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deleted59964
For REAL. I have had to stop looking at Facebook. I didn’t know I knew so many conservative conspiracy theorists.
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Conspiracy theories, and derangement are not exclusive to one political persuasion.
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Exactly. Republicans and also right- wingers.
Most people out there aren't that bright, regardless of political persuasion.
That said, this is very reminiscent of the parable of the boy who cried "Wolf!" If not for the concocted bull**** about Russia, Ukraine, "very fine people" hoax, etc., the media would have had more credibility on this very real problem.
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deleted171991
Not sure if correct, but this is a worst case scenario coming from a former Medicare chief:
www.dailymail.co.uk
This is his Twitter account: Andy Slavitt (@ASlavitt) | Twitter
America's hospitals will be overrun in just eight days, officials warn
Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services, issued the dire warning on Twitter on Saturday.
This is his Twitter account: Andy Slavitt (@ASlavitt) | Twitter
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deleted171991
A TIMELINE OF WHAT ITALY DID (and wasn't enough)
D0 - 21 Feb - 20 cases - We notice the outbreak
D2 - 23 Feb - 150 cases - Closed schools, 11 cities in quarantine
D10 - 1 Mar - 1700 cases - First hospitals saturated - 1700 cases
D11 - 2 Mar - 2040 cases – 10% of Lombardy doctors are sick or in isolation
D17 - 8 Mar - 7400 cases - Lombardy + 14 provinces in lockdown, 12M people affected, first reports of patients who cannot get care, jail riots
D19 - 10 Mar - 10150 cases - All Italy in lockdown
D21 - 12 Mar - 15000 cases - Most retail shops closed in all of Italy, enforced isolation, army given police powers.
D0 - 21 Feb - 20 cases - We notice the outbreak
D2 - 23 Feb - 150 cases - Closed schools, 11 cities in quarantine
D10 - 1 Mar - 1700 cases - First hospitals saturated - 1700 cases
D11 - 2 Mar - 2040 cases – 10% of Lombardy doctors are sick or in isolation
D17 - 8 Mar - 7400 cases - Lombardy + 14 provinces in lockdown, 12M people affected, first reports of patients who cannot get care, jail riots
D19 - 10 Mar - 10150 cases - All Italy in lockdown
D21 - 12 Mar - 15000 cases - Most retail shops closed in all of Italy, enforced isolation, army given police powers.
The president has told 16,000 lies or misrepresentations and conservative boomers between 2016 and now have spread more fake news online than any other demographic......but sure, let's blame the media 🙄
"Second and more importantly, there is the conservative propaganda machine. The American right-wing media is without question the most unhinged, hysterical, irresponsible, and conspiracy-addled major press complex in the world. The right-wing media in the U.K. and Australia come close (probably because of shared language and ownership), but nobody beats Fox News in their combination of wide reach and utterly shameless propaganda.
On the one hand, Fox News, The Federalist, Rush Limbaugh, and so on are akin to the state media in a communist dictatorship. The movement is never wrong, Republican politicians are always right, and their political enemies are loathsome traitors who hate freedom, puppies, and apple pie. News that reflects badly on Trump is either made up or the product of a dastardly foreign or left-wing conspiracy. Aging white people across the country have turned their brains to pudding watching Sean Hannity yell insane racist nonsense at them night after night.
But on the other, a dominant faction of Republican politicians, including President Trump, are themselves melt-brained propaganda addicts. This is not how dictatorships usually work. In communist China, the top political leadership sets the party line coming out of the agitprop press, rather than the other way around. Leaders are influenced by party ideology, of course, but they still have wide latitude to change course — like when the initial line that the coronavirus outbreak in Wuhan was in hand turned out to be drastically mistaken, the Chinese Communist Party turned on a dime and started mass quarantines and lockdowns.
Trump, by contrast, has been loyally watching and live-tweeting Fox News while the epidemic spreads like wildfire, and doing almost nothing to stop it. The line coming from that network and the rest of conservative media is largely that the coronavirus is either fake, a foreign bioweapon, or a Democratic Party/mainstream media conspiracy to undermine the GOP. Rush Limbaugh said the virus was just the "common cold" that was being "weaponized as yet another element to bring down Donald Trump." Hannity suggested it might be entirely a fraud. (To be fair, Tucker Carlson and Michael Savage have tried to raise the alarm, but they are outliers.)
