RadOncDoc21

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Speaking of garlic, for last 2 years, l have taken kyolic aged garlic pills and never gotten sick.
There is actually some decent literature on this

You could have shared this a little sooner!
 
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KHE88

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As a trump hater, I honestly worry that he will turn out to be right and gain electoral support. 1) death rate may not be high and a very high Asymptomatic spread may push down the death rate. 2)testing just won’t help in that scenario unless everyone is tested.

Even if covid is gone in a month, the economic impact is done and will take years to recover from.
I can't wait to be arguing about whether trashing the economy to probably the greatest extent in the history of America and putting millions out of work was all worth it. As well as the inevitable expanding of the size and scope of the federal government.

The analysis of actual covid deaths vs. collateral consequences including personal financial ruin, layoffs, the death of small business in america, suicides, divorces, etc. The monday-morning quarterbacking will go on for 30 years and only serve to further divide us.

On the left, you've got the reasonable willing to take a look at the question of the economic impact, and the unreasonable virtue-signallers screaming how dare you worry about money if one extra person might die because of covid. Even on the right-wing, there are 3 different factions that have formed and going at each other's throats: the full-blown covid-deniers/trumpers, the traditional and moderate republicans who still think it's a big deal, and the fringe right who think it's a Chinese-made bioweapon and hunkered down in the bunkers/moms' basements with hundreds of assault weapons and piles of toilet paper spouting conspiracy theories online.

Who knows how all this will play out politically. I do know that a large number of our leaders in all three branches of government are well in the range of those who could be seriously affected if they get sick, and I can look at the death rates in the 70-80+ crowd, and well... there's going to be some changes I suspect.
 
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deleted1002574

Even if covid is gone in a month, the economic impact is done and will take years to recover from.
I can't wait to be arguing about whether trashing the economy to probably the greatest extent in the history of America and putting millions out of work was all worth it. As well as the inevitable expanding of the size and scope of the federal government.

The analysis of actual covid deaths vs. collateral consequences including personal financial ruin, layoffs, the death of small business in america, suicides, divorces, etc. The monday-morning quarterbacking will go on for 30 years and only serve to further divide us.

On the left, you've got the reasonable willing to take a look at the question of the economic impact, and the unreasonable virtue-signallers screaming how dare you worry about money if one extra person might die because of covid. Even on the right-wing, there are 3 different factions that have formed and going at each other's throats: the full-blown covid-deniers/trumpers, the traditional and moderate republicans who still think it's a big deal, and the fringe right who think it's a Chinese-made bioweapon and hunkered down in the bunkers/moms' basements with hundreds of assault weapons and piles of toilet paper spouting conspiracy theories online.

Who knows how all this will play out politically. I do know that a large number of our leaders in all three branches of government are well in the range of those who could be seriously affected if they get sick, and I can look at the death rates in the 70-80+ crowd, and well... there's going to be some changes I suspect.

That's a pretty good summary of it.

The major issue is that if you go full "Boris Johnson" on it (guess he has it now?) and push for herd immunity ASAP but don't have the resources, you're going to get a lot of deaths.

The other problem with "over doing" it is that you don't see positive results, but if you "under do" it then you definitely see negative effects. It's a lose-lose for the "Trashing The Economy" path (who some might call "Saving Humanity" method). You can't show that it worked plus you get the economic losses.

No matter what happens, the Trumpy right will see we didn't need to do it. Right? I don't see a way around that.
 
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RickyScott

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Even if covid is gone in a month, the economic impact is done and will take years to recover from.
I can't wait to be arguing about whether trashing the economy to probably the greatest extent in the history of America and putting millions out of work was all worth it. As well as the inevitable expanding of the size and scope of the federal government.

The analysis of actual covid deaths vs. collateral consequences including personal financial ruin, layoffs, the death of small business in america, suicides, divorces, etc. The monday-morning quarterbacking will go on for 30 years and only serve to further divide us.

On the left, you've got the reasonable willing to take a look at the question of the economic impact, and the unreasonable virtue-signallers screaming how dare you worry about money if one extra person might die because of covid. Even on the right-wing, there are 3 different factions that have formed and going at each other's throats: the full-blown covid-deniers/trumpers, the traditional and moderate republicans who still think it's a big deal, and the fringe right who think it's a Chinese-made bioweapon and hunkered down in the bunkers/moms' basements with hundreds of assault weapons and piles of toilet paper spouting conspiracy theories online.

