How long should the lock down last?

[turkeyjerky]

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I'm impressed people on this board have enough N-95s. You really don't have to reprocess and reuse them?

Yeah, I'm surprised too. My larger hospital is reprocessing them and the small one is having people reuse them indefinitely. At the latter, most of the docs bring their own backup supply.

 

[Birdstrike]

I'm impressed people on this board have enough N-95s. You really don't have to reprocess and reuse them?

I had an N-95 a month ago that melted when I autoclaved it. Our office just got some new N-95s after waiting for 2 months. And no, we don't get a new one each day. It's, "Here's your N-95 and a pat on the back. Make it last, buddy." We have a crap ton of face shields and disposable gowns, though. I've just been using a surgical mask and letting the PCPs who are seeing and swabbing the COVID patients have the best PPE.

 

[miacomet]

If people are reusing N-95s, which are a single-use item (they do have a reusable version in Germany, but they are not available here), then there is an ongoing shortage of PPE at their workplace.

These are approved for single use. Not reprocessing. Not all day or all week use. Single use.

@turkeyjerky where are the docs getting their personal supply of N-95s?

 

[deleted1005514]

If N95s are equivalent to KN95s, they’re selling them at hardware stores in my area.

 

[Rekt]

If people are reusing N-95s, which are a single-use item (they do have a reusable version in Germany, but they are not available here), then there is an ongoing shortage of PPE at their workplace.

These are approved for single use. Not reprocessing. Not all day or all week use. Single use.

@turkeyjerky where are the docs getting their personal supply of N-95s?

That's only because this hasn't happened before. We don't have a shortage, but I still use a single N95 per shift or respirator. There's no evidence to say you'll get COVID for using an N95 for 8-12 hours. If I tube or line in a N95 then I change it. Although I've mostly switched to my respirator.

 

[miacomet]

That's only because this hasn't happened before. We don't have a shortage, but I still use a single N95 per shift or respirator. There's no evidence to say you'll get COVID for using an N95 for 8-12 hours. If I tube or line in a N95 then I change it. Although I've mostly switched to my respirator.

There is no evidence that N-95s are safe or efficacious for greater than 8 hours continuous use. I don't need proof or evidence that I will get COVID from off-label N-95 use, but I would strongly prefer evidence that I won't.

Agreed on respirators. Can you recommend one without an exhalation valve? How do you clean it?

 

[miacomet]

If N95s are equivalent to KN95s, they’re selling them at hardware stores in my area.

There are lots of fake KN-95s in the USA. The FDA even has a site addressing this. KN-95s are not approved for use in the US, and with good reason. Thanks though.

FDA removes Emergency Use Authorization for some KN95 masks

The U.S. Food and Drug Administration has removed its Emergency Use Authorization for several KN95 masks, which are made in China, after they failed to meet a minimum particulate filtration efficiency of 95% in National Institute for Occupational Safety and Health testing.

www.ada.org

 

[Birdstrike]

It's remarkably similar to chickenpox prior to the vaccine. Adult death rates were 25x the child death rates. Worse with comorbidities. (yes, the overall rate was still much lower). This is why people are likely going to have COVID parties. Honestly, I think I'm already seeing a lot of it.

Dr.McNinja called it!

Teens "are throwing Covid-19 parties...where ... the first person to get infected receives a payout, local officials said." -CNN

'Merca!

 

[GeneralVeers]

Dr.McNinja called it!

Teens "are throwing Covid-19 parties...where ... the first person to get infected receives a payout, local officials said." -CNN

'Merca!

Unsurprisingly I don't have an issue with this, since they are likely to get it at some point anyway. Flame away!

 

[Nobutyesbutno]

Hitting that sweet spot is the challenge.

You can't save every life and you can't save every business either..

 

[miacomet]

Most adults had varicella as a child, so the baseline immunity is different, so less of an issue with overwhelming the healthcare system, it would seem.

 

[Birdstrike]

You can't save every life and you can't save every business either..

True, and true.

 

[xaelia]

Unsurprisingly I don't have an issue with this, since they are likely to get it at some point anyway. Flame away!

Unfortunately, all those people will then go and interact with the higher-risk population. What we’re looking for, if you want to build up a buffer of herd immunity in young to reduce the R value, are like 14-day COVID party cruises.

 

[xaelia]

 

[SeekerOfTheTree]

I have more than enough N95s here. I personally like my PAPR. I have never felt at my place that I couldn't have access to PPE. We have been spoiled here.

