bcl05

https://www.nytimes.com/2020/03/31/opinion/coronavirus-cases-united-states.html This NYT article is what I was trying to cut and paste from. The bottom line is that we suck at this. Some difference may be from testing differences (though testing in both Spain and Italy appears far more consistent and aggressive than here) and from reporting differences (I don't trust China's data at all), but mainly the fact that the US is full of idiots. And led by a moron.

damn. cut ant pasting not cooperating. Apparently work computer can't handle simultaneous ES and zoom meeting.

If there are any other HCPs on here, I found thread this very informative.

I don't think the numbers are totally worthless. I am still refreshing all the monitoring sites as many times as I can. I also know that the numbers reported by my state health department and the numbers actually seen in my hospital don't line up. Not even particularly close. I also know that testing capacity varies dramatically among different states/cities/hospitals. At many centers, tests are being saved for patients for whom the result will make a significant difference in treatment/disposition. For many, the treatment will be the same regardless of whether or not the respiratory symptoms are COVID or some other bug. (basically stay hydrated, stay home, tylenol, etc). Almost every hospital has been seeing more patients with coughing and fever than in a typical March, and many patients are being sent home labeled as "likely COVID19" without testing. Hopefully this is becoming less true as testing capacity increases. Just don't make too much of the numbers. This is a bad virus, and there are going to be a lot of deaths. Far more than there should be, but here we are. The more we all stay away from each other and the more we wash our hands, the better.

I don't even know that I trust the death numbers. There are people dying with presumed covid but who didn't have testing who aren't counted in total numbers. I'm not sure we'll ever have a truly accurate assessment of what this virus is doing.

I'm having a grim day at the hospital, but this just brought me a bit of joy. https://twitter.com/MarkZuckerman/status/1244706442097184769

My god. The idiot in chief just tried to frame the debate to say that if there is "only" 100,000-200,000 deaths, then he's done a GREAT job. I'm nauseous.

I'm in a physicians-only COVID19 facebook discussion group. Lots of fascinating and distressing discussions. Lots of talk about the mechanics and compromises of splitting ventilators. It's amazing that this is even being contemplated. Here's an interesting position statement: https://www.apsf.org/news-updates/joint-statement-on-multiple-patients-per-ventilator/ Desperate times...

My wife is a nurse whose day job is running our vaccine clinics. She's been redeployed and is on the front lines tonight. Wish us well.

Just to be clear, we only need this surge of ventilator and PPE production because of the abject failure to even attempt to contain this virus when it first came to the US. This is damage control, after the problem was created by failure of leadership and organization. Also, ventilators are highly specialized, delicate machines that need to work precisely, or patients die. I'm very worried that well-meaning companies may do their very best to produce vents, but actually cause more chaos by producing unreliable or highly variable machines. I don't really know anything about manufacturing, though, so I may be way off... Just seems implausible to me that a factory that has been making cars or washing machines or whatever can just rapidly switch over to making something completely different.

I have no idea why some people continue to insist that it is difficult to understand why mitigation and social distancing is critical to changing the trajectory of this virus. Maybe they can't read. Or are lacking some critical brain function. I simply don't get it. I'll try to make it simple. Imagine a dangerous virus is spreading through a small community of 1000 people. This is a bug that requires life-saving treatment. Eventually, given the infectiousness of the bug, everyone is going to get it. Now, imagine the hospital in town has enough equipment and staff to save 10 people per day. If the virus spreads slowly, 10 people show up every day at the hospital for 100 days in a row. How many die? (zero). Now imagine 20 show up every day for 50 days in a row. How many die? (500). Now imagine all 1000 show up sick at the same time. How many die? (990). This is a simplification, obviously, but maybe it will make sense to the simple. The only reason we are seeing critical shortages of key equipment is because too many people are getting sick too fast. People die in excess when we exceed capacity. Slowing the spread means we can save the vast majority of affected people. The cost of "opening up the economy" is that huge numbers of people get covid19 at the same time and huge numbers die who don't need too. The amorality of someone who would choose that is grotesque. Sorry if this comes off snarky. I'm about to start my 4th meeting of the day about this virus. Our hospital is straining - this is as severe a threat to our continuance as a medical center as has ever happened. We're in trouble here, and the people who minimize this are part of the problem.

I'm in the midwest. It is here. It is not reflected in the reported national numbers (I don't know why), but it is definitely here. My hospital is like nothing I've ever seen right now. The daily tally of reported cases is basically meaningless at this point, and more a reflection of our inadequate testing than anything else .

The plural of anecdote is anecdotes, not data. I'm very skeptical that chloroquine will be a "game-changer." It's interesting, and deserves rigorous study. I haven't seen any real data yet.

This article is so damning. https://www.washingtonpost.com/national-security/us-intelligence-reports-from-january-and-february-warned-about-a-likely-pandemic/2020/03/20/299d8cda-6ad5-11ea-b5f1-a5a804158597_story.html

Nashville TN. https://www.newschannel5.com/news/vanderbilt-university-medical-center-setting-up-temporary-covid-19-screening-area

This is a makeshift ward set up in a parking garage at a hospital where I used to work... Get ready for chaos.

I'm a geneticist. Good luck to anyone I have to intubate. It won't go well...

Watch this video. As a doc, it sent chills up my spine. https://news.sky.com/video/coronavirus-italy-the-shocking-centre-of-the-covid-19-crisis-11960656

i wish we had allergies. We had snow and ice overnight. Still, its been a weirdly warm Minnesota winter overall.

There is not a simple answer. If you feel she is in imminent danger, then certainly call 911. If it is less urgent, then I would call primary provider. Different areas are taking different approaches to testing for COVID19. In my area, we have a phone triage system for the sick (but not critical) patients that routes people to controlled drive-through testing. I'm not sure what the approach in your area would be, but I would expect the primary physicians in the area to know.

I haven't slept well in days. The stress level at my hospital is palpable. Next few weeks are going to be rough.

Exactly. And why your question about whether the economic disruption is worth it for only 10,000 deaths is misguided. The number of illnesses and deaths is directly related to the social distancing and economic disruption. We are now choosing to economic disruption in order to avoid huge numbers of deaths (which would also be wildly economically disruptive). We had an opportunity to avoid both huge case numbers and huge economic disruption (we couldn't have avoided either altogether) early if we had adequate leadership and competence in government. But we don't, so now our options are worse. Also, I still think numbers are going to go far past 100,000 sick/10,000 dead. Also, there is emerging evidence that people who recover from this are at high risk long term for progressive pulmonary fibrosis, which is terrible.