Who knows how all this will play out politically. I do know that a large number of our leaders in all three branches of government are well in the range of those who could be seriously affected if they get sick, and I can look at the death rates in the 70-80+ crowd, and well... there's going to be some changes I suspect.
we have to put a dollar on lives. We do this with the flu and we do this with driving/cars. We did not shut down the country in 1918 or for polio, diseases that struck down the young. I think the immediate shut down is warranted out of precaution and until widespread testing (especially antibody ones)is deployed and we understand what is going on.

Btw- Boris Johnson just got it.
 

RadOncDoc21

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we have to put a dollar on lives. We do this with the flu and we do this with driving/cars. We did not shut down the country in 1918 or for polio, diseases that struck down the young. I think the immediate shut down is warranted out of precaution and until widespread testing (especially antibody ones)is deployed and we understand what is going on.

Btw- Boris Johnson just got it.

I bet he just wanted to get it to show off how tough he is. Get the virus, hopefully live and get back to work.
 

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Do you guys travel at all? Butchering of live animals in markets is common all over the world. This is in no way exclusively Chinese. Many of the things people eat around the world would be disgusting to you.

Edit: I will write that 1. Sanitation in these markets need to be brought to modern standards and enforced and 2. Sale of endangered species or species linked to human diseases needs to stop. Still, even if we're perfect in this, I don't think this will stop this from happening again. How exactly will that stop us from getting another swine flu variant? Or a mosquito borne disease? Etc etc etc ...
Yet, the most dangerous viruses come from areas where exotic animals are killed eaten or sold (China and parts of Africa). So maybe people should, you know, not do that.
 
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Yet, the most dangerous viruses come from areas where exotic animals are killed eaten or sold (China and parts of Africa). So maybe people should, you know, not do that.
From my favorite source in Jan
 

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My hero
 

KHE88

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Yet, the most dangerous viruses come from areas where exotic animals are killed eaten or sold (China and parts of Africa). So maybe people should, you know, not do that.

This. Bushmeat is dangerous and a disgrace whether it happens in China or Africa. China needs to be held accountable for this. Saying it's China's fault is no way an attempt to incite hate towards Chinese people. It's simply stating facts. And the media's narrative to try and spin it as intentional spreading of xenophobia is a dishonest as any of the other crap they spew.

This is a good read published today on the horrific traditional Chinese "medicine" ironically being used non-scientifically to try and treat COVID, which originated from such stupid practices to begin with:


And this is also one of my favorite charities. I would encourage people to contribute.
 
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Lamount

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Not a trump supporter here, but this epidemic is due to Chinese negligence in not shutting down wet markets after prior SARS epidemics. Don’t have an issue with anyone attributing blame to them.

And yet, despite having a three month head start and 1/4 the population spread over a larger country, we have surpassed them in cases. We get some blame too. So let’s just stick to its scientific name and leave branding and blaming to those disinclined to know any better.
 
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Lamount

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Today in nejm Fauci says case fatality rate is much less than 1% and akin to bad flu. Trump is going to emerge from this in a stronger position. He very well may turn out to be more correct than leading medical thought leaders and influences like Eric Topol, Etc who would love for it turn out that he was personally responsible for massive loss of American lives.

OK, so let’s assume the mortality rate is 1%. The R0 of seasonal flu is approximately 1.3 whereas they R0 of the COVID-19 virus is about twice that. There’s a decent chance that most Americans will get this at some point, so for arguments sake let’s say 50. Now you’re talking about 1.6 million people dying. I don’t know about you, but I don’t think those who downplay this will come out looking all that bright.
 

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And yet, despite having a three month head start and 1/4 the population spread over a larger country, we have surpassed them in cases. We get some blame too. So let’s just stick to its scientific name and leave branding and blaming to those disinclined to know any better.
Don’t disagree with you, but although we had a head start, Chinese have plenty of “practice” since 2001 with SARS and god knows what else -since they choose not to shut down wet markets.

This is the 3rd SARS epidemic, but the first one to affect us. While out response has been slow, can’t compare ourselves to countries that have been practicing for 15 years. I am sure we will be much better the next time...
 
