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New Shelter in Place Order?

pmrmd

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Not here. Another general shutdown will not be tolerated and it's still a bad idea IMO. Enforcement of commonsense principles is what needs to happen and finally is. Some bars got shutdown and owners cited in the Scottsdale party zone for their behaviors and the county mandated masks in public. Hospitals are limiting their own elective procedures so an executive order isn't necessary.
 
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lonelobo

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Not here. Another general shutdown will not be tolerated and it's still a bad idea IMO. Enforcement of commonsense principles is what needs to happen and finally is. Some bars got shutdown and owners cited in the Scottsdale party zone for their behaviors and the county mandated masks in public. Hospitals are limiting their own elective procedures so an executive order isn't necessary.
Your state was one of last to shutdown and first to reopen you think that was a mistake?
 

SSdoc33

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Not here. Another general shutdown will not be tolerated and it's still a bad idea IMO. Enforcement of commonsense principles is what needs to happen and finally is. Some bars got shutdown and owners cited in the Scottsdale party zone for their behaviors and the county mandated masks in public. Hospitals are limiting their own elective procedures so an executive order isn't necessary.

it really is mostly about hospital capacity. if the hospitals cant handle the load, then you have to lock it down again.

the rebound may happen in the northeast as well eventually, but you really dont see people without masks on in public.

ie: you don't see this:



1594137479175.png
 

lobelsteve

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@SSdoc33 and @lonelobo

You too are doing a lot of virtue signaling these days. Have you ever considered the ultimate win? Let the virus go unchecked watch millions die and then you will win the presidency the House and the Senate. An amazing political strategy at the expense of only a few million Americans.
 
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SSdoc33

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@SSdoc33 and @lonelobo

You too are doing a lot of virtue signaling these days. Have you ever considered the ultimate win? Let the virus go unchecked watch millions die and then you will win the presidency the House and the Senate. An amazing political strategy at the expense of only a few million Americans.

the house is not in play. we will win the senate (maybe) and presidency anyway.

i dont want to see "a few million" die. also, it would be much better for the economy if DJT actually did his job to try to deal with the pandemic.
 

Ducttape

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@SSdoc33 and @lonelobo

You too are doing a lot of virtue signaling these days. Have you ever considered the ultimate win? Let the virus go unchecked watch millions die and then you will win the presidency the House and the Senate. An amazing political strategy at the expense of only a few million Americans.
the means do not justify the end results if people are dying.

i acknowlege i am being partisan, but this mindset is more in line with trump's philosophy of winning at all costs.
 

lonelobo

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@SSdoc33 and @lonelobo

You too are doing a lot of virtue signaling these days. Have you ever considered the ultimate win? Let the virus go unchecked watch millions die and then you will win the presidency the House and the Senate. An amazing political strategy at the expense of only a few million Americans.
Virtue signaling - the action or practice of publicly expressing opinions or sentiments intended to demonstrate one's good character or the moral correctness of one's position on a particular issue

One might say you tend to partake in this quite frequently
 
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lobelsteve

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Virtue signaling - the action or practice of publicly expressing opinions or sentiments intended to demonstrate one's good character or the moral correctness of one's position on a particular issue

One might say you tend to partake in this quite frequently
Only when it comes to doing my job.
 
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Orin

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It'll require state or federal intervention to get another shut down of elective procedures as most hospitals lost too much revenue in the first pause, and unfortunately I'm not sure the political/public capital is there yet. By the time it gets there, it'll likely be too late. Things will be flooding most metro areas and setting up to sweeping back through prior hot spots.

This hopefully is more like influenza or SARS and less like Dengue fever where the second infection is more likely to be far more clinically severe due to a robust immune response.

I don't think it's a political thing as much as it is a money thing. The economy does not have a pause button.
Hopefully the EU/China can bail us out though...
 

Gauss

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@SSdoc33 and @lonelobo

You too are doing a lot of virtue signaling these days. Have you ever considered the ultimate win? Let the virus go unchecked watch millions die and then you will win the presidency the House and the Senate. An amazing political strategy at the expense of only a few million Americans.

