in the UK. That is if social isolation and closures work. Without all the shut downs in the US we are looking at 4 mil dead and globally 90 mil dead _POTENTIALLY. _
> 
> ...



On the other hand, the disease ran rampant through China who waited months before reacting and imposing safeguards.. How many total died there in 3 months?


----------



## mgr22 (Mar 19, 2020)

Remi said:


> Well the reality is that you CAN’T trust the media.
> 
> the media’s general lack of credibility is why so many folks are so skeptical.



Your reality, perhaps. Mine is that it's hard to know whom to trust. Some outlets are more reliable than others, but if it weren't for the presence of independent news media, we'd probably be a captive audience exclusively for government-sponsored propaganda. In my opinion, there are at least as many skeptical folks due to politicians' lack of credibility. And, like the media, some are worse than others.


----------



## Chimpie (Mar 19, 2020)

*Let's keep this discussion on topic - Coronavirus. Thanks!*


----------



## RocketMedic (Mar 19, 2020)

So apparently isolation doors are “unnecessary”, per second- line supervisor. And there’s supposed to be no PPE in the cab to prevent cross contamination. So, pray tell, how are we supposed to limit the spread of aerosolized droplets forward from the module to the cab without a hard physical barrier?

@NomadicMedic bro this is why I complain BTW.


----------



## Peak (Mar 19, 2020)

Tigger said:


> Please tell me this is WM and not another agency already following suit.



So far I haven't seen any others. 

That being said most of our patients are being flown in. The teams are wearing a n95 and goggles, but the same flight suit and jacket they are going to wear out and no gown. They are obsessed with wiping down their equipment, but do nothing to barrier the infectious agent from the clothing that they are wearing for the next 12-24 hours. That has been across every big agency in the region, and several out of state players that fly to us as well.


----------



## Peak (Mar 19, 2020)

Tigger said:


> I hope that there aren't people out there pretending this isn't real.
> 
> I transported a symptomatic patient with several immunocompromising diseases already...she went to triage because the the ED is slammed.



The sad thing is the hugely variable resources and where patients seek to get care. We have had open ED beds for the past two weeks, and haven't had to triage in the waiting room. Because we are canceling elective cases we actually have excess RT, nursing, and medical staff. We are sending our old backup vents to sister hospitals who have been seeing the brunt of the covid patients, and we have many of our new vents sitting in the halls from all of our canceled cases. Meanwhile the county hospital and the U have been on advisory to divert quite a bit.


----------



## DesertMedic66 (Mar 19, 2020)

Peak said:


> So far I haven't seen any others.
> 
> That being said most of our patients are being flown in. The teams are wearing a n95 and goggles, but the same flight suit and jacket they are going to wear out and no gown. They are obsessed with wiping down their equipment, but do nothing to barrier the infectious agent from the clothing that they are wearing for the next 12-24 hours. That has been across every big agency in the region, and several out of state players that fly to us as well.


Our policy as of right now is that once we get back to base we are to go out of service, decon all equipment/aircraft wearing our PPEs. Once that is done all flight suits get tossed in the washer with hot water and all crew members are to shower. It’s been seeming like the usual out of service time for that has been 4-5 hours.


----------



## Phillyrube (Mar 19, 2020)

GMCmedic said:


> I think that at least in healthcare, we recognize the seriousness of the situation, but also recognize that the media has also created a panic.
> 
> In other news, hadnt seen this posted so in case you havent seen it.
> 
> ...



So whats with the "Not Wuhan virus".  Im calling it the Wuhan flu, watch a liberals head explode!


----------



## GMCmedic (Mar 19, 2020)

Phillyrube said:


> So whats with the "Not Wuhan virus". Im calling it the Wuhan flu, watch a liberals head explode!


Its out of Seattle


----------



## DragonClaw (Mar 19, 2020)

We no longer will let family ride with us unless absolutely necessary. effective this morning.


----------



## DragonClaw (Mar 19, 2020)

Also, partner who potentially was exposed is now home and originally was "a bit" sick now has a "super bad cough" .

Hopefully it's not the rona.

Not sure if he's been tested or what the deal is.


----------



## johnrsemt (Mar 19, 2020)

And if the quarantine for the virus (businesses closed, no dining in, etc.) isn't bad enough.  Salt Lake City area had a 5.7 earthquake yesterday morning.  Nice wake up at 85 miles away.


----------



## SandpitMedic (Mar 19, 2020)

FiremanMike said:


> On the other hand, the disease ran rampant through China who waited months before reacting and imposing safeguards.. How many total died there in 3 months?


Right. Exactly why I’m not sure what to believe. There are also so many variables between us and China and us and Italy... I find real hard to believe we will fare worse than those nations.

From what I am seeing now, the authorities such as government, hospitals, and most agencies are taking this with seriousness to the extreme.

I liken it to hurricane preparation except on a global scale. So many forecast models, but no one really knows... is that Cat6 unheard of monster going to hit, or is going to track away from making landfall?

For now we best just batten down the hatches.


----------



## SandpitMedic (Mar 19, 2020)

RocketMedic said:


> So apparently isolation doors are “unnecessary”, per second- line supervisor. And there’s supposed to be no PPE in the cab to prevent cross contamination. So, pray tell, how are we supposed to limit the spread of aerosolized droplets forward from the module to the cab without a hard physical barrier?
> 
> @NomadicMedic bro this is why I complain BTW.


It’s my understanding it is only aerosolized if you do something to make it so. I’m not talking projectile droplets. I’m talking aerosols, so neb treatments, CPAP, intubating, etc.

Guidelines are changing to withhold those interventions unless they are in negative pressure rooms and providers have full and proper PPE.

If you are that worried go get a* trash bag* and some *duct tape* to seal off the cab from the back... ghetto yet effective. Go old school.


----------



## Summit (Mar 19, 2020)

RocketMedic said:


> So apparently isolation doors are “unnecessary”, per second- line supervisor. And there’s supposed to be no PPE in the cab to prevent cross contamination. So, pray tell, how are we supposed to limit the spread of aerosolized droplets forward from the module to the cab without a hard physical barrier?
> 
> @NomadicMedic bro this is why I complain BTW.


You should double visqueen barrier the passthrough bewteen the cab and box to isolate the front and max fan in the cab


----------



## NomadicMedic (Mar 19, 2020)

You can also open the window or turn on vents in front and turn on the exhaust fan in the back to create a negative pressure gradient. 
(Or so the CDC says)


----------



## DragonClaw (Mar 19, 2020)

NomadicMedic said:


> You can also open the window or turn on vents in front and turn on the exhaust fan in the back to create a negative pressure gradient.
> (Or so the CDC says)



We were always told to turn on the vent in the back with respiratory pts.


----------



## RedBlanketRunner (Mar 19, 2020)

Meanwhile, out in the field... minor trials and tribulations
Change outs and decontamination between patients just isn't going to happen, especially door to door health checks. Resorted to personal spray downs with alcohol. Running out of alcohol. Leaves many resorting to 200 ppm bleach or H2O2 sprays, neither of which is wet enough to have reliable efficacy, and of course, ends up turning you white and ruining your clothes. 
And how do you explain pandemic to people where words like paramedic and contagious don't even exist in local language vocabularies?


----------



## NomadicMedic (Mar 19, 2020)

PA has ordered all “non life sustaining” businesses to close.


----------



## DragonClaw (Mar 19, 2020)

Greg Abbott closed sitdown resturaunts,  bars,  taverns,  schools, banned visitors in hospitals expect in certain cases. Etc

But,  if you buy food,  you can get alcohol delivered


----------



## VentMonkey (Mar 19, 2020)

DragonClaw said:


> But,  if you buy food,  you can get alcohol delivered


If I buy alcohol, I can get alcohol delivered.


----------



## RedBlanketRunner (Mar 19, 2020)

Coronavirus: Why washing hands is difficult in some countries
					

The World Health Organisation's advice is difficult to follow in some developing countries.



					www.bbc.com


----------



## E tank (Mar 19, 2020)

NomadicMedic said:


> PA has ordered all “non life sustaining” businesses to close.


No pot dispensaries in PA?


----------



## RedBlanketRunner (Mar 19, 2020)

This virus is as sneaky stealth as it gets. 7-8 days from probably infection to developing symptoms, no nasal congestion, mild sore throat, fever <99.2-3, all about down in the lungs. Now, 12 days later coughing has subsided but is still come and go along with a slight sore throat that might just be caused by the smog. Still have slight lower lung congestion but fluid not present. Test for virus presence not available at this time unless I want to go sit in a crowded waiting room for a few hours.


----------



## Medic511 (Mar 19, 2020)

Tigger said:


> Many texts from AMR saying to reuse gowns if you wore it but the patient was not suspicious for COVID. Also folks need to be wearing full PPE if participating in the decon process so unless the sole provider with contact also does the decon (takes forever), I am not sure how we will not have both ambulance crew members in full PPE.


I guess I am so old that I remember when Universal Precautions were, well, universal.  That has kept me well for almost 20 years through hep-C, AIDS/HIV, Swine Flu, and ebola.  Now "my" current service is all upset that I say, no, reusing gowns and much more so N95 masks is not an acceptable process.  When did assuring that the scene was safe before entering cease to be a critical fail?  These request are folly and appear to say that ou employers just do not give two cents about our wellbing if it costs them money.  By the way, the problem is not that no gowns are available but that gown substitutes are more costly and require washing with adequate bleach.  That's the real complaint, otherwise these managers would be on line and on the phone placing orders to chef's coats and aprons, long-sleeve scrub, and raingear.  

I hope others will post their take on this sudden safety-no-longer-important stuff.


----------



## Medic511 (Mar 19, 2020)

Summit said:


> There is guidance on reuse of masks. Are you saying you're actually reusing gowns? What's a recipe for self contamination? That is.


My current department is indeed telling use to put used single-use disposable gowns in paper bag on scene and re-use them.  Pretty much ditto for used N95 masks if we do not "THINK" the patient has COVID.  Since when do we use our gut feel for our scene-safe determination?


----------



## Medic511 (Mar 19, 2020)

Aprz said:


> To me, reusing the mask doesn't make sense. The front of the mask is contaminated. If you are using it because it is possible the patient has something, how do you know if they did or didn't have something, and that when you reuse it, how are you avoiding cross contamination? Wherever you put it, you are contaminating something. Back in your pocket? Contaminated. Plastic bag? Contaminated. Touch the front with your hand? Contaminated? It seems pretty impossible to not cross contaminate, if you are reusing it. I feel like reusing it just leads to a false sense of security.
> 
> 
> 
> ...


I agree with you whole-heartedly.  The suggestion of reusing N95s and gowns is just plain irresponsible.  The better solution for gowns is buying launder-able cloth long-sleeve scrubs, chef coats and aprons, or rain gear.  Did the mental midgets who made those suggestion never hear of Universal Precautions and learn that not assuring a safe scene is a critical fail.  Any scene with a potental SARS-CoV-2 patient is NOT safe UNLESS you are using the appropriate PPE.  That includes at an absolute minimum Mask, eye protection, gown, and gloves.  Anything less is just playing cards against the house -- do it often enough and you WILL go broke.


----------



## Summit (Mar 19, 2020)

@RedBlanketRunner do you have any advice on processing plastic gowns? We are being told to be "creative" in reuse. Someone suggested "wiping them off" and I just laughed.

I was thinking 70% ipa dip or bleach dip by someone with a VOC filtered full face respirator as long as there was no visible bioburden.

Or just buying a bunch of trashbags and cutting holes...

Washable gowns are apparently on 6 week backorder and I hate those things too... so much opportunity to self contaminate in doffing.


----------



## SandpitMedic (Mar 19, 2020)

CA on lockdown. 

Stay at home order issued by the governor, and martial law may be next. 

Wild times.


----------



## PotatoMedic (Mar 19, 2020)

SandpitMedic said:


> CA on lockdown.
> 
> Stay at home order issued by the governor, and martial law may be next.
> 
> Wild times.


I heard about that.  What are they doing for food?


----------



## Sled Driver (Mar 19, 2020)

I guess those who are homeless or don't have adequate food supply at home will either rely on Gov. Newsome to feed them or the looting will begin shortly. Standby.


----------



## CCCSD (Mar 20, 2020)

Food banks for those who can’t shop.


----------



## DesertMedic66 (Mar 20, 2020)

PotatoMedic said:


> I heard about that.  What are they doing for food?


Restaurants, grocery stores, banks, and other essential services are still open. People are allowed to leave their house to get food and other needed items.


----------



## RedBlanketRunner (Mar 20, 2020)

Summit said:


> do you have any advice on processing plastic gowns? We are being told to be "creative" in reuse. Someone suggested "wiping them off" and I just laughed.


i'd suggest raiding the overalls discarded from surgery along with the discards and cramming the whole pile into a tub filled with around 200 ppm chlorine for 24 hours. Call it a 99% get by. They should hold up to the bath.
Or if you have a hospital connection, depending on workload in CS, when they aren't looking stuff the EO or flasher to the eyeballs and look really innocent. CS may just be willing to allocate sterilizer time during slow hours. Not sure how that plastic would hold up in the steam though. EO is your best bet but it would prob need to ride for 48 hours. If path lab uses an autoclave for discards that's another sterilizer you might be able to commandeer.
Just take a chunk from a plastic gown and ask CS or whoever runs the sterilizers to wrap and bake in a flasher. If it doesn't do a melt down you're golden. A normal sized flasher could cook up around 40-50 gowns at a time. Just don't leave melted plastic all over the insides. The surg sup will have you for breakfast.


----------



## SandpitMedic (Mar 20, 2020)

This is a counter to the Imperial study and other data out there indicating mass die off. Great read, and I tend to agree while continuing to believe caution is the best exercise these days.









						A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data
					

A fiasco in the making? As the #coronavirus pandemic takes hold, we are making decisions without reliable data.




					www.statnews.com


----------



## RedBlanketRunner (Mar 20, 2020)

@Summit CORRECTION! 2500 ppm chlorine or >160cc household bleach per gallon of water.


----------



## Jim37F (Mar 20, 2020)

I'm just glad that here disposable masks and gowns still means just that, use 'em then dispose of 'em...


----------



## NomadicMedic (Mar 20, 2020)

Things are bad at several hospitals, where staff are not only reusing masks, they’re SHARING them.

Our current policy, based on the CDC guidelines, is N95 respirators may be reused up to 5 times. The complete guideline set is below. 





__





						This Page is No Longer Available
					

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”).




					www.cdc.gov


----------



## FiremanMike (Mar 20, 2020)

Medic511 said:


> I agree with you whole-heartedly.  The suggestion of reusing N95s and gowns is just plain irresponsible.  The better solution for gowns is buying launder-able cloth long-sleeve scrubs, chef coats and aprons, or rain gear.  Did the mental midgets who made those suggestion never hear of Universal Precautions and learn that not assuring a safe scene is a critical fail.  Any scene with a potental SARS-CoV-2 patient is NOT safe UNLESS you are using the appropriate PPE.  That includes at an absolute minimum Mask, eye protection, gown, and gloves.  Anything less is just playing cards against the house -- do it often enough and you WILL go broke.



Of course it's irresponsible, but if the choice is between no protection and recycled/re-used protection, then it changes things..

That's where some folks are at right now.


----------



## Carlos Danger (Mar 20, 2020)

SandpitMedic said:


> This is a counter to the Imperial study and other data out there indicating mass die off. Great read, and I tend to agree while continuing to believe caution is the best exercise these days.
> 
> 
> 
> ...


Good read. I’ve been thinking similarly all along. It may be my epidemiological and infectious disease ignorance, or it may just be wishful thinking, but I suspect the AAR will show that this thing was not, statistically speaking, nearly as bad as the doomsday predictions foretold. 

Which doesn’t mean we shouldn’t be taking lots of precautions, of course. But I think the economic impact of these decisions will be massive and will be felt for a long time and many will rightly question whether economic suicide was necessary - or worth it.

We were so unprepared for this in so many ways, even though we’ve known for a long time that something like this was an eventuality. This thing didn’t surprise us - we knew it was coming someday. That we simply couldn’t be bothered to invest in surge capacity and financial preparation on the macro, micro, and individual levels does not surprise me, but further reinforces my lack of confidence in and disdain for our major institutions.


----------



## Carlos Danger (Mar 20, 2020)

Some good analysis here:









						COVID19 vs Influenza: why it’s worse, why it’s not.
					

OOPS: these are per 10,000, not 1000.   You’re seeing lots of graphs and tables on COVID 19.  In a disgusting display of fear mongering, networks are now keeping running counts of the cases a…



					www.enkiops.org


----------



## RocketMedic (Mar 20, 2020)

NomadicMedic said:


> You can also open the window or turn on vents in front and turn on the exhaust fan in the back to create a negative pressure gradient.
> (Or so the CDC says)


Oh, I’m aware. I’m just venting at the culture that says protective measures are “unnecessary”. Before this is over, American EMS is going to have a few tragedies brought on by complacency.


----------



## Gurby (Mar 20, 2020)

Remi said:


> Some good analysis here:
> 
> 
> 
> ...



Excellent, this hits it right on the nose. 



> "If these trends hold, the US can expect about 30 to 35 million people to be “symptomatic” (most mild), 400,000 to 500,000 need hospitalization, and 30-40 thousand deaths.  Compare to the 2017 influenza season: 45 million symptomatic, 810,000 hospitalized, 61,000 died.  *HOWEVER, rather than coming over 20 weeks or so, those cases will come over maybe 4 weeks -five times faster. * The US health care system can’t really keep up with a normal flu season; there is no way it can handle this flood.


----------



## Tigger (Mar 20, 2020)

Medic511 said:


> I guess I am so old that I remember when Universal Precautions were, well, universal.  That has kept me well for almost 20 years through hep-C, AIDS/HIV, Swine Flu, and ebola.  Now "my" current service is all upset that I say, no, reusing gowns and much more so N95 masks is not an acceptable process.  When did assuring that the scene was safe before entering cease to be a critical fail?  These request are folly and appear to say that ou employers just do not give two cents about our wellbing if it costs them money.  By the way, the problem is not that no gowns are available but that gown substitutes are more costly and require washing with adequate bleach.  That's the real complaint, otherwise these managers would be on line and on the phone placing orders to chef's coats and aprons, long-sleeve scrub, and raingear.
> 
> I hope others will post their take on this sudden safety-no-longer-important stuff.


I don't think anyone thinks that safety is not an issue here. But we can't just put our heads in the sand and say that we don't have a shortage and to operate business as usual. We have a problem, the solutions require both creativity and frankly time.


----------



## akflightmedic (Mar 20, 2020)

GEICO just "paused" all policy cancellations for non-payment through April 30th...nice job. (Coronoa related right?)


----------



## GMCmedic (Mar 20, 2020)

akflightmedic said:


> GEICO just "paused" all policy cancellations for non-payment through April 30th...nice job. (Coronoa related right?)


I also saw Senator Warren wants to pause all student loans and give healthcare/first responders $10,000 off their loan balance.


----------



## DragonClaw (Mar 20, 2020)

My partner got tested for COVID. Wonder how long till he gets results.


----------



## RedBlanketRunner (Mar 20, 2020)

@Summit Decontaminating and reusing.  Excuse if I sound redundant or whatever here.

Sterilizing is pretty much the same as debridement. If you can't supply an environment where all organisms and spores cannot survive mechanical energy has to be applied to facilitate the kill. In an autoclave molecular acceleration supplies the energy and the more energetic, the faster the kill. The alternative is a toxic environment which involves time for the toxin to work it's way into all molecules and shut down reproductive cycles.
Simplified. Disinfectant sprays are only effective against some of the organisms. They shut down reproduction and inhibit regrowth of the organsms they are able to come in contact with. They are largely ineffective against spores. Also, they do not have the full ability to invade individual cells and kill the viruses contained in them. Simple mechanics - the disinfectant molecules, massive blocks so to speak, aren't wet enough or small enough to get in and do the job.
So spray downs of PPEs just does superficial kills.

The quickest and simplest way to effect a very high kill ratio along with a reproductive cycle knock down is solutions like chlorine baths. The problem with chlorine is the molecules are gigantic and ... best analogy would be a blindfolded wrecking crew going into a room armed with sledge hammers to eradicate a roach infestation.  Give them, the chlorine bath, sufficient time they will get all the roaches except the eggs, the spores lurking in the corners.

Other disinfectant chemicals operate much the same as chlorine and some are much faster but usually far more expensive. H2O2 is another cheap alternative but has a severe limitation. Replace the crew's sledge hammers with one shot cannot be reloaded pistols. Once the extra oxygen atom explodes, is freed, doing a kill, it's done and gone, turned into ordinary water and gas. And H2O2, like chlorine, is a big clunky molecule, not all that wet and has difficulty penetrating materials.

So, lacking access to autoclaves or EO chambers, your cheapest and most reliable sterilizer is a chlorine bath soak, preferably 24 hours. An additional advantage of chlorine is you can reuse the bath as long as you maintain the chlorine concentration ~ 2500 PPM, and keep the solution clear of particulates. Not perfect, but a reliable 99%. 

(Perfect, 100% kill of all life-> an oven >500F for 8 hours. Even then, some dead spores have demonstrated the ability to revive themselves, mechanism unknown.)


----------



## GMCmedic (Mar 20, 2020)

DragonClaw said:


> My partner got tested for COVID. Wonder how long till he gets results.


My wife is still waiting on test results of a patient she cared for on Sunday. At this point im just assuming the hospital never actually tested the patient. Patient had atypical bilateral Viral pneumonia/ARDS presentation.


----------



## Peak (Mar 20, 2020)

GMCmedic said:


> I also saw Senator Warren wants to pause all student loans and give healthcare/first responders $10,000 off their loan balance.



It's a bit annoying that I worked full time through my BS and BSN to graduate without loans and those who took out 100k+ for a nursing degree get rewarded.


----------



## Peak (Mar 20, 2020)

GMCmedic said:


> My wife is still waiting on test results of a patient she cared for on Sunday. At this point im just assuming the hospital never actually tested the patient. Patient had atypical bilateral Viral pneumonia/ARDS presentation.



We have had some low priority tests taking 5 days to get back.


----------



## DragonClaw (Mar 20, 2020)

Peak said:


> We have had some low priority tests taking 5 days to get back.



I assume my partner won't be back for a bit


----------



## RocketMedic (Mar 21, 2020)

Peak said:


> It's a bit annoying that I worked full time through my BS and BSN to graduate without loans and those who took out 100k+ for a nursing degree get rewarded.


Those pansies with their vaccines, air conditioning and pavement!


----------



## DragonClaw (Mar 21, 2020)

Peak said:


> It's a bit annoying that I worked full time through my BS and BSN to graduate without loans and those who took out 100k+ for a nursing degree get rewarded.



Wait it's actually given? Not just talked about?


----------



## Peak (Mar 21, 2020)

DragonClaw said:


> Wait it's actually given? Not just talked about?



Not that I know of.


----------



## Medic511 (Mar 21, 2020)

FiremanMike said:


> Of course it's irresponsible, but if the choice is between no protection and recycled/re-used protection, then it changes things..
> 
> That's where some folks are at right now.


No, we follow our basic training.  We DO NOT enter an unsafe scene.  Attending a COVID-19 pt without MEGG (mask, eye protection, gown, and gloves) is an UNSAFE scene.  Universal Precautions work well but only at all when used universally.

Would you ever enter a burning structure without SCBA just because your department didn't have enough working ones on hand?

No SCBA = no entry             ----------------------  no mask = unsafe scene

EMS's core safety concept is we do not ever enter an unsafe scene.  To do so is critical fail and irresponsible.  

A guideline we have learned from day one is "it's not our emergency."  We ALWAYS put our safety first, followed by our partner's, and our patients'.  

These life sustaining guidelines are just as true at a one patient call, a huge bus crash, or yes one heck of a nationwide pandemic.


----------



## Peak (Mar 21, 2020)

Medic511 said:


> No, we follow our basic training.  We DO NOT enter an unsafe scene.  Attending a COVID-19 pt without MEGG (mask, eye protection, gown, and gloves) is an UNSAFE scene.  Universal Precautions work well but only at all when used universally.
> 
> Would you ever enter a burning structure without SCBA just because your department didn't have enough working ones on hand?
> 
> ...



Would you say that includes cops and firefighters who's job is to enter an IDLH environment? We may mitigate risk but it is very real.


----------



## DesertMedic66 (Mar 21, 2020)

Medic511 said:


> No, we follow our basic training.  We DO NOT enter an unsafe scene.  Attending a COVID-19 pt without MEGG (mask, eye protection, gown, and gloves) is an UNSAFE scene.  Universal Precautions work well but only at all when used universally.


I don’t think anyone is advocating to approach a suspected COVID patient wearing no PPE at all. We are running very low on supplies so for now we must make them last and we have the CDC approval to do so. Times have changed greatly in EMS. When I first started EMS was only ever to operate in the cold zone where we could say “the scene is safe” but more and more EMS is starting to operate in warm zones. 

Guess what? We were all also taught in medic school to never ever use a medication that is expired however when there is a severe shortage of medications we get clearance from the FDA and drug manufacturers to use medications past their expiration date.


----------



## Medic511 (Mar 21, 2020)

Peak said:


> Would you say that includes cops and firefighters who's job is to enter an IDLH environment? We may mitigate risk but it is very real.


Cops and firefighters ALWAYS face a higher risk level than EMS.  But they are trained for those threats and let's face it, they are better able physically to defend themselves than are we (admittedly, that varies from person to person bit is true in general.)  Also, cops and firefighters have safety rules and precepts that they are trained not to cross.  My example of the SCBA is relevant to your point.  No SCBA = no entry.  I hope you are not suggesting that we think outside the box and use a tire inflating air tank with a mouthpiece?  No way!!

Single-use medical equipment (and even more so, medical supplies) can, under federal law and regulations, only be reused if cleaned and repackaged by an entity holding federal license to manufacture equipment of that type.  No EMS provider holds such a license.  This reuse is not only unsafe and dumb, it is ILLEGAL.


----------



## GMCmedic (Mar 21, 2020)

Medic511 said:


> Cops and firefighters ALWAYS face a higher risk level than EMS. But they are trained for those threats and let's face it, they are better able physically to defend themselves than are we (admittedly, that varies from person to person bit is true in general.) Also, cops and firefighters have safety rules and precepts that they are trained not to cross. My example of the SCBA is relevant to your point. No SCBA = no entry. I hope you are not suggesting that we think outside the box and use a tire inflating air tank with a mouthpiece? No way!!
> 
> Single-use medical equipment (and even more so, medical supplies) can, under federal law and regulations, only be reused if cleaned and repackaged by an entity holding federal license to manufacture equipment of that type. No EMS provider holds such a license. This reuse is not only unsafe and dumb, it is ILLEGAL.


Please post a link to the applicable federal law. Curious to read that. Even more curious if there is an actualy federal law, or if youre referencing and administrative rule.


----------



## DragonClaw (Mar 21, 2020)

https://imgur.com/a/PjpuhyL


Calls be like


----------



## Medic511 (Mar 21, 2020)

DesertMedic66 said:


> more and more EMS is starting to operate in warm zones.



On this point my experience is entirely different from yours.  When I started, we routinely restrained patients on our own (without law enforcement) unless they had firearms or knives).  Now, we are required to "stage" (basically hide around the corner and await law enforcement) on many calls including preteen and early-teen suicide gestures by pills.  What is the kid going to do, throw the pills at my partner and me?  On a call a while back, my partner and I were required to remain staged for just shy of an hour while a man with a gunshot wound was prone on the dark blacktop on a sunny afternoon with the temperature at 105 degrees.  We watched him try to crawl, then just move arms, finally seize, then never move again as he had died.  Law enforcement told us the scene wasn't safe because they were searching for a suspect who, it turned out, did not exist as the deceased had shot himself then staggered into the street.

It is now accepted as proven that SARS-CoV-2 virus lives on some hard surfaces for 3 days or more and on porous materials for hours.  When a single-use mask is over you mouth the outside catches droplets which carry virus.  You gown performs the same function and gathers droplets and thus virus particles.  The act of bagging, storing, unbagging, and reusing means that you are handling a contaminated item.  Pathogens from the already used item transfer to your hands even if gloved.  You then touch the inside part of that same mask and you have just placed virus inside the mask and ready to be sucked into your mouth with you inhale through the mask.  You are contaminated.  And that has nothing to do with whether the single-use mask is mechanically able to perform properly once its designed single use has taken place.

Contaminated, you go home each evening as the virus count increases and you pass the infection to your souse, kids, parents, and grandparents.  The improper and unsafe reuse of a disposable medical supply has now compromised  your loved ones.  That my friend is why we ALWAYS use Universal Precautions and NEVER enter an unsafe scene.  Our professional responsibility requires that we not contaminate others.  Above all else, do no harm!


----------



## Medic511 (Mar 21, 2020)

GMCmedic said:


> Please post a link to the applicable federal law. Curious to read that. Even more curious if there is an actually federal law, or if you're referencing and administrative rule.


There is no single paragraph that says all that in one place.  That is not unusual in the federal legal area.  Statutes usually contain broad directions and form departments, administrations, agencies, bureaus,  services, ,etc, etc.  Each of those governmental sub-parts drafts, publishes, and eventually adopts rules, regulations, directives, and the like.  It is truly a field day for lawyers.  Complexity = confusion, confusion = disagreements, disagreement = litigation, litigation = big, big buck for lawyers.

If you have a taste from reading very long, very complex sentences, you can research and navigate the legal tree.  Basically, it is that only federally licensed manufactures can produce anything for use in medical care.  Rules, regulations, and court rulings going back years, have found and defined anything after the first use as reuse but once used the original certification is gone, so, the logic goes, the item is uncertified* until it is re-manufactured by a licensed manufacturer, who by packaging and labeling the item(s) is deemed to be certifying it.  Otherwise it is not certified and cannot be used in medical care.  Yes, it is a long and rambling sequence of transitions from one step to another.  But, AND THIS IS KEY, it is not unusual because that's how most federal regulation of medicine works.  Really!!

* If you notice, the packaging of medical supplies has a notation something like "Single Use Only."  With bulk items, this statement may not be on every single item but will be on the packaging somewhere.


----------



## DesertMedic66 (Mar 21, 2020)

Medic511 said:


> On this point my experience is entirely different from yours.  When I started, we routinely restrained patients on our own (without law enforcement) unless they had firearms or knives).  Now, we are required to "stage" (basically hide around the corner and await law enforcement) on many calls including preteen and early-teen suicide gestures by pills.  What is the kid going to do, throw the pills at my partner and me?  On a call a while back, my partner and I were required to remain staged for just shy of an hour while a man with a gunshot wound was prone on the dark blacktop on a sunny afternoon with the temperature at 105 degrees.  We watched him try to crawl, then just move arms, finally seize, then never move again as he had died.  Law enforcement told us the scene wasn't safe because they were searching for a suspect who, it turned out, did not exist as the deceased had shot himself then staggered into the street.
> 
> It is now accepted as proven that SARS-CoV-2 virus lives on some hard surfaces for 3 days or more and on porous materials for hours.  When a single-use mask is over you mouth the outside catches droplets which carry virus.  You gown performs the same function and gathers droplets and thus virus particles.  The act of bagging, storing, unbagging, and reusing means that you are handling a contaminated item.  Pathogens from the already used item transfer to your hands even if gloved.  You then touch the inside part of that same mask and you have just placed virus inside the mask and ready to be sucked into your mouth with you inhale through the mask.  You are contaminated.  And that has nothing to do with whether the single-use mask is mechanically able to perform properly once its designed single use has taken place.
> 
> Contaminated, you go home each evening as the virus count increases and you pass the infection to your souse, kids, parents, and grandparents.  The improper and unsafe reuse of a disposable medical supply has now compromised  your loved ones.  That my friend is why we ALWAYS use Universal Precautions and NEVER enter an unsafe scene.  Our professional responsibility requires that we not contaminate others.  Above all else, do no harm!


Several things about this post make me cringe. Firstly if you are staged so close to a location that you are able to see someone crawling just in front of the residence, that defeats the purpose of being staged...

I would also like to see how you would explain your refusal to enter a scene, despite you having the CDC recommended equipment/PPE, to your employer and licensing agency. At that point you have a duty to act but you are breaching that duty and depending on the circumstances it could very well lead to further injury or death to the patient.

Are we seeing doctors and nurses refusing to treat patients because they are running on very limited supplies? At least in my area I haven’t.


----------



## FiremanMike (Mar 21, 2020)

Medic511 said:


> No, we follow our basic training.  We DO NOT enter an unsafe scene.  Attending a COVID-19 pt without MEGG (mask, eye protection, gown, and gloves) is an UNSAFE scene.  Universal Precautions work well but only at all when used universally.
> 
> Would you ever enter a burning structure without SCBA just because your department didn't have enough working ones on hand?
> 
> ...



Ok, then what's your solution for if/when we run out of PPE?


----------



## NomadicMedic (Mar 21, 2020)

I'll just put this here:





__





						This Page is No Longer Available
					

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”).




					www.cdc.gov


----------



## RocketMedic (Mar 21, 2020)

NomadicMedic said:


> I'll just put this here:
> 
> 
> 
> ...


Should probably mention that the CDC is subject to political pressure and that these guidelines are not necessarily unbiased.


----------



## FiremanMike (Mar 21, 2020)

Medic511 said:


> On this point my experience is entirely different from yours.  When I started, we routinely restrained patients on our own (without law enforcement) unless they had firearms or knives).  Now, we are required to "stage" (basically hide around the corner and await law enforcement) on many calls including preteen and early-teen suicide gestures by pills.  What is the kid going to do, throw the pills at my partner and me?  On a call a while back, my partner and I were required to remain staged for just shy of an hour while a man with a gunshot wound was prone on the dark blacktop on a sunny afternoon with the temperature at 105 degrees.  We watched him try to crawl, then just move arms, finally seize, then never move again as he had died.  Law enforcement told us the scene wasn't safe because they were searching for a suspect who, it turned out, did not exist as the deceased had shot himself then staggered into the street.
> 
> It is now accepted as proven that SARS-CoV-2 virus lives on some hard surfaces for 3 days or more and on porous materials for hours.  When a single-use mask is over you mouth the outside catches droplets which carry virus.  You gown performs the same function and gathers droplets and thus virus particles.  The act of bagging, storing, unbagging, and reusing means that you are handling a contaminated item.  Pathogens from the already used item transfer to your hands even if gloved.  You then touch the inside part of that same mask and you have just placed virus inside the mask and ready to be sucked into your mouth with you inhale through the mask.  You are contaminated.  And that has nothing to do with whether the single-use mask is mechanically able to perform properly once its designed single use has taken place.
> 
> Contaminated, you go home each evening as the virus count increases and you pass the infection to your souse, kids, parents, and grandparents.  The improper and unsafe reuse of a disposable medical supply has now compromised  your loved ones.  That my friend is why we ALWAYS use Universal Precautions and NEVER enter an unsafe scene.  Our professional responsibility requires that we not contaminate others.  Above all else, do no harm!



Just so I'm clear, in the beginning of your post you opine about the good old days when we wouldn't wait for cops and bitterly recalled watching a man die while the cops searched for a potential gunman..

Then in the end of your post and the general tone of your other posts on the topic of covid, you imply that you'll refuse to even be near covid patients if you don't have a fresh set of PPE..

Does that about sum it up?


----------



## Summit (Mar 21, 2020)

Medic511 said:


> Single-use medical equipment (and even more so, medical supplies) can, under federal law and regulations, only be reused if cleaned and repackaged by an entity holding federal license to manufacture equipment of that type.  No EMS provider holds such a license.  This reuse is not only unsafe and dumb, it is ILLEGAL.



No...
https://www.fda.gov/medical-devices...vation-strategies-letter-healthcare-providers
Not in desperate times

And these are desperate times (because of insufficient preparation)

And now we are in a viral war where we are going to be sent into battle with tattered boots and one pair of socks.


----------



## Medic511 (Mar 21, 2020)

DesertMedic66 said:


> Firstly if you are staged so close to a location that you are able to see someone crawling just in front of the residence, that defeats the purpose of being staged...


My partner and I staged where we were told to.  In our opinion there never was any threat to us.  Dispatch had been told, and she passed on to us when we requests available details, that the RP was a neighbor who had witnessed the patient shoot himself and stagger to the road.  Law enforcement directed that "EMS stage at 123 Streetname"  We did.  We carried (as was required by that service with rural areas) a set of binoculars.

Regarding duty, we have no legal duty to follow unsafe directions.  We have a moral obligation not to follow directions that unreasonably place others in danger.  (Of course, "unreasonable" is subjective and perhaps it is that about which we do not agree.)  The decision that I have to make is whether I will report to work if I know that I will be requested to reuse "single-use" supplies.  That I will not do.  So, my decision is complicated by the fact that some, as have you, will argue that I cannot decline only those calls that I feel are unsafe, that is those with possible COVID+ patients when I have inadequate PPE for such a call.  So, you are arguing that I should simply quite my job.  Well, if you feel that to be my correct decision, I should have quite on my first day at work about 20 years ago because I had been taught and I had decided that I would never knowingly enter an unsafe scene.  Being merely human, of course, I could not tell until I was on scene whether the scene would be safe, as I had been taught that scene safety was a rational, fact-base decision and not a mantra to be chanted upon arrival.  

Part of my frustration is that pandemics are know to occur.  A federal government exercise  last year sponsored by the current administration clearly identified an enormous shortage of medical supplies specifically including gowns and gloves.  Not  a single item was purchased that I know of to address the issue.  Whose emergency do YOU think this is?  

You can read about the details at this link:


			Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded


----------



## FiremanMike (Mar 21, 2020)

Medic511 said:


> My partner and I staged where we were told to.  In our opinion there never was any threat to us.  Dispatch had been told, and she passed on to us when we requests available details, that the RP was a neighbor who had witnessed the patient shoot himself and stagger to the road.  Law enforcement directed that "EMS stage at 123 Streetname"  We did.  We carried (as was required by that service with rural areas) a set of binoculars.
> 
> Regarding duty, we have no legal duty to follow unsafe directions.  We have a moral obligation not to follow directions that unreasonably place others in danger.  (Of course, "unreasonable" is subjective and perhaps it is that about which we do not agree.)  The decision that I have to make is whether I will report to work if I know that I will be requested to reuse "single-use" supplies.  That I will not do.  So, my decision is complicated by the fact that some, as have you, will argue that I cannot decline only those calls that I feel are unsafe, that is those with possible COVID+ patients when I have inadequate PPE for such a call.  So, you are arguing that I should simply quite my job.  Well, if you feel that to be my correct decision, I should have quite on my first day at work about 20 years ago because I had been taught and I had decided that I would never knowingly enter an unsafe scene.  Being merely human, of course, I could not tell until I was on scene whether the scene would be safe, as I had been taught that scene safety was a rational, fact-base decision and not a mantra to be chanted upon arrival.
> 
> ...



Is it the federal government's responsibility to buy supplies for your agency?  They don't buy anything for mine..


----------



## Medic511 (Mar 21, 2020)

FiremanMike said:


> Just so I'm clear, in the beginning of your post you opine about the good old days when we wouldn't wait for cops and bitterly recalled watching a man die while the cops searched for a potential gunman..
> 
> Then in the end of your post and the general tone of your other posts on the topic of covid, you imply that you'll refuse to even be near covid patients if you don't have a fresh set of PPE..
> 
> Does that about sum it up?


It makes the point that there is a disconnect somewhere along the line and that safety (a fundamental and good policy) can be interpreted and potentially bent so it barely resembles  its original purpose.  The staging-while-patient-died was not long a ago and the staging-for-teenybopper-'suicide' was a few month ago.   So passage of time is not a likely explanation of the difference. 

I may also have failed to make clear that, at the minute, it's more a matter of cost than availability.  Example: chef's coats and aprons are currently available and can be easily washed and sanitized, then safely reused.  The problem?  Cost mostly and a true purist may argue that medical use of culinary gear is not allowed.   But THAT is not the argument the 'outside the box bean counters'  are reusing.  The practical objection is cost.  The impact my friend is on your health and your loved ones' health.


----------



## FiremanMike (Mar 21, 2020)

Medic511 said:


> It makes the point that there is a disconnect somewhere along the line and that safety (a fundamental and good policy) can be interpreted and potentially bent so it barely resembles  its original purpose.  The staging-while-patient-died was not long a ago and the staging-for-teenybopper-'suicide' was a few month ago.   So passage of time is not a likely explanation of the difference.
> 
> I may also have failed to make clear that, at the minute, it's more a matter of cost than availability.  Example: chef's coats and aprons are currently available and can be easily washed and sanitized, then safely reused.  The problem?  Cost mostly and a true purist may argue that medical use of culinary gear is not allowed.   But THAT is not the argument the 'outside the box bean counters'  are reusing.  The practical objection is cost.  The impact my friend is on your health and your loved ones' health.



Perhaps you are not involved in purchasing at your agency, but I am responsible for it at mine.  I can assure you, the cost has not changed even slightly, availability is ZERO, and manufacturers aren't even giving a backorder date anymore..


----------



## DesertMedic66 (Mar 21, 2020)

You could also get full leather BDSM suits and then just wipe each other down with sani-wipes after each call and call it good.


----------



## Peak (Mar 21, 2020)

DesertMedic66 said:


> You could also get full leather BDSM suits and then just wipe each other down with sani-wipes after each call and call it good.



Or we can do the rain/snow homeless special. Trash-bag top, personal belongings bags shoes.


----------



## Medic511 (Mar 21, 2020)

FiremanMike said:


> Is it the federal government's responsibility to buy supplies for your agency?  They don't buy anything for mine..


Well, we can probably agree that it is NOT your responsibility or mine to buy our agency's/department's PPE but that it is their duty to do so.  It would be our medical director's responsibility to be sure that the "available" resources and caches ARE adequate.  It is the states responsibility to assure the the EMS and Health Service folks in their state are fullfilling their responsibilities in that regard and the the hospitals are fulfilling theirs.  Hospital bean counters year back saw there were, in total, billions of dollars in supplies sitting around but that each month only a small fraction of those were used.  So, hospitals started buying less and targeting to purchase each month just slightly what was used in similar prior periods.  They saved big bucks and the CEO got handsome bonuses.  BUT, and it's a big one, the rainy day (pandemic) caches were depleted almost out of existence.  The entire US strategic stockpile of N95 masks in February was 13 million.  (Please remember, we have 330 million or so people.  Does that sound adequate to you? 

For a detailed report of who learned what about the adequacy of our country's medical preparation for a pandemic, please take the time to actually the following news article and please don't judge it before you read it):



			Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded
		


[I fixed bad link.  Sorry!]
It just is not our place to endanger lives by spreading an infection as a result of working unsafe scenes with inadequate and improper gear.  Above all else, it is our professional responsibility to do no harm.  To me, that includes not doing things that we know to a certainty will pass on an infection.  You will have to make your own decision of course.  Committing suicide because of shame over being unable to accomplish an important task is common in some cultures but not in mine.


----------



## DesertMedic66 (Mar 21, 2020)

Peak said:


> Or we can do the rain/snow homeless special. Trash-bag top, personal belongings bags shoes.


I look better in a skin tight BDSM suit than trash bags. Might as well feel fabulous while getting infected.


----------



## Medic511 (Mar 21, 2020)

FiremanMike said:


> Perhaps you are not involved in purchasing at your agency, but I am responsible for it at mine.  I can assure you, the cost has not changed even slightly, availability is ZERO, and manufacturers aren't even giving a backorder date anymore..


Mike:  With all due respect, you did not read what I wrote.  I rather plainly said that there are OTHER products that will work but are more costly.  If you are risking your people because you are not reading the information available to you, please maybe consider getting some sleep and taking a new run at finding something that works for your people.  You will not be a hero if you stay within budget and loose staff or run up legal costs because you sent people to risky call with inadequate some talking point suggested.   (The laguage being used across the coutry clearly has a common origin. )


----------



## FiremanMike (Mar 21, 2020)

Medic511 said:


> Mike:  With all due respect, you did not read what I wrote.  I rather plainly said that there are OTHER products that will work but are more costly.  If you are risking your people because you are not reading the information available to you, please maybe consider getting some sleep and taking a new run at finding something that works for your people.  You will not be a hero if you stay within budget and loose staff or run up legal costs because you sent people to risky call with inadequate some talking point suggested.   (The laguage being used across the coutry clearly has a common origin. )



Ok, well your position is known.  You’ll be calling off sick wishing things were different and most of the rest of us will be at work, making the best of this reality..


----------



## ffemt8978 (Mar 21, 2020)

DesertMedic66 said:


> I look better in a skin tight BDSM suit than trash bags. Might as well feel fabulous while getting infected.



Great...now in addition to a shortage of hand sanitizer, we're going to have a shortage of mind bleach.  😅


----------



## Seirende (Mar 21, 2020)

ffemt8978 said:


> Great...now in addition to a shortage of hand sanitizer, we're going to have a shortage of mind bleach.  😅



I went to a mind bleach site once and was quite disappointed to discover that the babes section was not full of smiling babies.


----------



## RedBlanketRunner (Mar 22, 2020)

Is he trying to kill people? The heck with impeachment. How about 70 million counts of reckless endangerment?

March 21, 2020, 10:17

              Donald J. Trump        

✔            @realDonaldTrump

HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).....
....be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov 









*              Dr. Edsel Salvana      

✔            @EdselSalvana
Please don't take hydroxychloroquine (Plaquenil) plus Azithromycin for #COVID19 UNLESS your doctor prescribes it. Both drugs affect the QT interval of your heart and can lead to arrhythmias and sudden death, especially if you are taking other meds or have a heart condition.*
(https://www.virology-education.com/edsel-salvana-md-dtmh-fpcp-fidsa/)


----------



## SandpitMedic (Mar 22, 2020)

RedBlanketRunner said:


> Is he trying to kill people? The heck with impeachment. How about 70 million counts of reckless endangerment?
> 
> March 21, 2020, 10:17
> 
> ...


Ummm hey guy.... mr orange man bad guy....
Yes, um, do you think these drugs grow on trees? Perhaps you can make them with common household products under the sink? Is there an Azithromycin fairy- do I leave an NSAID and wake up with a Z-Pack?

YOU GET THEM WITH A PRESCRIPTION *FROM *A DOCTOR.... you don’t buy Hydroxychloroquine off the street, dude.

(I noticed you intentionally omitted the part of the context where the speakers also addressed this being a decision between a patient and their doctor... convienient for your agenda).

Cut out the political posts. We get it... you’re smarter than us all- and POTUS is antichrist. You’ve been heard, move along now.


----------



## SandpitMedic (Mar 22, 2020)

RedBlanketRunner said:


> Is he trying to kill people? The heck with impeachment. How about 70 million counts of reckless endangerment?
> 
> March 21, 2020, 10:17
> 
> ...


Also it’s really laughable that your source to bash the POTUS and how to treat/not treat COVID is from the NIGERIAN CDC! Hahaha.

Dude... stretching it thin to another level! I didn’t know that Nigeria was hiding the most brilliant doctors and scientists.


----------



## RocketMedic (Mar 22, 2020)

FiremanMike said:


> Ok, well your position is known.  You’ll be calling off sick wishing things were different and most of the rest of us will be at work, making the best of this reality..


Hero complex much, bro?


----------



## RedBlanketRunner (Mar 22, 2020)

SandpitMedic said:


> Also it’s really laughable that your source to bash the POTUS and how to treat/not treat COVID is from the NIGERIAN CDC! Hahaha.


1. I grabbed the first and last reference from a very long list.
2. Hydroxychloroquine in the form of Plaquenil, an antimalarial, is available over the counter in some countries and handed out like candy by physicians in many others.


----------



## GMCmedic (Mar 22, 2020)

RedBlanketRunner said:


> 1. I grabbed the first and last reference from a very long list.
> 2. Hydroxychloroquine in the form of Plaquenil, an antimalarial, is available over the counter in some countries and handed out like candy by physicians in many others.


Why would other countrys care what our president says? Dont they have their own president to listen too?

And since the US is currently sporting one of the lowest mortality rates, Id say were doing something right.


----------



## RedBlanketRunner (Mar 22, 2020)

Now that testing is underway at an almost reasonable pace in the U.S. it has jumped to #3, just below Italy and China in the number of infections.


GMCmedic said:


> Why would other countrys care what our president says? Dont they have their own president to listen too?


They do. Why is irrelevant but tens of millions of people look to exalted authority figures regardless of nationality and take their word as gospel facts. Subservience runs very deep among the poorly educated.
But none of this is relevant. Why is a non medically qualified person in a position of authority advocating the use of certain drugs? Drugs that have not undergone proper testing no less. I'm not sure what the medical standards are in the US at this moment, but anyone who works as a health care provider below qualified physician who suggests untested drugs would have been given walking papers in my day.


----------



## GMCmedic (Mar 22, 2020)

RedBlanketRunner said:


> Now that testing is underway at an almost reasonable pace in the U.S. it has jumped to #3, just below Italy and China in the number of infections.
> 
> They do. Why is irrelevant but tens of millions of people look to exalted authority figures regardless of nationality and take their word as gospel facts. Subservience runs very deep among the poorly educated.
> But none of this is relevant. Why is a non medically qualified person in a position of authority advocating the use of certain drugs?


Im not talking about number of infections, im talking mortality rate.


----------



## FiremanMike (Mar 22, 2020)

RocketMedic said:


> Hero complex much, bro?



Not in the slightest, I was literally stating the facts of this thread.  He said he’d call off sick, and most of the rest of us are going to go to work and do our best.


----------



## mgr22 (Mar 22, 2020)

Based on daily televised briefings I’m seeing from federal, state and local officials, I get the impression most of the non-medical public think outcomes from COVID-19 infections are binary: either death or complete recovery. With published mortality rates hovering around 3% and the reasonable assumption that most of those people will be elderly and/or chronically ill, I think there’s a false sense of security among younger, healthy adults, who are vulnerable to autoimmune complications that aren’t getting much publicity.

I’m wondering if any of you see opportunities to educate people about that third category of COVID-19 outcomes – long-term or permanent disability (if not death) secondary to organ damage. Perhaps such feedback would encourage those in allegedly lower-risk groups to take recommended precautions.

Any thoughts?


----------



## RocketMedic (Mar 22, 2020)

mgr22 said:


> Based on daily televised briefings I’m seeing from federal, state and local officials, I get the impression most of the non-medical public think outcomes from COVID-19 infections are binary: either death or complete recovery. With published mortality rates hovering around 3% and the reasonable assumption that most of those people will be elderly and/or chronically ill, I think there’s a false sense of security among younger, healthy adults, who are vulnerable to autoimmune complications that aren’t getting much publicity.
> 
> I’m wondering if any of you see opportunities to educate people about that third category of COVID-19 outcomes – long-term or permanent disability (if not death) secondary to organ damage. Perhaps such feedback would encourage those in allegedly lower-risk groups to take recommended precautions.
> 
> Any thoughts?


I think this is going to be a VERY relevant finding in three to six months, and might help to blunt secondary and tertiary peaks. Historically, people were accepting of pandemics, but debility was terrifying- polio, scarlet fever, typhoid, etc. We don’t have that cultural awareness and I think that particular hazard will loom large in the public consciousness going forward, especially as people don’t recover to their pre-infection normal.


----------



## Summit (Mar 22, 2020)

GMCmedic said:


> And since the US is currently sporting one of the lowest mortality rates, Id say were doing something right.



You mean testing too narrowly, triaging testing, having really delayed test results, and giving the lowest priority to testing dead people?

Yes, that does tend to make our numbers LOOK better. USA! USA! USA!

I'm a patriot BUT a realist. The WEAKEST part of the American system is our ability to respond to a mass public health emergency. Witness our reality, do not deny it.


----------



## PotatoMedic (Mar 22, 2020)

Summit said:


> You mean testing too narrowly, triaging testing, having really delayed test results, and giving the lowest priority to testing dead people?
> 
> Yes, that does tend to make our numbers LOOK better. USA! USA! USA!


Hey!  You "can't" have it if you don't test for it!


----------



## RocketMedic (Mar 22, 2020)

“Died of the pleurisy”


----------



## Carlos Danger (Mar 22, 2020)

Summit said:


> You mean testing too narrowly, triaging testing, having really delayed test results, and giving the lowest priority to testing dead people?
> 
> Yes, that does tend to make our numbers LOOK better. USA! USA! USA!
> 
> I'm a patriot BUT a realist. The WEAKEST part of the American system is our ability to respond to a mass public health emergency. Witness our reality, do not deny it.


Actually, there is good reason to think that we are going to fare much better than both China and Italy, in terms of both rates of infection and mortality.


----------



## Summit (Mar 22, 2020)

Remi said:


> Actually, there is good reason to think that we are going to fare much better than both China and Italy, in terms of both rates of infection and mortality.


All ears........


----------



## NomadicMedic (Mar 22, 2020)

Remi said:


> Actually, there is good reason to think that we are going to fare much better than both China and Italy, in terms of both rates of infection and mortality.


I’m also interested to hear this.


----------



## E tank (Mar 22, 2020)

Side by side comparisons of the US as a whole and China/European countries are not valid. Comparisons by state, maybe. Vast differences in population density, mass transit infrastructure and total population just for starters are confounders that make the math next to impossible. Hearing otherwise smart people compare a country like Italy to the US in this situation is embarrassing.


----------



## Jim37F (Mar 22, 2020)

The Mayor has just ordered an emergency Stay at Home/Shelter In Place order for Oahu and a 14 day quarantine for travelers.

There's currently 56 confirmed cases in the State, 3 requiring hospitalization, no deaths


----------



## Carlos Danger (Mar 22, 2020)

Most of what is presented in the media is done without any context and is even intentionally slanted so as to be sensational. Most of the projections are based on the assumption that mitigating steps won't help all that much, and that in the absence of government mandates, individuals won't modify their own behavior at all. 

The projections are also based on the idea that what happens in China and Italy is likely to happen here, despite the fact that most parts of China have much higher population densities than most parts of the US, as do the parts of Italy that have been hardest hit. A much higher part of China's population smoke cigarettes (30%), and in Italy it is almost 50% as well as having a much older population. Sanitation is also a problem in many parts of China. 

Because their is no specific treatment for COVID-10, testing rates are moot as long as enough people are social distancing anyway, especially anyone who is sick.

We are probably just now entering the steep part of the upslope and are in for a scary few weeks. Lots of people are going to get sick, hospitals will be overwhelmed, and some of those who die would not have if we had better surge capacity. After a few weeks of that, things will likely start to get better as quickly as they got bad.  

There are a handful of sources that credibly buck the popular narrative. One of my favorites, and a good stating point is the blog at Enki Research. 

Also google Jeffrey Epstein, and read this article.


----------



## pregnancywhine (Mar 22, 2020)

In this worldwide situation, we can clearly see how obedient and disciplined people are in following the government alongside the health workers in fighting Covid 19 virus. We can also see the impact of our lifestyle and how clean and healthy we are. Deeply praying that we gonna survive this pandemic.


----------



## luke_31 (Mar 22, 2020)

Jim37F said:


> The Mayor has just ordered an emergency Stay at Home/Shelter In Place order for Oahu and a 14 day quarantine for travelers.
> 
> There's currently 56 confirmed cases in the State, 3 requiring hospitalization, no deaths


Any idea how long the order is for?  I’m supposed to go end of June to Maui but if it’s still in effect then I will need to change plans, again


----------



## E tank (Mar 22, 2020)

Remi said:


> Also google Jeffrey Epstein....



Help me out here...


----------



## Jim37F (Mar 22, 2020)

luke_31 said:


> Any idea how long the order is for?  I’m supposed to go end of June to Maui but if it’s still in effect then I will need to change plans, again


Supposedly till the end of next month, April 30th


----------



## SandpitMedic (Mar 22, 2020)

E tank said:


> Help me out here...


Never forget.
Epstein did not kill himself.


----------



## Carlos Danger (Mar 23, 2020)

E tank said:


> Help me out here...


I meant Richard Epstein: Reason Podcast


There may be a reason why less apocolyptic analysis is not that easy to come across in the media, though plenty of it exists:
Where's the (Relatively) Positive Coronavirus News? Some Say it's Suppressed

Medium Deleted a Post by a Person Who Had the Audacity to use Math to Question the Hysteria

I've been saying since the beginning: however harmful the virus itself ends up being - and I make no claims whatsoever to having an answer to that, though as always, I am highly skeptical that the sky is actually falling - our hysterical reaction to it will likely cause much more lasting damage.


----------



## luke_31 (Mar 23, 2020)

Jim37F said:


> Supposedly till the end of next month, April 30th


Ok. Hopefully it doesn’t get extended then. Thanks


----------



## FiremanMike (Mar 23, 2020)

I got bored, so I looked up the CDC statistics on influenza, note these stats are for America only, *not globally*

2018-2019 - 35.5m infected (est), 490,600 hospitalized, 34,200 dead
2017-2018 - 44.8m infected (est), 808,129 hospitalized, 61,099 dead
2016-2017 - 29.2m infected (est), 496,912 hospitalized, 38,230 dead
2015-2016 - 23.5m infected (est), 276,198 hospitalized, 22,705 dead

Do you know what we didn't have?  Daily death tickers, global shutdown, $1 trillion stimulus packages, frenzied rushes for toilet paper and N95 masks..


----------



## mgr22 (Mar 23, 2020)

It makes sense to me that a new virus would provoke more anxiety than an old one. We have vaccines for the flu and lots of experience dealing with it.

As for the media's role, I find few things as ironic and useless as any media outlet, such as Newsweek in the above example, criticizing the media. Competition, alone, can lead to biased reporting.


----------



## DrParasite (Mar 23, 2020)

FiremanMike said:


> Do you know what we didn't have?  Daily death tickers, global shutdown, $1 trillion stimulus packages, frenzied rushes for toilet paper and N95 masks..


don't forget social quarantine, media fear mongering, and anything to make POTUS look bad....

oh, and just think, those numbers are what we had WITH the flu vaccine.....


----------



## RedBlanketRunner (Mar 23, 2020)

US just jumped mortality by 100.

Intensive care specialist Hugh Montgomery: The average flu is about 1.3 to 1.4 contagious. that is in a community each person who contracts it will pass it on to 1.3 to 1.4 people on average. So 10 generations of transmission causes about 20 infections. 1 > 1.4 > 1.96 > 2.74 > 3.84 > 5.37 > 7.52 > 10.54 > 14.75 > 20.66
Covid-19 is much more contagious. In the community each person will pass it on to 3 people. So 10 generations of transmission can cause about 59,000 infections. 1 > 3  > 9 > 27 > 81 > 243 > 729 > 2187 > 6561 > 19683 > 59094


----------



## Aprz (Mar 23, 2020)

Because of th shelter in place, it has been a lot slower in my area. When we do get calls, they are still mostly minor. They've been sending some crews home voluntarily.


----------



## E tank (Mar 24, 2020)

RedBlanketRunner said:


> US just jumped mortality by 100.
> 
> Intensive care specialist Hugh Montgomery: The average flu is about 1.3 to 1.4 contagious. that is in a community each person who contracts it will pass it on to 1.3 to 1.4 people on average. So 10 generations of transmission causes about 20 infections. 1 > 1.4 > 1.96 > 2.74 > 3.84 > 5.37 > 7.52 > 10.54 > 14.75 > 20.66
> Covid-19 is much more contagious. In the community each person will pass it on to 3 people. So 10 generations of transmission can cause about 59,000 infections. 1 > 3  > 9 > 27 > 81 > 243 > 729 > 2187 > 6561 > 19683 > 59094



With everyone at home? Staying 6 feet away from each other? This country has stopped functioning. Your math means absolutely nothing. That doesn't even include weaker mutations of the virus as time goes on.


----------



## Peak (Mar 24, 2020)

Aprz said:


> Because of th shelter in place, it has been a lot slower in my area. When we do get calls, they are still mostly minor. They've been sending some crews home voluntarily.



Same. EMS volume is down, ED volume is down, inpatient volume has tanked.


----------



## RedBlanketRunner (Mar 24, 2020)

E tank said:


> Your math means absolutely nothing. That doesn't even include weaker mutations of the virus as time goes on.


Agreed. His math is just a general rule to go by.  The reality is worse: 17.2% increase in infections (58,479) in the last 24 hrs. 337,114->395,593 Source: J. Hopkins M.C., WHO, +


----------



## Tigger (Mar 24, 2020)

FiremanMike said:


> I got bored, so I looked up the CDC statistics on influenza, note these stats are for America only, *not globally*
> 
> 2018-2019 - 35.5m infected (est), 490,600 hospitalized, 34,200 dead
> 2017-2018 - 44.8m infected (est), 808,129 hospitalized, 61,099 dead
> ...


Sure, but the flu season is a bit more spread out don't you think?

Everything sucks right now frankly. I rarely dislike going to work, but I don't like being here now. Will all of the attempts to slow this matter? I doubt we'll ever know.


----------



## RedBlanketRunner (Mar 24, 2020)

FiremanMike said:


> I got bored, so I looked up the CDC statistics on influenza, note these stats are for America only, *not globally*
> 
> 2018-2019 - 35.5m infected (est), 490,600 hospitalized, 34,200 dead
> 2017-2018 - 44.8m infected (est), 808,129 hospitalized, 61,099 dead
> ...


Add those stats the Covid-19. While you are at it, could you include motor vehicle accidents?
BTW, mortality for the common (seasonal) flu is .1% Present Covid-19 mortality 4.1+%
Let's use your stats, 2018-2019: 34,200 / 35.5m infected * 100 = .096 deaths per 100 infections in the US. Average world wide is about the same.
Covid-19: 16567 / 382612 * 100 = 4.32 deaths per 100 infections (March 23 numbers)

The difference is, seasonal flu is multiple source in the wild. Covid-19 is single source. Consider Covid-19 with a few hundred thousand sources like the common flu, like we have right now. Consider how naive that comparison is.


----------



## looker (Mar 24, 2020)

RedBlanketRunner said:


> Add those stats the Covid-19. While you are at it, could you include motor vehicle accidents?
> BTW, mortality for the common (seasonal) flu is .1% Present Covid-19 mortality 4.1+%
> Let's use your stats, 2018-2019: 34,200 / 35.5m infected * 100 = .096 deaths per 100 infections in the US. Average world wide is about the same.
> Covid-19: 16567 / 382612 * 100 = 4.32 deaths per 100 infections (March 23 numbers)
> ...


Mortality rate is not 4.1+, it's that because we only test those that are basically getting admitted. We are not testing those with mild symptoms. When you only use those that are admitted and use death rate to get mortality rate, you will get highly elevated rate. Instead look at SK numbers. It's around .05%, yes it's 5 times higher compare to regular flu and yes many do have some immunity to it . While COVID-19 does have dangerous symptoms to those that with compromise immune system be it elderly and/or younger population many do not. In fact some might never even have any symptoms at all.  It's hard to say if we have overreacted but it's possible. For now it sure looks like it's overreaction or we are dogging the bullet but only time will tell.


----------



## RedBlanketRunner (Mar 24, 2020)

looker said:


> When you only use those that are admitted and use death rate to get mortality rate, you will get highly elevated rate.


Same thing applies to the seasonal flu. Covid-19 is estimated between 25% and 45% higher mortality rate. WHO


----------



## SandpitMedic (Mar 24, 2020)

Didn’t you say you have COVID, Red?


----------



## RedBlanketRunner (Mar 24, 2020)

RedBlanketRunner said:


> Same thing applies to the seasonal flu. Covid-19 is estimated between 25% and 45% higher mortality rate. WHO


Not % -> times higher



SandpitMedic said:


> Didn’t you say you have COVID, Red?


Yes. Seems to be following a pretty normal pattern. Infection Feb. 26m symptoms March 6th-7th - minor sore throat, no sinus issues, and bringing up a lot of mucus from the lungs. I had no fever, my wife 99.2-4 By March 10th we both were bringing up an incredible amount of mucus, coughing almost contiuously, and around the 15th it started tapering off. Still very minor cough and slight sore throat. Notable is it was like a heavy duty flu but complete lack of sinus involvement.
Our municipality went on total lock down today. Lots of police checkpoints.

One notable thing if this is anything to go by. I hit the hills on my bike to the tune of 100 miles a week. My wife exercise is zilch. Her respiratory distress was much greater than mine, unable to lie down flat for 2 nights. I'd venture a guess a PFT would coincide pretty closely with severity. Not that anyone has a few thousand spare RTs with the time to do that screening.


----------



## Sled Driver (Mar 24, 2020)

Jim37F said:


> Supposedly till the end of next month, April 30th



Hawaii is currently quarantining all incoming visitors for 14 days.


----------



## Summit (Mar 24, 2020)

Sled Driver said:


> Hawaii is currently quarantining all incoming visitors for 14 days.


Alaska too


----------



## FiremanMike (Mar 24, 2020)

RedBlanketRunner said:


> US just jumped mortality by 100.
> 
> Intensive care specialist Hugh Montgomery: The average flu is about 1.3 to 1.4 contagious. that is in a community each person who contracts it will pass it on to 1.3 to 1.4 people on average. So 10 generations of transmission causes about 20 infections. 1 > 1.4 > 1.96 > 2.74 > 3.84 > 5.37 > 7.52 > 10.54 > 14.75 > 20.66
> Covid-19 is much more contagious. In the community each person will pass it on to 3 people. So 10 generations of transmission can cause about 59,000 infections. 1 > 3  > 9 > 27 > 81 > 243 > 729 > 2187 > 6561 > 19683 > 59094



Maybe,  but if that infection rate was accurate, don't you think our worldwide infection rate would be significantly higher?  China alone, with 1.386 billion people, didn't lock down the country until 3 months after the virus was identified, yet they still only report 81,000 cases to the WHO as of yesterday morning.



Tigger said:


> Sure, but the flu season is a bit more spread out don't you think?
> 
> Everything sucks right now frankly. I rarely dislike going to work, but I don't like being here now. Will all of the attempts to slow this matter? I doubt we'll ever know.



The flu season is said to be 6 months, we're now at about 4 months into COVID.. while it's possible that we jump from 300,000 to 35m+ (will have to look at worldwide flu stats at some point to be fair), it seems unlikely.



