Anyone quit recently or thought about quitting for a while due to Covid?

[zurned]

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My hospital seems ill prepared for this so far. (Lack of PPE, no real policies or rules in place about employee safety). I guess this is expected since it is still early

 

[TooMuchResearch]

It's not expected. And it's not early. How small of a hospital and are they affiliated with a larger system?

No, I won't leave my SDG mostly unicorn. I wouldn't have any job options in the area if I did, anyway.

 

[zurned]

It's not expected. And it's not early. How small of a hospital and are they affiliated with a larger system?

No, I won't leave my SDG mostly unicorn. I wouldn't have any job options in the area if I did, anyway.

No affiliation with larger system. It is kind of an inner city place in a major metro area (curtains for rooms, lots of hallway beds, understaffed, etc). But no more n95s during my last shift and lots of Possible Covid patients. It is probably a hard place to work on a normal day, but bearable. Now it just may be downright dangerous.

I am new there as well. I can just go back to my old job if I needed to tbh without missing a beat.

 

[thegenius]

My wife wants me to

She wants me to live in an RV for 2 months and not step foot in our home.

 

[gro2001]

It's a sad state of affairs if doctors are running away from epidemics.

 

[Groove]

I'm not worried about it. This is what we do. I'm not leaving my colleagues or patients in the middle of a pandemic. It's just not how I roll.

Personally, I think the panic is way overblown and about a year from now we're all going to realize this is just another virus like the myriads of others we are exposed to on an annual basis and most are going to recover just fine.

 

[doyinDO]

I'm not worried about it. This is what we do. I'm not leaving my colleagues or patients in the middle of a pandemic. It's just not how I roll.

Personally, I think the panic is way overblown and about a year from now we're all going to realize this is just another virus like the myriads of others we are exposed to on an annual basis and most are going to recover just fine.

How is it overblown? I think the panic is legit when you compare this pandemic to past ones. The other viruses didn't spread as easily and had lower death rates.

 

[GeneralVeers]

I have an okay job with great pay in a major city. I can't quit and ever expect to find the same type of job again .

 

[Groove]

How is it overblown? I think the panic is legit when you compare this pandemic to past ones. The other viruses didn't spread as easily and had lower death rates.

Because the U.S. COVID-19 mortality rate is still about 1-1.5%. This is about on par with influenza. The reason some European countries have a much higher rate is because they have different demographics and less immediate access to health care. Italy has the oldest European population and most of the deaths there have been in the elderly.

The global mortality rate is about 4% Germany has less than 0.5%

It's more easily transmissible because most pt's have very mild symptoms and are LESS SICK, therefore it gets spread around. It would be just as easy to spread panic and mass hysteria over the flu, but we don't....because we're used to it, we understand it, we have therapies for it, etc.. The same will be for COVID-19, just give it time.

This is NOT the "Black Death" or bubonic plague. (40-60% mortality, killed 30-60% of European population)

 

[deleted859689]

Because the U.S. COVID-19 mortality rate is still about 1-1.5%. This is about on par with influenza. The reason some European countries have a much higher rate is because they have different demographics and less immediate access to health care. Italy has the oldest European population and most of the deaths there have been in the elderly.

The global mortality rate is about 4% Germany has less than 0.5%

It's more easily transmissible because most pt's have very mild symptoms and are LESS SICK, therefore it gets spread around. It would be just as easy to spread panic and mass hysteria over the flu, but we don't....because we're used to it, we understand it, we have therapies for it, etc.. The same will be for COVID-19, just give it time.

This is NOT the "Black Death" or bubonic plague. (40-60% mortality, killed 30-60% of European population)

The media always seems to report the highest number of possible infection even if the range is for example 20k to over 1m. They always report that 1m figure in their headlines - all they want are clicks and traffic. Everyone should learn to read news headlines with just a little bit of skepticism in the back of their mind.

While I say that, covid-19 is real and people are dying and scared. I agree with @Groove ‘s comment though.

 

[thegenius]

Because the U.S. COVID-19 mortality rate is still about 1-1.5%. This is about on par with influenza. The reason some European countries have a much higher rate is because they have different demographics and less immediate access to health care. Italy has the oldest European population and most of the deaths there have been in the elderly.

The global mortality rate is about 4% Germany has less than 0.5%

It's more easily transmissible because most pt's have very mild symptoms and are LESS SICK, therefore it gets spread around. It would be just as easy to spread panic and mass hysteria over the flu, but we don't....because we're used to it, we understand it, we have therapies for it, etc.. The same will be for COVID-19, just give it time.