In another alarming public address Friday, Trump insisted he and his cronies were doing an "incredible job," despite the ongoing failure to test remotely adequately or pass anything to deal with the developing economic crisis. (He did however boast that America has many large companies.)
The remarkable thing about the denial-and-downplay strategy is that conservative Americans, being disproportionately elderly, are also disproportionately at risk from novel coronavirus. Limbaugh himself is 69 years old and has lung cancer. It could be that, given how utterly incompetent Trump is, furious spinning is the only strategy available."
On the one hand, Fox News, The Federalist, Rush Limbaugh, and so on are akin to the state media in a communist dictatorship. The movement is never wrong, Republican politicians are always right, and their political enemies are loathsome traitors who hate freedom, puppies, and apple pie. News that reflects badly on Trump is either made up or the product of a dastardly foreign or left-wing conspiracy. Aging white people across the country have turned their brains to pudding watching Sean Hannity yell insane racist nonsense at them night after night.
But on the other, a dominant faction of Republican politicians, including President Trump, are themselves melt-brained propaganda addicts. This is not how dictatorships usually work. In communist China, the top political leadership sets the party line coming out of the agitprop press, rather than the other way around. Leaders are influenced by party ideology, of course, but they still have wide latitude to change course — like when the initial line that the coronavirus outbreak in Wuhan was in hand turned out to be drastically mistaken, the Chinese Communist Party turned on a dime and started mass quarantines and lockdowns.
Trump, by contrast, has been loyally watching and live-tweeting Fox News while the epidemic spreads like wildfire, and doing almost nothing to stop it. The line coming from that network and the rest of conservative media is largely that the coronavirus is either fake, a foreign bioweapon, or a Democratic Party/mainstream media conspiracy to undermine the GOP. Rush Limbaugh said the virus was just the "common cold" that was being "weaponized as yet another element to bring down Donald Trump." Hannity suggested it might be entirely a fraud. (To be fair, Tucker Carlson and Michael Savage have tried to raise the alarm, but they are outliers.)
In another alarming public address Friday, Trump insisted he and his cronies were doing an "incredible job," despite the ongoing failure to test remotely adequately or pass anything to deal with the developing economic crisis. (He did however boast that America has many large companies.)
The remarkable thing about the denial-and-downplay strategy is that conservative Americans, being disproportionately elderly, are also disproportionately at risk from novel coronavirus. Limbaugh himself is 69 years old and has lung cancer. It could be that, given how utterly incompetent Trump is, furious spinning is the only strategy available."
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deleted87051
Hey Bernie, why are we making a virus political again?
You and your ilk have been pushing inanities like the Russian collusion hoax, Ukrainian phone call nothingburger, and fake news about Charlottesville for the past three years. Oh, and by the way, the timeline of the impeachment process overlaps very substantially with the development and spead of Sars-CoV-2 in China, and the circus in Congress likely diverted attention from the very serious issue now bearing down on our country. Well, the consequence of that is that mature people can hold the non-contradictory recognitions that the media spins mostly nonsense and that Trump - apart from the issues on which he was elected - is a vulgar buffoon.
The Chinese coronavirus pandemic doesn't vindicate the Left or Trump... it more or less reveals how dysfunctional the system is from top to bottom.
The major political lesson here is to bring manufacturing back to America and divest from China. From the disgusting open-air meat markets filled with carcasses to China's secrecy regarding the virus's severity (so as to preserve its economic image) to their threats to withhold antibiotics from us, it's time to walk away from them.
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LOL, now COVID is Congress's fault because they started impeachment proceedings months ago? What's next, you're gonna blame Congress for Trump and Bolton getting rid of the NSC pandemic office or Trump just having proposed CDC cuts in the budget? Did Congress also force Trump to make the totally *****ic and sociopathic "“I don't need to have the numbers double because of one ship.” statement?
It's amazing the kind of delusional world you and your emperor live in. Trump is still lying or being misleading as we speak and yet you're so aggrieved by the libs pursuing Trump's bonafide corruption that you're totally blind to it.
And as for who holds responsibility for what happens....