RedBlanketRunner said:


> Add those stats the Covid-19. While you are at it, could you include motor vehicle accidents?
> BTW, mortality for the common (seasonal) flu is .1% Present Covid-19 mortality 4.1+%
> Let's use your stats, 2018-2019: 34,200 / 35.5m infected * 100 = .096 deaths per 100 infections in the US. Average world wide is about the same.
> Covid-19: 16567 / 382612 * 100 = 4.32 deaths per 100 infections (March 23 numbers)
> ...



Why would I look at auto accidents?  I'm striking debate over our response to infectious diseases.  I think there's evidence to show the flu is just as virulent and deadly, but for some reason we don't have this worldwide panic every year for the flu.

The bottom line is we'll likely NEVER know how many worldwide infectious there are of COVID, but what we can compare is the patients who are tested which has been, for the most part, the patients who are really sick with symptoms..

Flu - patients who are hospitalized, 2019 - 6.9% mortality, 2018 - 7.6% mortality, 2017 - 7.7% mortality, 2016 - 8.2% mortality

It's my understanding that confirmed cases reported by the WHO are ones with positive test results back, not those who simply are assumed based on screening.  Speaking for my area, which is likely similar to the rest of the world, the only patients who have had testing completed and returned are the ones who are severely ill.

Worldwide COVID - 332,930 cases, 14,510 deaths = 4.4% mortality rate (which includes countries with poor access to healthcare).

Now, whether or not the confirmed cases is a fair comparison to the number of folks who are hospitalized with the flu is unclear.  But that number of 332,930 worldwide cases seems shockingly low to me given how virulent covid is reported to be.

*MY OPINION* - there's really only two realities to the above number.. First, it really is as virulent (or more) as the the flu, and there are actually tens if not hundreds of millions of people worldwide already infected, meaning the mortality rate is dramatically lower than is being reported.  The other possibility is that the mortality rate is high, but the infection rate is significantly lower than what they led on.

At this point, I lean more towards my first conclusion, but who knows.


----------



## RedBlanketRunner (Mar 24, 2020)

Unofficial word I have received from the medical quarter is Covid-19 contagiousness will not be significantly lowered by hot weather. This need further information and verification.


----------



## Carlos Danger (Mar 24, 2020)

Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress. 

By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"


----------



## FiremanMike (Mar 24, 2020)

Remi said:


> Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.
> 
> By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"



The thing I worry about more than saying "ehh, we overreacted" is that people will conclude that this reaction was appropriate and is the new norm for next year's outbreak of (insert pathogen here), and the one in 2021, and 2022...


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## RedBlanketRunner (Mar 24, 2020)

S l o w... o n ... t h e... u p t a k e...
My only snack: Lays sour cream and onion potato chips. Sitting at dinner tonight wifey asked me why there is 4 or 5 opened bags each mostly uneaten. I hypothesized they had to have changed the recipe. Really blah. Up there with unflavored rice cake. Dig in the trash and find an old bag and compare ingredients. No difference.
Wife asks if the dinner she brought home was good. Told her it was okay. Nothing special. Just blah. She tells me the only restaurant open was that place where I hate their cooking. Going upstairs while trying to gag down Lays sour cream and onion rice cake when I had a PING! Maybe?? Give it the ultimate taste test: grab the jar of Vegemite and suck on a glop. Nada. Might as well have been Vaseline.
Yup. Dang virus can blow your sense of taste and smell all to heck. Hope it doesn't stay this way but in the meantime I'm heading straight for the rip-the-top-of-your-head-off-and-frightens-the-cat Thai dishes I usually shunned.


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## Peak (Mar 24, 2020)

The problem with trying to develop any reasonable epidemiologic model is that we don't have adequate testing.

Of course if we only test those who present to the hospital or their PCP then we are going to have sicker appearing COVID patients. 

Tests are taking over a week to get back now, even on our oncology and transplant patients. We have discharged several inpatients before we even know if they were positive or negative. 

We are starting to diagnose based on chest xray, CT, and clinical appearance and are basically just sending off the test as a formality at this point. 

Essentially any data the state is reporting is inaccurate for the past week, we can't even know how many positive patients there are. 

I've seen older adults who present in significant ARDS to the ED who have been at home with several family members who present no symptoms, and said adult hasn't been out of the house in weeks. There is clearly a large amount of subclinical/asymptomatic spread, especially in kids and young adults, but we have zero idea what it even is because it is impossible to create any real kind of epidemiologic model.


----------



## RocketMedic (Mar 24, 2020)

Peak said:


> The problem with trying to develop any reasonable epidemiologic model is that we don't have adequate testing.
> 
> Of course if we only test those who present to the hospital or their PCP then we are going to have sicker appearing COVID patients.
> 
> ...


Exactly what you’d expect from a politically-sensitive and considerate testing model.


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## E tank (Mar 24, 2020)

Not seeing a lot of Covid, but H1N1 is declaring itself among the 20-40- ish set...


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## Summit (Mar 24, 2020)

Seeing COVID, Flu A, hMPV, RSV, PIV, in that order of prevalence..


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## silver (Mar 24, 2020)

Remi said:


> Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.
> 
> By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"



I don't know, currently in NYC and seeing a rapid rise of critically ill patients will little availability of PPE. Hospitals are not able to increase their surge capacity quickly enough and only have a limited number of ventilators left. Kind of wishing we took stronger measures sooner.


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## RocketMedic (Mar 24, 2020)

silver said:


> I don't know, currently in NYC and seeing a rapid rise of critically ill patients will little availability of PPE. Hospitals are not able to increase their surge capacity quickly enough and only have a limited number of ventilators left. Kind of wishing we took stronger measures sooner.


It’s almost as if a hazardous novel virus has emerged...


----------



## RedBlanketRunner (Mar 25, 2020)

That's nice to hear. Covid-19 no big deal. Trump administration triage: you are expendable, the economy isn't.


----------



## Achilles (Mar 25, 2020)

Remi said:


> By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"


Is all of this a fact (including the part about looking back on it in the Summer, or are you spreading misinformation? Asking for a friend...


----------



## Sled Driver (Mar 25, 2020)

silver said:


> I don't know, currently in NYC and seeing a rapid rise of critically ill patients will little availability of PPE. Hospitals are not able to increase their surge capacity quickly enough and only have a limited number of ventilators left. Kind of wishing we took stronger measures sooner.



This is a fair assessment


----------



## DrParasite (Mar 25, 2020)

RedBlanketRunner said:


> That's nice to hear. Covid-19 no big deal. Trump administration triage: you are expendable, the economy isn't.


Translation: Orange man bad, twist his words to make yourself sound like you could have done any better.  Let me guess: is he also not your president?  Your TDS is on full display there

Lets leave the overtly political comments to facebook and twitter.


----------



## mgr22 (Mar 25, 2020)

It's kind of hard to separate politics from COVID-19. In my opinion, politics has had at least as much of an impact as medicine in how the U.S. has been reacting to the disease. I don't think assessing the COVID-19-related actions of any politician should be out of bounds. For example, when elderly patients refuse care and/or transport because they've heard the Lt. Governor of Texas suggest grandparents should be willing to sacrifice their health for the good of the economy, how should we respond?

There are going to be smart things and stupid things done by politicians during this crisis. We should be able to discuss and learn from both.


----------



## GMCmedic (Mar 25, 2020)

Is anyone seeing ECMO or CRRT in these critical patients?


----------



## SandpitMedic (Mar 25, 2020)

Remi said:


> Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.
> 
> By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"


This! FFS! This! And as someone else said-
will this National/worldwide reaction be the new normal?


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## DesertMedic66 (Mar 25, 2020)

GMCmedic said:


> Is anyone seeing ECMO or CRRT in these critical patients?


Pretty sure a COVID patient I transported yesterday will end up on ECMO.  PEEP of 12 and FiO2 of 1.0 and a crappy SpO2/SaO2.


----------



## Gurby (Mar 25, 2020)

Remi said:


> Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.
> 
> By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"



What should the country do, if not lock down? 

Do we shrug and say "oh well, guess a bunch of people will just have to die" as the virus burns itself out?

How are hospitals supposed to handle the surge of patients?

I think I asked the same questions a while ago, and you said the virus wasn't affecting your hospital.  Is that still the case?


----------



## GMCmedic (Mar 25, 2020)

DesertMedic66 said:


> Pretty sure a COVID patient I transported yesterday will end up on ECMO. PEEP of 12 and FiO2 of 1.0 and a crappy SpO2/SaO2.


I was just curious, as I mentioned in the directionless thread the State is not allowing transport unless the originating cannot provide care, but most of the outlying facilities cannot do ECMO or dialysis. We only have 2 perfusionists at the level 2 were based at, I assume the other local system is about the same.


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## VFlutter (Mar 25, 2020)

GMCmedic said:


> Is anyone seeing ECMO or CRRT in these critical patients?



Yes


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## Peak (Mar 25, 2020)

DesertMedic66 said:


> Pretty sure a COVID patient I transported yesterday will end up on ECMO.  PEEP of 12 and FiO2 of 1.0 and a crappy SpO2/SaO2.



I've see far worse vent settings than that. 



VFlutter said:


> Yes



Any word on how they are actually coming out. We haven't taken ECMO off the table completely but we are concerned that if patients are that sick that they will never come off.


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## Tigger (Mar 25, 2020)

Gurby said:


> I think I asked the same questions a while ago, and you said the virus wasn't affecting your hospital.  Is that still the case?


And even if it isn't, does that matter? Does that somehow abdicate us from taking public health steps?


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## E tank (Mar 25, 2020)

Tigger said:


> And even if it isn't, does that matter? Does that somehow abdicate us from taking public health steps?



No one is suggesting that, but to suggest that regional differences exist is only being honest. Afton, Wyoming isn't NYC, NY, isn't San Francisco, isn't Seattle....folks were pretty confident that Seattle was supposed to be brought to it's knees by now and we're still waiting. Same goes for the Bay Area. 

Making these observations in a non-anonymous forum will get you in trouble, to be sure because of the urgency of the situation but also because there is a lot of irrational fear and decision making based on speculation and best guesses. 

There will be a lot to learn when this is all over. It's worth at least to be able to talk about it now.


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## Summit (Mar 25, 2020)

GMCmedic said:


> Is anyone seeing ECMO or CRRT in these critical patients?


yes


----------



## Summit (Mar 25, 2020)

1. A coordinated national public health approach should be taken on the mitigation front for all regions and
2. the purchased time  must be used to
a. stand up laboratory capacity,
b. expand public health tracing to isolate and stomp out clusters, and
c. institute absolute control over national borders to control for external reintroduction until a vaccine is deployed

Otherwise, discombobulated regional public health efforts are just be a short stay of execution as hot spots flare up again and the infection ping pongs from region to region requiring more mitigation than would otherwise be necessary and the concomitant economic impact.


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## Peak (Mar 25, 2020)

Summit said:


> yes



How are their outcomes looking?


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## Summit (Mar 25, 2020)

Peak said:


> How are their outcomes looking?


we are tubing early often skipping nippv
i've seen tubed people get off the vent and go home
i haven't seen anyone get off ecmo yet but the n is small


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## Peak (Mar 25, 2020)

Summit said:


> we are tubing early often skipping nippv
> i've seen tubed people get off the vent and go home
> i haven't seen anyone get off ecmo yet but the n is small



I'm mostly curious to see how the ECMO turns out. We are very hesitant to cannulate a COVID patient and fortunetly haven't been put in the position to do it yet. I am concerned that the damage that is happening to the sickest patient's lungs isn't going to be reversible.


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## Summit (Mar 25, 2020)

I've been arguing very hard to hire Paramedics to help run vents in a disaster level surge scenario



Peak said:


> I'm mostly curious to see how the ECMO turns out. We are very hesitant to cannulate a COVID patient and fortunetly haven't been put in the position to do it yet. I am concerned that the damage that is happening to the sickest patient's lungs isn't going to be reversible.


the data aren't clear even internationally... but it wouldn't be the first time a non-salvageable lung ended up on ECMO


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## Medic511 (Mar 25, 2020)

Remi said:


> Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.
> 
> By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"


In this age of Evidence Based Medicine, it seems odd to me that you blame the news media for the consequences of a pandemic.  Seems like you are saying that that you are not sick until you know it and that so long as you do not know about a problem, risk or threat it does not exist in your world.  I believe that is a corollary of denial.


----------



## Medic511 (Mar 25, 2020)

mgr22 said:


> It makes sense to me that a new virus would provoke more anxiety than an old one. We have vaccines for the flu and lots of experience dealing with it.
> 
> As for the media's role, I find few things as ironic and useless as any media outlet, such as Newsweek in the above example, criticizing the media. Competition, alone, can lead to biased reporting.


Assuming that people turn to the news media to learn the facts of the world around them, competition would serve to foster and improve accurate reporting.  Accurate reporting would be  desired by those readers seeking factual information.  Readers looking for comfort (regardless of accuracy) would be likely to be unhappy with factually accurate media.  Does that sound like anyone you know?


----------



## Carlos Danger (Mar 25, 2020)

Gurby said:


> I think I asked the same questions a while ago, and you said the virus wasn't affecting your hospital.  Is that still the case?


The rural hospitals I work in and the larger health system that we are part of has been minimally affected thus far. We are in a (relatively) sparsely populated region so we don't expect to be as overwhelmed as many areas, even though we have fewer resources (beds, ventilators)  and sicker patient (on average) per capita. That said, we obviously don't know what is going to happen. We know there will be challenges and our doing our best to become as prepared as possible.



Gurby said:


> What should the country do, if not lock down?
> 
> Do we shrug and say "oh well, guess a bunch of people will just have to die" as the virus burns itself out?
> 
> How are hospitals supposed to handle the surge of patients?


We are in a dire situation where a bunch of people are going to die no matter what we do. I would never make that statement flippantly or "shrug" when I do. However, it is what it is. We can't stop it. Of course we hope to minimize mortality and suffering, but, in large part because of our utter lack of preparation for what was an entirely predictable event, we are very limited in our capacity to do so.

Just like many thousands of other healthcare providers, I am planning on at some point being in a position where I will willingly risk not only my own health, but that of my family in order to provide care to sick patients. Also, I have family members whose health status puts them squarely in the highest risk category and who are likely to require healthcare services at some point while the system is overwhelmed. So please don't act as though I don't take this seriously just because I think hysteria and economic suicide are the wrong approach.   

If we had a healthy financial system, we could probably shut down the entire economy and make everyone stay home and send every American a paycheck for months and stimulate all the important industries and deal with the economic ramifications of this thing easily. However, not only would many people still contract COVID-19 and die if we did that, but we don't have a healthy financial system at all. Our nation is well over $20TRILLION in debt in addition to many TRILLIONS more in unfunded liabilities and projections to add at least another $1T per year for at least the next decade. Some of our largest states, adjusted for scale, are even worse off. Our domestic economy is also debt-based with multiple bubbles growing at once (mortgages, student loans, credit cards), and the value of our money is based on nothing more than the willingness of foreign corporations to keep loaning us more. It's like a family with a house and cars they can't afford and massive consumer debt and no savings trying to deal with a huge unexpected expense. That type of thing makes families go bankrupt. Only the US can't go bankrupt, we can only default on our debts which means no one else will loan us money, which means that we'll have no way to pay for all of our massive programs. Or, we can print an unlimited amount of money and use that to pay our debts, but then the money becomes worthless. We've been warned for years that we were approaching a point where any number of unplanned for global events could bring the whole thing crashing down. I don't know for sure that this is it, but we should not be confident that it isn't.

The dollar value of a life is not limitless, especially a life that is nearing its end anyway. That sounds really harsh but it's a reality that we all implicitly accept, even if we never think about it, and even if we refuse to acknowledge the fact that healthcare, like every other scarce thing, will always need to be rationed one way or another. What follows is a very legitimate question: is it worth sacrificing millions of jobs and tens of thousands of businesses and resulting years (potentially decades, if this causes a real collapse) of economic suffering and all the health effects that come along with that, in order to hopefully save probably fewer lives that we lose to the flu in a normal year? I don't necessarily have the correct answer to that, but I suspect that when this is over, many more people will be asking that question than are asking it now.

What we _should_ have done over the past decades was prepare our healthcare system for this. We knew this was coming. There are government agencies and offices in cities and healthcare systems and universities whose sole job is to anticipate and prepare for these types of eventualities. More than a decade since the H1N1 pandemic and only a few years since Influenza A killed 60,000 Americans and hospitals are STILL only keeping enough N95's on hand for the anticipated number of TB patients and we STILL have no strategic stockpile of PPE and vents, and they're telling us to wrap bandanas around our faces when we run out of N95's!?!? Great job, feds and planners and healthcare executives! 

Another thing we _should _have done was not allow our federal government to put our financial system in such a precarious and helpless position so that something like this potentially throws us into a deep and prolonged recession.

I can do one more: giving the CDC and FDA so much power that they had the ability to **** up the early development and deployment of testing kits was just brilliant. Great job again, feds! We should totally keep trusting what you say! 

So, all that said….now that the feds and the healthcare industry that they closely oversee have ****ed this up every way possible, what should we do? I think the best way to balance limiting the spread with keeping our economy going is to stress the importance of those in high risk groups self-quarantining, and encouraging social distancing such as people working and schooling from home as much as possible. If certain densely populated locales (NYC) think it's worth the cost of shutting everything down because of their increased risk, then fine. But that should be the exception rather than the norm, IMO.


----------



## Medic511 (Mar 25, 2020)

FiremanMike said:


> Not in the slightest, I was literally stating the facts of this thread.  He said he’d call off sick, and most of the rest of us are going to go to work and do our best.


Actually Fireman, I did NOT say I would call of sick.  I said I would NOT compromise other patients and my loved ones by breaking the 'we do not enter unsafe scenes' rule.  That means I would turn down calls that cannot be handled because of a lack of reasonably adequate safety supplies or substitutes.  "Above all else, do no harm."  

I would compassionately suggest that you consider the risk-benefit balance of you going into unsafe scenes abut increasing the spread of this disease in the process.  You CAN think outside the box to find reasonably safe solutions without disregarding the fundamental 'never enter an unsafe scene' precept.  It may cost your employer a few dollars more, but then your employer made the decision long ago to save then-current dollars by not stocking and maintaining an adequate stockpile of mission critical safety supplies.  So it is understandable that the added financial cost  of the late acquisition of those self-same mission critical supplies fail on those who saved those dollars in the past.

And, do not tell me there are none available.  There are many items out there.  They will cost more and you may have to de-con and re-use, assemble, retrofit, or accept additional inconvenience or expense but your employer can fulfill its mission.  You and your employer just need to put on you big-boy pants and bite the bullet and do it.  It wasn't pretty, by my agency finally saw the light and our EMTs, our patients, and the loved one of all of them re better off.  It's worth the effort.  You and I have dual roles.  We are not only employees, we are professionals and that imposes upon us the duty and privilege of being advocates for our patients, current and future.


----------



## Carlos Danger (Mar 25, 2020)

Medic511 said:


> In this age of Evidence Based Medicine, it seems odd to me that you blame the news media for the consequences of a pandemic.  Seems like you are saying that that you are not sick until you know it and that so long as you do not know about a problem, risk or threat it does not exist in your world.  I believe that is a corollary of denial.


If you don't think that news media intentionally sensationalizes and exploits situations like this for the purposes of their own importance and profit rather than for informing the public and that doing so causes unnecessary panic and real harm, than one of us is not only in denial but also ignorant of history, and it ain't me.

Residents of an island town where I own property are arguing that not only should it be illegal for non-residents to enter the town, but that anyone walking on the beach should be charged with attempted manslaughter, and some have suggested that doing so may even justify shooting those people in self defense.

Why do they think that? Because news sources have suggested repeatedly that coronavirus carries up to a 10% mortality rate AND have hosted quacks that imply the virus is not unlikely to be passed between people on a public beach many feet away from each other.

So what was that about evidence based medicine and denial?

If you think CNN and Fox News and countless columnists and bloggers have your welfare in mind, then I can't help you.


----------



## Medic511 (Mar 25, 2020)

Remi said:


> I will willingly risk not only my own health, but that of my family


We will have to disagree on that one.

I share and support your willingness to risk your life.  I am equally bothered by your (apparently unilateral) decision to risk your family, especially if your family include minor children.  That can of course be a cultural and/or religious matter I suppose but please at least reflect on whether you truly mean what you say.

Medical professionals are being pressed to disregard the long-held fundamental rule of provider safety first (and assuring safe scene) by being asked to re-use single-use supplies and accept low-level protection devices.  These "think outside the box" talking points cover up the fact (intentionally or otherwise) that they confuse the "safety" box with the "availability" box.  It is never appropriate to think outside the safety box BUT searching for alternatives and creatively using alternate devices and procedures IS appropriate but does come with a financial cost.  We should not put that added financial cost above our personal safety and the health of our loved ones.  Buy and de-con re-usable, use available alternative masks or effective masking devices, use SCBA rather than N95, yell at, report, and shame government officials that are hoarding existing supplies, make the news media your friend for a change, do not be afraid to say "no, not until," explain that being told "no" is not acceptable, etc. 

Remember your role as advocate.  That is an import role for a professional.  Attempting to be a hero at the cost of your family's safety is not appropriate in my opinion.


----------



## FiremanMike (Mar 25, 2020)

Medic511 said:


> And, do not tell me there are none available.  There are many items out there.  They will cost more and you may have to de-con and re-use, assemble, retrofit, or accept additional inconvenience or expense but your employer can fulfill its mission.  You and your employer just need to put on you big-boy pants and bite the bullet and do it.  It wasn't pretty, by my agency finally saw the light and our EMTs, our patients, and the loved one of all of them re better off.  It's worth the effort.  You and I have dual roles.  We are not only employees, we are professionals and that imposes upon us the duty and privilege of being advocates for our patients, current and future.



I get hit with this about once per day at work, despite the fact that we actually have a pretty decent supply..

"Well I found respiratory filters right away on the internet"
"Well I found N95 masks on the internet just last night"
"Well I found.."

To which I say "folks, I'm open, I've been looking, and I can't find any.  PLEASE send me the thinks so we can purchase these things ASAP"

Number of links I've received = 0

If you have links to supplies, send them to me.


----------



## Gurby (Mar 25, 2020)

Remi said:


> The rural hospitals I work in and the larger health system that we are part of has been minimally affected thus far. We are in a (relatively) sparsely populated region so we don't expect to be as overwhelmed as many areas, even though we have fewer resources (beds, ventilators)  and sicker patient (on average) per capita. That said, we obviously don't know what is going to happen. We know there will be challenges and our doing our best to become as prepared as possible.
> 
> 
> We are in a dire situation where a bunch of people are going to die no matter what we do. I would never make that statement flippantly or "shrug" when I do. However, it is what it is. We can't stop it. Of course we hope to minimize mortality and suffering, but, in large part because of our utter lack of preparation for what was an entirely predictable event, we are very limited in our capacity to do so.
> ...



Thanks for writing this all out, this side of the argument feels a lot more reasonable to me now.  My hospital is getting hit pretty hard, and the panic in the press makes it easy to forget that the sky is not falling everywhere.


----------



## Sled Driver (Mar 25, 2020)

The NYC Morgue is near capacity, per Weather.com


----------



## Carlos Danger (Mar 25, 2020)

Medic511 said:


> We will have to disagree on that one.
> 
> I share and support your willingness to risk your life.  I am equally bothered by your (apparently unilateral) decision to risk your family, especially if your family include minor children.  That can of course be a cultural and/or religious matter I suppose but please at least reflect on whether you truly mean what you say.
> 
> ...


I love how every time one publicly acknowledges the risk inherent in a situation they are derided as having a hero complex and/or accused of not having considered those risks. 

 You make a lot of assumptions. I'd think the view from way up in that ivory tower would be better than it apparently is.


----------



## mgr22 (Mar 25, 2020)

Medic511 said:


> Assuming that people turn to the news media to learn the facts of the world around them, competition would serve to foster and improve accurate reporting.  Accurate reporting would be  desired by those readers seeking factual information.  Readers looking for comfort (regardless of accuracy) would be likely to be unhappy with factually accurate media.  Does that sound like anyone you know?



Given your opening assumption, I'd agree competition among media should lead to better reporting, but I'm referring to media outlets that choose to appeal to special interests by slanting content. Their audiences are the ones unhappy with accurate, unbiased media.


----------



## Medic511 (Mar 25, 2020)

FiremanMike said:


> . . .
> 
> To which I say "folks, I'm open, I've been looking, and I can't find any.  PLEASE send me the thinks so we can purchase these things ASAP"
> 
> ...


Links?  No wonder you are having trouble.  Call you long-time sources and look for acceptable substitiutes.  No, you will not of course find Medical N95 now.  You MAY find construction N95s.  You will be able to find some re-useable (more expensive) equal or better (also expensive). Single-use gowns?  No, of course not now.  But, look for re-usable gowns, bleach, and a washing machine (all available) as well as Tyvek coveralls, butcher aprons and upper uniforms.  Be creative.  Your definition of "creative" seems to be based on accepting decreased safety.  THAT is what is not acceptable.  There is a secret at work here:  the longer you wait, the less choice you will have and the more you will ultimately pay both financially and otherwise.


----------



## E tank (Mar 25, 2020)

Sled Driver said:


> The NYC Morgue is near capacity, per Weather.com



So here's an example of media hyping the situation...Weather.com picked that up from Politico that looks like a story from the NYT where a young lady is holding a bloody organ of some sort or another...(paywall)









						Piled Bodies, Overflowing Morgues: Inside America’s Autopsy Crisis (Published 2020)
					

Medical examiners provide crucial insights into public health and safety. What happens when we don’t have enough of them?




					www.nytimes.com
				




Some questions that won't be answered in any media outlet...has this happened before? How many times? Under what conditions?

While having elements of truth, they add nothing to the conversation and just create more angst while selling clicks. This then forces policy makers to make decisions based on faulty or false information in order to appear as though they're in control. 

I'm not a fan of capital punishment, but if there were public hangings of opportunistic "journalists" after all of this was said and done, I might grab some popcorn.


----------



## Medic511 (Mar 25, 2020)

mgr22 said:


> Given your opening assumption, I'd agree competition among media should lead to better reporting, but I'm referring to media outlets that choose to appeal to special interests by slanting content. Their audiences are the ones unhappy with accurate, unbiased media.


Sorry.  I assumed you meant real news media.  You are correct, Fox News as an example was formed by Mr Murdock as a propaganda machine and never intended to be a real news outlet.


----------



## Medic511 (Mar 25, 2020)

Remi said:


> . . .
> 
> If you think CNN and Fox News and countless columnists and bloggers have your welfare in mind, then I can't help you.


Your islander neighbors are panicking. There is nothing on CNN that would lead a reasonable person to reach any of the conclusions you recite.  There ARE 62,000 confirmed cases in the US today.  More than 3 dozen DOCTORS have DIED in Italy.  Some (not all) some EMS agencies ARE re-using single use supplies here in the US.  THESE ARE FACTS.  If your neighbors are over-reacting perhaps you can counsel them but why you blame the media sounds like you blame the messenger or support censorship, just in the public good of course.  If you want to re-write the US Constitution, form a PAC, get donors, and go for it.  THAT is your right.  For the time being, a free press is MY RIGHT.


----------



## FiremanMike (Mar 25, 2020)

Medic511 said:


> Links?  No wonder you are having trouble.  Call you long-time sources and look for acceptable substitiutes.  No, you will not of course find Medical N95 now.  You MAY find construction N95s.  You will be able to find some re-useable (more expensive) equal or better (also expensive). Single-use gowns?  No, of course not now.  But, look for re-usable gowns, bleach, and a washing machine (all available) as well as Tyvek coveralls, butcher aprons and upper uniforms.  Be creative.  Your definition of "creative" seems to be based on accepting decreased safety.  THAT is what is not acceptable.  There is a secret at work here:  the longer you wait, the less choice you will have and the more you will ultimately pay both financially and otherwise.



Yeah, thats what I thought.  Every chucklehead “just knows there’s options out there” and feels “you should just more creative” but when pressed, they really have no clue what they’re talking about.

If you’ve unearthed the magic outside the box solution to all of the exposure control needs of the entire planet, share it or shut it..


----------



## DrParasite (Mar 25, 2020)

This popped up in my linkedin feed today


----------



## FiremanMike (Mar 25, 2020)

Good find, thanks for sharing.. Email sent, hopefully we're one of the 30


----------



## GMCmedic (Mar 25, 2020)

We've had overwhelming local responses to the homemade masks requests. One of our nurses daughters is currently making some for our crews now. It appears on the N95 front were doing ok


----------



## MonkeyArrow (Mar 25, 2020)

E tank said:


> I'm not a fan of capital punishment, but if there were public hangings of opportunistic "journalists" after all of this was said and done, I might grab some popcorn.


That’s an unbelievably reckless statement to make.


----------



## E tank (Mar 25, 2020)

MonkeyArrow said:


> That’s an unbelievably reckless statement to make.


What...junior mints instead? I'm open...


----------



## Lemur (Mar 25, 2020)

Remi said:


> Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.
> 
> By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"


Curious then, if not the keyboard epidemiologists, which ones are you listening to? There is a clear consensus in the community of scientists who study infectious disease - we are not overreacting, we are under-reacting. You can put the media aside- they having nothing to do with the expert consensus. The public health community is united in calling for drastic measures to be implemented and maintained.


----------



## Carlos Danger (Mar 25, 2020)

Lemur said:


> Curious then, if not the keyboard epidemiologists, which ones are you listening to? There is a clear consensus in the community of scientists who study infectious disease - we are not overreacting, we are under-reacting. You can put the media aside- they having nothing to do with the expert consensus. The public health community is united in calling for drastic measures to be implemented and maintained.


Actually, that isn't true. The voices who are promoted in the media are the ones you hear, but there are plenty of credible analysts who disagree with the necessity of our current approach.


----------



## RedBlanketRunner (Mar 25, 2020)

Medic511 said:


> Assuming that people turn to the news media to learn the facts of the world around them, competition would serve to foster and improve accurate reporting.


One would certainly hope all people involved in the medical profession wouldn't stoop to sensationalist cat barf when the real deal is at your fingertips: WHO, CDC, ECDC, NHC, DXY, 1point3acres, Worldometers.info, BNO
And of course, do contrapuntal comparisons on your own.
-If you aren't thinking critically and analytically, somebody else is doing your thinking for you-
-You will get more truth, and gain more knowledge and understanding, from one honest intelligent critic than from an army of sycophants-


----------



## Medic511 (Mar 25, 2020)

FiremanMike said:


> Yeah, thats what I thought.  Every chucklehead “just knows there’s options out there” and feels “you should just more creative” but when pressed, they really have no clue what they’re talking about.
> 
> If you’ve unearthed the magic outside the box solution to all of the exposure control needs of the entire planet, share it or shut it..


Any fair reading of my posts will show quite specific suggestions that have worked for us.  There is no "magic" solution, just hard work.  You are not exactly an easy person to help, since you feel you have already done all of which you feel you are capable.  Your EMTs who depend upon you have my best wishes.


----------



## SandpitMedic (Mar 25, 2020)

Sled Driver said:


> The NYC Morgue is near capacity, per Weather.com


Weathermen are notorious for their accuracy.


----------



## Lemur (Mar 26, 2020)

Remi said:


> Actually, that isn't true. The voices who are promoted in the media are the ones you hear, but there are plenty of credible analysts who disagree with the necessity of our current approach.


True, there are some dissenting voices. But they aren’t really being pushed aside by the media, they are just an extremely tiny minority. There was an op ed in the NYT by David Katz on the 20th for example, where he argued for more selective measures to protect the elderly and other vulnerable groups while letting the rest of society get on with it. This hasn’t caught on, because again, the almost universal consensus amongst everybody else is that it won’t work. Which absolutely sucks by the way. But I would dispute your assertion that there are “plenty of credible” authorities who disagree. I’m happy to talk this out in more detail, and get into the weeds if you want. But I’m also confident that in 5 days time, there will be no argument and no other side to this debate. We are about to see really horrible things happen in New York City and no one will want replicated where they live.

I do think there is room to be more flexible in parts of the country where there are not many cases. But you need a robust public health infrastructure that can test and isolate cases. We don’t have that yet.


----------



## RedBlanketRunner (Mar 26, 2020)

Medic511 said:


> Any fair reading of my posts will show quite specific suggestions that have worked for us. There is no "magic" solution, just hard work. You are not exactly an easy person to help, since you feel you have already done all of which you feel you are capable. Your EMTs who depend upon you have my best wishes.


Seems you've just been covering the bases. Not sure why the negativity.

Honestly, a whole heck of a lot of people who work medical would benefit from a gig or two in a back water third world clinic or hospital. Patients on gurneys in long lines down every wide hall. Private rooms are 2 or 4 bed. Not a single spare piece of equipment standing idle. Everyone has more than a 100% work load. Your face mask is often used for a week at a time. Patients families camping outside anywhere they can find room ...
Recollection of the main hospital in Fiji, 1991. Do NOT look at the floor. Housekeeping, constantly overwhelmed, gave up doing more than sweeping a few years back.

Interesting conjecture from a S.E. Asia medical group. Mortality rate of Covid-19 may be far lower than the seasonal flu. Conjecture based upon the apparent much greater variation in symptoms of Covid-19, from non noticeable on out.


----------



## FiremanMike (Mar 26, 2020)

Medic511 said:


> Any fair reading of my posts will show quite specific suggestions that have worked for us.  There is no "magic" solution, just hard work.  You are not exactly an easy person to help, since you feel you have already done all of which you feel you are capable.  Your EMTs who depend upon you have my best wishes.



Your *final* post offered a small number of suggestions, some of which are not acceptable forms of PPE and some of them have already been in place and/or in stock at our agency for decades.

Frankly, you have no idea what my stockpile looks like, nor do you have any idea what message I'm sending to my crew.  We were actually fairly well stocked from the H1N1 outbreak and I'm relatively confident that we'll make it through this..  

You're a boot on the ground, this is obvious from your posts.  You may or may not be a great provider, you may be an excellent employee.  I was there too, and when I lacked perspective I used to have the same feelings of angst as you.. "why isn't admin doing more", "I could do it so much better", "they just don't care".  Then I found myself in an admin role and my perspective changed.  Pieces of the puzzle that I had previously filled with assumption were now filled with first hand experience and I realized how little I actually understood.

You don't know what you don't know, and the more you double down with your condescension towards me, the more foolish you appear.


----------



## Phillyrube (Mar 26, 2020)

Remi said:


> If you don't think that news media intentionally sensationalizes and exploits situations like this for the purposes of their own importance and profit rather than for informing the public and that doing so causes unnecessary panic and real harm, than one of us is not only in denial but also ignorant of history, and it ain't me.
> 
> Residents of an island town where I own property are arguing that not only should it be illegal for non-residents to enter the town, but that anyone walking on the beach should be charged with attempted manslaughter, and some have suggested that doing so may even justify shooting those people in self defense.
> 
> ...



Seeing news articles from Jersey where shore townies are complaining about people from Philly and ny are going to their shore houses to shelter in place.   Same with the Poconos where ny' ers are escaping to their second houses.


----------



## SandpitMedic (Mar 26, 2020)

Alright ladies and gentlemen...
The science dudes over there who wrote the big scary Imperial Study (you know, the one which claimed we were all destined to die or be building coffins soon if we didn’t enact a complete shut down) have recanted their study. They admit they were wayyyyyy off base. To the tune of reducing their death tolls by *94*%

What a crock of ****. So much panic. So much distress over that study.

****, even Red had the virus and got over it and is saying the numbers actually aren’t that bad.

According to the new data this thing actually is closer to the flu numbers and not the extinction level event the media would have you believe.

There is a necessity for preparedness at all levels of healthcare. I’m not saying prudence should not be the order of the day, yet the massive overblown reaction by the world may turn out to be just that. Yes, it’s a novel virus. We should be safe. But the panic, the hoarding, lockdowns, and destroying the economy were not right.









						Epidemiologist Behind Highly-Cited Coronavirus Model Drastically Downgrades Projection | The Daily Wire
					






					www.dailywire.com


----------



## FiremanMike (Mar 26, 2020)

SandpitMedic said:


> Alright ladies and gentlemen...
> The science dudes over there who wrote the big scary Imperial Study (you know, the one which claimed we were all destined to die or be building coffins soon if we didn’t enact a complete shut down) have recanted their study. They admit they were wayyyyyy off base. To the tune of reducing their death tolls by *94*%
> 
> What a crock of ****. So much panic. So much distress over that study.
> ...



I wonder when the mainstream media will start picking up these stories?


----------



## Carlos Danger (Mar 26, 2020)

SandpitMedic said:


> Alright ladies and gentlemen...
> The science dudes over there who wrote the big scary Imperial Study (you know, the one which claimed we were all destined to die or be building coffins soon if we didn’t enact a complete shut down) have recanted their study. They admit they were wayyyyyy off base. To the tune of reducing their death tolls by *94*%
> 
> What a crock of ****. So much panic. So much distress over that study.
> ...


Related:

Half of UK Already Infected, Says Oxford Model

This is exactly the kind of thing that the "tiny minority" of voices that I keep referring to has been saying all along. 

Let's see if this or the story that Sandpit posted are front and center on any of the major news websites any time soon. I think we know the answer to that, and I think we know why.


----------



## mgr22 (Mar 26, 2020)

Before y'all commit intellectually to what you're reading on www.dailywire.com, I suggest you click on their "2020 Election Page." If you lean politically in the same direction as Dailywire, you have nothing to fear.

I'm not saying I know who's right and who's wrong, but I think the quoted article is a good example of politics competing with medicine for the attention of the public.


----------



## DrParasite (Mar 26, 2020)

mgr22 said:


> Before y'all commit intellectually to what you're reading on www.dailywire.com, I suggest you click on their "2020 Election Page." If you lean politically in the same direction as Dailywire, you have nothing to fear.
> 
> I'm not saying I know who's right and who's wrong, but I think the quoted article is a good example of politics competing with medicine for the attention of the public.


I was waiting for someone to make that claim...... I mean, the same argument could be made for anyone who watches, reads, or listens to anything CNN says....

But if you want some other sources:









						UK has enough intensive care units for coronavirus, expert predicts
					

Neil Ferguson, whose modelling has informed the UK's coronavirus strategy, says that the need for intensive care beds will come close to, but not exceed, national capacity




					www.newscientist.com
				











						Imperial College scientist who predicted 500K coronavirus deaths in UK adjusts figure to 20K or fewer
					

A scientist who warned that the coronavirus would kill 500,000 people in the United Kingdom has presented evidence that if current measures work as expected, the death toll would drop to roughly 20,000 people or fewer.




					www.washingtonexaminer.com
				











						Neil Ferguson, Doctor Behind Coronavirus Imperial College Study, Revises Predictions
					

The doctor behind a U.K. college study that painted a doomsday scenario over the coronavirus pandemic now says he holds a more optimistic view about the spread.




					dailycaller.com
				











						British prof who predicted 500k dead from coronavirus now estimating a radically lower number | The College Fix
					

He cites the UK lockdown that began two days ago.




					www.thecollegefix.com
				




haven't heard anything from CNN, MSNBC, the NY Times (other than a tweet), etc: maybe they don't want to kill their massive click bait headlines, so they are waiting on reporting on the actual facts, and want to continue to spread baseless fear and incorrect information?


----------



## FiremanMike (Mar 26, 2020)

mgr22 said:


> Before y'all commit intellectually to what you're reading on www.dailywire.com, I suggest you click on their "2020 Election Page." If you lean politically in the same direction as Dailywire, you have nothing to fear.
> 
> I'm not saying I know who's right and who's wrong, but I think the quoted article is a good example of politics competing with medicine for the attention of the public.



I don’t look a single source and hedge my whole opinion on that.  I will say my personal analysis of the statistics we have are more in line with the above posted article than the MSM reports..

I won’t speak for the others, but I bet they hold the same views..


----------



## Carlos Danger (Mar 26, 2020)

Lemur said:


> True, there are some dissenting voices. But they aren’t really being pushed aside by the media, *they are just an extremely tiny minority.* There was an op ed in the NYT by David Katz on the 20th for example, where he argued for more selective measures to protect the elderly and other vulnerable groups while letting the rest of society get on with it. This hasn’t caught on, because again, the almost universal consensus amongst everybody else is that it won’t work. Which absolutely sucks by the way. *But I would dispute your assertion that there are “plenty of credible” authorities who disagree.*


Yes, you are correct that those who question whether our current reaction is necessary or worth it are a minority. Are they "extremely tiny" in number? No. It just appears that way because the vast majority of these folks aren't published in the NYT or featured on CNN.  This is a common tactic which is used on all sorts of issue. Mainstream media ignores those with a dissenting point of view, so for all practical purposes, they don't exist.

Any why is that? It's because - profit motive and political agendas aside - despite this entire issue being primarily an economic one (epidemiology is essentially as much a branch of economics as it is medicine, and public health in general is driven more by economic forces than any other), no one is thinking at all about the immediate or downstream costs of our current policies, with the exception of the "tiny minority" who are dismissed out of hand by those incapable of thinking past their current fear.


Lemur said:


> I’m happy to talk this out in more detail, and get into the weeds if you want. But I’m also confident that in 5 days time, there will be no argument and no other side to this debate. *We are about to see really horrible things happen in New York City and no one will want replicated where they live.*


Really horrible things are already happening in NYC, and they are going to worsen before they improve. Much of it can not possibly be replicated in many parts of the country because of demographic and geographic factors. Not coincidentally, the NYC area has by far the highest population density in the country, as well as perhaps the largest population of recent world travelers. None of that explains or justifies why the same policies that are being implemented in NYC and other densely populated hotspots are being forced in rural, low-density parts of the country that haven't seen a single case. Businesses are closing and many will never re-open. People are losing their jobs and will soon be unable to pay their mortgages and some will deplete whatever life savings they've accumulated. This will likely result in a deep and prolonged recession, if not worse. What do you think the ripple effects of that might be? On the economy? On our government's ability to help those in need? On rates of domestic violence, crime, alcoholism, and suicide? On people's health?


----------



## mgr22 (Mar 26, 2020)

FiremanMike said:


> I don’t look a single source and hedge my whole opinion on that.  I will say my personal analysis of the statistics we have are more in line with the above posted article than the MSM reports..



And you may be right. I hope you are. Meanwhile, there's this:









						How the Pandemic Will End
					

The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.




					www.theatlantic.com


----------



## Peak (Mar 26, 2020)

FYI NYC has a chronic bed shortage. It's not uncommon for patients to wait 1-3 days in the ED before an ICU bed opens up. ED nurses average a 1:8 ratio. That's all the time pre-covid. 

NYC is a uniquely bad example of how a local disease breakout quickly overwhelms a lacking healthcare system.


----------



## GMCmedic (Mar 26, 2020)

Peak said:


> FYI NYC has a chronic bed shortage. It's not uncommon for patients to wait 1-3 days in the ED before an ICU bed opens up. ED nurses average a 1:8 ratio. That's all the time pre-covid.
> 
> NYC is a uniquely bad example of how a local disease breakout quickly overwhelms a lacking healthcare system.


You can save people from trans fats and fountain drinks but whentheyre living on top of each other its bound to happen.


----------



## mgr22 (Mar 26, 2020)

Peak said:


> FYI NYC has a chronic bed shortage. It's not uncommon for patients to wait 1-3 days in the ED before an ICU bed opens up. ED nurses average a 1:8 ratio. That's all the time pre-covid.
> 
> NYC is a uniquely bad example of how a local disease breakout quickly overwhelms a lacking healthcare system.



Not sure I understand. Are you saying New York's characteristics pre-covid make them less likely to have a bad outcome during the current crisis? Or that they're atypical and shouldn't be used to predict what will happen in the rest of the U.S.? Or something else?


----------



## PotatoMedic (Mar 26, 2020)

mgr22 said:


> Not sure I understand. Are you saying New York's characteristics pre-covid make them less likely to have a bad outcome during the current crisis? Or that they're atypical and shouldn't be used to predict what will happen in the rest of the U.S.? Or something else?


He's saying that before all this started NYC had an issue with overcrowding and not enough beds.


----------



## firecoins (Mar 26, 2020)

NYC is usually overcrowded.  Its a lot worse now of course.  I've been In Elmhurst Medical center within the last couple of days and the situation there isn't good.


----------



## RedBlanketRunner (Mar 26, 2020)

Nothing to see here. Get back to work! Your lung damage is probably not permanent.
Confirmed cases:
US 82,404
China 81,702
Italy 80,589
Spain 56,347

US:
Total deaths from the 4 common flu's since season start, approx 41,000 (averaged). Deaths per day, 230.
Total deaths from Covid-19 since January 20th, 1201. Deaths per day, 18.

Difference between Covid-19 and common flu, common flu in the wild, multiple pools of infection. Covid, single point initially.
Insufficient data on Covid-19 to run comparative to common flu but mortality rate of common flu is staying steady just under .1% Covid >1.4%, averaged by region, present rate. Covid mortality rate 14 times higher than all common seasonal flus combined.


----------



## Seirende (Mar 26, 2020)

If there's one thing this pandemic has taught me, it's that a lot of people have a very sketchy knowledge of infection control. I'm seeing a lot of unnecessary gloves and masks.


----------



## jgmedic (Mar 26, 2020)

Outside of the new scientist those are all right wing news sites. So kinda the pot calling the kettle black with the criticism of CNN,MSNBC and the like. Bias swings both ways.


----------



## mgr22 (Mar 26, 2020)

jgmedic said:


> Outside of the new scientist those are all right wing news sites. So kinda the pot calling the kettle black with the criticism of CNN,MSNBC and the like. Bias swings both ways.



Yup. It's not hard to find Internet sources to support either side of the argument. What IS hard is knowing what's true. I'm just sitting here in TN, drawing my own conclusions about a disease that's infecting people at an increasing rate based on state and county sources. As they warn us about things getting worse, I doubt they're spreading baseless fear. Hope I'm wrong.


----------



## RedBlanketRunner (Mar 26, 2020)

Where the projections come from that 80% of the people in the world will contract Covid-19. The primary problem with this model is how late and slow the testing has been. Of note, the model won't ever be entirely accurate until some times after the 1% susceptible is reached. Presently reported actual infections is extremely low, well below 50% possible, as most of the testing is performed on people with obvious symptoms. 




(As he said, this is a standard model. IE all computations will follow this same formula)


----------



## Akulahawk (Mar 27, 2020)

Among other things, I just hope that this doesn't hit my region anywhere near as hard as we're gearing up for... Of course we're gearing up for basically a worst-case scenario and hoping that reality isn't as bad as that. My region isn't anywhere near as densely populated as NYC is, so we shouldn't have the hospital overload that area does. That being said:

I also just saw a news article that my local hospitals are all now bracing for a coming surge in COVID19 patients. Basically they're all looking at repurposing hospital areas for inpatient care and some places are looking at possibly using outpatient ambulatory surgery sites, using on-campus buildings, and other non-traditional spaces to help absorb the surge. Nurses and physicians that aren't typical ED/ICU/Med-Tele/Med-Surg types are being briefed so that they can also take care of inpatients.

I'm an ED RN and if this does get bad, I have little doubt that I'll end up providing a lot of the care of our vented patients. Basically I'll probably split my time between doing my "usual" ED duties and providing care for lower-acuity ICU patients.

If, by chance, I end up going mostly quiet on here, it'll be from having to Work, Eat, Sleep, Wash-Rinse-Repeat and will be too tired to do much else. However, never fear, for I plan on being on here as much as I can, though I'm sure some of that will be after I get sufficient sleep. 

Anecdotally, my perception of ED and hospital census has been down from normal over the past few days and while my managers are backing that up, I just get the feeling that we're in the proverbial "calm before the storm."  I do hope that storm doesn't arrive... for I'll end up being seriously tired and overcaffeinated if it does.


----------



## OceanBossMan263 (Mar 27, 2020)

In less catastrophic news, my paramedic program has been put on hold. I am in the third cohort of New York's EMT-CC to Paramedic Bridge program and was slated to take the cardiology FISDAP exam next week. Due to unavailability of some or all of the testing sites, the program is to be delayed until they can come up with a solution. The cohort ahead of me was slated for the trauma exam in 2 weeks, followed shortly by the course final and skills update sessions.


----------



## mgr22 (Mar 27, 2020)

OceanBossMan263 said:


> In less catastrophic news, my paramedic program has been put on hold. I am in the third cohort of New York's EMT-CC to Paramedic Bridge program and was slated to take the cardiology FISDAP exam next week. Due to unavailability of some or all of the testing sites, the program is to be delayed until they can come up with a solution. The cohort ahead of me was slated for the trauma exam in 2 weeks, followed shortly by the course final and skills update sessions.



I hope they let you folks continue to practice as CCs until things get back to normal.


----------



## OceanBossMan263 (Mar 27, 2020)

We are practicing at that level now, but the state is no longer running refresher classes at that level. Continuing Education is still a route for those who will expire and don't want to upgrade or downgrade yet, and if the agency is enrolled in the CME program. I'm good for another 2+ years since I refreshed right before enrolling in the bridge.


----------



## mgr22 (Mar 27, 2020)

OceanBossMan263 said:


> We are practicing at that level now, but the state is no longer running refresher classes at that level. Continuing Education is still a route for those who will expire and don't want to upgrade or downgrade yet, and if the agency is enrolled in the CME program. I'm good for another 2+ years since I refreshed right before enrolling in the bridge.



Sounds good. I spent some time in and around NYC as a medic.

Good luck.


----------



## GMCmedic (Mar 27, 2020)

Out of curiosity I googled some population density numbers. 

Per sq mile.

US as a whole ~90
China ~ 300
Italy ~ 500
NYC ~27,000


----------



## DrParasite (Mar 27, 2020)

and there is this from CNN: 
*Why New York is the epicenter of the American coronavirus outbreak*


----------



## RedBlanketRunner (Mar 27, 2020)

I'm flat out amazed. Somebody equated population density with disease communicability.

Covid-19 infection rate slowly ramping up. Up to 12% increase per day from 10% a week ago. Mortality is proportional. Hopefully social distancing will kick in soon and force that curve down. If it doesn't that will be a solid indicator of it's communicability.

Encephalitis from eating human brains<------------------------------------------------------------------------------------------>Common cold
Covid-19 might be somewhere in between. Discounting certain space ships and aliens theories.

Bill Gates, very likely a little smarter than the average politician, predicts the rise in Covid infections will peak in late April. Well okay, a little smarter than any 100 politicians roaming the sewers of congress combined... I mean, which is more successful and capable, US infrastructure or health care, or MS Windows?


----------



## OceanBossMan263 (Mar 27, 2020)

Social distance cycle in NY and Long Island seems to be going this way:
1. Governor or other politician implores distance, noting that people are congregating in X place
2. People keep hanging out there
3. Governor closes area or restricts activity
4. People pissed because they don't listen 

Also, what parent or teacher or school board member thought it was a good idea to start little teacher parades through the neighborhoods where they teach? Sure the teachers are in cars away from people, but now you're encouraging a whole school and their families to congregate on a few blocks


----------



## Lemur (Mar 27, 2020)

Remi said:


> Yes, you are correct that those who question whether our current reaction is necessary or worth it are a minority. Are they "extremely tiny" in number? No. It just appears that way because the vast majority of these folks aren't published in the NYT or featured on CNN.  This is a common tactic which is used on all sorts of issue. Mainstream media ignores those with a dissenting point of view, so for all practical purposes, they don't exist.
> 
> Any why is that? It's because - profit motive and political agendas aside - despite this entire issue being primarily an economic one (epidemiology is essentially as much a branch of economics as it is medicine, and public health in general is driven more by economic forces than any other), no one is thinking at all about the immediate or downstream costs of our current policies, with the exception of the "tiny minority" who are dismissed out of hand by those incapable of thinking past their current fear.
> 
> Really horrible things are already happening in NYC, and they are going to worsen before they improve. Much of it can not possibly be replicated in many parts of the country because of demographic and geographic factors. Not coincidentally, the NYC area has by far the highest population density in the country, as well as perhaps the largest population of recent world travelers. None of that explains or justifies why the same policies that are being implemented in NYC and other densely populated hotspots are being forced in rural, low-density parts of the country that haven't seen a single case. Businesses are closing and many will never re-open. People are losing their jobs and will soon be unable to pay their mortgages and some will deplete whatever life savings they've accumulated. This will likely result in a deep and prolonged recession, if not worse. What do you think the ripple effects of that might be? On the economy? On our government's ability to help those in need? On rates of domestic violence, crime, alcoholism, and suicide? On people's health?



Again, media aside, the consensus is what it is, and dissenting views are quite limited in number. How do I know this? Because you can look investigators and labs well known in infectious disease transmission and modeling from coast to coast, and they are virtually all in agreement. They all agree that without drastic action, the hospitalization and death tolls will be enormous. And they agree that these measures are needed as much in NYC as they are in Ohio, Florida, California, Arizona, and Louisiana. Perhaps they can be more relaxed in very rural areas with low numbers of cases and robust testing and public health infrastructure, but maybe not. By the way my offer stands, I am happy to talk about specific people, specific labs, and specific models. Really. 

I don't think anyone is ignoring the economic costs here. They will be profound. Probably unfathomable. And I think you're right, there will be lasting effects on mental health. But unfortunately I think you are wrong about what the likelihood of that is happening in NYC being replicated in other parts of the country. It can happen, its beginning to happen in Detroit right now. And Louisiana right now. And in Los Angeles right now. We have only one tool to apply the brakes, and its a blunt tool.


----------



## Lemur (Mar 27, 2020)

DrParasite said:


> I was waiting for someone to make that claim...... I mean, the same argument could be made for anyone who watches, reads, or listens to anything CNN says....
> 
> But if you want some other sources:
> 
> ...


The reason no reputable sources are echoing these claims is because this is a gross misrepresentation of what Ferguson actually said. He said deaths _could_ be significantly scaled back with *months *of intense social distancing. And he quoted numbers from the table of the same publication people are claiming that he refuted. Otherwise the estimates from his original paper of up to 500,000 deaths still stand. So no, he did not refute or retract anything. 



			https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Global-Impact-26-03-2020.pdf
		

See page 11


----------



## Seirende (Mar 27, 2020)

Are you guys optimistic that we'll be better prepared if something with even worse morbidity and mortality rates were to start to spread in the future?


----------



## Peak (Mar 27, 2020)

Seirende said:


> Are you guys optimistic that we'll be better prepared if something with even worse morbidity and mortality rates were to start to spread in the future?



No


----------



## Carlos Danger (Mar 27, 2020)

Seirende said:


> Are you guys optimistic that we'll be better prepared if something with even worse morbidity and mortality rates were to start to spread in the future?


No. If ebola and SARS and H1N1 and Influenza A in 2017-2018 (almost 70 thousand died) combined didn't convince the powers-that-be that modest investments into stockpiles of PPE and ventilators and planning should be done, then I doubt this will.

As big a deal as this is to all of us right now, it will be over at some point and once it is, the experience will quickly fade in influence as health systems, governments, and individuals shift their focus towards the struggle to recover economically and trying to get back to some normalcy.

There will be meetings and conferences and round tables and congressional hearings, and some organizations and committees will make really good recommendations and those in charge will act like they are all about making sure that next time we are much more prepared and able to react more quickly and effectively. Blame will be placed. Leaders will pat themselves on the back because "if not for us, it would have been much worse". Laws and regulations will be passed. But nothing that really has a significant impact on our actual preparedness. 

As a nation we do a really, really horrible job of learning from our mistakes.


----------



## VentMonkey (Mar 27, 2020)

Remi said:


> As a *planet* we do a really, really horrible job of learning from our mistakes.


I think your post is spot on, but regardless of it affecting the third, or first world countries I can’t help but feel agendas are globally...universal.


----------



## RedBlanketRunner (Mar 27, 2020)

Lemur said:


> How do I know this? Because you can look investigators and labs well known in infectious disease transmission and modeling from coast to coast, and they are virtually all in agreement.


Like 800,000 physicians telling Trump to STFU?  Let's not jump to conclusions. Best to wait for a consensus. Or Fox opinion squad to chime in.



Remi said:


> No. If ebola and SARS and H1N1 and Influenza A in 2017-2018 (almost 70 thousand died) combined didn't convince the powers-that-be that modest investments into stockpiles of PPE and ventilators and planning should be done, then I doubt this will.


Boggles the mind. Let's compare the costs of a few warehouses stuffed to the rafters with PPEs just sitting there year after year just in case, and what we have now.


----------



## Gurby (Mar 27, 2020)

Seirende said:


> Are you guys optimistic that we'll be better prepared if something with even worse morbidity and mortality rates were to start to spread in the future?



I can say that my SHTF closet is going to be filled out quite a bit more in the future.

I feel like this pandemic has made me acutely aware of how close we are to anarchy at any given moment.  People have been literally fighting over toilet paper.  My local grocery store is completely unable to keep the shelves stocked with eggs, bread, pasta or rice.  It's really easy to imagine how quickly things would go off the rails if there was a real supply chain disruption.  Stores would be out of food in <48 hours and people would be on their own...


----------



## Seirende (Mar 27, 2020)

Gurby said:


> I feel like this pandemic has made me acutely aware of how close we are to anarchy at any given moment.  People have been literally fighting over toilet paper.  My local grocery store is completely unable to keep the shelves stocked with eggs, bread, pasta or rice.  It's really easy to imagine how quickly things would go off the rails if there was a real supply chain disruption.  Stores would be out of food in <48 hours and people would be on their own...



When we were getting bought out of stuff a bit ago people would come up to us at the store and ask why we weren't stocking the shelves. Um, because we don't have anything to put on the shelves?


----------



## RedBlanketRunner (Mar 28, 2020)

Comic relief. Only in times like these, or, third world blues and screws.
BMW SUV gets stopped in police checkpoint. Flagged over, driver ordered out. As our eagle eyed reporters noticed as they went through the SUV is stuffed to the headliner with face masks. Down the road they pull over to watch.
An army convoy pulls up, pulls over, Brass gets into a discussion with police. As the discussion drags on the driver of the vehicle casually strolls off, disappearing between some houses. Army vs cops, gesticulating, it goes on and on. Maybe 10 people talking on phones at one point. Police brass drive up. Gets more complicated. SUV gets unloaded by soldiers. Police appear to not like this. About a half hour into the movie the SUV gets reloaded and a cop drives it off to a turnout. Soldiers finally leave.
1. Scalping PPEs is a given.
2. Thou shalt not question the activities of the Bangkok buck$ folks. They own the police.
3. Kick backs have apparently not been properly paid.
4. Military probably wanted the masks for their soldiers. They answer only to the PM and the junta.
5. Cops win. Pay off - kick backs all around had to have been arranged.
6. The missing driver went entirely unnoticed.

Now if only Washington DC was to operate as smoothly as this.


----------



## Peak (Mar 28, 2020)

While the politics are certainly a topic that could be argued over, I prefer to think about this on a societal level.

"A person is smart. People are dumb, panicky dangerous animals and you know it."

Politics didn't make people continue to play basketball and tan side by side in the park despite a city order for social distancing. Politics didn't make some people buy months worth of supplies when there was no apparent threat to said supply chains. Politics didn't make people buy and hoard nor steal from hospitals masks and hand sanitizer which is of little or limited use to them, but critical to high risk patients in the community and healthcare providers.


----------



## RedBlanketRunner (Mar 28, 2020)

Peak said:


> "A person is smart. People are dumb, panicky dangerous animals and you know it."


When people don't get a straight answer and the authorities waffle, they will get panicky. Calm clear cpable leadership without mixed signals, walk backs or hidden agendas is what prevents or dissuades people from acting cautiously and sensibly.

Talking trash: how to promote panic or get people to ignore authorities
"Anybody that needs a test can get a test."
“Within a couple of days [the number of positive cases is] going to be down to close to zero.” 
"This virus is a hoax."
“Nobody could have ever seen something like this coming.”
"We’re “very close” to a vaccine."


----------



## mgr22 (Mar 28, 2020)

Remi said:


> Leaders will pat themselves on the back because "if not for us, it would have been much worse".



Incredibly, the back-patting has already begun.


----------



## Akulahawk (Mar 28, 2020)

Remi said:


> If ebola and SARS and H1N1 and Influenza A in 2017-2018 (almost 70 thousand died) combined didn't convince the powers-that-be that modest investments into stockpiles of PPE and ventilators and planning should be done, then I doubt this will.





RedBlanketRunner said:


> Boggles the mind. Let's compare the costs of a few warehouses stuffed to the rafters with PPEs just sitting there year after year just in case, and what we have now.


It really shouldn't boggle the mind all that much. Our strategic stockpile isn't set up for pandemics, just regional events like something affecting the entire LA Basin or Chicago area, or the NYC metro area. Anything bigger would quickly overwhelm all resources. As much as the SARS, H1N1, Influenza A, and Ebola epidemics of the past 20 years functioned as the proverbial "Canary in the coal mine" for this stuff, the "powers that be" didn't learn the lessons taught by those events. When everywhere in the world is but a few hours away, every one of those epidemics could have easily become a pandemic of massive proportions. Seriously, worldwide, none of the policymakers thought that there'd be another pandemic that could equal the size of the 1918 "Spanish Flu" pandemic. They probably figured that the infectious disease folks would detect the bug early, quarantine it quickly, and it would burn out quickly. 



Peak said:


> "A person is smart. People are dumb, panicky dangerous animals and you know it."


That's putting it mildly.


----------



## RedBlanketRunner (Mar 28, 2020)

@Akulahawk Valid and insightful, but what you say assumes across the board reasonably rational thinking. The stupendous herd of day glow pink elephants in the room negates it all: national protection and the war machine. Just recently have a look at it. From WWII on; the absolute need to replace 5 battleships which were never deployed, mothballed and eventually scrapped, the tens of thousands of tons of equipment and ordinance shipped back to the US and destroyed from the Korean conflict on, the huge ongoing government surplus sales dumping taxpayer purchases on the market at a few pennies for dollars spent, implausible weaponry made simply because a politician has certain factories in their constituencies, I think it is reasonably safe to say at least a trillion taxpayer dollars pissed straight down the drain.

A fraction of those ultra improbable just in case deterrents could and should be spent foreseeing things like potential pandemics instead of say, stockpiled over overkill nuclear weaponry... but probably won't because.... there's little or no profit in it.
But maybe this is a good thing. Imagine the cost of a basic N95 mask purchased through government procurement. $50 each?
(I'm recalling when the ultimate end all - be all infantry rfile, the M16 came out. After causing the death of a couple hundred GI's a new ammo was produced for it, at $15 per cartridge, along with a cleaning kit at a similarly ridiculous price.)


----------



## Carlos Danger (Mar 28, 2020)

Gurby said:


> I can say that my SHTF closet is going to be filled out quite a bit more in the future.
> 
> I feel like this pandemic has made me acutely aware of how close we are to anarchy at any given moment.  People have been literally fighting over toilet paper.  My local grocery store is completely unable to keep the shelves stocked with eggs, bread, pasta or rice.  *It's really easy to imagine how quickly things would go off the rails if there was a real supply chain disruption. * Stores would be out of food in <48 hours and people would be on their own...


The prepping community has been trying to raise awareness about this for decades and has been rewarded by being portrayed as paranoid circus freaks. The truth is, it wouldn't take long for large numbers of people to become very desperate, and desperate people are very dangerous. I never understood why the thought of having a few month's of essential supplies on hand and plans for how you'd use them was anything but an obviously good idea.


----------



## FiremanMike (Mar 28, 2020)

Seirende said:


> Are you guys optimistic that we'll be better prepared if something with even worse morbidity and mortality rates were to start to spread in the future?



I will say it taught me that n95 masks do have a shelf life.  The stockpile we have leftover from h1n1 is plagued with dry rotted straps.. We’re working to fix that..

So my lesson learned is to replace our stock every 8-10 years..


----------



## RedBlanketRunner (Mar 28, 2020)

Just coming out. Covid-19 causes at least 10 times the number of deaths compared to the common flu. It is also at least as contagious.


----------



## FiremanMike (Mar 28, 2020)

RedBlanketRunner said:


> Just coming out. Covid-19 causes at least 10 times the number of deaths compared to the common flu. It is also at least as contagious.



Seeing as we have absolutely no idea how many people have been infected, there is literally zero credibility to that statement.

How do you have internet access anyways, aren’t you in some remote village in a third world country working as the sole healthcare provider for hundreds?


----------



## RedBlanketRunner (Mar 28, 2020)

FiremanMike said:


> Seeing as we have absolutely no idea how many people have been infected, there is literally zero credibility to that statement.
> 
> How do you have internet access anyways, aren’t you in some remote village in a third world country working as the sole healthcare provider for hundreds?


A. Wouldn't you venture a guess a few experts have been exhaustively using quantitative and qualitative forecasting techniques combined with projective analysis? I'd  guess that algorithms for comparative analysis to establish upper and lower boundaries have been used considering the mortality rate figure, 1%, is off by 3 percentage points from present reported numbers. (Lower boundary)
B. It seems that your various comments you have posted and your knowledge of facts may differ significantly, as clearly demonstrated by that query..


----------



## Carlos Danger (Mar 28, 2020)

RedBlanketRunner said:


> A. Wouldn't you venture a guess a few experts have been exhaustively using quantitative and qualitative forecasting techniques combined with projective analysis? I'd  guess that algorithms for comparative analysis to establish upper and lower boundaries have been used considering the mortality rate figure, 1%, is off by 3 percentage points from present reported numbers. (Lower boundary)
> B. It seems that your various comments you have posted and your knowledge of facts may differ significantly, as clearly demonstrated by that query..



0.32% CFR worldwide in the 20-50 year old cohort, 1.3% among those in their 50’s, and  3.6 % for those in their 60’s. All among KNOWN CASES.

Doesn’t take into account the fact that perhaps a massive majority of cases are unidentified, or account for selection bias.  Both of which would likely cut those percentages dramatically.

What that means is that even though this thing is clearly a big deal, any given individual is at very low risk. Which I think most of us understand, but you’d never know if you got all your information from the mainstream media.


----------



## Summit (Mar 28, 2020)

FiremanMike said:


> Seeing as we have absolutely no idea how many people have been infected, there is literally zero credibility to that statement.



WE in the USA have only an extrapolated guess of the number of infected.

In other countries, the datasets are more complete.


----------



## FiremanMike (Mar 28, 2020)

Summit said:


> WE in the USA have only an extrapolated guess of the number of infected.
> 
> In other countries, the datasets are more complete.