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OK, so let’s assume the mortality rate is 1%. The R0 of seasonal flu is approximately 1.3 whereas they R0 of the COVID-19 virus is about twice that. There’s a decent chance that most Americans will get this at some point, so for arguments sake let’s say 50. Now you’re talking about 1.6 million people dying. I don’t know about you, but I don’t think those who downplay this will come out looking all that bright.
Fauci in nejm today said mortality rate could approach .1%. It very well may go way down with increased testing and finding that it is already everywhere. Oxford group is saying this. Won’t know full story until widespread antibody testing
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medgator

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Fauci in nejm today said mortality rate could approach .1%. It very well may go way down with increased testing and finding that it is already everywhere. Oxford group is saying this. Won’t know full story until widespread antibody testing
Deployed
Yet you have nyc and la saying they are still in the early innings of this....

 

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Yet you have nyc and la saying they are still in the early innings of this....

My total and relatively uniformed nonexpert opinion is that the r0 is much higher than thought because of asymptomatic spread and many cases will present in a short period of time unlike flattened curve flu.
 

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There are many unknowns in these stats.

1. Testing policy of countries. Some test alot (South Korea, Switzerland), some do not (Turkey). The more you test, the more you are going to find. This certainly has to do with resources available but also with country policy. More positive tests --> more concerned public.
It is impossible to have a good idea on the fatality rates if you do not know how many people are affected.

2. Cause of deaths. Not every country classifies people dying and having being positively tested as COVID-deaths. In Italy they actually tested some of the dead and found out they had 2019-nCoV afterwards. This certainly affects reported death rates.

I do agree that the number of 2019-nCoV-positive patients is a lot higher than we think. Thus the "true" fatality rate is lower than we might think.
However the fatality rate still remains relevent in those who are symptomatic and alot of persons can become symptomatic and overload the health care system. Italy and Spain are both struggling as we speak. Furthermore, deaths seem to rise alot AFTER you have widespread infection but it takes 10+ days to see the numbers rise. The numbers of dead we see right now in NYC might seem high, but given how many people are tested positive and the sharp rise in the US, I fear we are going to see a lot more dead in 10-14 days from now. Thus, drawing conclusions on fatality rates right now is premature. Italy is still experiencing a surge a people dying from COVID, although the number of newly positive-tested persons seems to stabilize or drop a bit.
 
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RadOncDoc21

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I hope that this crisis will give rise to the medical profession again.

I just want to send a special shout out to the first responders, the ER staff and all the critical care and internal medicine folks out there on the front lines. I know I’ve complained a lot about our field but you guys are dealing with all of this head on. I feel it’s only right that I won’t complain about what I get to do for a little while (which is also very important) but definitely not as stressful or dangerous.
 
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dieABRdie

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The reservoir was always there and continues to be there. At some point this would have likely jumped from bats to people by some other circumstances. And if it wasn't coronavirus, it would be something else. For example, ebola came from a different source and a different place entirely.

We have to be prepared for pandemics. People knew this was coming at some point. Epidemics have happened throughout human history, and the ability to jump on an airplane in modern times just makes it easier to spread novel pathogens. The fact that we were caught unprepared and unable to respond to a known threat in our modern world after such a huge economic boom time just shows the weaknesses in our society to be prepared for and manage foreseeable crises.

I am grateful that the fatality rate for this bug is low. If this had been as fatal as ebola or smallpox there would be total chaos--in the USA especially with hundreds of millions of guns and everyone stocking up on assault rifles and ammo. Hooooo boy.

The third week of January we had a mandated "HAZMAT Decontamination" course pop up out of nowhere that no one had ever had to take. Part of the course was learning to don and doff a full PPE suit with respirator. During the course the instructor said "Well you all will most likely never have to use this; BUT... there are things out there that I know about that you do not."

I wonder what he was talking about?
 
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medgator

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The reservoir was always there and continues to be there. At some point this would have likely jumped from bats to people by some other circumstances. And if it wasn't coronavirus, it would be something else. For example, ebola came from a different source and a different place entirely.

We have to be prepared for pandemics. People knew this was coming at some point. Epidemics have happened throughout human history, and the ability to jump on an airplane in modern times just makes it easier to spread novel pathogens. The fact that we were caught unprepared and unable to respond to a known threat in our modern world after such a huge economic boom time just shows the weaknesses in our society to be prepared for and manage foreseeable crises.

