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[gonnif]

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[Pluto98]

"I have nothing to offer but blood, toil, tears and sweat"

Those words were spoken, by Winston Churchill in his first speech to the House of Commons (British Parliament) after taking over as prime minister in 1940, just as as the German ‘Blitzkrieg’ (lightening war) was about to take over most of Europe. It was the beginning of World War II. Millions of people, of all ages, thru all professions, could not possibly fathom the utterly profound ways that their lives, and society, would change for many years, indeed how the world would be forever changed.

As a nation, as a planet, we are facing what can only be compared to the beginning of a World War. It’s not some sci-fi fantasy movie, but something much more real and personal. Being in New York today makes me wonder if these is how the residents of London felt as the air raid sirens warned of another wave of German bombers came over during "The Blitz" in the summer of 1940. This Pandemic of the Novel Corona virus / COVID-19 is about to change your world in ways that are nearly inconceivable to most of you and for years to come.

Already hospitals in New York are running out of isolation space and ICU beds. Supplies such as masks, gowns, gloves are running low. We are setting up field hospitals in the Javits Exposition Center, isolation beds in college dorms, and medical ships are moving in. Seattle has called out to the public to start sewing facemasks. Not only are ventilators in short supply, complex and lengthy to build, and complicated to manage and use, but Nebulizers, the first weapon for respiratory distress, will run low with the deluge of patients that will overwhelm our healthcare system. Not only those with COVID-19, but the usual flow of strokes, heart attacks, and all the rest the come into the ERs and hospitals looking for help.

“Civilian” patients are beginning to get sick and die, but so are the front line troops: the doctors, nurses, technicians, first responders, cooks, cleaners, and the rest of the staff that make a hospital run. As premeds and especially those already accepted, you are now part of this team. Not in 4 years when you have graduate but very soon. I will not be at all surprised that many of you who start medical school this summer will be quickly pressed into service, as they will be desperate for any pair of hands that hasn’t fallen ill. Your school orientation may be “Here is a mask, here are some gloves, now follow me.”

Decisions are being made already who lives and who dies. How? Manufacturers need to pick and choose which hospital is going to get some of the precocious ventilators. Even myself, a non-physician, is beginning to make choices. Do I send my precious few hand sanitizers to my older brother with complications from years of diabetes or to my sister with cancer or my elderly adopted aunt still recovering from a fractured pelvis? All these have been in the hospital and nursing homes as recent as a month ago. What do I do if their personal home health aides get sick? Do I fly out to take care of them? Can I even get a flight? Yesterday, the FAA paused operations at several airports as staff tested positive and facilities had to be cleaned. Airlines are cutting up to 70% of flights. Well opening day for baseball is soon. Nope, cancelled. Can I see a basketball game? No both the NBA and college basketball are suspended; March Madness has a new meaning. Restaurants, gyms, movie theaters, clubs, department stores, senior centers, schools, everything is closing.

As for those who have spent the several years preparing to apply with questions about what about the upcoming cycle, how will MCAT work, what will happen? The answer is we do not know. We do not know how any of this coming application cycle will work out. You can only go forward with what you know at this moment but that will change moment to moment. We can only speculate on this global crisis as we fight a virus with no vaccine, no medications, short of supplies, short on understanding, and short on time. We have almost “... nothing to offer but blood, toil, tears and sweat."

How likely is this to actually happen? Entering first year students don't know anything how might they take care of patients during a pandemic?

 

[aSagacious]

I don't know any more than most, but the anticipated bottleneck is infrastructure (e.g., ventilators, pressurized medical-grade O2, and hospital beds) rather than personnel. Yes, a lack of PPE will essentially guarantee that most healthcare providers will get COVID. However, the overwhelming majority of them (95%; source) will be sick for 10-14 days, recover, and get right back into the ring. Yes, I too have heard the anecdotes of young healthy providers dying of COVID but we all know the plura of anecdote is not data. It is definitely possible - even likely - that niche specialists may get recruited to help staff the ED, wards, and ICU. But I don't think that (pre-clinical) medical students add any more value than an allied health professional. As such, I highly doubt that they'll be substantially involved.