Are you saying that the number of people infected = the number of positive test results reported across the planet are accurate in everywhere but America (and probably China).

If that's the case, then the virus isn't anywhere near as contagious as they let on..


----------



## mgr22 (Mar 28, 2020)

I'm not sure "percent of population infected" is as meaningful an indicator of risk as trends. I live in a less-populous area where new cases are increasing arithmetically, if not geometrically. That makes me feel my family's risk of infection is uncomfortably high without any input from "mainstream media."

At this point, I think it's a hard sell to spin COVID-19 as not too bad. We aren't just talking about death; disability lasting at least weeks should be a big concern, too. And not just for grandparents.


----------



## Summit (Mar 28, 2020)

FiremanMike said:


> Are you saying that the number of people infected = the number of positive test results reported across the planet are accurate in everywhere but America (and probably China).


Are you saying that you like to put words in people's mouths?


----------



## Seirende (Mar 28, 2020)

Summit said:


> Are you saying that you like to put words in people's mouths?



Sassy


----------



## DragonClaw (Mar 28, 2020)

Went to a local hospital to pick up a pt. Hospital isn't that big. 

49 yof cc sob, resolved.

We get into the hospital and my partner is primary. She's getting the report from the nurse and such.  I go to go get the gurney ready and make pt contact.  

Staff has to buzz me into the area,  (a lot of places now have heightened security,  protocols, limited access,  block certain entry and egress points), so,  no biggie.  We can't go our normal route to the rooms. 

I get into the area she's in,  the staff member opens the door for me.  No PPE on yet. Then I see someone with a gown,  face mask with shield, gloves , the works. 

"What are you doing back here without PPE?"

"Huh...?"

They let me into the Coronadome and I didn't even know it. 

 The reason we couldn't go pur normal route was because they put up like weird foam wall things and taped every gap. Etc.

So I leave and go get PPE. 

Our pt was there because she got a letter from the hospital saying she might have been exposed. 

But she's a sedentary 275 lbs with CHF. 

Then her CHF acted up and she thought she got the Rona. So they put her with all the other respiratory pts that definitely or might have it.

The confirmed cases were further down the wing.  But. ... 

WHY ISN'T THERE A PRECAUTION NOTICE ON THE DOOR. WHY DID THEY LET ME IN SO NONCHALANTLY. Geez.


----------



## FiremanMike (Mar 28, 2020)

Summit said:


> Are you saying that you like to put words in people's mouths?



Wow dude, I was trying to engage your point.  Do you think the reported positive cases accurately reflects the total number of infected patients.



Chill.


----------



## DrParasite (Mar 28, 2020)

RedBlanketRunner said:


> Like 800,000 physicians telling Trump to STFU?  Let's not jump to conclusions. Best to wait for a consensus. Or Fox opinion squad to chime in.


You know what the problem with your post is?  it's all wrong.  It's not accurate.  and It's spreading misinformation.  

"More than 800,000 physicians across the country signed a letter urging President Donald Trump to keep social distancing practices in place after he said he wants to reopen businesses by Easter. "  Not the STFU.  not to wait for consensus.  and not to listen to fox. 

Don't believe me?  why not check out a left leaning source: https://www.huffpost.com/entry/doctors-trump-social-distancing_n_5e7e0bb3c5b6256a7a29273f

 Your post shows your clear case of TDS is in full bloom, and the facts don't matter to you:  it's all orange man bad, and even if he personally cured cancer tomorrow, you would still hate him.  

Here, lets so you some more examples:


RedBlanketRunner said:


> "Anybody that needs a test can get a test."


Well, it depends on how you define "need" a test.  If you follow the CDC recommendations:

The CDC says health care providers are the ones who decide whether someone gets tested for coronavirus.
Factors clinicians should consider include whether individuals were in close contact with a lab-confirmed or suspected COVID-19 patient within 14 days of symptom onset, or traveled from affected geographic areas within 14 days of symptom onset.
Symptoms of COVID-19 are fever, cough, and difficulty breathing.
Now, with testing running short, not everyone who wants a test can get one, but if you have symptoms, you can be tested.


RedBlanketRunner said:


> "This virus is a hoax."


Sorry, this has been verified to be a distortion of the truth by many fack checkers.  Here is Snope's response: https://www.snopes.com/fact-check/trump-coronavirus-rally-remark/



RedBlanketRunner said:


> “Nobody could have ever seen something like this coming.”


 and yet, at 8 years of democratic leadership we still aren't prepared.  but it's all Trumps fault.

you make a lot of wild claim, many with no factual backing.  or half truths.  or snippets from WaPo or CNN, two notorious anti-trump news agencies.   Maybe you should lay off the MSNBC, or even check out fox news, so you can see what the other half of the political spectrum is saying? It might even help you get over your TDS, and mature into an intelligent individual.


----------



## DrParasite (Mar 28, 2020)

Remi said:


> 0.32% CFR worldwide in the 20-50 year old cohort, 1.3% among those in their 50’s, and  3.6 % for those in their 60’s. All among KNOWN CASES.
> 
> Doesn’t take into account the fact that perhaps a massive majority of cases are unidentified, or account for selection bias.  Both of which would likely cut those percentages dramatically.


Now now.... don't go injecting facts into a discussion with a person who can only see "Orange man bad."  if you keep that up he might even call you racist!


----------



## Summit (Mar 28, 2020)

FiremanMike said:


> Do you think the reported positive cases accurately reflects the total number of infected patients.


Depends on the dataset. And total number infected is different than total number with the disease. SK probably offers the best representation of what you are asking for as they tested contacts and they have a 1.6% CFR and I think that will rise a bit, maybe to 2%. If you wanted to then assume that they missed half of the SARS-COV-2 infections that didn't develop COVID-19, you still get 1% and that is 10x the CFR of seasonal influenza.


----------



## DrParasite (Mar 28, 2020)

one thing we, the healthcare providers, need to remember is that all this preparation starts at the local and agency level.  So if you don't have enough masks, questions should be asked to your local leadership as to why they didn't plan for this situation in their disaster response plan: what happens if we can't get mask from our regular supplier?  how much of a supply do we have?  What if our staff get sick, how do we survive?  If we run out of resources, we should reach out to the county or state.... what do they have?  what preparations do they have?  What resources can we draw on? do they have plans for a major pandemic, once that all the experts say was a realistic possibility?   

If you want to blame trump, and FEMA, for the lack of equipment, that's fine; but remember, FEMA doesn't have major stockpiles, they have commercial contracts for when the local resources are exhausted.  That's why the responsibility and response starts at the local level and works up, and why FEMA isn't the lead agency on anything (despite what the media is claiming).  they are a logistical resource only providing response support; the CDC and medical professionals are still running the show, and providing reports to our elected leaders.

And yes, the scenario would be better if Trump stopped tweeting, and if the states and locals were better prepared for this pandemic.


----------



## Tigger (Mar 28, 2020)

If you're going to post numbers, maybe post where you got them?


----------



## FiremanMike (Mar 28, 2020)

The numbers I watch are the ones on my local state's health department website as well as the WHO status updates


----------



## DrParasite (Mar 28, 2020)

I think he's asking you to post the links to where you found your numbers.... so others can see what your source was.

Otherwise, your numbers can be as made up and fake as @RedBlanketRunner


----------



## FiremanMike (Mar 28, 2020)

I'm not talking about obscure sites here..









						Coronavirus Disease (COVID-19) Situation Reports
					

The Weekly Epidemiological Update provides an overview of the global, regional and country-level COVID-19 cases and deaths, highlighting key data and trends; as well as other pertinent epidemiological information concerning the COVID-19 pandemic.




					www.who.int
				




You are free to google your own state's DH website..


----------



## Carlos Danger (Mar 28, 2020)

Tigger said:


> If you're going to post numbers, maybe post where you got them?











						Global Covid-19 Case Fatality Rates - The Centre for Evidence-Based Medicine
					

The total number of cases and the total number of deaths from COVID-19 outbreak data was drawn down (scraped) from Worldometers.




					www.cebm.net


----------



## RedBlanketRunner (Mar 28, 2020)

@DrParasite The quoted statements I made you are refuting were Trump quotes. I thought that was rather obvious.
"When you are aiming down intently on a rabbit you might not notice you are about to fall off a cliff."


----------



## Akulahawk (Mar 28, 2020)

Everyone, this is your friendly reminder to play nice. This thread is for Corona virus, not for blaming whatever on any one particular person or group of people. Stick to the facts as we know it (and we can therefore see how things evolve over time) and we can Monday Morning Quarterback this when it's all over.


----------



## VentMonkey (Mar 28, 2020)

The silver lining to all of this?...

It’s all but confirmed decades-worth of our most obvious suspicions...

The majority of people’s “emergencies” can, in fact, wait.


----------



## FiremanMike (Mar 28, 2020)

VentMonkey said:


> The silver lining to all of this?...
> 
> It’s all but confirmed decades-worth of our most obvious suspicions...
> 
> The majority of people’s “emergencies” can, in fact, wait.



Volume for us is down.. you too?


----------



## VentMonkey (Mar 28, 2020)

FiremanMike said:


> Volume for us is down.. you too?


Sí.


----------



## GMCmedic (Mar 28, 2020)

Between 3 local EDs, 2 of which are level 2 Trauma centers, the third is a comprehensive stroke center depending on the day of the week. They average ~100 ED patients a day each, are down to 20 a day. Nearly all of which are discharged home. 

Were not even gearing up for a Covid rush anymore, now were gearing up for the people that have been ignoring their symptoms for 3 weeks.


----------



## akflightmedic (Mar 28, 2020)

Hospital and EMS calls way down here in Maine too. ER sent home several travelers as not needed, been cutting hours of staff or reassigning to other units. 

12 beds of the 48 bed ER have been converted to COVID holding. Cardiac floor has converted 18 rooms to COVID inpatient ward.

Fun fun....we are only around 240 +/- confirmed cases here so far, however we have had a HUGE influx of New Yorkers, Massholes, and New Hampshirians flee their state to come to their second homes...of course potentially bringing in whatever they were fleeing.


----------



## RedBlanketRunner (Mar 28, 2020)

U.S. reported infections on runaway at 122,000+ up from 33,000+ a week ago. First place world wide. However, as a testament to the medical community efforts, the mortality rate is 6th place. Definitely doing something right. Fingers crossed.

I was asked why am I so interested in this. Took a moment to reflect. What have I been doing the past 12+ years? Teaching hygiene, disease prevention along with testing and shoveling data up the slope to the number crunchers. In turn the statistics and watch fors would trickle back down and were of acute interest. On more occasions than I can count they would point out trends and give notices of problem zones and impending outbreaks. We have a pretty hefty load of common diseases here and the stats are all we've got for putting the effort where it's needed the most.








						Thailand Major infectious diseases - Demographics
					

Facts and statistics about the Major infectious diseases of Thailand. Updated as of 2020.



					www.indexmundi.com
				




A perfect example of connecting statistics dots ending up with a win-win-win. There was endemic version of schistosomiasis here. Field health care workers gleaned numbers and tossed them up the ladder. Misinformation and gossip was nailed down as the cause. Rice farmers had become convinced the open bill storks were eating the young rice plants and hunted them into endangered status in the country. Word went out through both government announcement and, more importantly, word of mouth passed on to the locals who seldom if ever heard government noise. PROTECT THE STORKS. They don't eat plants. They are carnivores and their preferred diet is snails. They are protecting you farmers from disease.
Word trickled on out. A year ago I saw them clearing vegetation out of a river. Dozens of villagers were sifting through the muck and mess looking for crabs and fingerling fish. They all had a plastic bags covering their hands and as they searched they would pick out the snails and toss them away from the river where they would die. The storks are now a common sight in the rice fields and the parasitic infections have dropped to a small handful at present.


----------



## FiremanMike (Mar 28, 2020)

RedBlanketRunner said:


> U.S. reported infections on runaway at 122,000+ up from 33,000+ a week ago. First place world wide. However, as a testament to the medical community efforts, the mortality rate is 6th place. Definitely doing something right. Fingers crossed.
> 
> I was asked why am I so interested in this. Took a moment to reflect. What have I been doing the past 12+ years? Teaching hygiene, disease prevention along with testing and shoveling data up the slope to the number crunchers. In turn the statistics and watch fors would trickle back down and were of acute interest. On more occasions than I can count they would point out trends and give notices of problem zones and impending outbreaks. We have a pretty hefty load of common diseases here and the stats are all we've got for putting the effort where it's needed the most.
> 
> ...



Are you aware that tests are taking 7+ days to return in stable patients and 2-3 days on critical patients?

You’re not necessarily seeing a surge in new cases, you’re seeing a surge in test result returns.


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## Summit (Mar 28, 2020)

FiremanMike said:


> Are you aware that tests are taking 7+ days to return in stable patients and 2-3 days on critical patients?
> 
> You’re not necessarily seeing a surge in new cases, you’re seeing a surge in test result returns.


we send sick people home without testing on o2
We test them a few days later when they come back and get admitted 
then we wait for result
How do you think that skews stats


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## Peak (Mar 28, 2020)

FiremanMike said:


> Are you aware that tests are taking 7+ days to return in stable patients and 2-3 days on critical patients?
> 
> You’re not necessarily seeing a surge in new cases, you’re seeing a surge in test result returns.



We are finally starting to see all of our test come back at quicker pace, but are still easily averaging 2-4 days for all of our patients. Not only are you seeing a surge of a week ago, but the tests that are coming back now.


----------



## silver (Mar 28, 2020)

FiremanMike said:


> Are you aware that tests are taking 7+ days to return in stable patients and 2-3 days on critical patients?
> 
> You’re not necessarily seeing a surge in new cases, you’re seeing a surge in test result returns.



In high prevalence areas like NYC (which has about 1/4th the number of cases in the US) we are seeing testing at some hospitals come back in about 8hrs now. Its more a surge in the number of tests than anything.


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## Peak (Mar 28, 2020)

Apparently Abbott has developed a 5 to 13 minute test for COVID 19. I hop that this is accurate and it gets to be rolled out soon. 

I do find it odd that the government is willing to facilitate a possibly questionable COVID test, but is also willing to take away the lactate cartridges that are so critical to the every day function and efficiency of EDs, ICUs, PICUs, and Cardiac ICUs accross the country. I'm very happy for the potential of a 5 minute COVID test, but far more patients have had care delayed by us not being able to perform bedside lactate testing.


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## RedBlanketRunner (Mar 29, 2020)

FiremanMike said:


> Are you aware that tests are taking 7+ days to return in stable patients and 2-3 days on critical patients?


Slightly less than 7 days, and out in the remote villages where there may be no community water system or reliable electric power nearly every home has a near new vehicle they are trying to make payments on and every person has a cell phone. Internet out there? Cell, tablet and lap top, I can't avoid it. And of course I don't live out there. Had a nice jeep that helped loose the Vietnam war I put a half million miles on during my little commutes.
You really could benefit from an little bit more open mind. I've heard all the rhetoric and misinformation but I try to read it all. I'm always open to new ideas, correcting my thinking, and absorbing other peoples knowledge. Various peoples comments here have been taken to heart and are now part of my knowledge base. Care to join me?



Peak said:


> I'm very happy for the potential of a 5 minute COVID test,


That test would go a long long way in breaking this pandemic's back. A whole heck of a lot of providers are constantly checking for updates on the progress.


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## RedBlanketRunner (Mar 29, 2020)

DrParasite said:


> Otherwise, your numbers can be as made up and fake as @RedBlanketRunner


I like that! Funny, I crank out numbers from multiple country sources and the US people say "FAKE" while they lagged behind almost everyone else in testing. Care to review some of my past posts now?
Here's another fake number for you I heard around March 10: "We will have over 1 million infections by April." FAKE! Might be April 2nd by the time it gets that high.

What's so sweet and endearing about that is all my numbers come from sources that have proven to be trustworthy. Even more darling is the western world mentality that they are the center of the universe and there couldn't possibly be the slightest variation from their info and situation and third world countries. IE, The prima donna complex.


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## Sled Driver (Mar 29, 2020)

Peak said:


> Apparently Abbott has developed a 5 to 13 minute test for COVID 19. I hop that this is accurate and it gets to be rolled out soon.



The FNC clip I saw said that this new Abbott Labs test was approved for use by the FDA within 43 hours of being preseented to them and is 15 minutes to get a result and Abbott Labs will manufacture 50,000 test kits this coming week.


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## Sled Driver (Mar 29, 2020)

I found this FNC clip about the above test. It is 50,000 / a day manufactured, not per week.


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## Jim37F (Mar 29, 2020)

How is the false positive/false negative rate on these fast tests compared to the previous ones? That's my worry


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## SandpitMedic (Mar 29, 2020)

Gurby said:


> I can say that my SHTF closet is going to be filled out quite a bit more in the future.
> 
> I feel like this pandemic has made me acutely aware of how close we are to anarchy at any given moment.  People have been literally fighting over toilet paper.  My local grocery store is completely unable to keep the shelves stocked with eggs, bread, pasta or rice.  It's really easy to imagine how quickly things would go off the rails if there was a real supply chain disruption.  Stores would be out of food in <48 hours and people would be on their own...


All those dumb preppers are laughing at posts like this now. Guess who was right? When SHTF it usually isn’t a foreseeable event. I too wish I had more, even sitting on a good supply.

While I don’t think this virus is _the one that kills us all..._ I think things will get worse before they get better. And there will be lasting effects.


----------



## SandpitMedic (Mar 29, 2020)

@RedBlanketRunner are you a US citizen? How did you get a long term gig in Siam?


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## akflightmedic (Mar 29, 2020)

Dyson...yes the vacuum god of gods, Dyson created a brand new ventilator in 10 days...









						James Dyson designed a new ventilator in 10 days. He's making 15,000 for the pandemic fight
					

Dyson has received an order from the UK government for 10,000 ventilators to support efforts by the country's National Health Service to treat coronavirus patients.




					www.cnn.com


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## FiremanMike (Mar 29, 2020)

Peak said:


> We are finally starting to see all of our test come back at quicker pace, but are still easily averaging 2-4 days for all of our patients. Not only are you seeing a surge of a week ago, but the tests that are coming back now.



We had our first crew exposure this week, patient crashed, was intubation, admitted to the ICU, took just over 2 days to get the results


RedBlanketRunner said:


> Slightly less than 7 days, and out in the remote villages where there may be no community water system or reliable electric power nearly every home has a near new vehicle they are trying to make payments on and every person has a cell phone. Internet out there? Cell, tablet and lap top, I can't avoid it. And of course I don't live out there. Had a nice jeep that helped loose the Vietnam war I put a half million miles on during my little commutes.
> You really could benefit from an little bit more open mind. I've heard all the rhetoric and misinformation but I try to read it all. I'm always open to new ideas, correcting my thinking, and absorbing other peoples knowledge. Various peoples comments here have been taken to heart and are now part of my knowledge base. Care to join me?



We’re back to the remote village drivel?  No I don’t care to join you.  You’re on a different planet, and I’m quite fond of earth.


----------



## Sled Driver (Mar 29, 2020)

Elon Musk / Tesla & GM can learn a lot from Dyson. 

Dyson, a no BS guy, tell me what my Country needs and it will be done immediately type of guy. Deserves the Queens Medal when this is over. The story I read 2 days ago about this said he would make 30,000 vents within the next 2-3 weeks and he would personally donate 5,000 units. He did not like the Vent machine he was given to copy and instead designed his own.

Tesla is supposedly ramping up with a Giga factory in N.Y., to make vents, I assume it is the one in Buffalo they walked away from. Finished product could quickly be trucked down the Thruway and right into NYC upon completion, going from factory production line into use at PT bedside in a matter of hours.


----------



## Carlos Danger (Mar 29, 2020)

Gurby said:


> I think I asked the same questions a while ago, and you said the virus wasn't affecting your hospital.  Is that still the case?



This past Thursday we tubed and lined our first very likely (still no test result) COVID patient at my facility. My colleague garbed up and tubed the guy in his negative pressure room. Because the patient was over 230kg,, I also garbed up and watched from outside the room in case any help was needed. None was.

As of Friday, several other admitted patients were awaiting testing results, all of whom the hospitalists had low suspicion of actually having coronavirus however.

We are hopeful that we won't have as severe an onslaught of sick COVID cases as other regions, mainly due to our low population density, but also because we seem (we hope) to have gotten out ahead of this thing pretty well with the social distancing. Schools closed and people started staying home before there were any known cases in our area. We're on what, week two of that? And still only a pretty small handful of confirmed cases in our catchment area, with most of our surrounding counties having zero known cases. Seems like reassuring trend.  

Still, predictions are that that this thing won't peak in our area for a few more weeks, so we'll see. We are as prepared as we can be for whatever comes though the door. Hoping that much more PPE gets delivered before that happens, and also for testing to ramp way up and start turn results around much faster. It is taking 10 days on average for results to come back, which in the case of this thing makes the testing pretty much worthless.


----------



## E tank (Mar 29, 2020)

Remi said:


> This past Thursday we tubed and lined our first very likely (still no test result) COVID patient at my facility. My colleague garbed up and tubed the guy in his negative pressure room. Because the patient was over 230kg,, I also garbed up and watched from outside the room in case any help was needed. None was.
> 
> As of Friday, several other admitted patients were awaiting testing results, all of whom the hospitalists had low suspicion of actually having coronavirus however.
> 
> ...


What's your standard intubation PPE? Just N95's? Those fitted or just 'off the rack'?


----------



## Carlos Danger (Mar 29, 2020)

E tank said:


> What's your standard intubation PPE? Just N95's? Those fitted or just 'off the rack'?


PAPR if available (they are for now), fitted N95 with face-shield over it if no PAPR. Gown, double gloves, observer for doffing it all.


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## Gurby (Mar 29, 2020)

RedBlanketRunner said:


> U.S. reported infections on runaway at 122,000+ up from 33,000+ a week ago. First place world wide. However, as a testament to the medical community efforts, the mortality rate is 6th place. Definitely doing something right. Fingers crossed.



That fatality rate is creeping up though, at 1.8% across the country now.  NYC was holding at 0.5% for quite a while but now they're up to 1.6%.  I remember reading somewhere that in China it was taking around 14 days on average from symptom onset to death, in those who will die.  I'm worried that we are going to see that mortality rate keep going up especially in NYC as cases continue to explode at a ridiculous rate, and as people get further along in the progression of disease.




SandpitMedic said:


> All those dumb preppers are laughing at posts like this now. Guess who was right? When SHTF it usually isn’t a foreseeable event. I too wish I had more, even sitting on a good supply.
> 
> While I don’t think this virus is _the one that kills us all..._ I think things will get worse before they get better. And there will be lasting effects.



This won't be the one that gets us, but it certainly wasn't too far off the mark.


----------



## silver (Mar 29, 2020)

Remi said:


> PAPR if available (they are for now), fitted N95 with face-shield over it if no PAPR. Gown, double gloves, observer for doffing it all.



As you start to see cases in the community, I would start to take precautions to view every intubation as a COVID one. PAPR/N95 + eye protection and if possible RSI for every intubation even in the OR.


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## E tank (Mar 29, 2020)

silver said:


> As you start to see cases in the community, I would start to take precautions to view every intubation as a COVID one. PAPR/N95 + eye protection and if possible RSI for every intubation even in the OR.


What we've done in our shop....that's a lot of intubations....I still don't believe that's completely warranted given the scarcity of PPE or liklihood of it. But they didn't ask me....we're still way on the left side of the curve....


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## SandpitMedic (Mar 29, 2020)

Gurby said:


> ...but it certainly wasn't too far off the mark.


Yes it was. You don’t have to agree.

We have become accustomed to our lives and believe ourselves to be the center of this planet.
We forget how insignificant we really are, and that Mother Nature could hard reset this planet at any moment taking millions if not billions of lives. Shoot, remember that tsunami in Indonesia? 228,000 dead— In a snap.

This virus kills 35,000 since November and we’re losing our collective minds.


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## Summit (Mar 29, 2020)

Sandpit it is because if we did nothing the virus would have been happy to kill 100+ million across this world... is there anxiety about what comes next? Yes.

On the plus side, now that we FINALLY are seeing some halfway decent test triage, seeing turnarounds of 1-3 days. But I'm also getting test results back from 11 days ago...


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## Carlos Danger (Mar 29, 2020)

Gurby said:


> That fatality rate is creeping up though, at 1.8% across the country now.  NYC was holding at 0.5% for quite a while but now they're up to 1.6%.  I remember reading somewhere that in China it was taking around 14 days on average from symptom onset to death, in those who will die.  I'm worried that we are going to see that mortality rate keep going up especially in NYC as cases continue to explode at a ridiculous rate, and as people get further along in the progression of disease.



Good read here: https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/


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## DrParasite (Mar 29, 2020)

RedBlanketRunner said:


> I like that! Funny, I crank out numbers from multiple country sources and the US people say "FAKE" while they lagged behind almost everyone else in testing. Care to review some of my past posts now?


sure.... when you provide your actual source, I will gladly review them.


RedBlanketRunner said:


> Here's another fake number for you I heard around March 10: "We will have over 1 million infections by April." FAKE! Might be April 2nd by the time it gets that high.


and yet, you failed to provide a source for this quote.... again....

I think we are done here.


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## Summit (Mar 29, 2020)

I had a site that had awesome CFR convergence lines for
current cases / current mortality
cases 7 day prior / current mort
cases 14 days prior / current mort
and compared them for a couple regions
Can't find it...


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## SandpitMedic (Mar 29, 2020)

Summit said:


> Sandpit it is because if we did nothing the virus would have been happy to kill 100+ million across this world... is there anxiety about what comes next? Yes.


I think that’s a bit hyperbolic, even the WHO estimates ~250-650k deaths a year from influenza... 100+M??? Come on, I understand you’re stressed and anxious about this. I also understand unchecked COVID could kill some more of us, but again, we have the ability to defeat the natural process of “survival of the fittest” to some degree. Which inflates our self significance and makes us hypersensitive and hyperemotional to events like this. The mass media doesn’t help either.

My point was not that we should “do nothing” or this isn’t affecting people. I have relatives and friends in the at-risk group too. My point was that this is nowhere in the ballpark of a mankind killer or nature’s worst pandemic and no where near_ the big one_. And that’s it- it’s more of a philosophical outlook.


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## Summit (Mar 29, 2020)

SandpitMedic said:


> I think that’s a bit hyperbolic, even the WHO estimates ~250-650k deaths a year from influenza... 100+M??? Come on, I understand you’re stressed and anxious about this. I also understand unchecked COVID could kill some more of us, but again, we have the ability to defeat the natural process of “survival of the fittest” to some degree. Which inflates our self significance and makes us hypersensitive and hyperemotional to events like this. The mass media doesn’t help either.
> 
> My point was not that we should “do nothing” or this isn’t affecting people. I have relatives and friends in the at-risk group too. My point was that this is nowhere in the ballpark of a mankind killer or nature’s worst pandemic and no where near_ the big one_. And that’s it- it’s more of a philosophical outlook.


1918 paninfluenza killed 50-100 million in a world with 25% of today's population. I don't think a similar number would be out of the ballpark for COVID-19 if no action was taken... but we are taking action so it won't be like that. 

How bad will it be remains to be seen. I worry about people I care about, people in general, and about the economy.

I agree that we shouldn't panic and I know you weren't advocating inaction.


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## MonkeyArrow (Mar 29, 2020)

In metro Atlanta, my ED volume is down by about half. Patients we are seeing are sicker. Units starting to fill up. I heard some talk today of some only having a handful of ventilators left. And I will echo what some others have said: we’re seeing a ton of bounce backs who come into the ED initially, are discharged as presumptive COVID positives but who look well, and return 3-5 days significantly worse requiring admissions. Interesting thing is we haven’t been intubating a ton of COVID patients in the ER. The ones we have intubated have had COVID as some lesser component of their overall presentation.


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## Peak (Mar 29, 2020)

Sounds like I'm gonna be spending the next couple of weeks/months in the adult ICUs


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## RedBlanketRunner (Mar 29, 2020)

This was directed toward third world care providers but still applies.

_"Our greatest concern, as it always has been, is ignorance. In some areas it took us decades to convince indigenous populations the mosquito was the cause of endemic illnesses.  Presently we have tens of millions of people around the globe who do not understand this virus. People who will discount it as just another malady to be ignored that will eventually run it's course. There is no room for discussion here. Inevitably this ignorance will be the greatest cause of the mortality when all the numbers are in and added up."_


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## RedBlanketRunner (Mar 29, 2020)

MonkeyArrow said:


> And I will echo what some others have said: we’re seeing a ton of bounce backs who come into the ED initially, are discharged as presumptive COVID positives but who look well, and return 3-5 days significantly worse requiring admissions.


Not that this is anything to go by but, that is what happpened to both my wife and I.  Our symptoms, aside from irritating lung congestion were minor. More or less just that congestion and no other significant symptoms. So there seems to be a threshold which makes this virus stealth. No big deal to suddenly on top of you.  I'm wondering while pretty clueless here, if there is some quick and dirty pulmonary test that could ballpark susceptibility. Potential for this thing going off like a bomb. At the least establish a watch-for guideline??


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## Akulahawk (Mar 30, 2020)

Peak said:


> Sounds like I'm gonna be spending the next couple of weeks/months in the adult ICUs


I wouldn't be surprised if I end up being sent to back up the ICU and/or makeshift COVID19 units at my hospital. Of course I easily could end up being assigned to doing work (literally) out front of the ED with COVID19/Suspected COVID19 patients that just need breathing tx and discharge.


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## SandpitMedic (Mar 30, 2020)

RedBlanketRunner said:


> Post


You didn’t answer my question.
Are you an American citizen? And how did you get a great long term international gig in Thailand?


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## RedBlanketRunner (Mar 30, 2020)

SandpitMedic said:


> You didn’t answer my question.
> Are you an American citizen? And how did you get a great long term international gig in Thailand?


Apologies. Not ignoring you just ... arseholes and alligators ring bells?

Sob story. Violins and/or crying towels
U.S. Citizen. My disability hit full on in 1997. Permanent non reversible, degenerative. Employer at that time managed to trash out most of my benefits as my wife cleaned out the bank accounts and filed for divorce. Decided life on minimum SSI in the US sucked I bailed to Asia. Made contacts with NGOs. Volunteered at first then given incurred expense compensation. 40 years in and around emergency services mostly in the boondocks of the US came in handy along with three med stints in third world.  I let all certifications drop as they are all meaningless here.
Retired for good a few months ago. Still do on call work as a facilitator and maintain my connections to various NGOs throughout Europe, Africa and Asia. Presently getting ragged on big time to get back in the saddle.

Emails galore. Since this question is getting asked a few million times a day. *"I feel sick. Do I have Corona virus?" *
People, get real. If I say no and you do, then what? Get the test, and accompany your negative with studious meticulous thought out social distancing and disinfection.


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## Summit (Mar 30, 2020)

Influenza incidence dropped off to zero. Social distancing! Still COVID-19 cases


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## cruiseforever (Mar 30, 2020)

akflightmedic said:


> Hospital and EMS calls way down here in Maine too. ER sent home several travelers as not needed, been cutting hours of staff or reassigning to other units.
> 
> 12 beds of the 48 bed ER have been converted to COVID holding. Cardiac floor has converted 18 rooms to COVID inpatient ward.
> 
> Fun fun....we are only around 240 +/- confirmed cases here so far, however we have had a HUGE influx of New Yorkers, Massholes, and New Hampshirians flee their state to come to their second homes...of course potentially bringing in whatever they were fleeing.


Same thing is happening in Minnesota.  Our ambulance calls have dropped 75%.  The hospitals are cutting staff like crazy.  Just wondering how many hospitals will go out of business?


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## Sled Driver (Mar 30, 2020)

Speaking of Maine.









						Armed 'vigilantes use a tree as a roadblock to quarantine three men'
					

Police said they were called on Friday afternoon to the island of Vinalhaven to reports of  several people with guns threatening a man who had left his home.




					www.dailymail.co.uk


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## OceanBossMan263 (Mar 30, 2020)

Nassau County NY put out communications with field triage flowcharts and info to encourage self-care and isolation of patients who don't need hospitalization. Yesterday, they also sent out the directive that field termination of all cardiac arrests (of medical origin) should be considered unless there is ROSC or imminent danger to providers if not transporting. Termination was always available but it is now being encouraged to avoid further overloading hospitals. 

Also for the last few weeks, they have really centralized the EMS system notifications for alarms. Volunteers need to have staff guaranteed to be available or they're pulled from the matrix for that period (6-hour shifts). They've also stopped dual notification of the police department ambulance (single medic, driven by cop from scene to hospital) to cases where there is a staffed FD or hospital/private ambulance responding.


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## Aprz (Mar 30, 2020)

Can someone change the title so coronavirus is spelled correctly?


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## Peak (Mar 30, 2020)

Aprz said:


> Can someone change the title so coronavirus is spelled correctly?



Can we call it: The 'Rona discussion thread


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## VentMonkey (Mar 30, 2020)

Aprz said:


> Can someone change the title so coronavirus is spelled correctly?


By the laws that govern all things EMS, it *is* spelt currectlee.

I second The ‘Rona thread title.


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## VentMonkey (Mar 30, 2020)

Also worth noting: it only took 25 pages for someone to notice it was misspelled. Ha! And they said we’d never progress.


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## Sled Driver (Mar 30, 2020)

well, if you are taking suggestions, I vote for ChiCom Flu.


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## Aprz (Mar 30, 2020)

VentMonkey said:


> Also worth noting: it only took 25 pages for someone to notice it was misspelled. Ha! And they said we’d never progress.


Pfff... I noticed a long time ago. Most of us did, right? I just didn't say anything cause the thread wasn't big at the time. Now I feel like this is our most active thread.


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## RedBlanketRunner (Mar 30, 2020)

It's a really good idea to misspell thread titles. Helps to ferret out the fussbudgets, nitpickers and trolls at a glance.

Simple solution that will assure a pandemic never gets out of the gate: At the first hint close all public venues that serve alcohol. That is, the locations where personal hygiene, inhibitions and intelligence of the participants is, generally speaking, very low.


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## E tank (Mar 30, 2020)

Love what @DragonClaw  called...the 'Rona Dome.....


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## Sled Driver (Mar 30, 2020)

In Borough Park Brooklyn, while an FDNY FF from E282 / L148 was checking on hydrants he was harassed by Hasidic Jewish boys. One of them went up to the FF and sneezed in his face. 4 days later the FF felt flu like symptoms and was able to get tested for COVID-19, his test came back positive.


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## Aprz (Mar 30, 2020)

In other news, I might have caught it. I had a temperature of 99.1 when I went to work today. I've had vague symptonms, but I have had them for like a week or two. My work told me they weren't going to send me home because I didn't have a fever at the time. I have had generalized weakness, nausea, and short of breath on exertion (no cough until today). Today, I started getting body aches. I kept chalking it up to other things like getting old, working too much (I've been working a bunch of overtime/mandation shifts), weird sleeping schedule (I got back and forth between days and night shifts), and wearing the masks. Wearing the masks get me super short of breath. Anyways, at the end of shift, I got back to the station and had a fever of 100.4. I just tested myself at home and got 100.2. They wouldn't let me back into the station and told me that I am off work paid for the next 2 weeks. I'm not happy about it.


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## Sled Driver (Mar 30, 2020)

Effective today in NYC, the NYC REMAC committee issued advisory 2020-07, TEMPORARY Lowering of Staffing Standards for Disaster Response

FDNY ALS bus will now be staffed with one Paramedic and one EMT-B
FDNY BLS bus will now be staffed with one EMT-B and one CFR

This staffing reduction will remain in effect until the Governor State of Disaster has been terminated.
This order is also recommended for owners/operators of Ambulance and ALS First response services within the 5 Boroughs ...


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## DragonClaw (Mar 30, 2020)

E tank said:


> Love what @DragonClaw  called...the 'Rona Dome.....



You've come at the right time. 

Bring in EMS or healthcare automatically grants you a full access pass to the Coronathon. 

Unfortunately,  it does not include Hazard Pay, N95s, safe scenes or TP. 

Have a great day.


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## Tigger (Mar 30, 2020)

I bought my own half face today with P100 cartridges. While perhaps N95s can be reused, putting them in a paper bag for who knows how long does not sit great with me. We have zero idea if these masks are contaminated (with other things besides COVID19 as well), and carrying around contaminated equipment is just undoing all of our decon. Also on a personal level, I find taking them on and off properly to be a huge pain and have watched everyone I work with and myself self contaminate while doffing. At least the half face can be wiped down after use. We'll see if work throws a fit, they keep saying we have "loads of PPE."


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## Aprz (Mar 30, 2020)

I trained donning and doffing reusing the same equipment at a post. I was planning on using it the next call I needed to, which was today. I recorded myself to make sure I didn't accidentally contaminated anything. I made notes on things I would screw up like walking back (flare up the gown hitting me in the face), did it the wrong order taking off the mask before the gown and accidentally touched my gown, etc. I thought I would be good, but I guess not.


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## DragonClaw (Mar 30, 2020)

Aprz said:


> I trained donning and doffing reusing the same equipment at a post. I was planning on using it the next call I needed to, which was today. I recorded myself to make sure I didn't accidentally contaminated anything. I made notes on things I would screw up like walking back (flare up the gown hitting me in the face), did it the wrong order taking off the mask before the gown and accidentally touched my gown, etc. I thought I would be good, but I guess not.



I haven't really used an N95 since the fit test during new employee training.  I think I have trouble with them since I've used it like twice. it's slipping on my hair and I can't even get a haircut


----------



## Aprz (Mar 31, 2020)

DragonClaw said:


> I haven't really used an N95 since the fit test during new employee training.  I think I have trouble with them since I've used it like twice. it's slipping on my hair and I can't even get a haircut


If I recall, you're a woman, right? I would put my ponytail up high and put the top strap against it. That worked well or so I thought.... I also have tried using bobbypins to keep it in place.


----------



## DragonClaw (Mar 31, 2020)

Aprz said:


> If I recall, you're a woman, right? I would put my ponytail up high and put the top strap against it. That worked well or so I thought.... I also have tried using bobbypins to keep it in place.



I am.

Unfortunately my hair is short enough a ponytail is difficult (plus I can't actually put one up by myself) but long enough to get in the way.  It's also the literal texture of my hair.  It's smooth,  straight and quick to get oily. The band's slip right off sometimes.


----------



## Summit (Mar 31, 2020)

PPE is hard to do right every time
That's a major reason hcw get sick


----------



## DragonClaw (Mar 31, 2020)

Summit said:


> PPE is hard to do right every time
> That's a major reason hcw get sick



Yeah and using an N95 wasn't really very often.  Usually a combo mask would suffice.


----------



## Aprz (Mar 31, 2020)

DragonClaw said:


> I am.
> 
> Unfortunately my hair is short enough a ponytail is difficult (plus I can't actually put one up by myself) but long enough to get in the way.  It's also the literal texture of my hair.  It's smooth,  straight and quick to get oily. The band's slip right off sometimes.


Try a bobby pin or two to hold the strap in place? I feel like bobby pins should work on short hair too?


----------



## DragonClaw (Mar 31, 2020)

Aprz said:


> Try a bobby pin or two to hold the strap in place? I feel like bobby pins should work on short hair too?



I actually don't own any...

I have the chromosomes,  yeah. But I don't know anything about "lady" things like hair or makeup or whatever it is. 

But,  ha ha.  I keep forgetting not to worry. We don't have any N95s left in my size anyway.


----------



## Akulahawk (Mar 31, 2020)

Aprz said:


> Try a bobby pin or two to hold the strap in place? I feel like bobby pins should work on short hair too?





DragonClaw said:


> I actually don't own any...
> 
> I have the chromosomes,  yeah. But I don't know anything about "lady" things like hair or makeup or whatever it is.
> 
> But,  ha ha.  I keep forgetting not to worry. We don't have any N95s left in my size anyway.


----------



## Peak (Mar 31, 2020)

PAPR for life, I have never trusted any of the standard n95 products to make a real seal.


----------



## RedBlanketRunner (Mar 31, 2020)

Summit said:


> PPE is hard to do right every time


Shades of haz mat training, sulfur triox, cyanides, PCBs and their friends. Got to be some FFs here who have done this.  SCBA practice. Don your full turnout and other PPE gear and put on the SCBA blind in a toxic environment. Repeat until you do it rote perfect. Especially the part of a complete strip down without contaminating yourself.



DrParasite said:


> Otherwise, your numbers can be as made up and fake as @RedBlanketRunner


Yup. Dead on. Fake to the max. Won't hit 1 million infections until April 3! Cover me with rue.


----------



## RedBlanketRunner (Mar 31, 2020)

In the field get bys. Nearly all disposable masks can withstand this: 20 minute bath in boiling water followed up with 24 hours in a 200+ ppm chlorine bath.
Got access to an autoclave? Slow cooker, 217F, 2 hours. Flasher? 5 minutes @228F+. EO, 48 hours. Common autoclaves in hospitals can accommodate a thousand masks per run with ease. Don't forget if path lab has an autoclave. Stinky but sterile.
If the head bands on the masks get trashed, cut them off ahead of time and staple them back on.



DragonClaw said:


> I haven't really used an N95 since the fit test during new employee training. I think I have trouble with them since I've used it like twice. it's slipping on my hair and I can't even get a haircut


Slipping around masks. Old SCBA tricks. Scrub off skin oils with alcohol first. You can glue the mask to your face with tiny dabs of corn starch. Facial fur causing leaks, goo it up with Vaseline.


----------



## StCEMT (Mar 31, 2020)

1st positive patient last night from a nursing home. The county north of me has a nursing home with something like 8 deaths and 30+ confirmed infections. Guess it's finally coming around now.


----------



## RedBlanketRunner (Mar 31, 2020)

StCEMT said:


> 1st positive patient last night from a nursing home. The county north of me has a nursing home with something like 8 deaths and 30+ confirmed infections.


When the epidemic task force gets rebuilt it needs to have a priority list with 'sitting duck' victims such as nursing home receiving both in place and quick response preventive/protective measures. Maybe Trump dismantling the task force was a blessing in disguise. Between what it was and what we are learning from the present pandemic could write us a highly comprehensive permanent template, and set the model in stone so some ignoramus can't just blunder up and trash it out.

Wouldn't hurt to add something to the foundation laws to make it a serious offense, without regard for a persons position or station, to gaslight or otherwise publicly disseminate false, misleading or deceptive information that runs counter to the health and well being of humanity .... 
	

	







						FEMA sending 85 refrigerated trucks to New York City for COVID-19 bodies
					

New York City is so short on morgue space for coronavirus victims that FEMA is hauling in trailers to store all the bodies. “We are sending refrigeration trucks to New York to help with some …




					nypost.com


----------



## CCCSD (Mar 31, 2020)

Most of you are using your masks incorrectly. Fit is key. Wearing them properly is key.

If you put anything on your face to use as a “glue”, you just adhered any bio hazard onto and into your skin.

 Let’s NOT post bad advice.


----------



## Phillyrube (Mar 31, 2020)

Sled Driver said:


> well, if you are taking suggestions, I vote for ChiCom Flu.


Wuhan flu..
Wuhan virus..
Chinese flu...
Kung flu?


----------



## RedBlanketRunner (Mar 31, 2020)

CCCSD said:


> If you put anything on your face to use as a “glue”, you just adhered any bio hazard onto and into your skin.


If the contamination hazard is that critical use alcohol for the starch wetting agent of course. Or povidone iodine. You can also use that as an weak adhesive by itself.
Additionally, though it will look weird, povidone iodine is the cats meow for those contaminated places like the edges of the nail beds when you don't have a scrub brush and antiseptic soap handy.

The world is wall to wall problems. The fun part is finding solutions for them.
Thinking outside the box is often optional in clinical situations but mandatory outside of them.


----------



## Sled Driver (Mar 31, 2020)

FEMA is sending 250 buses and 
500 EMT's & Paramedics to NYC

Per FNC

Per the situation I don't think NYC REMAC or NYS DOH will be saying we don't recognize NR or other States Certs' / Licenses etc. at this point willingness to go into harms way counts more than whose card is in your pocket, MHO.


----------



## VFlutter (Mar 31, 2020)

@GMCmedic @Peak @E tank

Pretty cool link that shows real-time data for COVID-19 patients on ECMO for hospitals that participate in the ELSO registry.  There are a few large ECMO centers in the US that are not part of ELSO so the actual incidence  is likely higher.

https://www.elso.org/Registry/FullC...bdSrrYu7aDKAkwKMJ7wk5wiSD-9q54CSPoGjL441wj-SI


----------



## DragonClaw (Mar 31, 2020)

RedBlanketRunner said:


> If the contamination hazard is that critical use alcohol for the starch wetting agent of course. Or povidone iodine. You can also use that as an weak adhesive by itself.
> Additionally, though it will look weird, povidone iodine is the cats meow for those contaminated places like the edges of the nail beds when you don't have a scrub brush and antiseptic soap handy.
> 
> The world is wall to wall problems. The fun part is finding solutions for them.
> Thinking outside the box is often optional in clinical situations but mandatory outside of them.



I really don't think I'm going to glue anything to my face, to be honest.


----------



## Phillyrube (Mar 31, 2020)

Not sure to do what, but the guv down here wants retired LE and health workers to volunteer...

https://www.clickorlando.com/news/lo...ight-covid-19/


----------



## GMCmedic (Mar 31, 2020)

Phillyrube said:


> Not sure to do what, but the guv down here wants retired LE and health workers to volunteer...
> 
> https://www.clickorlando.com/news/lo...ight-covid-19/


I like how he makes it seem so dire, yet a week ago, tourism was still booming.


----------



## ffemt8978 (Mar 31, 2020)

Akulahawk said:


>


Duct tape fixes all.


----------



## ffemt8978 (Mar 31, 2020)

Phillyrube said:


> Wuhan flu..
> Wuhan virus..
> Chinese flu...
> Kung flu?


Kung Flu just made me spit out my tea. 😂


----------



## Seirende (Mar 31, 2020)

DragonClaw said:


> I can't even get a haircut



Go to Walmart and buy a pair of scissors if you don't have one. DYI that ****.


----------



## SandpitMedic (Mar 31, 2020)

I’ll bet this all that ****in’ ***** Carol Baskins fault!


----------



## DesertMedic66 (Mar 31, 2020)

SandpitMedic said:


> I’ll bet this all that ****in’ ***** Carol Baskins fault!


Hey there all you cool cats and kittens


----------



## RedBlanketRunner (Mar 31, 2020)

DragonClaw said:


> I really don't think I'm going to glue anything to my face, to be honest.


Give it some serious thought. That mask stays in place and does NOT MOVE. If you have to adjust it, tweak it around or whatever, you stand a good chance you contaminated it and removing it later can be much more difficult.
The #1 source of self contamination is hands to face. Adjusting your mask is an invitation for something to get past it.

Doc at hospital had more post op infections than all other surgeons combined. Observing him in the OR he had a habit of moving his mask about with the back of his hand.


----------



## DragonClaw (Mar 31, 2020)

Seirende said:


> Go to Walmart and buy a pair of scissors if you don't have one. DYI that ****.



Um I can't even cut a straight line on paper with the dotted lines. No thanks


----------



## Sled Driver (Mar 31, 2020)

Todays FDNY advisory
Any currently cert' EMT or P on the Fire side of the house, will immediately report to the EMS side of the house for backfill duty.



I wonder how long before FDNY puts out a call for recently retired FDNY to come back to work...


----------



## DragonClaw (Mar 31, 2020)

Sled Driver said:


> Todays FDNY advisory
> Any currently cert' EMT or P on the Fire side of the house, will immediately report to the EMS side of the house for backfill duty.
> 
> 
> ...


What's backfill


----------



## Akulahawk (Mar 31, 2020)

DragonClaw said:


> What's backfill


If/when there's an open slot in the EMS schedule, you pull "qualified" people from elsewhere in the department to fill that slot.


----------



## DragonClaw (Mar 31, 2020)

Akulahawk said:


> If/when there's an open slot in the EMS schedule, you pull "qualified" people from elsewhere in the department to fill that slot.


----------



## Jim37F (Mar 31, 2020)

Damn, so two of our FFs at the same station have come down positive. They're shutting the station down overnight fir cleaning/disinfect, and the guys who normally work there are all on home quarantine while they're gonna bring in OT guys to work there in the meantime....









						More first responders test positive for COVID-19
					

Hawaii Fire Fighters Association president Bobby Lee said Station 32 at Kalihi-Uka will be shut down after two firefighters tested positive for COVID-19.




					www.khon2.com


----------



## RedBlanketRunner (Mar 31, 2020)

Akulahawk said:


> If/when there's an open slot in the EMS schedule, you pull "qualified" people from elsewhere in the department to fill that slot.


Sounds very FD. But if you think about it, their flexibility strongly lends to effectiveness. I'm thinking of when I was a seasonal on wildland fires and how they would play musical chairs with the people power to get boots on the ground where it was needed most as fast as possible. I bounced from brush axe to supply delivery to quick attack to EMT back up.


----------



## CCCSD (Apr 1, 2020)

RedBlanketRunner said:


> Give it some serious thought. That mask stays in place and does NOT MOVE. If you have to adjust it, tweak it around or whatever, you stand a good chance you contaminated it and removing it later can be much more difficult.
> The #1 source of self contamination is hands to face. Adjusting your mask is an invitation for something to get past it.
> 
> Doc at hospital had more post op infections than all other surgeons combined. Observing him in the OR he had a habit of moving his mask about with the back of his hand.



Dude, just stop. Seriously. We all know about touching your face. When you are working in a Hot Zone directly treating patients, you can talk. But not utter BS about sticking masks to your face.

Am THERE. Doing IT.


----------



## Tigger (Apr 1, 2020)

If the medical director and leadership at my part time job thinks I'm going to watch a 45 minute *daily *update on COVID19 procedures, they must also assume I enjoy some daily crack.

There is so much information out there that it absolutely needs to be dispensed in usable chunks, otherwise providers are just wasting their time and things will be missed. It is asking for trouble to ask staff to stay up on such an information overload, especially for those with multiple jobs and responsibilities right now. I thought having a county medical director would be cool...turns out there is such thing as too much engagement. We don't need the physician calling the station and asking them to build a homemade isolette for the cot.

For those in the podcast realm, I've found EMCases to be supremely helpful in breaking this disease down into digestible topics. While each episode is 35-45 minutes long, they don't attempt to cover a dozen topics in a single segment and the presenters are very easy to understand. You go, Canada.


----------



## RedBlanketRunner (Apr 1, 2020)

CCCSD said:


> Dude, just stop. Seriously. We all know about touching your face. When you are working in a Hot Zone directly treating patients, you can talk. But not utter BS about sticking masks to your face.


What is your problem? Do you represent the tens of thousands of guests and click bys that visit this forum?  Why are you the supreme authority of what is to be posted? Ordinary people visit these forums all the time just looking for information. Just stop driving them away with your elitist trolling.


----------



## DragonClaw (Apr 1, 2020)

RedBlanketRunner said:


> What is your problem? Do you represent the tens of thousands of guests and click bys that visit this forum?  Why are you the supreme authority of what is to be posted? Ordinary people visit these forums all the time just looking for information. Just stop driving them away with your elitist trolling.



You want me to glue a mask to my face with cornstarch and call him the troll? 

We're an evidence based group of folks.  Submit your findings please. 

Anyone here knows I've well gotten into it with CCCSD previously. Take that as a hint on how you sound right now.


----------



## Peak (Apr 1, 2020)

I'm not saying this at @Tigger but rather as a reflection of many of the members of the medical and public service community that I interact with every day.

This is a war, and it isn't a fair one. We don't have adequate supplies, limited knowledge, and an even more limited time frame. 

Keeping up to date with developments day to day may be the difference between keeping yourself, your crew, and your family safe. While this disease does target the old and sick, young healthy people have died from it too. 

Nobody would leave an incident briefing at a wild land fire early nor would they leave roll call early on the LEO side. That information, no matter how mundane it may seem, is one of the few things we can try to use.


----------



## RedBlanketRunner (Apr 1, 2020)

DragonClaw said:


> You want me to glue a mask to my face with cornstarch and call him the troll?


Common uses of corn starch: Athlete's foot, chemical free base for makeup, relief from itching from bug bites and irritants like poison ivy (rhus), non toxic base for children to make paints with, deodorant, water based adhesive, diaper rash, sunburn, etc etc.
Got a problem with it, don't use it. Simple.


----------



## DragonClaw (Apr 1, 2020)

RedBlanketRunner said:


> Common uses of corn starch: Athlete's foot, chemical free base for makeup, relief from itching from bug bites and irritants like poison ivy (rhus), non toxic base for children to make paints with, deodorant, water based adhesive, diaper rash, sunburn, etc etc.



But that's not what you're suggesting I use it for,  is it? 

Peer reviewed studies of N95 Cornstarch-sealed masks please.


----------



## RedBlanketRunner (Apr 1, 2020)

DragonClaw said:


> Peer reviewed studies of N95 Cornstarch-*sealed* masks please.


Sealed? Better reread my post.


----------



## DragonClaw (Apr 1, 2020)

RedBlanketRunner said:


> Sealed? Better reread my post.



You can adhere it,  sure (theoretically,  anyway aside from that detractor),  but if it's not sealed,  then what's the point?


----------



## ffemt8978 (Apr 1, 2020)

RedBlanketRunner said:


> Sealed? Better reread my post.


Based upon my decades of experience in nuclear engineering, fire fighting and hazmat I would like to point out something you seem to be overlooking. Tips and tricks that you can get away with when using a positive pressure SCBA are down right dangerous when using a respirator.  So please stop with the inappropriate tricks.


----------



## Kevinf (Apr 1, 2020)

Since we're on the topic of respirators, I can't recommend a full-face respirator strongly enough. Having spent all day in poly N95 respirators, half-face respirators, and full-face respirators... by far the most comfortable and secure was the full-face.

Downside, of course, is the cost. A high-end full face is $100-$150, half-face are about $25-$60, and N95s are just dirt cheap (usually ).

Unfortunately, getting your hands on a proper respirator may be difficult these days. HOWEVER, your company is REQUIRED to provide properly fitting PPE. If your supplied PPE is slipping, they MUST provide an alternative per OSHA.


----------



## RedBlanketRunner (Apr 1, 2020)

ffemt8978 said:


> Based upon my decades of experience in nuclear engineering, fire fighting and hazmat I would like to point out something you seem to be overlooking. Tips and tricks that you can get away with when using a positive pressure SCBA are down right dangerous when using a respirator. So please stop with the inappropriate tricks.


I agree completely. I suggested tiny bits of corn starch to keep masks from slipping around. A few dots of corn starch paste the size of the head of a pin. I assumed nobody would use enough to compromise the seal!  That would be ridiculous. Also agree with the pos press. We had some antique demand type SCBAs at a station I worked for a while. Hand to mouth desperate FD that used discarded and retired equipment. Those demand type units were accidents waiting to happen and greasing them up all the way around with vaseline was mandatory. Crank the straps down so tight you got neck spasms and raging headaches.



Kevinf said:


> Unfortunately, getting your hands on a proper respirator may be difficult these days.


Yup. Thinking everyone is going to have access to new quality masks is Trump think. Some people are going to have to make do. You know, at the rate things are going a few hundred thousand people going to have to resort to various tricks to be safe.

@ffemt8978 Thanks for clarifying. Honestly, in my book, assuming I suggested compromising a seal is dumber than thinking that's what I suggested. I will assume something else here. You've been in a boiling black room, flashlight useless, and thanks to modern plastics burning, C monoxide, hydrogen chlorides, cyanides and PCBs instead of air - on par with getting a case of Covid if that mask leaks? Except of course you can go down in a few seconds. One or two lung fulls.

Corn starch. We had some really stiff Scott SCBAs. Get sweating the things would slide all over your face. Old timer captain came up after we had the masks fitted and added a tiny dab of the starch in a few spots around the outer edge of the seal. Worked like a charm.
I suggested it in response to someone who posted their mask slipped around.


----------



## OceanBossMan263 (Apr 1, 2020)

Should be interesting to see how this FDNY staffing protocol shakes out. Many people only work for FDNY EMS so that they can go to FDNY fire side as a promotion instead of dealing with all of the issues of hoping to get hired off the open competitive exam. Unlike some other municipal departments, they were truly separate jobs until now and just happened to have the same logo on the trucks.


----------



## Carlos Danger (Apr 1, 2020)

ffemt8978 said:


> Kung Flu just made me spit out my tea. 😂


That's my favorite, too.


----------



## Carlos Danger (Apr 1, 2020)

I have seen some talk in unofficial channels about two things that I have yet to see anything "official" published about anywhere:


NOT intubating early and instead giving folks as much chance as possible to avoid going on the vent much the same way we typically approach respiratory compromise, in part because vents are so limited in some places and also because of the high mortality rate of patients who get intubated for this (nearly 50%)


NOT reflexively using ARDS vent strategies in intubated patients who lack radiological evidence of ARDS, as has been the prevalent approach and recommendation. Some believe that the primary issue in many patients with COVID-19 is not ARDS but pulmonary vasculopathy (an idea which apparently there is a fair amount of evidence for), in which case high PEEP can cause increased PVR and the problems that follow, potentially contributing to high mortality rate of vented COVID-19 patients. 

Anyone seen any mention of either of these things in the clinical media?


----------



## MonkeyArrow (Apr 1, 2020)

Remi said:


> I have seen some talk in unofficial channels about two things that I have yet to see anything "official" published about anywhere:
> 
> 
> NOT intubating early and instead giving folks as much chance as possible to avoid going on the vent much the same way we typically approach respiratory compromise, in part because vents are so limited in some places and also because of the high mortality rate of patients who get intubated for this (nearly 50%)
> ...


I've seen a lot of talk about the first point too through various channels. Not intubating early, awake proning with HFNC, trying CPAP. An interesting topic I've heard is the concept of "silent hypoxemia" or "happy hypoxemia" where you let these individuals who are on high Fi02 non-invasive ventilation with low SpO2s but who are otherwise not in distress sit there for hours and even days with low SpO2s. I don't know how comfortable I personally would feel about that.

As to your second point, most of the COVID+ patients who get intubated at my shop have had the fairly classic ARDS infiltrates. However, I have seen a lot of FiO2/PEEP titration tables in recent days that seem to suggest starting with a low FiO2/PEEP and titrating them up in tandem. We don't really do that that. Upon placement on the vent, we of course use low tidal volume ventilation (aim for 6 mL/kg IBW) but with FiO2 of 1.0 and minimal PEEP (around 5) and have had some success with a high FiO2/lower PEEP strategy, at least initially.

Do you have a link to anyone talking about the pulmonary vasculopathy theory?


----------



## VentMonkey (Apr 1, 2020)

@Remi @MonkeyArrow go to EMCrit and FOAMfrat. Both podcasts have been covering these topics heavily over the last few episodes.

Weingart interviews a doc from Italy in one about vent conservation and what they’ve done in Italy to remedy the situation. It all seems like their approaches are constantly evolving because of the constant inconsistencies in patient presentations.

Also, @RedBlanketRunner drop the political stuff. Your posts are hard enough to read without them.


----------



## SandpitMedic (Apr 1, 2020)

VentMonkey said:


> Also, @RedBlanketRunner drop the political stuff. Your posts are hard enough to read without them.


2nd that. Can we give this guy a two week social media isolation?


----------



## silver (Apr 1, 2020)

RedBlanketRunner said:


> I agree completely. I suggested tiny bits of corn starch to keep masks from slipping around. A few dots of corn starch paste the size of the head of a pin. I assumed nobody would use enough to compromise the seal!



If you need corn starch to stop it slipping around you are wearing a surgical or N95 mask wrong. The caveat though is people frequently are seen taping masks but that is to reduce fogging of glasses/shields or to help prevent glasses from falling off + comfort w/ glasses..


----------



## SandpitMedic (Apr 1, 2020)

silver said:


> If you need corn starch to stop it slipping around you are wearing a surgical or N95 mask wrong. The caveat though is people frequently are seen taping masks but that is to reduce fogging of glasses/shields or to help prevent glasses from falling off + comfort w/ glasses..


Don’t encourage him.


----------



## SSMTB (Apr 1, 2020)

So from what I’ve heard the hospital I work at have been intubating suspect patients early. To avoid everyone running in the room  if the patient crashes and to avoid having the patient  on BI Pap. Once the patient  is on 6 liters they intubate and transfer to ICU, although I can’t see this being a long term solution as we are getting full. Anyone else have similar experiences?


----------



## Tigger (Apr 1, 2020)

Peak said:


> I'm not saying this at @Tigger but rather as a reflection of many of the members of the medical and public service community that I interact with every day.
> 
> This is a war, and it isn't a fair one. We don't have adequate supplies, limited knowledge, and an even more limited time frame.
> 
> ...


Here's my thing. We aren't completely adrift out here. There are guidelines that are either for or are applicable to EMS. We have to utilize these as a) they are actually somewhat vetted and b) have some consistency out there. A lack of consistency makes for error prone environments. We can't fall victim to just "doing what you think is right" for every last issue. And that is the issue I have with this particular employer, they've gone so far out in left field that there is no way to stay up on what is supposed to be done as it flies in the face of what literally everyone else does. Not to mention the amount of ego at play, a drive thru testing site was set up staffed by vollie EMS at one point and there was of course mention of being "first in the state." Who. Cares.

As the cliche goes, this a marathon not a sprint. Getting worked up early, when there is no appreciable caseload, ensures hysteria when things pick up. If you can't disseminate your plan, you have no plan.


----------



## Phillyrube (Apr 1, 2020)

Got some troubles in Texas...









						Toilet paper shipment goes up in flames in Texas truck crash
					

A tractor-trailer carrying a load of toilet paper rolled over and burst into flames on a Texas highway early Wednesday morning, as people are hoarding the household necessity around the country during the coronavirus pandemic.




					www.foxnews.com


----------



## VFlutter (Apr 1, 2020)

Just had a fulminant shock patient presumed to be COVID Cytokine Storm. Did not survive transport


----------



## DragonClaw (Apr 1, 2020)

VFlutter said:


> Just had a fulminant shock patient presumed to be COVID Cytokine Storm. Did not survive transport


...?

ELI5?


----------



## GMCmedic (Apr 2, 2020)

DragonClaw said:


> ...?
> 
> ELI5?


Sudden onset shock due to a massive systemic release of WBC's and cytokines causing organ failure.


----------



## DragonClaw (Apr 2, 2020)

GMCmedic said:


> Sudden onset shock due to a massive systemic release of WBC's and cytokines causing organ failure.


Something like Compartment syndrome?


----------



## toyskater86 (Apr 2, 2020)

Hopefully your organization isn’t blatantly telling you to steal from others who are also suffering


----------



## hpclayto (Apr 2, 2020)

So I don’t know much about this. My understanding is this is causing people to develop ARDS?


----------



## Peak (Apr 2, 2020)

hpclayto said:


> So I don’t know much about this. My understanding is this is causing people to develop ARDS?



The presentation in the COVID 19 patient varies greatly. 

Kids seem to have almost no significant illness with a very small number of hospitalizations and extremely rare deaths. The reported numbers in peds are low, but if kids are only mildly symptomatic they are unlikely to present for testing and even less likely to be eligible for the limited number of tests. 

Young healthy adults do seem to represent a decent number of infections and a not insignificant number of hospitalizations, however they do not seem to have a significant amount of representation in those who are critically ill or who die. 

Older or more complex adults seem to be the bulk of hospitalizations and deaths. Almost all deaths are the result of ARDS. Because NSAIDs are linked to a cytokine response in asthmatics, NSAIDS are linked to worse outcomes in COVID 19, there is a popular theory that those who are present ARDS are largely either a result of cytokine storm or ventilator related barotrauma. 

Interestingly I had a discussion with an a world rebound pulmonologist shortly before COVID 19 became publicized regarding NSAIDs and asthma. She told me that she has only seen one case of NSAID mediated asthma and that it is exceptionally rare. Certainly a new and novel virus can present a new complication not seen before, but this would somewhat bring some of said premise into question. That being said I think that we have incredibly limited information regarding the pathophysiology of COVID 19 and very unreliable information as far as the epidemiology of the virus. 

Those adult who do develop ARDS (and I exclude peds because we have such limited data) seem to almost always have a devastating outcome. This certainly isn't universal among COVID infections or even of critical care patient. While I would say that the ARDS pathway is a big killer of these patients, I wouldn't generalize to say that ARDS is a predictable outcome for most COVID 19 patients.


----------



## Peak (Apr 2, 2020)

toyskater86 said:


> Hopefully your organization isn’t blatantly telling you to steal from others who are also suffering



That is incredible. I'm shocked that any agency would essentially advocate for stealing supplies from someone else.


----------



## VFlutter (Apr 2, 2020)

hpclayto said:


> So I don’t know much about this. My understanding is this is causing people to develop ARDS?





			https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext
		


It does but there is a subset of patients, usually younger, who are abruptly dying of overwhelming shock and multi-system orgam failure without significant ARDS or other known causes.


----------



## Carlos Danger (Apr 2, 2020)

Peak said:


> Older or more complex adults seem to be the bulk of hospitalizations and deaths. Almost all deaths are the result of ARDS. Because NSAIDs are linked to a cytokine response in asthmatics, *NSAIDS are linked to worse outcomes in COVID 19,* there is a popular theory that those who are present ARDS are largely either a result of cytokine storm or ventilator related barotrauma.


My understanding was that the thing about NSAIDS and worse outcomes was a hypothesis based on anecdote and that there was no objective evidence at to support the link. Is that still the case?



Peak said:


> That is incredible. I'm shocked that any agency would essentially advocate for stealing supplies from someone else.


I'm not the least bit shocked that an agency would advocate "scrounging", but I'm a little surprised they were dumb enough to distribute it in writing.

Times like this have a tendency to bring out the best in some people, and the worst in others.


----------



## CCCSD (Apr 2, 2020)

Remi said:


> My understanding was that the thing about NSAIDS and worse outcomes was a hypothesis based on anecdote and that there was no objective evidence at to support the link. Is that still the case?



That is the current googe.


----------



## Capital (Apr 2, 2020)

VFlutter said:


> https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext
> 
> 
> 
> It does but there is a subset of patients, usually younger, who are abruptly dying of overwhelming shock and multi-system orgam failure without significant ARDS or other known causes.