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Dude could you knock it off and so the rest of us can get back to the covid stuff? It's possible to dislike Trump and put that to the side while we deal with the pandemic.
I didn't vote for Trump either but good God give it a rest
You consistently miss the point because you refuse to read what other people actually write.
I give Trump very low scores on his handling of COVID-19. But there are plenty of failing grades to go around. Your earlier post mentioned Tucker Carlson... well, I've been in agreement with him since he started coverage of the Chinese coronavirus: this administration was wrong to not have taken it more seriously sooner. Though, the fact that we have a bit of a lag behind a number of other countries is a point in their favor.
To address both this post and the topic of this thread (COVID-19's epidemiology): DeBlasio, the mayor of NYC, continues to refuse to close public schools in one of the country's largest and densest cities.
Trump's team ****ed up in the beginning. Bad. DeBlasio is ****ing up in one of the country's largest and most financially-consequential cities now, when we already know just how bad this could (and likely will) get. Far, far worse.
(And not that this is the point, but NYC happens to be emblematic as a deep-blue city.)
What you wrote was very clear. While totally ignoring anything Trump has done or not done, you first blamed the media implying it was their fault that there are conservative idiots who think the COVID is a hoax. And then you attributed some blame to Congress as well for our lack of progress. Or did a poltergeist write the following?
"Oh, and by the way, the timeline of the impeachment process overlaps very substantially with the development and spead of Sars-CoV-2 in China, and the circus in Congress likely diverted attention from the very serious issue now bearing down on our country. "
Maybe don't write stuff if you don't want people to take it seriously?
Not surprised you're spinning the NYC school closure issue as if it's 100% clear cut, when in fact there are 1m students, 750k of whom are living at or below the poverty line (including 100,000 who are actually homeless) and they all depend on going to school. Not to mention the thousands upon thousands of first responders and healthcare workers who don't have access to reliable childcare during the day if the schools are out. Unlike Trump, DeBlasio is actually taking in all the expert opinions, knows the pros and cons, and is making a tough decision. I don't agree with it and I think they should close, but let's not pretend the situation there is anything analogous to POTUS' buffoonery.
"
Dr. Jennifer Nuzzo, an epidemiologist and professor at Johns Hopkins Bloomberg School of Public Health, said she did not support mass closures in part because districts closing schools seemed to have no clear plan for how to handle the resulting disruption, or even when to reopen their schools.
“I don’t really understand what the endgame here is,” she said, adding that the two-week closures and cleaning days that some schools were adopting seemed arbitrary. “As soon as someone comes in and coughs, it’s not clean anymore.”
Schools would likely have to close for the extent of the epidemic, which could be many months, to be truly effective, she said.
“The public health benefits of closing schools to try to mitigate the impacts of this virus are not clear by any means,” Dr. Nuzzo said. “This is largely an experiment.”
Dr. Theodora Hatziioannou, also a virologist and professor at Rockefeller, supports closures, but agreed that they would have to come with clear guidelines in order to be effective. “This doesn’t mean you roam around, it means you stay home.”
The potential domino effect of mass school closures in New York is staggering.
The mayor said on Thursday that the three things the city was most concerned about preserving were its schools, mass transit and health care, which provide essential lifelines for the city’s most vulnerable, in particular, and are tightly linked.
A public hospital nurse, for example, would likely not be able to stay home from work even if her child was home from school. And home health aides who have children enrolled in public schools provide crucial support for elderly New Yorkers, who are particularly vulnerable to the virus.
“The downsides are very well known: We know kids will miss meals, we know parents will have to stay home, including health care workers,” said Mark Levine, a Manhattan city councilman who chairs the Council’s health committee. Mr. Levine said he had spoken to hospital presidents who have said they are worried about a potential staffing shortage if public schools are shut.
Experts agreed that it would be difficult to shut schools without other severe restrictions on city life, including strong encouragement or even a requirement to keep children at home, rather than simply excusing them from school.
"
To quote candidate Trump: "You are the single biggest liar, you are probably worse than Jeb Bush."
You ignore any degree of nuance in the posts with which you disagree. It's a shame that you do, because your clinical experience gives you an otherwise-useful perspective.