This is NOT the "Black Death" or bubonic plague. (40-60% mortality, killed 30-60% of European population)

The problem is that this coronavirus has done more economic damage in 2 months than the flu has done in, eh...20 years? **** the flu probably keeps people employed on some level. How many times has the stock market dropped 35% due to the flu? One estimate of the global tourism revenue exceeds $1T. We are going to have to live in a cave for the next 2 months, and even then we don't be able to move around from region to region (let alone to other countries) unless we have a vaccine or we wait long enough that the virus dies off or we get herd immunity.

It's so interesting how this virus was probably living in a bat or a pangolin (whatever the hell that is) for years or decades until we decided to kill one and eat it.

The virus itself is not all that interesting. 99% of people will survive, it and most won't even need to be admitted to the hospital. Idris Elba has a simple runny nose and he has it.

 

[Groove]

The problem is that this coronavirus has done more economic damage in 2 months than the flu has done in, eh...20 years? **** the flu probably keeps people employed on some level. How many times has the stock market dropped 35% due to the flu? One estimate of the global tourism revenue exceeds $1T. We are going to have to live in a cave for the next 2 months, and even then we don't be able to move around from region to region (let alone to other countries) unless we have a vaccine or we wait long enough that the virus dies off or we get herd immunity.

It's so interesting how this virus was probably living in a bat or a pangolin (whatever the hell that is) for years or decades until we decided to kill one and eat it.

The virus itself is not all that interesting. 99% of people will survive, it and most won't even need to be admitted to the hospital. Idris Elba has a simple runny nose and he has it.

Yeah, I was just reading an article about him. Someone had posted he was in the ICU and when asked, he said he was perfectly fine. Idris Elba shares coronavirus update, denies he's in critical condition in intensive care

The economic impact has been severe and honestly, I didn't anticipate such a dire downturn in the market (though I probably should have..). Be that as it may, it's more reason for us to keep working and, in my case, pick up extra shifts. I'm doing all I can to earn extra $$$ so I can buy these stocks on sale. I spent 20K yesterday snatching up stocks in the bargain bin and will invest some more in a couple weeks. It's a great time to buy.

 

[VA Hopeful Dr]

Because the U.S. COVID-19 mortality rate is still about 1-1.5%. This is about on par with influenza. The reason some European countries have a much higher rate is because they have different demographics and less immediate access to health care. Italy has the oldest European population and most of the deaths there have been in the elderly.

The global mortality rate is about 4% Germany has less than 0.5%

It's more easily transmissible because most pt's have very mild symptoms and are LESS SICK, therefore it gets spread around. It would be just as easy to spread panic and mass hysteria over the flu, but we don't....because we're used to it, we understand it, we have therapies for it, etc.. The same will be for COVID-19, just give it time.

This is NOT the "Black Death" or bubonic plague. (40-60% mortality, killed 30-60% of European population)

That's not even close. Flu has a total mortality of around 0.1%. So we're looking at 10X the mortality at the moment.

 

[calvnandhobbs68]

Because the U.S. COVID-19 mortality rate is still about 1-1.5%. This is about on par with influenza. The reason some European countries have a much higher rate is because they have different demographics and less immediate access to health care. Italy has the oldest European population and most of the deaths there have been in the elderly.

Did you even look up the influenza mortality rate before you just starting spouting numbers?

 

[deleted59964]

Italy
0-14 years: 13.6% (male 4,326,862 /female 4,136,562)
15-24 years: 9.61% (male 2,994,651 /female 2,984,172)
25-54 years: 41.82% (male 12,845,442 /female 13,183,240)
55-64 years: 13.29% (male 4,012,640 /female 4,261,956)
65 years and over: 21.69% (male 5,817,819 /female 7,683,330) (2018 est.)

USA

• 0–14 years: 18.62% (male 31,255,995/female 29,919,938)
• 15–24 years: 13.12% (male 22,213,952/female 21,137,826)
• 25–54 years: 39.29% (male 64,528,673/female 64,334,499)
• 55–64 years: 12.94% (male 20,357,880/female 21,821,976)
• 65 years and over: 16.03% (male 22,678,235/female 28,376,817)

you think this age difference is reassuring?

 

[deleted59964]

the reason Italy has a terrible mortality rate is because they have too many cases and can't cope.
will happen elsewhere when exponential growth catches up - they're just a week or so ahead.

maybe there's some difference, maybe the lockdown being earlier will help - I hope so.