This is what we are seeing in our level 2 trauma ED also. About half of the patients under 60 are presenting with abdominal pain/distress. They seem to deteriorate faster, and have a higher mortality, than those that present with respiratory symptoms. We're still running about 5-7 days for test results, and private tests were only made available to us a few days ago (before that we were begging the state).

We are also only doing MDI and hi-flow, or RSI - no nebs, no BiPAP - all or nothing. We're limiting the number of staff in the room, and have added the PPE buddy check to the TImeOut procedure.

Edit to add:
We are seeing a significant increase in our (already overloaded) mental health services. So many of our frequent fliers have no skills or ability to handle the anxiety of this situation and they *keep* coming back in. I'm an ED nurse, not a psych nurse, for a reason. Debating with these folks while sweating my *** off in a N95, gown and double gloves is getting old...


----------



## DrParasite (Apr 2, 2020)

Capital said:


> We are also only doing MDI and hi-flow, or RSI - no nebs, no BiPAP - all or nothing.


I get the no nebs,  but why not BiPAP?  I would imagine the alternative is a tube, and a vent, and aren't we trying to keep people off a vent unless they medically need it?


----------



## Capital (Apr 2, 2020)

DrParasite said:


> I get the no nebs,  but why not BiPAP?  I would imagine the alternative is a tube, and a vent, and aren't we trying to keep people off a vent unless they medically need it?


There are questions about the expiratory port filter efficacy on our BiPap. We have 50+ rooms, but only a few are negative pressure, and a fairly open layout. So they've made the decision to not use BiPap with any potential Covid until we have clearer evidence. I've never seen any situation this fluid, changing by the hour as to policy and entire procedures. It's frankly exhausting.


----------



## GMCmedic (Apr 2, 2020)

Remi said:


> My understanding was that the thing about NSAIDS and worse outcomes was a hypothesis based on anecdote and that there was no objective evidence at to support the link. Is that still the case?
> 
> 
> I'm not the least bit shocked that an agency would advocate "scrounging", but I'm a little surprised they were dumb enough to distribute it in writing.
> ...


I read some stuff out of New York last night. Theyre still avoiding NSAIDs cause of the anecdotal french evidence,and cause of down stream renal failure.


----------



## Carlos Danger (Apr 2, 2020)

Capital said:


> There are questions about the expiratory port filter efficacy on our BiPap. We have 50+ rooms, but only a few are negative pressure, and a fairly open layout. So they've made the decision to not use BiPap with any potential Covid until we have clearer evidence. I've never seen any situation this fluid, changing by the hour as to policy and entire procedures. It's frankly exhausting.


The thing about BiPAP and CPAP is that even if your expiratory filter works perfectly, there's still a significant risk of aerosolization from mask leaks.

Personally, its seems as though avoiding NIPPV generally makes sense even aside from the concerns about aerosolization. ARDS requiring mechanical support is almost universally going to wind up needing a tube anyway. Those who do not have evidence of ARDS and just low Sp02 can potentially get over the hump with oxygen and positioning and may be harmed by PPV. If they get to a point that they do need mechanical support (but still without ARDS), then they are usually very sick with a high mortality rate and will need a tube, resource allocation allowing. 

At least that seems *generally* true to me based on everything I'm reading. Still have been involved with very few cases where I work.


----------



## VentMonkey (Apr 2, 2020)

Remi said:


> The thing about BiPAP and CPAP is that even if your expiratory filter works perfectly, there's still a significant risk of aerosolization from mask leaks.
> 
> Personally, its seems as though avoiding NIPPV generally makes sense even aside from the concerns about aerosolization. ARDS requiring mechanical support is almost universally going to wind up needing a tube anyway. Those who do not have evidence of ARDS and just low Sp02 can potentially get over the hump with oxygen and positioning and may be harmed by PPV. If they get to a point that they do need mechanical support (but still without ARDS), then they are usually very sick with a high mortality rate and will need a tube, resource allocation allowing.
> 
> At least that seems *generally* true to me based on everything I'm reading. Still have been involved with very few cases where I work.


I want to say one of the docs on the podcast I had listened to eluded to the fact that they were wanting to allow the NIV patients the chance to self-position/ self-prone and had seen some positive results.


----------



## MonkeyArrow (Apr 2, 2020)

Remi said:


> Personally, its seems as though avoiding NIPPV generally makes sense even aside from the concerns about aerosolization.


Well I think we're now coming around to the idea that aerosolization is not a legitimate means of transferring COVID. There was this from JAMA at the beginning of the month finding no evidence of COVID in air samples, and I believe one or two similarly small studies backed that up.

In my opinion, true aerosol transmission is unlikely (assuming everyone who is sufficiently exposed to COVID becomes symptomatically infected). If that were the case, all these asymptomatic carriers who were out and about before the self-quarantining period would've infected droves of more people. So either: a) COVID is not airborne or b) there are a LOT of asymptomatic carriers (significantly more than modeled) or some combination there of.


----------



## Carlos Danger (Apr 2, 2020)

MonkeyArrow said:


> Well I think we're now coming around to the idea that aerosolization is not a legitimate means of transferring COVID. There was this from JAMA at the beginning of the month finding no evidence of COVID in air samples, and I believe one or two similarly small studies backed that up.
> 
> In my opinion, true aerosol transmission is unlikely (assuming everyone who is sufficiently exposed to COVID becomes symptomatically infected). If that were the case, all these asymptomatic carriers who were out and about before the self-quarantining period would've infected droves of more people. So either: a) COVID is not airborne or b) there are a LOT of asymptomatic carriers (significantly more than modeled) or some combination there of.


There is a difference between a pathogen not being airborne and not being able to be aerosolized.

From the WHO: Airborne transmission is different from droplet transmission as it refers to the presence of microbes within droplet nuclei, which are generally considered to be particles <5μm in diameter, can remain in the air for long periods of time and be transmitted to others over distances greater than 1 m.

It seems pretty well established that coronavirus does not meet this definition of "airborne" or present the same risk that measles or TB do, both of which you can potentially be exposed to just by breathing air in the same room as someone who has those diseases. This is reflected in the current recommendations that level 3 masks rather than N95's are sufficient when caring for a known coronavirus carrier.

However, it is also pretty well established that droplets can potentially be aerosolized during airway procedures. For this to present a potential hazard to someone in close proximity to the patient - performing a bronch or suctioning or mask ventilating, for instance - does not require that the "droplets remain in the air for long periods of time and be transmitted over distances greater than 1m", which is I believe is what that study you mention was looking at. This is why a PAPR or N95 is recommended when doing things like that.


----------



## Peak (Apr 2, 2020)

Remi said:


> My understanding was that the thing about NSAIDS and worse outcomes was a hypothesis based on anecdote and that there was no objective evidence at to support the link. Is that still the case?



No, I'm not aware of any meaningful evidence. That was what I was alluding to with the NSAIDs in asthma thing thing, it's a theory that's been perpetuated far beyond what the current evidence is.


----------



## Sled Driver (Apr 4, 2020)

Yesterday, at 17:20 Verizon sent out an Emergency Alert, like they do for an inbound Hurricane or similar, but this time it was an appeal by NYC for duly licensed Healthcare workers to report to NYC Healthcare facilities to Volunteer to help with the crisis. This was even after yesterday's annoucnement that 20,000 out of State providers have signed up and are coming to help us.

This is a bad sign.

If I knew how to post a pic, I did take a screen shot of it, before it disappeared if anyone would like to see it.


----------



## Phillyrube (Apr 4, 2020)

Interesting article.   









						The Naval War College Ran a Pandemic War Game in 2019. The Conclusions Were Eerie
					

The war game involved 50 experts who spent two days coordinating response, containment and messaging efforts.




					www.military.com


----------



## RedBlanketRunner (Apr 4, 2020)

Of course it's just a bizarre coincidence the U.S. far exceeds the number of infections of all countries (presently over 1/4th of all reported infections world wide) and the denial, misinformation and outright lies from Fox and Trump.
The worst is yet to come. Look to the countries Trump has insulted and alienated to help bail the U.S. out.


----------



## DesertMedic66 (Apr 4, 2020)

RedBlanketRunner said:


> Of course it's just a bizarre coincidence the U.S. far exceeds the number of infections of all countries (presently over 1/4th of all reported infections world wide) and the denial, misinformation and outright lies from Fox and Trump.
> The worst is yet to come. Look to the countries Trump has insulted and alienated to help bail the U.S. out.


Again with the political BS? I thought that got shut down.


----------



## RedBlanketRunner (Apr 4, 2020)

DesertMedic66 said:


> Again with the political BS? I thought that got shut down.


Get real. You medicals are just dealing with symptoms. Lambs to the slaughter.


----------



## VentMonkey (Apr 4, 2020)

RedBlanketRunner said:


> Get real. You medicals are just dealing with symptoms. Lambs to the slaughter.


Dude, seriously no one even knows what you’re talking about anymore.

1st world, 3rd world. It doesn’t matter. Keep the political agendas out of this thread.

Mods, you all need to crack the ban hammer or lock the thread already. Exercise your liberties.


----------



## CALEMT (Apr 4, 2020)

Haven’t visited this thread in a while. It sure has taken a 180 degree turn.


----------



## Akulahawk (Apr 6, 2020)

Now a not so polite reminder to keep politics out of this thread. This is for factual discussion about SARS-CoV2/COVID19 as we understand it and learn more about it. Once this is past us, we can Monday-morning Quarterback this all we want. I have already placed a ban on one user for bringing politics into this thread. That user may not reply in this thread for a few days. Keep this civil, and keep politics out of this thread. I do not want to have this thread turned into a moderated one.


----------



## ffemt8978 (Apr 6, 2020)

DOJ approves medical logistics companies collaborating









						US medical suppliers get antitrust clearance to collaborate during pandemic
					

The Justice Department said joint logistics operations among five American medical supply distributors to provide protective medical gear to virus hot spots does not violate antitrust law.




					www.freightwaves.com


----------



## Jim37F (Apr 9, 2020)

Locally at least, the numbers *seem* to be starting to head in a better direction. 

There are 442 confirmed COVID-19 cases statewide (Hawaii). 7 are newly confirmed. Only 42 cases have required hospitalization (none of the new ones). 6 deaths. 251 have recovered or have otherwise been released from isolation. 









						7 new cases of COVID-19 bring state total to 442
					

HONOLULU (KHON) — The Department of Health reported 7 new cases of COVID-19 today: 6 on Oahu, 2 on Hawaii Island, and 3 from Maui County. These numbers include 4 previously reported cases tha…




					www.khon2.com


----------



## CCCSD (Apr 9, 2020)

Good. Maui bound at the end of August. Start digging the Imu for me.


----------



## SandpitMedic (Apr 9, 2020)

Man, I can't wait to take a vacation. **** is going to be so cheap. 

Hawaii sounds great!


----------



## Jim37F (Apr 9, 2020)

Just dont book to soon. Right now all incoming travelers have a mandatory 14 day quarantine (subject to arrest if you dont actually stay in your lodging).








						Kauai police arrest visiting Florida man for violating 14-day quarantine order
					

Kauai police arrested a 62-year-old Tampa, Fla., man for allegedly violating the state’s mandatory 14-day quarantine order.




					www.staradvertiser.com


----------



## SandpitMedic (Apr 9, 2020)

I meant after this is over. People will be back at work and everything will be cheap


----------



## Peak (Apr 9, 2020)

Jim37F said:


> Just dont book to soon. Right now all incoming travelers have a mandatory 14 day quarantine (subject to arrest if you dont actually stay in your lodging).
> 
> 
> 
> ...



You didn't follow a stay at home order so we are going to transport and lock you in a small confined space with law enforcement and potentially other people. That seems like a logical way to prevent the spread of disease.


----------



## Carlos Danger (Apr 9, 2020)

Peak said:


> You didn't follow a stay at home order so we are going to transport and lock you in a small confined space with law enforcement and potentially other people. That seems like a logical way to prevent the spread of disease.


Well, there's very little logical about any of this so at least we're being consistent here.


----------



## Carlos Danger (Apr 9, 2020)

SandpitMedic said:


> I meant after this is over. People will be back at work and everything will be cheap


I'm looking forward to the cut rates on Outer Banks beach houses AND new trucks this summer!


----------



## SandpitMedic (Apr 9, 2020)

Remi said:


> I'm looking forward to the cut rates on Outer Banks beach houses AND new trucks this summer!


Got my eye on my new truck already! Haha!


----------



## FiremanMike (Apr 10, 2020)

Remi said:


> I'm looking forward to the cut rates on Outer Banks beach houses AND new trucks this summer!



I've saved almost 40% off my August cruise since my original booking in January.. They also gave me $100 on board credit just for not cancelling..


----------



## FiremanMike (Apr 10, 2020)

SandpitMedic said:


> Got my eye on my new truck already! Haha!



I called a salesman and told him when he's ready to give me the ridiculously discounted price PLUS the 84 months 0%, I'm ready to buy..


----------



## DesertMedic66 (Apr 10, 2020)

FiremanMike said:


> I've saved almost 40% off my August cruise since my original booking in January.. They also gave me $100 on board credit just for not cancelling..


My cruise this month was cancelled and we were offered 100% credit for the cruise plus an additional 50% of future cruise credit. I will gladly take that.


----------



## FiremanMike (Apr 10, 2020)

DesertMedic66 said:


> My cruise this month was cancelled and we were offered 100% credit for the cruise plus an additional 50% of future cruise credit. I will gladly take that.



Sounds like the recipe for a longer cruise in a nicer room!


----------



## DesertMedic66 (Apr 10, 2020)

FiremanMike said:


> Sounds like the recipe for a longer cruise in a nicer room!


It was already a 7 day cruise in a room with a balcony haha. I guess I’ll have to do a suite


----------



## Sled Driver (Apr 10, 2020)

My local Mercedes Benz Dealer has reduced the hours of their Service Dept. Mechanics from 5 days per week to 3 days per week.

I am sensing this year will be a good time to buy a car and do some hard business...


----------



## Kavsuvb (Apr 10, 2020)

Has anyone ever noticed during this pandemic that EMT's are largely left out of this and only Paramedics, NP, PA, DO and MD's are in the news. It just seems odd that EMT's are left out of this pandemic and you don't hear anything on how EMT's are helping in this pandemic.


----------



## akflightmedic (Apr 10, 2020)

1. Quit your whining
2. You are simply being lumped into the more advanced category of Paramedic...sure beats the other way around when "we" constantly get called EMTs...


----------



## DesertMedic66 (Apr 10, 2020)

Kavsuvb said:


> Has anyone ever noticed during this pandemic that EMT's are largely left out of this and only Paramedics, NP, PA, DO and MD's are in the news. It just seems odd that EMT's are left out of this pandemic and you don't hear anything on how EMT's are helping in this pandemic.


In the news they tend to use EMS/EMT/Paramedic interchangeably


----------



## Sled Driver (Apr 10, 2020)

Many lay persons could not tell you the difference between an EMT and a Paramedic. To them its one and the same.


----------



## mgr22 (Apr 10, 2020)

Kavsuvb said:


> Has anyone ever noticed during this pandemic that EMT's are largely left out of this and only Paramedics, NP, PA, DO and MD's are in the news. It just seems odd that EMT's are left out of this pandemic and you don't hear anything on how EMT's are helping in this pandemic.



No, I haven't. Sometimes I get called an EMT. Sometimes EMTs are called paramedics. I don't think the terms are well understood by those outside the industry. Sometimes we're all called ambulance people. Sounds like a Wes Craven movie.


----------



## Kavsuvb (Apr 10, 2020)

What I mean by that is I am wondering why EMT's are being left out of the loop during this pandemic. It seems like Many states are asking for medical help but many states are not asking EMT's to pitch in and help. Instead many states are asking Paramedics,, NP, PA, MD and Do's to help out.


----------



## DesertMedic66 (Apr 10, 2020)

Kavsuvb said:


> What I mean by that is I am wondering why EMT's are being left out of the loop during this pandemic. It seems like Many states are asking for medical help but many states are not asking EMT's to pitch in and help. Instead many states are asking Paramedics,, NP, PA, MD and Do's to help out.


Many states have been asking for any personal with a medical license to help out. Our state Medical Assistance Team is putting together a team of EMTs and Paramedics to head up north and help staff a SNF.


----------



## Phillyrube (Apr 10, 2020)

Peak said:


> You didn't follow a stay at home order so we are going to transport and lock you in a small confined space with law enforcement and potentially other people. That seems like a logical way to prevent the spread of disease.


Yea,  Orlando police arrested a homeless guy at 0400 for breaking curfew....while they're clearing out the lockups.


----------



## Phillyrube (Apr 10, 2020)

Sled Driver said:


> Many lay persons could not tell you the difference between an EMT and a Paramedic. To them its one and the same.


And we're all ambulance drivers.


----------



## SandpitMedic (Apr 10, 2020)

NYTimes reporting summer peak will be worse after quarantines lifted than if we had never quarantined at all. Info sourced from CDC and other Fed agencies.



> The models show a higher demand for ventilators in the short term if states had never issued the stay-at-home orders. But the spike in demand 150 days after lifting such an order is expected to be more severe than if the United States had never issued such orders and instead relied on school closures, sending people home to telework and directing the public to socially distance.
> 
> The federal agencies advised in the model that the projected demand for ventilators are “a worst-case scenario” and did not factor in states sharing the lifesaving devices across state lines.



(I know it is NYT... I like to get news from various outlets).

"Coronavirus Live Updates: U.S. Projects Summer Spike in Infections if Stay-At-Home Orders Are Lifted" https://www.nytimes.com/2020/04/10/us/coronavirus-updates-usa.html


----------



## Kavsuvb (Apr 10, 2020)

DesertMedic66 said:


> Many states have been asking for any personal with a medical license to help out. Our state Medical Assistance Team is putting together a team of EMTs and Paramedics to head up north and help staff a SNF.


In my State of Connecticut for example, they seem to have left out EMT's and only are asking for Paramedics, PA, NP, MD, RT's and Do's.


----------



## Jim37F (Apr 10, 2020)

They've suggested releasing people from our jails. Both the DA and the Police Chief have balked at that idea. Basically said "Why? They're already about as isolated/quarantined as they're gonna get that we're already asking everyone else to do. Plus everything is closed, what jobs are they gonna get? Wont help anyone to release them in this situation, they're just gonna wind up going back into whatever crime they did ..."


----------



## CCCSD (Apr 10, 2020)

Kavsuvb said:


> What I mean by that is I am wondering why EMT's are being left out of the loop during this pandemic. It seems like Many states are asking for medical help but many states are not asking EMT's to pitch in and help. Instead many states are asking Paramedics,, NP, PA, MD and Do's to help out.



You are so flat out wrong on this it's just sad. Perhaps your local area is doing this. EVERY state that has staffing issues is asking for all levels, from CNA to MD. Your inability to understand this is an example of not knowing what is going on in the world.
Please, do some simple research before you post.

The above is an example of mentoring.


----------



## PotatoMedic (Apr 10, 2020)

Kavsuvb said:


> In my State of Connecticut for example, they seem to have left out EMT's and only are asking for Paramedics, PA, NP, MD, RT's and Do's.


They want the advanced practice providers.  I know one new Jersey hospital has pulled most of their medics from the field and are using them in the hospital.  Now they are back filling the field with out of state providers.  And I have see way to many tik toc videos of basics running lights and sirens from states away in a convoy fashion as they are coming to help new your.  *Facepalm*


----------



## Phillyrube (Apr 10, 2020)

So has it come down to this?  Guy dragged off a bus for not wearing a mask?









						Pa. is still seeking 1,000 ventilators; $450 million loan package will help hospitals struggling in the coronavirus pandemic
					

As both White House and state officials praised Philadelphia’s response to the coronavirus pandemic Friday, Mayor Jim Kenney cautioned that does not mean the city is out of the woods yet.




					www.inquirer.com


----------



## GMCmedic (Apr 11, 2020)

Science and things

ETA: I found this from a trusted source one facebook, but im having some issues verifying it so this may be fake afterall.


----------



## GMCmedic (Apr 11, 2020)

GMCmedic said:


> Science and things
> 
> ETA: I found this from a trusted source one facebook, but im having some issues verifying it so this may be fake afterall.
> 
> ...


Seems consensus is that this is a leaked document and is still under peer review.


----------



## Carlos Danger (Apr 12, 2020)

Phillyrube said:


> So has it come down to this?  Guy dragged off a bus for not wearing a mask?


Unfortunately, this type of thing is the predictable result of mass hysteria + ignorance. The longer this goes on and the more we catastrophize and exaggerate the danger, the more of this type of thing we’ll see.


----------



## VFlutter (Apr 12, 2020)

Another r/o COVID VA-ECMO  flight. Keep seeing severe cardiac complications with or without "ARDS"


----------



## Tigger (Apr 12, 2020)

Kavsuvb said:


> In my State of Connecticut for example, they seem to have left out EMT's and only are asking for Paramedics, PA, NP, MD, RT's and Do's.


What role do you envision EMTs playing?


----------



## Sled Driver (Apr 12, 2020)

Sled Driver said:


> In Borough Park Brooklyn, while an FDNY FF from E282 / L148 was checking on hydrants he was harassed by Hasidic Jewish boys. One of them went up to the FF and sneezed in his face. 4 days later the FF felt flu like symptoms and was able to get tested for COVID-19, his test came back positive.




Well, following up on the above.









						NYC firehouse crippled by coronavirus as 11 firefighters test positive
					

A Borough Park firehouse has been crippled by COVID-19 — with 11 firefighters testing positive and a dozen others suffering symptoms — as it responds to emergencies in a Hasidic community that larg…




					nypost.com
				





I would not let any Boss disrespect to me that way, he ran his mouth, now time to back it up and step into the parking lot.


----------



## GMCmedic (Apr 13, 2020)

GMCmedic said:


> Science and things
> 
> ETA: I found this from a trusted source one facebook, but im having some issues verifying it so this may be fake afterall.
> 
> ...


I did more digging on this, all of these docs are opthalmologist. I'm calling this an internet hoax.


----------



## Phillyrube (Apr 13, 2020)

GMCmedic said:


> I did more digging on this, all of these docs are opthalmologist. I'm calling this an internet hoax.


Kinda like when yur working a code and a doctor shows up and wants to call the shots.  What kind of doc are you?   Dermatologist.   Heres the radio, talk to my doc.


----------



## VentMonkey (Apr 13, 2020)

VFlutter said:


> Another r/o COVID VA-ECMO  flight. Keep seeing severe cardiac complications with or without "ARDS"


Ok, educate me. Why VA vs. VV-ECMO? Are these patients post-arrest/ MODS? I’m seriously looking for some firsthand education.


----------



## VFlutter (Apr 13, 2020)

VentMonkey said:


> Ok, educate me. Why VA vs. VV-ECMO? Are these patients post-arrest/ MODS? I’m seriously looking for some firsthand education.



Some of the patients we are seeing are having significant cardiac complications that could be Cytokine Storm, Myocarditis,  or Kakotsubo like cardiomyopathy requiring VA. Others primarily need VV but may be on high pressor requirments that preclude VV. Generally pressor requirments go down once VV is initiated due to improved oxygenation however some are still crashing so VA is safer. Some are post arrest. 

Some of it is chicken or the egg, do they just happen to be COVID positive or is COVID an instigating factor for MI or worsening HF


----------



## GMCmedic (Apr 13, 2020)

VFlutter said:


> Some of the patients we are seeing are having significant cardiac complications that could be Cytokine Storm, Myocarditis, or Kakotsubo like cardiomyopathy requiring VA. Others primarily need VV but may be on high pressor requirments that preclude VV. Generally pressor requirments go down once VV is initiated due to improved oxygenation however some are still crashing so VA is safer. Some are post arrest.
> 
> Some of it is chicken or the egg, do they just happen to be COVID positive or is COVID an instigating factor for MI or worsening HF


This is the second time this week ive heard mention of Takotsubo. IIRC it was 3rd or 4th hand that they were finding it during caths at UofL.


----------



## SandpitMedic (Apr 14, 2020)

GMCmedic said:


> This is the second time this week ive heard mention of Takotsubo. IIRC it was 3rd or 4th hand that they were finding it during caths at UofL.


It’s a thing.


----------



## Peak (Apr 14, 2020)

VentMonkey said:


> Ok, educate me. Why VA vs. VV-ECMO? Are these patients post-arrest/ MODS? I’m seriously looking for some firsthand education.



You can also typically oxygenate better with VA ECMO than VV. You are flow limited on VV as the "venous" side can end up pulling blood from the "arterial" side of the VV catheter. Also keep in mind that ECMO only supports a portion of the cardiopulmonary flow, there is still going to be flow whether on VV or VA through the heart and lungs.

We very rarely perform VV, we would rather perform VA and suppress native cardiac function.


----------



## silver (Apr 14, 2020)

Peak said:


> You can also typically oxygenate better with VA ECMO than VV. You are flow limited on VV as the "venous" side can end up pulling blood from the "arterial" side of the VV catheter. Also keep in mind that ECMO only supports a portion of the cardiopulmonary flow, there is still going to be flow whether on VV or VA through the heart and lungs.
> 
> We very rarely perform VV, we would rather perform VA and suppress native cardiac function.


Your group planning to put in VADs and transplant these patients during the height of the pandemic?


----------



## Peak (Apr 14, 2020)

silver said:


> Your group planning to put in VADs and transplant these patients during the height of the pandemic?



The height of the pandemic? The vast majority of our beds in the state sit empty.


----------



## silver (Apr 14, 2020)

Peak said:


> The height of the pandemic? The vast majority of our beds in the state sit empty.


Emphasis on the word planning. ECMO is bridging to somewhere right (even if its recovery) but every path takes time? What is your group's plan during the height of your pandemic if you are taking in these VA patients now?

We certainly are not currently doing VA, even the phrase "STEMI activation" is more or less non-existent.


----------



## VFlutter (Apr 14, 2020)

silver said:


> Emphasis on the word planning. ECMO is bridging to somewhere right (even if its recovery) but every path takes time? What is your group's plan during the height of your pandemic if you are taking in these VA patients now?
> 
> We certainly are not currently doing VA, even the phrase "STEMI activation" is more or less non-existent.



VA-ECMO as bridge to recovery, lesser support i.e Impella, or withdrawal. Our local center has created a separate unit just for COVID ECMO. I know one of the patients went for a valve. I would assume they would still do a VAD if needed. Viral infection isn't a hard stop as with a fungal or bacterial. 



Peak said:


> You can also typically oxygenate better with VA ECMO than VV. You are flow limited on VV as the "venous" side can end up pulling blood from the "arterial" side of the VV catheter. Also keep in mind that ECMO only supports a portion of the cardiopulmonary flow, there is still going to be flow whether on VV or VA through the heart and lungs.
> 
> We very rarely perform VV, we would rather perform VA and suppress native cardiac function.



What are you doing about LV venting? Re-circ is an issue, but can be mitigated, and max achievable Pa02 is less than VA however VV is still an extremely useful modality.


----------



## ffemt8978 (Apr 14, 2020)

Sailor dies from Covid-19 and almost 600 test positive after outbreak on USS Theodore Roosevelt
					

Death of first US active duty military member comes 11 days after captain was fired for voicing concerns over safety of his crew on ship off Guam




					www.theguardian.com


----------



## E tank (Apr 14, 2020)

VFlutter said:


> Some of the patients we are seeing are having significant cardiac complications that could be Cytokine Storm, Myocarditis,  or Kakotsubo like cardiomyopathy requiring VA. Others primarily need VV but may be on high pressor requirments that preclude VV. Generally pressor requirments go down once VV is initiated due to improved oxygenation however some are still crashing so VA is safer. Some are post arrest.
> 
> Some of it is chicken or the egg, do they just happen to be COVID positive or is COVID an instigating factor for MI or worsening HF



I think early on, folks were using VA too soon or inappropriately (ie not VV at the outset) and ending up dealing with north/south syndrome.


----------



## VentMonkey (Apr 14, 2020)

Good stuff shared by the in-hospital/ nursing folks. Certainly way out of my comfort zone. I’d say I’m out of touch. Thanks all.


----------



## Jim37F (Apr 14, 2020)

A local Coast Guard Cutter almost had an outbreak. A Crewman was sick, they took him off just as they left for patrol, and then the guy tested positive for COVID-19, but since he wasn't on board none of the other Coasties tested positive. 









						Early action helps Coast Guard keep coronavirus at bay in Hawaii
					

As fallout continues from the outbreak of COVID-19 aboard the aircraft carrier USS Theodore Roosevelt — with nearly 600 infected and one crew member dead — the Coast Guard appears to have had a close call, but that’s all, with the virus on the Honolulu-based cutter Midgett.




					www.staradvertiser.com


----------



## Jim37F (Apr 14, 2020)

But otherwise, sure looks like the curve is flattening out here. Like last week we were getting 30 new cases each day, today only 5 new cases.









						Hawaii’s coronavirus cases rise by only 5 to a total of 504, health director Bruce Anderson says
					

UPDATE: 4 p.m.




					www.staradvertiser.com


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## Peak (Apr 14, 2020)

silver said:


> Emphasis on the word planning. ECMO is bridging to somewhere right (even if its recovery) but every path takes time? What is your group's plan during the height of your pandemic if you are taking in these VA patients now?
> 
> We certainly are not currently doing VA, even the phrase "STEMI activation" is more or less non-existent.



We only offer ECMO to patients who we believe are likely to benefit, we are pretty strict on the 80/80 rule across the age span. We do not believe in long term ECLS, patients must have a reversible condition of some kind.

Supposedly we are in the height of our pandemic.



VFlutter said:


> What are you doing about LV venting? Re-circ is an issue, but can be mitigated, and max achievable Pa02 is less than VA however VV is still an extremely useful modality.



We start everyone on a pretty high dose of milrinone to decrease SVR and ward off failure. 

We run pretty high flows but try to minimize pressure. We will start nicardipine, labetalol, and nitro drips to keep us at the bottom end of goal pressure. 

We can place impellas in patients who are large enough, but this is very rare. We don't really see any dialated failure in our patients on ECMO though.


----------



## Phillyrube (Apr 14, 2020)

ffemt8978 said:


> Sailor dies from Covid-19 and almost 600 test positive after outbreak on USS Theodore Roosevelt
> 
> 
> Death of first US active duty military member comes 11 days after captain was fired for voicing concerns over safety of his crew on ship off Guam
> ...


He was a Chief.  Dang Wuhan virus.


----------



## Akulahawk (Apr 16, 2020)

Jim37F said:


> But otherwise, sure looks like the curve is flattening out here. Like last week we were getting 30 new cases each day, today only 5 new cases.
> 
> 
> 
> ...


As long as we ALL continue to stay generally away from each other for a while, even after a "go back to work" is declared, we won't overload the hospitals. That's mostly what the "social distancing" was all about. My hospital ED is down about 40% of daily volume, mostly from people that usually see us for their PCP needs. That also means our general acuity level is up and we actually have the beds in-hospital to support those patients so they don't spend much time holding in the ED. That also means people are sometimes waiting too long and they get way sick before they come in.


----------



## E tank (Apr 16, 2020)

Peak said:


> We start everyone on a pretty high dose of milrinone to decrease SVR and ward off failure.
> 
> We run pretty high flows but try to minimize pressure. We will start nicardipine, labetalol, and nitro drips to keep us at the bottom end of goal pressure.



If you have to work so hard to suppress native cardiovascular function why not just do VV?


----------



## Peak (Apr 17, 2020)

E tank said:


> If you have to work so hard to suppress native cardiovascular function why not just do VV?



VV ECMO doesn't allow for as much flow across the membrane decreasing the amount of gas exchange. It also means that if we needed to transition from VV to VA that we would need to do additional surgery, or patients who needed VA to start would need additional surgery to transition to VA.


----------



## VFlutter (Apr 17, 2020)

Peak said:


> VV ECMO doesn't allow for as much flow across the membrane decreasing the amount of gas exchange. It also means that if we needed to transition from VV to VA that we would need to do additional surgery, or patients who needed VA to start would need additional surgery to transition to VA.



Do you only do central cannulations? Your program is primarily Peds and CHD, correct? It sounds like your specific programs preference is heavily towards VA however may not translate elsewhere.

Converting pVV to pVA is pretty straight forward and actually ends up being a better set up, VVA

Choosing good components, including an oxygenator with an adequate rated flow, and multi-stage or triple cannulation there is really no downside to VV ECMO with normal cardiac function. And single access cannula are amazing for longer term VV awaiting transplant.


----------



## E tank (Apr 17, 2020)

Peak said:


> VV ECMO doesn't allow for as much flow across the membrane decreasing the amount of gas exchange. It also means that if we needed to transition from VV to VA that we would need to do additional surgery, or patients who needed VA to start would need additional surgery to transition to VA.



Yes, the accepted oxygenation parameters are lower with VV, but that doesn't mean they aren't acceptable and therapeutic, otherwise no one would do VV.

 These are adults we're talking about? How often do these patients need to be taken to the OR for cannulation? Bedside perc access not a thing where you are?  How often does a pt. need transitioning from VV to VA?


----------



## VFlutter (Apr 17, 2020)

To bring it back to the topic on hand I do think it is prudent to err on the side of VA for COVID patients as anecdotally we are frequently encountering patients who develop severe shock or cardiac dysfunction quickly and unexpectedly.


----------



## FiremanMike (Apr 17, 2020)

Anyone paying attention to Sweden?

Voluntary social distancing, no lockdown, schools still in session, et..  1400 deaths in a population of 10.9 million..

Would love to hear your thoughts..


----------



## akflightmedic (Apr 17, 2020)

FiremanMike said:


> Anyone paying attention to Sweden?
> 
> Voluntary social distancing, no lockdown, schools still in session, et..  1400 deaths in a population of 10.9 million..
> 
> Would love to hear your thoughts..



You mean a country that values human life over profit (from the very top down)? A socialist system that has one of the highest quality of life ratings with access to healthcare, high employment, and many other elements of a civil, proper society which tries to ensure no one suffers?

Yeh, 'Murika is so far from that.


----------



## Peak (Apr 17, 2020)

VFlutter said:


> Do you only do central cannulations? Your program is primarily Peds and CHD, correct? It sounds like your specific programs preference is heavily towards VA however may not translate elsewhere.
> 
> Converting pVV to pVA is pretty straight forward and actually ends up being a better set up, VVA
> 
> Choosing good components, including an oxygenator with an adequate rated flow, and multi-stage or triple cannulation there is really no downside to VV ECMO with normal cardiac function. And single access cannula are amazing for longer term VV awaiting transplant.





E tank said:


> Yes, the accepted oxygenation parameters are lower with VV, but that doesn't mean they aren't acceptable and therapeutic, otherwise no one would do VV.
> 
> These are adults we're talking about? How often do these patients need to be taken to the OR for cannulation? Bedside perc access not a thing where you are?  How often does a pt. need transitioning from VV to VA?



We do neo through adults, CHD and non-CHD. We predominantly do neck and chest cannulation, leg cannulation is pretty rare as we have seen quite a bit of complications from it.

I think the biggest difference between our program and most others is that we don’t see ECMO as a long term intervention. We don’t us ECMO as a bridge to transplant,and we don’t put people on that we don’t think have a good chance of coming off. We are very strict on the 80/80 criteria, and don’t offer it simply because a person is crashing and it is the last thing left to do.

Some patients are cannulated at the bedside, some are done in OR. Regardless cardiac or general surgery come in to cannulate (with the rest of the OR team), and we treat the room as an OR. Compared to most adult CVICUs and MICU/SICUs we consider sterile technique much more strictly, and everyone in the room needs to be in surgical scrubs, do a two minute hand wash with the appropriate sponge, and so on whether they are actually going to scrub in, circulate, or whatever else

Due to a large number of factors we encourage patients who are at the point of lung transplant to either consider palliative care or to move out of state. We used to do lung transplants in the past but outcomes just aren’t that great across multiple local transplant centers. 

Simply put I can easily flow 150-180 mL/kg/min of IWB on VA, I can’t get close to that with almost any VV setup.


----------



## E tank (Apr 17, 2020)

VFlutter said:


> To bring it back to the topic on hand I do think it is prudent to err on the side of VA for COVID patients as anecdotally we are frequently encountering patients who develop severe shock or cardiac dysfunction quickly and unexpectedly.



I guess that's my question...I've not read anything at all about recommendations for "just in case" VA ecmo for patients that only need vv. It isn't a casual decision going to ecmo in the first place, let alone determining which mode to use.


----------



## E tank (Apr 17, 2020)

Peak said:


> Simply put I can easily flow 150-180 mL/kg/min of IWB on VA, I can’t get close to that with almost any VV setup.



😲....12 L/min in a 70 kg pt? Is that really a thing in your covid unit? We are talking covid patients here.


----------



## Peak (Apr 17, 2020)

FiremanMike said:


> Anyone paying attention to Sweden?
> 
> Voluntary social distancing, no lockdown, schools still in session, et..  1400 deaths in a population of 10.9 million..
> 
> Would love to hear your thoughts..



From the data it looks like they are just starting to build cases, and their growth doesn’t seem entirely dissimilar from other countries. Rate of critical illness and death among those tested appear inline with most other counties. I’m not familiar with how many patients they are actually testing, what the criteria to get tested is, et cetera.

So far my experience has been that patients seem to fall into and stay in a few categories. Mild to moderate symptoms that don’t need to come in, moderate to high symptoms that require hospitalization, those that require critical care but have a good clinical course, and those who are on maximized support and have a awful course of illness.

I think the availability of resources is going to most greatly affect those who only require basic hospitalization or have good critical care courses, these are the patients that actually need medical access for survival.

Provided that the system is not overwhelmed (NYC, Italy) I don’t think the specific type of healthcare system as long as it is modern is going to greatly affect survival rates. It seems that those who truly crash in the unit all seem to have the same outcome regardless of specific treatment courses. I suspect that those who turn it around with whatever novel drug trial would likely have done so anyway, though possibly over a longer period of time.


----------



## Peak (Apr 17, 2020)

E tank said:


> 😲....12 L/min in a 70 kg pt? Is that really a thing in your covid unit? We are talking covid patients here.



We have yet to offer ECMO to a COVID patient (so far all of our patients have either done well enough to not need ECMO or their chronic health status makes them very unlikely to recover), but yes we have flowed that high on acute respiratory disease without cardiac component before.


----------



## FiremanMike (Apr 17, 2020)

akflightmedic said:


> You mean a country that values human life over profit (from the very top down)? A socialist system that has one of the highest quality of life ratings with access to healthcare, high employment, and many other elements of a civil, proper society which tries to ensure no one suffers?
> 
> Yeh, 'Murika is so far from that.



Do you believe those items influence the fact their lack of oppressive lockdown is not showing a significant increase in infection/mortality?

FYI Their recorded cases in Sweden started at the beginning of March, which is about when our numbers became trackable, so in terms of viral introduction, they aren't that far behind us (if you believe covid didn't enter the US before late February..)


----------



## akflightmedic (Apr 17, 2020)

I just like being snarky. 

I looked up their stats...not terrible but not amazingly diminished either. They are willing to try something different, so at least we will have a model to compare our actions versus others for when the next wave hits.

But even if their model worked, we (USA) would never copy it. We like to be stubborn mostly...


----------



## FiremanMike (Apr 17, 2020)

akflightmedic said:


> I just like being snarky.
> 
> I looked up their stats...not terrible but not amazingly diminished either. They are willing to try something different, so at least we will have a model to compare our actions versus others for when the next wave hits.
> 
> But even if their model worked, we (USA) would never copy it. We like to be stubborn mostly...



I’m not necessarily saying their mode worked, but it’s really the only comparison we have to say whether or not our strict lockdown was useful..


----------



## Peak (Apr 17, 2020)

FiremanMike said:


> Do you believe those items influence the fact their lack of oppressive lockdown is not showing a significant increase in infection/mortality?
> 
> FYI Their recorded cases in Sweden started at the beginning of March, which is about when our numbers became trackable, so in terms of viral introduction, they aren't that far behind us (if you believe covid didn't enter the US before late February..)



I don’t believe we actually started in February, I think we started seeing cases as early as December based on the number of FLS kids we saw in the state with negative influenzas.

I think one of the greatest hurdles we face in making any kind of reliable model is how little reliable testing we actually have.


----------



## VFlutter (Apr 17, 2020)

E tank said:


> I guess that's my question...I've not read anything at all about recommendations for "just in case" VA ecmo for patients that only need vv. It isn't a casual decision going to ecmo in the first place, let alone determining which mode to use.



To clarify, I am not advocating placing hemodynamically stable patients only in need of respiratory support on VA ECMO just in case however there are some patients who are borderline, on minmal to moderate vasopressor support or slight cardiac dysfunction, that traditionally would be expected to improve with VV support may be better off leading towards early VA due to how we have been seeing COVID patients progress.

There are many recommendations for ECMO but when it comes down to shocky patients with multi-system organ failure the decision on which mode to initiate gets a little grey. Some stabilize quickly after improved oxygenation with VV ECMO and come off pressor support, some do not and require conversion to VA. However with a COVID positive patient I would rather cannulate once and not have to crash on to VA or code a patient on VV later



Peak said:


> Simply put I can easily flow 150-180 mL/kg/min of IWB on VA, I can’t get close to that with almost any VV setup.



Why would you need to flow that much? What pump and oxygenator are you using? Because the rated flow of Ped Quadrox is ~3L so any kid over 11kg is out of luck


----------



## Peak (Apr 17, 2020)

VFlutter said:


> Why would you need to flow that much? What pump and oxygenator are you using? Because the rated flow of Ped Quadrox is ~3L so any kid over 11kg is out of luck



Our perfusionists built our ECMO setups with various parts that they prefer, it’s a bit of a Frankenstein machine.

We titrate flow based on the patient goals. If they aren’t perfusing and need more flow (as opposed to some other intervention), they get more flow. We favor flow and filling the vascular space over pressors or needing to rely on using the lungs in addition to the pump. 

Again, we don’t view ECMO as an early therapy, so by the time we cannulate our patients are pretty sick (probably more so than most other programs). Based on prior ECMO conversations here we evidently also staff to a much higher level than many other ECMO programs.


----------



## silver (Apr 17, 2020)

Peak said:


> We have yet to offer ECMO to a COVID patient (so far all of our patients have either done well enough to not need ECMO or their chronic health status makes them very unlikely to recover), but yes we have flowed that high on acute respiratory disease without cardiac component before.



Oh my comment earlier I thought you were putting COVID patients on...oops.


----------



## Carlos Danger (Apr 17, 2020)

FiremanMike said:


> Anyone paying attention to Sweden?
> 
> Voluntary social distancing, no lockdown, schools still in session, et..  1400 deaths in a population of 10.9 million..
> 
> Would love to hear your thoughts..



Exactly what we should have been doing in most of the US: Strongly advise the vulnerable to quarantine themselves, and advise everyone else to clean their hands frequently and use common sense. Done.

Instead, we are trying to force EVERYONE to stay home, and citing paddle boarders and surfers (CA) and people going for early morning jogs on empty beaches (NC), and giving $500 tickets to people attending church services in their cars with their windows rolled up (MS) and making people wear filthy, completely ineffective cloth masks in public (NY).  We're telling people that they can go to Home Depot but they can't buy paint or gardening supplies but they can buy state lottery tickets (MI), and people from out to state can come in to vacation in rental homes, but state residents can't go to their own second residences (MI). The feds have added $2T to our already outrageous debt and weakened the dollar by printing $4T out of thin air, all so that they can send $1,200 checks to people who haven't lost their jobs and give massive amounts of money (that they could never justify doing on its own merits) to a laundry list of pet industries that have absolutely nothing to do with the pandemic.

Obliterating individual liberties, putting millions of people out of work, destroying businesses, AND putting the lead foot down on the accelerator of the car headed towards fiscal ruin, over a virus that will likely end up having a CFR comparable to the seasonal flu. Awesome! 

Whatever small amount of faith I still had in our political "leaders" before March is all used up now.



akflightmedic said:


> You mean a country that values human life over profit (from the very top down)? A socialist system that has one of the highest quality of life ratings with access to healthcare, high employment, and many other elements of a civil, proper society which tries to ensure no one suffers?
> 
> Yeh, 'Murika is so far from that.



Not to get off topic, but Sweden is not a socialist country. The have a thriving market economy and actually rank higher in some indexes of economic freedom than the US does. They do have a generous welfare state. Thats pretty easy to manage when you have a tiny, culturally homogenous population, a very healthy GDP per capita, little debt and a political system that actually works.


----------



## akflightmedic (Apr 17, 2020)

Not to go off topic, but I did not say they were a socialist country. I said "socialist system". And who are you? Name changer should let people know....LOL


----------



## VFlutter (Apr 17, 2020)

akflightmedic said:


> Not to go off topic, but I did not say they were a socialist country. I said "socialist system". And who are you? Name changer should let people know....LOL



I vote for a "Artist formally known as..." feature


----------



## Seirende (Apr 17, 2020)

VFlutter said:


> I vote for a "Artist formally known as..." feature



There's a username change history feature


----------



## RedBlanketRunner (Apr 18, 2020)

Want to do a comparison try Singapore right now. Report a fever and there's a solid chance you will be on your way to a hospital in an ambulance in an hour. When your country only has people as a natural resource things are decidedly different.


----------



## chriscemt (Apr 19, 2020)

FiremanMike said:


> Anyone paying attention to Sweden?



According to the IHME site the projected peak in Sweden is the 29th of April; they will require 1093 ICU beds and have only 79 available.

They will definitely be the interesting counterpoint to social distancing.


----------



## FiremanMike (Apr 19, 2020)

chriscemt said:


> According to the IHME site the projected peak in Sweden is the 29th of April; they will require 1093 ICU beds and have only 79 available.
> 
> They will definitely be the interesting counterpoint to social distancing.



There's only 79 ICU beds in the entire country of Sweden?


----------



## chriscemt (Apr 19, 2020)

FiremanMike said:


> There's only 79 ICU beds in the entire country of Sweden?



_According to https://covid19.healthdata.org/sweden_, "*ICU beds available* is the total number of ICU beds available for COVID patients minus the average historical ICU bed use."


----------



## SandpitMedic (Apr 19, 2020)

Carlos Danger said:


> Exactly what we should have been doing in most of the US: Strongly advise the vulnerable to quarantine themselves, and advise everyone else to clean their hands frequently and use common sense. Done.
> 
> Instead, we are trying to force EVERYONE to stay home, and citing paddle boarders and surfers (CA) and people going for early morning jogs on empty beaches (NC), and giving $500 tickets to people attending church services in their cars with their windows rolled up (MS) and making people wear filthy, completely ineffective cloth masks in public (NY).  We're telling people that they can go to Home Depot but they can't buy paint or gardening supplies but they can buy state lottery tickets (MI), and people from out to state can come in to vacation in rental homes, but state residents can't go to their own second residences (MI). The feds have added $2T to our already outrageous debt and weakened the dollar by printing $4T out of thin air, all so that they can send $1,200 checks to people who haven't lost their jobs and give massive amounts of money (that they could never justify doing on its own merits) to a laundry list of pet industries that have absolutely nothing to do with the pandemic.
> 
> ...


Wow. Can I get an _AMEN_!


----------



## Summit (Apr 19, 2020)

FiremanMike said:


> Anyone paying attention to Sweden?
> 
> Voluntary social distancing, no lockdown, schools still in session, et..  1400 deaths in a population of 10.9 million..
> 
> Would love to hear your thoughts..


If you scaled Swedens 1540 deaths up to the US population it would be 46,370 to the US's 39,291. Sweden is a poor comparison to non-nordics and it is a misconception that they are doing nothing.

Swedes naturally social distance, many live alone, very high rate of remote workers, and as a smaller more cohesive society than the US, naturally do the things they ought to be doing to limit the virus. There are a lot of factory and business shutdowns/furloughs, much tourism and travel have stopped, domestic traffic is way down. Schools are running normally for younger children.


----------



## RedBlanketRunner (Apr 19, 2020)

Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk.  + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.


----------



## E tank (Apr 19, 2020)

RedBlanketRunner said:


> Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk.  + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.


So...getting my Casio hand computer calculator out....famine,  war lord of the flies culture, 3rd world  totalitarian opportunistic thuggery....Covid flu not even sparking on the radar....I'm missing the point...obviously....


people lucky to be dying of Covid-19 in CAR...am I close?


----------



## Bullets (Apr 19, 2020)

RedBlanketRunner said:


> Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk.  + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.


Which i am sure will get totally equal coverage on western news....


----------



## Akulahawk (Apr 20, 2020)

RedBlanketRunner said:


> Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk.  + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.


Honestly, I really don't think COVID19 is going to really have much of a blip on things there. For much of Africa, COVID19 will either go largely unrecognized for what it is or many of the really sick will die before they're able to reach (or often afford) high-quality healthcare that is capable of handling vented patients. The ones that have severe symptoms and don't die will eventually recover and it'll (sadly) be just another problem among all the other problems there. It's for all those "religious, regional, cultural, and logistics issues" that I say this.


----------



## Akulahawk (Apr 20, 2020)

Bullets said:


> Which i am sure will get totally equal coverage on western news....


Oh yeah... and on the front page of what newspapers there are left...🙄


----------



## SandpitMedic (Apr 20, 2020)

E tank said:


> So...getting my Casio hand computer calculator out....famine,  war lord of the flies culture, 3rd world  totalitarian opportunistic thuggery....Covid flu not even sparking on the radar....I'm missing the point...obviously....
> 
> 
> people lucky to be dying of Covid-19 in CAR...am I close?


Not only are you close... you are on the X!


----------



## Summit (Apr 20, 2020)

I think the primary danger for Africa is if it goes exponential, you could end up with societal and supply chain disruptions of the type the rest of the world is avoiding with public health measures in the US. That is to say, the economy grinds to a halt when people stop going to work because they are sick, taking care of someone who is sick, going to the funeral of someone who was sick, or afraid to show up because they might become sick. This bug spreads a lot easier than ebola. On the other hand, the population age pyramid and comorbidity distribution (as it relates to COVID) is in Africa's favor vs say Italy or USA.


----------



## VFlutter (Apr 20, 2020)

Akulahawk said:


> It's for all those "religious, regional, cultural, and logistics issues" that I say this.



Just like the Ebloa outbreak when it was nearly impossible to stop some tribes from spending the night in the same room as their deceased relatives or to touch the body as part of the mourning process.

Side note, The Hot Zone is an awesome book


----------



## Summit (Apr 20, 2020)

VFlutter said:


> Just like the Ebloa outbreak when it was nearly impossible to stop some tribes from spending the night in the same room as their deceased relatives or to touch the body as part of the mourning process.
> 
> Side note, The Hot Zone is an awesome book


Read Preston's new book: Crisis in the Red Zone
It is about the 2014 ebola epidemic. It is every bit as good.


----------



## mgr22 (Apr 20, 2020)

Today, I heard for the first time about blood clots anecdotally linked to COVID-19. I'm wondering if any of you have information to share on that; specifically:
1. Are we talking about, say, DIC, or isolated clots?
2. Could cytokine storms be responsible? The literature sounds like that could go either way.
3. What about NSAIDs like ibuprofen and naproxen?

I wasn't able to find studies on this yet, probably because there aren't any.

Thoughts?


----------



## Peak (Apr 20, 2020)

mgr22 said:


> Today, I heard for the first time about blood clots anecdotally linked to COVID-19. I'm wondering if any of you have information to share on that; specifically:
> 1. Are we talking about, say, DIC, or isolated clots?
> 2. Could cytokine storms be responsible? The literature sounds like that could go either way.
> 3. What about NSAIDs like ibuprofen and naproxen?
> ...



I know that an elevated dimer seems to be present in almost every critically ill patient we have seen. Most have had negative vascular ultrasounds and I haven’t  seen a remarkable number of PEs. Dimers can certainly be elevated for a variety of reasons beyond clotting, and I’m not entirely sure we fully understand the link.

Increased risk of clotting isn’t unknown in large infections or immobility from bed rest. We have almost all of our COVID patients on heparin in some form, but typically our dosing is just consistent with DVT or line prophylaxis.


----------



## rescue1 (Apr 20, 2020)

mgr22 said:


> Today, I heard for the first time about blood clots anecdotally linked to COVID-19. I'm wondering if any of you have information to share on that; specifically:
> 1. Are we talking about, say, DIC, or isolated clots?
> 2. Could cytokine storms be responsible? The literature sounds like that could go either way.
> 3. What about NSAIDs like ibuprofen and naproxen?
> ...




A lot of the website is a bit excessive for EMS, but Josh Farkas at the Internet Book of Critical Care has a section on COVID where he discusses the prothrombotic state that patients seem to be in.

Obviously it's based on very flimsy evidence but that's about as good as it gets right now.


----------



## mgr22 (Apr 20, 2020)

rescue1 said:


> A lot of the website is a bit excessive for EMS, but Josh Farkas at the Internet Book of Critical Care has a section on COVID where he discusses the prothrombotic state that patients seem to be in.
> 
> Obviously it's based on very flimsy evidence but that's about as good as it gets right now.



Thanks. This looks like an important part of what you linked:


COVID produces a form of disseminated intravascular coagulation (DIC) which is usually marked by hypercoagulability.
The exact causes of this are unclear and likely numerous.  They could include the following:
(1) Inflammation (e.g. IL-6) stimulates up-regulation of fibrinogen synthesis by the liver (Carty 2010).
(2) Virus may bind directly to endothelial cells.

There is likely a bi-directional, synergistic relationship between DIC and cytokine storm (wherein each exacerbates the other).
DIC appears to be a driver of disease severity.  As might be expected, it is a strong prognostic factor for poor outcome (Tang et al. 2020).
Microthrombi have been reported as autopsy findings in patients with COVID-19 (Luo et al.)


----------



## silver (Apr 20, 2020)

Peak said:


> I know that an elevated dimer seems to be present in almost every critically ill patient we have seen. Most have had negative vascular ultrasounds and I haven’t  seen a remarkable number of PEs. Dimers can certainly be elevated for a variety of reasons beyond clotting, and I’m not entirely sure we fully understand the link.
> 
> Increased risk of clotting isn’t unknown in large infections or immobility from bed rest. We have almost all of our COVID patients on heparin in some form, but typically our dosing is just consistent with DVT or line prophylaxis.



As you mention its not uncommon to be coagulopathic with infections. With a relative increase severe sepsis from COVID presenting to hospitals across the world, its hard to say if there is an increased rate of sepsis induced coagulopathy vs. we are just seeing so much of the same disease and don't have a treatment. I often don't check D-dimers, so not surprised that I see more elevated numbers than normal.

That being said, I anecdotally feel like I am seeing a ton of high dimers, some DVTs, dialysis lines clotting and also RV dysfunction suggestive of PE. However will reference back to my original statement. Some academic systems are full dose anticoagulating high D-dimers without evidence of clinically significant clots while others are just promoting aggressive prophylaxis. Only the data will tell us.




rescue1 said:


> A lot of the website is a bit excessive for EMS, but Josh Farkas at the Internet Book of Critical Care has a section on COVID where he discusses the prothrombotic state that patients seem to be in.
> 
> Obviously it's based on very flimsy evidence but that's about as good as it gets right now.



Some of his recommendations in there appear to not be completely consistent with what other people are experiencing, however overall its a great primer.


----------



## rescue1 (Apr 20, 2020)

silver said:


> Some of his recommendations in there appear to not be completely consistent with what other people are experiencing, however overall its a great primer.



Yeah I've noticed that too. I don't think there's any one source that we can individually rely on right now for COVID, but his is definitely the most comprehensive all in one place.


----------



## Carlos Danger (Apr 20, 2020)

rescue1 said:


> Yeah I've noticed that too. I don't think there's any one source that we can individually rely on right now for COVID, but his is definitely the most comprehensive all in one place.


I would agree. Of all the resources out there, PulmCrit is probably my favorite.

This one is not strictly clinical, but is also good: Brief19


----------



## Peak (Apr 20, 2020)

silver said:


> That being said, I anecdotally feel like I am seeing a ton of high dimers, some DVTs, dialysis lines clotting and also RV dysfunction suggestive of PE. However will reference back to my original statement.



What are you treating your patients with? We haven’t seen PEs but have a seen a significant amount of pulmonary hypertension and have gotten decent (although typically temporary) improvement with nitric.


----------



## silver (Apr 20, 2020)

Peak said:


> What are you treating your patients with? We haven’t seen PEs but have a seen a significant amount of pulmonary hypertension and have gotten decent (although typically temporary) improvement with nitric.



We haven't really been scanning people. Ive had 2 patients in new refractory shock w/ severe RV dysfunction on POCUS (no hx) and known DVTs with markers suggestive of hyper-coagulable state. Started on iNO and epi and have done ok for now. We aren't really lysing much either, just riding out therapeutic AC. Its a different world when you have >150 covid ICU patients in house.


----------



## Peak (Apr 20, 2020)

silver said:


> We haven't really been scanning people. Ive had 2 patients in new refractory shock w/ severe RV dysfunction on POCUS (no hx) and known DVTs with markers suggestive of hyper-coagulable state. Started on iNO and epi and have done ok for now. We aren't really lysing much either, just riding out therapeutic AC. Its a different world when you have >150 covid ICU patients in house.



For sure. When we scan we have to shut down the room for an hour before we can even start the terminal clean. We are pretty resource rich and since we have canceled a lot of electives we have been able to use the IR/Hybrid CTs without affecting our main CTs.


----------



## mgr22 (Apr 21, 2020)

Apparently, CORONA-19 associated coagulopathy, or CAC, is now a thing. Here's an article that compares and contrasts it to DIC and suggests treatment:





__





						COVID-19 and Coagulopathy - Hematology.org
					

COVID-19 and Coagulopathy




					hematology.org
				




To me, this seems like an underreported reason for continued caution among even the young and healthy.


----------



## GMCmedic (Apr 23, 2020)

New study suggest Covid-19 is not likely to be transmitted sexually. 


Glad someone wasted their time with that one.


----------



## E tank (Apr 23, 2020)

GMCmedic said:


> New study suggest Covid-19 is not likely to be transmitted sexually.
> 
> 
> Glad someone wasted their time with that one.


 Thus the importance of study design...." not likely to be transmitted sexually."

 How about while having sex?


----------



## Carlos Danger (Apr 23, 2020)

E tank said:


> Thus the importance of study design...." not likely to be transmitted sexually."
> 
> *How about while having sex?*


No, you are fine as long as you wear a PAPR and use hand sanitizer after.


----------



## CCCSD (Apr 23, 2020)

PAPRs blow...


----------



## DesertMedic66 (Apr 23, 2020)

Carlos Danger said:


> No, you are fine as long as you wear a PAPR and use hand sanitizer after.


Hold on a second babe, I need protection.


----------



## ffemt8978 (Apr 24, 2020)




----------



## SandpitMedic (Apr 24, 2020)

... actually butt stuff can give you COVID as the virus is shed through fecal material


----------



## VentMonkey (Apr 24, 2020)

ffemt8978 said:


> View attachment 4926


Lol I was gonna post this reference but you beat me to it. Now I’m simply wondering how many people on here are old enough to remember this...


SandpitMedic said:


> ... actually butt stuff can give you COVID as the virus is shed through fecal material


True statement. However, the only other person I’ve heard make mention of this was Eric Bauer.


----------



## SandpitMedic (Apr 24, 2020)

VentMonkey said:


> True statement. However, the only other person I’ve heard make mention of this was Eric Bauer.


Well that’s ‘cause he likes butt stuff 😂


----------



## SandpitMedic (Apr 27, 2020)

Dwindling... like seriously. Almost as if the response was overblown. Or was it?


----------



## akflightmedic (Apr 27, 2020)

"If you stay at home and nothing happens...THAT's the POINT!"

Just sayin...

Toothpaste never became popular until they added a chemical that made it froth.
Febreeze is odorless yet effective. The company nearly bankrupted, until they added a fake scent.

Human psychology dictates we have to "see" things working.


----------



## FiremanMike (Apr 27, 2020)

SandpitMedic said:


> Dwindling... like seriously. Almost as if the response was overblown. Or was it?



I think the only way we’ll know for sure is what the numbers look like after this quarantine is lifted..

I was thinking this week though - this quarantine is a joke.  We‘re still leaving the house, we’re still touching things, we’re still interacting with people.. I’d bet we’ve come direct and indirect contact with pretty much everyone by now at least once..


----------



## Carlos Danger (Apr 27, 2020)

SandpitMedic said:


> Dwindling... like seriously. Almost as if the response was overblown. Or was it?


But millions upon millions would be dead in the US alone if if not for the destruction of countless businesses, the creation of record unemployment and budget deficits, and the wrecking of our economy!

I mean, can you just imagine the carnage if we hadn't sent stimulus checks to folks who didn't lose their jobs, given hundreds of millions in small business loans to profitable mega-corporations, given millions in pork to the museum industry, and arrested people for jogging on empty beaches in the early morning hours or for listening to easter church services over their car radio with the windows rolled up?!?!


----------



## GMCmedic (Apr 27, 2020)

FiremanMike said:


> I think the only way we’ll know for sure is what the numbers look like after this quarantine is lifted..
> 
> I was thinking this week though - this quarantine is a joke. We‘re still leaving the house, we’re still touching things, we’re still interacting with people.. I’d bet we’ve come direct and indirect contact with pretty much everyone by now at least once..



I think the data coming out of New york, USC, and now berkely is enough to confidently say the mortality rate is under 1%.


----------



## mgr22 (Apr 27, 2020)

GMCmedic said:


> I think the data coming out of New york, USC, and now berkely is enough to confidently say the mortality rate is under 1%.



One key statistic that will trail all others is long-term disability. I'm guessing it will be many times higher than mortality.


----------



## SandpitMedic (Apr 27, 2020)

If you look at the Sweden data objectively (very hard thing for people to do these days) you can see that shutdowns were not necessary.

The vulnerable needed to be sheltered and protected. Everyone else- not so much. It was life as normal. 

I’ll bet when antibody testing like that done in CA becomes more mainstream the data will show was already out on the community which is more data to show lock downs were not necessary.

To those claiming “we will never know” how lockdowns helped saved civilization and countless lives or if it was worth it to suicide the economy... yes we will- the answer is no it wasn’t. It’s not political. It is demonstrably a fact.


----------



## FiremanMike (Apr 27, 2020)

mgr22 said:


> One key statistic that will trail all others is long-term disability. I'm guessing it will be many times higher than mortality.



I was unaware of long term disability - I thought people either died or recovered.



SandpitMedic said:


> If you look at the Sweden data objectively (very hard thing for people to do these days) you can see that shutdowns were not necessary.
> 
> The vulnerable needed to be sheltered and protected. Everyone else- not so much. It was life as normal.
> 
> ...



People will argue that Sweden is different because of reasons.. So in my mind, the true apples to apples will be on May 1, when we start to lift this "quarantine".  If we see an explosion of cases, it'll indicate it was as virulent as they said.  If we see an explosion of deaths, it may indicate it was as deadly as they said. 

I will concede these points - the data does indicate that this was more rapidly fatal than the flu, in that we are 8 weeks in from our first reported "this is a covid death" patient to today and we're seeing a mortality statistic which is similar to a typical 6 month flu season.  It is also worth noting that on the data I've been charting since March 1 (from the WHO numbers), the mortality % compared to confirmed cases has actually steadily rose instead of steadily fallen, which is what I would have suspected as tests became more available.


----------



## mgr22 (Apr 27, 2020)

FiremanMike said:


> I was unaware of long term disability - I thought people either died or recovered.



The immune systems of some patients overreact to the virus, leading to organ damage. Also, there's a syndrome known as CAC (COVID-19 associated coagulopathy) which can cause emboli leading to CVA, MI, etc. CAC may be an aberrant immune response, too. And I'm pretty sure being on O2 and a vent for a while can lead to permanent lung damage, but I defer to the respiratory experts out there on that one.


----------



## silver (Apr 27, 2020)

FiremanMike said:


> I was unaware of long term disability - I thought people either died or recovered.
> 
> 
> 
> ...



Same with every other illness w/ prolonged hospitalization, people are seriously debilitated and experiencing all the complications that come with that. Many will have lasting damage to their lungs as seen in your run of the mill severe pneumonia as well. Those who survive the ICU will more or less be trached and many recovering from serious kidney damage and clots (DVTs/PEs, MIs, CVAs).

Saying you can translate the data from Sweden to the US seems like a stretch. Sweden can really only be compared to similar EU countries. The US population is less healthy, more self centered, and has different end of life values while being set in a very different type of health system.


----------



## PotatoMedic (Apr 27, 2020)

Crush the curve Idaho has been doing mass antibody testing for anyone who wants it and they are finding about 1.8% of the people tested has the antibodies.


----------



## FiremanMike (Apr 27, 2020)

silver said:


> Saying you can translate the data from Sweden to the US seems like a stretch. Sweden can really only be compared to similar EU countries. The US population is less healthy, more self centered, and has different end of life values while being set in a very different type of health system.



I didn't say that, I said apples to apples will be on May 1.. I was referencing May 1 in America..


----------



## silver (Apr 27, 2020)

FiremanMike said:


> I didn't say that, I said apples to apples will be on May 1.. I was referencing May 1 in America..


Oh I know, I just didn't want to spend the time cutting your comment to quote only part of it about disability... 

But I also don't think you can compare May 1 as apples in the US unless we had a similar population that didn't take the same interventions as us. We have drastically increased supply chains of PPE + testing capacity, increased availability of hospital beds, increased understanding of the disease process, and society will be more cautious and aware.


----------



## GMCmedic (Apr 27, 2020)

FiremanMike said:


> I was unaware of long term disability - I thought people either died or recovered.
> 
> 
> 
> ...


Not that it makes much difference but were nearly 12 weeks in. The first known death was february 6th in California,confirmed by pathology results.


----------



## FiremanMike (Apr 27, 2020)

silver said:


> Oh I know, I just didn't want to spend the time cutting your comment to quote only part of it about disability...
> 
> But I also don't think you can compare May 1 as apples in the US unless we had a similar population that didn't take the same interventions as us. We have drastically increased supply chains of PPE + testing capacity, increased availability of hospital beds, increased understanding of the disease process, and society will be more cautious and aware.



Just so we’re on the same page, I mean post May 1 America compared to pre May 1 America..