Think of the QI Swiss cheese model. Many balls had to have been dropped for the country to arrive at the level of dysfuntionality we currently observe. Blame can be ladled generously into the bowls of Chinese markets' unsanitary practices, the CCP's malicious hiding of COVID-19's realities, Trump's reluctance to understand the threat this virus presents, the media's abdication of its role in the consistent presentation of reliable information, Congress's stupid partisan games over the past years/decades, the anti-vax movement, etc.
It's hard to understand why you think you can gaslight people over written words that you've made in the span of less than a couple hours. You're pretending now that you've been having some nuanced sociopolitical discussion in regard to the virus when back in the way, way long ago of 3:18 PM ET today you pretty much put on your best Rush Hannity impression with "If not for the concocted bull**** about Russia, Ukraine, "very fine people" hoax, etc., the media would have had more credibility on this very real problem. "
With schools open, there is no way that NYC becomes anything but a festering hotbed of COVID-19. Want to contain or or "flatten the curve"? Follow the Chinese model a little more closely (though I'm not certain that welding building doors shut will happen). This is not even a question. It neuters virtually every other containment strategy.
To branch out a bit, this is the problem with a society determined to operate at full capacity, and in which "schools" become one-stop-shops for "education", daycare, and welfare, and in which both parents so frequently need to work full-time to maintain the nationally-expected lifestyle. It leaves little societal reserve for crises such as this one.
What I wrote is true. Completely true.
Americans have heard about all sorts of "crises" from the media in the past three years. The last one of which ended with a complete flop on the Senate floor. Oh, and while the Chinese coronavirus was furiously spreading, guess what headline The Atlantic cooked up?
The Next Trump Crisis Is Already Here
Ukraine is by no means the only dirty secret being covered up.
As I've written time and again, Trump bears a great deal of responsibility for the rollout of America's response. But parables exist for a reason. The media have cried "Wolf!" too many times. Fortunately, the village finally sees the wolf now that it's here.
What I wrote is true. Completely true.
Americans have heard about all sorts of "crises" from the media in the past three years. The last one of which ended with a complete flop on the Senate floor. Oh, and while the Chinese coronavirus was furiously spreading, guess what headline The Atlantic cooked up?
The Next Trump Crisis Is Already Here
Ukraine is by no means the only dirty secret being covered up.www.theatlantic.com
Yes, I'm sure you believe it's completely true. Back here in reality (and I swear, I really, really don't want to relitigate all this sht again because we both know neither of us is changing our minds so it's totally pointless), there actually was a ton of actual Russia smoke, Trump actually did obstruct justice in the Mueller investigation, he committed an impeachable offense with Ukraine, and obviously he's a racist who is supported by white supremacist organizations and has an actual white supremacist named Stephen Miller working in the west wing.
But to get back to the point you're trying to make, even if the media had some responsibility in conservatives thinking COVID19 is a hoax, you really should lead with the "Trump has lied 16,000 times and GOP boomers spread fake news like wildfire" part.
The thing is, you didn't write it time and again until you wanted make your fervor to blame the media and Congress seem like it had some "nuance"
Coronavirus skeptic Rush Limbaugh thinks COVID-19 means there were 18 other COVIDS
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deleted171991
Can we please keep POLITICS out of the CLINICAL/EPIDEMIOLOGICAL thread, so that it stays USEFUL and INFORMATIVE?
To get back on topic, we currently have 2 confirmed in our MICU:
One is age 60+. Other is 40+. Both had obesity, DM, HTN. Presented with low WBC ct and lymphocytopenia, mildly bumped LFTs. Rapidly progressive hypoxemia. ARDS picture on CXR. Deteriorated quickly and were intubated. Both proned, 100% Fi, high PEEP, paralysis, and requiring vasopressors. One is getting marginally better and is now supine. Other is still requiring proning trials. We currently are not using any experimental therapies.
One is age 60+. Other is 40+. Both had obesity, DM, HTN. Presented with low WBC ct and lymphocytopenia, mildly bumped LFTs. Rapidly progressive hypoxemia. ARDS picture on CXR. Deteriorated quickly and were intubated. Both proned, 100% Fi, high PEEP, paralysis, and requiring vasopressors. One is getting marginally better and is now supine. Other is still requiring proning trials. We currently are not using any experimental therapies.
