no COVID-19 thread?

[oreosandsake]

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wondering what people's experiences have been. who has taken care of someone with this virus? I have read posts online about viral cardiomyopathy and young healthy people going from healthy to mild illness to vented within short period of time. what's the deal? also if people are walking around asymptomatic for weeks before they get sick.. it's going to be everywhere

 

[JustPass]

I don't think there is a need to talk about this on here. Spreads unnecessary fear and anxiety.
There's already enough on the news anyways.

 

[rokshana]

I don't think there is a need to talk about this on here. Spreads unnecessary fear and anxiety.
There's already enough on the news anyways.

Then don’t talk...no one is forcing you to either post or read...however others may find it helpful.

 

[tacowithgreensauce]

my SO and I ran out of toilet paper at literally the worst timing.

 

[JustPass]

Then don’t talk...no one is forcing you to either post or read...however others may find it helpful.

 

[chessknt]

Active threads on SPF and anesthesia boards--try there

 

[jdh71]

I don't think there is a need to talk about this on here. Spreads unnecessary fear and anxiety.
There's already enough on the news anyways.

are you high?

physicians NEED to be talking about experience with this virus

 

[JustPass]

are you high?

physicians NEED to be talking about experience with this virus

Calm down. Why are you being so aggressive?
I wrote my opinion and you don't have to agree with it.

 

[jdh71]

Calm down. Why are you being so aggressive?
I wrote my opinion and you don't have to agree with it.

because I find it ****ing irritating as someone on the front lines

do you have ANY clue what is happening in Italy right now??

 

[JustPass]

because I find it ****ing irritating as someone on the front lines

do you have ANY clue what is happening in Italy right now??

Dude, just because I wrote that making a thread about what people read online about going from 0 to 100 doesn't mean I don't care or is clueless about what happening in the world. You aren't the only one in the front lines.

 

[jdh71]

Dude, just because I wrote that making a thread about what people read online about going from 0 to 100 doesn't mean I don't care or is clueless about what happening in the world. You aren't the only one in the front lines.

This is an IM forum. The specialty where most of this country’s Intensivists come from. And the specialty of hospitalists who will also be taking care of these patients. Your opinion was noted it’s was just stupid and wrong in this forum.

 

[JustPass]

This is an IM forum. The specialty where most of this country’s Intensivists come from. And the specialty of hospitalists who will also be taking care of these patients. Your opinion was noted it’s was just stupid and wrong in this forum.

Hey, I'm just trying to stop unnecessary fear and anxiety. I think that's part of our job too.
Just as there are people in the world who are bunkering down and buying up all the food in stores, there are those who take necessary precautions and live out their normal lives.
If something good come out of this thread, great.
But I don't think us talking about how we ran out of TP make any significant help to current problem.
I'm done replying to this thread.
I mean no harm or trying to minimize current situation.

 

[rokshana]

Calm down. Why are you being so aggressive?
I wrote my opinion and you don't have to agree with it.

You must be new here...

 

[rokshana]

Dude, just because I wrote that making a thread about what people read online about going from 0 to 100 doesn't mean I don't care or is clueless about what happening in the world. You aren't the only one in the front lines.

You’re an intern for god sake...most institutions are making covid pts attending only...exactly how much front line are you having??

Jdh? He’s hard core...

 

[tantacles]

You’re an intern for god sake...most institutions are making covid pts attending only...exactly how much front line are you having??

Jdh? He’s hard core...

where's that thread about stupid things we're doing with covid? here's mine!

My institution at this point has deemed that all covid patients must go to teaching teams only.

 

[jdh71]

where's that thread about stupid things we're doing with covid? here's mine!

My institution at this point has deemed that all covid patients must go to teaching teams only.

wait for it

there will be more than enough to go around soon

 

[DrMetal]

where's that thread about stupid things we're doing with covid? here's mine!

My institution at this point has deemed that all covid patients must go to teaching teams only.

Corona Virus: Idiot things people are doing

Corona Virus: Idiot things people are doing because of the COVID-19 Hysteria. [this should be documented, why not here?!] - Fist bumping instead of shaking hands (b/c the virus hangs out on your finger tips, but not on your knuckles) - Elbow bumping (even worse, b/c you've been coughing...

forums.studentdoctor.net

 

[rokshana]

where's that thread about stupid things we're doing with covid? here's mine!