----------



## silver (Apr 27, 2020)

FiremanMike said:


> Just so we’re on the same page, I mean post May 1 America compared to pre May 1 America..


Yea over time things change, I mentioned some of them. I think the only conclusion we could make if we go from full on quarantine to no quarantine on May 1st and there is a huge spike in cases is that some interventions (of the ones we implemented) were likely helpful. If no huge spike you really can't make a conclusion.


----------



## MMiz (Apr 28, 2020)

Is access to PPE improving?


----------



## FiremanMike (Apr 28, 2020)

MMiz said:


> Is access to PPE improving?



We're set for everything but gowns..  Battelle developing their sterilization process for respirators and masks is a godsend..


----------



## DesertMedic66 (Apr 28, 2020)

MMiz said:


> Is access to PPE improving?


I will admit that our company has been on top of things. Plenty of gowns, surgical masks, N95s company wide. We are now working with hospitals who are having difficulties to help them source PPE. We are now wearing PPE on all flights regardless of patient complaint and while at base using surgical masks.


----------



## GMCmedic (Apr 28, 2020)

We're good I haven't even worn an N95 since this whole thing started.


----------



## PotatoMedic (Apr 28, 2020)

Were good on supplies.  N95 gown gloves eyes and a surgical mask on all calls.  All patients get a surgical mask as well.  Hoping the gowns on all end before the summer hits.


----------



## DesertMedic66 (Apr 28, 2020)

PotatoMedic said:


> Were good on supplies.  N95 gown gloves eyes and a surgical mask on all calls.  All patients get a surgical mask as well.  Hoping the gowns on all end before the summer hits.


Summer has already hit here. High today was 107


----------



## Bullets (Apr 28, 2020)

Gowns and Surgical masks are still hard to come by, and the hospitals requiring us provide a surgical mask really hit us hard for like a week, but at this point it seems like every Larry, Moe and Curly has their own N95, so that helps. Gowns are still and issue, however we have been getting suits donated from contractors and we had a decent amount stocked from Ebola


----------



## E tank (Apr 28, 2020)

Bold statements that are really going out on a limb...seem like normal guys...not suicidal....clearly they believe what they're saying publicly is worth the heat they're getting...









						Accelerated Urgent Care doctors recommend lifting shelter-in-place order
					

Doctor and co-owners of Accelerated Urgent Care in Bakersfield say it may not be necessary anymore for residents to shelter-in-place.




					www.turnto23.com
				













						Joint statement issued by national physicians’ groups calls local doctors' statement "reckless and untested musings"
					






					www.turnto23.com


----------



## SandpitMedic (Apr 28, 2020)

E tank said:


> Bold statements that are really going out on a limb...seem like normal guys...not suicidal....clearly they believe what they're saying publicly is worth the heat they're getting...
> 
> 
> 
> ...


They’re right. Get out and play unless you have a reason to be sincerely concerned of getting ill.


----------



## GMCmedic (Apr 28, 2020)

E tank said:


> Bold statements that are really going out on a limb...seem like normal guys...not suicidal....clearly they believe what they're saying publicly is worth the heat they're getting...
> 
> 
> 
> ...


ACEP and AAEM released a joint statement on this today.









						ACEP-AAEM Joint Statement on Physician Misinformation
					

The American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) jointly and emphatically condemn the recent opinions released by Dr. Daniel Erickson and Dr. Artin Massihi. These reckless and untested musings do not speak for medical societies and are...




					www.acep.org


----------



## Summit (Apr 28, 2020)

Their data was obviously skewed and math comically bad. They cannot Really be that incompetent.... Ulterior motive seems likely.


----------



## catherder (Apr 29, 2020)

Summit said:


> Their data was obviously skewed and math comically bad. They cannot Really be that incompetent.... Ulterior motive seems likely.



I'm glad the ACEP put out that statement but unfortunately, the horse has left the proverbial barn. The video of these two docs has gone viral- pardon the term.


----------



## GMCmedic (Apr 29, 2020)

Looks like remdesivir is going to get Fauci and FDA approval


----------



## Phillyrube (Apr 29, 2020)

Hey, how come all those *** holes in Congress and TV all have haircuts and nice nails and makeup?????


----------



## ffemt8978 (Apr 29, 2020)

Phillyrube said:


> Hey, how come all those *** holes in Congress and TV all have haircuts and nice nails and makeup?????


Because nobody trusts them to hamdle sharp objects by themselves.


----------



## Peak (Apr 29, 2020)

GMCmedic said:


> Looks like remdesivir is going to get Fauci and FDA approval



I’ve had a couple of patients on it. For those who are profoundly sick (conventional vents with 20+ peep, inverse ration, HFOV...)  it doesn’t seem to be delivering on the hype. Even those on more conventional settings there isn’t this instantaneous turn around that I think has been projected in the media.

I do worry that if it gets approved (and subsequently there doesn’t need to be study inclusion or compassionate appeal) that it will end up bought up for low acuity patients and that referral hospitals will not be able to actually get it.


----------



## E tank (Apr 29, 2020)

catherder said:


> I'm glad the ACEP put out that statement but unfortunately, the horse has left the proverbial barn. The video of these two docs has gone viral- pardon the term.


Well, they really probably should have stopped with the 2 paragraph joint statement. If these two guys turn out to be right, even by accident, the "additional information" part will look pretty dumb. And the reality is, everyone is speculating, there have been pretty serious flaws in some credible epidemiologic models and data gathering and interpretation and what will actually happen is  pretty much up for grabs. 

They absolutely were correct in making the first statement, but IMO should have left it at that.


----------



## E tank (Apr 29, 2020)

Peak said:


> I’ve had a couple of patients on it. For those who are profoundly sick (conventional vents with 20+ peep, inverse ration, HFOV...)  it doesn’t seem to be delivering on the hype. Even those on more conventional settings there isn’t this instantaneous turn around that I think has been projected in the media.
> 
> I do worry that if it gets approved (and subsequently there doesn’t need to be study inclusion or compassionate appeal) that it will end up bought up for low acuity patients and that referral hospitals will not be able to actually get it.



It's more useful early than late.


----------



## Peak (Apr 29, 2020)

E tank said:


> It's more useful early than late.



Sure, but the profoundly sick drop quick. Most of our extremely sick patients went from asymptomatic to maximized therapy in less than 48 hours, many in less than 24.


----------



## E tank (Apr 30, 2020)

Peak said:


> Sure, but the profoundly sick drop quick. Most of our extremely sick patients went from asymptomatic to maximized therapy in less than 48 hours, many in less than 24.


Right, so this isn't the population that it is showing benefit in.


----------



## Peak (Apr 30, 2020)

E tank said:


> Right, so this isn't the population that it is showing benefit in.



Certainly those who are profoundly sick must be part of the studies if decreased mortality is a signficiant finding. The healthy ones don't die.


----------



## SandpitMedic (Apr 30, 2020)

E tank said:


> If these two guys turn out to be right, even by accident...
> ...the reality is, everyone is speculating, there have been pretty serious flaws in some credible epidemiologic models and data .


100% spot on...
This is the thing... no one knows for certain. The fact that no one wants to give these guys any credit and immediately flag them as crack pots who shouldn’t be listened to under any circumstances makes me more likely to side with them and to do my own research.

I’ve heard a lot of comparisons- Sweden to Norway is not one I’ve heard, and instead of giving it any credence, people just blanket them as putting out misinformation.

I realize I’m in the minority. I also realize anyone who isn’t on the apocalypse train is quickly lambasted by the media. Makes my spider senses tingle.


----------



## Seirende (May 6, 2020)

Health authorities shut Brooklyn funeral home for improperly storing bodies in U-Haul trucks | amNewYork
					

BY JESSICA PARKS




					www.amny.com


----------



## SandpitMedic (May 9, 2020)

How’s the Rona in y’all’s neck of the woods nowadays?

Seems like other than NYC it’s a big old dud outside of nursing homes and the severely immunocompromised.


----------



## GMCmedic (May 9, 2020)

SandpitMedic said:


> How’s the Rona in y’all’s neck of the woods nowadays?
> 
> Seems like other than NYC it’s a big old dud outside of nursing homes and the severely immunocompromised.


Underwhelming


----------



## Jim37F (May 9, 2020)

600 something people tested positive statewide, less than 20 deaths, only like 50 or 60 active cases, the rest are all "released from isolation"


----------



## Peak (May 10, 2020)

SandpitMedic said:


> How’s the Rona in y’all’s neck of the woods nowadays?
> 
> Seems like other than NYC it’s a big old dud outside of nursing homes and the severely immunocompromised.



Very underwhelming.


----------



## Akulahawk (May 10, 2020)

Peak said:


> Very underwhelming.


Thankfully, very underwhelming.


----------



## ffemt8978 (May 10, 2020)

Akulahawk said:


> Thankfully, very underwhelming.


While I'm grateful it has been mostly underwhelming, I'm worried we've created a 'boy who cried wolf' scenario for the next pandemic.


----------



## Peak (May 10, 2020)

ffemt8978 said:


> While I'm grateful it has been mostly underwhelming, I'm worried we've created a 'boy who cried wolf' scenario for the next pandemic.



I agree. All of the epidemilogical models were based on very limited data and poor methods, and then sold as a guarantee of a disaster. I worry about the public trust in the medical field as a whole.


----------



## Akulahawk (May 10, 2020)

ffemt8978 said:


> While I'm grateful it has been mostly underwhelming, I'm worried we've created a 'boy who cried wolf' scenario for the next pandemic.


This is a concern of mine as well. This pandemic has been a bit insidious, actually. It appears that this actually got going much earlier than most of the world realized and also spread faster/farther than initially realized. I quite suspect that among certain groups, this is probably a wake-up call. Our world is _very_ interconnected and we can pretty much go from anywhere to anywhere inside 24 hours, if we wanted. From a certain viewpoint (bioweapons), this particular pandemic has been quite instructive. From an epidemiological standpoint, it's also being very instructive as well, in particular, when to focus on containment, when to focus on mitigation, when to focus on vulnerable populations, and when to focus on isolation of key infrastructure/industry/government personnel to ensure that all stays up and running. It also (hopefully) will instruct disaster planners about just how in-depth the planning must go in order to preserve the ability of the healthcare system to continue to function and absorb a high-influx of patients that potentially overwhelm the system.


----------



## Peak (May 10, 2020)

Akulahawk said:


> It also (hopefully) will instruct disaster planners about just how in-depth the planning must go in order to preserve the ability of the healthcare system to continue to function and absorb a high-influx of patients that potentially overwhelm the system.



I do think it is important to remember that many of the systems that became massively overwhelmed (NYC, Italy, et cetera) have thin resources to start with. Areas with more healthcare resources at baseline (especially critical care capacity) don't seem to be having any trouble with the volumes.


----------



## Akulahawk (May 10, 2020)

Peak said:


> I do think it is important to remember that many of the systems that became massively overwhelmed (NYC, Italy, et cetera) have thin resources to start with. Areas with more healthcare resources at baseline (especially critical care capacity) don't seem to be having any trouble with the volumes.


And that's yet another lesson for future planning. Good point!!


----------



## Carlos Danger (May 10, 2020)

ffemt8978 said:


> While I'm grateful it has been mostly underwhelming, I'm worried we've created a 'boy who cried wolf' scenario for the next pandemic.


We can only hope so.

The boy has been crying wolf for decades already though. Every few years there is something new that we are told presents if not an existential threat, then at least a threat to our security and health and way of life. Yet we're all still here. And in fact by any economic or health measure, life has been getting steadily better for a large majority of us for decades…..until March 2020.

This time it _was_ different, though. The government's overreaction was absolutely unprecedented and mind-boggling. It's only a matter of time before the same self-serving politicians and their incompetent agencies and mindless lap dogs in the media once again tell us that This New Threat is so big that we again need to destroy countless lives in order to hopefully save a handful.

I certainly hope that the next time it happens, the general public is much more skeptical and a lot less willing to roll over and trade their rights and livelihoods for the hope of some safety.


----------



## mgr22 (May 10, 2020)

Not sure about the boy-crying-wolf analogy. I get the part about regional variation in the number and severity of cases, but isn't COVID-19 a legitimate pandemic? If not, how many people need to get infected or die per day to make it one?

I agree with the comment about incompetent agencies and self-serving politicians, but I think there's been as much under-reaction as over-reaction.


----------



## Carlos Danger (May 10, 2020)

mgr22 said:


> Not sure about the boy-crying-wolf analogy. I get the part about regional variation in the number and severity of cases, but isn't COVID-19 a legitimate pandemic? If not, how many people need to get infected or die per day to make it one?
> 
> I agree with the comment about incompetent agencies and self-serving politicians, but I think there's been as much under-reaction as over-reaction.


Is it a legitimate pandemic? Clearly. 

Does it justify destroying countless businesses and livelihoods and essentially putting tens of millions of healthy people at very low risk on house arrest indefinitely? Not a chance. 

Following the logic that mass closure of the economy and house arrest was necessary, then when do those interventions end? When we have a vaccine? When unemployment reaches 60%? When the dollar completely collapses? What is the metic we're looking at?


----------



## SandpitMedic (May 10, 2020)

Carlos Danger said:


> Is it a legitimate pandemic? Clearly.
> 
> Does it justify destroying countless businesses and livelihoods and essentially putting tens of millions of healthy people at very low risk on house arrest indefinitely? Not a chance.
> 
> Following the logic that mass closure of the economy and house arrest was necessary, then when do those interventions end? When we have a vaccine? When unemployment reaches 60%? When the dollar completely collapses? What is the metic we're looking at?


This is along the lines of what I have been saying since it began.

I had one brief moment of “wow this thing may just ravage us all,” and then promptly realized I’d been bamboozled by those who would use this as an excuse to further their agenda.

The virus wasn’t really the problem for the majority of people. The response is and was the problem. Sad.


----------



## mgr22 (May 10, 2020)

Carlos Danger said:


> Is it a legitimate pandemic? Clearly.
> 
> Does it justify destroying countless businesses and livelihoods and essentially putting tens of millions of healthy people at very low risk on house arrest indefinitely? Not a chance.
> 
> Following the logic that mass closure of the economy and house arrest was necessary, then when do those interventions end? When we have a vaccine? When unemployment reaches 60%? When the dollar completely collapses? What is the metic we're looking at?



Good questions. I don't have the answers. Someone should.


----------



## Kevinf (May 10, 2020)

It did highlight the areas that we would have issues should a "true" plague-tier pandemic come knocking. People traveling down to spring break then spreading over most of the eastern half of the country during a lock-down bodes poorly for any future containment efforts. We need to be ready to account for that.

It helped to gauge what the true community baseline needs for medical response are, but also helped to show that the riff-raff complaints help keep staffing and response at levels that would be useful during a widespread disaster.

It highlighted supply chain problems of medical equipment, along with issues with government run programs such as unemployment compensation and other social support programs that had major hitches during deployment.

This was a war-game of an unprecedented scale, and I'm hoping we can learn from it.


----------



## Phillyrube (May 10, 2020)

Kevinf said:


> This was a war-game of an unprecedented scale, and I'm hoping we can learn from it.



I had some training up at Ft Detrick when I was doing cbrne stuff for the cops.   This is exactly what would happen in a global war scenario:  release an innocuous bug, and see what happens.  Look at results as far as global economics, nationwide response and risk mitigation.

Then there was the war gaming at the Naval Academy in 2019.


----------



## RedBlanketRunner (May 10, 2020)

Of course all the comments downplaying the virus ignore A, the mortality rate is 10-50 times higher than the seasonal flu, B, the infection rate is still on a near exponential climb and holding steadily there for around 40 days, and C, this is the first wave (which hasn't crested yet) and basic statistics all state there will be a second one.
IE An analogy being standing in a doorway during an earthquake saying 'This isn't so bad. I don't see any buildings falling down from my living room window.'

But there is an interesting paradox. The voices here are mostly those of the medics of America and America wants to ignore the disease and go on about business as usual while it leads the  world in new infections. Has anyone here given thought as to what the infection and mortality rate in America would have been without the lockdown? It can be safely assumed the lockdown reduced transmission rate by at least 50%, likely quite a bit higher. In dropping the lockdown and going back about your lives could very well be the same as saying 'the Med Surg floors don't need positive pressure hallways' . Well, nobody here has worked in a hospital without those magnahelics and positive pressure hallways so you have no idea what could happen.
I'm reminded of the clinics and hospitals out on the borders here. No infection containment zone controls and it is assume every patient has a case of active TB.


----------



## mgr22 (May 10, 2020)

Phillyrube said:


> I had some training up at Ft Detrick when I was doing cbrne stuff for the cops.   This is exactly what would happen in a global war scenario:  release an innocuous bug, and see what happens.  Look at results as far as global economics, nationwide response and risk mitigation.
> 
> Then there was the war gaming at the Naval Academy in 2019.



So there was some amount of preparation by the feds for a pandemic before this one hit?


----------



## Carlos Danger (May 10, 2020)

RedBlanketRunner said:


> Has anyone here given thought as to what the infection and mortality rate in America would have been without the lockdown?


Yes. Overall fatality rate looks to be around 0.1 - 0.5%. Higher in those who are statistically likely to die from other causes within a few years anyway; lower among those who are not. 

It sucks, but trying to drive that number down a little is definitely not worth  widespread economic destruction and violation of basic human rights, IMO. Especially when you consider the human toll of high unemployment rates.

I hate to come off as callous, but the reality is if we just stopped spending 70% of all healthcare dollars on folks who are going to die within a year anyway, it would solve a lot of economic problems and would free up a lot of money that could potentially do a lot more good.


----------



## RedBlanketRunner (May 10, 2020)

Carlos Danger said:


> Yes. Overall fatality rate looks to be around 0.1 - 0.5%.


Present C-19 mortality rate world wide is 6.4%. 4,184,742 confirmed infections, 284,078 deaths. US: 1,367,638 infections, 80,787 deaths. John Hopkins statistics.


----------



## Carlos Danger (May 10, 2020)

RedBlanketRunner said:


> Present C-19 mortality rate world wide is 6.4%. 4,184,742 confirmed infections, 284,078 deaths. US: 1,367,638 infections, 80,787 deaths. John Hopkins statistics.


That's the gross fatality rate - the percentage of those KNOWN to have the virus who die. That number is almost meaningless.

These were the first two hits from a 5 second Google search:









						Multiple Studies Suggest COVID-19 Mortality Rate May Be Lower Than Expected  | BioSpace
					

The actual death toll for COVID-19 won’t be calculable for some time, but there are early indications that it may be significantly lower than calculations of deaths per confirmed cases lead one to believe.




					www.biospace.com
				












						Study Puts U.S. COVID-19 Infection Fatality Rate at 1.3%
					

As alarming as the numbers appear, the researchers said, their estimates "may be slightly conservative."




					www.healthleadersmedia.com
				




Pretty much the worst case REASONABLE estimates right now are that the virus kills around 1% of those who are symptomatic. Nevermind the many, many folks who get the virus but never develop significant symptoms. Again, that percentage is higher in high-risk populations, and even lower in healthy people.

It's not exactly like the seasonal flu, but it's more alike than it is different.


----------



## Akulahawk (May 10, 2020)

RedBlanketRunner said:


> Present C-19 mortality rate world wide is 6.4%. 4,184,742 confirmed infections, 284,078 deaths. US: 1,367,638 infections, 80,787 deaths. John Hopkins statistics.


Using those world-wide numbers, it looks more like 6.78% of _known_ infections vs deaths. I'm going to assume that since those are the _known_ cases and "we" think about 80% don't know they've had/have it because symptoms are so mild/non-existent that they don't get tested, it's possible that 21,900,000 (or more) have had the disease. This would mean about a 1.3% fatality rate among ALL infected persons. 

It is NOT out of the realm of possibilities that this could essentially be a precursor event to a bigger problem, essentially being a test of global systems and responses to a biological agent. Is that a tin-foil hat thought? Absolutely. Even if it _isn't_ a planned thing, this is going to be very instructive among groups that model biological warfare. This bug has a prodromal period that is too long for a good bioweapon. You want to wipe out your enemy, not your own people. Now if you're looking for a world-wide genocidal agent, then this might be a good model... just change the payload to something that has a high mortality rate vs one that's barely over 1%...


----------



## RedBlanketRunner (May 10, 2020)

Lots and lots of short sighted thinking from subjective viewpoints. C-19 isn't this and hasn't that therefore... Ignoring other factors like much of the world population has endemic TB and other diseases that will inevitably compound the C-19 effects. As long as it isn't in our back yard!
Anyone giving any thought to the millions of people in refugee camps with little or no proper medical care? Sure sounds like a potential C-19 genetic pool, doesn't it? One of several no doubt. And of course the little mother nature jump-shifts like HIV and now this virus. No reason to be alarmed and change our life styles, thinking and preparedness, it can't possibly happen again.

Interesting modern day mindset:
*"We demand the lockdown cease so that we can return to our usual unsustainable lifestyles that will doom most of the life on the planet in the next 100-200 years, or less. Self gratification is paramount above all else."*


----------



## E tank (May 10, 2020)

RedBlanketRunner said:


> *"We demand the lockdown cease so that we can return to our usual unsustainable lifestyles that will doom most of the life on the planet in the next 100-200 years, or less. Self gratification is paramount above all else."*



It's exactly these kind of shrill, tiresome statements that have people doubting the conventional wisdom that changes daily.


----------



## silver (May 10, 2020)

Carlos Danger said:


> I hate to come off as callous, but the reality is if we just stopped spending 70% of all healthcare dollars on folks who are going to die within a year anyway, it would solve a lot of economic problems and would free up a lot of money that could potentially do a lot more good.



Nothing is more American though than doing everything possible to keep 90+ y/o old demented and bed-bound grandma alive in the ICU for months.


----------



## ffemt8978 (May 10, 2020)

E tank said:


> It's exactly these kind of shrill, tiresome statements that have people doubting the conventional wisdom that changes daily.


And will make them even more doubtful the next time around.


----------



## DrParasite (May 11, 2020)

SandpitMedic said:


> How’s the Rona in y’all’s neck of the woods nowadays?
> 
> Seems like other than NYC it’s a big old dud outside of nursing homes and the severely immunocompromised.


Spoke to one of my former coworkers in central NJ last week... she said they were getting slammed, and FEMA had sent them additional ambulances to cover the rising call volume.  

around here, the ERs are mostly empty.  EMS call volumes are down.  People are working from working remotely and staying home.  I don't think its a dud, but it has highlighted how underfunded EMS and public health is for a pandemic.  And how if you watch the mainstream media, you will think the sky is falling, because they are fearmongering many of their ignorant viewers.


----------



## FiremanMike (May 11, 2020)

RedBlanketRunner said:


> Lots and lots of short sighted thinking from subjective viewpoints. C-19 isn't this and hasn't that therefore... Ignoring other factors like much of the world population has endemic TB and other diseases that will inevitably compound the C-19 effects. As long as it isn't in our back yard!
> Anyone giving any thought to the millions of people in refugee camps with little or no proper medical care? Sure sounds like a potential C-19 genetic pool, doesn't it? One of several no doubt. And of course the little mother nature jump-shifts like HIV and now this virus. No reason to be alarmed and change our life styles, thinking and preparedness, it can't possibly happen again.
> 
> Interesting modern day mindset:
> *"We demand the lockdown cease so that we can return to our usual unsustainable lifestyles that will doom most of the life on the planet in the next 100-200 years, or less. Self gratification is paramount above all else."*



It's interesting that you sit on your shaky platform, condescendingly asserting everyone here has short sighted, subjective opinions while you are giving a short-sighted, subjective opinion.

1.  Social distancing DID NOT kill the virus, nor was it ever intended to
2.  When the lockdown gets lifted, if you (and the early models) are correct, we should see an explosion in infections and deaths
3.  The lockdown actually has been eased and continues to be phased in over the next two weeks
4.  The ACTUAL raw data, not your opinion of what it should be, is as follows

(below are rolling 7 day averages, starting yesterday and going backwards)
World growth rate over the last 7 days  - 2.26%, 2.39%, 2.44%, 2.50%, 2.50%, 2.52%, 2.56%
US growth rate over the last 7 days - 1.88%, 2.12%, 2.28%, 2.42%, 2.50%, 2.56%, 2.50%

OBJECTIVELY - that is a downward trend in growth rate.. 

So then, here's my subjective opinion, based on the big picture - if this faux quarantine wasn't ever going to kill the virus, and we are eventually going to lift the lockdown WELL BEFORE a vaccine is available.  Once the lockdown is lifted, there will be community spread and more deaths, so wasn't the quarantine just a waste of time?  Sure, I'll concede that an early quarantine might have been appropriate to give the healthcare system time to get supplies and equipment, but the truth is the majority of us have been fully stocked for 6-8 weeks now, sitting on our thumbs and waiting for the explosion.


----------



## Carlos Danger (May 11, 2020)

RedBlanketRunner said:


> As long as it isn't in our back yard!
> Anyone giving any thought to the millions of people in refugee camps with little or no proper medical care?



Yeah, I’m sure allowing people to go to their factory jobs in Detroit and get haircuts in Iowa and eat a meal out in N.C. is going to make things way worse for folks in refugee camps on the other side of the world.


----------



## RedBlanketRunner (May 11, 2020)

In the mass of ridicule I see nothing about endemic TB exacerbated by C-19, not to mention other similar compounding factors. We're not talking 90 year old grandmothers here but a whole heck of a lot of young people that may carry the lung damage for the rest of their lives.

And by the way, what is with this playing god thing? Deciding that one patient is more valuable than another? Are people thinking that person is more viable and deserves better treatment?


----------



## Summit (May 11, 2020)

Heard of one TB COVID patient in the state.

But I haven't seen any evidence to suggest TB is exacerbated by COVID. Can you cite?

I do get quite worried that people are reacting to effective public health mitigation results with the false conclusion that this means everything is fine and it was never going to be bad. Depending on the area I'd wager 0 (some counties) to 30% (NYC) of the population have had COVID and average population in the US has had 10% incidence cumulative. Next peaks will occur June/July depending on region and will be worse than the first because resistance to resume interventions may outweigh improved testing and PH response capability.

I also worry about communities that think that flattening the curve means squashing prevalence to 0% without considering the economic and mental health costs. That is lunacy unless you are Alaska, Hawaii, or another geographically isolated areas that can effectively enforce 14 day quarantines on new community arrivals. Otherwise one postpones the inevitable at horrific cost.

The point was always to keep prevalence from peaking above healthcare capacity, then relax opening up society as much as possible while still holding it hold it at or below capacity.


----------



## Akulahawk (May 12, 2020)

RedBlanketRunner said:


> In the mass of ridicule I see nothing about *endemic TB exacerbated by C-19*, not to mention other similar compounding factors.


Please do cite examples of this. I'd actually like to read the literature on this and learn if TB treatment has been actually changed by co-infection by SARS-CoV2.


----------



## Carlos Danger (May 12, 2020)

RedBlanketRunner said:


> In the mass of ridicule I see nothing about endemic TB exacerbated by C-19, not to mention other similar compounding factors. We're not talking 90 year old grandmothers here but a whole heck of a lot of young people that may carry the lung damage for the rest of their lives.
> 
> And by the way, what is with this playing god thing? Deciding that one patient is more valuable than another? Are people thinking that person is more viable and deserves better treatment?


TB endemic? Playing god? I have no idea what you are even talking about.


----------



## DrParasite (May 12, 2020)

Carlos Danger said:


> TB endemic? Playing god? I have no idea what you are even talking about.


Oh good, I thought I was the only one who was lost on what he was talking about.


----------



## CCCSD (May 12, 2020)

No...you guys called it. He has...issues...


----------



## SandpitMedic (May 12, 2020)

RedBlanketRunner said:


> _absurd rantings cut for brevity_


Truly an example of "it takes all kinds."

It's like trying to have a conversation with a turkey sandwich except I can stomach a turkey sandwich. I have had more insightful conversations with manic, intoxicated, hallucinating psych patients.


----------



## GMCmedic (May 14, 2020)

IU, ISDH release preliminary findings about impact of COVID-19 in Indiana
					

A study measuring the spread of the novel coronavirus in the state shows a general population prevalence of about 2.8 percent.




					news.iu.edu
				




Another study, this time out of IUPUI showing higher than known infection rate in Indiana, and a much lower mortality. 0.58% for indiana.


----------



## Bullets (May 14, 2020)

DrParasite said:


> Spoke to one of my former coworkers in central NJ last week... she said they were getting slammed, and FEMA had sent them additional ambulances to cover the rising call volume.
> 
> around here, the ERs are mostly empty.  EMS call volumes are down.  People are working from working remotely and staying home.  I don't think its a dud, but it has highlighted how underfunded EMS and public health is for a pandemic.  And how if you watch the mainstream media, you will think the sky is falling, because they are fearmongering many of their ignorant viewers.


Highly regional even within Central Jersey. Outside the northeast corner, it has been pretty slow. We never hit capacity. A main academic center had 30 ventilators sitting in a room unused. FEMA trucks were used in the central but that was more to alleviate the longer turn around times due to deconing. Plenty of hospitals south of the Raritan that are empty


----------



## RedBlanketRunner (May 14, 2020)

Akulahawk said:


> Please do cite examples of this. I'd actually like to read the literature on this and learn if TB treatment has been actually changed by co-infection by SARS-CoV2.


Nobody is in the offices right now for me to get my hands on the studies. There is one quite well translated from Thai I will try to get so I ask you to settle for anecdotal purely from observations for the moment. TB is extremely prevalent in most of the third world relative to quality and availability of health care. That is one paper I'll try to get my hands on.
Back in the early 2000s during a serious AIDS epidemic TB was becoming active on a serious scale. A hospital in Mae Rim had over 90% TB opportunity infection rate. HIV-AIDS patients went straight to the respiratory wards.
I believe in 2006 there were several extensive studies done which all appear to be down in Kuala Lumpur at this time at the tropical disease center where they were correlating the opportunity infector incidents with the local epidemics most notably AIDS, Dengue, Hepatitis - all forms, encephalitis, and I forget which others. Cholera and Leptospirosis were also included due to their prevalence in outlying areas where all villages had free ranging chickens and raised hogs.
Again, I'm going by first hand experiences here. There was a white paper which I'm trying to get my hands on that correlated weakened immune system from the common epidemic infections with TB becoming active. (Everyone tests positive for TB presence throughout S.E. Asia).
There are a LOT of studies done on this.
Anyway, obviously any new virus that targets the lungs and or has a significant effect on the immune system is a concern that active TB is almost a given.  This paper gives a good general scope of the problem:








						Tuberculosis in Tropical Areas and Immigrants
					

About 95% of cases and 98% of deaths due to tuberculosis (TB) occur in tropical countries while, in temperate low incidence countries, a disproportionate portion of TB cases is diagnosed in immigrants.Urbanization, poverty, poor housing conditions and ...




					www.ncbi.nlm.nih.gov
				




Esp.
_"Despite encouraging progress, the burden of tuberculosis (TB) remains enormous with about one third of the World population latently infected with the etiologic agent Mycobacterium tuberculosis,1 8.7 million new cases of active disease and 1.4 million people died in 2011.2 Some authors state that 95% of all cases and 98% of deaths due to TB, occurs in tropical countries.3 "_

Additionally, something I never followed up on. When my sister-in-law contracted dengue, she was moved to a different hospital where they had full respiratory support capabilities and were undertaking an extensive study in the apparently unrelated symptoms of dengue were triggering active TB episodes. She had developed pneumonia around the end of the first week of the dengue developing and was placed in a ward with several other dengue patients. The language barrier coupled with physicians (who spoke English) being present for less than an hour per day made it next to impossible for me to get additional information. A very common problem on getting the low down on anything here.

In reciprocal, if you have any info,  links, I''d very much appreciate you posting them.


And something worth bearing in mind here. I'm flying blind nearly all of the time. Operating on ancient paramed skills from the 80's and 90's. Almost no medical professional I meet speaks English, nurses and technicians operate rote by written instructions and them thinking on their feet is most often sternly forbidden. The average pay of a physician is $7 per patient for an initial office visit and nearly all physicians make most of their money as 'used car dealers'. Selling diagnostics in hospitals and getting kickbacks. 
This is not the first world cutting edge medical wise. If I want any serious low down on medical issues the most available info is in hospitals down in Bangkok 500 miles away and anything epidemilogical is mostly down in Malaysia.


----------



## RedBlanketRunner (May 14, 2020)

@Akulahawk Off on an odd tangent. I recently read about a strange corollary that is presently being explored. The incidence rate of TB in migrants to the European countries and the Covid-19 incidence rate is approximately the same. Italy, Spain, France, Germany and the UK the major infection centers of both, but the diseases and their spread are apparently unrelated. Or are they?
The paper I read was focused mainly on globalization and the 'our back yards are now becoming everyone's back yards' concept and that the entire world wide medical community is going to be forced to rethink itself and the standards of practice. All community communicable diseases may/will eventually become endemic in every country on the planet. We can't simply go into lockdown every time an epidemic flares up. I'm trying to find out if that paper is publicly released and will link if possible.


----------



## DrParasite (May 15, 2020)

OK, I might not be as smart or educated as some of the others, but I am having trouble understanding how any of the above two posts are related to Covid-19 at all (especially the first one).  It looks like a lot of irrelevant information that doesn't answer the question @Akulahawk asked. Can someone help me out?

Other than how we can't lock down society every time an epidemic flares up.  Which is odd, because that is what the conservatives in the US have been saying, while the liberals have been saying the opposite.


----------



## SandpitMedic (May 15, 2020)

DrParasite said:


> Other than how we can't lock down society every time an epidemic flares up.  Which is odd, because that is what the conservatives in the US have been saying, while the liberals have been saying the opposite.


Actually a lot of us here have been saying that as well. And RumRunner has been arguing that lockdown was necessary to avoid the apocalypse, yet now he seems to have slipped a little crow eating into large irrelevant rants instead of just acknowledging he may have missed the mark.


----------



## CCCSD (May 15, 2020)

Since his KSA’s are 30 years old...


----------



## FiremanMike (May 15, 2020)

CCCSD said:


> Since his KSA’s are 30 years old...



No formal education IIRC, 10 hour first aid class, all street learned..

Or something.

Cric'd a dude in the middle of the woods in rural Cali though, then hopped on "the bird" to help the crew fly.. or something.


----------



## ffemt8978 (May 15, 2020)

That's enough.  Get back on topic without getting personal.


----------



## RedBlanketRunner (May 17, 2020)

@Akulahawk Not the papers I referred to but some backgrounder info




__





						Coronavirus disease (COVID-19): Tuberculosis
					

WHO is continuously monitoring and responding to tuberculosis (TB) prevention and care during the COVID-19 pandemic. Health services need to be actively engaged for an effective and rapid response to COVID-19 while ensuring that TB and other essential health services are maintained.




					www.who.int
				











						COVID-19 Warnings! SARS-CoV-2 Coronavirus  Infection Could Activate Dormant Tuberculosis - Thailand Medical News
					

COVID-19 Warnings:  A new pre-print research finding that has yet to be peer reviewed, warns that the SARS-CoV-2 coronavirus could activate the dormant Tuberculosis bacteria in certain individuals. It was found that the novel coronavirus activates a stem cell-mediated defense mechanism that...




					www.thailandmedical.news
				





			https://www.who.int/docs/default-source/documents/tuberculosis/infonote-tb-covid-19.pdf
		


I'll keep looking.


----------



## Akulahawk (May 17, 2020)

RedBlanketRunner said:


> @Akulahawk Not the papers I referred to but some backgrounder info
> 
> 
> 
> ...


I don't put much stock in WHO's abilities these days, considering they basically parroted the info that China wanted them to. However, the info in the Thailand Medical News does sound interesting and I await peer review and publication of their findings. I'm not saying, and haven't said, that SARS-CoV2 doesn't preclude co-infection or reactivation of an existing infection, just that I want to see the studies that will help the rest of us quantify the risks. 

Please keep looking.


----------



## RocketMedic (May 23, 2020)

We’re no longer nebulizing anything, but have no MDIs yet.


----------



## SandpitMedic (May 24, 2020)

So are we going to take bets on the 2nd spike? I’m saying around July 14th.


----------



## Carlos Danger (May 24, 2020)

SandpitMedic said:


> So are we going to take bets on the 2nd spike? I’m saying around July 14th.


I don’t know about the timing of a spike, but I’m guessing the timing of the next wave of new fear mongering and shutdowns and political uproar will be closer to Election Day than that.


----------



## Peak (May 24, 2020)

Considering that we currently have no adult ICU patients with active COVID infections and that we have never filled to ICU capacity (or even came close), I don’t think that there’s any guarantee that we will see another spike, let alone one that overwhelms the system.


----------



## DesertMedic66 (May 24, 2020)

One of the areas near me is just starting to get slammed with COVID patients. Several hospitals in Mexico have closed down causing all the American citizens who were there to cross the border and seek medical attention at the 2 hospitals in that area. The hospitals have declared an emergency since the 15th and have been flying out around 15 patients per day, the majority of them are critical COVID patients. 

All ambulance traffic with patients who have any COVID signs or symptoms are being diverted to hospitals that are 2 hours away if their patients are stable. It has made for a lot of sleepless nights and staging at locations closer to the hospitals.


----------



## RedBlanketRunner (May 25, 2020)

Akulahawk said:


> I don't put much stock in WHO's abilities these days, considering they basically parroted the info that China wanted them to. However, the info in the Thailand Medical News does sound interesting and I await peer review and publication of their findings. I'm not saying, and haven't said, that SARS-CoV2 doesn't preclude co-infection or reactivation of an existing infection, just that I want to see the studies that will help the rest of us quantify the risks.


Re WHO. Numerous people have been voicing gripes about WHO. Mixed signals. Single source info. Their aggregates still seem to be trustworthy. What is of greater concern is the possibility of politics entering into the works. I was closely monitoring China and WHO response, appreciated the announcement China was giving WHO free run of the place, then WHO started sounding like a sycophant. WTF??

Not sure what is going on down in Kuala Lumpur. Tropical Disease center seems to be in limbo. Numerous experts aren't answering emails. I'll keep trying. Really want to get my hands on those white papers. I might try an end run, maybe MSF, but they are a huge pain to get any info out of. Everything in French and Nes Pas Diffuser on every page.


----------



## CCCSD (May 25, 2020)

MSF is just as biased as China and WHO.


----------



## SandpitMedic (May 25, 2020)

Carlos Danger said:


> I don’t know about the timing of a spike, but I’m guessing the timing of the next wave of new fear mongering and shutdowns and political uproar will be closer to Election Day than that.


You might be on to something there.


----------



## ffemt8978 (Jun 2, 2020)

This certainly hasn't helped matters.









						China delayed releasing coronavirus info, frustrating WHO
					

Throughout January, the World Health Organization publicly praised China for what it called a speedy response to the new coronavirus. It repeatedly thanked the Chinese government for sharing the genetic map of the virus “immediately,” and said its work and commitment to transparency were “very...




					apnews.com


----------



## SandpitMedic (Jun 2, 2020)

Rona is over. Haven’t you heard? We’re moving on   in June.


----------



## FiremanMike (Jun 2, 2020)

Rona is so last week.. It's riot time.. 

It will be interesting to see if there's a mass 'Rona outbreak with the re-opening of the country combined with the riots..


----------



## Carlos Danger (Jun 2, 2020)

When are the murder hornets? July?


----------



## CCCSD (Jun 2, 2020)

They were delayed by the smoke and Fire.


----------



## Jim37F (Jun 2, 2020)

Those were just a filler episode


----------



## ffemt8978 (Jun 2, 2020)

Carlos Danger said:


> When are the murder hornets? July?


They were reported in Canada so they may be on a maple syrup sugar high.


----------



## FiremanMike (Jun 17, 2020)

I keep seeing news reports of spikes that are occurring right now.. Nationwide data has been a pretty steady daily increase of ~20,000 +/- ~2000 for the last several weeks with some outliers and no obvious evidence of a spike.. 

What do you guys make of these reported spikes?


----------



## Summit (Jun 17, 2020)

It's regional.


----------



## FiremanMike (Jun 17, 2020)

So areas seeing a spike are offset by areas seeing a decrease?


----------



## mgr22 (Jun 17, 2020)

FiremanMike said:


> So areas seeing a spike are offset by areas seeing a decrease?



I doubt if anyone here could answer that accurately for the U.S. in general. In my state, TN, we're seeing new cases reported at what seems to be an increasing rate.


----------



## FiremanMike (Jun 17, 2020)

mgr22 said:


> I doubt if anyone here could answer that accurately for the U.S. in general. In my state, TN, we're seeing new cases reported at what seems to be an increasing rate.



Do you think that's due to an increase in testing?  I know some states have announced free testing statewide to anyone who wants it..


----------



## mgr22 (Jun 17, 2020)

FiremanMike said:


> Do you think that's due to an increase in testing?  I know some states have announced free testing statewide to anyone who wants it..



Probably some of it, but from where I sit, it seems like we're still dealing with an uncontrolled disease that could get much worse before it gets much better. And as I've said before, I think we need to count long-term disability as a significant consequence of Coronavirus, even though it's too early to have much data on that.

I think you're asking good questions. Maybe someone has better answers than I can offer.


----------



## DesertMedic66 (Jun 17, 2020)

Yesterday was the highest number of new cases in my county since this all started. I’m expecting today to be higher as it has been in a steady climb upwards. 

We haven’t opened up any new testing sites and have been testing Monday-Friday 0900-1700 at multiple sites. Some of the local hospitals are only testing if that specific patient is going to be admitted into their facility otherwise no test regardless of their symptoms.


----------



## Summit (Jun 17, 2020)

FiremanMike said:


> So areas seeing a spike are offset by areas seeing a decrease?


Yes.

Also, this isn't solely or even primarily due to increased testing.

It is blindingly obvious if increased cases is due to increased testing or actual upward inflection of the epidemic curve. If positivity rates change with particular ratio to new cases, then it is a feature of testing revealing true incidence rather than a change in actual incidence. Otherwise changes in new case rates indicates true incidence is changing, as in a spike. Luckily, epidemiologists know all about this, and would not be sounding alarm bells if spikes were merely features of surveillance. Look at AZ hospital capacity. That's not a statistical boo boo.


----------



## FiremanMike (Jun 17, 2020)

mgr22 said:


> Probably some of it, but from where I sit, it seems like we're still dealing with an uncontrolled disease that could get much worse before it gets much better. And as I've said before, I think we need to count long-term disability as a significant consequence of Coronavirus, even though it's too early to have much data on that.
> 
> I think you're asking good questions. Maybe someone has better answers than I can offer.



As a coordinator, I’m a data guy.  So many things “feel” like something, but numbers just don’t back it up.. “It feels like we take a ton of mutual aid medic runs” - actually you only take 1ish per shift.. “It feels like” - actually data shows...

This is why I ask so many analytical questions.  I come across as an *******, but really I just like to understand.  I will say (anecdotally) that in my department, Covid runs have been extremely rare over the last several weeks, my bin of soiled n95 masks has exactly 4 masks to be sent out for cleaning and hasn’t been taken in for 4-5 weeks.. We take about 7000 EMS runs per year, I find that interesting.

I do have some first hand knowledge of the morbidity which is worse than I expected (not me) but unfortunately I don’t think it’s fair to share it due to privacy.  I will say that what I’m seeing does tend to confirm the notion that Covid is not just a “recover and done” like the flu..



Summit said:


> Yes.
> 
> Also, this isn't solely or even primarily due to increased testing.
> 
> It is blindingly obvious if increased cases is due to increased testing or actual upward inflection of the epidemic curve. If positivity rates change with particular ratio to new cases, then it is a feature of testing revealing true incidence rather than a change in actual incidence. Otherwise changes in new case rates indicates true incidence is changing, as in a spike. Luckily, epidemiologists know all about this, and would not be sounding alarm bells if spikes were merely features of surveillance. Look at AZ hospital capacity. That's not a statistical boo boo.



I actually don’t understand what you mean in your post, but I’m going to make an effort tomorrow to study how epidemiologists can decipher that data..


----------



## Summit (Jun 17, 2020)

FiremanMike said:


> I actually don’t understand what you mean in your post, but I’m going to make an effort tomorrow to study how epidemiologists can decipher that data..



Look at:
Sensitivity, particularly how it varies over time and within cohorts (screening/surveillance, asymptomatic, symptomatic sub-acute, hospitalized) being tested (and when these present for testing).
Pretest probability of those being tested with different levels of morbidity.
What groups are tested at what rates and how those rates have varied over time (hint, some groups haven't changed, others have expanded but have naturally low pretest probabilities so you expect low positivity rates).
Test positivity and how it is driven by the above vs testing rates vs disease incidence/prevalence (and know the difference).
Alternate metrics to validate data trends (is it showing what I think its showing?)


----------



## silver (Jun 17, 2020)

FiremanMike said:


> As a coordinator, I’m a data guy.  So many things “feel” like something, but numbers just don’t back it up.. “It feels like we take a ton of mutual aid medic runs” - actually you only take 1ish per shift.. “It feels like” - actually data shows...
> 
> This is why I ask so many analytical questions.  I come across as an *******, but really I just like to understand.  I will say (anecdotally) that in my department, Covid runs have been extremely rare over the last several weeks, my bin of soiled n95 masks has exactly 4 masks to be sent out for cleaning and hasn’t been taken in for 4-5 weeks.. We take about 7000 EMS runs per year, I find that interesting.
> 
> ...



The regional variation in the US is pretty significant and there is a lot of variation in publicly reported data. Just randomly googling looked at AZ DHS. There you can see that over the past few weeks there is an increasing number of PCR tests being performed while also having an increasing % positive rate with increasing utilization of hospital beds and ventilators.

Much of the national data is skewed by NY metro area.


----------



## Carlos Danger (Jun 17, 2020)

silver said:


> The regional variation in the US is pretty significant and there is a lot of variation in publicly reported data. Just randomly googling looked at AZ DHS. There you can see that over the past few weeks there is an increasing number of PCR tests being performed while also having an increasing % positive rate with increasing utilization of hospital beds and ventilators.
> 
> Much of the national data is skewed by NY metro area.


If you take NYC out of the equation, the US as a whole is one of the least hardest hit of all the nations with the most cases. Ganted this article is like a million years old in 2020 years, but I'd bet the proportions still hold: https://pjmedia.com/news-and-politi...the-united-states-coronavirus-numbers-n385151

As of mid-June, hospitalizations are way up in several states. Some take that as meaning the world is ending AGAIN. The correct interpretation is that any highly communicable virus with any latent period spreads rapidly and that the lockdowns and forced social distancing simply interrupted the natural course of the spread. Also don't forget that if your government incentivizes higher rates of reporting of a thing, that rates of reporting of that thing will increase.

Analyzing all of this is complicated mostly by the fact that our federal and state governments are throughly incompetent, largely by the fact that testing and reporting among the states is very inconsistent, and partly by the daunting logistics of analyzing data from such a massive and heterogeneous nation is ours. The political incentives don't help either, of course. 

I follow some very smart and very objective data guys who follow this thing closely and they all say, basically, "the data is so scattered and inconsistent that no one can honestly and objectively say that they have any good understanding of what is happening".


----------



## silver (Jun 17, 2020)

Carlos Danger said:


> I follow some very smart and very objective data guys who follow this thing closely and they all say, basically, "the data is so scattered and inconsistent that no one can honestly and objectively say that they have any good understanding of what is happening".



Is it more scattered and inconsistent than other epidemiological data though? I don't do epi, but have read enough to say that the argument that its quite the opposite can be made.

Edit:
That being said, everything comes down to local data at this point as a way of implementing targeted public health interventions. However, that requires competent government.


----------



## FiremanMike (Jun 18, 2020)

silver said:


> Is it more scattered and inconsistent than other epidemiological data though? I don't do epi, but have read enough to say that the argument that its quite the opposite can be made.
> 
> Edit:
> That being said, everything comes down to local data at this point as a way of implementing targeted public health interventions. However, that requires competent government.



I certainly think it's reasonable to say that it's been more scattered.. First, there wasn't testing for several weeks, if I'm remembering right, China wouldn't even help produce the virus so that testing could be developed.. Coupled with this brand new virus, symptoms have been evolving from day one, compared to the flu which has a pretty set standard of "this is what the flu generally looks like, these are the folks you should test/track"..


----------



## chriscemt (Jun 18, 2020)

The alarmist leftist in my FB feed (also, the head of a local EMS agency) just declared that this second spike will be worst than the first. Also, stated that the area hospitals are "at capacity" (they are, uh, very much not).

Given the politicisation in the initial phase, I'm awfully dubious that further waves will be anything near whatever it was the first was, whatever that was.


----------



## mgr22 (Jun 18, 2020)

chriscemt said:


> The alarmist leftist in my FB feed (also, the head of a local EMS agency) just declared that this second spike will be worst than the first. Also, stated that the area hospitals are "at capacity" (they are, uh, very much not).
> 
> Given the politicisation in the initial phase, I'm awfully dubious that further waves will be anything near whatever it was the first was, whatever that was.



I share your concern about politicizing the virus, and think we should be past the point of characterizing concern about the virus as "alarmist." Not too many months ago, I would have been considered an alarmist by some if I'd suggested the virus would kill over 100,000 people in the U.S.


----------



## Summit (Jun 18, 2020)

Had China been more open, we could have had the sequencing at least 1 week earlier sourced from them, possibly 2 weeks earlier if they'd shared samples. They only shared when they did because an independent group had isolated the virus and sequenced then released it on the internet.

If they hadn't hidden the severity of the outbreak, suppressed information, attacked countries who prepared, and strong-armed the WHO to downplay the issue, the world would have acted more severely and swiftly several weeks earlier, possibly preventing worldwide spread.

China set the world up for pandemic failure... again...


----------



## Phillyrube (Jun 18, 2020)

Carlos Danger said:


> When are the murder hornets? July?


Fouled deck, cats down.


----------



## Phillyrube (Jun 18, 2020)

Summit said:


> Had China been more open, we could have had the sequencing at least 1 week earlier sourced from them, possibly 2 weeks earlier if they'd shared samples. They only shared when they did because an independent group had isolated the virus and sequenced then released it on the internet.
> 
> If they hadn't hidden the severity of the outbreak, suppressed information, attacked countries who prepared, and strong-armed the WHO to downplay the issue, the world would have acted more severely and swiftly several weeks earlier, possibly preventing worldwide spread.
> 
> China set the world up for pandemic failure... again...


That's racist..


----------



## chriscemt (Jun 18, 2020)

mgr22 said:


> I share your concern about politicizing the virus, and think we should be past the point of characterizing concern about the virus as "alarmist." Not too many months ago, I would have been considered an alarmist by some if I'd suggested the virus would kill over 100,000 people in the U.S.



Just to be clear, I am not and would not equate concern about the virus as alarmist.  I am referring to someone specifically as such.  There are ranges of outcomes, with given percent probabilities.  Taking the worst possible case scenario (being shot into the sun by an alien slingshot, for instance) isn't reasonable.  It's alarmist.


----------



## GMCmedic (Jun 18, 2020)

Were still sitting good in indiana. 3.7% of vents are tied to covid patients. A little over 9 percent are non covid, leaving over 80% of vents available. 

Only about 30% of ICU beds available but usually at least 20% of ICU patients could be on a floor.


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## Summit (Jun 18, 2020)

A good way to look at which states have accelerating or decelerating incidence.









						Where U.S. coronavirus cases are on the rise
					

The states where the outbreak is growing fastest




					graphics.reuters.com


----------



## Carlos Danger (Jun 19, 2020)

Summit said:


> Had China been more open, we could have had the sequencing at least 1 week earlier sourced from them, possibly 2 weeks earlier if they'd shared samples. They only shared when they did because an independent group had isolated the virus and sequenced then released it on the internet.
> 
> If they hadn't hidden the severity of the outbreak, suppressed information, attacked countries who prepared, and strong-armed the WHO to downplay the issue, the world would have acted more severely and swiftly several weeks earlier, possibly preventing worldwide spread.
> 
> China set the world up for pandemic failure... again...


There's plenty of blame to go around. I don't expect much from the PRK, but we should from our own federal agencies. Yet they also screwed us pretty hard by delaying the roll out of testing developed by private labs so that the CDC could fart around and try to re-invent the wheel. Once the CDC was finally forced to admit its utter incompetence (they couldn't get a test right after several tries) and gave the go-ahead to use the privately-developed tests, then the FDA stepped in and said "Whoa hold on there, now…..there's an approval process you have to go through". All this also added about two weeks to the roll out of the tests at a time when two weeks of testing and contact tracing could probably have made a massive difference.


----------



## MonkeyArrow (Jun 19, 2020)

Carlos Danger said:


> All this also added about two weeks to the roll out of the tests at a time when two weeks of testing and contact tracing could probably have made a massive difference.


This is a bit hyperbolic. We're, what, 4 months out from when the virus really took hold in the states and we still don't have effective contact tracing in place. I highly, highly doubt earlier testing would have done anything other than give us a more accurate numbers of hospitalized patients and deaths with Covid. The early private testing kits were not widely available at the outset and were usually restricted to hospitalized patients suspected of Covid only, not for everyone out in the community.


----------



## DesertMedic66 (Jun 19, 2020)

We still don’t even have accurate testing procedures. I had a patient last week who tested positive at the sending facility and then tested negative 3 hours later at the receiving facility.


----------



## silver (Jun 19, 2020)

FiremanMike said:


> I certainly think it's reasonable to say that it's been more scattered.. First, there wasn't testing for several weeks, if I'm remembering right, China wouldn't even help produce the virus so that testing could be developed.. Coupled with this brand new virus, symptoms have been evolving from day one, compared to the flu which has a pretty set standard of "this is what the flu generally looks like, these are the folks you should test/track"..


In contrast look how the flu gets tracked. Mostly via voluntary registries, which then estimate totals off of swab sensitivity and prior years cases, and automated coding of death certificates.


----------



## Summit (Jun 19, 2020)

DesertMedic66 said:


> We still don’t even have accurate testing procedures. I had a patient last week who tested positive at the sending facility and then tested negative 3 hours later at the receiving facility.



The second PCR was probably collected with poor technique in this situation. That is definitely a positive. Why the hell did the receiving waste a test when there was a positive in the system?


----------



## DesertMedic66 (Jun 19, 2020)

Summit said:


> The second PCR was probably collected with poor technique in this situation. That is definitely a positive. Why the hell did the receiving waste a test when there was a positive in the system?


Hospital’s policy for all patients. They want to do their own test on all patients who enter their system even if another facility has already tested them. Quite a few of our hospitals are doing this now.


----------



## Carlos Danger (Jun 19, 2020)

MonkeyArrow said:


> This is a bit hyperbolic. We're, what, 4 months out from when the virus really took hold in the states and we still don't have effective contact tracing in place. I highly, highly doubt earlier testing would have done anything other than give us a more accurate numbers of hospitalized patients and deaths with Covid. The early private testing kits were not widely available at the outset and were usually restricted to hospitalized patients suspected of Covid only, not for everyone out in the community.


I would concede that without proper deployment of the tests and response to the results (contact tracing), earlier availability of tests would likely have had little impact.

if anything though, rather than supporting any accusation of “hyperbole” here, the fact that several months into this thing we still don’t have a cogent testing and tracing strategy simply means that the CDC’s later failures obviated their earlier failures.

My main point is that the PRC’s deception means little when our own response to Important Information is so impotent.

The PRC cannot be trusted, but our own CDC is beyond worthless.


----------



## CCCSD (Jun 19, 2020)

DesertMedic66 said:


> We still don’t even have accurate testing procedures. I had a patient last week who tested positive at the sending facility and then tested negative 3 hours later at the receiving facility.



You obviously cured him. Good show.


----------



## silver (Jun 25, 2020)

No concern, nothing to see here.


----------



## Tigger (Jun 27, 2020)

Do you feel like your agency and its providers are remaining vigilant when it comes to PPE and and cleaning? I've noticed we are starting to slip a little bit with wearing gowns and N95s when needed or not thoroughly cleaning reusable equipment. Of course everyone is a bit fatigued of all this, but I fear that in the closed confines of the ambulance we are really setting ourselves up for an exposure and subsequent cross contamination of other patients and our stations. 

I don't want to nag and I'm tired too, but I don't think Colorado is going to stay immune from second outbreaks forever.


----------



## akflightmedic (Jun 27, 2020)

VERY, VERY relaxed here in my area.


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## Akulahawk (Jun 28, 2020)

Summit said:


> The second PCR was probably collected with poor technique in this situation. That is definitely a positive. Why the hell did the receiving waste a test when there was a positive in the system?


They could also be using a different system with a different (possibly higher) threshold for positive vs negative than what the sending facility uses. The "in-house" system we use is fast but it requires a fairly high load before it give a positive result. The system we use for our "send-out" testing, which has a 24 hour turnaround, is far more sensitive but it does take that 24 hours. We used to use a 4 hour TAT system, but apparently no longer. So, we're at a 45 min TAT or a 24 hour TAT... 

Now that being said, we have probably seen more COVID+ patients using our 45m TAT system in the past week than we've seen in the month or so before that. We'd see 1-3 patients per day, most tested neg. Now we're seeing more like 8-10 and about half or so are pos.


----------



## Jim37F (Jul 1, 2020)

So, Statewide, we have had a total of 917 diagnosed cases. Which is good cuz I think there have been a couple states where that has been the new daily totals? 

18 were reported today (they're saying that's like 1.5% of 1200 tests processed in that 24hr timeframe)

Anyways, 917 total cumulative cases, but 736 of those have recovered to the point of having been "released from isolation". 18 total deaths, leaves a current active case count of 163.

Only 12% of those 917 total have required hospitalization. The rest have largely recovered/recovering at home.

There's 244 ICU beds in the State. Approximately 48% are occupied, but they haven't said how many by COVID patients, other than to say the majority of ICU cases are not COVID.

10% of the 459 ventilators in State are also in use (once again, no breakdown of how many are COVID patients)

So we're seeing a bit of a second wave, but new cases are jumping between 2 a day to 30 a day so its been kinda hard to see the overall trend, but with 4th of July coming up, officials are def worried about a new wave.

People have largely been wearing face masks here. Its required pretty much everywhere public. Most places have started reopening. Though restaurants are still mostly take out/delivery, there's plans for phased dine in reopenings. Pretty much only bars and nightclubs remain totally closed, though karaoke bars have been given the go ahead to reopen (as long as theres like a plexiglass barrier or something between the singer and audience lol)

At the FD we're still limited in overtime, only allowed to work our own truck still. Despite only FFs having gotten the virus here, so hopefully they'll start allowing OT soon lol.

Mandatory quarantine has been lifted only for Inter-island flights. All other flights (international, mainland) are still 2 week automatic quarantine, but there's plans (or planning) to ease that somewhat (I guess they like Alaskas model where if you can show a confirmed negative test within like 3 days of your flight you dont need to quarantine, so we'll see...)









						Most COVID-19 patients recover at home, but hospitalizations higher among seniors
					

Despite recent upticks in cases, Lt. Gov. Josh Green and other officials say Hawaii’s hospitals are in good shape.




					www.hawaiinewsnow.com
				









						Hawaii COVID-19 Data | Disease Outbreak Control Division | COVID-19
					






					health.hawaii.gov


----------



## DesertMedic66 (Jul 1, 2020)

Jim37F said:


> So, Statewide, we have had a total of 917 diagnosed cases. Which is good cuz I think there have been a couple states where that has been the new daily totals?
> 
> 18 were reported today (they're saying that's like 1.5% of 1200 tests processed in that 24hr timeframe)
> 
> ...


There have been counties who have been reporting 1,000+ new cases per day


----------



## RocketMedic (Jul 1, 2020)

Anyone else having to wear a mask 24/7?


----------



## CCCSD (Jul 1, 2020)

You wear a mask when you sleep?


----------



## ffemt8978 (Jul 1, 2020)

CCCSD said:


> You wear a mask when you sleep?


Well, I am forced to use a CPAP so yes.


----------



## CCCSD (Jul 1, 2020)

ffemt8978 said:


> Well, I am forced to use a CPAP so yes.



You are MORE than covered!


----------



## GMCmedic (Jul 1, 2020)

RenegadeRiker said:


> Anyone else having to wear a mask 24/7?


We were never directed to wear masks on station but ill spend the day in my room before I do that.


----------



## Jim37F (Jul 1, 2020)

We're technically supposed to be wearing face masks in station and trying to social distance... yeah I've seen a couple stations do that, most are like "Yeah, No"

Though from what I've seen, we've been good about wearing N95s to every single call regardless...


----------



## Akulahawk (Jul 3, 2020)

At my hospital, we've seen a dramatic increase over the past week or so in numbers of patients that are COVID19+. Typically we'd see two or five per DAY and _maybe_ we might have an admission out of those. In the past week, we're admitting between 4 and 6 COVID19 patients per day and we're seeing around a dozen or so (and discharging them home) every day. Part of this is that we're seeing a LOT more volume of patients every day than we have over the past couple months and we're testing a LOT more. Basically everyone that gets admitted _anywhere_ from the ED gets tested. If you're going to a SNF, MHF, to a floor or unit, or transferred to another hospital you're getting tested. We're on universal masking for all patient-care facing employees and N95 or better for known COVID cases. When I get to work, I grab a PAPR, assemble and test it, and then I put it with my PAPR helmet and the entire assembly follows me everywhere.


----------



## DragonClaw (Jul 3, 2020)

Most our units are getting 1-4 COVID calls a day.  More are symptomatic now than before it seems?


----------



## RocketMedic (Jul 3, 2020)

First COVID intubation last night.


----------



## E tank (Jul 3, 2020)

Akulahawk said:


> When I get to work, I grab a PAPR, assemble and test it, and then I put it with my PAPR helmet and the entire assembly follows me everywhere.



Must be nice to have PAPRs you can just grab...I have to leave a baby for collateral...


----------



## Summit (Jul 3, 2020)

We charge interest against the collateral


----------



## Akulahawk (Jul 3, 2020)

E tank said:


> Must be nice to have PAPRs you can just grab...I have to leave a baby for collateral...





Summit said:


> We charge interest against the collateral


We have so few PAPR hoods that most of the people at work don't get to use a PAPR. They generally have to ask the House Supervisor for a hood. Since I have my own PAPR helmet that is 100% compatible with our system, I don't have to ask the House Sup for a hood and I don't have to worry about tears in the hood fabric. Even with me using one of the PAPR blowers, we have at least 2 more in the supply cart, one on each crash cart, and two more in an "emergency box" and that's just in the ED. ICU and our (now resurrected) COVID floor has them on their crash carts and a couple extras too, in addition to what Respiratory Therapy has. We used to have just 6 units total in the entire hospital. We now probably have 2-3 times that. 

Since our PAPR units aren't use very often, I don't have to leave any collateral. I just have to remember to put it back...

I'll also likely purchase my own (better) unit with a couple "big" batteries in the next month or so, simply so that I don't have to draw from hospital equipment.


----------



## Summit (Jul 3, 2020)

So you are short on helmets? 3m?


----------



## luke_31 (Jul 3, 2020)

Guess I should feel lucky to have my own PAPR mask that was provided for me. We also have the filters and everything for each of us on the truck


----------



## CanadianBagel (Jul 4, 2020)

We have intubation tarps, face shields, gowns, eye pro, and N-95’s. We’re supposed to wear gloves, eye pro and N-95 on every call, but most people don’t. Some people take off their masks in the back of the rig, which I find kinda gross. I wear my mask every time I walk into a scene or facility, since we have no shortage of masks here. I actually haven’t transported a COVID in two months. It’s pretty much down to a simmer here.


----------



## Akulahawk (Jul 4, 2020)

Summit said:


> So you are short on helmets? 3m?


No. We're short on 3M hoods. Once you're assigned one, it's yours unless/until it rips. I currently have the only 3M Versaflo helmet in the hospital.


----------



## Bishop2047 (Jul 4, 2020)

In Canada we are more or less totally reopened, with new rules in place at most stores, gyms, and public spaces. We were very lucky in most areas to have very low total cases thus far, and our vastness really helped. Not hard to social distance in most areas of the country. Cities were hit the hardest, but now they seem to have a pretty good system in most provinces for contact tracing and quelling outbreaks. 

Places like New Brunswick border Maine and have similar demographics, but very different stats. 

Maine- 3373 total cases thus far and 105 dead.
New Brunswick - 165 total cases and 2 deaths. 

On the West Coast

British Columbia-  2947 total cases and 177 deaths.
Washington St- 34151 total cases and 1342 deaths. 

All things are not equal but the numbers certainly are interesting. Quebec was our hardest hit province so far percentage wise. 

Quebec (8.4Mil)- total cases  55 682 with 5560 deaths
Virginia (8.6Mil)- total cases 64,350 and 1845 deaths


----------



## Summit (Jul 4, 2020)

Antimaskers are cut from the same cloth as antivaxxers. It is supremely frustrating.



Akulahawk said:


> No. We're short on 3M hoods. Once you're assigned one, it's yours unless/until it rips. I currently have the only 3M Versaflo helmet in the hospital.


How did you get your own? We are having huge issues with getting 3M to supply PAPRs and supplies.


----------



## Peak (Jul 5, 2020)

Akulahawk said:


> No. We're short on 3M hoods. Once you're assigned one, it's yours unless/until it rips. I currently have the only 3M Versaflo helmet in the hospital.



We share our 3M hoods and clean them in between each use. We have had some hoods last week over two months. How often often are y’all replacing yours?


----------



## Peak (Jul 5, 2020)

Bishop2047 said:


> In Canada we are more or less totally reopened, with new rules in place at most stores, gyms, and public spaces. We were very lucky in most areas to have very low total cases thus far, and our vastness really helped. Not hard to social distance in most areas of the country. Cities were hit the hardest, but now they seem to have a pretty good system in most provinces for contact tracing and quelling outbreaks.
> 
> Places like New Brunswick border Maine and have similar demographics, but very different stats.
> 
> ...



It’s interesting that y’all seem to have a lower case  load per capita but a higher fatality rate of those infected, what do you think contributes to the discrepancy?


----------



## Akulahawk (Jul 5, 2020)

Peak said:


> We share our 3M hoods and clean them in between each use. We have had some hoods last week over two months. How often often are y’all replacing yours?


Right now we're not having to share hoods. Most of ours seem to last a couple months. In our ED, we've only had to replace a couple. My helmet should last a few years... and that allows me to stretch our supply just that much farther because I'm not drawing from hospital supplies for a hood.