Do you know how long the intervals were from initial URI sx to resp distress?
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On Nytimes today, it is reported that France has 300 patients in critical condition and half are under 50 years of age. They have 4500 cases so about 6.6% in ICU which is a high rate. I can only speculate how many are hospitalized. I assume we can say France is a first world healthcare, oui? If that is true, it’s concerning that we aren’t imposing stricter quarantine here is the USA. Also, it seems like middle age people are getting hit too in France, I surely don’t want to contract this bad boy.
We still paralyzing after ROSE trial? I’m a fan of inhaled nitric or PGs
It’s going to be very telling when numbers of infected and dying will drop in Italy due to the stricter quarantine rules. I’m thinking that the locked down will come to us sometime next week.
Problem with ROSE is that proning was at the discretion of the treatment team. I also dont know what's the mechanism by which use of cis was associated with increased CV events. I still paralyze for refractory ARDS but it's always after proning trial and usually after inhaled flolan trial (another thing with which it's difficult to demonstrate benefit).
One of them went to urgent care this past Monday feeling flu-ish and by Thurs PM was intubated. Another had shortness of breath starting around the 6th or 7th. Brought in by EMS on the 9th. Intubated on the 10th.
All patients in ROSE were also at baseline much more sedated than PROSEVA. I'll usually bolus rocuronium and if there's a benefit start a cis infusion.
When you prone, how quickly are u seeing improvement in SpO2? Minutes? Hours? Days? How many days of proning trials do you try before declaring it a failure?
you expect an irrational liberal to think rationally? Good luck
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deleted171991
I haven't proned since fellowship, but the majority of our few (last-resort) proning trials worked, some truly spectacularly (i.e. in minutes). I remember that, when it works, one can see it rather sooner than later (i.e. in a matter of hours).
I would stop if the patient does not get better while proned after 2 nights (we used to prone for 16 hours, from 4 pm to 8 am, afternoon rounds to morning rounds). For us, it was usually last resort (this was back when proning hadn't been clearly proven to help), nowadays people may do it sooner. As I said, sometimes the results are very impressive.
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A couple almost immediately (posterior recruitment). Most within a few hours (lung water redistribution). We usually do prone for 12-16h, supine for 12-8h per day.
I never declare proning a failure. The pt declares it a failure because they’re usually dead in 36-72h if it’s not working (our ECMO program is not up yet).
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deleted87051
Care for Critically Ill Patients With COVID-19
This JAMA Insights article reviews care for the most severely ill patients with coronavirus disease 2019 (COVID-19), including standards of management of ARDS, preventing SARS-CoV-2 spread in health care settings, and surge preparation.
jamanetwork.com
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deleted87051
Coronavirus - Public health emergency - ESICM
COVID-19 A coronavirus is one of many viruses that cause diseases in mammals and birds. In humans, coronaviruses cause respiratory tract infections that are typically mild, such as the common cold, though rarer forms such as SARS, MERS and COVID-19 can be lethal. A novel coronavirus (nCoV) is a...
www.esicm.org
Doctor on coronavirus: 'I think we have between 50,000 and half a million cases right now walking around in the United States'
The impact of the coronavirus is continuing to escalate, and Johns Hopkins University Professor of Public Health Dr. Marty Makary says, "I think we have between 50,000 and half a million cases right now walking around in the United States". He joins Yahoo Finance's On the Move panel to discuss.
If true, why hasn’t the zombie apocalypse started?
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Are you guys trying hydroxychloroquine or any antivirals?
No.
Also, forgot to mention earlier...both pts came in with elevated Cr and both developed AKI requiring CRRT. Unclear what their pre-admission kidney function was like but I've read reports that a lot of other pts are requiring CRRT as well.
Crap. Itll be hard to keep these respiratory patients from getting volume overloaded. Can’t win with this thing. But I think it’ll be good for us to max out our resources so our country can finally have a discussion on realistic goals of care
This is going to be a problem too. We've mostly been talking about respiratory failure and ventilator shortages, but I haven't seen any discussion about dialysis.
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deleted87051
Fauci on coronavirus: "We'll be thankful that we're overreacting"
"For a while, life is not going to be how it used to be in the United States."