My institution at this point has deemed that all covid patients must go to teaching teams only.

WHAT??? Smh!!

 

[jm192]

Hey, I'm just trying to stop unnecessary fear and anxiety. I think that's part of our job too.
Just as there are people in the world who are bunkering down and buying up all the food in stores, there are those who take necessary precautions and live out their normal lives.
If something good come out of this thread, great.
But I don't think us talking about how we ran out of TP make any significant help to current problem.
I'm done replying to this thread.
I mean no harm or trying to minimize current situation.

Please remember you have to always understand your audience.

This is SDN. This is full of pre-meds, med-students, residents, fellows, attendings, pharmacists, etc. These are not the people that you need to calm the fear in. You're doing no public service by stopping fear and anxiety amongst medical professionals. If you can't talk about it without being afraid or anxious, exit stage left.

I think in a week or two, we're going to see a major upswing of hospitalized patients. People need to be prepared. There is no unnecessary fear or anxiety right now. The crap may very well hit the fan.

 

[jdh71]

Please remember you have to always understand your audience.

This is SDN. This is full of pre-meds, med-students, residents, fellows, attendings, pharmacists, etc. These are not the people that you need to calm the fear in. You're doing no public service by stopping fear and anxiety amongst medical professionals. If you can't talk about it without being afraid or anxious, exit stage left.

I think in a week or two, we're going to see a major upswing of hospitalized patients. People need to be prepared. There is no unnecessary fear or anxiety right now. The crap may very well hit the fan.

the upswing begins this week

next week the nightmare

 

[jm192]

the upswing begins this week

next week the nightmare

I fear you're probably right.

 

[jm192]

There's a Twitter #
#Covid4MDs which has been the best resource I've seen. Though in my medium sized Kentucky town, we've not had any (yet).

Quick shots:

If not sick, send home. Don't admit for "rule out."
IF alternative diagnosis exists--don't test, don't admit because "could also be." If influenza +, Rhinovirus +, etc--send home, do not pass go, do not collect COVID test.
Typical imaging appearance is bilateral infiltrates. People can deteriorate quickly, and the sickest of them will develop ARDS

No high flow or Bipap. If they get to that point--you're going to have to tube them and High flow/bipap will aerosolize the virus.

Sounds like most aren't requiring ECMO, Vent is doing the job. Oxygenation isn't the issue.

A lot of cases of viral cardiomyopathy which often happens after people seem to be turning the corner.

Most importantly: Be super cautious with your PPE. You can't help or save anyone if you're sick or quarantined.

 

[Goldenlightwave01]

Please remember you have to always understand your audience.

This is SDN. This is full of pre-meds, med-students, residents, fellows, attendings, pharmacists, etc. These are not the people that you need to calm the fear in. You're doing no public service by stopping fear and anxiety amongst medical professionals. If you can't talk about it without being afraid or anxious, exit stage left.

I think in a week or two, we're going to see a major upswing of hospitalized patients. People need to be prepared. There is no unnecessary fear or anxiety right now. The crap may very well hit the fan.

You are right, as an MDs you have to be alive to reality and be ready to face any VHF's prevalence...

Sent from my Infinix HOT 4 using Tapatalk

 

[jdh71]

There's a Twitter #
#Covid4MDs which has been the best resource I've seen. Though in my medium sized Kentucky town, we've not had any (yet).

Quick shots:

If not sick, send home. Don't admit for "rule out."
IF alternative diagnosis exists--don't test, don't admit because "could also be." If influenza +, Rhinovirus +, etc--send home, do not pass go, do not collect COVID test.
Typical imaging appearance is bilateral infiltrates. People can deteriorate quickly, and the sickest of them will develop ARDS

No high flow or Bipap. If they get to that point--you're going to have to tube them and High flow/bipap will aerosolize the virus.

Sounds like most aren't requiring ECMO, Vent is doing the job. Oxygenation isn't the issue.

A lot of cases of viral cardiomyopathy which often happens after people seem to be turning the corner.

Most importantly: Be super cautious with your PPE. You can't help or save anyone if you're sick or quarantined.