----------



## RocketMedic (Jul 5, 2020)

I suspect this is the new normal with regards to PPE


----------



## Bishop2047 (Jul 5, 2020)

Peak said:


> It’s interesting that y’all seem to have a lower case  load per capita but a higher fatality rate of those infected, what do you think contributes to the discrepancy?



We are not testing as much as the USA. Might be part of it. Especially early on we were only testing those with several symptoms and a good story. was not until the curve was very much flattened that testing was opened up to all.









						Testing rate for COVID-19 most impacted countries worldwide 2022 | Statista
					

As of November 8, 2022, Austria had performed the most COVID-19 tests per one million population among the countries most severely impacted by the pandemic.




					www.statista.com


----------



## Virgil (Jul 6, 2020)

Well, I tested positive a few days ago. My division supe said I was the third one that day calling with the same story 

I feel fine, my taste and smell disappeared so that’s when I made the call. But I feel completely fine other than that, and the doc says I’m towards the ending of the infection.

Unfortunately my housemates also contracted it(From me) and have been experiencing different symptoms. Some have fevers, others have no taste, and a few also have diarrhea, and we’re all super fatigued.


----------



## SandpitMedic (Jul 6, 2020)

Diarrhea is one of the most common symptoms in my experience. Almost every C19+ patient I’ve had has c/o some bout of diarrhea with it.


----------



## Virgil (Jul 6, 2020)

SandpitMedic said:


> Diarrhea is one of the most common symptoms in my experience. Almost every C19+ patient I’ve had has c/o some bout of diarrhea with it.


Oh that’s interesting. My stomach has been kinda weird for a while but I definitely noticed stomach pain and all that much more within the last week or so.

Is it true that there are different “strains” of Covid? Because I’ve had friends be positive with a more chest related illness(SOB, chest tightness, worsening cough, etc) while me and my housemates have had a more sinus/head sickness. We’ve had no taste or smell, congestion, sinus pressure, etc.


----------



## DragonClaw (Jul 6, 2020)

Virgil said:


> Oh that’s interesting. My stomach has been kinda weird for a while but I definitely noticed stomach pain and all that much more within the last week or so.
> 
> Is it true that there are different “strains” of Covid? Because I’ve had friends be positive with a more chest related illness(SOB, chest tightness, worsening cough, etc) while me and my housemates have had a more sinus/head sickness. We’ve had no taste or smell, congestion, sinus pressure, etc.



News says the strain down here (Houston) is more virulent. But... who knows?


----------



## Carlos Danger (Jul 6, 2020)

Summit said:


> Antimaskers are cut from the same cloth as antivaxxers. It is supremely frustrating.


So anti-maskers all have the same reasoning for their positions, as do anti-vaxers? Tell me more.


----------



## FiremanMike (Jul 6, 2020)

Summit said:


> Antimaskers are cut from the same cloth as antivaxxers. It is supremely frustrating.



As a mask skeptic, I disagree.  I don’t feel masks are dangerous, I just don’t understand the science of my sports team cotton mask with loose ends as being effective in stopping the spread of an airborne virus which is small enough to blow through the holes in cotton cloth.


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## DragonClaw (Jul 6, 2020)

According to a poster the #1 way to stop/prevent Corona is washing your hands. If this is true why isn't washing hands mandatory in public? Mask ordinance/law is a thing


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## FiremanMike (Jul 6, 2020)

WARNING - ANECDOTE

We had a guy get sick. really sick, spent a few days in the hospital, very long recovery time at home.

Turns out, he worked for several days with a cough (thought it was allergies) before it was bad enough to get tested..  Rode the medic with multiple partners,  no masks being worn at the firehouse (don’t get me started).  This was about 8 weeks ago.. (side note, he’s off at least another month).

To date, there have been NO OTHER symptomatic Covid cases at work.  His partners are also negative.


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## Carlos Danger (Jul 6, 2020)

There are several of reasons to not want to wear a mask that don't involve being a "science denier", not the least of which is that the overall strategy of trying to stop the spread of the virus through social distancing and mask wearing among the general public is itself questionable.


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## VFlutter (Jul 6, 2020)

FiremanMike said:


> As a mask skeptic, I disagree.  I don’t feel masks are dangerous, I just don’t understand the science of my sports team cotton mask with loose ends as being effective in stopping the spread of an airborne virus which is small enough to blow through the holes in cotton cloth.



I agree with some arguments against masks however that is not one. Cloth masks are intended to prevent large droplet transmission usually from coughing or sneezing, not protect against an airborne virus which COVID-19 is not. It is hard to argue the effectiveness of them for that purpose.


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## FiremanMike (Jul 7, 2020)

VFlutter said:


> I agree with some arguments against masks however that is not one. Cloth masks are intended to prevent large droplet transmission usually from coughing or sneezing, not protect against an airborne virus which COVID-19 is not. It is hard to argue the effectiveness of them for that purpose.



Are they saying covid isn't airborne anymore?


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## DragonClaw (Jul 7, 2020)

FiremanMike said:


> Are they saying covid isn't airborne anymore?



It's been droplet this whole time?


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## Carlos Danger (Jul 7, 2020)

FiremanMike said:


> Are they saying covid isn't airborne anymore?


It has never been technically considered "airborne" the way measles and TB are, but respiratory droplets containing the virus can aerosolize through coughing, sneezing, even talking, and that aerosol can stay suspended for a few minutes within a small radius. Exactly like influenza and the common cold. The difference with COVID-19 is that it is considered to be much more contagious than seasonal influenza or the cold, so with the same amount of exposure you are more likely to get it. There's no question that masks reduce that to at least some extent, especially if both parties (the sick one and the not-sick one) are wearing them. Effectiveness depends widely on who you ask, as well as the characteristics of the masks themselves, of course. 

The questions in my mind are: is masking among the general public really necessary; is the effectiveness of masking among the general public consistently worth the mandates; what are the unintended consequences of mask mandates (there are _always_ unintended consequences); what about individual autonomy (always a foremost concern in my mind); and, lastly, is trying to stop the spread really the best strategy to begin with, vs. instead focusing on protecting the minority of the population who is likely to develop severe disease and allowing those who are at very little risk to be exposed naturally and develop herd immunity? Especially considering that the more we learn about it, the less deadly we are finding out it is on a per-case basis.


The officials have been wrong about pretty much everything they've told us since day 1. They've changed most of their recommendations at least once, been inconsistent and self-contradictory in their messaging in general, and every prediction has failed to come true. We HAVE managed, however, to beat the hell out of our economy, massively increase our federal debt, create record unemployment, destroy many, many businesses, force the cancellation of countless weddings, graduations, family vacations, and funerals, seen a huge spike in suicides, a huge spike in mortgage defaults, etc, etc. All that, and it isn't even clear that any of the lockdown and social distancing orders were really necessary or all that effective. Considering all that, I'd say anyone who _doesn't _question the necessity of mask mandates at least a little bit, should probably give some more thought to the reliability and intentions of the governing officials who are telling us how important it is.


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## mgr22 (Jul 7, 2020)

An aspect of COVID that gets relatively little publicity is disability.  I haven't been able to find any studies -- too soon, I guess -- but I've read dozens of reports of ongoing disability secondary to the disease. I doubt such outcomes were considered by the President when he claimed 99% of cases are "totally harmless" (and I doubt most symptomatic COVID sufferers would describe their experiences as harmless).

Looking at COVID outcomes merely as binary -- i.e., alive or dead -- and thinking of herd immunity as a largely inconsequential process are mistakes, I believe.


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## Carlos Danger (Jul 7, 2020)

mgr22 said:


> An aspect of COVID that gets relatively little publicity is disability.  I haven't been able to find any studies -- too soon, I guess -- but I've read dozens of reports of ongoing disability secondary to the disease. I doubt such outcomes were considered by the President when he claimed 99% of cases are "totally harmless" (and I doubt most symptomatic COVID sufferers would describe their experiences as harmless).
> 
> Looking at COVID outcomes merely as binary -- i.e., alive or dead -- and thinking of herd immunity as a largely inconsequential process are mistakes, I believe.


So what is the alternative? Keep the economy half closed and allow businesses to keep failing and unemployment to keep rising and keep vulnerable people isolated for however long as it takes for the virus to mutate itself away, or a vaccine is developed, and just hope that one of those things happens sooner rather than later?

I've never heard a single person suggest that the process of achieving herd immunity is inconsequential, yet I also have very rarely heard any of the alarmists acknowledge the many consequences of higher rates of unemployment and significant contraction of the economy.


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## mgr22 (Jul 7, 2020)

Carlos Danger said:


> So what is the alternative? Keep the economy half closed and allow businesses to keep failing and unemployment to keep rising and keep vulnerable people isolated for however long as it takes for the virus to mutate itself away, or a vaccine is developed, and just hope that one of those things happens sooner rather than later?
> 
> I've never heard a single person suggest that the process of achieving herd immunity is inconsequential, yet I also have very rarely heard any of the alarmists acknowledge the many consequences of higher rates of unemployment and significant contraction of the economy.



Not sure where you are, but where I live, herd immunity is on the table. So is the belief that doctors are all pessimists, science is part of a deep-state conspiracy, and the President speaks the truth.

An alternative to relying on herd immunity? I'd start with clear, consistent, science-based, top-down policy originating from the White House. We've seen that delegating responsibility for a COVID response to thousands of local officials produces a mix of good and bad decisions. I think there's a workable middle ground between closing the country and partying like it's 1999, but people need to be lead there. Centralized virus avoidance guidelines, while not laws, would at least produce a consistent message and leave room for folks to weigh compliance against one consistent set of realistic consequences.


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## Summit (Jul 7, 2020)

DragonClaw said:


> According to a poster the #1 way to stop/prevent Corona is washing your hands. If this is true why isn't washing hands mandatory in public? Mask ordinance/law is a thing


Washing your hands is the #1 way to stop the spread of contagious diseases in general because the most common contagions are most commonly spread by contact.

(Fomite transmission example is someone with rhinovirus wipes their nose with their hand, touches the doornob, you touch the doornob and then start eating chips).

Not the case for COVID-19. Droplet spread is the predominant mode of community transmission.

Universal masking, physical distancing, and staying home if ill are the primary ways to prevent the community spread of COVID-19.

Wash your hands too. Fomite transmission is a concern.


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## E tank (Jul 7, 2020)

mgr22 said:


> Not sure where you are, but where I live, herd immunity is on the table. So is the belief that doctors are all pessimists, science is part of a deep-state conspiracy, and the President speaks the truth.
> 
> An alternative to relying on herd immunity? I'd start with clear, consistent, science-based, top-down policy originating from the White House. We've seen that delegating responsibility for a COVID response to thousands of local officials produces a mix of good and bad decisions. I think there's a workable middle ground between closing the country and partying like it's 1999, but people need to be lead there. Centralized virus avoidance guidelines, while not laws, would at least produce a consistent message and leave room for folks to weigh compliance against one consistent set of realistic consequences.



Ban the sale of alcohol...done....you're welcome....


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## Summit (Jul 7, 2020)

FiremanMike said:


> Are they saying covid isn't airborne anymore?


We’ve suspected it was airborne since January and known it was airborne since February. However, we know that the predominant mode of transmission in community spread is droplet.

Healthcare transmission is potentially different because of cumulative exposure, the patients are sicker and we do stuff to patients that either generates aerosols, or makes airborne indistinguishable from droplet (extended close contact with high densities of fine droplets).


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## Summit (Jul 7, 2020)

Carlos Danger said:


> There are several of reasons to not want to wear a mask that don't involve being a "science denier", not the least of which is that the overall strategy of trying to stop the spread of the virus through social distancing and mask wearing among the general public is itself questionable.



Please expand on your reasoning. I need some clarity on your point... I'll front load by saying:

1. We have good evidence that universal masking functions as source control to reduce transmission rates, which allows us to relax other economically and socially painful mitigation measures.

2.  I don't want to put words in your mouth, but many of the antimask posts I've seen on the internet (from the ones that are blatanly antiscience and denying COVID exists or that masks will kill you by hypoxia) relate to the deside to get to community immunity faster. If not, disregard. IF you are of the camp that slowing transmission is undesirable because it "delays herd immunity," then how exactly do you propose to achieve the optimal prevalence rate and hold it there? For herd immunity, can you state: target seroprevalence results that indicate community immunity, current seroprevalence rates, and duration of immunity?


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## ffemt8978 (Jul 7, 2020)

E tank said:


> Ban the sale of alcohol...done....you're welcome....


Because Prohibition worked out so well last time?


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## Summit (Jul 7, 2020)

Carlos Danger said:


> The questions in my mind are:
> 1 is masking among the general public really necessary;
> 2 "cost benefit of masks"
> 3 what about individual autonomy (always a foremost concern in my mind);


1. You admit that its effective. We have evidence it is. We need to control transmission. Masks seem the least costly, easiest, yet effective techniques to cut transmission.
2. Yes, in fact, there have been a few analyses that show they both save lives and money. AND what would the consequences of the alternative methods of control?
3. Temporarily having to mask in social situations is only slightly more intrusive than laws requiring a certain amount of clothing.

We have similar levels of libertarian outlook, except in a public health crisis it would appear. What you keep missing here:* What is the alternative?*

Without masks, controlling transmission rates requires  more draconian action like further increasing contract tracing, isolation orders, and societal/economic restrictions.

Masks are the lesser of temporary evils.



> lastly, is trying to stop the spread really the best strategy to begin with, vs. instead focusing on protecting the minority of the population who is likely to develop severe disease



Communities full of multigenerational households, health workers, diabetics, old people, obese people.... the minority with significant risk factors is large.

You understand public use of masks is source control, then in the next breath imply we can end universal masking while still protecting the most susceptible? We have a disease with significant cryptic transmission and long incubation... so how do you keep all the people who interact with the huge "minority of the population" from being infected? Or the people who interact with them? And on and on?



> and allowing those who are at very little risk to be exposed naturally and develop herd immunity?


See my post above. We are nowhere near it, we don't even know how durable immunity is, and we cannot hope to isolate the more vulnerable part of the population while infection burns through the rest.



> Especially considering that the more we learn about it, the less deadly we are finding out it is on a per-case basis.


Maybe IFR is not the 5% that initial Chinese data shows, but the morbidity, mortality, disability, and cost of disease is vastly higher than seasonal influenza.



> The officials have been wrong about pretty much everything they've told us since day 1. They've changed most of their recommendations at least once, been inconsistent and self-contradictory in their messaging in general,


No, not everything. Yea, there has been some **** messaging, some of it even disingenuous (CDC on public masking, WHO on a lot).

Other things change as we know more, as you would expect with a novel pathogen driven pandemic that arose in a communist nation that suppresses and alters information to save face.



> and every prediction has failed to come true.


While there were some wild models out there, the predicted outcomes were the motivation to take action. Actions avoided many of the predicted the outcomes. You cast that as a failure of prognostication rather than a success of mitigation.



> We HAVE managed, however, to beat the hell out of our economy, massively increase our federal debt, create record unemployment, destroy many, many businesses, force the cancellation of countless weddings, graduations, family vacations, and funerals, seen a huge spike in suicides, a huge spike in mortgage defaults, etc, etc.


Yes. And it is tragic. The cost is real and atrocious. If only we had acted earlier and with more determination and coordination, and been better prepared on the whole, some or much could have been avoided.



> All that, and it isn't even clear that any of the lockdown and social distancing orders were really necessary or all that effective.


You can place your personal valuation of cost vs benefit in here, and you can compare not doing the draconian things to countries where the fire burned much hotter and see... but to argue that it was not effective is a mind boggling claim that I'd love to see you defend... unless you mean the haphazard, political stunted way in which we executed it piecemeal  caused a dilution in effectiveness.


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## E tank (Jul 7, 2020)

ffemt8978 said:


> Because Prohibition worked out so well last time?



sarcasm alert......


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## ffemt8978 (Jul 7, 2020)

E tank said:


> sarcasm alert......


No, really?


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## VFlutter (Jul 7, 2020)

I am fairly libertarian in most regards however with masks I do not disagree to the point of contention. I rather wear a mask to avoid the social confrontations of those who are fearful and not medically inclined. However, I can agree that masks can reduce transmission from droplets and still contend that they are redundant to social distancing and with asymptomatic persons.


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## Akulahawk (Jul 7, 2020)

Summit said:


> We’ve suspected it was airborne since January and known it was airborne since February. However, we know that the predominant mode of transmission in community spread is droplet.
> 
> *Healthcare transmission is potentially different because of cumulative exposure, the patients are sicker and we do stuff to patients that either generates aerosols, or makes airborne indistinguishable from droplet (extended close contact with high densities of fine droplets).*


I'm one of the few that go straight from surgical mask to PAPR at work. I rarely will wear an N95 mask, and that's only when a PAPR blower isn't available. When I'm wearing a mask, I don't spend much time close-in with a patient. One of the other ways that I try to help others out at work is because I do have the helmet is that I'll do the aerosol-producing procedures for some of my colleagues so their exposure is more limited. 

I'm not exactly expecting this to go completely away for quite a while... even if it appears to go "quiet" for a few months. Once flu season rolls around again, I actually expect this to come back either by itself or as a co-infection with influenza and if that happens, it ain't gonna be pretty...


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## RedBlanketRunner (Jul 8, 2020)

Carlos Danger said:


> So what is the alternative? Keep the economy half closed and allow businesses to keep failing and unemployment to keep rising and keep vulnerable people isolated for however long as it takes for the virus to mutate itself away, or a vaccine is developed, and just hope that one of those things happens sooner rather than later?


Do what Thailand did?  Government jumped on it, masks and social distancing mandatory the first of March, with people being arrested for non compliance. Almost all businesses shuttered,  Stay at home order in effect. Near 100% compliance. Customers at the stores that were opened were turned away if they didn't wear masks and use the mandatory alcohol hand scrubs out in front of every one of those businesses.

March 29 had the worst number of new infections per day at 143. The second week of April the new infection rate started tapering off. By May 1st new infection rate was under 10 per day and the curve was nearly flat. The government kept full lockdown in place until June 1st then with only re-entires from foreign countries infected they allowed small businesses to cautiously open back up, masks and social distancing still enforced.
And at present the curve remains flat. The government is considering allowing large venues such as shopping malls and schools to reopen in August. Present new infection rate per week, >10, all repatriations. Lockdown will only be eased off further in accordance with the infection rate.

Everyone felt the hurt, and per capita about the same number of jobs have been lost as in the US. But here they played hardball and did it right the first time. Waffling, misleading and gaslighting only serves to prolong the agony.


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## mgr22 (Jul 8, 2020)

VFlutter said:


> I am fairly libertarian in most regards however with masks I do not disagree to the point of contention. I rather wear a mask to avoid the social confrontations of those who are fearful and not medically inclined. However, I can agree that masks can reduce transmission from droplets and still contend that they are redundant to social distancing and with asymptomatic persons.



That's pretty much how I feel. I started wearing a mask in public a few days ago.


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## RedBlanketRunner (Jul 8, 2020)

Economies can recover. Dead bodies, not so much.


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## VFlutter (Jul 8, 2020)

RedBlanketRunner said:


> Economies can recover. Dead bodies, not so much.



Duly noted


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## ffemt8978 (Jul 8, 2020)

RedBlanketRunner said:


> Economies can recover. Dead bodies, not so much.


Are we now disregarding the effects a broken economy has on things like suicide and crime rates? Bad economies can be just as deadly as the disease in some cases.


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## SandpitMedic (Jul 8, 2020)

ffemt8978 said:


> Are we now disregarding the effects a broken economy has on things like suicide and crime rates? Bad economies can be just as deadly as the disease in some cases.


More lives will be touched by an economic depression (and for far longer) than will be by COVID19.


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## ffemt8978 (Jul 9, 2020)

SandpitMedic said:


> More lives will be touched by an economic depression (and for far longer) than will be by COVID19.


Exactly.  Look at just some of the side effects of an economic depression: personal depression, suicide, crime, starvation/hunger, lack of medical care, homelessness, reduction in education.  Everything on that list at one time or another has been proclaimed to be the most severe thing we face and we must fix it for the benefit of society and to help people.  

There is ALWAYS a risk vs benefit factor involved in everything we do as a society and as an individual.  Focusing on one risk (the pandemic) to the detriment of the other risks doesn't help solve the problem.  It would be like killing Peter to save Paul. The same goes for the benefit side of the equation.

Unfortunately, I'm beginning to believe that our governments and health organizations blew it with their COVID-19 response.  Not enough common sense and effective response in the early stages appears to have led to more draconian responses in the later stages.  The next time we face a global pandemic, people may be less likely to adhere to government regulations and guidelines, because they will remember how badly it hurt them this time.

Chicken Little or the boy who cried wolf ring a bell to anyone?


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## RocketMedic (Jul 9, 2020)

ffemt8978 said:


> Exactly.  Look at just some of the side effects of an economic depression: personal depression, suicide, crime, starvation/hunger, lack of medical care, homelessness, reduction in education.  Everything on that list at one time or another has been proclaimed to be the most severe thing we face and we must fix it for the benefit of society and to help people.
> 
> There is ALWAYS a risk vs benefit factor involved in everything we do as a society and as an individual.  Focusing on one risk (the pandemic) to the detriment of the other risks doesn't help solve the problem.  It would be like killing Peter to save Paul. The same goes for the benefit side of the equation.
> 
> ...


Yes, there are life challenges posed by public-health measures. Doesn’t justify someone willfully engaging in behavior that poses a public health hazard.
A very direct question for you: have you ever treated a COVID patient?


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## E tank (Jul 9, 2020)

RenegadeRiker said:


> Yes, there are life challenges posed by public-health measures. Doesn’t justify someone willfully engaging in behavior that poses a public health hazard.
> A very direct question for you: have you ever treated a COVID patient?


The question is what is "engaging in behavior that poses a public health hazard" mean? It's different in San Francisco, Chicago, Miami and Bozeman, MT. And even in those places going to church is not going to a bar is not "protesting" en masse is not going to the grocery store. 

There are absurd, completely arbitrary public health edicts in places like San Francisco that have no basis in science at all. An example would be the 12 person limit to indoor church services in buildings that have a capacity of at least 500 people. 

And I doubt seriously that Anthony Fauci has ever treated a COVID patient so I can't see how that is even relevant to  the discussion.


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## Summit (Jul 9, 2020)

It is sad that we have some really poorly crafted health orders out there. Cali seems to be the epicenter.


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## ffemt8978 (Jul 9, 2020)

RenegadeRiker said:


> Yes, there are life challenges posed by public-health measures. Doesn’t justify someone willfully engaging in behavior that poses a public health hazard.
> A very direct question for you: have you ever treated a COVID patient?


Thank you for making my point.  You chose a perfunctory acknowledgement and dismissal of the other risks to ask me a direct question about the current risk.


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## Carlos Danger (Jul 9, 2020)

VFlutter said:


> I am fairly libertarian in most regards however with masks I do not disagree to the point of contention. I rather wear a mask to avoid the social confrontations of those who are fearful and not medically inclined. However, I can agree that masks can reduce transmission from droplets and still contend that they are redundant to social distancing and with asymptomatic persons.


Pretty much my feeling. I do not at all support government-mandated masking, but rather than continuing to be "that guy" as I have most of my life, the wiser me of today just puts a mask on when I go into the store. I wear them all day anyway at work. Another 20 minutes isn't going to hurt me in any way, and if it reduces the anxiety of others a little and lessens the chance of some type of confrontation, then I'll play along. 

Rather than address the critics of my previous posts point-by-point, I'll just reiterate my position:

There are three potential ways this thing ends:
1) The virus mutates into a form which is far less contagious or far less deadly
2) We achieve population immunity as a result of widespread vaccination
3) We achieve population immunity

Any of those are possibilities, but can we _count on_ an effective, safe, affordable vaccine being developed anytime soon? The answer to that is clearly no. Can we _count on_ the virus mutating itself into harmlessness?  Also no. Is herd immunity a perfect solution? Of course not. On balance, what other option is there? They say that with an R0 of 2-3, we need about 60% of the population to develop antibodies in order to see a very significant, natural slowing of the spread. Many estimate that about 25% of the population has been exposed already. How else does this thing end?

What about the vulnerable? There's no reason why we shouldn't focus our efforts on protecting them. That's what I've been saying all along. Multigenerational households? Old folks needing to go grocery shopping? We put a man on the moon using technology developed in the 1950's; I think we can figure it out. Families, neighbors, churches, community organizations, local governments can do it all. Many grocery stores voluntarily open earlier for vulnerable people. Maybe some could require masks of everyone and dramatically increase cleaning in order to help the elderly feel safer and attract their business. Grocery delivery services and ride-sharing services have instituted steep discounts for elderly folks. There's a lot more that we can think of, too. We can allow healthy people in their 20s, 30's, and 40's to go to work and have a drink at the bar with their friends. Maybe the obese diabetics should exercise some personal responsibility and choose not to join them for beers? 

Does the social distancing even help? I mean, yeah, you lock the whole population in their house for months under threat of criminal penalty, and you'll see transmission slow. I don't think that's the real question, though. How much of this is really necessary? Why do bars that serve food get to open but bars that don't serve food had to fire all their employees? Why are church services and outdoor concerts and sporting events banned, but public political protests advocating left-wing positions are encouraged? Why do surfers on isolated beaches with no one around, or people jogging on the beach or boardwalk or people sitting in their cars with the windows rolled up at the drive-in Easter church service need to be fined? Why are remote state parks and national forests closed? I think we know the real reason, and it has little or nothing to do with slowing the spread of the virus.

Masks? It's pretty indisputable that in the types of controlled environments that are conducive to study, the wearing of clean, properly constructed masks can slow the spread of respiratory droplets and prevent aerosolization of them to a significant degree. If you are intubating someone, or spending hours in close quarters with a patient caring for them, or sharing a cab or crowded elevator or helicopter cabin with others, there's probably some real value there. But how pertinent is that really to people walking past each other in the grocery store? Is a significant benefit not conferred on the wearer alone, regardless of whether others have them on? Does the cleanliness or construction of the mask matter at all? 

The negative effects of economic downturn on public health, quality of life, and mortality rate are practically ignored. We know that in recessions, rates of alcoholism and abuse of other drugs, depression, anxiety, suicide, child and elder abuse, hunger, homelessness, and overall mortality rates increase. Why are we pretending that isn't true? Why are we just automatically assuming that whatever benefit is conferred from restrictions is definitely worth it? Doesn't seem very scientific to me. 

What about the political costs of government officials overplaying their hand in general, often hypocritically? Public animosity towards these interventions and the officials who issue the diktats and then (in some very high profile cases) exempt themselves or their cronies does not bode well for compliance with similar orders in the future, perhaps during a much worse epidemic. You can't tell people "the sky is falling" too many times before they just stop listening.  



Summit said:


> IF you are of the camp that slowing transmission is undesirable because it "delays herd immunity," then how exactly do you propose to achieve the optimal prevalence rate and hold it there? For herd immunity, can you state: target seroprevalence results that indicate community immunity, current seroprevalence rates, and duration of immunity?


Why are those who promote the idea that allowing the virus to mostly spread naturally (aside from providing vigorous protections from those whose health status or age makes them more vulnerable than the general population) expected to have an answer to every question but those who promote the "close everything down and make everyone wear masks" approach don't have to provide even a general idea on what the goal really is and how we should expect this thing to end, OR to justify the countless societal costs exacted by that approach? Seems a little one-sided and hypocritical.


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## RedBlanketRunner (Jul 9, 2020)

By all means, get on with your lives. But don't be a vector.  That's the problem. Deliberately not wearing masks and practicing social distancing converts an individual with established rights and freedoms into a negligent irresponsible potential vector


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## ffemt8978 (Jul 9, 2020)

RedBlanketRunner said:


> By all means, get on with your lives. But don't be a vector.  That's the problem. Deliberately not wearing masks and practicing social distancing converts an individual with established rights and freedoms into a negligent irresponsible potential vector


For once you said something I agree with


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## RocketMedic (Jul 9, 2020)

I love how Senõr Danger completely misses both the point and the fact that the examples of the USA and Sweden are being ravaged by preventable public communication while populations that don’t associate a cloth face mask and some personal space with tyranny are not.


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## Carlos Danger (Jul 9, 2020)

RenegadeRiker said:


> I love how Senõr Danger completely misses both the point and the fact that the examples of the USA and Sweden are being ravaged by preventable public communication while populations that don’t associate a cloth face mask and some personal space with tyranny are not.


Well, those are certainly all words.


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## CCCSD (Jul 9, 2020)

RenegadeRiker said:


> I love how Senõr Danger completely misses both the point and the fact that the examples of the USA and Sweden are being ravaged by preventable public communication while populations that don’t associate a cloth face mask and some personal space with tyranny are not.



I’d like to buy a coherent sentence for $100, Alex.


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## RedBlanketRunner (Jul 10, 2020)

ffemt8978 said:


> For once you said something I agree with


Look, it's simply about understanding, fathoming where a person is coming from and trying to grasp a different point of view. The wearing masks and social distancing thing is a perfect example. People getting belligerent to the point of demanding others remove their masks.
Average person who disregards the basics simply has poor understanding and grasp. Many probably couldn't come very close to explaining what a vector is. I said vector in the circles here on this forum and it's a given. Greater understanding.

It's the same when I mentioned driving a hearse converted to an ambulance and we had no authority to give treatments. People think that suddenly type 1s appeared with a full load of equipment and a long list of accepted procedures they could undertake.  The modern day ambulance services went through over 50 years of evolution.  When I first learned first aid rescue it was some silliness waving the patients arms around. CPR wasn't even on the horizon until 15 years down the road.
Expand your understanding of where people are coming from. Try to grasp what their experiences were.

Just imagine stepping out on the stage at that recent rally in Tulsa, pointing at the crowd and announcing, "You people are all vectors!" Would they all rush to put masks on or shout you down and tell you to get off the stage?


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## Carlos Danger (Jul 10, 2020)

RenegadeRiker said:


> I love how Senõr Danger completely misses both the point and the fact that the examples of the USA and Sweden are being ravaged by preventable public communication while populations that don’t associate a cloth face mask and some personal space with tyranny are not.


After reading this a few times, I think I understand.

Señor Danger does not miss the point. Señor Danger recognizes that some countries have had handled this thing differently. Señor Danger also knows that the media have misled you into thinking the the US has been hit far worse AND handled the thing far worse than most of the world, because if you take out just a few of our most densely populated urban centers, which is fair to do because they are not representative of most of the US, that the US doesn't even make the top ten countries in terms of known infections per million or deaths per million. Señor Danger wonders if you knew that?


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## ffemt8978 (Jul 10, 2020)

RedBlanketRunner said:


> Look, it's simply about understanding, fathoming where a person is coming from and trying to grasp a different point of view. The wearing masks and social distancing thing is a perfect example. People getting belligerent to the point of demanding others remove their masks.
> Average person who disregards the basics simply has poor understanding and grasp. Many probably couldn't come very close to explaining what a vector is. I said vector in the circles here on this forum and it's a given. Greater understanding.
> 
> It's the same when I mentioned driving a hearse converted to an ambulance and we had no authority to give treatments. People think that suddenly type 1s appeared with a full load of equipment and a long list of accepted procedures they could undertake.  The modern day ambulance services went through over 50 years of evolution.  When I first learned first aid rescue it was some silliness waving the patients arms around. CPR wasn't even on the horizon until 15 years down the road.
> ...


I understand where people are coming from far more than I let on.  Where they are coming from is a factor, but not as important as what they are trying to accomplish and how.  In today's society of intolerance for everyone and everything not on a particular side, those of us who are in the middle are left facing two opposing extremes on any issue, when in reality there should be a middle of the road option that would work.

The same thing could be said of the COVID19 response by governments and health organizations.  By dropping the ball early and not implenting sensible recommendations (recommendations, not requirements), they were forced to implement draconian requirements that place extreme burdens on people and the economy.    Some people were accepting of these requirements because they either feel this is the most severe threat we've ever faced (news flash...it's not), or because they don't seem to have the ability to consider more than one thing at a time.


----------



## RedBlanketRunner (Jul 11, 2020)

Well, I'll toss out *one* reason why Americans are in such a hurry to reopen the economy. Affluenza. All those motorhomes, RVs and other non essential toys just sitting there.
As for demanding the right to not wear masks. .........................

It's a little funny. For around 15 years doing the health and hygiene gig in the boonies around here, I was so used to wearing a mask I quit noticing I was wearing it, and near bathing in alcohol, up to a liter a day. And now, I've encountered about 20 people from the outlying areas making a point they are doing like I was. Pointing to their masks and holding up hand sanitizer bottles. They're quite happy to be doing their part in disease control.
Of course there are extenuating circumstances. Widespread epidemics are commonplace here and all the working class and farmers are totally victimized by the medical system. Anything they can do to get a little control of their lives is okay by them.


----------



## Carlos Danger (Jul 11, 2020)

RedBlanketRunner said:


> Well, I'll toss out *one* reason why Americans are in such a hurry to reopen the economy. Affluenza. All those motorhomes, RVs and other non essential toys just sitting there.


Yeah, it's all greed. 

It has nothing at all to do with the fact that the majority of our population lives paycheck to paycheck and struggles to make their rent or mortgage payment if they miss a single paycheck. It couldn't possibly be that the highest unemployment rates since the Great Depression nearly 100 years ago are certain to cause very real problems that far outlast COVID-19, especially when superimposed on pre-existing consumer debt, mental health, and drug abuse crises. 

No, it definitely can't be any of that…..it's gotta be the RV's.


----------



## GMCmedic (Jul 11, 2020)

I don't understand why people in other countries are always obsessed about what we're doing in America, more specifically, what they think were doing wrong.


----------



## luke_31 (Jul 11, 2020)

GMCmedic said:


> I don't understand why people in other countries are always obsessed about what we're doing in America, more specifically, what they think were doing wrong.


It’s that they feel their way is better and if we don’t follow their path we are wrong.


----------



## RedBlanketRunner (Jul 11, 2020)

GMCmedic said:


> I don't understand why people in other countries are always obsessed about what we're doing in America, more specifically, what they think were doing wrong.


You don't? Let's see.
1. American has been the #1 trend setter for the world for quite a few years. In part thanks to Hollywood.
2. America has a habit of telling other countries what to do and how to live that far exceeds the British Empire colonization during it's heyday.
3. The world economy is more strongly affected by the US dollar than any other currency.
4. It's possible there are more American expats than any other country. (SE Asia has >150,000, myself included.)
5. The US military presence in foreign countries.
6. The US has placed itself and it's politics as the example of freedom and prosperity.
7. The US has a wide open door on foreign national property ownership and as such, there are several million big bucks persons and entities that watch it's internal goings on very carefully.(see note below)
8. And more recently of course, the US is the greatest threat to continue the spread of C-19 around the world.
And quite a few other reasons.
When a country has gone to such lengths to be front and center on the world stage what isn't understood is why Americans don't understand why people in other countries watch it so closely.

Property ownership, exemplified. Observed: Large real estate company in the SF bay area was doing an open house tour of available real estate. On several occasions they hosted large Chinese entourages. Very often these tours would simply drive past and glance at the properties for sale, not getting out of their vehicles. At the end of the tour they might remove a property or two from the list then buy all the rest. The has gone on for many years all over the country. Renting American homes to Americans is a gigantic cash cow. How much of America do American's really own?

And of course, how many million mortgages in American are held by foreign investment operations? It's almost impossible to trace where a mortgage actually is with the bundling and rebundling. A labyrinthine maze of financial transactions.
How could it possibly be that Americans wonder why they are constantly in the international spotlight?


----------



## CCCSD (Jul 11, 2020)

#8. Wrong. China. You really believe all the bs coming out of that country? If so, you are woefully ignorant of the world.

BTW, your timelines on your childhood stories and your supposed medical training and history don’t add up. You would be around 80 years old from some of the claims you’ve made.


----------



## Carlos Danger (Jul 11, 2020)

RedBlanketRunner said:


> Property ownership, exemplified. Observed: Large real estate company in the SF bay area was doing an open house tour of available real estate. On several occasions they hosted large Chinese entourages. Very often these tours would simply drive past and glance at the properties for sale, not getting out of their vehicles. At the end of the tour they might remove a property or two from the list then buy all the rest. The has gone on for many years. How much of America do American's really own?
> 
> And of course, how many million mortgages in American are held by foreign investment operations? It's almost impossible to trace where a mortgage actually is with the bundling and rebundling. A labyrinthine maze of financial transactions.
> How could it possibly be that Americans wonder why they are constantly in the international spotlight?



So lots of land in the SF area and lots of mortgages are backed by Chinese investors. So what? Do you have a problem with the Chinese?


----------



## E tank (Jul 11, 2020)

RedBlanketRunner said:


> You don't? Let's see.
> 1. American has been the #1 trend setter for the world for quite a few years. In part thanks to Hollywood.
> 2. America has a habit of telling other countries what to do and how to live that far exceeds the British Empire colonization during it's heyday.
> 3. The world economy is more strongly affected by the US dollar than any other currency.
> ...



9. Without US lead NATO containment of the USSR, Europe especially would look like East Berlin in the 1960's right now. 

There is no other entity on the planet that has the resources to counter authoritarian,  totalitarian threats other than the US. The US presence in foreign countries is by invitation (you left that part out). 

What frosts people about Americans with deconstructionist ideologies that are based on what amount to Marxist tropes is the double standards and hypocrisy that they depend on for their arguments. No credible claims that the US doesn't have dark episodes in our history can be made. But to point those episodes out as if they are in isolation in world history is a joke. 

That there are Americans absolutely willing to sell their country down the river is another conversation all together, and that's for Americans on American soil.


----------



## RedBlanketRunner (Jul 11, 2020)

Carlos Danger said:


> So lots of land in the SF area and lots of mortgages are backed by Chinese investors


Yup. It's only in only spot in California. Nowhere else in the country.  😂



E tank said:


> 9. Without US lead NATO containment of the USSR, Europe especially would look like East Berlin in the 1960's right now.


As I said, any many other reasons. The US is also the #1 contributor to world wide aid being another. Lots and lots and lots of reasons the place is under a microscope.
But being the epicenter of a world wide pandemic is a pretty serious one right now.



Carlos Danger said:


> Do you have a problem with the Chinese?


Mentioned only because I have no first hand knowledge of UAE, Isreali and several other countries investment interests.



CCCSD said:


> BTW, your timelines on your childhood stories and your supposed medical training and history don’t add up. You would be around 80 years old from some of the claims you’ve made.


Your keen interest in me is flattering. Impressive. Obsessive? But yes, I've been around for a while. And I'm just so wonderful! I got my junior life saving badge at the ripe old age of 6! Not sure where the YMCA stacks up in the training ladder.



CCCSD said:


> #8. Wrong. China. You really believe all the bs coming out of that country? If so, you are woefully ignorant of the world.


Infections to date: China - 85067, US - 3,354,925.

Epicenter, 2nd definition: n.  The focal point of a usually harmful or unpleasant phenomenon or event; the center.
Do I need to point out the present focal point? Why the debate and hair splitting?


----------



## ffemt8978 (Jul 11, 2020)

RedBlanketRunner said:


> Infections to date: China - 85067, US - 3,354,925.


Reliable source for this claim?


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## VFlutter (Jul 11, 2020)

https://www.kmov.com/why-did-21-mil...cle_80456379-e8af-52a8-9366-f8af64b45fd1.html


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## jgmedic (Jul 11, 2020)

VFlutter said:


> https://www.kmov.com/why-did-21-mil...cle_80456379-e8af-52a8-9366-f8af64b45fd1.html


Okay, so devil's advocate here. If the above mentioned article is correct and there are anywhere close to 21 Million deaths in China, would that not mean we need stricter measures to control it, else end up like them?


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## VFlutter (Jul 11, 2020)

jgmedic said:


> Okay, so devil's advocate here. If the above mentioned article is correct and there are anywhere close to 21 Million deaths in China, would that not mean we need stricter measures to control it, else end up like them?



Merely pointing out that the official data from China is likely wildly inaccurate and to use it as an argument is laughable. Population density is a huge factor in viral spread. That is one of the reasons Italy and Spain were hit so hard as is why majorly populated cities in the US are hotspots. China really isn't comparable to other countries both from population density and public health policies.


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## FiremanMike (Jul 12, 2020)

Are there still people who believe China only had 85,000 covid cases?

Is it really any wonder why it's so easy for the media to manipulate us?


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## RedBlanketRunner (Jul 12, 2020)

ffemt8978 said:


> Reliable source for this claim?


Hopkins +. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

This web site gets it's data from Hopkins and all over. Not as accurate, more of a ballpark. Continuous updated. I do cross checking randomly with other sites and they hit it pretty accurately. As example, CDC Florida daily infection, 15,299, this site, 15,300.
Of course, cross checking and never trusting a single source is only sensible.








						Coronavirus statistics and information
					

Real-time Coronavirus (COVID-19) cases tracker and resources to keep you safe.




					corona.help
				




Went into a clinic ward yesterday. The place reeked! Sprays are all the same. And sprayers. That unique stench you smell when the farmers are spraying the fields. How much glyphosate and pesticides was in the antiseptic sprayer is anybodies guess. But government hospital. Yell too loud and a persona non grata is in your future. Went back a few hours later and an intense odor of disinfectant was added to the stench.



FiremanMike said:


> Are there still people who believe China only had 85,000 covid cases?


It's pretty academic at this point. But having first hand knowledge of how China operates, the numbers seem reasonably correct. China government is quite capable of locking down an entire city in a few hours. And I mean emptying the streets. Ghost town look. Scary how much clout they have. The general population is very cooperative.
You can get a pretty good snapshot of this same mentality in Singapore. An incident stands out. A man in a business suit came out of his shop house. Dogs in the middle of the night had raided his trash which was scattered over the sidewalk. And up the street was a pair of officers walking his way. On hands and knees he was in a panic stuffing the trash back into the container. The cops saw him, his efforts, and slowed their pace to a stroll. Fine for littering then $1000, payable on the spot. Zero tolerance, no excuses accepted. Chinese, Chinese mentality. Avoid brushes with the law under all circumstances.


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## Carlos Danger (Jul 12, 2020)

RedBlanketRunner said:


> But having first hand knowledge of how China operates, the numbers seem reasonably correct. China government is quite capable of locking down an entire city in a few hours. And I mean emptying the streets. Ghost town look. Scary how much clout they have. The general population is very cooperative.


Too bad that isn't at all what they did…..at least not until it was way too late.


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## RedBlanketRunner (Jul 12, 2020)

Carlos Danger said:


> Too bad that isn't at all what they did…..at least not until it was way too late.


Actually, it appears they did clamp down, but in their typical style.  First major police operation is roadblocks, always. Undoubtedly that's what they did. Wuhan is the crossroads of central China and there was definitely no major spreading to other provinces. Word would have gone out. Then the systematic shut down of a city of around 10 million people about half the size of the entire greater Los Angeles area.
It seems they went into lockdown around the 1st of February, but in typical political style. Lots of government officials giving out contradicting orders. And somewhere along the line Beijing stepped in, probably slapped a few local officials around, and shut the whole province down. Mobilized a couple hundred thousand police and paramilitary and cut all the road and communication. Standard policy.


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## RedBlanketRunner (Jul 13, 2020)

Something that bears mentioning. North Thailand, Chiang Mai to be precise, is the out of country Chinese playground. Thailand has capitalized on Chinese tourism. No visa required and around $100 gets a round trip ticket and a week or two in a nice hotel.
When the virus hit in China everyone was gearing up for Chinese New Years. We were wall to wall Chinese tourists. Word came down of the virus and Thailand cancelled the celebration. We probably had a half million people in Thailand that needed to be repatriated. Word came from all quarters from gossip all the way up to government announcements Wuhan was locked down. If a person had to return there they going to get trapped for the long haul. The other provinces were open, at least to enter the country, and there was minimal hassle involved.

We also have a large local population of Chinese people and Thainese, born in Thailand, around 15% of the population of Thailand, that stay in touch with friends and relatives back home.  There is simply no way there could be a cover up on any grand scale without them hearing about it.

So the grand conspiracy theory of China sandbagging virus info is simply ridiculous. Word would have leaked out ten thousand different ways through friends and relatives. It was confined to Wuhan, it was contained, and the infection rate couldn't have been much more than what was officially reported.
When Wuhan opened back up, the info flood gates were opened as well. Absolutely no word has come down, from word on the streets, through NGO sources, through the thousands of businesses contacts and connections, through various unofficial government channels or through the Chinese government announcements, of anything more than what was reported by WHO and is taken to be the facts at the CDCs.


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## RedBlanketRunner (Jul 13, 2020)

Wuhan - C-19 addendum. Lockdown as done in the US, and lockdown as they did in Wuhan, would be decidedly different. I've been in Wuhan a couple of times. The place is like Manhattan Monday morning rush hour but 24/7. Driving there is ... well, you may forget where third and the higher gears are. Call it almost gridlock, day or night.
I talked to some people who were in Wuhan during the lockdown and saw pictures they had taken. Might as well have been on the moon. Police checkpoints at just about every intersection and nearly all vehicles on the road were motorcycle delivery people who would often get stopped every block. The city central was pretty much deserted. It was such a transformation people were taking pictures of the city streets. The usually jamb packed sidewalks with nobody in sight.
This lockdown went for 3 solid months during which time nearly everyone had been tested for the virus. Lockdown was lifted only when the curve went flat.
I just can't imagine compliance like that in other countries. It takes a police state to have that degree of compliance. But it should be kept in mind, crowd control is a perfected science in China. People are used to being told what to do and cooperation among individuals is not entirely voluntary. Stay in line, do as you're told, observe the rules and if you want to cut loose and seriously party, take it out of the country during your vacations.


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## FiremanMike (Jul 13, 2020)

China has a  population of 1.4 billion people.  For them to have only 85,000 cases is either lack of testing and/or false data reporting.

This is not debatable.


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## GMCmedic (Jul 13, 2020)

I'll take a pandemic over apartment building doors being welded shut and police and military with orders to shoot violators on site. Hard pass on China tactics.


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## CCCSD (Jul 13, 2020)

China will easily sacrifice millions just to do it. They have zero concern for their people except how to win the Long March. ALL are subject to the needs of the PLA/Party.

Anyone who believes any reporting out of China is a complete fool.


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## RedBlanketRunner (Jul 13, 2020)

GMCmedic said:


> I'll take a pandemic over apartment building doors being welded shut and police and military with orders to shoot violators on site. Hard pass on China tactics.


That constant 'big brother' presence... i't's often subtle, but constantly there in your mind. I suppose coming from a free and open country like America makes me much more aware of it than most of the people who were born and raised under it.
Something like the Wuhan lockdown shoves it into stark relief. Yes, they can mobilize a 100,000 strong police force in very short order.


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## RedBlanketRunner (Jul 13, 2020)

After going through the usual morass of news sources this AM. Not being political one way or the other. It would be refreshing, more to the point unprecedented, to get just a few days in a row of purely scientific C-19 info and reports without having to sort through a half million tons of political slants, denials, accusations, innuendo, gaslighting, untruths and other assorted garbage.
Right now it's like trying to read a white paper or morbidity report  filled with commercial messages.
Instead of them being voices lost in the wilderness, just some plain facts from the medical community as headlines and follow ups, even if they disagree or are outright contradictory, would be better than the present rat sandwiches with mustard and marmalade.


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## Jim37F (Jul 14, 2020)

3 new fatalities reported today. 1st time we've had more than 1 death reported from COVID-19 at any one time. Total deaths stand at 22 statewide.

We've def seen a second wave, we had had zero new cases for a couple days in a row, started opening back up, then new cases spiked back into the 20-30 per day, including the single largest daily spike (42 new cases on Saturday).

Total cases are approximately 1,250 Statewide. 

Though most have recovered or been released from isolation already, with that number standing at 911

Out of the 300 or so active cases, only 30 are currently hospitalized, and only 3 of those are in the ICU.

Approximately 90 of the States 190 ICU beds are in use by non COVID patients, so we still have half our capacity available. 









						Hawaii reports 3 new COVID-19 fatalities, pushing death toll to 22
					

“We all extend our heartfelt sympathies to the family and friends of these three people."




					www.hawaiinewsnow.com
				












						Close to 30 people are currently hospitalized with COVID-19 statewide
					

Sources say the majority of Hawaii’s COVID-19 patients are being treated at The Queen’s Medical Center.




					www.hawaiinewsnow.com
				








__





						U.S. COVID Risk & Vaccine Tracker
					

Covid Act Now has real-time tracking of your community's COVID risk level. Explore how your community is doing.




					covidactnow.org


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## RedBlanketRunner (Jul 14, 2020)

Thailand just got hammered. https://www.bangkokpost.com/thailand/general/1950752/covid-19-cases-trigger-inquiry
So far, the grand total has been 3227 positives, 58 deaths.


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## Jim37F (Jul 14, 2020)

Not anywhere near as bad as Thailand, but at least 44 cases here can be traced to one individual who worked out at two different gyms and attended a work training program (Hawaiian Airlines)









						DOH: Clusters at Hawaiian Airlines, local gyms involve same patient
					

At least 44 cases of coronavirus that have been confirmed in Hawaii over the last several weeks can potentially be traced back to a single individual, the state health director said Monday.




					www.hawaiinewsnow.com


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## ffemt8978 (Jul 14, 2020)

Sadly, this was a matter of just when this would happen.









						Man killed by police after mask dispute at Michigan store
					

DETROIT (AP) — A Michigan sheriff’s deputy on Tuesday fatally shot a man suspected of stabbing another man who had challenged him about not wearing a mask at a store, police said...




					apnews.com


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## RedBlanketRunner (Jul 14, 2020)

ffemt8978 said:


> Sadly, this was a matter of just when this would happen.
> 
> 
> 
> ...


That is a WTF moment of near biblical proportions. Along the lines of too improbable for a plot in a cheap Hollywood B movie.  How did homo erectus manage to get this far in evolution without being outclassed by wombats and penguins?

BTW, just a voice in the wilderness, a small objective point of view from left field; congrats extended to the US medical profession in general for flattening the mortality curve. That this is being done during a near exponential rise in infections makes the effort all the more impressive.
And a question along this line. Is there any particular effort or aspect that stands out in the mortality reduction?


And a PS. While this man assumed the position of PM through a coup, he is conducting himself and the government in an exemplary manner in response to the pandemic.  The humility he displayed in this public statement is very impressive. Pardon me for saying it, but a counterpoint to what's going on in the US. https://www.bangkokpost.com/thailand/general/1951312/prayut-apologises-vows-to-step-up-measures
It's all the more impressive in that the apology was made in the orient where face and the face game runs and rules the entire social structure.


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## RedBlanketRunner (Jul 15, 2020)

Wish I could post this picture. An associate's friend in Wuhan who was born and raised in New York. Fully covered in PPEs Arms folded over his chest, Almost up to his knees in flood water.  Captioned, 'Going to work. Isn't this just dandy. Imagine the Hudson rising 15 feet overnight.'


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## RedBlanketRunner (Jul 15, 2020)

Hospital data on coronavirus patients will now be rerouted to the Trump administration instead of first being sent to the US Centers for Disease Control and Prevention, the Department of Health and Human Services confirmed on Tuesday. 

First rule when invading another country. Seize the lines of communication and control the media news sources.


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## ffemt8978 (Jul 15, 2020)

RedBlanketRunner said:


> Hospital data on coronavirus patients will now be rerouted to the Trump administration instead of first being sent to the US Centers for Disease Control and Prevention, the Department of Health and Human Services confirmed on Tuesday.
> 
> First rule when invading another country. Seize the lines of communication and control the media news sources.


Once again, source for your claim? 

Also, and this goes for everyone, the political commentary has no place in this thread unless it specifically pertains to COVID-19 and treatments.


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## PotatoMedic (Jul 15, 2020)

ffemt8978 said:


> Once again, source for your claim?
> 
> Also, and this goes for everyone, the political commentary has no place in this threas unless it specifically pertains to COVID-19 and treatments.











						Trump administration orders hospitals to bypass CDC with data reporting - CNN Video
					

Hospital data on coronavirus patients will now be rerouted to the Trump administration instead of first being sent to the US Centers for Disease Control and Prevention, the Department of Health and Human Services confirmed to CNN.




					www.cnn.com


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## ffemt8978 (Jul 15, 2020)

PotatoMedic said:


> Trump administration orders hospitals to bypass CDC with data reporting - CNN Video
> 
> 
> Hospital data on coronavirus patients will now be rerouted to the Trump administration instead of first being sent to the US Centers for Disease Control and Prevention, the Department of Health and Human Services confirmed to CNN.
> ...


I had seen that too, was just trying to get him to start posting links to the source of his claims.  There's been more than enough unsupported claims about this disease.


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## Summit (Jul 15, 2020)

That reporting switch took a better part of my day. Ugh. 

Having data on infection not go to CDC is just bizarre.


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## Jim37F (Jul 15, 2020)

I'm more confused by the "1st rule of invasion, seize lines of communication..." bit

Not like changing the reporting chain is in prep for invading anything. CDC and HHS are both federal government branches, and if anything the media is going to become even more critical of him for this...


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## mgr22 (Jul 15, 2020)

Jim37F said:


> I'm more confused by the "1st rule of invasion, seize lines of communication..." bit
> 
> Not like changing the reporting chain is in prep for invading anything. CDC and HHS are both federal government branches, and if anything the media is going to become even more critical of him for this...



Well, yes. It's newsworthy, so I'd expect the news media to cover it. As for criticism, can you think of a compelling reason that isn't self-serving to shunt COVID-19 information away from the CDC?


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## ffemt8978 (Jul 15, 2020)

mgr22 said:


> Well, yes. It's newsworthy, so I'd expect the news media to cover it. As for criticism, can you think of a compelling reason that isn't self-serving to shunt COVID-19 information away from the CDC?


There is some merit to that, but that is a lot different than comparing it to invading a country and taking over the media.  Those type of political conspiracies belong over at Reddit.


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## GMCmedic (Jul 15, 2020)

mgr22 said:


> Well, yes. It's newsworthy, so I'd expect the news media to cover it. As for criticism, can you think of a compelling reason that isn't self-serving to shunt COVID-19 information away from the CDC?


I suspect, just knowing how much of a narcissist Trump is, that theyre looking for irregularities in the data to prove his inital assertion that Covid isnt that big of a deal.


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## Akulahawk (Jul 15, 2020)

mgr22 said:


> Well, yes. It's newsworthy, so I'd expect the news media to cover it. As for criticism, can you think of a compelling reason that isn't self-serving to shunt COVID-19 information away from the CDC?


It could be that the administration doesn't trust that they're getting good data from the CDC. Thus they're requiring the data be sent to another agency within the DHHS. I'd be surprised if CDC doesn't receive the info as well but it would have to be forwarded to them. If the CDC is filtering their "output" through a political lens, that's a problem as that's not supposed to be what they do. 

The CDC is supposed to be an apolitical entity but occasionally they aren't. A couple decades ago, they got slapped pretty hard because they were advocating for gun control so funding toward advocating for gun control was cut to zero. They're still (and always have been) able to study morbidity and mortality in the setting of firearm-related injury and death. I suspect that the administration is concerned that the CDC isn't being apolitical in this particular instance (regarding COVID19). I doubt this move was undertaken as a "spur of the moment" thing, but we probably won't see the internal stuff going on that prompted this to happen, so it's a surprise to many.


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## Akulahawk (Jul 15, 2020)

GMCmedic said:


> I suspect, just knowing how much of a narcissist Trump is, that theyre looking for irregularities in the data to prove his inital assertion that Covid isnt that big of a deal.


Well within the realm of possibilities. Also possible is that the CDC may be "cooking the books" somewhat. After all, any death where a person is infected with COVID 19/Sars CoV2 at the time of death is counted as a "COVID 19 death" even if the cause of death clearly isn't COVID 19.


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## ffemt8978 (Jul 15, 2020)

Akulahawk said:


> It could be that the administration doesn't trust that they're getting good data from the CDC. Thus they're requiring the data be sent to another agency within the DHHS. I'd be surprised if CDC doesn't receive the info as well but it would have to be forwarded to them. If the CDC is filtering their "output" through a political lens, that's a problem as that's not supposed to be what they do.
> 
> The CDC is supposed to be an apolitical entity but occasionally they aren't. A couple decades ago, they got slapped pretty hard because they were advocating for gun control so funding toward advocating for gun control was cut to zero. They're still (and always have been) able to study morbidity and mortality in the setting of firearm-related injury and death. I suspect that the administration is concerned that the CDC isn't being apolitical in this particular instance (regarding COVID19). I doubt this move was undertaken as a "spur of the moment" thing, but we probably won't see the internal stuff going on that prompted this to happen, so it's a surprise to many.


That is a distinct possibility.


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## RedBlanketRunner (Jul 16, 2020)

Akulahawk said:


> The CDC is supposed to be an apolitical entity but occasionally they aren't.


On the other hand, HHS is a cabinet level executive branch of the government with numerous political appointees and ultimately answers to the president.



RedBlanketRunner said:


> First rule when invading another country. Seize the lines of communication and control the media news sources.


Pardon the analogy. America is at war, with Covid-19. The war has become politicized. Turned into a media 3 ring circus, and somebody who specializes in sandbagging, gaslighting and misinformation is desperately trying to be in the center ring.
The medical profession is in very serious trouble if necessary, even vital information, is being withheld from them. As if I needed to spell that out.





						Doctors Have Another Enemy To Fight Besides COVID-19 Itself. This Might Help Them.
					

<div><img src=




					www.newyorkglobe.co
				




Simply put, the CDC is populated mostly by members of the medical profession. It's ridiculous, even farcical that it is being compared to the political paper pushers of HHS.

PS If I don't cite references it is usually because the noise I make is open knowledge and everyone can, and should, be doing their own research. Snatch the text, open a few windows, and fire the text off to at least a half dozen search engines. It takes all of 10 seconds and you will then have far far more data than I could possibly give you from numerous sources, hopefully with opposing viewpoints so you can reach your own conclusions.


----------



## Akulahawk (Jul 16, 2020)

RedBlanketRunner said:


> On the other hand, HHS is a cabinet level executive branch of the government with numerous political appointees and ultimately answers to the president.


This is true. However, since the DHHS is the "parent" organization of the CDC, moving the reporting from the CDC to another entity (or DHHS itself), isn't too far of a "move." Doing so is rather unusual and given that the CDC is an entity entirely within the executive branch, the White House should be able to provide oversight, without doing this. However, given the unusualness of this action, I have a feeling that this was done because of something the CDC was doing (or not doing) vs the White House wanting better control over information dissemination or collection. 

Putting my managerial hat on, if I have several employees that I'm in charge of, and one of them isn't doing something correctly, but I still need that employee do continue performing other functions, instead of "firing" the "bad" employee, I'm going to reassign the task to someone else and if I want to publicly shame that "bad actor" employee, I'm going to make sure everyone knows the task was reassigned. That also serves as a warning to the "new" person to whom I've reassigned that task. Do it correctly or I'll give it to someone else that can. I want reliable data... good, bad, or ugly. I need to know the actual situation so I can make better decisions. Simple explanation. Simpler is usually correct. I wouldn't be at all surprised if it turns out to be basically something along these lines.


----------



## RedBlanketRunner (Jul 16, 2020)

@Akulahawk Informative.
I can't comment further on HHS as I'm strongly prejudiced. It was under the auspices of HHS that women on reservations were informed tubal ligation was reversible. This went on for several years.



Spoiler



A friend of my sister was scheduled for tubal ligation as a form of birth control. She asked me about the procedure. Further investigation on my part and others revealed this was a common practice. Several women on our reservation had already undergone the procedure. Each was informed it was reversible.


----------



## Akulahawk (Jul 16, 2020)

RedBlanketRunner said:


> @Akulahawk Informative.
> I can't comment further on HHS as I'm strongly prejudiced. It was under the auspices of HHS that women on reservations were informed tubal ligation was reversible. This went on for several years.
> 
> 
> ...


Considering that IHS is under HHS, and that IHS has done some really shady stuff in the past, I'm not at all surprised you'd be strongly biased against HHS. Just as IHS is, CMS, FDA, CDC, and NIH all are under the HHS. Because of this, I would normally expect you to cast a wary eye toward CDC as well...


----------



## RedBlanketRunner (Jul 16, 2020)

Akulahawk said:


> Because of this, I would normally expect you to cast a wary eye toward CDC as well...


Very wary. But fortunately there are CDCs the world over to compare to and on the whole the US is toeing the line. Actually a bit more lax and tolerant than many other countries. Fauci's equivalent in some countries has got the local politicians hiding in closets and under rocks.


----------



## RedBlanketRunner (Jul 16, 2020)

We had a similar situation to the C-19 response in the US. The ministry of tourism and the local provincial governments downplayed, sandbagged, the disease prevalence. Tourism=big $$$$. Then along came a woman with degrees in pathology and forensics. Pure cut to the chase and hold nothing back. She read the politicians the riot act earning her the nickname the Iron Lady. Often went out in the field and got her hands dirty doing her own research. She eventually moved up to the position approximately that of Fauci. The floodgates broke, people were well informed of the various diseases as they occurred and the entire country had a trend in cleaning up their act. 
Thailand can attribute a lot of it's response and actions today to the precedents she set. Not that the ministry of tourism is exactly overjoyed. They went from a powerhouse that gave orders to the prime minister, literally, to a soft voice in the wilderness during this pandemic.


----------



## Summit (Jul 16, 2020)

Akulahawk said:


> It could be that the administration doesn't trust that they're getting good data from the CDC. Thus they're requiring the data be sent to another agency within the DHHS. I'd be surprised if CDC doesn't receive the info as well but it would have to be forwarded to them. If the CDC is filtering their "output" through a political lens, that's a problem as that's not supposed to be what they do.



You have the power balances absolutely backwards. CDC's director serves at the pleasure of the president and can be replaced at any moment without senate confirmation.

DHHS, the VP, and the President can have access to the raw NHSN data collected by CDC if they think there is anything biased, hinky, or whatever in their interpretation thereof.

Instead a new collection infrastructure and interface was created and all the hospitals had little notice to prepare to shift their reporting. Why?

It is so bizarre that nefarious assumptions come easily. The only reason to move the data collection on infection out of CDC is to filter what CDC has access to, or to simply be capricious in response to not giving the president''s preferred political spin by suppressing data (and seemingly to make life harder for all the hospitals that already have gargantuan data reporting burdens to many levels of government by making us all switch, again).

Last, your implication that COVID-19 death stats are skewed by counting dead people with the virus is pretty silly. Many or most states track COVID vs COVID-related deaths, but it is a distinction with little meaning. It is like saying that CDC skews smoking related death statistics because they count lung cancer in smokers as smoking related deaths when it was really the cancer or complications of cancer that killed them. What upset the apple cart?


----------



## VFlutter (Jul 16, 2020)

Summit said:


> Last, your implication that COVID-19 death stats are skewed by counting dead people with the virus is pretty silly. Many or most states track COVID vs COVID-related deaths, but it is a distinction with little meaning. It is like saying that CDC skews smoking related death statistics because they count lung cancer in smokers as smoking related deaths when it was really the cancer or complications of cancer that killed them. What upset the apple cart?



I am not sure that implication is silly at all. There are likely many COVID positive patients who die due to other factors that are counted as COVID deaths. Many hospitals have treated it as guilty until proven innocent. There is a distinction that needs to be made there.


----------



## Summit (Jul 16, 2020)

VFlutter said:


> I am not sure that implication is silly at all. There are likely many COVID positive patients who die due to other factors that are counted as COVID deaths. Many hospitals have treated it as guilty until proven innocent. There is a distinction that needs to be made there.


That is not borne out by the data in any significant manner unless you believe the hysterical crap being posted by "COVID is a hoax" types saying that hospitals are swabbing skydiving fatalities, car accident victims, and gunshot fatalities (they aren't), that those are then positive, and that this why the numbers are so high (it isn't).

If there was a swab, there was a reason. The only universal screening recommendation is obstetrics. Some systems also swab scheduled electives (who must quarantine and be asymptomatic) but these are <<1% positive and <<1% mortality!

Apart from screening those specific populations above, people get swabbed at hospital for a reason: either they have COVID symptoms or they are critically ill without explanation.

On a death certificate (have you seen one?) there is typically a leading cause of death, the immediate antecedents (secondary to and tertiary to,) and then major comorbidities. So if someone dies of lung adenocarcinoma secondary to smoking with comorbidities of COPD, hypertension and atherosclerosis... do you find it unreasonable to say that is a smoking related death? If you don't think so, then the logical extension is that smoking doesn't really kill very many people and neither does COVID.

Otherwise, you see what I mean by a distinction without difference.

Nobody is reporting a death as COVID related without a positive PCR. Think critically: who is dying, and why did they get swabbed?


----------



## RedBlanketRunner (Jul 16, 2020)

@Summit That summed it up admirably.

And here we go. The major debate is on:








						The Trump administration just pulled coronavirus data out of the CDC's hands, and it means Americans can't see where hospital beds are filled
					

In a statement, the CDC said "hospital-reported COVID-19 data summaries will no longer be provided."




					www.businessinsider.com
				



And








						A secretive government project to track coronavirus data is now at the center of a Trump controversy. Here's what you need to know about HHS Protect.
					

The Centers for Disease Control and Prevention will no longer collect coronavirus data directly from hospitals.




					www.businessinsider.com
				




And of course, the Russians....








						Russian hackers linked to the Kremlin have targeted coronavirus vaccine research facilities in the US, the UK, and Canada, according to security officials
					

A hacking collective called Cozy Bear has been accused of targeting coronavirus research organizations.




					www.businessinsider.com
				





By the way, can anyone point me towards a simplified explanation of the RNA rule of six? I'm having a beast of a time simplifying this to explain to non nerds.


----------



## ffemt8978 (Jul 16, 2020)

This is the last warning for everyone to keep your political opinions out of this thread.  Next time somebody gets a forum quarantine.


----------



## RedBlanketRunner (Jul 16, 2020)

ffemt8978 said:


> Also, and this goes for everyone, the political commentary has no place in this thread unless it specifically pertains to COVID-19 and treatments.