 

[Mad Jack]

The problem is that this coronavirus has done more economic damage in 2 months than the flu has done in, eh...20 years? **** the flu probably keeps people employed on some level. How many times has the stock market dropped 35% due to the flu? One estimate of the global tourism revenue exceeds $1T. We are going to have to live in a cave for the next 2 months, and even then we don't be able to move around from region to region (let alone to other countries) unless we have a vaccine or we wait long enough that the virus dies off or we get herd immunity.

It's so interesting how this virus was probably living in a bat or a pangolin (whatever the hell that is) for years or decades until we decided to kill one and eat it.

The virus itself is not all that interesting. 99% of people will survive, it and most won't even need to be admitted to the hospital. Idris Elba has a simple runny nose and he has it.

1% is still millions of people that don't survive, and would kill more people than the flu does in around 50 years

 

[Groove]

Did you even look up the influenza mortality rate before you just starting spouting numbers?

Question is...Did YOU look it up?

CDC influenza stats in the US (2018-2019 season):

35.5 million cases, ~34K deaths = around 1% (all ages) (0.96)

CDC COVID-19 official data for U.S.:

15,219 cases, 201 deaths = ~1.3%

Yes, the numbers may change as we go along, but that's what we have so far and all this stuff is readily available on the CDC website.

 

[VA Hopeful Dr]

Question is...Did YOU look it up?

CDC influenza stats in the US (2018-2019 season):

35.5 million cases, ~34K deaths = around 1% (all ages) (0.96)

CDC COVID-19 official data for U.S.:

15,219 cases, 201 deaths = ~1.3%

Yes, the numbers may change as we go along, but that's what we have so far and all this stuff is readily available on the CDC website.

I think you're having problems with math today.

34k deaths out of 35 million cases isn't 1% death rate, its 0.1% death rate.

 

[Groove]

I think you're having problems with math today.

34k deaths out of 35 million cases isn't 1% death rate, its 0.1% death rate.

Oops, not enough coffee this a.m. Ok, 0.1% then....I still don't see a reason for the hysteria with a U.S. mortality around 1%. I mean, if businesses shut down and it takes multiple stimulus packages and we go without TP and paper towels for a year every time a bacterial or viral infection kills 1% of us...we'll never thrive as a species.

Like it or not, the current approach to a viral illness of this level of severity is NOT sustainable long term. The media hysteria is insane. I can't find TP or paper towels within 25 mile radius of my city. I can't even buy eggs or milk. 25% of businesses are completely shut down. DOW down 10K points.

1% !! Good grief.

 

[Spikebd]

I daydream all the time about getting out of medicine. I'm in my third year of residency in a non-EM field and can't stand the groupthink in academia. Unless I had my own business there just aren't better options out there for me.
I guess since I finished intern year and have a medical license I could try to open a primary care type outpatient clinic. Has anyone tried doing that?

 

[cyanide12345678]

Question is...Did YOU look it up?

CDC influenza stats in the US (2018-2019 season):

35.5 million cases, ~34K deaths = around 1% (all ages) (0.96)

CDC COVID-19 official data for U.S.:

15,219 cases, 201 deaths = ~1.3%

Yes, the numbers may change as we go along, but that's what we have so far and all this stuff is readily available on the CDC website.

34k is actually 0.1%. 340k is 1%. 3.4mil is 10%.

34000/34,000,000 = 0.001 or 0.1%

So yeah.... This is 10 x more deadly than the flu based on what you just said. So there's a difference.

R0 for flu is also lower at around 1.6 while this is hovering around 2.3

 

[VA Hopeful Dr]

Oops, not enough coffee this a.m. Ok, 0.1% then....I still don't see a reason for the hysteria with a U.S. mortality around 1%. I mean, if businesses shut down and it takes multiple stimulus packages and we go without TP and paper towels for a year every time a bacterial or viral infection kills 1% of us...we'll never thrive as a species.

Like it or not, the current approach to a viral illness of this level of severity is NOT sustainable long term. The media hysteria is insane. I can't find TP or paper towels within 25 mile radius of my city. I can't even buy eggs or milk. 25% of businesses are completely shut down. DOW down 10K points.

1% !! Good grief.

That's the mortality rate when we aren't having to ration ventilators.

 

[Birdstrike]

Question is...Did YOU look it up?

CDC influenza stats in the US (2018-2019 season):

35.5 million cases, ~34K deaths = around 1% (all ages) (0.96)

CDC COVID-19 official data for U.S.:

15,219 cases, 201 deaths = ~1.3%

Yes, the numbers may change as we go along, but that's what we have so far and all this stuff is readily available on the CDC website.