CDC has pretty good guidelines on reusingN95s

Healthcare Workers

COVID-19 guidance, tools, and resources for healthcare workers.

www.cdc.gov

In Indiana and Michigan we are doing pretty good. I see maybe 1 every other shift that I think has Covid.

 

[DoctwoB]

Unfortunately, all those people will then go and interact with the higher-risk population. What we’re looking for, if you want to build up a buffer of herd immunity in young to reduce the R value, are like 14-day COVID party cruises.

Covid make out parties neglects the idea of viral load being associated with outcomes. It’s definitely not proven but would make sense why outcomes have appeared worse in healthcare or high contact settings It could very well be the reason the ongoing second wave appears to not have as high mortality thus far (note thus far is the key point) is that due to distancing measures and masking people are still getting infected but with lower doses.

 

[Rekt]

Unfortunately, all those people will then go and interact with the higher-risk population. What we’re looking for, if you want to build up a buffer of herd immunity in young to reduce the R value, are like 14-day COVID party cruises.

Why are we responsible for young people interacting with high risk patients? It's not like they don't know. As much as I'd like to visit my grandparents, even asymptomatically, its a bad idea. They should know better and the high risk population should be quarantining and/or refusing these interactions.

 

[GeneralVeers]

Interesting article on increasing cases in TX. Basically it's an increase in testing of young, barely symptomatic symptoms, plus testing ALL admitted patients regardless if they are there for COVID or not. They also mention several times that they are being pushed to include COVID as a diagnosis in order to improve reimbursement. So if Grandma is there for a hip replacement, they test her for COVID and if positive it's listed as a "COVID hospitalization".

Why We Should Not Be Concerned About Increasing Covid-19 Cases in Texas | The Daily Economy

"That increased testing means we are discovering more young and healthy people with COVID-19 should not be surprising or alarming in the slightest. The ...

www.aier.org

 

[miacomet]

Interesting article on increasing cases in TX. Basically it's an increase in testing of young, barely symptomatic symptoms, plus testing ALL admitted patients regardless if they are there for COVID or not. They also mention several times that they are being pushed to include COVID as a diagnosis in order to improve reimbursement. So if Grandma is there for a hip replacement, they test her for COVID and if positive it's listed as a "COVID hospitalization".

Why We Should Not Be Concerned About Increasing Covid-19 Cases in Texas | The Daily Economy

"That increased testing means we are discovering more young and healthy people with COVID-19 should not be surprising or alarming in the slightest. The ...

www.aier.org

Interesting. So the hospitals aren't seeing any increase in admission in symptomatic Covid cases? Why the ICU strain and overflow beds? Also, why would I get my medical info from an econ journal? Especially when it's all anecdata? It does not appear peer-reviewed or to have any scientists or epidemiologists involved.

 

[NurWollen]

Interesting article on increasing cases in TX. Basically it's an increase in testing of young, barely symptomatic symptoms, plus testing ALL admitted patients regardless if they are there for COVID or not. They also mention several times that they are being pushed to include COVID as a diagnosis in order to improve reimbursement. So if Grandma is there for a hip replacement, they test her for COVID and if positive it's listed as a "COVID hospitalization".

Why We Should Not Be Concerned About Increasing Covid-19 Cases in Texas | The Daily Economy

"That increased testing means we are discovering more young and healthy people with COVID-19 should not be surprising or alarming in the slightest. The ...

www.aier.org

But if grandma is asymptomatic from Covid, don't they send her home and reschedule the hip? How does that count as a hospitalization?

 

[Birdstrike]

But if grandma is asymptomatic from Covid, don't they send her home and reschedule the hip? How does that count as a hospitalization?

It depends how quick the test result comes back.

 

[GeneralVeers]

But if grandma is asymptomatic from Covid, don't they send her home and reschedule the hip? How does that count as a hospitalization?

Possibly. The article didn't spell out all the theoretical possibilities.

Isn't it interesting that if the government subsidizes hospitals to find more COVID they will?

 

[Apollyon]

Possibly. The article didn't spell out all the theoretical possibilities.

Isn't it interesting that if the government subsidizes hospitals to find more COVID they will?

History repeats itself. What was it, in the middle of the 1800s, in India, the British put a bounty on cobras, so, people started to breed them, and, finally, the British said they had enough, and stopped the bounty, so, all these snake farmers just released all of the snakes?

 

[Birdstrike]

History repeats itself. What was it, in the middle of the 1800s, in India, the British put a bounty on cobras, so, people started to breed them, and, finally, the British said they had enough, and stopped the bounty, so, all these snake farmers just released all of the snakes?