Hiflow and Bipap have not been demonstrated to significantly aerosolize in general, especially when fitted appropriately. This is more theoretical risk than a known one. One Italian center used CPAP VERY effectively. We only have so many vents. The positive pressure associated with MV also causes inflammation - it is the beginning of the problems NOT the end of them.

Many of the sick won't be offered ECMO given age and likely associated comorbids. ECMO will be reserved for those in their 40s and 50s.

There is no specific evidence for *viral* cardiomyopathy. Cardiomyopathy with associated acute failure and shock, YES, but that doesn't mean it is a *viral* etiology. We cannot directly connect that dot at this time.

 

[thehundredthone]

IF alternative diagnosis exists--don't test, don't admit because "could also be." If influenza +, Rhinovirus +, etc--send home, do not pass go, do not collect COVID test.

Sounds like most aren't requiring ECMO, Vent is doing the job. Oxygenation isn't the issue.

A lot of cases of viral cardiomyopathy which often happens after people seem to be turning the corner.

I'd be careful with any of these generalizations. We have already seen one "double diagnosis" currently in ARDS. A few with significant refractory hypoxemia (although driving pressure/compliance has not been as much of an issue). You're mostly right about the ECMO requirement but I think ECMO creates a false security that a ventilated patient is less sick. When the numbers increase and ventilators run out, it quickly becomes a very big problem. And like jdh71 said, there is no direct link to pinpoint the etiology of the cardiomyopathy as being viral. And a lot of cases is very subjective because the phrase is used in a relative sense rather than absolute.

 

[bananas85]

Hospitalist here! Been off for about 21 days, and about to start some shifts tomorrow. It has been really depressing waking up to thie news every day!! for the last 10 days.

 

[turkeyjerky]

Hiflow and Bipap have not been demonstrated to significantly aerosolize in general, especially when fitted appropriately. This is more theoretical risk than a known one. One Italian center used CPAP VERY effectively. We only have so many vents. The positive pressure associated with MV also causes inflammation - it is the beginning of the problems NOT the end of them.

Many of the sick won't be offered ECMO given age and likely associated comorbids. ECMO will be reserved for those in their 40s and 50s.

There is no specific evidence for *viral* cardiomyopathy. Cardiomyopathy with associated acute failure and shock, YES, but that doesn't mean it is a *viral* etiology. We cannot directly connect that dot at this time.

I think in Italy they use a helmet interface. Also, a big part their usage is buying 12-24 hrs until a vent opens up (ie another patient dies). Have to be careful to use viral filters as well.

 

[wjs010]

On critical care. Last week had a co resident who admitted a patient for volume overload and hyperkalemia. Really just needed HD. We fixed him and sent him off our service. Come to find out today when they were on the floor, they got tested, and are positive. On the hospitalist service. They are being treated with chloroquine.

The 4 of us residents and the attending who went in the room are considered having been exposed. We don’t have to stay home (unless symptoms of course) but we do have to take temp twice a day for 2 weeks, wear surgical masks , and get tested for covid. I’m feeling normal, but this patient had no cough and zero fever . Temp was stone cold normal. I say all this to say that we are likely all exposed... we can only be so careful. But keep doing it because right now we have no other choice.


Sent from my iPhone using SDN

 

[Instatewaiter]

I'd be careful with any of these generalizations. We have already seen one "double diagnosis" currently in ARDS. A few with significant refractory hypoxemia (although driving pressure/compliance has not been as much of an issue). You're mostly right about the ECMO requirement but I think ECMO creates a false security that a ventilated patient is less sick. When the numbers increase and ventilators run out, it quickly becomes a very big problem. And like jdh71 said, there is no direct link to pinpoint the etiology of the cardiomyopathy as being viral. And a lot of cases is very subjective because the phrase is used in a relative sense rather than absolute.

Agreed. We currently have a person who is rhinovirus and covid positive. They're currently on VV ECMO...

 

[Instatewaiter]

What are everyone's thoughts on all healthcare providers wearing surgical masks in the hospital, irrespective of whether they are caring for a covid 19 patient.

Both south Korea and Singapore showed a marked reduction in healthcare worker transmission by doing this.

Also note that with the sneeze or a cough particles can travel as far as 8 m. That's a lot more than the 6 ft that day we're previously saying. That 6 ft distance was based upon data from the 1930s.