What @Groove is talking about here is super important.

It is true that people are quoting the case fatality rate (CFR) for COVID-19 by using deaths / confirmed cases, but comparing that to an influenza CFR calculated very different, i.e. deaths / total cases.

"So what you say? Those are the same."

No they're not. "Confirmed cases" and not the same as "total cases." The total cases number being used for influenza is confirmed influenza cases (you sent a + swab). But total cases is confirmed + clinically diagnosed flu (provider diagnoses "influenza-like virus").

THAT MAKES A HUGE DIFFERENCE. Just think about how many times you, a PCP, a nurse or NP in thousands of urgent cares across the country diagnose "influenza like illness" and never swab the person. It's millions, and in fact the great majority of cases. And that becomes part of the denominator and necessarily gives a much smaller number for the death rate.

Currently, there is no reliable estimate for the "total COVID-19" cases in the US and most places, other than the 6.1:1 ratio I sited on the "What Do I Need To Know About Coronavirus Thread" out of China. I don't even think there's an ICD10 code yet, for "COVID-19-like virus" for the CDC to track. So we, and the CDC are missing, and currently have no way to track or compile those cases to get the real number.

In fact, many people with presumed COVID-19 with mild disease probably are sent home, not tested and given a "flu-like virus" ICD code, which further drives down the flu death rate and raises the COVID-19 death rate.

I do think COVID-19 is worse than the flu from an immunity standpoint since we're all (mostly) COVID-19 naive. But whether or not the ultimate death rate, total deaths or cases will be worse, similar or less, remains to be seen. I definitely think COVID-19 has the potential to be worse than the flu, since it's hitting so fast in some areas due to the lack of immunity, but I do still think that paradoxically, we could end up with a death rate and total deaths similar or less, than the flu. Or it could be higher. There are too many unknowns. But I do not think we'll hit the cataclysmic numbers (1.6 million, 2.2 million Americans dead several groups have predicted) which I still think was a combination of garden variety media driven hype, social media panic, and experts being wrong.

 

[Birdstrike]

That's the mortality rate when we aren't having to ration ventilators.

Do you have patients at your facility that need to be intubated that you don't have vents for?

 

[Birdstrike]

I daydream all the time about getting out of medicine. I'm in my third year of residency in a non-EM field and can't stand the groupthink in academia. Unless I had my own business there just aren't better options out there for me.
I guess since I finished intern year and have a medical license I could try to open a primary care type outpatient clinic. Has anyone tried doing that?

Yes, people have tried it. It is a terrible idea. And this is the wrong thread.

 

[VA Hopeful Dr]

Do you have patients at your facility that need to be intubated that you don't have vents for?

Nope, but we only have 2 confirmed cases in the county.

Do the countries that are ahead of us in cases have this problem?

Yes.

Also this:

Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals (Published 2020)

There are already critical shortages: A Bronx hospital is running out of ventilators. In Brooklyn, doctors are reusing masks.

www.nytimes.com

 

[Spikebd]

Yes, people have tried it. It is a terrible idea. And this is the wrong thread.

Bird strike I think you’re struggling to remember which thread you’re in man. Re-read the title.
And trust me I’m well aware my best option is to gut it out in this field.

 

[Birdstrike]

Nope, but we only have 2 confirmed cases in the county.

Do the countries that are ahead of us in cases have this problem?

Yes.

Also this:

Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals (Published 2020)

There are already critical shortages: A Bronx hospital is running out of ventilators. In Brooklyn, doctors are reusing masks.

www.nytimes.com

I know what's happened in China, Italy and Iran with vents and running out. We and the media have been talking about that until blue in the face for weeks. I also know about that article and this rumor that hospitals in Bronx are running out of vents based on that one line in NY Times that no one else can confirm and none of the other NY papers are reporting. So, yes, everyone seems 100% sure that someone somewhere else is "running out of vents." That's why when you said "we" are having to ration ventilators that maybe it was happening to you, as opposed to someone talking about what's happening elsewhere to someone else and might happen to them. I don't mean to be picky. What I'm hoping is that given the fact we've had those warnings, we're able to prepare so that those critical shortages, though feared and threatening, don't happen, or at a minimum happen only rarely and not a severe as elsewhere.

 

[bougiecric]

Check out EM Docs group on facebook.

Case after case after case of 30s-50s with no comorbidities getting intubated.

If that doesn't cause you to reflect on what you're walking into every time you enter the ER, I don't know what will.