 

[ItAintEasyBeingCheesy]

They should waive tuition if this happens. I’d be down if it means they’ll waive tuition.

 

[Mkif586]

To elaborate on that a little bit:
There are 97,776 ICU beds in the US according to AHA (American Hospital Association).
Roughly 10% of those who are infected with COVID-19 will be in need of ICU for up to a few weeks.
Even if we assume that ~30% of those beds will be needed for all other kinds of patients, then we just need 685,000 cases to overwhelm our healthcare system. In 30-50 days we will be in this situation if not earlier. Italy has already made a tough decision to leave those who are 80+ years of age (and those who are otherwise suffer from untreatable diseases) without medical care. This is an unprecedented decision for a non war time in the modern human history.

 

[Mr.Smile12]

"I have nothing to offer but blood, toil, tears and sweat"

Those words were spoken, by Winston Churchill in his first speech to the House of Commons (British Parliament) after taking over as prime minister in 1940, just as as the German ‘Blitzkrieg’ (lightening war) was about to take over most of Europe. It was the beginning of World War II. Millions of people, of all ages, thru all professions, could not possibly fathom the utterly profound ways that their lives, and society, would change for many years, indeed how the world would be forever changed.

As a nation, as a planet, we are facing what can only be compared to the beginning of a World War. It’s not some sci-fi fantasy movie, but something much more real and personal. Being in New York today makes me wonder if these is how the residents of London felt as the air raid sirens warned of another wave of German bombers came over during "The Blitz" in the summer of 1940. This Pandemic of the Novel Corona virus / COVID-19 is about to change your world in ways that are nearly inconceivable to most of you and for years to come.

Already hospitals in New York are running out of isolation space and ICU beds. Supplies such as masks, gowns, gloves are running low. We are setting up field hospitals in the Javits Exposition Center, isolation beds in college dorms, and medical ships are moving in. Seattle has called out to the public to start sewing facemasks. Not only are ventilators in short supply, complex and lengthy to build, and complicated to manage and use, but Nebulizers, the first weapon for respiratory distress, will run low with the deluge of patients that will overwhelm our healthcare system. Not only those with COVID-19, but the usual flow of strokes, heart attacks, and all the rest the come into the ERs and hospitals looking for help.

“Civilian” patients are beginning to get sick and die, but so are the front line troops: the doctors, nurses, technicians, first responders, cooks, cleaners, and the rest of the staff that make a hospital run. As premeds and especially those already accepted, you are now part of this team. Not in 4 years when you have graduate but very soon. I will not be at all surprised that many of you who start medical school this summer will be quickly pressed into service, as they will be desperate for any pair of hands that hasn’t fallen ill. Your school orientation may be “Here is a mask, here are some gloves, now follow me.”

Decisions are being made already who lives and who dies. How? Manufacturers need to pick and choose which hospital is going to get some of the precocious ventilators. Even myself, a non-physician, is beginning to make choices. Do I send my precious few hand sanitizers to my older brother with complications from years of diabetes or to my sister with cancer or my elderly adopted aunt still recovering from a fractured pelvis? All these have been in the hospital and nursing homes as recent as a month ago. What do I do if their personal home health aides get sick? Do I fly out to take care of them? Can I even get a flight? Yesterday, the FAA paused operations at several airports as staff tested positive and facilities had to be cleaned. Airlines are cutting up to 70% of flights. Well opening day for baseball is soon. Nope, cancelled. Can I see a basketball game? No both the NBA and college basketball are suspended; March Madness has a new meaning. Restaurants, gyms, movie theaters, clubs, department stores, senior centers, schools, everything is closing.

As for those who have spent the several years preparing to apply with questions about what about the upcoming cycle, how will MCAT work, what will happen? The answer is we do not know. We do not know how any of this coming application cycle will work out. You can only go forward with what you know at this moment but that will change moment to moment. We can only speculate on this global crisis as we fight a virus with no vaccine, no medications, short of supplies, short on understanding, and short on time. We have almost “... nothing to offer but blood, toil, tears and sweat."

Someone show me how to make a sticky of this post. Or stick this post up. Make sure you date it in the header if you do.