I am grateful that the fatality rate for this bug is low. If this had been as fatal as ebola or smallpox there would be total chaos--in the USA especially with hundreds of millions of guns and everyone stocking up on assault rifles and ammo. Hooooo boy.
If only we had a pandemic team, or CDC operatives in China to address these issues... Oh wait
 

seper

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Lots of folks sold stock at that point.

The third week of January we had a mandated "HAZMAT Decontamination" course pop up out of nowhere that no one had ever had to take. Part of the course was learning to don and doff a full PPE suit with respirator. During the course the instructor said "Well you all will most likely never have to use this; BUT... there are things out there that I know about that you do not."

I wonder what he was talking about?
 
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evilbooyaa

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No doubt that China didn’t do their part to help in controlling the outbreak along with their practice. I even saw that hantavirus was recently in the news there. But to suddenly start calling the virus a “Chinese virus” or “kung flu” is the typical deflection we’ve seen time and time again and is truly unnecessary.

Maybe we should look into the origins of all diseases and start renaming them. We could start with smallpox, the bubonic plague, chickenpox, influenza, malaria, measles, scarlet fever, tuberculosis, etc.

Bottom line is that It doesn’t help nor does it add any value to what we already know. The focus should be on saving lives.

Can we call measles - "Anti-vaxxers rash"
 

evilbooyaa

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The reservoir was always there and continues to be there. At some point this would have likely jumped from bats to people by some other circumstances. And if it wasn't coronavirus, it would be something else. For example, ebola came from a different source and a different place entirely.

We have to be prepared for pandemics. People knew this was coming at some point. Epidemics have happened throughout human history, and the ability to jump on an airplane in modern times just makes it easier to spread novel pathogens. The fact that we were caught unprepared and unable to respond to a known threat in our modern world after such a huge economic boom time just shows the weaknesses in our society to be prepared for and manage foreseeable crises.

I am grateful that the fatality rate for this bug is low. If this had been as fatal as ebola or smallpox there would be total chaos--in the USA especially with hundreds of millions of guns and everyone stocking up on assault rifles and ammo. Hooooo boy.

If it had the lethality rate of ebola or smallpox it wouldn't have the infectivity and we'd be in a place more similar to where we were with the Ebola outbreak and the SARS pandemic (and MERS I think too) where mortality rates were in the clear double digit percentages.

This thing is way more infective, in part, because it's less lethal (at least early on).
 
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evilbooyaa

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We still haven’t reached the peak yet and what happens when the hospitals start to overflow? I hope this is the case but I wouldn’t start counting my Chickens (eggs) just yet. Speaking of which, why are people hoarding eggs!

My favorite was seeing a picture of somebody hoarding like 15 gallons of milk.
 

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Not a trump supporter here, but this epidemic is due to Chinese negligence in not shutting down wet markets after prior SARS epidemics. Don’t have an issue with anyone attributing blame to them.
China likely to be lying about COVID. Btw they don’t count asymptomatic positive as a case.

 

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China likely to be lying about COVID. Btw they don’t count asymptomatic positive as a case.

We may count it but unclear whether we are managing them appropriately. Also many parts of the country are still way undertesting

 

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Can we bill 77427 if we perform our weekly on treatment visits via Zoom or facetime? or do they need to be performed in person?
 

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Can we bill 77427 if we perform our weekly on treatment visits via Zoom or facetime? or do they need to be performed in person?
Still has to be done in person at this time. No guarantee CMS will pay for telehealth for OTVs. I've been talking with the patients as they go into/out of the vault to make it quick and limit interactions.
 
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scarbrtj

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Still has to be done in person at this time. No guarantee CMS will pay for telehealth for OTVs. I've been talking with the patients as they go into/out of the vault to make it quick and limit interactions.
They may/may not pay for "telehealth" but ASTRO has asked for CMS to cover general supervision of *all* radiotherapy. This is not telehealth but medical care delivered from afar as long as the MD is reachable by phone. And since ASTRO made no carve-out for OTVs under a request for general supervision... well, debate time I guess. But my point is that general supervision is kind of sort of a form of telehealth which has been paid for long before telehealth was a word. And if you're already expressly covered by general supervision (ie all hospitals in America)? Double debate time.