 

[VA Hopeful Dr]

I know what's happened in China, Italy and Iran with vents and running out. We and the media have been talking about that until blue in the face for weeks. I also know about that article and this rumor that hospitals in Bronx are running out of vents based on that one line in NY Times that no one else can confirm and none of the other NY papers are reporting. So, yes, everyone seems 100% sure that someone somewhere else is "running out of vents." That's why when you said "we" are having to ration ventilators that maybe it was happening to you, as opposed to someone talking about what's happening elsewhere to someone else and might happen to them. I don't mean to be picky. What I'm hoping is that given the fact we've had those warnings, we're able to prepare so that those critical shortages, though feared and threatening, don't happen, or at a minimum happen only rarely and not a severe as elsewhere.

Actually I said we aren't having to ration ventilators.

That's the mortality rate when we aren't having to ration ventilators.

That's the whole point of all of this. We're trying to make sure we don't get to that point.

 

[Birdstrike]

Bird strike I think you’re struggling to remember which thread you’re in man. Re-read the title.

We probably think alike since I’ve “daydreamed about getting out of Medicine” off and on my whole career. But yes, I am a little confused. I'm well aware this thread on the SDN EM forum is about having thoughts of quitting EM (at least for “a while”) due to COVID-19. But you're not EM, you're in primary care, and you're not suggesting quitting the practice of Medicine at all, just quitting your residency during your third year of residency, yet still staying in Medicine and doing Primary Care without board certification, where you'll see COVID patients all day long. So yes, I'm struggling to follow.

And trust me I’m well aware my best option is to gut it out in this field.

You haven't told us what field you're in, so how can we agree or disagree "your best option" is to get out? Maybe it is or maybe it's not. In fact, I was just thinking the other day, that I'm fortunate to be in Medicine, which is one of the rare fields that allows me to keep working during a national shutdown which is going to bankrupt a lot of other people. Granted, I'm doing pain injections on people now and the COVID patients are only passing me in the hallway on their way to see their PCPs (or coughing on me while I do their injection/med refill). I realize it's not the same as having to work EM shifts intubating SARS or COVID-19 patients at 2 am without a mask, so I get that it's totally different if I was still on the front lines. I'm sure I'd be on here going ballistic if I hadn't found my "way out," which wasn't really a way "out" since I'm still having to practice Medicine and be somewhat exposed, while non-medical shelter in place totally unexposed.

But I don't know. Clarify and get me up to speed. Or not. Either way, it's all good.

 

[Birdstrike]

That's the whole point of all of this. We're trying to make sure we don't get to that point.

Agree.

 

[Angry Birds]

Anyone worried about spreading this to their spouse? Should we live separately during this time to protect them? Especially if the spouse has a lung condition like asthma or what not

 

[Birdstrike]

@zurned I thought about shutting down for two weeks (which is an option for me since I do Interventional Pain now, no longer EM) like the rest of America, to reduce my exposure. That’s the easy “feel good” option. But then I asked myself, what will the case counts, death numbers and total viral burden be out there in two weeks when I reopen? Lower, same or higher?

They’re going to be higher in two weeks, not lower. Shutting down for two weeks or three weeks gains me nothing. That’s why I decided there’s no point. I can’t shut down forever. I can’t shut down until there’s a vaccine in six months. If you have the f- you money to walk away for 6 months, then sure, do it. But I don’t.

So, I’ve decided to follow precautions. Plow ahead. Hope that either I don’t get exposed, or if I do, I’m late in the cycle when there’s a vaccine, or if I do get exposed quickly to put my bets on the fact that being under 50 with no serious diseases, that statistically I’d come through it okay.

But then again, I’m doing office based procedures and clinic in a PCP office where there “might” be COVID-19. I’m not intubating confirmed, frothy, COVID-19 patients without PPE.

 

[Matthew9Thirtyfive]

What @Groove is talking about here is super important.

It is true that people are quoting the case fatality rate (CFR) for COVID-19 by using deaths / confirmed cases, but comparing that to an influenza CFR calculated very different, i.e. deaths / total cases.

"So what you say? Those are the same."

No they're not. "Confirmed cases" and not the same as "total cases." The total cases number being used for influenza is confirmed influenza cases (you sent a + swab). But total cases is confirmed + clinically diagnosed flu (provider diagnoses "influenza-like virus").

THAT MAKES A HUGE DIFFERENCE. Just think about how many times you, a PCP, a nurse or NP in thousands of urgent cares across the country diagnose "influenza like illness" and never swab the person. It's millions, and in fact the great majority of cases. And that becomes part of the denominator and necessarily gives a much smaller number for the death rate.