A news outlet pointed out reading "The Plague" by Albert Camus, for those who have to stay at home. I'm more into plays so I suggest "Rhinoceros" by Eugene Ionescu and "An Enemy of the People" by Henrik Ibsen. I'm sure there are other things to read or view.

My hopeful thoughts, prayers, and hopes are with you gonnif, your family, and your peers.

 

[Mr.Smile12]

My comments: I'm not in any position to predict what's going to happen with entering students, but I suspect all health professions students (nursing, PA, dental, podiatry, allied health), residents, and retirees with any health professions experience will be enlisted if it hasn't already happened. Blood supplies are crucial, and anecdotally I have heard that the low supplies are being or will be replenished by exhausted health care providers because blood banks are empty, as I think it is happening in Italy and Spain?. Rationing and reuse of usually disposable PPE and tubing is going to really stress the sanitation, laundry, and sterilization facilities, so they need all the help possible.

 

[Ganon]

I’m a previous healthcare professional and MS-2, and I received an e-mail today outlining duties that uses the phrase “deputized.”

Essentially, I will practice at my legal level, but will be encouraged to help as much as possible in the ICUs. They want deputy staff to be hands-on, freeing up other staff for the paperwork/documentation/critical things that I might not know how to do (I’m unaware of policy changes from the past two years, for example).

Nothing is official yet, but I see this coming and am happy to help.

 

[deleted966164]

Regarding Nebulizers - there is a trend to change the approach to airway management to prevent aerosolizing patient droplets. Alternative ways to administer albuterol are being used.

 

[ChymeofPassion]

I wonder if this enlistment occurs, will it be mandatory? I figure PPE will go to medical students last...

 

[allantois]

I seriously doubt any students will be recruited to help

 

[deleted688779]

According to CNN last night, student volunteers were included in the list of 30,000 New York volunteers, despite headlines saying “retired doctors”

 

[Princeton Medical Student]

Just watching and working this from the EMS perspective has been quite enlightening. Absolutely insane how no one was anywhere near prepared for this kind of event, and we're just making things work as it goes along. A part of me thinks that this event will make a good trial run for worse pandemics yet to come.

 

[deleted966164]

Just watching and working this from the EMS perspective has been quite enlightening. Absolutely insane how no one was anywhere near prepared for this kind of event, and we're just making things work as it goes along. A part of me thinks that this event will make a good trial run for worse pandemics yet to come.

Compressions in PAPR became a reality...

 

[proudofmykids]

To Gonnif and everyone- some wise words to remember as the stress of the epidemic grows and likely to become more and more personal as well.

Calm, Thoughtful, Focused, Ohmmm

 

[swoopy]

To "blood, toil, tears, and sweat," we can add hoarding: Doctors Are Hoarding Unproven Coronavirus Medicine by Writing Prescriptions for Themselves and Their Families — ProPublica

Marvelous.

 

[imbesrs]

I abbreviate CTFO!

Wow. Ive been active on SDN for ~1yr and finally have gotten the double entendre. Big brain as hell, lmao.

Anyways great post. As someone who lives in NY, its pretty scary to know there is 23k cases in my state and its literally all around me. I am not too concerned about myself but I do worry for my parents and especially my mother. I have 4 best friends who are nurses across NYC and Long Island, and 1 EMT friend, and 1 MD friend at Stonybrook and they are obviously all being called into action one way or another. Every day one of their close colleagues checks out of work with COVID symptoms and each day they check in until their own symptoms appear. They all are comfortable with the fact that they are likely to get it, either through occupation (and lack of PPE) or just living in the highest density population/COVID area and its what they all, and WE ALL, have signed up for as current and future healthcare professionals.

Wishing everyone and their families good health

 

[deleted994889]

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

I came across this interesting article. What does everyone make of it?

Edit: Some more articles. I'm not trying to downplay the matter. I'm genuinely curious what people think.

Opinion | Is Our Fight Against Coronavirus Worse Than the Disease? (Published 2020)

There may be more targeted ways to beat the pandemic.

www.nytimes.com

Coronavirus may have already infected half of UK, study says

The rapidly spreading coronavirus may have already infected half the UK population — but that is encouraging news, according to a new study by the University of Oxford. The modeling by resear…

nypost.com

 

[Goro]

A Medical Class ‘Minted by the Pandemic’ (Published 2020)

Across the nation, medical students are graduating directly into the path of an epic health crisis.

www.nytimes.com

A Medical Class ‘Minted by the Pandemic’

Across the nation, medical students are graduating directly into the path of an epic health crisis.