Legit cobra post.

 

[xaelia]

Interesting article on increasing cases in TX. Basically it's an increase in testing of young, barely symptomatic symptoms, plus testing ALL admitted patients regardless if they are there for COVID or not. They also mention several times that they are being pushed to include COVID as a diagnosis in order to improve reimbursement. So if Grandma is there for a hip replacement, they test her for COVID and if positive it's listed as a "COVID hospitalization".

Why We Should Not Be Concerned About Increasing Covid-19 Cases in Texas | The Daily Economy

"That increased testing means we are discovering more young and healthy people with COVID-19 should not be surprising or alarming in the slightest. The ...

www.aier.org

Looks like an opinion piece written for a pro-business platform based on anecdotal accusations absent any proof of existence.

Sounds like it could realistically be a fraction of a percent of hospitalizations. The in-hospital mortality of COVID+ at the TMC is upwards of 8% so far. 7,500 are hospitalized across TX right now and over 3000 in AZ, and the new daily hospitalization trendlines keep going up.

I’ll agree a “lockdown” isn’t economically or culturally acceptable, but serious changes need to be made. It seems to me so far those who have minimized this virus have been on the wrong side of recent history, and I would bet one year from now those who continue to do so will be proven similarly off-base.

 

[miacomet]

Looks like an opinion piece written for a pro-business platform based on anecdotal accusations absent any proof of existence.

Sounds like it could realistically be a fraction of a percent of hospitalizations. The in-hospital mortality of COVID+ at the TMC is upwards of 8% so far. 7,500 are hospitalized across TX right now and over 3000 in AZ, and the new daily hospitalization trendlines keep going up.

I’ll agree a “lockdown” isn’t economically or culturally acceptable, but serious changes need to be made. It seems to me so far those who have minimized this virus have been on the wrong side of recent history, and I would bet one year from now those who continue to do so will be proven similarly off-base.

I agree. If we are getting our medical information from non peer reviewed opinion pieces in economics journals, we deserve to be replaced by midlevels.

 

[GeneralVeers]

My issue is that we don't have real numbers.

What percentage of "Covid Hospitalizations" presented for a non-COVID reason?

How often is COVID being listed on patients who have no symptoms?

What percentage of ICU utilization is due to non-COVID patients?

 

[RustedFox]

My issue is that we don't have real numbers.

What percentage of "Covid Hospitalizations" presented for a non-COVID reason?

How often is COVID being listed on patients who have no symptoms?

What percentage of ICU utilization is due to non-COVID patients?

You know why we don't have 'real numbers'?

Because the clipboard-carrying nurses are in charge of reporting those numbers;

AND

1.) They get their orders from the top. That is; "every COVID case is more $$$ for the hospital, so use the word "COVID" as much as you can."
2.) They're generally piss-poor nurses at best, which is why they're out of direct patient care, and now they just want the easiest route thru their *management* job so they can post about how they're "saving lives" on Fartbook. Thus, every time they write the word "COVID", they get a pat on the head from C-suite.

Never once did the thought occur to a clipboard-carrying nurse: "Hmm.... maybe this isn't COVID-related. Maybe this patient has a broken femur, and has tested positive for COVID, but those two facts are not related. After all, the sky is blue, and the grass is high, but those two facts are not related."

ClipboardRN thought: "COVID is GOOD because PANIC is MONEY and DISEASE is BAD and instead of wanting to see the manager now I AM THE MANAGER."

Thanks, Karen.

You. You've ruined it for everyone.

 

[SeekerOfTheTree]

Just provide me a mask at every store and I will wear it. I am lazy.

 

[AMEHigh]

If your hospital is running out of PPE now, that's a failure of your administration. There's enough to go around. I'm betting that most of the procedures you're thinking are pointless are at ASCs anyway.

You should probably share with the rest of us the secret hook up you have for PPE! I think supplies are not ideal at many places, including where I work. What information are you basing your fact that there’s plenty to go around?

 

[miacomet]

Apparently there are PPE and staffing issues in Houston: As Coronavirus Slams Houston Hospitals, It’s Like New York ‘All Over Again’

That having been said, Houston has a much better hospital system and much higher quality care than New York, so presumably things will go better.

 

[wamcp]

Newsom vows crackdown on coronavirus scofflaws. Will law enforcement cooperate?

Gov. Gavin Newsom again Wednesday threatened more enforcement for businesses that fail to follow coronavirus guidance, but how it would work remains unclear

www.latimes.com

Arrest the citizen contributing to the economy, providing desired goods and services.

but look the other way at the thousands of mass gathering protesters (looters).