My apologies extended if I'm the culprit mentioned. Please consider excusing me if I ask that this be better defined: "_unless it specifically pertains to COVID-19 and treatments_." Does this specifically *pertain to treatment* and not general info on the larger stage relevant to C-19? That is, directly as opposed to obliquely. Ex: hacking virus vaccine trials being obliquely but not quite directly related to treatment.


----------



## ffemt8978 (Jul 16, 2020)

RedBlanketRunner said:


> My apologies extended if I'm the culprit mentioned. Please consider excusing me if I ask that this be better defined: "_unless it specifically pertains to COVID-19 and treatments_." Does this specifically *pertain to treatment* and not general info on the larger stage relevant to C-19? That is, directly as opposed to obliquely. Ex: hacking virus vaccine trials being obliquely but not quite directly related to treatment.


PM sent.  Newsworthy links are allowed....political commentary on those links is not.

Edit to clarify for everyone: objective political information is part of dealing with COVID-19.  Subjective opinions of the political aspects is what will get you in trouble.


----------



## Carlos Danger (Jul 16, 2020)

Summit said:


> That is not borne out by the data in any significant manner unless you believe the hysterical crap being posted by "COVID is a hoax" types saying that hospitals are swabbing skydiving fatalities, car accident victims, and gunshot fatalities (they aren't), that those are then positive, and that this why the numbers are so high (it isn't).



So the director of the Illinois department of public health is lying?






There were lots of stories coming out of NYC at the height the crisis there about COVID being listed as the cause of death if there was even a possibility that it could have been true. Certainly you aren't suggesting that all of the people saying that were tin-foil hat wearing science deniers? Some are respected physicians.



Summit said:


> If there was a swab, there was a reason.


That may have been true early on, but now that tests are much more widely available and so many authorities have been claiming that an important part of getting a handle on this and learning about it is testing, there are an awful lot of people getting tested who don't have a clinical "reason" at all.



Summit said:


> Apart from screening those specific populations above, people get swabbed at hospital for a reason: either they have COVID symptoms or they are critically ill without explanation.


"COVID symptoms" is pretty broad. We are testing anyone who presents anywhere in the system (ER, urgent care, doctor's office)  with _any_ type of respiratory complaint or fever, and some physicians are testing much more liberally than that based on non-classic but known symptoms such as GI complaints and factors such as age and the patient's risk of exposing others. And considering that there are free COVID tests offered all over the area several times a week that see hundreds of people who don't necessarily have any complaints at all, it isn't difficult to imagine that a person could be tested and have a diagnosis without having classic COVID symptoms or even any symptoms at all.


----------



## SandpitMedic (Jul 16, 2020)

I swabbed someone today who was simply seeing me for a med refill for some chronic neuropathic pain. She had an SpO2 of 90% for no known reason (historically >95%) and no history of or symptoms of cardiovascular  illness.

It’s provider discretion. I can swab anyone I want if they are willing (and due to hysteria everyone is willing).


----------



## silver (Jul 16, 2020)

VFlutter said:


> I am not sure that implication is silly at all. There are likely many COVID positive patients who die due to other factors that are counted as COVID deaths. Many hospitals have treated it as guilty until proven innocent. There is a distinction that needs to be made there.



Why should one disease get different treatment in how we report deaths?


----------



## Summit (Jul 16, 2020)

Carlos Danger said:


> There were lots of stories


Dude... I totally go on stories... internet is full of many truths right?  And things never get blown out of proportion and those with an agenda never magnify a few anecdotes and piece of hearsay as a proven dominant trend, right?

Quality confirmation bias... 



> there are an awful lot of people getting tested who don't have a clinical "reason" at all.


Dead people?



> And considering that there are free COVID tests offered all over the area several times a week that see hundreds of people who don't necessarily have any complaints at all, it isn't difficult to imagine that a person could be tested and have a diagnosis without having classic COVID symptoms or even any symptoms at all.


Dead people?

I thought we were talking about deaths. You are talking about sub-acute walky talkies going to a testing tent. 

Yawn.

Commercial lab TAT are easily approaching 10 days because of the surge in cases. Just 2-3 weeks ago it was 3 days. Must be all those dead people they are testing.


----------



## GMCmedic (Jul 16, 2020)

SandpitMedic said:


> (and due to hysteria everyone is willing).



Not I!!!!

I still don't understand why people are so willing to get a qtip shoved into their brain to diagnose something that has no treatment.


----------



## RedBlanketRunner (Jul 16, 2020)

Carlos Danger said:


> there are an awful lot of people getting tested who don't have a clinical "reason" at all.


During a pandemic the only reason that I can think of to not get tested is if you are an alien life form. Even a hermit troglodyte has a chance of exposure on the way to getting tested.



GMCmedic said:


> I still don't understand why people are so willing to get a qtip shoved into their brain to diagnose something that has no treatment.


Check the hundreds of thousands of stupid moves videos on youtube. Qtip to the brain is small change. Now 40 Qtips with the test performed by a drunk chimpanzee with zilch fine motor skills... naw, there would still be some people giving that a try.


----------



## CCCSD (Jul 17, 2020)

There is no reason to get tested unless you are feeling sick. The minimal amount of supplies should be saved for those in need. Getting tested, for something that won’t show positive unless you are sick is a huge waste of resources.

The only thing testing tells you is if you are already infected, you are infected. If you aren’t, its a negative, AT THAT TIME ONLY, creating a false sense of security.

Perhaps if you were working in this arena, you might understand it.


----------



## RedBlanketRunner (Jul 17, 2020)

Excuse me. Confused. Since people can be asymptomatic, presymptomatic or paucisymptomatic and still be contagious, test->positive->isolation->1 less vector in the wild. Where's the flaw here?
I can see the logic with say, dengue, > 'Yups. you have dengue. Want to feel like death warmed over here or at home? All the same unless you show signs of hemmorhage. Your call rolling those dice. One in four chance. '


----------



## FiremanMike (Jul 17, 2020)

Carlos Danger said:


> So the director of the Illinois department of public health is lying?
> 
> 
> 
> ...


In this area, anyone going in for an elective procedure MUST have a negative Covid test within 72 hours of procedure, so there’s another chunk of folks getting asymptomatic testing.. 

Didn‘t the CDC come out within the last few weeks and say that viral spread from an asymptomatic patient was actually pretty rare?


----------



## GMCmedic (Jul 17, 2020)

FiremanMike said:


> In this area, anyone going in for an elective procedure MUST have a negative Covid test within 72 hours of procedure, so there’s another chunk of folks getting asymptomatic testing..
> 
> Didn‘t the CDC come out within the last few weeks and say that viral spread from an asymptomatic patient was actually pretty rare?


They did, then they came back the next day and said what they actually meant was "we dont know enough about covid yet"


----------



## Carlos Danger (Jul 17, 2020)

Summit said:


> Dude... I totally go on stories... internet is full of many truths right?  And things never get blown out of proportion and those with an agenda never magnify a few anecdotes and piece of hearsay as a proven dominant trend, right?
> 
> Quality confirmation bias...


Again, if you are intent on dismissing everyone who disagrees with you as a tin-foil hat wearing idiot - even the well regarded physician in charge of the Illinois Dept of Health - then I can't help you. What was that about confirmation bias?

To refuse to acknowledge that this thing has been politicized and capitalized upon to a large degree is pretty remarkable.



Summit said:


> I thought we were talking about deaths. You are talking about sub-acute walky talkies going to a testing tent.


I was specifically presenting examples to counter your assertion that only people likely sick with COVID were being tested for it. Now you know that isn't true.


----------



## Peak (Jul 17, 2020)

FiremanMike said:


> Didn‘t the CDC come out within the last few weeks and say that viral spread from an asymptomatic patient was actually pretty rare?



While there is a lot that we don’t fully understand, I don’t quite get why asymptomatic spread is such a mystery to people.

If patient A is symptomatic and is coughing and sneezing and patient B has no symptom to act as a vector to spread disease, then even if they had the same viral load (which is unlikely) then it isn’t difficult to reason that the asymptomatic patient is going to be less contagious.


----------



## FiremanMike (Jul 17, 2020)

Peak said:


> While there is a lot that we don’t fully understand, I don’t quite get why asymptomatic spread is such a mystery to people.
> 
> If patient A is symptomatic and is coughing and sneezing and patient B has no symptom to act as a vector to spread disease, then even if they had the same viral load (which is unlikely) then it isn’t difficult to reason that the asymptomatic patient is going to be less contagious.


Makes perfect sense to me, but it certainly wasn’t the case early on when they were shutting down entire firehouses for 14 days because one person tested positive..


----------



## RedBlanketRunner (Jul 17, 2020)

FiremanMike said:


> Makes perfect sense to me, but it certainly wasn’t the case early on when they were shutting down entire firehouses for 14 days because one person tested positive..


Better safe than sorry approach?

Simple comparison between the US to a very well documented other country that has undertaken extreme precautions.
Thailand close to fully shutting back down when 1 asymptomatic person tested positive, which turned into 3 a day later and 7 four days later. 

Sum totals:
Thailand: 3,239 infections, 58 deaths, 3 active cases at present. Country is closed to foreign visitors.
US: 3,764,000 infections, 141,000 deaths, active cases 1,911,870 (https://corona.help/country/united-states)
Comparison to US: 20% population. .086% infection rate. .041% deaths attributed to C-19.  
Chinese tourists per year, 2019, approx 10,000,000. (search engine: _Chinese visitors to Thailand per year_)
One major difference between the two countries is economically Thailand relies much more heavily on foreign tourism than the US.


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## SandpitMedic (Jul 17, 2020)

How long does this go on? Everyone is so scared.
I haven’t seen any reliable data to indicate this is something to be so afraid of. The mortality rate is not that high, the scientific community flip flops daily on information, and the virus ultimately will take its course despite social distancing, mask wearing, etc because we aren’t doing it forever but the virus will be out there forever.

Let’s face it... this is all politics now. We flattened the curve, we prepped logistics, and we have more treatments.

I’d like to get back to normal with some heightened precautionary measures for the obviously demonstrated vulnerable ones, but ultimately more normal than not.


----------



## DesertMedic66 (Jul 17, 2020)

SandpitMedic said:


> How long does this go on? Everyone is so scared.
> I haven’t seen any reliable data to indicate this is something to be so afraid of. The mortality rate is not that high, the scientific community flip flops daily on information, and the virus ultimately will take its course despite social distancing, mask wearing, etc because we aren’t doing it forever but the virus will be out there forever.
> 
> Let’s face it... this is all politics now. We flattened the curve, we prepped logistics, and we have more treatments.
> ...


There are still some communities that are being hit extremely hard by this virus. As in no ED beds available, no ICU beds available, all ventilator being utilized, and all HFNC being utilized, with 20% of the population being positive. Unfortunately some of our local doctors are still having to pick who will get a ventilator and who will die because there are not enough resources. 

I’ve been out of work the past week since I tested positive for the Rona however in that week things have not changed in my local area. 

Sure in the majority of the US it may be political but there are areas where it is more than that and should still be taken very seriously.


----------



## RedBlanketRunner (Jul 18, 2020)

SandpitMedic said:


> We flattened the curve


Never got near it. Reasonably accurate ultra easy to interpret charts. First chart, top left, infection history. Curve lessened very slight on May 8th. Picked up June 18th, went near exponential June 24. https://corona.help/country/united-states
Compare to a country that strictly adhered to lockdown, used masks and maintained social distancing: https://corona.help/country/thailand

The US just hit over 80,000 new infections in a 24 hour period. Appears Fauci's prediction of 100,000 per day will become conservative.


----------



## SSMTB (Jul 18, 2020)

DesertMedic66 said:


> There are still some communities that are being hit extremely hard by this virus. As in no ED beds available, no ICU beds available, all ventilator being utilized, and all HFNC being utilized, with 20% of the population being positive. Unfortunately some of our local doctors are still having to pick who will get a ventilator and who will die because there are not enough resources.
> 
> I’ve been out of work the past week since I tested positive for the Rona however in that week things have not changed in my local area.
> 
> Sure in the majority of the US it may be political but there are areas where it is more than that and should still be taken very seriously.


I second this, I work at a hospital in Los Angeles and none of us could have envisioned at the start of the year some of the stuff  going on right now.


----------



## SandpitMedic (Jul 18, 2020)

I’m not a denier of the virus. I’m a realist. I actually went to work in hard hit areas on contracts. I understand the severity in some places. I have treated Rona+ patients face to face. 

However, those communities are densely populated areas that have absolutely nothing in common with the majority of the remaining landmass of the nation. The one size fits all approach is not appropriate.

The realism is this- and it’s hard to hear because everyone has some level of fear... This virus is much like other virulent illnesses in that it isn’t going away and it is going to get you sooner or later. There’s nothing we can do. You can hide in your house, you can wear a mask, you can avoid gatherings. Sooner or later you will come out, you will take your mask off, you will go to a social function, or you will slip up on the protections you have... and you will get this virus. And for, oh I don’t know, ~98% +/- of people it will be no big deal or a bad “flu like illness.” For a few it will equal lasting complications, for far fewer death. 

Members here have had it, known people who have had it, and appear to be alright save for some who have lost someone vulnerable to it. It affects people differently, but eventually it will affect you to some degree. So all this shutting everything down and halting civilization is a bogus. It’s just delaying the inevitable.


----------



## SSMTB (Jul 18, 2020)

My knowledge of American demographics isn’t the best, but don’t the densely populated areas, host the majority of the population ? (Genuine question, I have actually have poor knowledge )


----------



## Peak (Jul 18, 2020)

SSMTB said:


> My knowledge of American demographics isn’t the best, but don’t the densely populated areas, host the majority of the population ? (Genuine question, I have actually have poor knowledge )



Yes, but what is considered densely populated in the US is far more sparse than in Europe or many parts of Asia


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## RedBlanketRunner (Jul 18, 2020)

CDC-HHS mass confusion: https://precoinnews.com/politics/inside-the-coronavirus-data-mess-the-trump-administration-created/



Peak said:


> Yes, but what is considered densely populated in the US is far more sparse than in Europe or many parts of Asia


All depends:
Population of Los Angeles: Population 3,884,307, 4850 sq mi.  New York city Population 8,244,910, 210 sq mi. Bangkok, population 8,280,925, 605 sq mi. Jakarta Population 35,934,000, 2,468 sq mi.


----------



## SandpitMedic (Jul 18, 2020)

The pandemic will end. It won’t be because we wore masks or didn’t or did go to a baseball game or didn’t. That’s all I’m saying.


----------



## RedBlanketRunner (Jul 18, 2020)

SandpitMedic said:


> The pandemic will end. It won’t be because we wore masks or didn’t or did go to a baseball game or didn’t. That’s all I’m saying.


Probably taper off, like the 1918 H1N1 flu. So far they are tracking very similarly.  Spanish flu averaged 19 million infections per month over 26 months. C-19, almost 5 million per month average and rising very steadily. Spanish flu had 5 waves, C-19 3+ months into the first.


----------



## mgr22 (Jul 18, 2020)

SandpitMedic said:


> How long does this go on? Everyone is so scared.
> I haven’t seen any reliable data to indicate this is something to be so afraid of. The mortality rate is not that high, the scientific community flip flops daily on information, and the virus ultimately will take its course despite social distancing, mask wearing, etc because we aren’t doing it forever but the virus will be out there forever.
> 
> Let’s face it... this is all politics now. We flattened the curve, we prepped logistics, and we have more treatments.
> ...



As I've been saying for several months, I think long-term disability is the least understood and possibly the most consequential part of this virus. I'm attaching the first research I've seen on it. It's just a starting point.

I agree that politics is embedded in COVID-19 debates, but I wouldn't call it "all politics." I think it's reasonable and prudent to take precautions -- e.g., masks, distancing -- despite what some public figures say, at least until a vaccine is ready. I also think it would be much harder to make an argument to family members of the dead or disabled that the virus is nothing to be afraid of. Chuck Woolery is a high-profile example of how family illness can upend one's conviction that the virus is overrated.


----------



## RedBlanketRunner (Jul 18, 2020)

Exemplary infection outbreak response. https://www.straitstimes.com/asia/e...ew-coronavirus-cases-including-16-in-xinjiang



mgr22 said:


> As I've been saying for several months, I think long-term disability is the least understood and possibly the most consequential part of this virus. I'm attaching the first research I've seen on it. It's just a starting point.


There's been some talk in international circles about the long term effects. It's a little aggravating at present in that proper clinical procedures are being rigidly followed. Nothing wrong with that in itself but many procedures can take months to undergo proper reviews, get published and disseminated to the public. Such is the case with long lasting and or debilitating effects. It could be a year or two down the road before we get a full heads up.

I'm really wondering why some countries are playing so fast and loose with this virus, treating it like just another version of H1N1.


----------



## RedBlanketRunner (Jul 18, 2020)

Updated info on the organism. https://www.bbc.com/news/health-53325771



SandpitMedic said:


> Let’s face it... this is all politics now. We flattened the curve,





RedBlanketRunner said:


> Never got near it.


I need to correct myself, in that the mortality rate is indeed flattened and a negative trend in the US. I inquired in an earlier post as to what significant factors this could be attributed to.


----------



## RedBlanketRunner (Jul 19, 2020)

Reopening the economy without a hitch here. Malls and big box stores opening back up. Ministry of public health in conjunction with the CDC has established rigid guidelines.
Went to a home builders supply today.
Single entrance. Masks mandatory. If you don't have one they are selling them at the entrance. N95 masks. I was already wearing one but got them to sell me 2 more. High quality for about 35 cents each. Cost price? Gov. subsidized? Then sign in, use provided hand sanitizer and get temperature checked.
Looked like a double or even triple shift of employees. Big businesses helping out the working stiffs. They were present to enforce social distancing as well as customer service. And at the checkout line, another dose of hand sanitizer after handling merchandise and money.


----------



## RedBlanketRunner (Jul 19, 2020)




----------



## Jim37F (Jul 26, 2020)

Dang. 3rd day in a row of record high new diagnosed cases. Thursday saw 55 new cases, yesterday was 60, and now 73 today.

Statewide cumulative total is 1,620. Of those, 1,167 people have been released from isolation while 161 have been hospitalized. No new updates on our ICU load, tho I haven't heard anything to make me think those numbers have changed significantly (we're sitting juuussst under half capacity) Hopefully these new spikes won't need to change that....









						Hawaii reports third straight single-day record with 73 new COVID-19 cases
					

"If we want to get control of this, we’re going to have to really put the brakes on."




					www.hawaiinewsnow.com


----------



## SandpitMedic (Jul 28, 2020)

Where are all the studies on Hydroxychloroquine etc.?
There is too much back and forth. I see the FDA statements. I’d like to see the studies.

I’ll keep digging


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## Carlos Danger (Jul 29, 2020)

SandpitMedic said:


> Where are all the studies on Hydroxychloroquine etc.?
> There is too much back and forth. I see the FDA statements. I’d like to see the studies.
> 
> I’ll keep digging


I assume you saw this already?



			https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535?fbclid=IwAR2z22ZII6mPsa_EpHAcaF7fllXlP_86uQe93cnwDUlxZ8vuqhWweCBtQWs


----------



## DrParasite (Jul 29, 2020)

Carlos Danger said:


> I assume you saw this already?
> 
> 
> 
> https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535?fbclid=IwAR2z22ZII6mPsa_EpHAcaF7fllXlP_86uQe93cnwDUlxZ8vuqhWweCBtQWs


It will never work.  Trump supports the use of it, so it must be bad.  Any medical professional who supported it now faces the cancel culture backlash.  facts and studies be damned, if you tell people to use it, it must be because Trump said so.  After all, if the economy stays closed, if more people die, the greater the chances that Trump will lose in November.


> In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence


very true words


----------



## ffemt8978 (Jul 29, 2020)

Im going to reopen this thread for now.  For everyone's reference and clarification: you can discuss the political aspects of the COVID9 response by governments as long as you leave the descriptive and divisive adjectives and adverbs out of it.  In addition, the tinfoil hat conspiracies have no place here.

Comments like that buffoon in charge is doing everything wrong or the great one is doing everything right will be removed and earn you a vacation.  Comments like i think the government is doing this wrong or right and here's why will be allowed.


----------



## VentMonkey (Jul 29, 2020)

Haha, we’re all a little lost in this pandemic.


----------



## Jim37F (Jul 30, 2020)

Wellp, yesterday we nearly doubled our Corona daily record, with over a hundred new cases, 109 to be exact.

We even have a new confirmed case in my Department. The guy is at a station a couple battalions away, but still....

They're basically planning on re-shutting down the bars, limiting gathers of no more than 10 people at a time, and whatnot. 

Here i was hoping our Dept would start to ease up on overtime restrictions (because of COVID and the desire to limit any spread, they've been restricting us to only being able to work our own station, even if there's openings elsewhere. Which is cutting down that OT $$ to like nothing... at this rate of new cases, they'll clamp down on that!)

So apparently there's been some drama, our Dispatchers have told us that they've been told that due to HIPAA, they're not allowed to tell us that a patient is confirmed COVID positive if they know about it. Well one of our Captains sent a, well not politically nice, email to the higher ups about that, and well, there's gonna be fallout, still gotta see where it lands, but one statement that came from on high is that "Oh, no! Dispatch has always been allowed to tell you!" Of course our Dispatchers (theyre actual Firefighters who were in the field, and can/will eventually return to the field, they keep in touch with their friends and whatnot...) are all saying "Thats not what you told us earlier...."

So yeah, Drama....


----------



## CCCSD (Jul 30, 2020)

That HIPAA line was waived. They need to coordinate with PH and get it correct. As long as they don’t name names, they can code it or inform of precautions needed.


----------



## Summit (Jul 30, 2020)

CCCSD said:


> That HIPAA line was waived. They need to coordinate with PH and get it correct. As long as they don’t name names, they can code it or inform of precautions needed.


Absolutely. "Broad discretion"


----------



## Jim37F (Aug 2, 2020)

Word is yet another guy in our Dept now has COVID. Thats 7 or 8 FFs at 3 different stations all in the last 2, 3 days coming up positive. Before that we had 2 guys back in like March, then nothing till this spike. Coincidentally (or not...) as a State, we have also had massive spikes including 3 days in a row of triple digit new cases (though today was "only" 80 something new cases...)

And now EMS has their first confirmed case...









						Second EMS worker tests positive for COVID-19
					

The first case in an EMT was announced by the department on Saturday.




					www.hawaiinewsnow.com


----------



## Jim37F (Aug 2, 2020)

CCCSD said:


> That HIPAA line was waived. They need to coordinate with PH and get it correct. As long as they don’t name names, they can code it or inform of precautions needed.





Summit said:


> Absolutely. "Broad discretion"


And yet they still told us that HIPAA said "No, can't tell them" even tho it doesn't make sense. One of our Capts had to send a rather scathing email that got the attention of the Chiefs for them to say "Oh no, they are allowed to tell you", but only AFTER the Dispatchers were telling us they weren't allowed to tell, so hopefully that'll get cleared up.


----------



## E tank (Aug 2, 2020)

Jim37F said:


> ... as a State, we have also had massive spikes including 3 days in a row of triple digit new cases (though today was "only" 80 something new cases...)



So much for masks, distancing and quarantines.


----------



## GMCmedic (Aug 2, 2020)

Were seeing about 800 new cases a day, I think we even got a shout out from Fauci that we were working towards trouble. 

ICU bed usage increased to just shy of 15% from 11%, but ventilator usage is still down from even 2 months ago.


----------



## RocketMedic (Aug 2, 2020)

We’ve got a few medics out sick, one really sick. And management is out on the “mask all the time” in quarters mandate...like they actually expect it to happen.


----------



## Jim37F (Aug 2, 2020)

While we're pretty compliant with masks here, people have def not been social distancing as much.

It may be purely coincidental that all these spikes are showing up a couple weeks after lockdown restrictions were being lifted and people were gathering for parties, going to bars, etc.

After 2 bars were linked to multiple cases, they have just re-shut down all bars for 3 weeks. Those that serve food can stay open as restaurants, but can't serve any booze past 10pm to discourage people gathering and partying at said bar.

At least a dozen cases have been linked to one guy who had a large gathering employee training and then went to two different gyms and did group workout sessions 

Heck, there's been a cluster of cases tied to a large funeral that took place

So yeah those large gatherings are def helping spread this thing.


----------



## silver (Aug 2, 2020)

GMCmedic said:


> Were seeing about 800 new cases a day, I think we even got a shout out from Fauci that we were working towards trouble.
> 
> ICU bed usage increased to just shy of 15% from 11%, but ventilator usage is still down from even 2 months ago.



Total ICU usage or COVID+ ICU patients?


----------



## GMCmedic (Aug 2, 2020)

silver said:


> Total ICU usage or COVID+ ICU patients?


Those are covid numbers. Total ICU usage is 73%ish


----------



## Summit (Aug 2, 2020)

It is an interesting social observation that healthcare workers naturally assume that the (nonsymptomatic) patient is the likely potential source of infection rather than their colleagues in this COVID situation. I see it at hospital, EMS, and more manifested in not-masking or not distancing.


----------



## PotatoMedic (Aug 3, 2020)

I can only speak for one local hospital system, but if you don't wear a mask at work it is an immediate sent home without pay and a meeting scheduled with HR to discuss your future with the system.  At my agency we're all doing pretty well with masks.  Emphasized by management but no punitive actions are being taken.


----------



## Tigger (Aug 3, 2020)

Summit said:


> It is an interesting social observation that healthcare workers naturally assume that the (nonsymptomatic) patient is the likely potential source of infection rather than their colleagues in this COVID situation. I see it at hospital, EMS, and more manifested in not-masking or not distancing.


Breaking station life habits has probably been the subtly hardest part of this whole thing. I spend more time with my shift than anyone else and staying away from each other (which we are fortunate is even somewhat possible here) takes a lot of thought that frankly most people just don't want to do.


----------



## GMCmedic (Aug 5, 2020)

It appears my wife likely has covid. I doubt we will ever know for sure since she is just as against having her brain swabbed for a viris with no treatment as I am. 

That is unless work requires her to be tested, bit I also doubt that sinnce she probably caught it from one of the many known covid + employees working in the ICU right now.


----------



## DesertMedic66 (Aug 5, 2020)

GMCmedic said:


> It appears my wife likely has covid. I doubt we will ever know for sure since she is just as against having her brain swabbed for a viris with no treatment as I am.
> 
> That is unless work requires her to be tested, bit I also doubt that sinnce she probably caught it from one of the many known covid + employees working in the ICU right now.


I was required to test for it. If I tested negative then I would have to use a mix of PTO and sick time as it would have been treated like a normal illness. Since I tested positive I am receiving my normal pay including OT/DT without having to utilize and of my PTO or sick pay. I’ve been off work for 4 weeks now.


----------



## Summit (Aug 5, 2020)

DesertMedic66 said:


> I was required to test for it. If I tested negative then I would have to use a mix of PTO and sick time as it would have been treated like a normal illness. Since I tested positive I am receiving my normal pay including OT/DT without having to utilize and of my PTO or sick pay. I’ve been off work for 4 weeks now.


Yea not depleting PTO is key.

4 weeks? What on Earth is your return to work criteria? I hope it is not test based...


----------



## DesertMedic66 (Aug 5, 2020)

Summit said:


> Yea not depleting PTO is key.
> 
> 4 weeks? What on Earth is your return to work criteria? I hope it is not test based...


Completely symptom free with a negative test once all symptoms have been gone for 24 hours or more.


----------



## Summit (Aug 5, 2020)

DesertMedic66 said:


> Completely symptom free with a negative test once all symptoms have been gone for 24 hours or more.


I sincerely hope your symptoms have resolved at this point.

That guidance is outdated. CDC specifically recommends against test based strategies for RTW except in rare cases (immunocompromised), and in those cases, two negative tests are recommended.

We have good evidence that for mild to moderate cases in immunocompetent patients, no viable virus is shed after reaching both day 9 from symptom onset (we use 10 to be safe) + 1 day post improved symptoms (without antipyretics).

We know people can shed RNA targets of the PCRs after that criteria causing positive tests well after the period of contagiousness is past. We've known this for a while actually. The latest greatest read is this prepress metanalysis of 79 studies looking at viral shedding by respiratory, stool and serum. The important take home is that while patients can shed viral RNA for quite a while (as much as 89 days), the maximum viable virus has been 9 days after onset of symptoms.


----------



## DesertMedic66 (Aug 5, 2020)

Summit said:


> I sincerely hope your symptoms have resolved at this point.
> 
> That guidance is outdated. CDC specifically recommends against test based strategies for RTW except in rare cases (immunocompromised), and in those cases, two negative tests are recommended.
> 
> ...


My situation is a little odd at this point. I had a cough before covid started. I still currently have a cough and since that is a symptom of covid I am not cleared as of right now.


----------



## CCCSD (Aug 5, 2020)

DesertMedic66 said:


> My situation is a little odd at this point. I had a cough before covid started. I still currently have a cough and since that is a symptom of covid I am not cleared as of right now.



It’s just TB. No sweat.


----------



## Tigger (Aug 5, 2020)

DesertMedic66 said:


> I was required to test for it. If I tested negative then I would have to use a mix of PTO and sick time as it would have been treated like a normal illness. Since I tested positive I am receiving my normal pay including OT/DT without having to utilize and of my PTO or sick pay. I’ve been off work for 4 weeks now.


Too bad that PTO use is based on the results of testing that to my understanding is still not super accurate. Feeling v fortunate that we don't have to use sick for any sort of covid type symptoms.


----------



## Summit (Aug 5, 2020)

DesertMedic66 said:


> My situation is a little odd at this point. I had a cough before covid started. I still currently have a cough and since that is a symptom of covid I am not cleared as of right now.


Completely symptom free is a huge hurdle, and one that is not commanded by CDC guidance nor the literature. This is especially so with a singular pre-existing symptom like a cough. Improved symptoms is the expectation (and no fever).

Anyway, even in severely ill cases who are immunocompetent, there is no way you are infections at 15 days, much less 20. 4 weeks? That is ridiculous. That's what happens when organizations pick and choose little bits of this strategy, mix it with that strategy, then impose some additional caveats too.

Enjoy the free vacation I suppose!


----------



## Carlos Danger (Aug 6, 2020)

DesertMedic66 said:


> My situation is a little odd at this point. I had a cough before covid started. I still currently have a cough and since that is a symptom of covid I am not cleared as of right now.


That’s crazy. I live in the southeast where the environmental allergens have me and half the population dealing with a mild, intermittent cough and other minor respiratory symptoms on and off almost year round. Myself and half the hospital medical and nursing staff would be quarantined at home indefinitely if we used your employers criteria.


----------



## GMCmedic (Aug 7, 2020)

Wife gets her brain swabbed tomorrow morning. Work requires it, they dont actually care what the results are as far as returning to work. They only care that she has the test. 

As one of the least hit areas of the country as far as hospital admissions, I find it kind of ridiculous that covid positive employees are allowed to work in the hospital, let alone the ICU.


----------



## CCCSD (Aug 7, 2020)

#Covidlivesmatter.


----------



## GMCmedic (Aug 7, 2020)

CCCSD said:


> #Covidlivesmatter.


I need a laughy face like facebook


----------



## Jim37F (Aug 8, 2020)

Wellp, after almost a week straight of triple digit new cases each day, ICU usage went from like 49% to 53% but at least one hospital is "full up"
(And our department after no cases since March has had 11 FFs (from 3 seperate stations) in the past week or so) 

Basically they were saying that our hospitals were managing the COVID cases (when it was like 20-30 per day or less), but at this new current rate of infection they could be overwhelmed by the end of the month.

So, theyre locking things back down. Inter-Island travel mandatory 14 day quarantine has been reinstated. Bars are closed for 3 weeks. Public parks, including beaches are closed. You can swim, surf, dive, fish (below high water mark, etc) but are only allowed on the sand to get to the water, no sunbathing, walking, running, biking, etc not allowed)


----------



## ffemt8978 (Aug 8, 2020)

GMCmedic said:


> I need a laughy face like facebook


There is one...click the thumb icon next to Like and it will bring up several other options.


----------



## GMCmedic (Aug 8, 2020)

ffemt8978 said:


> There is one...click the thumb icon next to Like and it will bring up several other options.


Im on tapatalk


----------



## Jim37F (Aug 26, 2020)

ICU capacity is still hovering around 50% filled Statewide. 

But apparently Med/Surge beds are at over 90% capacity and they're requesting Military nurses









						Hawaii Asks Feds To Send More Nurses To Help With The Pandemic
					

Local hospitals still have enough space to expand and respond to an increase in coronavirus patients but need more specialized nursing staff.




					www.civilbeat.org
				




And apparently the other day virtually every hospital on island was on divert all at once due to overcrowded ERs









						As hospitalizations soar, ‘unprecedented’ number of ERs are turning ambulances away
					

The number of COVID-19 hospitalizations in Hawaii has nearly quadrupled since the first of the month.




					www.hawaiinewsnow.com
				




So we're back on lockdown. Another 2 weeks of Work from Home/Stay at Home orders closing all non-essential businesses 









						Mayor Kirk Caldwell announces new stay-at-home, work-from-home order for Oahu
					

Oahu will be put under another stay-at-home, work-from-home order starting 12:01 a.m. Thursday for two weeks, Honolulu Mayor Kirk Caldwell announced today.




					www.staradvertiser.com
				





> “If you need to get a haircut, go now,”  [Mayor Kirk Caldwell] said.


----------



## ffemt8978 (Aug 26, 2020)

This may be the neverending disease.  Apparently a man who already had COVID was reinfected with. A different strain.









						Healthy 33-yr-old man first to have confirmed reinfection with SARS-CoV-2
					

It's not surprising or necessarily concerning, but there's important data to dig into.




					arstechnica.com


----------



## GMCmedic (Aug 26, 2020)

ffemt8978 said:


> This may be the neverending disease. Apparently a man who already had COVID was reinfected with. A different strain.
> 
> 
> 
> ...


The important part here is the second infection was mild, or in this case no symptoms. With only one confirmed case of a second infection, we can only speculate, but hopefully this means the body has a much better memory for covid than it does for influenza.


----------



## ffemt8978 (Aug 27, 2020)

GMCmedic said:


> The important part here is the second infection was mild, or in this case no symptoms. With only one confirmed case of a second infection, we can only speculate, but hopefully this means the body has a much better memory for covid than it does for influenza.


Hope for the best, prepare for the worst.  After all, this is only the first *confirmed* case of reinfection.  There's been way too many mistakes, disinformation, and unknown factors about this disease to rest easy yet.


----------



## MMiz (Oct 26, 2020)

As a civilian I'm still struggling to find nitrile gloves, N95 masks, and cleaning wipes.

How is everyone doing supply wise?


----------



## DesertMedic66 (Oct 26, 2020)

MMiz said:


> As a civilian I'm still struggling to find nitrile gloves, N95 masks, and cleaning wipes.
> 
> How is everyone doing supply wise?


No issues for either of my companies. Plenty of gloves, N95/P100, gowns, and cleaning supplies.


----------



## NysEms2117 (Oct 26, 2020)

MMiz said:


> As a civilian I'm still struggling to find nitrile gloves, N95 masks, and cleaning wipes.
> 
> How is everyone doing supply wise?


Wipes & gloves i'm good & have a fair amount. K*N95 masks i have a 20 pack i found at my local store


----------



## Seirende (Oct 26, 2020)

@NysEms2117 you're alive!


----------



## NysEms2117 (Oct 26, 2020)

Seirende said:


> @NysEms2117 you're alive!


May or may not have vanished into ghost mode for work... Sorry for the topic distraction


----------



## Bullets (Oct 26, 2020)

FWIW, i tested positive for antibodies in June and tested negative twice last week. Wonder if this is normal?


----------



## Summit (Oct 26, 2020)

Bullets said:


> FWIW, i tested positive for antibodies in June and tested negative twice last week. Wonder if this is normal?


It's not abnormal. It doesn't mean you are necessarily no longer immune... if you ever were immune.


----------



## Tigger (Oct 27, 2020)

Finally got a large quantity of wipes in last week so we should be set for a bit, but man that is a struggle. We have other options but in the interest of keeping crews motivated to do a good job cleaning after every patient...wipes it is. We're doing wellish on PPE, I can't just order gloves anymore but my vendor is good about approving a case or two every few weeks. By reducing the number of providers contacting respiratory patients we've reduced N95 use...as to whether this is appropriate who knows?


----------



## akflightmedic (Oct 27, 2020)

I do know some of the smaller departments in my area have worked together on supplies. Being that call volume can vary so drastically from one town to the next, and some depts had stockpiles from low usage anyways, they now just keep ordering their usual pars and then reimburse each other based on needs. It works for them.


----------



## PotatoMedic (Oct 27, 2020)

As Red Green says.  "Remember I'm pulli'n for ya, were all in this together."


----------



## MMiz (Oct 27, 2020)

Appreciate the responses.  I'm not in need of anything, but I find it fascinating to see how different agencies are handling the situation.


----------



## Peak (Oct 27, 2020)

Apparently we are in PPE heaven. I no longer have to give away my firstborn to get PPE, and we are no longer reusing any supplies.


----------



## Summit (Oct 27, 2020)

Gloves, gowns, and surgical masks in good supply
N95 supply is intermittent on individual types leading to the need to frequently re-fit-test some users
PAPRs are still heavily backordered with many months of lead time
HEPA blowers are still hard to get with many weeks of lead time


----------



## Jim37F (Oct 27, 2020)

Meanwhile we're starting to run out of N95s here. I dont think we have any issues with gloves or gowns, and we all just got issued new goggles and face shields (and apparently we're gonna get plastic sheets to drape over patients for CPR calls...)

But N95s, we're being asked to reuse them, we even got UV machines to sanitize them in between use (though you can only use it a max of 5 times before the UV breaks down the mask too much) so especially on calls where there's a (perceived) low risk of COVID or other "nasty" to see guys just spray their N95 with spray disinfectant and use it again, and then "nuke" it for the next shift and end up keeping the same N95 for the whole cycle (though pretty much any CPR or BVM case or really any known or suspected COVID positive or other "nasty" we will toss immediately afterwards, we have just enough stock...)

We have like 3 boxes of one size I'm fit tested for in station, and apparently none left (of any size I'm fit tested for) in the storeroom at the moment...

And if you go on a CPR or BVM call wearing an N95 style/size you're not fit tested for, they want you to self isolate/quarantine afterwards. One of the other shifts at my station had that happen to them...

We did get half face respirators for. Initially intended for Engineers pumping at fires if the smoke blows onto them so they don't have to go on air to stay at the pump, we got P100 cartridges and half masks for everyone now to be used as a backup to the N95s. We also got an adapter to use those P100 cartridges with our SCBA facemask as well...


----------



## Summit (Oct 28, 2020)

@Jim37F 5 UV cycles is likely too much unless you have a specific study for your UV source with your specific mask. 2 UV cycles is what I remember when I was I looking into it


----------



## FiremanMike (Oct 28, 2020)

If you guys were unaware, there’s a company called Battelle which has an approved sanitizing process.  You need to setup an account with them and then you just ship them off when soiled..

I‘ve not sent any off yet as our burn rate has been extremely low, but I’ve had my account setup for months..

only thing - they won’t do p100 filters or KN95, only stamped N95 masks..


----------



## Summit (Oct 28, 2020)

FiremanMike said:


> If you guys were unaware, there’s a company called Battelle which has an approved sanitizing process.  You need to setup an account with them and then you just ship them off when soiled..
> 
> I‘ve not sent any off yet as our burn rate has been extremely low, but I’ve had my account setup for months..
> 
> only thing - they won’t do p100 filters or KN95, only stamped N95 masks..



It depends on the N95 and the process. We only do 2 UVGI treatments before we waste the mask due to degradation concerns. I had a pile of studies on it a few months back, but here's one from my browser history:



			https://www.jaad.org/article/S0190-9622(20)30835-5/fulltext


----------



## FiremanMike (Oct 28, 2020)

Summit said:


> It depends on the N95 and the process. We only do 2 UVGI treatments before we waste the mask due to degradation concerns. I had a pile of studies on it a few months back, but here's one from my browser history:
> 
> 
> 
> https://www.jaad.org/article/S0190-9622(20)30835-5/fulltext







__





						Newsroom | Battelle
					

Explore our latest news,  press releases, and more to stay updated on the most recent Battelle achievements, innovations, and philanthropic endeavors.




					www.battelle.org
				



They claim a mask can be cleaned up to 20 times using vaporized hydrogen peroxide


----------



## Summit (Oct 28, 2020)

FiremanMike said:


> __
> 
> 
> 
> ...


Oh its the H2O2 system, thought it was UV.


----------



## NomadicMedic (Oct 28, 2020)

We just topped 200,000 cases in PA.


----------



## Jim37F (Oct 28, 2020)

Summit said:


> @Jim37F 5 UV cycles is likely too much unless you have a specific study for your UV source with your specific mask. 2 UV cycles is what I remember when I was I looking into it


Per the Procedure published by our departments OSHO Battalion Chief, it says "Do not use/sanitize a N95 mask or filter more than five times. After the fifth cycle, properly dispose of the N95 mask and obtain a new N95 mask or filter set."

The Cleanslate machine itself, is programmed with a 100 second cycle for N95 and other porous materials, and a 20 second cycle for non-porous materials (i.e. phones, keys, etc). 
The machine uses a Ultraviolet germicidal irradiation (UVGI) at 1.4 J/cm², and the 100 second cycle "represents 40% more strength than the CDC recommendation."


----------



## FiremanMike (Oct 28, 2020)

Seems to me that UV cleaning would be limited to visible areas, which would be overcome by vaporized hydrogen peroxide


----------



## Akulahawk (Oct 29, 2020)

Summit said:


> N95 supply is intermittent on individual types leading to the need to frequently re-fit-test some users
> PAPRs are still heavily backordered with many months of lead time


Where I work, we are starting to look at rationing our N95 masks again. We used to have 3 different masks (one style w/ 2 sizes and 1 "universal" size) and now we have gone to a different mask style so lots of fit-testing is needed...

But I now have my own TR-600 PAPR system. I didn't have to wait too long to get it. All I have to do now is get it approved for use at work.


----------



## Summit (Oct 29, 2020)

Akulahawk said:


> Where I work, we are starting to look at rationing our N95 masks again. We used to have 3 different masks (one style w/ 2 sizes and 1 "universal" size) and now we have gone to a different mask style so lots of fit-testing is needed...
> 
> But I now have my own TR-600 PAPR system. I didn't have to wait too long to get it. All I have to do now is get it approved for use at work.


Colorado has a law (PHEW) that states workers have a right to use their own PPE if it:
1. provides more protection that equipment provided at the workplace;
2. is recommended by a government health agency; and
3. does not make the worker unable to do the job

If you tried to do something like using the PAPR in the OR you'd get shut down for IP reasons, but otherwise, you'd be good to go in CO.


----------



## Carlos Danger (Oct 29, 2020)

Summit said:


> Colorado has a law (PHEW) that states workers have a right to use their own PPE if it:
> 1. provides more protection that equipment provided at the workplace;
> 2. is recommended by a government health agency; and
> 3. does not make the worker unable to do the job
> ...


Why wouldn’t they let you use a PAPR in the OR?


----------



## Summit (Oct 29, 2020)

Carlos Danger said:


> Why wouldn’t they let you use a PAPR in the OR?


The concern is sterile field contamination. Different models of PAPRs and cuff/hood configurations may offer increased/decreased risk over N95/surgical masks. A total join hood setup is obviously a risk mitigation solution. I personally think that there are ways to do it safely with more traditional PAPR products, and there are some studies that demonstrate this. However, many health systems do not permit PAPRs in the OR.


----------



## Carlos Danger (Oct 29, 2020)

Summit said:


> The concern is sterile field contamination. Different models of PAPRs and cuff/hood configurations may offer increased/decreased risk over N95/surgical masks. A total join hood setup is obviously a risk mitigation solution. I personally think that there are ways to do it safely with more traditional PAPR products, and there are some studies that demonstrate this. However, many health systems do not permit PAPRs in the OR.


Interesting. I knew that was what you were going to say, though this is the first I’ve heard of it. Many anesthesia providers I know routinely wear PAPRs in the OR these days,  though I do not.

I would never work for a system that did not allow PAPRs in the OR where they were indicated.


----------



## Akulahawk (Oct 30, 2020)

I have seen a PAPR hood covering thing that basically directed all outflow down and away from the sterile field. It seems to be a bit unwieldy but at least at a glance, it should alleviate the concern of sterile field contamination. 

As far as using personally-owned PPE, I haven't yet seen anything similar to Colorado's law/regs in California... not that I haven't heard that such a beast exists, but that I haven't yet heard of actual law/regs/case law that would protect me should I start using my own compete PAPR system. What I have is at least as good, if not better, than what is currently provided.


----------



## Summit (Oct 30, 2020)

I really like the TR-300/600 series. Some place love MaxAir but they are loud because of the fan location.


----------



## Bullets (Oct 30, 2020)

Akulahawk said:


> As far as using personally-owned PPE, I haven't yet seen anything similar to Colorado's law/regs in California... not that I haven't heard that such a beast exists, but that I haven't yet heard of actual law/regs/case law that would protect me should I start using my own compete PAPR system. What I have is at least as good, if not better, than what is currently provided.


I thought that was an OSHA regulation, as long as approved by the employer? It is also the case in my state. While as an agency i have struggled with keeping N95s in stock, most of my staff have personally purchased EHFMs with P100 filters and wear them on respiratory or COVID concern calls. This has thankfully kept my N95 burn rate low. SUrgical masks were rough in the beginning but now i can buy them at 7-11 of all places so i or the crew pick up a box or three at the start of every shift. Ive got a good stock pile now


----------



## Akulahawk (Nov 1, 2020)

Bullets said:


> I thought that was an OSHA regulation, as long as approved by the employer


That's the crux of the problem. If it's an OSHA reg, if the employer doesn't approve of it, then it's a no-go, even if the personal PPE is equivalent or superior to what's provided. I haven't found (yet) anything that would override employer approval if the personal PPE is equivalent or superior to provided PPE.


----------



## E tank (Nov 1, 2020)

Summit said:


> The concern is sterile field contamination. Different models of PAPRs and cuff/hood configurations may offer increased/decreased risk over N95/surgical masks. A total join hood setup is obviously a risk mitigation solution. I personally think that there are ways to do it safely with more traditional PAPR products, and there are some studies that demonstrate this. However, many health systems do not permit PAPRs in the OR.


Another unsubstantiated "concern" just like cloth head coverings, non-bouffant caps and forced air warmers...surprised these places aren't drowning witches....


----------



## Chem2Do (Nov 2, 2020)

I watched an interesting youtube video on mask making from a doctor's wife using a HEPA filter vacuum bag (OSHA certified).
Here is the link


----------



## FiremanMike (Nov 17, 2020)

I was just now thinking back to the beginning of this.. When I decided to order 200 N95 masks "just in case"..

Ready for this to be done, can't believe it's gone on this long..


----------



## ffemt8978 (Nov 17, 2020)

FiremanMike said:


> I was just now thinking back to the beginning of this.. When I decided to order 200 N95 masks "just in case"..
> 
> Ready for this to be done, can't believe it's gone on this long..


It will never be done.  Even if we get past COVID, there will be another disease that threatens us unless we take drastic actions.


----------



## Summit (Nov 17, 2020)

ffemt8978 said:


> It will never be done.  Even if we get past COVID, there will be another disease that threatens us unless we take drastic actions.


Ya maybe sometime in the future when some dude chows down on another uncooked Pangolin. 

But hopefully not for many decades


----------



## FiremanMike (Nov 17, 2020)

ffemt8978 said:


> It will never be done.  Even if we get past COVID, there will be another disease that threatens us unless we take drastic actions.


Maybe, but history would suggest that it’ll be awhile.. probably won’t see this again in our career or even lifetime..


----------



## CCCSD (Nov 17, 2020)

China has a bio lab FULL of chimeras...


----------



## ffemt8978 (Nov 18, 2020)

How quickly we forget.  The past 20 years have been full of claims of a pandemic that we need to take actions to stop.  SARS, Swine Flu, Bird Flu, Monkeypox etc...

Yes, COVID-19 is extremely virulent...but that same claim was made about all those other diseases.  COVID-19 has set the new baseline for all future pandemics, and when the next disease comes down the pike people will look to the actions we've taken as a starting point to contain the next one.  For better or worse, we will never be done with this, nor will we ever go back to the "way it was".


----------



## FiremanMike (Nov 18, 2020)

ffemt8978 said:


> How quickly we forget.  The past 20 years have been full of claims of a pandemic that we need to take actions to stop.  SARS, Swine Flu, Bird Flu, Monkeypox etc...
> 
> Yes, COVID-19 is extremely virulent...but that same claim was made about all those other diseases.  COVID-19 has set the new baseline for all future pandemics, and when the next disease comes down the pike people will look to the actions we've taken as a starting point to contain the next one.  For better or worse, we will never be done with this, nor will we ever go back to the "way it was".


I don’t forget those, I was a medic through all of them.  None of them were as impactful nor did any of them require the same extreme measures to try to slow the spread.


----------



## ffemt8978 (Nov 18, 2020)

FiremanMike said:


> I don’t forget those, I was a medic through all of them.  None of them were as impactful nor did any of them require the same extreme measures to try to slow the spread.


In hindsight, that is correct.  At the time, when we were still learning about them, there were a plethora of calls about how each disease was the next disaster.  It turns out that this time, COVID-19 actually warranted those calls unlike the others.


----------



## PotatoMedic (Nov 18, 2020)

MERS is the one I'm afraid of if it ever became as infectious as COVID-19.


----------



## Akulahawk (Nov 23, 2020)

PotatoMedic said:


> MERS is the one I'm afraid of if it ever became as infectious as COVID-19.


How about any of the viral hemorrhagic fevers... If they mutate to become easily droplet or airborne transmissible between humans...


----------



## Summit (Nov 23, 2020)

Exactly. Ebola isn't scary from a US pandemic potential in it's current corm, but it's a mutator








						Current Medical Literature
					






					jamanetwork.com
				




and the Reston strain showed _possible _airborne transmission, but it wasn't clear. Any successful mutation changing to a dominant airborne (or droplet) transmission mode in the wild is likely to become the dominant strain in short order. At least we have an Ebola vaccine now...


----------



## GMCmedic (Nov 24, 2020)

Starting to look like they really junped the gun on that whole "14 days to flatten the curve" mess.


----------



## RedBlanketRunner (Nov 28, 2020)

Meanwhile in Wonkyland, S.E. Asia. Border jumper. Socializing elite rich kid and suspected part time hooker develops classic symptoms, tests positive. Shared a cigarette with occupants of a 'girl bar'.  Roamed a mall, shopping center and visited a theater. Contact tracing of around 350 people and growing by the hour.  Nothing quite like spreading the joy.
Meanwhile government agency A fires a broadside at government agency B after 5 persons jumped another border. 4 went into quarantine, a fifth, who later tested positive, with some tenuous connections to various officials, was allowed to skip the mandatory isolation.

Waiting for the government to slam all the doors shut again.


----------



## Fezman92 (Nov 28, 2020)

I’m waiting for the next lockdown here in NJ/PA. Also wonder if there will be another NYC level spike.


----------



## NomadicMedic (Nov 28, 2020)

The mRNA vaccine strategy looks like it’ll be effective on lots of other viruses, so if nothing else, the research push was a positive.


----------



## NomadicMedic (Nov 28, 2020)

Fezman92 said:


> I’m waiting for the next lockdown here in NJ/PA. Also wonder if there will be another NYC level spike.


Probably won’t be a full lockdown in PA again. But I expect additional mitigation measures within a week or two. Our region’s inpatient/ICU/vent use is going through the roof.


----------



## Fezman92 (Nov 28, 2020)

NomadicMedic said:


> Probably won’t be a full lockdown in PA again. But I expect additional mitigation measures within a week or two. Our region’s inpatient/ICU/vent use is going through the roof.


I know Philly (is starting to see a spike)


----------



## GMCmedic (Nov 30, 2020)

In Indiana our larger level ones are out (or nearly out) of critical care beds. Our local level IIs are in and out of diversion this week. At this point a lock down is basically using a garden hose on a fully involved fire. 

Might as well let it run its course.


----------



## Summit (Nov 30, 2020)

"So... ICU can be 3:1 because we said so... and if we give you an office admin assistant to grab supplies for you, 4:1 or 5:1"

Patients are gonna die and nurses are gonna quit


----------



## silver (Nov 30, 2020)

Summit said:


> "So... ICU can be 3:1 because we said so... and if we give you an office admin assistant to grab supplies for you, 4:1 or 5:1"
> 
> Patients are gonna die and nurses are gonna quit


The alternative is turn patients away?


----------



## Peak (Dec 1, 2020)

Summit said:


> "So... ICU can be 3:1 because we said so... and if we give you an office admin assistant to grab supplies for you, 4:1 or 5:1"
> 
> Patients are gonna die and nurses are gonna quit





silver said:


> The alternative is turn patients away?



At a certain point, yes. Giving poor care to many isn’t better than giving adequate care to some. In a limited resource environment rationing becomes the ethical decision at some point, and you have to consider how to do the most good for the most number of people. That may mean those over 75 don’t get an ICU bed, or those with metastatic disease are not eligible for intubation.


----------



## Carlos Danger (Dec 1, 2020)

Peak said:


> At a certain point, yes. Giving poor care to many isn’t better than giving adequate care to some. In a limited resource environment rationing becomes the ethical decision at some point, and you have to consider how to do the most good for the most number of people. That may mean those over 75 don’t get an ICU bed, or those with metastatic disease are not eligible for intubation.


Rationing is always an option and is occasionally necessary, but a better option is to plan and staff for known eventualities instead of pretending they aren't going to happen in order to improve the bottom line of the healthcare orgs.


----------



## silver (Dec 1, 2020)

Peak said:


> At a certain point, yes. Giving poor care to many isn’t better than giving adequate care to some. In a limited resource environment rationing becomes the ethical decision at some point, and you have to consider how to do the most good for the most number of people. That may mean those over 75 don’t get an ICU bed, or those with metastatic disease are not eligible for intubation.


Totally.

Was more wondering has 3:1 ICU staffing met that threshold for them?


----------



## Summit (Dec 1, 2020)

There are some creative staffing models out there, and you can try to crosstrain staff, but at a certain point you cannot create competent ICU nurses out of thin air. Same for intensivists and RTs. You can crosstrain medics and hospitalists but they are in short supply. At a certain point you have to push anesthesia and PACU into your exploding ICUs (or rather you convert the PACU). When that stopgap hits overflow, you ration.


----------



## FiremanMike (Dec 1, 2020)

Summit said:


> There are some creative staffing models out there, and you can try to crosstrain staff, but at a certain point you cannot create competent ICU nurses out of thin air. Same for intensivists and RTs. You can crosstrain medics and hospitalists but they are in short supply. At a certain point you have to push anesthesia and PACU into your exploding ICUs (or rather you convert the PACU). When that stopgap hits overflow, you ration.


Our medical director works at a major local hospital.  She said the docs were told "all hands on deck" to take care of inpatient units.. This included among other things, ER docs staffing their patients on the floor and... wait for it...  dermatology residents working on gen med floors..


----------



## Fezman92 (Dec 1, 2020)

I feel like that I don’t deserve how people treat me when they find out that I’m an EMT. I just do transport.


----------



## Fezman92 (Dec 1, 2020)

Do any of you wear your mask in the ambulance when you aren’t transporting/treating?


----------



## DesertMedic66 (Dec 1, 2020)

Fezman92 said:


> Do any of you wear your mask in the ambulance when you aren’t transporting/treating?


Yes. N95 when I have a patient. Surgical or cloth when I am up front with my partner.

About a month ago we had an EMT who came to work for a week with symptoms but didn’t tell anyone and didn’t wear a mask. He ended up giving COVID to about 4 medics.

I don’t want to be labeled as a spreader and my facial hair also isn’t up to company standards so a face mask hides it.


----------



## PotatoMedic (Dec 1, 2020)

DesertMedic66 said:


> Yes. N95 when I have a patient. Surgical or cloth when I am up front with my partner.
> 
> About a month ago we had an EMT who came to work for a week with symptoms but didn’t tell anyone and didn’t wear a mask. He ended up giving COVID to about 4 medics.
> 
> I don’t want to be labeled as a spreader and my facial hair also isn’t up to company standards so a face mask hides it.


My wife has been complaining that I'm only shaving once a week.  The masks do really help hide it 😅


----------



## Fezman92 (Dec 1, 2020)

My dad is immunosuppressed so I have a P100. Side note: the immune system is weird.


----------



## VentMonkey (Dec 1, 2020)

My wife’s immunocompromised and has had a bit of a go with this. I’m fairly healthy for my age, but it still manages to remind me what a PITA the virus is.
Not all the way out of the woods yet. 

Maybe I’ll type up a synopsis of it when we’re all done and recovered. Sh*t does suck *** though.


----------



## DesertMedic66 (Dec 1, 2020)

VentMonkey said:


> My wife’s immunocompromised and has had a bit of a go with this. I’m fairly healthy for my age, but it still manages to remind me what a PITA the virus is.
> Not all the way out of the woods yet.
> 
> Maybe I’ll type up a synopsis of it when we’re all done and recovered. Sh*t does suck *** though.


Yep. I got it back in July. Work put me out 2 months for it.


----------



## silver (Dec 1, 2020)

Summit said:


> There are some creative staffing models out there, and you can try to crosstrain staff, but at a certain point you cannot create competent ICU nurses out of thin air. Same for intensivists and RTs. You can crosstrain medics and hospitalists but they are in short supply. At a certain point you have to push anesthesia and PACU into your exploding ICUs (or rather you convert the PACU). When that stopgap hits overflow, you ration.



Yep, never in my career did I anticipate that I would be suctioning tubes, providing oral care and brushing teeth, hanging meds, emptying urine etc and not see a RT or ICU RN for days. I am still very thankful we didn't have to turn people away.


----------



## Fezman92 (Dec 2, 2020)

Too much?


----------



## Medic511 (Dec 2, 2020)

I have been an EMT and Medic for 20+ years, much of it essentially a volunteer.  I never regretted a minute of it and have always felt like an important part of an essential service and thankful that other circumstances allowed me to do EMS because I loved the chance to help.  I lived through the Swine Flu II pandemic of the early 2000's.  EMS were in the first group to receive vaccinations.

Now, it appears that politics and big money have entered into the prioritization of COVID vaccine and that nursing home residents are more important that those of us on the streets.  That is a pill too sour for me to swallow.  Yes, older are at risk, BUT if their caregivers are vaccinated and the older patients do not interact with others outside their facilities, they are NOT at risk.  EMS, on the other hand, are at grave risk on every call that we run.  We have to deal with non-mask compliant people and face homes that are filthy and full of people who will lie about their medical histories and possible exposure.  

But the meat cutter at the slaughterhouse and the cashier at the grocery and liquor store are just as "essential" as we in EMS are deemed to be.  I think it's time for me to retire.


----------



## DesertMedic66 (Dec 2, 2020)

Medic511 said:


> I have been an EMT and Medic for 20+ years, much of it essentially a volunteer.  I never regretted a minute of it and have always felt like an important part of an essential service and thankful that other circumstances allowed me to do EMS because I loved the chance to help.  I lived through the Swine Flu II pandemic of the early 2000's.  EMS were in the first group to receive vaccinations.
> 
> Now, it appears that politics and big money have entered into the prioritization of COVID vaccine and that nursing home residents are more important that those of us on the streets.  That is a pill too sour for me to swallow.  Yes, older are at risk, BUT if their caregivers are vaccinated and the older patients do not interact with others outside their facilities, they are NOT at risk.  EMS, on the other hand, are at grave risk on every call that we run.  We have to deal with non-mask compliant people and face homes that are filthy and full of people who will lie about their medical histories and possible exposure.
> 
> But the meat cutter at the slaughterhouse and the cashier at the grocery and liquor store are just as "essential" as we in EMS are deemed to be.  I think it's time for me to retire.


Last I heard the CDC was recommending that both frontline healthcare providers and nursing home residents will be the first ones to get the vaccine. I haven’t seen any information that says nursing home residents will be put above anyone in the frontline healthcare field.


----------



## ffemt8978 (Dec 2, 2020)

DesertMedic66 said:


> Last I heard the CDC was recommending that both frontline healthcare providers and nursing home residents will be the first ones to get the vaccine. I haven’t seen any information that says nursing home residents will be put above anyone in the frontline healthcare field.


Considering it will be up to each state to determine how it distributes the vaccine, Im sure we'll see plenty of variations and complaints about it.


----------



## mgr22 (Dec 2, 2020)

Medic511 said:


> I have been an EMT and Medic for 20+ years, much of it essentially a volunteer.  I never regretted a minute of it and have always felt like an important part of an essential service and thankful that other circumstances allowed me to do EMS because I loved the chance to help.  I lived through the Swine Flu II pandemic of the early 2000's.  EMS were in the first group to receive vaccinations.
> 
> Now, it appears that politics and big money have entered into the prioritization of COVID vaccine and that nursing home residents are more important that those of us on the streets.  That is a pill too sour for me to swallow.  Yes, older are at risk, BUT if their caregivers are vaccinated and the older patients do not interact with others outside their facilities, they are NOT at risk.  EMS, on the other hand, are at grave risk on every call that we run.  We have to deal with non-mask compliant people and face homes that are filthy and full of people who will lie about their medical histories and possible exposure.
> 
> But the meat cutter at the slaughterhouse and the cashier at the grocery and liquor store are just as "essential" as we in EMS are deemed to be.  I think it's time for me to retire.



Has that decision been made in your state, or are you speaking in general terms?


----------



## CCCSD (Dec 2, 2020)

Nursing home residents are priority, as it should be. They are the most vulnerable.


----------



## Summit (Dec 2, 2020)

I was always a bit shocked that nursing homes were initially tier 1C instead of 1A. CFR in a nursing home can exceed 20%! It is the ethical thing to do to vaccinate them first.

Your PPE works better than isolating nursing homes. A single point of failure in nursing homes can hospitalize and kill scores. Plus, some of these people haven't been able to have a visitor since March! Imagine what not seeing your family for another few months, or ever, may mean to these people?


----------



## Carlos Danger (Dec 2, 2020)

Medic511 said:


> I have been an EMT and Medic for 20+ years, much of it essentially a volunteer.  I never regretted a minute of it and have always felt like an important part of an essential service and thankful that other circumstances allowed me to do EMS because I loved the chance to help.  I lived through the Swine Flu II pandemic of the early 2000's.  EMS were in the first group to receive vaccinations.
> 
> Now, it appears that politics and big money have entered into the prioritization of COVID vaccine and that nursing home residents are more important that those of us on the streets.  That is a pill too sour for me to swallow.  Yes, older are at risk, BUT if their caregivers are vaccinated and the older patients do not interact with others outside their facilities, they are NOT at risk.  EMS, on the other hand, are at grave risk on every call that we run.  We have to deal with non-mask compliant people and face homes that are filthy and full of people who will lie about their medical histories and possible exposure.
> 
> But the meat cutter at the slaughterhouse and the cashier at the grocery and liquor store are just as "essential" as we in EMS are deemed to be.  I think it's time for me to retire.


Are you for real? Where exactly does the “big money” and political influence of nursing home residents come from? 

The prioritization is based on risk and resource utilization. Long term care residents make up nearly 50% of all COVID deaths and place a higher strain on the healthcare system than any other demographic. Think about that. It makes perfectly good sense that they will be the first to be vaccinated.

Maybe it really is time for you to retire.


----------



## CCCSD (Dec 2, 2020)

Medic511 said:


> I have been an EMT and Medic for 20+ years, much of it essentially a volunteer.  I never regretted a minute of it and have always felt like an important part of an essential service and thankful that other circumstances allowed me to do EMS because I loved the chance to help.  I lived through the Swine Flu II pandemic of the early 2000's.  EMS were in the first group to receive vaccinations.
> 
> Now, it appears that politics and big money have entered into the prioritization of COVID vaccine and that nursing home residents are more important that those of us on the streets.  That is a pill too sour for me to swallow.  Yes, older are at risk, BUT if their caregivers are vaccinated and the older patients do not interact with others outside their facilities, they are NOT at risk.  EMS, on the other hand, are at grave risk on every call that we run.  We have to deal with non-mask compliant people and face homes that are filthy and full of people who will lie about their medical histories and possible exposure.
> 
> But the meat cutter at the slaughterhouse and the cashier at the grocery and liquor store are just as "essential" as we in EMS are deemed to be.  I think it's time for me to retire.


Yep. You are so far out of line that you need to leave the medical things to those that know how to Do No Harm.


----------



## NomadicMedic (Dec 2, 2020)

CCCSD said:


> Yep. You are so far out of line that you need to leave the medical things to those that know how to Do No Harm.



correct.
and in PA, its health care workers and vulnerable nursing home patients who will get the vax first.


----------



## Akulahawk (Dec 2, 2020)

Carlos Danger said:


> The prioritization is based on risk and resource utilization. Long term care residents make up nearly 50% of all COVID deaths and place a higher strain on the healthcare system than any other demographic. Think about that. It makes perfectly good sense that they will be the first to be vaccinated.


This, right here, is exactly why LTC residents (in particular) and other elderly people are going to be among the first to be vaccinated. They're the most vulnerable and will take up the most resources in hospital should they become sick. If you vaccinate this population, you effectively remove them from the pool that you'd have to worry about. In my ED, literally ALL of our very sick patients being boarded in the ED (because the ICU is full) that have COVID19 illnesses are ALL over 50 and ALL of them have co-morbidities. Nearly ALL of the COVID19 patients in our ICU are also in that same demographic. Take them out of the picture and we end up freeing up an entire floor along with 1/2 of the ICU. 

HCW's will also be vaccinated so their availability will be maximized. Staffing can easily be the limiting component when considering being able to provide good (if not excellent) vs. substandard/poor care. The worse the staffing, the more likely it is someone (or a lot of people actually) end up having bad outcomes as a result. 

It's absolutely true that you can't make ICU nurses out of thin air. I'm an ED RN (and a reasonably good one at that). While I do provide care for ICU patients, that's not the ONLY thing that I do, so I'm not an expert at it. Move me to the ICU and I'd best be used for providing care for "soft" ICU patients so that I can free-up the actual ICU nurses to care for the patients that need their expertise. It would still take me MONTHS to cross-train to ICU to the point where I'd become proficient.