Indeed. Med student are on what I call the hinge of history

 

[PeleHonuaMea]

I seriously doubt any students will be recruited to help

Mmm... perhaps they'll want to recruit medical students with experience to practice according to their current/active license (RNs/LPNs/RTs) and those without for caregiving duties (feeding, turning, ADLs) or cleaning of units and supplies.

 

[rdyotz]

NYU allowing some students to graduate 3 months early to help with COVID at NYU Langone IM and EM. NYU offers early graduation to senior med students in bid to fight coronavirus

The way things are going, more schools might follow suit.

 

[Goro]

To help doctors, N.Y.U. turns to senior medical students
Faced with a shortage of doctors, New York University’s medical school announced that it will allow students to graduate early if they agree to join the fight against the corona virus epidemic.

“We ask for your help,” the school said in an email to students this week. Only those set to graduate this year and who have met most of their requirements are allowed to take the offer.
The students would have to begin working as interns in the university’s internal and emergency medicine departments in April, about three months earlier than they would normally begin working. A spokeswoman for the university confirmed that students would be allowed to graduate early pending approval from the New York State Department of Education.
At hospitals in New York and the region, a sense of desperation is setting in as waves of sick patients begin to overwhelm the healthcare system.
Some health care workers have begun to get sick or have been asked to quarantine, and hospitals are looking to augment their work force in any way they can. Mr. Cuomo has already asked retired doctors and nurses to volunteer to help fill staffing shortages.
Medical students at other institutions in New York expect to be called up as well.
David Edelman, a medical student at Columbia, said that classes and rotations were canceled in early March, but students soon expected to be called in to help with routine matters as more experienced doctors become inundated.
“We need some kind of stable of support for when things are going to get worse,” he said.

1918 all over again.

 

[Mr.Smile12]

The tsunami of physician-perspective books should also hit about 6-12 months later. Instagram/Livestream videos will be up much sooner.

 

[BCB153]

Einstein is now asking 4th year medical students to “return to work” and volunteer at the level of an intern


Sent from my iPhone using SDN mobile

 

[LizzyM]

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

I came across this interesting article. What does everyone make of it?

Edit: Some more articles. I'm not trying to downplay the matter. I'm genuinely curious what people think.

Opinion | Is Our Fight Against Coronavirus Worse Than the Disease? (Published 2020)

There may be more targeted ways to beat the pandemic.

www.nytimes.com

Coronavirus may have already infected half of UK, study says

The rapidly spreading coronavirus may have already infected half the UK population — but that is encouraging news, according to a new study by the University of Oxford. The modeling by resear…

nypost.com

Katz, the author of the pandemic social distancing opinion piece is a physician affiliated with Yale and an expert in nutrition and health promotion/disease prevention. In fact, he has a book on the subject coming out soon. His opinion that we can reduce social distancing for some segments of the populaiton was derided in a letter published by the NY Times on 3/23 signed by Sten H. Vermund, dean of the Yale School of Public Health, two epidemiologists, and Saad Omer, the director of the Yale Institute fo Global Health. I predict uncomfortable moments in the faculty lounge.

And here's the view from the Payne Whitney gym:

Yale converts gym space for COVID-19

Yale has repurposed a complex in its Payne-Whitney Gym into a subacute-care facility for university community members who have contracted covid-19 but don’t need to go to the hospital.

ctmirror.org

 

[Mkif586]

I predict uncomfortable moments in the faculty lounge.

Something like this?

 

[Matthew9Thirtyfive]

Many of my classmates, including myself, have fairly significant healthcare experience prior to medical school. We went to our admin to volunteer and were told the best thing we can do is to do well in school. We’re MS1s, but a lot of us have taken care of patients independently or pretty independently and could easily do lower level things.

So definitely not happening everywhere even when it’s offered.