Currently, there is no reliable estimate for the "total COVID-19" cases in the US and most places, other than the 6.1:1 ratio I sited on the "What Do I Need To Know About Coronavirus Thread" out of China. I don't even think there's an ICD10 code yet, for "COVID-19-like virus" for the CDC to track. So we, and the CDC are missing, and currently have no way to track or compile those cases to get the real number.

In fact, many people with presumed COVID-19 with mild disease probably are sent home, not tested and given a "flu-like virus" ICD code, which further drives down the flu death rate and raises the COVID-19 death rate.

I do think COVID-19 is worse than the flu from an immunity standpoint since we're all (mostly) COVID-19 naive. But whether or not the ultimate death rate, total deaths or cases will be worse, similar or less, remains to be seen. I definitely think COVID-19 has the potential to be worse than the flu, since it's hitting so fast in some areas due to the lack of immunity, but I do still think that paradoxically, we could end up with a death rate and total deaths similar or less, than the flu. Or it could be higher. There are too many unknowns. But I do not think we'll hit the cataclysmic numbers (1.6 million, 2.2 million Americans dead several groups have predicted) which I still think was a combination of garden variety media driven hype, social media panic, and experts being wrong.

CFR is actually deaths/recovered. Using deaths/confirmed cases underestimates CFR if some of the cases are still active, possibly grossly if the majority of the cases are still active.

 

[Birdstrike]

CFR is actually deaths/recovered. Using deaths/confirmed cases underestimates CFR if some of the cases are still active, possibly grossly if the majority of the cases are still active.

Using deaths/recovered right now massively overestimates CFR, since the recovered numbers lag weeks behind. Also, it may permanently lag since many patients may get lost to follow up never get confirmed negative tests, especially if they never felt they were very sick, to make it worth while.

 

[Matthew9Thirtyfive]

Using deaths/recovered right now massively overestimates CFR, since the recovered numbers lag weeks behind. Some may never get confirmed negative tests, and be lost to follow up.

That’s the problem with using CFR as a measure when you’re in the midst of it. Hard to say because only counting resolved cases likely overestimates, but using confirmed cases underestimates.

 

[ShockIndex]

Actually I said we aren't having to ration ventilators.



That's the whole point of all of this. We're trying to make sure we don't get to that point.

There is an interesting pattern to the postings from a small cohort in this thread and the other dumpster fire. It goes something like this:

“This virus is similar to seasonal influenza.“

Once the fallacy behind that line of thinking is exposed, the logic quickly shifts to:

“We can’t do this to our economy for long. Perhaps it’s best just to isolate the old people and turn the economic engine back on before we suffer irreparable damage.”

I’ve got some bad news. The economic engine is not going to restart when 1-2 million people go up in a puff of smoke and another 15-20 million are critically sickened (10-20% of the infected in Italy require hospitalization with half of those needing ICU care). If we relaxed the austerity measures while this thing is on the rise, we will fill every hospital bed and hallway with intubated 40-60 year olds. People are not going back to their routines under those circumstances.

People had better get used to the concept that the austerity could get much much worse - curfews, food rationing, mass unemployment ...lions...tigers...and bears. There is no option of clicking our heels thrice and saying “There’s no place like home” to go back to debt spending our way to 2% economic growth and 3% unemployment. That facade is gone and not coming back in the next 6-18 months.

 

[Birdstrike]

I just went for a run and it made me think. I was trying to think of when was the last time I saw this much fear in the medical community over a communicable disease. I don't remember anyone getting too worried about SARS, Bird Flu or Zika. We just didn't have enough cases for that to create much if any fear among my colleagues. Ebola created a lot of fear among the general population, but again, we didn't have enough cases here to cause widespread fear among anyone I worked with. None of the flu seasons, even though some of them killed 10's of thousands of people, seemed to cause any fear among the medical community, because that's something we're used to, and we've all lived with since birth.

The only thing I can remember causing this much fear among co-workers was during the early days of the AIDS epidemic in the late 80's early 90's. People were dying horrible, long, wasting deaths from a new disease. There was no cure. The death rate was very close to 100%, if not 100%, and there was no vaccine and no cure. In the early days, people weren't even really sure how it spread. People wondered, could you get it from a cough, sneeze, touch?! That turned out to be false. Can you get it from blood splatter on your hand?! That turned out to be false. No one seemed sure of anything, as this was literally a new disease that had emerged out of a foreign land, having originated in an animal (sound familiar?)