----------



## Fezman92 (Dec 2, 2020)

Carlos Danger said:


> Are you for real? Where exactly does the “big money” and political influence of nursing home residents come from?


You’ve never heard of Big Nursing Home? It’s right up there with the other big lobbyists groups, Big EMS and Big Air Freshener


----------



## Fezman92 (Dec 2, 2020)

Anyone else think that wearing masks for every call is going to stay even after all of this is over?


----------



## NomadicMedic (Dec 2, 2020)

Fezman92 said:


> Anyone else think that wearing masks for every call is going to stay even after all of this is over?



No. Unless you have patients with respiratory complaints, it’s unnecessary. 

I do think EMS agencies will continue to be more diligent in decontamination of the rigs and gear though.


----------



## DesertMedic66 (Dec 3, 2020)

NomadicMedic said:


> No. Unless you have patients with respiratory complaints, it’s unnecessary.
> 
> I do think EMS agencies will continue to be more diligent in decontamination of the rigs and gear though.


This. Along with keeping a much larger supply of cleaning equipment and PPE on hand.


----------



## Bullets (Dec 3, 2020)

Fezman92 said:


> Anyone else think that wearing masks for every call is going to stay even after all of this is over?


On every call? No, i think we will fall back into a lower level of PPE use. However i do think use of N95s and surgical masks will increase. Professionally, I will probably continue to wear clear safety glasses and some kind of respiratory protection on any call that involves an airway procedure. Nebs, tubes, ect, im gonna have my N95/100 on.  In public life i also think mask wearing will become more normal. I know that i will probably continue to wear a mask, at least during flu season when going into commercial establishments and such.


----------



## ffemt8978 (Dec 3, 2020)

NomadicMedic said:


> No. Unless you have patients with respiratory complaints, it’s unnecessary.
> 
> I do think EMS agencies will continue to be more diligent in decontamination of the rigs and gear though.


While I would hope that would be the case, the reality is that eventually cleaning will return to the same level of apathy it was before the pandemic.

There have always been diseases that require the rig to be cleaned appropriately yet after a while they fall by the wayside.  MRSA, VRE, Hepatitis, etc...are just a few.


----------



## GMCmedic (Dec 3, 2020)

Medic511 said:


> Yes, older are at risk, BUT if their caregivers are vaccinated and the older patients do not interact with others outside their facilities, they are NOT at risk.


This isn't true


----------



## Summit (Dec 3, 2020)

Risk, Benefit, and Ethics of vaccine allocation is discussed in the December 1 CDC ACIP meeting. 

Presentation here: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/COVID-02-Dooling.pdf

Of note:


By the end of December, the number of doses available will be about 40 million, enough to vaccinate 20 million people
21 million HCWs and 3M LTCF residents

As of Nov 30, at least 243,000 confirmed COVID-19 cases among HCP, with 858 deaths
Long-Term Care Facility (LTCF) residents and staff accounted for 6% of cases and 40% of deaths in the U.S.
LTCF modeling demonstrates more cases and death averted at the facility by vaccinating staff compared to vaccinating residents


----------



## GMCmedic (Dec 3, 2020)

Summit said:


> Risk, Benefit, and Ethics of vaccine allocation is discussed in the December 1 CDC ACIP meeting.
> 
> Presentation here: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/COVID-02-Dooling.pdf
> 
> ...


This is interesting, though again with the modeling. Not sure how trustworthy that is anymore. 


Either way, surprises me, but to flat out say they are not at risk is like saying I shouldnt vaccinate my kid cause yours is vaccinated.


----------



## Capital (Dec 5, 2020)

Akulahawk said:


> It's absolutely true that you can't make ICU nurses out of thin air. I'm an ED RN (and a reasonably good one at that). While I do provide care for ICU patients, that's not the ONLY thing that I do, so I'm not an expert at it. Move me to the ICU and I'd best be used for providing care for "soft" ICU patients so that I can free-up the actual ICU nurses to care for the patients that need their expertise. It would still take me MONTHS to cross-train to ICU to the point where I'd become proficient.


This, so much this. 
We're holding ICU patients *alongside* my other patients, without critical care support staff, proper equipment or training. Last night we had an adult cardiac arrest and a pediatric unresponsive come in 2 minutes apart. A full department, 20 in the waiting room and the HEAR never stopped ringing. Our ICU is full and working 3:1, and every ICU within 100 miles is on treat and transfer status.  Code black.
This is so beyond anything I've ever seen.


----------



## RedBlanketRunner (Dec 8, 2020)

Meanwhile, the battle of the politicians rages with the Ministry of Tourism winning the latest round. CDC and Ministry of Public Health being sidelined.  https://www.bangkokpost.com/thailand/general/2032075/thailand-now-open-to-the-whole-world

I've tentatively diagnosed the problem. Politicians are often allergic to science.


----------



## PotatoMedic (Dec 8, 2020)

Rumor is my agency will be getting the Moderna vaccine by the end of the month (pending FDA approval)


----------



## Bullets (Dec 8, 2020)

PotatoMedic said:


> Rumor is my agency will be getting the Moderna vaccine by the end of the month (pending FDA approval)


Were getting the Pfizer version this month. Im scheduled to get it week after Christmas


----------



## Jim37F (Dec 8, 2020)

We're supposed to be in the first group of people to get them here in Hawaii (First Responders and Healthcare Workers).

From what we've heard its voluntary, but if you don't want it you'll have to sign a refusal form essentially. 

Its supposed to be the one that you have to get a follow up shot 6 months later or something like that, not sure if thats a specific vaccine 9r if they're all like that though.

A lot of guys aren't too thrilled though. They're not "anti-Vax" but most of the opposition I've heard out loud in the stations is more that they don't like the idea if being the Guinea Pigs, that we'll find out some horrible side effects in 6 months when half the Department keels over.

So it'll be interesting to see just how many actually sign a refusal and how many go ahead and get the shot. Personally I dont like being a Guinea Pig either, but I think ill just go ahead and get the vaccine, hopefully im not a zombie in 3 months or something lol


----------



## luke_31 (Dec 8, 2020)

Jim37F said:


> We're supposed to be in the first group of people to get them here in Hawaii (First Responders and Healthcare Workers).
> 
> From what we've heard its voluntary, but if you don't want it you'll have to sign a refusal form essentially.
> 
> ...


My thoughts exactly. Not excited about it but I’ll most likely do it too. We haven’t heard anything on our end, but being federal who knows when we will get it. Wouldn’t surprise me if I show up to work one day and they tell us to go down and get the shot or quit.


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## RedBlanketRunner (Dec 9, 2020)

Any updates on potential allergic reactions to the shot? That is one extremely broad precaution statement.
"*People with a history of significant allergic reactions should not have the Pfizer/BioNTech Covid jab, regulators say."*


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## PotatoMedic (Dec 9, 2020)

RedBlanketRunner said:


> Any updates on potential allergic reactions to the shot? That is one extremely broad precaution statement.
> "*People with a history of significant allergic reactions should not have the Pfizer/BioNTech Covid jab, regulators say."*


Nope... But the UK is saying two people so far have had reactions.









						Pfizer COVID vaccine linked to life-threatening allergic reaction
					

UK bans Pfizer shot for people with "significant" history of allergies.




					www.israelnationalnews.com


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## NomadicMedic (Dec 9, 2020)

PA should have it here by the end of the week. EMS is at the front of the line to get it, although I don’t know where I fall on that list. As an aside, our region is close to crisis stage with small agencies being totally decimated by COVID related outages. Sone of the smaller hospitals are totally full.


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## RedBlanketRunner (Dec 9, 2020)

So us several million anaphylactoid or worse sufferers are S.O.L. and have to rely heavily on the mask and distancing cooperation as our front line.  Or bite the bullet and risk going through that end all be all toes to hair line mega itch for a week or two.
I'll say the redundant and obvious; vaccine aint no silver bullet.


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## NomadicMedic (Dec 9, 2020)

RedBlanketRunner said:


> So us several million anaphylactoid or worse sufferers are S.O.L. and have to rely heavily on the mask and distancing cooperation as our front line.  Or bite the bullet and risk going through that end all be all toes to hair line mega itch for a week or two.
> I'll say the redundant and obvious; vaccine aint no silver bullet.



don’t you have antibodies?


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## ffemt8978 (Dec 9, 2020)

How to get your post nuked from this thread:

1) Post in all caps that your rant comes from government websites so it is not fake news
2) fail to post a link back to the sources of your claims
3) post anti-vaccine rants with no supportive evidence for your claims

I'm not calling out any particular member, because it's happened more than once.  I'm just reminding everyone that you need to post links back to the sources of your claims so they can be properly evaluated.


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## RedBlanketRunner (Dec 10, 2020)

NomadicMedic said:


> don’t you have antibodies?


Very poor. I'm elderly with a couple of chronic conditions.

And just to set the record straight, I am very much pro vaccine. Aside from knowing the basic science, have semi functional pre-frontals able to weigh the lesser of evils, and I worked with a medical team through the heartbreaking aftermath a rubella outbreak that anti vaxxers had mowed through.


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## SandpitMedic (Dec 10, 2020)

Capital said:


> This, so much this.
> We're holding ICU patients *alongside* my other patients, without critical care support staff, proper equipment or training. Last night we had an adult cardiac arrest and a pediatric unresponsive come in 2 minutes apart. A full department, 20 in the waiting room and the HEAR never stopped ringing. Our ICU is full and working 3:1, and every ICU within 100 miles is on treat and transfer status.  Code black.
> This is so beyond anything I've ever seen.


Where the hell are you guys working? It is nothing like that where I am from. EMS volumes ways down... ER census way down. ICU maybe a little higher census, but not near capacity.  Literally, laying off ER staff and or EMS.


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## DesertMedic66 (Dec 10, 2020)

SandpitMedic said:


> Where the hell are you guys working? It is nothing like that where I am from. EMS volumes ways down... ER census way down. ICU maybe a little higher census, but not near capacity.  Literally, laying off ER staff and or EMS.


Wish it was like that here. EMS call volume is up. ED volume is up. ICU patients being held in the ED for 96+ hours, only 4.1% of ICU beds available. Sometime later this week we will being doing a surge transfer of a an entire PICU so it can be converted to a COVID ICU overflow.  Nurses are being pulled from the floors, given one day of training, and then being told they are now going to take care of ICU level patients. My flight company is starting to make agreements with hospitals that should the need arise we will be sent over to help with whatever is needed from doing triage in the ED to operating vents in the hospital. We are also starting to collect all of our spare vents and have them prepped to be sent out to local hospitals.

Some of the hospitals are already having to RSI patients due to no more HFNC or CPAP/BiPAP machines being available.


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## Fezman92 (Dec 10, 2020)

NomadicMedic said:


> PA should have it here by the end of the week. EMS is at the front of the line to get it, although I don’t know where I fall on that list. As an aside, our region is close to crisis stage with small agencies being totally decimated by COVID related outages. Sone of the smaller hospitals are totally full.


Who will distribute it for EMS? My employer, my regular doctor or someone else?


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## Akulahawk (Dec 10, 2020)

DesertMedic66 said:


> Wish it was like that here. EMS call volume is up. ED volume is up. ICU patients being held in the ED for 96+ hours, only 4.1% of ICU beds available.


Pretty much the same going on where I work too. ICU capacity at some hospitals is ZERO available beds. Apparently my county is starting to utilize the "surge" beds that haven't been utilized thus far this year. I quite suspect that hospitals are starting to send home patients that would normally be admitted, of course those patients would be those with relatively mild symptoms that would only be managed on a med/surg floor and not need IV fluids or IV meds. Some of those patients are getting an infusion of Bamlanivimab before going home. I don't see things getting much better for a while. This is, I think, the Thankgiving covid surge.


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## NomadicMedic (Dec 10, 2020)

Fezman92 said:


> Who will distribute it for EMS? My employer, my regular doctor or someone else?



The distribution plan is still being decided. It will not come from your employer, and most likely not from your PCP. At present, the vaccine will _probably_ be delivered at a hospital. That is subject to change.


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## NomadicMedic (Dec 10, 2020)

Akulahawk said:


> Pretty much the same going on where I work too. ICU capacity at some hospitals is ZERO available beds. Apparently my county is starting to utilize the "surge" beds that haven't been utilized thus far this year. I quite suspect that hospitals are starting to send home patients that would normally be admitted, of course those patients would be those with relatively mild symptoms that would only be managed on a med/surg floor and not need IV fluids or IV meds. Some of those patients are getting an infusion of Bamlanivimab before going home. I don't see things getting much better for a while. This is, I think, the Thankgiving covid surge.



Same here. The influx of patients is unbelievable.


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## RedBlanketRunner (Dec 10, 2020)

Re: A common and prevalent mentality expressed by some people here, the 'According to Hoyle' mindset. *If it isn't done this way* or *if these procedures aren't the present standard* or *circumstances appear extraordinary* or *isn't the demographic that I work with* it didn't happen, can't be correct, fake news / anecdote.
The house is obviously empty so we won't bother with a sweep. We have the patient right here. Why bother doing a full perimeter check to ascertain in there were other occupants in the vehicle.

Down to brass tacks.
Covid-19, these four people were isolated incidents, crossing the border illegally. Ignore the several hundred border jumpers in hiding knowing if they turn up they will be repatriated across the border and the Myanmar army is well known to shoot some of them on sight. The nearly 100 people hiding in the basement of a church, nearly all of them ill, knowing they are better off there than in those government care facilities.

Your equipment is not universal standard the world over. Your procedures are not accepted and applied in every country. People have markedly different attitudes and mindsets, country to country, culture to culture. The absurd in one location can be the norm right next door.

Conclusion jumping can cost lives. When dealing with epidemics the hazards of jumping to conclusions is exponentially higher.  No brainer the trained medical worker assumes. Everyone will wear masks and social distance.

On these threads regarding C-19. "No big." "People are being laid off." "More than enough PPEs." "Less beds occupied." Your experiences and circumstances are not universal.


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## Fezman92 (Dec 10, 2020)

Once we get vaccinated I’m assuming that we will still have to wear masks and all of that


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## RedBlanketRunner (Dec 10, 2020)

Patient wrapped and packaged, in the unit. Partner checking closely on patient called out to me to do a perimeter check. 30 feet from the vehicle on the other side of a 4 foot high wall I found a second victim. Patient in unit had whispered, "Where's Mike?"

17 years after we gave the new board planning the EMS system, along with all the latest EMT and pre-hospital patient care books and information, the use of C collars for forcible trauma victims is still not in the their procedures. Why? The people doing the training have no field experience and training is nearly entirely voluntary.

The Ministry of Tourism won this round. Country is opening it's borders to tourism as I write this.  Loss of revenue the deciding factor.  As a nod to the C-19 experts, various measures are being taken to prevent the spread of the virus.  However, the entry quarantine mandate has been waived in lieu of various tests before and upon arrival. Daily infection rate had been well under 10 until the border jumpers on Nov. 24.  Since then it's topping 20 and steadily climbing.  4169 infections, 60 deaths to date. Care to place bets where this is going?

I simply do not understand all these assumptions and conclusion jumpers. They aren't science. Yet even some of the top professionals indulge in them.  If science and worst case scenarios had been running the show from Wuhan on we wouldn't be in these dire straights. Just because it isn't happening in your little corner of paradise or fits in your immediate mode of thinking doesn't mean it isn't real.


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## VentMonkey (Dec 10, 2020)

I'm back to work after being out with it for a good while. It hit the whole household like a ton of bricks right around T-Day; definitely not worth reliving. 

As far as all the political jargon, "theories", and relevant/ irrelevant data? Welp, I'm just grateful my wife didn't end up sicker than I thought she was turning for a bit. And I'm pretty much over all of this.

In short, you suck, Covid.


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## GMCmedic (Dec 10, 2020)

Akulahawk said:


> Pretty much the same going on where I work too. ICU capacity at some hospitals is ZERO available beds. Apparently my county is starting to utilize the "surge" beds that haven't been utilized thus far this year. I quite suspect that hospitals are starting to send home patients that would normally be admitted, of course those patients would be those with relatively mild symptoms that would only be managed on a med/surg floor and not need IV fluids or IV meds. Some of those patients are getting an infusion of Bamlanivimab before going home. I don't see things getting much better for a while. This is, I think, the Thankgiving covid surge.


I think youre not just seeing a Thanskgiving surge, but actual Covid season. 

I still think we severely over reacted in March/April (non covid season) and now were paying for it.


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## RedBlanketRunner (Dec 10, 2020)

Sense of smell finally returning. This AM the powerful reek of the perfume in laundry detergent and my eggs and sausage breakfast, not jesting or exaggerating, smelled like fish fried in diesel oil. C-19 combined with a neurological condition is not recommended.



VentMonkey said:


> In short, you suck, Covid.


Amen to that. Glad she's on the road to recovery.


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## Fezman92 (Dec 10, 2020)

GMCmedic said:


> I still think we severely over reacted in March/April (non covid season) and now were paying for it.



what do you mean by that?


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## RedBlanketRunner (Dec 11, 2020)

GMCmedic said:


> I still think we severely over reacted in March/April (non covid season) and now were paying for it.





Fezman92 said:


> what do you mean by that?


Over reaction seems to be relative to the situation and numerous particular circumstances such as mindsets and cultures.
* Over reaction? Wuhan, C-19 outbreak. From numerous accounts, some first hand, in less than one week over 2 million law enforcement, emergency services, the military, and sundry were mobilized. Streets became ghost towns, nobody was allowed to go anywhere.  An unknown number of detentions occurred.  In part, no doubt, a reaction on the government's part to an *initial* *under-reaction and dissemination of falsehoods*.
* March/April in the US.
 - An obvious under reaction as all the charts of the spread of the virus and statistics clearly show.
 - An obvious under reaction as to the dissemination of factual information regarding the hazards of the disease. where falsehoods and outright propaganda were allowed to sway the judgement of millions of people.
 - Present over reaction as armed mobs protest the violation of 'inalienable rights' of individuals.

The real problem is blatantly obvious and apparent:  politics, personal agendas, lack of trust and trust squandered, has supplanted the proper scientific methodology that could have curtailed the spread of the disease. The problem is made exponentially worse by a lack of education and trustworthy information that isn't littered, poisoned, by pseudo science, rumors, hearsay, and outright fantasies.
At this juncture with the country so fiercely divided, the term irreducible seems to best apply.


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## GMCmedic (Dec 11, 2020)

Fezman92 said:


> what do you mean by that?


We always had a pretty good idea that it would have a season. Unfortunately for us that season wasn't in the spring when we had 3 months of flatten the curve in most places. 

It appears at the moment that covid season will line up with flu season.


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## GMCmedic (Dec 11, 2020)

RedBlanketRunner said:


> Over reaction seems to be relative to the situation and numerous particular circumstances such as mindsets and cultures.
> * Over reaction? Wuhan, C-19 outbreak. From numerous accounts, some first hand, in less than one week over 2 million law enforcement, emergency services, the military, and sundry were mobilized. Streets became ghost towns, nobody was allowed to go anywhere. An unknown number of detentions occurred. In part, no doubt, a reaction on the government's part to an *initial* *under-reaction and dissemination of falsehoods*.
> * March/April in the US.
> - An obvious under reaction as all the charts of the spread of the virus and statistics clearly show.
> ...



Under reaction? We closed the entire country because of what was happening in New York, a city thay has had a decades long chronic bed shortage. Meanwhile politicians burned any good faith they had, putting us in the position were in now, where most of the country has chronic bed shortages.


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## RedBlanketRunner (Dec 11, 2020)

GMCmedic said:


> Under reaction? We closed the entire country


Then opened it right back up prematurely. Compare Thailand statistics to the US. Thailand shut down in February and has just started to reopen this week. Other examples are easily available. Cue the 'economy' argument.

Rachael Maddow's interview in this video is very much worth a listen. Especially the part about the hazards not hitting home with the individual and the message getting across better when it's a close friend or loved one who gets the full C-19 hit.


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## GMCmedic (Dec 11, 2020)

RedBlanketRunner said:


> Then opened it right back up prematurely. Compare Thailand statistics to the US. Thailand shut down in February and has just started to reopen this week. Other examples are easily available. Cue the 'economy' argument.
> 
> Rachael Maddow's interview in this video is very much worth a listen. Especially the part about the hazards not hitting home with the individual and the message getting across better when it's a close friend or loved one who gets the full C-19 hit.


Dont cherry pick the qoute to meet your argument.

For the most part, ICUs werent packed full in July and August when restrictions were for the most part lifted across the Nation. They are full now, hence why I am suggesting were now in Covid season, and we were at the tail end of it during the "flatten the curve" debacle. We didnt open prematurely, we closed prematurely.


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## RedBlanketRunner (Dec 11, 2020)

GMCmedic said:


> Dont cherry pick the qoute to meet your argument.


It cherry picked itself. Was watching that interview when I paused and dropped in here.



GMCmedic said:


> For the most part, ICUs werent packed full in July and August when restrictions were for the most part lifted across the Nation. They are full now, hence why I am suggesting were now in Covid season, and we were at the tail end of it during the "flatten the curve" debacle. We didnt open prematurely, we closed prematurely.


Valid contention. Ignoring the many expert warnings of a second wave and calm before the storm scenarios, which proved spot on. So the contention is based upon people getting frustrated and becoming disobedient. Why did they do this and not heed the warnings? Were they fed misinformation? Were they making unwarranted assumptions? Were they fully informed, without contradictions, of the potential grave consequences of their actions and that by the end of the year the US would likely be seeing over 3000 deaths per day? Yes, they were, but the experts were drowned out by unscientific noise. 
A choice, blame premature, or immature, listening to and believing bad advice.


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## RedBlanketRunner (Dec 11, 2020)

It's a little odd, keeping track of what's happening in the US with C-19 and the various protests, then comparing them to here. People have the jitters with the 4 hookers that went out socializing that later tested positive. Masks back on everywhere voluntarily, the local markets turned into gauntlets as people try to keep their distance. Many people coming up with all sorts of excuses to not go into the city. What said it all was our farmer neighbor far out in the middle of his fields alone, hoeing furrows, wearing a mask.


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## NomadicMedic (Dec 11, 2020)

Fezman92 said:


> Once we get vaccinated I’m assuming that we will still have to wear masks and all of that



Yes. We'll be in masks well into 2021


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## Carlos Danger (Dec 11, 2020)

NomadicMedic said:


> Yes. We'll be in masks well into 2021


What is the point of being vaccinated then?


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## cruiseforever (Dec 11, 2020)

Carlos Danger said:


> What is the point of being vaccinated then?


I've heard that you maybe vaccinated and will not get ill.  But their not sure if you still can carry it and get others ill.


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## cruiseforever (Dec 11, 2020)

SandpitMedic said:


> Where the hell are you guys working? It is nothing like that where I am from. EMS volumes ways down... ER census way down. ICU maybe a little higher census, but not near capacity.  Literally, laying off ER staff and or EMS.



Minnesota here.  The spring for us was like you mentioned for your area.  But now it's crazy.  Every shift I have Covid pts. and some of them are very ill.  Took a guy I used to work with in.  He was very ill.  The scary part is he's younger than me.


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## akflightmedic (Dec 11, 2020)

Here in Maine...every hospital is overloaded, no beds, ER packed to capacity. They would bring back the COVID tents but we do not have staff to place in them. On the EMS side, we are running our asses off, confirmed COVIDs every single shift. Local nursing homes inundated. We had to go back to our State Pandemic Phase 4 guideline, basically refusing to transport some patients. Stay at home or in the nursing home and quarantine. I am getting hammered both pre-hospital and in the ER. One nursing home in particular had 8 deaths this past week and now has over 100 COVID+ in house and 30 staff COVID +.


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## NomadicMedic (Dec 11, 2020)

Test the social media “experts” continue to whine about “fake numbers” and social restrictions.


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## RedBlanketRunner (Dec 11, 2020)

NomadicMedic said:


> the social media “experts” continue to whine about “fake numbers” and social restrictions.


I suppose the blame can be laid square on the piss poor basic education systems both in the US and some locations in Europe. There is a vast gap between day to day lives and the academic world. Mr or Ms Average has no idea how science works and how difficult it is to fudge the numbers. More yet, they are completely clueless as to what happens to a reputable institute if they publish fake numbers. Reputation irredeemably shot to hell and you can kiss your funding, present and future good bye.


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## Bullets (Dec 11, 2020)

It literally popped off this week. Last week was slow, ERs were empty and us and the staff were more often and not hang out in the parking lot.

This week its bonkers. Running our tuchus off, ER is packed, we are triaging people to stay home. Thankfully our SNFs never really eased up on their procedures, which are basically Fort Knoxian so it hasnt started ripping through them again. The good thing is so far our patient populations are much younger and less severe than in March/April.Commonly complaining of weakness, lethargy, brain fog, and exertional dyspnea. Thankfully patients are pretty receptive to staying home after a little education from someone who has already had this. Even though our cases are through the roof, hospital census is like 1/3 of what it was in the Spring. Makes you wonder how many people had it back then


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## NomadicMedic (Dec 11, 2020)

This didn’t age well.


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## PotatoMedic (Dec 11, 2020)

FDA approved the vaccine.  Now the CDC needs to finish up some clerical work, and shots should start Monday for our local hospital workers.


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## RedBlanketRunner (Dec 12, 2020)

NomadicMedic said:


> This didn’t age well.


Sure it did. Compared to the science project I scraped off the bottom shelf of the fridge. But that festering glop probably had a year head start.


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## SandpitMedic (Dec 12, 2020)

NomadicMedic said:


> This didn’t age well.


Well, I guess my terminology was a bit brash and rushed.

The virus waxing/waning will probably be dealt with for a long time as we do with the flu. We knew this would spread, but the mortality rate remains relatively low. Also, there are a lot of issues with testing being inconsistent, inaccurate, and plainly not indicated which account for a part of the numbers.

My COVID+ patients have not been as sick as one would imagine based on the television. My experience is in hospital, and in COVID field hospitals x2. While many do wind up in the ICU, the vast majority of patients do not. There is an even larger proportion of asymptotic carriers.

There are still a lot of unknowns about the virus as well, as mortality is not the only concern. The long term sequelae of the virus and potentially the vaccine remain to be seen. I aim not to minimize the virus, but the reaction to the virus. The shut downs were/are an over reaction and evidently do not work.

I’m always learning and adapting as new information is available. It’s not a nothing burger, but it also is not the end of the world. We’ll see what happens as this progresses and we devise better treatments, and the virus mutates.


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## Carlos Danger (Dec 12, 2020)

RedBlanketRunner said:


> I suppose the blame can be laid square on the piss poor basic education systems both in the US and some locations in Europe. There is a vast gap between day to day lives and the academic world. Mr or Ms Average has no idea how science works and how difficult it is to fudge the numbers. More yet, they are completely clueless as to what happens to a reputable institute if they publish fake numbers. Reputation irredeemably shot to hell and you can kiss your funding, present and future good bye.


“iF ewE guiZz hAd betTeR SKoolZ, u wuLd kNot be skePtiCull of aNyTHing end yOo wULd aLwaYzz  jesT doo aS eWe r tolled. R lEEdurz wud nEVUR maniPooLate uS orE misLeeD uS.”

Pot, meet kettle. You completely owned yourself with this post, and you’ll probably never figure out what I mean by that.

If you think the only reason why so many folks are in such disagreement with the ham-handed responses that we’ve seen doled out by every level of government for the past 10 months is because we’re uneducated and simply too dumb to understand, then the joke is entirely on you, and try as you might, your lack of understanding of that precludes you from being able to make any sensible commentary on the matter.

I am firmly in the camp of thinking our federal and state governments made a bad problem even worse and that they absolutely DID mislead us when when it benefitted them, and I’m not quite the uneducated dolt that you’d like to think. Have you done graduate work in physiology and pharmacology and microbiology and clinical statistics and epidemiology? Just curious.


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## Tigger (Dec 12, 2020)

I still struggle with the whole “shut down didn’t work,” thing. I think we all knew it wouldn’t eliminate the virus. It did however give us some time to get capacity together and time to better figure out how to care for  patients.

I am not sure how you prove that it was unnecessary, there really isn’t another comparable event here. You might feel it was overdone, and you might be right. But it seems difficult to state this empirically which is why I am just not going to take a position.


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## E tank (Dec 12, 2020)

A Sensible and Compassionate Anti-COVID Strategy
					

We should respond to the COVID virus rationally: protect the vulnerable, treat the people who get infected compassionately, develop a vaccine. And while doing these things we should bring back the civilization that we had so that the cure does not end up being worse than the disease.



					imprimis.hillsdale.edu


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## mgr22 (Dec 12, 2020)

Tigger said:


> I still struggle with the whole “shut down didn’t work,” thing. I think we all knew it wouldn’t eliminate the virus. It did however give us some time to get capacity together and time to better figure out how to care for  patients.
> 
> I am not sure how you prove that it was unnecessary, there really isn’t another comparable event here. You might feel it was overdone, and you might be right. But it seems difficult to state this empirically which is why I am just not going to take a position.


I agree. I think one reason the shutdown didn't achieve better results -- medical, not economic -- is that it was compromised by mixed messaging from the feds. Who knows how much infection could have been prevented by staying the course, but I'm not discounting the financial consequences.


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## Carlos Danger (Dec 12, 2020)

Tigger said:


> I still struggle with the whole “shut down didn’t work,” thing. I think we all knew it wouldn’t eliminate the virus. It did however give us some time to get capacity together and time to better figure out how to care for  patients.
> 
> I am not sure how you prove that it was unnecessary, there really isn’t another comparable event here. You might feel it was overdone, and you might be right. But it seems difficult to state this empirically which is why I am just not going to take a position.


it is true that it is impossible to say with certainty how much the lockdowns did or did not help. What we do know as that in addition to whatever effect that those measures did or did not have on the spread of the virus, they had countless negative effects which I do not believe are given the consideration that they should. Millions of kids missed most of a year of school, an entire class of seniors were forced to forgo graduation, and many younger ones have endured social isolation and the school resources that they rely on for safety and security. A million small businesses have closed for good and countless people are unemployed or underemployed. The federal debt was increased by a staggering amount in just a few months. Alcohol abuse, drug abuse, domestic violence, and suicide have all likely increased. Trust in the government is at an all time low. None of this was caused by the virus, but by our response to it.

All that said, considering that nearly 50% of all COVID deaths have been among LTC residents and that most of the rest of the severe illnesses and deaths occurred within similarly well-defined populations, I think it is rather apparent that we could have very likely achieved at least similar and quite possibly much better results by focusing on protecting those populations much better than we did, and letting those who we knew were very unlikely to be affected keep going to work and school and church. There were some very smart folks making that case early on, and it always seemed obvious to me.


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## cruiseforever (Dec 12, 2020)

Sweden decided to join the rest of us when their no lock down policy did not get the results they were hoping for.

Long a Holdout From Covid-19 Restrictions, Sweden Ends Its Pandemic Experiment - WSJ


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## mgr22 (Dec 12, 2020)

Carlos Danger said:


> it is true that it is impossible to say with certainty how much the lockdowns did or did not help. What we do know as that in addition to whatever effect that those measures did or did not have on the spread of the virus, they had countless negative effects which I do not believe are given the consideration that they should...


Nor is COVID-related disability, which isn't publicized nearly as often as death, but has compromised many young and old COVID survivors indefinitely.


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## Summit (Dec 12, 2020)

I personally know several previously health ICU RNs and other HCWs younger than I (and I'm not that old) with long-term effects of COVID ranging from unpleasant to debilitating.


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## RedBlanketRunner (Dec 12, 2020)

@Summit Re: C-19 research, your signature says it all. An almost impossibly compressed time frame and far more unassigned variables than established facts. I'm fervently hoping the care providers don't turn into guinea pigs in a rushed, guesswork lab experiment.


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## Akulahawk (Dec 12, 2020)

Carlos Danger said:


> considering that nearly 50% of all COVID deaths have been among LTC residents and that most of the rest of the severe illnesses and deaths occurred within similarly well-defined populations, I think it is rather apparent that we could have very likely achieved at least similar and quite possibly much better results by focusing on protecting those populations much better than we did


I'm of a similar mind at the moment. If we'd done MUCH more to protect the vulnerable (and we knew basically who was most at risk early-on), and kept protecting them throughout the entire time, we'd probably be in an overall better place now. 

That and providing accurate info as we know it at the time...


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## E tank (Dec 12, 2020)

Summit said:


> I personally know several previously health ICU RNs and other HCWs younger than I (and I'm not that old) with long-term effects of COVID ranging from unpleasant to debilitating.


long term effects? it hasn't even been a year...


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## mgr22 (Dec 13, 2020)

E tank said:


> long term effects? it hasn't even been a year...


True, but I think even a few months of debilitating symptoms, without knowing if or when there's an endpoint, is enough to dispel the notion that COVID outcomes are binary, and that getting infected is no big deal for 98% of the population.


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## DrParasite (Dec 13, 2020)

The whole idea of the lockdowns was to "flatten the curve"; it was a short term (two week) solution to not overwhelm the healthcare system, with a huge rush of infections.  what people seem to forget was people were still going to get sick, and even die, but it wasn't going to be a huge spike.  So these long term lockdowns aren't supported by any actual science, but they do have some pretty bad side effects (financial ruin, mental health issues, drug/alcohol abuse, child abuse, educational regression for those in school, etc).  

I don't think COVID is like the bubonic plague, which killed 1/3 of Europe, which seem to be what many people think it is.  No one has ever said the virus didn't exist (despite what some are implying).  People WILL die, it happens every year.  Nursing homes, prisons, and college campuses are going to be hotspots; in fact any time you have large groups of people in close contact you will have issues.  However, outside, it's much rarer because UV light (from the sun or artificially created) dramatically shortens the virus's lifespan.

The simple truth is we can't lockout indefinitely.  We need to find a way to live with this virus, that has a 99% survival rate. We need to take extra precautions among those with comorbidities and find solutions to deal with large groups in small spaces.  I will be taking the vaccine once it's offered to me.  I have former coworkers who caught the covid, who said it sucked, who have since recovered.  Even if it's 95% effective, that's better than 0.  And if I give into the fear that COVID is going to fatal, then I'll take the side effects over death and "long-term effects of COVID ranging from unpleasant to debilitating."


----------



## E tank (Dec 13, 2020)

mgr22 said:


> True, but I think even a few months of debilitating symptoms, without knowing if or when there's an endpoint, is enough to dispel the notion that COVID outcomes are binary, and that getting infected is no big deal for 98% of the population.


I think this infection has taken on a kind of mythical status in that when events occur in the post recovery course (or the acute phase for that matter) it's the first time we've ever seen it...post severe pneumonia of any etiology can be a righteous bi**h. Deep vein thrombosis, loculated empyema (pleural pus pockets)requiring surgery, months of rehab, etc...this stuff is so common and when it's because of influenza A, no one bats an eyelash....C19 is obviously an order of magnitude more contagious and that means there will be more critically ill people with it, but the pneumonia it causes is pneumonia.


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## mgr22 (Dec 13, 2020)

E tank said:


> I think this infection has taken on a kind of mythical status in that when events occur in the post recovery course (or the acute phase for that matter) it's the first time we've ever seen it...post severe pneumonia of any etiology can be a righteous bi**h. Deep vein thrombosis, loculated empyema (pleural pus pockets)requiring surgery, months of rehab, etc...this stuff is so common and when it's because of influenza A, no one bats an eyelash....C19 is obviously an order of magnitude more contagious and that means there will be more critically ill people with it, but the pneumonia it causes is pneumonia.


I agree that long-term effects of the flu aren't discussed as much right now as long-term effects of COVID-19. What I'm more concerned about is the assumption that people who don't die from COVID will be fine. Until recently, there's been little publicity about a third group of COVID sufferers: those who don't die but aren't fine. Such knowledge is helpful in assessing the value of vaccines and even masks.


----------



## Summit (Dec 13, 2020)

E tank said:


> post severe pneumonia of any etiology can be a righteous bi**h. Deep vein thrombosis, loculated empyema (pleural pus pockets)requiring surgery, months of rehab, etc...this stuff is so common and when it's because of influenza A, no one bats an eyelash


I've always thought that it was absolutely insane that we as a society don't bat an eyelash at the incredible toll of seasonal flu. Less than half of adults get vaccinated. That is bonkers.


----------



## Carlos Danger (Dec 13, 2020)

mgr22 said:


> I agree that long-term effects of the flu aren't discussed as much right now as long-term effects of COVID-19. What I'm more concerned about is the assumption that people who don't die from COVID will be fine. Until recently, there's been little publicity about a third group of COVID sufferers: those who don't die but aren't fine. Such knowledge is helpful in assessing the value of vaccines and even masks.


Fatality rate is really the only metric we have, and as E tank said, post-complications of pneumonia from all causes can be significant and costly and unpleasant, but are rarely permanent. COVID does not appear to be unique in this way.


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## Carlos Danger (Dec 13, 2020)

Summit said:


> I've always thought that it was absolutely insane that we as a society don't bat an eyelash at the incredible toll of seasonal flu. Less than half of adults get vaccinated. That is bonkers.


On a macro level I agree that it seems a little bonkers, but you have to remember that society is made up of individuals for whom choosing not to get a flu shot may be a rational choice. People hate getting shots. Lots of folks report feeling like crap for a few days after getting a flu shot. Few of us personally know anyone who got really sick (nervermind died) from the flu. We are all aware of the fact that some years, the effectiveness of the vaccine is very low. More and more people are aware of the potentially perverse incentives that the pharm industry responds to, and distrust our major institutions in general. Personally, I’ve only had the flu once, and it was a year that I had been vaccinated.

Add all that up, and it’s no wonder why so many individuals elect not to get the flu vaccine.

Edit: most of this is also true of the coronavirus vaccines


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## RedBlanketRunner (Dec 13, 2020)

Not exactly binary. Select one or more from the list.
1 Fake. Just the seasonal flu plus media sensationalism
2 Worse than the flu but overblown
3 Significantly higher mortality rate -> US 30,000 to 55,000 seasonal flu deaths 2019, C-19: 306,000 so far
4 Financial-economic impact much higher
5 Quality of overall patient care significantly reduced as care facilities are overwhelmed.
6 Long term debilitating effects which may be permanent appear to be significantly higher than seasonal flu
7 Social impact
8 Misinformation effects





__





						Latest U.S & World News: Trusted Source - WorldNewsEra
					





					worldnewsera.com


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## Summit (Dec 13, 2020)

@Carlos Danger what you've identified a behaviorist explanation for why society doesn't take flu seriously. I agree with your assessment of the why. 

However, it should be used as roadmap to shift the paradigm of perception. Yes people rationalize that they haven't had bad flu, or that they don't know people that do, or they worry about Big Pharma (which is a valid concern in general but not realistically so with flu vaccine which is small $). The human and financial impact of flu is huge. I hope people can understand this in the future and perhaps mRNA vaccines will allow a shorter decision to production cycle on the seasonal flu vaccine to allow better targeting of predominant strains while also allowing protection against a wider variety of strains. Doing so would make the flu vaccine more reliable. If every year was as efficacious as it was last year, perhaps folks would be more keen to get it.


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## Bullets (Dec 13, 2020)

Akulahawk said:


> I'm of a similar mind at the moment. If we'd done MUCH more to protect the vulnerable (and we knew basically who was most at risk early-on), and kept protecting them throughout the entire time, we'd probably be in an overall better place now.
> 
> That and providing accurate info as we know it at the time...


The sadder part is, who among us (the healthcare community at large) didnt know this long before 2020? How long does one need to work in this industry to learn that LTC is a horrible, depressing, isolating place easily ripped apart by infections, where patient ratios are high and caregiver skill low.  COVID just shined a spotlight for the general public to learn what we already knew. How many of us ran calls in a nursing home wracked with influenza? 

We could have been ready


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## RedBlanketRunner (Dec 13, 2020)

Bullets said:


> The sadder part is, who among us (the healthcare community at large) didnt know this long before 2020?


News in the US and Europe. In third world countries it's the rule: never rely on governments or authorities. CYA and your family. Healthcare facilities are there to shovel antibiotics your way and a place to die.  Spending all day, or even two in a crowded waiting room is the norm. A place to contract diseases - best avoided.
An odd little irony is people are much more independent out in the boonies and prefer self or community reliance. So in order to avoid being told what to do, they do things like wearing masks. An extra irony, as an example, in the news almost every day. Down in Bangkok people protesting the Monarchy which can get an automatic 5 years in prison, but take a look at the pictures of the protesters. Just about everyone wearing masks. More common sense than developed first world countries.


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## Fezman92 (Dec 14, 2020)

So how quickly is everyone going to act like that this crisis is over now that we have a vaccine?


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## SandpitMedic (Dec 14, 2020)

Since someone mentioned money. Rest assured. There are companies and individuals who are going to get very, very rich from COVID-19.


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## DrParasite (Dec 14, 2020)

Fezman92 said:


> So how quickly is everyone going to act like that this crisis is over now that we have a vaccine?


Isn't that the solution though?  once we have a vaccine that works, give it to everyone who can take it, herd immunity the rest, and the big bad virus can't hurt us anymore?

now, if you mean the crisis of understaffing and underfunding of EMS, that has existed for decades.  public health's lack of funding?  nothing new.  the fact that our LTC/college campus's/prisons/any place where large numbers of people live in relatively small locations are breeding grounds for disease? not news to me.  our heathcare system's routine lack of resources to handle a long term surge?  yep, been that way for longer than we all want to admit.  the question will be, what is going to be done about all these crises, or will it simply be forgotten next year?


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## RedBlanketRunner (Dec 14, 2020)

They are now associating numerous neurological disorders with the virus. Lapses of cognitive ability appear to be frequent post recovery.


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## Fezman92 (Dec 14, 2020)

“the question will be, what is going to be done about all these crises, or will it simply be forgotten next year?”

Nothing will be done because this is America and collectively this country has a very short term memory. Hell these issues have been ignored during this entire crisis.


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## E tank (Dec 14, 2020)

SandpitMedic said:


> Since someone mentioned money. Rest assured. There are companies and individuals who are going to get very, very rich from COVID-19.


We'll if Pfizer and Moderna are in folk's 401K's, PERS  etc...let's hope so....


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## SandpitMedic (Dec 15, 2020)

E tank said:


> We'll if Pfizer and Moderna are in folk's 401K's, PERS  etc...let's hope so....


That is not what I meant.
I too hold stock in said companies, but I don't place the pennies I will make above my moral objection to billionaires profiteering, which is sure to happen with this virus, the vaccine(s), response, etc.

Nothing against you brother. I just think that if this is supposedly the extinction level event so many believe it is, and there is dire need to save so many lives, then perhaps their motivations should be a little more altruistic. I'm also a capitalist, but there is a line.


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## cruiseforever (Dec 15, 2020)

SandpitMedic said:


> Since someone mentioned money. Rest assured. There are companies and individuals who are going to get very, very rich from COVID-19.



This statement is true to just about anything that causes misery to others.  Disease, War, natural disasters, civil unrest


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## E tank (Dec 15, 2020)

SandpitMedic said:


> That is not what I meant.
> I too hold stock in said companies, but I don't place the pennies I will make above my moral objection to billionaires profiteering, which is sure to happen with this virus, the vaccine(s), response, etc.
> 
> Nothing against you brother. I just think that if this is supposedly the extinction level event so many believe it is, and there is dire need to save so many lives, then perhaps their motivations should be a little more altruistic. I'm also a capitalist, but there is a line.


I get it...but...that 2 vaccines were developed in the time frame they have is nothing short of monumental...a feat, really, unprecedented in history. And it was precisely because it was a private sector venture with minimized regulatory interference. An effort like this costs money. It is because the wealthy interest holders  had an interest (and, come on, there isn't anyone that wants so many sick people) that this was possible. No other system in the world is capable of what our system did. And I'm OK with that.


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## SandpitMedic (Dec 15, 2020)

E tank said:


> I get it...but...that 2 vaccines were developed in the time frame they have is nothing short of monumental...a feat, really, unprecedented in history. And it was precisely because it was a private sector venture with minimized regulatory interference. An effort like this costs money. It is because the wealthy interest holders  had an interest (and, come on, there isn't anyone that wants so many sick people) that this was possible. No other system in the world is capable of what our system did. And I'm OK with that.


Monumental... what’s a better word for monumental when kids start coming out with webbed feet?😂

mRNA vaccines are a relatively new technology. The safety profile of this vaccine is not fully understood. In the most layman’s terms I can think of right now... It is artificial chromosomes that go in to cells to copy the chromosomal data and pump out proteins for the body to recognize the “not self” and mount an immune response.

There are incredibly limited studies on them, and they’ve never been utilized in humans. The studies we have on the vaccines are  mostly all by the manufacturers (who stand to gain billions but will be sheltered if it goes bad) in which most of them are still in Phase 1 or barely into Phase 2.

It might work. Chances are it will work. But we will see, and what happens when desperation and greed combine with unseen biological sciences? We all have front row tickets.

Don’t get me wrong- I hope it works with little repercussions, and that it saves lives, and that it ends this pandemic so we can all get back to normal life. Like poorly run SNFs, other corporate greed, and corrupted leadership 😀. Color me as a cautiously optimistic skeptic.


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## E tank (Dec 15, 2020)

SandpitMedic said:


> Monumental... what’s a better word for monumental when kids start coming out with webbed feet?😂
> 
> mRNA vaccines are a relatively new technology. The safety profile of this vaccine is not fully understood. In the most layman’s terms I can think of right now... It is artificial chromosomes that go in to cells to copy the chromosomal data and pump out proteins for the body to recognize the “not self” and mount an immune response.
> 
> ...


well...if you have any better ideas, I'm sure they'd be all ears....


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## Peak (Dec 15, 2020)

SandpitMedic said:


> The studies we have on the vaccines are  mostly all by the manufacturers (who stand to gain billions but will be sheltered if it goes bad) in which most of them are still in Phase 1 or barely into Phase 2.



In the case of these vaccines manufacturers were allowed to run multiple trial phases concurrently to speed up development. Phase III trials are really about better understanding clinical efficacy and when to use a drug in practice once it is Phase IV (which is just post market surveillance). 

Also it is important to remember that most trial drugs don’t make it out of phase 0 or I, drugs often don’t show the promise that we hope for and we stop their trials early. Not making it to phase III or IV doesn’t mean that category of drug isn’t possible, it means that a specific formulation isn’t efficacious but that doesn’t necessarily make it dangerous.

It is not uncommon to have drugs given outside of trial anyway. We give compassionate exception drugs frequently even though they are still in phase II or III.


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## Mufasa556 (Dec 15, 2020)

Dan Aykroyd has webbed feet. He danced pretty good in the Blues Brothers and wrote Ghostbusters. Having webbed feet doesn’t seem all that bad. Maybe we’re just setting ourselves up for a future undefeatable Olympic swim team? USA! USA!


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## Summit (Dec 15, 2020)

The reason the mRNA vaccines were the first through phase 3 is that mRNA is way faster to get out of preclinical development.


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## Summit (Dec 15, 2020)

SandpitMedic said:


> I just think that if this is supposedly the extinction level event so many believe it is


So many believe that? Nobody believes that! 1918 level event? Yes many believe it _could _have been that. Despite all of our folly, we've managed this much better than 1918 and prevented a 1918 level event.


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## SandpitMedic (Dec 15, 2020)

E tank said:


> well...if you have any better ideas, I'm sure they'd be all ears....


Oh for sure 👍


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## SandpitMedic (Dec 15, 2020)

Summit said:


> So many believe that? Nobody believes that! 1918 level event? Yes many believe it _could _have been that. Despite all of our folly, we've managed this much better than 1918 and prevented a 1918 level event.


1918... ELE... take your pick at vocabulary. We’re talking past each other on this point.


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## SandpitMedic (Dec 15, 2020)

Mufasa556 said:


> Dan Aykroyd has webbed feet. He danced pretty good in the Blues Brothers and wrote Ghostbusters. Having webbed feet doesn’t seem all that bad. Maybe we’re just setting ourselves up for a future undefeatable Olympic swim team? USA! USA!


Hell yeah! USA! USA!
Hey look- we are all free to make our own medical decisions. I’m not anti-Vax, I just want to see what happens. As I said- cautiously optimistic skeptic.


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## Akulahawk (Dec 15, 2020)

SandpitMedic said:


> mRNA vaccines are a relatively new technology. The safety profile of this vaccine is not fully understood. In the most layman’s terms I can think of right now... It is artificial chromosomes that go in to cells to copy the chromosomal data and pump out proteins for the body to recognize the “not self” and mount an immune response.


There's this other method which uses a replication-disabled live virus that puts genetic material into cells to get the ribosomes in them to pump out proteins so the body can recognize the "not self" and mount an immune response... That method has been used for years. The mRNA method just skips using a live virus. The trick is getting the mRNA into the cells and both Pfizer/BioIntech and Moderna have figured out ways to do this without using a live virus. I suspect that since they now have developed a carrier for mRNA, I think we're going to see mRNA vaccines much more commonly soon. The lead time for an influenza vaccine is pretty long. Imagine doing the surveillance of the circulating strains, getting mRNA vaccine candidates for all those strains ready, then actually determining the actual influenza strains that have started circulating in humans and doing mass production of the mRNA vaccines for those strains just a few months before influenza season hits. You'd likely have a VERY effective vaccine against the actively circulating flu every year. Given the right info, it might be easier to produce a universal influenza vaccine this way too. 

I'd say mRNA is actually pretty well understood, it just hasn't been utilized in humans because other vaccine tech is a known quantity and people like going with what they know vs what they haven't tried before.


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## Summit (Dec 15, 2020)

All of what akulak said. MRNA is very well understood. The technology is 30 years old. The problem has been getting the mRNA to survive long enough to get in the cell. There were mRNA cancer treatments that were tested and found to be safe but not efficacious due to the problem of the MRNA not lasting long enough. There were mRNA vaccines developed but not tested because the vaccines were not needed. Pfizerbiontech and moderna have created phospholipid envelopes for the MRNA to allow it long enough to enter into the cytoplasm where it can hook up with ribosomes for some protein making fun. Moderna has more experience and was able to use sugars to temperature stabilize.


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## Summit (Dec 15, 2020)

SandpitMedic said:


> 1918... ELE... take your pick at vocabulary. We’re talking past each other on this point.


Maybe. Maybe you are speaking in hyperbole. Otherwise there's quite a stratum between our current mitigated covid experience, 1918 paninfluenza, the European medieval plague depopulation, the poly pathogen civilization ending pandemics following Americas' contact with European diseases, and an ELE.


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## SandpitMedic (Dec 16, 2020)

Summit said:


> All of what akulak said. MRNA is very well understood. The technology is 30 years old. The problem has been getting the mRNA to survive long enough to get in the cell. There were mRNA cancer treatments that were tested and found to be safe but not efficacious due to the problem of the MRNA not lasting long enough. There were mRNA vaccines developed but not tested because the vaccines were not needed. Pfizerbiontech and moderna have created phospholipid envelopes for the MRNA to allow it long enough to enter into the cytoplasm where it can hook up with ribosomes for some protein making fun. Moderna has more experience and was able to use sugars to temperature stabilize.


CDC info on mRNA COVID vaccine:








						Understanding mRNA COVID-19 Vaccines
					

Learn how mRNA vaccines trigger an immune response against COVID-19.




					www.cdc.gov
				




2012 study on mRNA use a medical "disruptive technology": Good stuff here.








						Developing mRNA-vaccine technologies
					

mRNA vaccines combine desirable immunological properties with an outstanding safety profile and the unmet flexibility of genetic vaccines. Based on in situ protein expression, mRNA vaccines are capable of inducing a balanced immune response comprising ...




					www.ncbi.nlm.nih.gov
				




I have heard of the glycogen capsules and synthetic phospholipids they are using to stabilize the particles for cell entry, although I have not researched that to any extent. I am not sure if that is proprietary information or open source. You are spot on that this technology was first theorized for medical use in 1989 (according to this study). I consider that relatively new.

However, and I am not arguing with you, I'm just saying, cancer/HIV/etc has killed, maimed, and otherwise destroyed more lives to the nth degree than COVID, yet they couldn't figure it out to "cure" cancer? HIV? Ebola? The common cold? The answer to that is a puzzling one, because mRNA as a vaccine and/or cancer treatment was theorized in 1989, and because they couldn't get it into the cell to do it's ribosomal dance as you noted. I guess those things just weren't as pressing.
Here is a quote, which demonstrates the initial hurdles which have apparently been figured out.

"For instance, in addition to the previously mentioned nucleotide modifications, novel delivery modes may severely affect vaccine adjuvanticity. While direct delivery into the cytosol would certainly enhance antigen expression, the lack of interaction with endosomal RNA receptors may severely weaken immunostimulation by the vaccine and this issue would likely have to be addressed."

What remains true is that it has only been used in vivo and in insects in vitro successfully in limited studies with the exception of the current COVID studies. This will be the first mRNA vaccine for humans (that works, so they say). The down stream effects are unknown- does it prevent or does it lessen, side effects, etc? The argument there is the risk of COVID is greater, some would say. We've already debated that and we all landed where we landed. CFR similar to influenza... some say its not.

I get you're fully bought in to it, and that is fine. I want it to work too; in fact, I want it to usher in more treatments and cures for longtime viruses. I still have my misgivings about the way it’s been done, down range effects, who stands to gain what from this, and the idea _everyone_ needs the vaccine.


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## SandpitMedic (Dec 16, 2020)

Summit said:


> Maybe. Maybe you are speaking in hyperbole. Otherwise there's quite a stratum between our current mitigated covid experience, 1918 paninfluenza, the European medieval plague depopulation, the poly pathogen civilization ending pandemics following Americas' contact with European diseases, and an ELE.


Yeah, maybe you just want to take it too literal and argue about it. In my opinion, over the past ~9 months the news media has portrayed this pandemic as the end of the world ad nauseam as a plague, and it's been compared to 1918, etc etc... causing many to believe that... If you missed that, then I envy you.

Lets keep talking vaccines, the virus, and response, this is a good conversation we are having. Let's not bog it down with semantics that aren't worth the bandwidth.


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## PotatoMedic (Dec 16, 2020)

Well scheduled to get the first jab on Tuesday.


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## Capital (Dec 16, 2020)

I'm scheduled for the first dose of the Pfizer vaccine on Friday morning.


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## PotatoMedic (Dec 16, 2020)

And my date is getting moved.  So hopefully next week.  Either way it will be soon.


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## Summit (Dec 16, 2020)

Got mine and no... side... brains.... BRAAAAAAAAAAAAAAAAAAIIIINSSS!


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## NomadicMedic (Dec 16, 2020)

Still no plan to get EMS in the vaccine queue in PA.


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## GMCmedic (Dec 17, 2020)

Its been 15 hours since being vaccinated and im not dead yet.


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## ffemt8978 (Dec 17, 2020)

GMCmedic said:


> Its been 15 hours since being vaccinated and im not dead yet.


Do you have a craving for brains though?


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## GMCmedic (Dec 17, 2020)

ffemt8978 said:


> Do you have a craving for brains though?


Not yet.


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## ffemt8978 (Dec 17, 2020)

GMCmedic said:


> Not yet.


Glad you qualified it with "yet"  lol


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## GMCmedic (Dec 17, 2020)

ffemt8978 said:


> Glad you qualified it with "yet" lol


The only way to respond to questions relating to zombies is with a "yet"


----------



## RedBlanketRunner (Dec 18, 2020)

ffemt8978 said:


> Do you have a craving for brains though?


Been that way all my life. But at this stage of the game it's a waste of resources.


----------



## Fezman92 (Dec 20, 2020)

I was talking to a few medics and they said that with COVID PTs the end tidal CO2 were showing up at normal levels. Wouldn’t it be different because the lungs are struggling to work? Also I didn’t know that long term intubation isn’t good because of the body becoming dependent on being vented.


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## VentMonkey (Dec 20, 2020)

Fezman92 said:


> I was talking to a few medics and they said that with COVID PTs the end tidal CO2 were showing up at normal levels. Wouldn’t it be different because the lungs are struggling to work? Also I didn’t know that long term intubation isn’t good because of the body becoming dependent on being vented.


No. The medics assessments are the end all be all with Covid. Lol kidding of course.


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## GMCmedic (Dec 21, 2020)

Fezman92 said:


> I was talking to a few medics and they said that with COVID PTs the end tidal CO2 were showing up at normal levels. Wouldn’t it be different because the lungs are struggling to work? Also I didn’t know that long term intubation isn’t good because of the body becoming dependent on being vented.


ETCO2 depends on the disease progression. 

Its not that long term intubation is bad, intubation period is bad.


----------



## DesertMedic66 (Dec 21, 2020)

We have been having to turn down a lot of flights recently due to HFNC or BiPAP >60% FiO2, our limitations with our current set up for flight.


----------



## Carlos Danger (Dec 21, 2020)

Fezman92 said:


> Wouldn’t it be different because the lungs are struggling to work? Also I didn’t know that long term intubation isn’t good because of the body becoming dependent on being vented.


People who are otherwise healthy usually wean from the vent pretty readily once the disease process that required them to be intubated resolves. However, there are all sorts of potential complications involved with intubation and mechanical ventilation, as well as the disease processes themselves. There's a lot that can go wrong with prolonged mechanical ventilation aside from developing dependence.


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## Fezman92 (Dec 21, 2020)

Like infections and possible damage to the lungs?


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## Fezman92 (Dec 25, 2020)

Well I have to go get the cooties test. Have had a sore throat for a few days and I woke up feeling that 'bleh' you feel before you get sick. I highly doubt it's the cooties.


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## NomadicMedic (Dec 25, 2020)

Fezman92 said:


> Well I have to go get the cooties test. Have had a sore throat for a few days and I woke up feeling that 'bleh' you feel before you get sick. I highly doubt it's the cooties.



or, COVID-19 or SARSCoV2.

act like a professional.


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## E tank (Dec 26, 2020)

Heard on ABC news on Christmas Eve that 30% of ICU's in California are at 80% capacity...I'm thinking to myself that is pretty darn good for any year in December let alone during a public heath crisis. But of course it was pitched as confirmation of a worsening situation.


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## DesertMedic66 (Dec 26, 2020)

E tank said:


> Heard on ABC news on Christmas Eve that 30% of ICU's in California are at 80% capacity...I'm thinking to myself that is pretty darn good for any year in December let alone during a public heath crisis. But of course it was pitched as confirmation of a worsening situation.


As someone who lives and works in CA, I can tell you it’s not getting better right now.


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## Summit (Dec 26, 2020)

Etank I think you know the difference between a physical bed and a staffed bed. Everyone was creating ICU capable surge beds willy nilly. Great... now capacity numbers sound better... but who is gonna staff? (hint, it's literally gonna be you).


DesertMedic66 said:


> As someone who lives and works in CA, I can tell you it’s not getting better right now.


Indeed this looks very very bad: https://public.tableau.com/views/COVID-19HospitalsDashboard/Hospitals?:embed=y&:showVizHome=no

It's kind of nervewracking watching that. I hope your curve bends hard and fast like it did in CO (and I hope ours stays bent).


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## Akulahawk (Dec 27, 2020)

Summit said:


> Etank I think you know the difference between a physical bed and a staffed bed. Everyone was creating ICU capable surge beds willy nilly. Great... now capacity numbers sound better... but who is gonna staff? (hint, it's literally gonna be you).
> 
> Indeed this looks very very bad: https://public.tableau.com/views/COVID-19HospitalsDashboard/Hospitals?:embed=y&:showVizHome=no
> 
> It's kind of nervewracking watching that. I hope your curve bends hard and fast like it did in CO (and I hope ours stays bent).


Good site for info.... and Sacramento County does appear to have 84 available ICU beds. However that's spread across (I think) 8 facilities and some of those facilities have no available ICU beds. And as above, it's not just the physical beds, it's the ability to staff them.


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## E tank (Dec 27, 2020)

Summit said:


> Etank I think you know the difference between a physical bed and a staffed bed. Everyone was creating ICU capable surge beds willy nilly. Great... now capacity numbers sound better... but who is gonna staff? (hint, it's literally gonna be you).


My point was not that there is not a public health crisis....the point I was trying to make (poorly apparently) was that a major news organization was taking a meaningless statistic and applying it across a state of 40 million people with wildly varying demographics and population densities and implying the condition existed from the Oregon border to Mexico. That is a demonstrably false conclusion but one that the media is happy to allow its consumers to arrive at.

It is the equivalent of citing South Central LA crime statistics and concluding that Afton, Wyoming is in the midst of a crime wave. It's BS and no one but some politicians and news agencies are benefiting from it.

And if they haven't needed me for staffing so far, they're not going to need me any time soon. It's as bad as it's ever been here and they're doing just fine...


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## SandpitMedic (Jan 12, 2021)

Seems the elected leaders of the biggest democratic areas now contend the lockdowns must end as they have too many unintended consequences. In a dramatic complete reversal of their opinions from only days ago, many wonder why the sudden change of heart. These lockdowns and perpetuating the lethality and dangers of COVID was _not_ politicized whatsoever. 

Did something happen recently that I missed? Some change in the wind? Ohhhhhhh- the election is over... probably just a coincidence. Let's not forget everyone will surely be getting vaccine 2/2 soon... I guess opening up before we know how effective it is could also be the plan here. I'd put another eye roll, but I'm sure you guys are catching my vibe.



			Sacramento region exits stay-at-home order, allowing many businesses to reopen
		




			https://headlineusa.com/cuomo-mocked-reverse-lockdown/
		


Meanwhile, COVID hospital admissions hit record highs and ICUs remain inundated.


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## Akulahawk (Jan 12, 2021)

SandpitMedic said:


> wonder why the sudden change of heart


Couldn't be that a certain Governor has a reasonably serious recall effort underway and should easily top 1.5M valid signatures before the deadline to force a recall election... couldn't be.


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## akflightmedic (Jan 12, 2021)

I am so tempted to take one of those SoCal contracts...10K a week right now.


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## SandpitMedic (Jan 12, 2021)

akflightmedic said:


> I am so tempted to take one of those SoCal contracts...10K a week right now.


There is a lot of work out there right now. Big money. Be careful of states like CA and NY, though, as they have sky high tax rates. Big money= more taxes.


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## SandpitMedic (Jan 12, 2021)

Akulahawk said:


> Couldn't be that a certain Governor has a reasonably serious recall effort underway and should easily top 1.5M valid signatures before the deadline to force a recall election... couldn't be.


How dare you! This is life and death here!!!!

....couldn't possibly be political.


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## akflightmedic (Jan 12, 2021)

SandpitMedic said:


> There is a lot of work out there right now. Big money. Be careful of states like CA and NY, though, as they have sky high tax rates. Big money= more taxes.


I have done my homework...I will be fine. Duplicating expenses and maintaining tax home and all that travel nurse jazz...


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## CCCSD (Jan 13, 2021)

SandpitMedic said:


> How dare you! This is life and death here!!!!
> 
> ....couldn't possibly be political.


Although I heartily endorse the recall..it IS life and death in SoCal.


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## Achilles (Jan 13, 2021)

NomadicMedic said:


> or, COVID-19 or SARSCoV2.
> 
> act like a professional.


Says the person who’s a edumacator...


pot meet kettle


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## NomadicMedic (Jan 13, 2021)

Achilles said:


> Says the person who’s a edumacator...
> 
> 
> pot meet kettle



redacted.


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## fm_emt (Jan 13, 2021)

Akulahawk said:


> Couldn't be that a certain Governor has a reasonably serious recall effort underway and should easily top 1.5M valid signatures before the deadline to force a recall election... couldn't be.


even though it didn't really change a whole lot. 

The previous "shelter in place" order (in my opinion) was not only totally worthless but potential dangerous as well. I think it made things worse. It certainly did irrecoverable damage to the restaurant industry. LA County was sued and asked to provide evidence showing that outdoor dining was causing the spread of covid-19, and their answer was essentially "Um... we'll get back to you." Which of course they never did. Same thing with hair salons. In fact, there was more data showing that even an infected hairdresser that was properly wearing a mask *did not* spread covid-19 to customers who were also wearing masks. Yet California decided "Oops, we better shut down barber shops!" The actions by the state government here make no sense sometimes.

Restrictions that make no sense and have no data to back them up not only do nothing, they contribute to the pandemic fatigue.


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## Achilles (Jan 13, 2021)

NomadicMedic said:


> redacted.


in regards to your question; yes...


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## NomadicMedic (Jan 13, 2021)

Achilles said:


> in regards to your question; yes...



surprising.


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## Achilles (Jan 13, 2021)

NomadicMedic said:


> surprising.


If you say so...


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## Akulahawk (Jan 13, 2021)

fm_emt said:


> even though it didn't really change a whole lot.
> 
> The previous "shelter in place" order (in my opinion) was not only totally worthless but potential dangerous as well. I think it made things worse. It certainly did irrecoverable damage to the restaurant industry. LA County was sued and asked to provide evidence showing that outdoor dining was causing the spread of covid-19, and their answer was essentially "Um... we'll get back to you." Which of course they never did. Same thing with hair salons. In fact, there was more data showing that even an infected hairdresser that was properly wearing a mask *did not* spread covid-19 to customers who were also wearing masks. Yet California decided "Oops, we better shut down barber shops!" The actions by the state government here make no sense sometimes.
> 
> Restrictions that make no sense and have no data to back them up not only do nothing, they contribute to the pandemic fatigue.


I would say that on its own, the recall effort didn't help much but when you look at the pandemic fatigue, the lawsuits, and the State's response to those lawsuits ("we'll get back to you...) all combined to make the State back down from the stay-at-home order. I think they're also attempting to moot the lawsuits as an added bonus.


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## ffemt8978 (Jan 14, 2021)

Nearly 2 million deaths and a year later, the WHO finally arrives in China to investigate the origin of COVID-19.









						WHO experts tasked with investigating coronavirus origins land in China - National | Globalnews.ca
					

The WHO team includes virus and other experts from the United States, Australia, Germany, Japan, Britain, Russia, the Netherlands, Qatar and Vietnam.




					globalnews.ca


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## Summit (Jan 14, 2021)

ffemt8978 said:


> Nearly 2 million deaths and a year later, the WHO finally arrives in China to investigate the origin of COVID-19.
> 
> 
> 
> ...


I'm certain Communist China will cooperate fully!


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