1594172206426.png
 
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clubdeac

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Just saw another video where a head policy official got up and point blank said anyone who dies with Covid gets Covid as the cause of death on their death certificate regardless of cause including MVA, CA patients on hospice, MI etc. I mean honestly, when we're tracking the numbers in this fashion how in the world can you believe any of it? It would appear that this is at least half smoke and mirrors
 

callmeanesthesia

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Just saw another video where a head policy official got up and point blank said anyone who dies with Covid gets Covid as the cause of death on their death certificate regardless of cause including MVA, CA patients on hospice, MI etc. I mean honestly, when we're tracking the numbers in this fashion how in the world can you believe any of it? It would appear that this is at least half smoke and mirrors
Excess mortality figures show otherwise. We are most likely dramatically undercounting cases, and probably undercounting deaths. Have seen quite a bit about how Florida is or at least was cooking the books on their case counts.
One of the surgeons in my group got diagnosed (asymptomatic, tested due to exposure), but no one would test his wife or kids even though he is quarantined at home with them.
 
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SSdoc33

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Just saw another video where a head policy official got up and point blank said anyone who dies with Covid gets Covid as the cause of death on their death certificate regardless of cause including MVA, CA patients on hospice, MI etc. I mean honestly, when we're tracking the numbers in this fashion how in the world can you believe any of it? It would appear that this is at least half smoke and mirrors

it is widely accepted that the number of covid deaths is UNDER reported. once again, you are way off the mark
 

Agast

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Have seen quite a bit about how Florida is or at least was cooking the books on their case counts.

Before I unfollowed the COVID Facebook groups I recall several Florida docs complaining that administration was making them remove suspicion of coronavirus from the charts. For example radiologists seeing young people with ground glass opacities and other signs of COVID pneumonia were told to remove it from their charts.
 

Gauss

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Just saw another video where a head policy official got up and point blank said anyone who dies with Covid gets Covid as the cause of death on their death certificate regardless of cause including MVA, CA patients on hospice, MI etc. I mean honestly, when we're tracking the numbers in this fashion how in the world can you believe any of it? It would appear that this is at least half smoke and mirrors

how many death certificates have you filled out?
from critical care on another board:

"Death certificates have a specific logic to them, in that the certifier fills out the proximal cause of death then sequential "intermediate steps" leading to an ultimate cause of death. There's also a segment for "contributory but not directly responsible" like if someone has COPD but they died of a septic leg...the COPD made it more likely they developed respiratory failure but it wasn't "in the line of death."

It's worth mentioning to rebut the conspiracy theorists that NOBODY has ever questioned my death certificates or coached me to include causes of death that were medically dubious.

For the patient already dying of a terminal illness who then succumbed to COVID, it's simple: COVID as the proximal cause of death, the underlying terminal illness as the ultimate cause of death. This is no different than a cancer patient who dies of a PE or pneumonia. List the PE as proximal cause of death and lung cancer as the ultimate cause of death.

The trickier situation is the patient who tested COVID19 positive but may be asymptomatic. All nursing homes here require a negative COVID test prior to discharge. Someone who got picked up that way but wasn't suffering pneumonia, renal failure with no other good reason etc and then suddenly died I'd probably err on the side of caution and list COVID in the "contributory causes" category unless I had reason to suspect that their deterioration was due to COVID, in which case it would be the proximal cause.

For clarification, people trumpeting the "hospitals are paid more for COVID cases so they're going out of their way to report" have the whole thing backwards. COVID cases are getting extra reimbursement because COVID cases have DRAMATICALLY longer hospital length of stay and cost compared to generically similar DRG like "community acquired pneumonia", so the "COVID surcharge" (partially) offsets that. Hospitals are not making a windfall off of COVID patients, in fact they are losing money on average. That's why the coders are desperate to capture everybody who qualifies as COVID so that they can (properly) recoup some of those losses. "
 
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Ducttape

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agree with Gauss.

i filled out hundreds of death certificates while in the ER. list a primary cause, then list contributing causes.

i was never coached per se, but previously, I would have to call the ME and state what i thought were the primary causes and the contributing causes. the ME would invariably agree but rarely ask questions that might make me have to throw out the form i already wrote and make a new one.



which occurred, um, once ever in my recollection.
 
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