Sounds about right

 

[GeneralVeers]

Newsom vows crackdown on coronavirus scofflaws. Will law enforcement cooperate?

Gov. Gavin Newsom again Wednesday threatened more enforcement for businesses that fail to follow coronavirus guidance, but how it would work remains unclear

www.latimes.com

Arrest the citizen contributing to the economy, providing desired goods and services.

but look the other way at the thousands of mass gathering protesters (looters).

Sounds about right

Welcome to our Woke, stupid country

 

[miacomet]

It seems like outdoor activities, regardless of political affiliation, are fairly safe as long as people distance/mask.

 

[wamcp]

It seems like outdoor activities, regardless of political affiliation, are fairly safe as long as people distance/mask.

Indoor activities are safe as well if masks are worn. Why else is the covid antibody positivity rate of nurses sitting at less than 3% - and that is with ONLY simple face mask use, going in and out of actively sick, coughing patient covid rooms- not with N95 (worn only if intubated or on bipap)?

 

[NITRAS]

But if grandma is asymptomatic from Covid, don't they send her home and reschedule the hip? How does that count as a hospitalization?

Bad example. Hips aren’t exactly an elective procedure. Morbidity and mortality increases if not done within days.

But all truly elective procedures are deferred. All procedures have PCR done.

Probably a third of the patient’s are “also covid” or intractable n/v. I have seen at least a few people go from “also COVID” to shoot real COVID.

Got to admit a married elderly couple yesterday. . . . This is getting not fun.

 

[bravotwozero]

Indoor activities are safe as well if masks are worn. Why else is the covid antibody positivity rate of nurses sitting at less than 3% - and that is with ONLY simple face mask use, going in and out of actively sick, coughing patient covid rooms- not with N95 (worn only if intubated or on bipap)?

How do you know it is with only surgical masks? At my ED, we have a designated covid area and the RNs usually have a n95 on. While the CDC and official hospital guideline is droplet precautions, most of our staff are being more cautious and using respirators for anyone with suspected covid. I suspect this is the case at many other hospitals.

 

[Birdstrike]

Two New Studies Suggest COVID-19 Herd Immunity May Be Much Closer Than Antibody Tests Suggest

Swedish study: Twice as many people have T-cell immunity to COVID-19, than is indicated by antibody testing.
German study: 81% of subjects who'd never had COVID-19 produced a T-cell response, from previous cold viruses (non-COVID19 coronaviruses).

Summary article

 

[miacomet]

Two New Studies Suggest COVID-19 Herd Immunity May Be Much Closer Than Antibody Tests Suggest

Swedish study: Twice as many people have T-cell immunity to COVID-19, than is indicated by antibody testing.
German study: 81% of subjects who'd never had COVID-19 produced a T-cell response, from previous cold viruses (non-COVID19 coronaviruses).

Summary article

Neither has been peer-reviewed

 

[TwoHighways]

Neither has been peer-reviewed

I’ve lost faith in the peer review process with anything related to Covid.

 

[miacomet]

I’ve lost faith in the peer review process with anything related to Covid.

Sure. There have been issues. But non peer reviewed is pointless.

 

[TwoHighways]

Sure. There have been issues. But non peer reviewed is pointless.

Take those studies for what they are, hypotheses worthy of closer examination. Proof will be in the pudding soon enough here if there is validity to them.

 

[Birdstrike]

Neither has been peer-reviewed

A study that passes peer review is better than one that doesn't. A study that hasn't yet had the chance to pass peer review is better than speculation by people (including myself) on the internet. But it won't matter if this passes peer review, because you or someone else with have a quick way to reject it out of hand, like any study that doesn't confirm what they already believe. You guys have all these quick rejection statements ready to go.

"It hasn't passed peer review!"

Study passes peer review...

"It's only an observational study!"

New study with a stronger design...

"It's not enough patients!"

Larger study...

"It's not randomized double blind placebo controlled!"

Next one is randomized, double blinded and placebo controlled...

"It has too many confounders!"

New study with less confounders...

"Well, that's just BS!"



You guys have gotten so good at spitting these responses out, without even reading, analyzing or opening your mind to any piece of information that doesn't fit the conclusion you've already drawn.

 

[Birdstrike]

Take those studies for what they are, hypotheses worthy of closer examination. Proof will be in the pudding soon enough here if there is validity to them.