The, when I was a pre-med in the early '90s, Magic Johnson was diagnosed and all Hell broke loose. I remember hearing about older orthopedic doctors retiring due to fear that they'd inhale blood splatter during the bone-sawing portion of total joint replacements. That turned out to be false. I remember ER docs saying, if they got a needle stick from an HIV positive patient, "It's a death sentence. 100% you're dead." That turned out to be mostly false (0.3% chance of transmission with positive needle stick). This was when HIV drugs were in their infancy and we weren't even sure if they'd work, of if they did, how well. The panic was real. People, medical people, were freaking out. Some of it was 100% justified. Some of it was overreaction out of fear, and uncertainty.

But in the end, the occupational hazard didn't turn out as bad as we had feared. In those past 25+ years I can't remember knowing a single colleague that died from an HIV needle stick. I'm sure there were some. I know of a few that got Hep C and died, which never seemed to create the same fear. I can remember people I knew and worked with that died of a bunch of other things since then: Car accidents, cancer, heart attacks, overdoses, you name it. But none of them feared dying of those things nearly as much as we all feared dying from HIV and AIDS due to a needle stick in those early days.

My point is not that COVID-19 and AIDS are the same. They're not. My point is not that COVID-19 isn't bad. COVID-19 is bad. It's real bad. And I'm not saying fear of it, is unjustified. Fear of it, is justified. But what I am saying is, as a medical community, we got through the initial very scary days of HIV/AIDS. It turned out to be a bad thing, real bad. A lot of people died. But as far as risks of contracting the disease while taking care of the patients, we got through it a lot better than we initially feared. And I'm hoping that COVID-19 turns out to be the same. That we get through this legitimately scary time, better than we had initially feared. I could be wrong. But I think there’s a good chance we will.

 

[HoosierdaddyO]

Can we converge the covid chats to the covid thread... and keep this for the titled questions lol 🙂. Hard to follow important discussions that belong over there.... thanks y’all and always appreciate the opinions on evolving issues!!!

 

[Birdstrike]

People had better get used to the concept that the austerity could get much much worse - curfews, food rationing, mass unemployment ...lions...tigers...and bears. There is no option of clicking our heels thrice and saying “There’s no place like home” to go back to debt spending our way to 2% economic growth and 3% unemployment. That facade is gone and not coming back in the next 6-18 months.

Yeah. I know. Certain people are like pigs in s**t over the fact that this virus is killing the great economy we had going.

 

[doyinDO]

@zurned I thought about shutting down for two weeks (which is an option for me since I do Interventional Pain now, no longer EM) like the rest of America, to reduce my exposure. That’s the easy “feel good” option. But then I asked myself, what will the case counts, death numbers and total viral burden be out there in two weeks when I reopen? Lower, same or higher?

They’re going to be higher in two weeks, not lower. Shutting down for two weeks or three weeks gains me nothing. That’s why I decided there’s no point. I can’t shut down forever. I can’t shut down until there’s a vaccine in six months. If you have the f- you money to walk away for 6 months, then sure, do it. But I don’t.

So, I’ve decided to follow precautions. Plow ahead. Hope that either I don’t get exposed, or if I do, I’m late in the cycle when there’s a vaccine, or if I do get exposed quickly to put my bets on the fact that being under 50 with no serious diseases, that statistically I’d come through it okay.

But then again, I’m doing office based procedures and clinic in a PCP office where there “might” be COVID-19. I’m not intubating confirmed, frothy, COVID-19 patients without PPE.

Number of cases will be higher in 2 weeks but shutting down has a point because the number of cases without shutting down would always increase at a higher rate compared to the rate with the shut down.

I get your point though, but if everyone thought like you, the spread would be worse.

 

[Birdstrike]

I get your point though, but if everyone thought like you, the spread would be worse.

Not everyone “thinks like me” and not everyone should think like me. Because not everyone is in healthcare. Healthcare as an industry is treated differently than a bar, concert or mass gathering. Sure, shut down the bars. But healthcare is considered a vital infrastructure industry and no one is talking about shutting all of it down during this. Mainly, they want to shut down anything that ties up a ventilator or ICU bed. Other than that no one is saying “shut down all healthcare.” “Shut down all doctors offices.” “You can go without your cholesterol medicine for two weeks. Shut down all pharmacies.”

We’ve set up telemedicine to reduce exposures, and made numerous changes in protocols to reduce risk, but they shutting down all PCP offices? All urgent cares? All Derm practices?

Are they suspending EMTALA and shutting down your ED to all but emergencies and COVID-19?