Quotes from the late Bogardus:
Hall way
Treatment console
Waiting room
Treatment room
Parking garage
Exam room
Which is a valid location for patient/physician encounter?
ALL OF THEM

At each encounter this patient had the opportunity ask
question related to her course of treatment.
At each encounter the patient acknowledges her
interaction with the physician.
At each encounter the physician has the opportunity to
evaluate the patient’s general condition.
At each encounter the physician will use his best
judgment to determine what is needed to evaluate
response to treatment and radiation reactions
There is no written requirement related to length of time
or location of the patient/physician encounter
As long as privacy concerns are met to the
satisfaction of both the physician and
the patient.
 
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Still has to be done in person at this time. No guarantee CMS will pay for telehealth for OTVs. I've been talking with the patients as they go into/out of the vault to make it quick and limit interactions.

This has changed as of today.

 

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This has changed as of today.

Nice for the hospital-based folks who are already under general supervision guidelines. Don't see it moving the needle in freestanding setting unless CMS decides to waive supervision guidelines during covid. ASTRO did send a letter, haven't heard anything yet though
 

RadOncDoc21

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Nice for the hospital-based folks who are already under general supervision guidelines. Don't see it moving the needle in freestanding setting unless CMS decides to waive supervision guidelines during covid. ASTRO did send a letter, haven't heard anything yet though

I’m honestly hesitant about loosening all these restrictions. I know it’s suppose to mean that we can make things more convenient to see and/or treat patients but it’s like we had all these regulations in our field and now all of sudden it became the Wild West.
 
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medgator

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I’m honestly hesitant about loosening all these restrictions. I know it’s suppose to mean that we can make things more convenient to see and/or treat patients but it’s like we had all these regulations in our field and now all of sudden it became the Wild West.
Agree. We are maintaining social distancing and minimal seating in the waiting room for patients, and we aren't on hospital grounds. I feel ok being present, personally, but i can see the need for telehealth in certain hospital based setups where there is a lot more people traffic.

There is an element of job security (and patient safety in certain situations) in having supervision regs but the way Astro has handled that issue has been a laughingstock
 

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Nice for the hospital-based folks who are already under general supervision guidelines. Don't see it moving the needle in freestanding setting unless CMS decides to waive supervision guidelines during covid. ASTRO did send a letter, haven't heard anything yet though
Regardless freestanding or hosp, it does let one do more remotely. In freestanding e.g., can just have the "clinic babysitter" in his office and the other MDs are still working and getting stuff done (from home or wherever). Which they couldn't have really done before.

My crystal ball is on fire.
 
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"Currently, many services paid under the physician fee schedule and provided in the physician office setting require the presence of a physician in the same location as the patient when the service is provided. Recognizing that physical proximity of a physician or practitioner may be presenting additional exposure risks, CMS is revising the definition of direct supervision to allow provision using real-time interactive audio and video technology for the duration of the PHE for the COVID-19 pandemic."

Hit my inbox today, can anyone verify this?

Sounds like this covers radiologist and rad oncs that cover freestanding centers, i would think?
 
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RadsWFA1900

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Still has to be done in person at this time. No guarantee CMS will pay for telehealth for OTVs. I've been talking with the patients as they go into/out of the vault to make it quick and limit interactions.

Haha. They’ll pay for it now and then take it back later.
 

RadsWFA1900

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Lol I saw this too. CMS will front the money and probably take it back down the line or consider it a loan and charge you interest.

If you gotta take it I mean what choice do you have?

When the smoke finally clears they’ll be back to bussiness as usual the zero sum game of cutting and redistributing.
 

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Our dept has been doing our best about isolating everyone, switched workflows, working remotely, all that. One of our trainees tested positive. Despite that, 3 ROs, several patients, and a few other trainees have been exposed and need to work remotely now for another week. Big switch in dept scheduling. It’s getting around.
 
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Our dept has been doing our best about isolating everyone, switched workflows, working remotely, all that. One of our trainees tested positive. Despite that, 3 ROs, several patients, and a few other trainees have been exposed and need to work remotely now for another week. Big switch in dept scheduling. It’s getting around.

where are you guys with testing? isn't it better to test the possible exposures and clear them, so they can come back, and also they don't have to worry about each of their respective exposures at home?
 

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As for our current health care system, our interactions qualify as 'high risk' and are unlikely to change. But because so many people were exposed, occupational health is going to do a detailed followup with each person to detail exposure and then reassess. Even between my post one trainee has been re-cleared for work.

To answer your question about testing, I don't think it changes it. If they are incubating, they may have too low of a viral level even with PCR, and it may be a false negative.
 
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  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.