You haven't learned the technique yet, TwoHighways? First, draw conclusions that you like first, then fight like hell to keep out any facts or new information that could change them.

How do I know people are doing this without even reading or considering? Because everything is rejected out of hand in a few seconds, too quick to even read more than a page or two. It's never, "Hmm...interesting. Not peer reviewed, but might change things if passes peer review and the study design is tweeked a bit, and repeated." It's always one of the above knee-jerk thoughtless responses, masquerading as thoughtful and open-minded analysis.

I've posted a lot of studies on this subject (>20?). And I'm not even necessarily endorsing any them. I don't know enough about the subject to take a hardened position on any of it. I just post what I find that others might find interesting. But they're all instantaneously 100% wrong on everything, or so I'm told. Not even one or two, by simple chance are right about something? Nope. It's alway a knee jerk response from the above template. But, whatevs. That's the internet.

 

[Birdstrike]

Sure. There have been issues. But non peer reviewed is pointless.

What about the studies I've posted on here before peer review, that have now passes peer review? Those are pointless, too? Have you gone back and checked which got published and didn't?

 

[DoctwoB]

Two New Studies Suggest COVID-19 Herd Immunity May Be Much Closer Than Antibody Tests Suggest

Swedish study: Twice as many people have T-cell immunity to COVID-19, than is indicated by antibody testing.
German study: 81% of subjects who'd never had COVID-19 produced a T-cell response, from previous cold viruses (non-COVID19 coronaviruses).

Summary article

interesting studies immunologically but hard to say what they mean clinically. Does having heterologous immunity to covid make you immune? Give you a less severe course? Make you more reactive with a more ARDSy picture? Hard to say.

 

[TwoHighways]

You haven't learned the technique yet, TwoHighways? First, draw conclusions that you like first, then fight like hell to keep out any facts or new information that could change them.

How do I know people are doing this without even reading or considering? Because everything is rejected out of hand in a few seconds, too quick to even read more than a page or two. It's never, "Hmm...interesting. Not peer reviewed, but might change things if passes peer review and the study design is tweeked a bit, and repeated." It's always one of the above knee-jerk thoughtless responses, masquerading as thoughtful and open-minded analysis.

I've posted a lot of studies on this subject (>20?). And I'm not even necessarily endorsing any them. I don't know enough about the subject to take a hardened position on any of it. I just post what I find that others might find interesting. But they're all instantaneously 100% wrong on everything, or so I'm told. Not even one or two, by simple chance are right about something? Nope. It's alway a knee jerk response from the above template. But, whatevs. That's the internet.

Just trying to give people the benefit of the doubt (we should all be more charitable in that respect).

 

[AMEHigh]

Two New Studies Suggest COVID-19 Herd Immunity May Be Much Closer Than Antibody Tests Suggest

Swedish study: Twice as many people have T-cell immunity to COVID-19, than is indicated by antibody testing.
German study: 81% of subjects who'd never had COVID-19 produced a T-cell response, from previous cold viruses (non-COVID19 coronaviruses).

Summary article

Interesting!
I only read the first one, don’t have enough band width for the 2nd one right now, ha.
I didn’t delve deeply in to all the tables though. I read the few comments posted. A lot of papers I read do also mention limitations, which helps me go back to look closer at the tables. Other than the low sample size what do you think the limitations of the first paper are? I read another paper about T cells but can’t remember where it was and can’t find it now.

Hopefully we’ll have more conclusive answers over the next year. I’ll be interested to see how the morbidity changed as more people are infected. I hope those things improve as well, but not smart enough to know how that’s tied to T cell immunity.

 

[Birdstrike]

On the subject of peer review: You've got to think for yourself. While peer review is all fine and good, peer review itself has been studied and shown to often be random, inconsistent and poorly reproducible when blinded (from a neurology article that itself was peer reviewed, in Brain).

JAMA tried to find proof peer review improved the quality of articles and couldn't, concluding the process itself was "untested with uncertain effects." Even BMC med, which is in the business of overseeing some 300 peer reviewed journals, concluded the peer review process itself wasn't even evidence based.

Bottom line: You've got to be an independent thinker. You can't rely on the concept of peer review to do your work for you.

 

[AMEHigh]

interesting studies immunologically but hard to say what they mean clinically. Does having heterologous immunity to covid make you immune? Give you a less severe course? Make you more reactive with a more ARDSy picture? Hard to say.

We must’ve been typing at the exact same time! Same things I was wondering in regards to morbidity. I’m not smart enough to know the answers. Crossing fingers that it does improve morbidity.