 

[doyinDO]

Because the U.S. COVID-19 mortality rate is still about 1-1.5%. This is about on par with influenza. The reason some European countries have a much higher rate is because they have different demographics and less immediate access to health care. Italy has the oldest European population and most of the deaths there have been in the elderly.

The global mortality rate is about 4% Germany has less than 0.5%

It's more easily transmissible because most pt's have very mild symptoms and are LESS SICK, therefore it gets spread around. It would be just as easy to spread panic and mass hysteria over the flu, but we don't....because we're used to it, we understand it, we have therapies for it, etc.. The same will be for COVID-19, just give it time.

This is NOT the "Black Death" or bubonic plague. (40-60% mortality, killed 30-60% of European population)

As others have stated, it's worse than the flu. Flu wasn't as lethal. Also, thanks for explaining why it's more easily transmissible but that doesn't go against what I was saying. These factors legitimize most of the panic we've seen.

Those plagues were worse but they were ages ago where no one currently alive has experienced to compare to now. I'm talking about recent history. I agree the mortality rate will eventually get lower, but who knows if it will be lower than the flu or eventually eradicated.

 

[Lexdiamondz]

I just went for a run and it made me think. I was trying to think of when was the last time I saw this much fear in the medical community over a communicable disease. I don't remember anyone getting too worried about SARS, Bird Flu or Zika. We just didn't have enough cases for that to create much if any fear among my colleagues. Ebola created a lot of fear among the general population, but again, we didn't have enough cases here to cause widespread fear among anyone I worked with. None of the flu seasons, even though some of them killed 10's of thousands of people, seemed to cause any fear among the medical community, because that's something we're used to, and we've all lived with since birth.

The only thing I can remember causing this much fear among co-workers was during the early days of the AIDS epidemic in the late 80's early 90's. People were dying horrible, long, wasting deaths from a new disease. There was no cure. The death rate was very close to 100%, if not 100%, and there was no vaccine and no cure. In the early days, people weren't even really sure how it spread. People wondered, could you get it from a cough, sneeze, touch?! That turned out to be false. Can you get it from blood splatter on your hand?! That turned out to be false. No one seemed sure of anything, as this was literally a new disease that had emerged out of a foreign land, having originated in an animal (sound familiar?)

The, when I was a pre-med in the early '90s, Magic Johnson was diagnosed and all Hell broke loose. I remember hearing about older orthopedic doctors retiring due to fear that they'd inhale blood splatter during the bone-sawing portion of total joint replacements. That turned out to be false. I remember ER docs saying, if they got a needle stick from an HIV positive patient, "It's a death sentence. 100% you're dead." That turned out to be mostly false (0.3% chance of transmission with positive needle stick). This was when HIV drugs were in their infancy and we weren't even sure if they'd work, of if they did, how well. The panic was real. People, medical people, were freaking out. Some of it was 100% justified. Some of it was overreaction out of fear, and uncertainty.

But in the end, the occupational hazard didn't turn out as bad as we had feared. In those past 25+ years I can't remember knowing a single colleague that died from an HIV needle stick. I'm sure there were some. I know of a few that got Hep C and died, which never seemed to create the same fear. I can remember people I knew and worked with that died of a bunch of other things since then: Car accidents, cancer, heart attacks, overdoses, you name it. But none of them feared dying of those things nearly as much as we all feared dying from HIV and AIDS due to a needle stick in those early days.

My point is not that COVID-19 and AIDS are the same. They're not. My point is not that COVID-19 isn't bad. COVID-19 is bad. It's real bad. And I'm not saying fear of it, is unjustified. Fear of it, is justified. But what I am saying is, as a medical community, we got through the initial very scary days of HIV/AIDS. It turned out to be a bad thing, real bad. A lot of people died. But as far as risks of contracting the disease while taking care of the patients, we got through it a lot better than we initially feared. And I'm hoping that COVID-19 turns out to be the same. That we get through this legitimately scary time, better than we had initially feared. I could be wrong. But I think there’s a good chance we will.

I think the difference here v the AIDS epidemic is that there are significant numbers of healthcare workers who have fallen ill and required hospitalisation as a result of this. I've never hospitalised a young person with no comorbidities for the flu, meanwhile there are more than a handful of young folks in our unit intubated thanks to COVID

 

[zurned]

Can we converge the covid chats to the covid thread... and keep this for the titled questions lol 🙂. Hard to follow important discussions that belong over there.... thanks y’all and always appreciate the opinions on evolving issues!!!

This is a good point. I already got enough input on this from this thread. Locking it now.