 

[Ganon]

Many of my classmates, including myself, have fairly significant healthcare experience prior to medical school. We went to our admin to volunteer and were told the best thing we can do is to do well in school. We’re MS1s, but a lot of us have taken care of patients independently or pretty independently and could easily do lower level things.

So definitely not happening everywhere even when it’s offered.

I couldn’t stand that but am dreading clearing my choice to help out with my dean in case that is his opinion.

If what we all wrote in our Personal Statements has ANY VALUE, we should all be chomping at the bit to help, and those of us who have the skills necessary should be allowed to.

Im nearing step 1 dedicated study for a step1 that will likely be pushed back anyway, so my time can be safely split between studying and working relief shifts in the ICU. (That’s my plan, anyway)

....plus, I’m so tired of hearing physicians complain about how back in their day there were no work hours restrictions. Imagine getting to tell them I worked front lines for a pandemic during step study time and still passed.

 

[Matthew9Thirtyfive]

I couldn’t stand that but am dreading clearing my choice to help out with my dean in case that is his opinion.

If what we all wrote in our Personal Statements has ANY VALUE, we should all be chomping at the bit to help, and those of us who have the skills necessary should be allowed to.

Im nearing step 1 dedicated study for a step1 that will likely be pushed back anyway, so my time can be safely split between studying and working relief shifts in the ICU. (That’s my plan, anyway)

....plus, I’m so tired of hearing physicians complain about how back in their day there were no work hours restrictions. Imagine getting to tell them I worked front lines for a pandemic during step study time and still passed.

Yeah I volunteered to go up on the Mercy, but no dice. I’m sure they’re just concerned with resource allocation and safety. They are letting the 3rd and 4th years volunteer. Edit: they apparently are graduating fourth years early to help out.

 

[Angus Avagadro]

Imagination (noun): the act or power of forming a mental image of something not present to the senses or never before wholly perceived in reality.
Failure (noun): the fact of someone or something not succeeding.

Whether Iraq, Afghanistan, Syria, or many other war-torn areas, we have seen how overwhelmed the hospitals become. Every space, from the beds to the hallways to the waiting rooms are filled with the injured. Doctors and nurses, many who themselves become victims in a war, frantically running from patient to patient, trying to make meager supplies last.

Three months ago, while most of us were celebrating New Years, we couldn’t imagine this virus would be part of our daily lives. Two months ago, while many of us were still wondering what do for Valentine’s Day, couldn’t imagine that college and schools would be shut down or go fully online for what will be an indefinite period. One month ago we may already started thinking about summer vacation or the upcoming application cycle, we couldn’t imagine, that the novel Corona virus would be the constant news from everywhere

In this World War of COVID-19, Seattle was the first battle. New York is now becoming the front line. The hospitals are beginning to fill to capacity; doctors, nurses and others are becoming sick; supplies such a ventilators, masks, PPE, are running short; and the wounded, those sick with COVID-19, are dying. A CNA died, having been forced to wear a plastic bag as a gown while treating a patient. A high school principal who worked with those who dropped out, and who treated these kids like her own, died today. The first city cop, one of New York’s Finest, has died. Many police, fire fighters, EMS, and other first responders are sick. So to are the “supply people,” in what other wars would have been called “rear echelon,” the food store workers, and especially the online warehouse staff and delivery people. In this war they are more exposed to the “enemy” than those of us sheltering in place. The daily body count in New York is now in the hundreds. Refrigerator trucks and ice rinks are being prepared as morgues. The churches have stopped funerals. Visitors are banned from hospitals. The patients will die alone.

Make no mistake about this, we are at war. A war that will take months to turn the tide of battle and many more months to finally declare some sort of “victory” thru control via vaccine and other methods. A war that will require us to deal with this first shock wave of social distancing that will lead to less restrictive but still required conditions for us to follow. A war that is now planning hundreds of military-style fields hospitals with thousands of beds. A war that will go across the country in waves with new battles sites erupting. A war that now had premeds and medical students on the front lines.