 

[gutonc]

What are everyone's thoughts on all healthcare providers wearing surgical masks in the hospital, irrespective of whether they are caring for a covid 19 patient.

Both south Korea and Singapore showed a marked reduction in healthcare worker transmission by doing this.

Also note that with the sneeze or a cough particles can travel as far as 8 m. That's a lot more than the 6 ft that day we're previously saying. That 6 ft distance was based upon data from the 1930s.

My hospital just went "masks on" in the inpatient and ambulatory settings.

We're in a relatively low infection rate area but adjacent to a very high infection rate area.

 

[Meerkatology]

u know that masks dont do anything if you arent also wearing goggles right?

also, if u really dont want to get infected, u wear a biosuit to every patient.

covid is contagious before symptoms show. espeically in an area with large #'s of infections, you really dont know who has it.
basing the need for PPE purely on presenting symptoms is inherently flawed. sure the risk level is different, but its your life and your family thats at stake.

 

[tantacles]

u know that masks dont do anything if you arent also wearing goggles right?

also, if u really dont want to get infected, u wear a biosuit to every patient.

covid is contagious before symptoms show. espeically in an area with large #'s of infections, you really dont know who has it.
basing the need for PPE purely on presenting symptoms is inherently flawed. sure the risk level is different, but its your life and your family thats at stake.

I wouldn't go so far as to say that masks "don't do anything". Even if they're not perfect, they presumably decrease your total exposure by a large amount, particularly if you are not performing high risk procedures.

 

[MyTachyBradyHeart]

Personally, I've been wearing masks around patients in the hospital for ~2 weeks now. I don't see a downside. Whether it is as effective as N95+faceshield is immaterial. I could be an asymptomatic carrier and wearing a mask protects against my hurting my coworkers or patients... in addition to offering some protection for myself as we all are immersed in a high risk environment. This is also coming from a cardiology fellow who is not necessarily on the "front line" but has come into contact with COVID patients in the hospital.

 

[tantacles]

Personally, I've been wearing masks around patients in the hospital for ~2 weeks now. I don't see a downside. Whether it is as effective as N95+faceshield is immaterial. I could be an asymptomatic carrier and wearing a mask protects against my hurting my coworkers or patients... in addition to offering some protection for myself as we all are immersed in a high risk environment. This is also coming from a cardiology fellow who is not necessarily on the "front line" but has come into contact with COVID patients in the hospital.

Same. A simple facemask is cheap compared to an N95, and even if reused can save lives.

 

[mjl1717]

When most hospital ERs in the United States test for COVID- 19 currently. Is the result only positive or negative..?
Or are we at that point where we right then and there know the Viral Load and T4 and T8 count. Similar to HIV testing.

 

[xoggyux]

When most hospital ERs in the United States test for COVID- 19 currently. Is the result only positive or negative..?
Or are we at that point where we right then and there know the Viral Load and T4 and T8 count. Similar to HIV testing.

The main test that is being done is a PCR that amplifies mRNA collected. Therefore, test can only tell you if the mRNA is present. Presumably if you have a + test and symptoms then you got your diagnosis. If you have a + test and no symptoms then you could be dealing with a false positive test or perhaps the patient is an asymptomatic patient or a patient that is recovering for the disease and have some leftover mRNA/virus particles that might or might not be viable (e.i patient might be asymptomatic carrier vs recovered and non-contagious but have "dead virus" sort to speak, please understand that virus do not perform metabolism on its own, and whether they are alive or not, to begin with, is debatable that's why I used quotes).
The other thing is, like any tests that exist, there are false positives/false negatives etc.

At some point, serology (checking for IgM and IgG might become more widespread. This might also help you to figure outpatients that already recovered and have a left-over "immunity" sort to speak. However, note that this is a previously unknown virus and it is not clear its potential to re-infection, mutation and re-infection, etc. We are in uncharted territory.
With the caveat that immunology was not my strongest subject during med-school, people that have positive titters for hepatitis, VZV, etc can in fact get re-infected. That is to say, that personally, even if at some point I get it, recover and are found to have anti-bodies, I would still use PPE like anyone else when dealing with these patients. I have seen in the news and even in the hospitals throwing around the idea of barebacking once found to have immunity and I find this preposterous.

 

[mjl1717]

Thank you!! Geez.