bcl05

I am so profoundly sick of people comparing COVID to the flu. This is vastly more contagious, and vastly more dangerous than our typical seasonal flu. We currently have about 4x more deaths from COVID than we do from a typical flu season, and that's WITH all the social distancing, economic shutdown, and masking. In my hospital, we have had hundreds of COVID patients, including many extraordinarily sick ones (including some very young, previously healthy people). While are getting better and better at keeping people alive with experience and science, survivors of this are often left with terrible effects. This virus specifically attacks the endothelial cells (the ones that line blood vessels), creating a vasculitis that causes strokes, lung scarring, severe kidney injury, and more. Survivors dealing with these things will have long term suffering and shorter, more painful lives because of this illness. This is not true of seasonal flu, where long term damage is very rare. Also, the patients who do ultimately die from this virus often do so weeks (or even months) after initially falling sick, so I'm not at all confident that the death numbers are going to stay low. Also, this pandemic has had a catastrophic effect on health care economics. We have had to curtail "elective" procedures and other services dramatically. Now, our health care economic system was a hot mess before this, but this has just made everything far worse. Many hospitals are going to go bankrupt because of this, exacerbating access problems that were pre-existing. It is stupid, irrational, irresponsible, and deadly to promote (or participate in) non-critical social gatherings and to discourage mask-wearing. Those who do have blood on their hands. This has been the most discouraging few months of my professional life. I'm so frustrated by the sheer stupidity and callousness of so many people in this country.

I don't miss Desmond the player, but I really miss Desi the man. He seems like a truly lovely human being. I don't think I ever heard a single bad thing about him.

My daughter and I visited the George Floyd memorial at the site of his murder yesterday. Very powerful.

That statue is like a caricature of a racist statue. Its ridiculous, and has to go. We can and should do better.

I did some of my training at Texas Children's hospital. That place is amazing, and is incredibly busy when "normal." I can't imagine the current situation. If any children's hospital is up to it, though, they are.

The American people are, as a whole, depressingly selfish and stupid. Wear a damn mask.

The WHO screwed up the communications, but the paper is really rather nuanced and interesting, but is not actionable. Again, the newly reported research shows that people who are infected and REMAIN ASYMPTOMATIC are less infectious than asymptomatic infected people who go on to develop symptoms later. There is a lot of investigation looking at people who remain asymptomatic to try and understand why. So the terminology here is important. Asymptomatic (in this paper) indicates those patients who remain asymptomatic through the entire course of their infection. Those people don't seem to be very infectious. Presymptomatic patients (those who are infected, feel fine today, but will feel sick in a day or two) are clearly highly infectious and a major source of viral spread. This is one paper, and who knows if its just data noise or a real finding. Either way, since we have no way of anticipating who amongst the newly infected will end up in which group (symptomatic or not), I don't see how this finding is actionable at all.

As I said in the re-opening thread: This study is getting a lot of talk, and not a lot of scrutiny. The data appears to imply that people who are infected and REMAIN asymptomatic do not contribute significantly to the spread of this virus. This is a retrospective analysis, with the benefit of hindsight. This does not say the same thing about people who are presymptomatic, meaning those who are shedding significant amount of virus before the start of symptoms. There is a lot of data suggesting significant viral shedding, and infectivity, in the 24-48 hours before symptom onset, among those who ultimately develop symptoms. Since we have no way of knowing who, among the newly infected, will ultimately fall into the symptomatic or asymptomatic category, this study should not, in any way, change our approach.

This study is getting a lot of talk, and not a lot of scrutiny. The data appears to imply that people who are infected and REMAIN asymptomatic do not contribute significantly to the spread of this virus. This is a retrospective analysis, with the benefit of hindsight. This does not say the same thing about people who are presymptomatic, meaning those who are shedding significant amount of virus before the start of symptoms, but do go on to develop symptoms. There is a lot of data suggesting significant viral shedding (with high infectivity) in the 24-48 hours before symptom onset. Since we have no way of knowing who, among the newly infected, will ultimately fall into the symptomatic or asymptomatic category, this study should not, in any way, change our approach.

Its a complicated show, looking back now. There is some extra-judicial policing stuff that is problematic. ON the other hand, there is some policing of the police which is good to see. We finished watching it about a month ago, before all this came to front of (my) mind. It does make it somewhat more complex in retrospect.

What a perfect encapsulation of our president.

I know there are good cops out there. There have to be. I try to assume most people are good, and I suppose that applies to police too. I just wish I could see it - a good cop stopping a bad cop in the middle of beating/killing an innocent. A policeman immediately getting arrested for obviously egregiously abusing their authority. That would be great. I assume it does happen, just far, far too rarely. Maybe there aren't that many great cops.

if you watch Fox News, you are part of the problem.

I’m about to start two weeks of inpatient call. Should be interesting. I think our PPE situation is ok for now.

There are countless videos from the last week of cops being wildly out of control, violent, aggressive, etc. I have yet to see ONE video where another cop stops the beating. There is a rotten culture within police forces. This is not an issue of bad apples. Its appalling. We need a re-imagining of how we staff, train, and use police forces.

Trump was asked about trust for police among POC. This is the transcript of his response. I am now dumber for having read this. I would love to hear anyone defend this madness, just for the sheer audacity and denial of reality.

Nailed it.

https://www.nytimes.com/video/opinion/100000007171122/protests-constitutional-rights.htm

This is an excellent article. https://newrepublic.com/article/157981/police-take-side-white-vigilantes

We just finished watching Bosch. Its a pretty standard crime/detective show, but we really enjoyed it. I think its more fun than really good, but definitely binge-able. Its on Amazon.

Just announced a curfew for my town in Minnesota tonight. Fingers crossed.