I suspect soon they will be a general call for volunteers. Not simply retired doctors and nurses, not simply medical students or premeds, but everyone will be needed as the many people who keep the hospitals running fall ill and as the soon-to-be hundreds of thousands of new beds in field hospitals open up. People will be need to feed patients, change beds, mop floors, take blood pressure, and every other seemingly mundane tasks that make these places run. This isn’t some “check-the-box” volunteering that many students do to fulfill requirements. This is the real deal.

With our multitude overlapping of towns, cities, counties, states and federal government, we have had a disjointed, unorganized, confusing response to this crisis. It is a failure of imagination that this seemingly sci-fi plot, this disease pandemic, this new world war, has put us all here. Do not let a personal failure of imagination keep you from understanding just where we all are.

We have been hearing about an impending pandemic since SARS, 17 yrs ago, and with each new one. Ebola, H1N1, MERS, Bird and Swine flu. Now we have a real one and no one in the world was adequately prepared. I'm not sure where my disappoint lies, with government cutting costs and health corps downsizing capacity, or the medical scientists providing 100yr old solutions from the Spanish flu of 1918. I mean the best our scientists can come up with is EVERYONE HIDE! I understand it is buying time until our capacity is built up, but who is going to staff all of this? Truly, American ingenuity and imagination will be the necessary tools in getting through this. We got this. This is where americans shine!

 

[deleted393595]

"I have nothing to offer but blood, toil, tears and sweat"

Those words were spoken, by Winston Churchill in his first speech to the House of Commons (British Parliament) after taking over as prime minister in 1940, just as as the German ‘Blitzkrieg’ (lightening war) was about to take over most of Europe. It was the beginning of World War II. Millions of people, of all ages, thru all professions, could not possibly fathom the utterly profound ways that their lives, and society, would change for many years, indeed how the world would be forever changed.

As a military history hobbyist and a professional jerk, it greatly grinds my gears whenever people use the term "blitzkrieg". It's a completely fabricated term that the Germans never used to describe their tactics. The correct term is "Bewegungskrieg", which means maneuver warfare and predates to the Stormtroopers of WW1. If interested, check out Gen. Guderian's seminal "Achtung - Panzer!"

(Amazon product)

“I fear all we have done is to awaken a sleeping giant and fill him with a terrible resolve.”
Isoroku Yamamoto (the Japanese Admiral who planned the attack on Pearl Harbor)

Also Yamamoto never ever uttered that phrase. It's mistakenly attributed to him from the movie "Tora Tora Tora"

He did though warn the Japanese government (based on his own experiences as an atache in the US) that Japan would not be able to win a protracted war against the US. He served anyways out of duty and honor till the bitter end.

 

[DrivingDoctor]

Someone show me how to make a sticky of this post. Or stick this post up. Make sure you date it in the header if you do.

A news outlet pointed out reading "The Plague" by Albert Camus, for those who have to stay at home. I'm more into plays so I suggest "Rhinoceros" by Eugene Ionescu and "An Enemy of the People" by Henrik Ibsen. I'm sure there are other things to read or view.

My hopeful thoughts, prayers, and hopes are with you gonnif, your family, and your peers.

Hey I read that book for a book report in 10th grade! Totally forgot until seeing your post right now!

 

[proudofmykids]

A general call for volunteers has been issued in NYC
New York City sent out a push alert to all phones asking licensed healthcare workers to volunteer in overburdened facilities

With Virus Surge, Dermatologists and Orthopedists Are Drafted for the E.R.

NYC sends emergency alert to phones

Volunteer is a vague word....
There were national calls and advertisements from New York to pay PAs and NPs $13,000/week, please luxury hotel, food stipend and travel reimbursement.
Physicians - no compensation offered in similar calls / advertisements.
Hospitals / healthcare systems, and insurance companies are all getting government guaranteed and accelerated funding, and continue to **** on physicians.

In other metro areas, new government sponsored pop up ‘hospitals’ are stealing local hospital nursing staff offering upward of 2x standard pay. 15:1 nurse to patient ratio planned instead of standard 3 or 4:1, and 15:1 physician ratio. Some hospitals offering physicians 20+ year old moonlighting rates, others 1.25x ER Physician standard rate.

Administration is talking out both sides of their mouths, trying to refer to physicians as hero’s but treating them like door mats.

Many of hope for the next generation to right the ship.