Per CDC definitions- the COVID epidemic has been over for at least a couple weeks!

[wamcp]

The COVID epidemic is over.

Per CDC guidelines the epidemic threshold is crossed when a disease causes more than 7.2% of the total weekly deaths. COVID became a CDC defined epidemic in the 1st week of April and stopped being one in mid-June.

https://pbs.twimg.com/media/EcArFl4VcAERIr_?format=jpg&name=large

However, we will continue to be in an indefinite state of “panic-demic” for the foreseeable future.

Why is the media not reporting on these facts?

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[RuralEDDoc]

Just admitted 4 hypoxic COVID patients today. Sure doesn’t feel over to me.

 

[naijacardriodoc]

it's definitely not over...

 

[24GaugeEJ]

The COVID epidemic is over.

Per CDC guidelines the epidemic threshold is crossed when a disease causes more than 7.2% of the total weekly deaths. COVID became a CDC defined epidemic in the 1st week of April and stopped being one in mid-June.

https://pbs.twimg.com/media/EcArFl4VcAERIr_?format=jpg&name=large

However, we will continue to be in an indefinite state of “panic-demic” for the foreseeable future.

Why is the media not reporting on these facts?

With due respect, the 7.2% threshold refers to combined influenza and pneumonia deaths and is used to make inferences regarding the causes of increased mortality; the drop in mortality may or may not be temporary and does not necessarily indicate the current rate of change in infections. Typically, there are not hard and fast numbers assigned to what is and is not an outbreak, epidemic, pandemic, etc., and there are good reasons for that. This is part of the CDC introductory epidemiology workbook:

Principles of Epidemiology | Lesson 1 - Section 11

Principles of Epidemiology in Public Health Practice, Third Edition An Introduction to Applied Epidemiology and Biostatistics Lesson 1 Section 11

www.cdc.gov

 

[Rekt]

Just admitted 4 hypoxic COVID patients today. Sure doesn’t feel over to me.

I mean unless this is your first time seeing COVID patients, this is essentially standard. It's the disease. It doesn't automatically mean they're taking the fatal course. I bet most of you guys aren't even following up on their hospital course. 95% of these patients go home within a few days.

 

[Birdstrike]

Interesting graph, @wampC

Do you have a link to where they got the graph? I’d be interested to read more on how the CDC defines these terms.

But I’m pretty an epidemic is not defined by “how I feel” at a given moment in time, or by what happens in my pod, on one shift, in one hospital, in one town, in one state, in a country of 1/3 billion people.

 

[RuralEDDoc]

I mean unless this is your first time seeing COVID patients, this is essentially standard. It's the disease. It doesn't automatically mean they're taking the fatal course. I bet most of you guys aren't even following up on their hospital course. 95% of these patients go home within a few days.

My point is that the pandemic sure doesn’t seem over from a clinical standpoint. I’ve been doing this for about 10 years and can tell you that before this year I’ve never once admitted a hypoxic patient from a viral respiratory syndrome in July. Not once. To a full hospital no less. So nothing about this seems standard, even if 95% do go home in a few days.

 

[Birdstrike]

I’ve been doing this for about 10 years and can tell you that before this year I’ve never once admitted a hypoxic patient from a viral respiratory syndrome in July.

Viral infiltrates can often look bacterial and bacterial can look viral. The only way to know the organism is with a grain stain & culture. You knew the organism of all your admitted hypoxic patients with chest x-ray findings, from bronchoalveolar lavage, gram stain and culture, either upon admission or that you followed to discharge?

 

[Birdstrike]

Actually that’s where you’re wrong amigo. This epidemic is very much defined by feelings and anecdotes. They’re the only things that seem to matter.

"But I'm scurred Mr. Hat, I'm scurred."

 

[RuralEDDoc]

Viral infiltrates can often look bacterial and bacterial can look viral. The only way to know the organism is with a grain stain & culture. You knew the organism of all your admitted hypoxic patients with chest x-ray findings, from bronchoalveolar lavage, gram stain and culture, either upon admission or that you followed to discharge?

That’s weirdly confrontational. I may be a simple country ER doc but I know rigors and a high white count more likely to be bacterial and patchy nonfocal XRs with normal WBC and CRP more likely to be viral. Have a nice day.

 

[Birdstrike]

That’s weirdly confrontational. I may be a simple country ER doc but I know rigors and a high white count more likely to be bacterial and patchy nonfocal XRs with normal WBC and CRP more likely to be viral. Have a nice day.

My apologies if I came off as a confrontational ****. My fault, not yours.

The only reason I asked is that COVID-19 has made me question a lot of my own assumptions. Like, "How many of those pneumonias I admitted, that I assumed were bacterial, turned out to be viral? In clinical practice, there's good way to know, since #1 Chest x-rays & labs don't reliable differentiate, #2 We don't follow up usually, and #3 The admitting team's focus is generally on using antibiotics & cultures to identify and treat bacterial pathogens, not chase down and identify untreatable viral ones. How many pneumonias have I admitted that turned out to be rhinovirus, RSV, influenza, parainfluenza, adenovirus, metapneumonia virus, or non-COVID-19 coronavirus? I'll never know, because if cultures don't show a bacterial organism, often not much effort is put into identifying viral causes since they're mostly untreatable.

 

[VA Hopeful Dr]

My apologies if I came off as a confrontational ****. My fault, not yours.

The only reason I asked is that COVID-19 has made me question a lot of my own assumptions. Like, "How many of those pneumonias I admitted, that I assumed were bacterial, turned out to be viral? In clinical practice, there's good way to know, since #1 Chest x-rays & labs don't reliable differentiate, #2 We don't follow up usually, and #3 The admitting team's focus is generally on using antibiotics & cultures to identify and treat bacterial pathogens, not chase down and identify untreatable viral ones. How many pneumonias have I admitted that turned out to be rhinovirus, RSV, influenza, parainfluenza, adenovirus, metapneumonia virus, or non-COVID-19 coronavirus? I'll never know, because if cultures don't show a bacterial organism, often not much effort is put into identifying viral causes since they're mostly untreatable.

The respiratory PCR panels have been gaining steam for a number of years which has helped sort this out.

 

[Birdstrike]

The respiratory PCR panels have been gaining steam for a number of years which has helped sort this out.

How common is it to admit a hypoxic patient with infiltrates and get a viral respiratory PCR panel back? And, how often does a positive prove causality? I'm asking because I don't know.

 

[RuralEDDoc]

I appreciate that - I’m probably overly sensitive. Your point is very well taken, diagnostic certainty in the ER may suggest overconfidence or ignorance, there’s a lot we don’t know and can’t explain. It’s good to question what we think we know and how we come to conclusions.
I’m probably sensitive about COVID right now as my area - rural NorCal - is looking grim currently. Full hospitals over half of which is Covid and a significant rise in the positive rates with an upward trend. Maybe it won’t be that bad, but all signs are pointing to a terrible couple of months.

 

[Birdstrike]

I appreciate that - I’m probably overly sensitive. Your point is very well taken, diagnostic certainty in the ER may suggest overconfidence or ignorance, there’s a lot we don’t know and can’t explain. It’s good to question what we think we know and how we come to conclusions.
I’m probably sensitive about COVID right now as my area - rural NorCal - is looking grim currently. Full hospitals over half of which is Covid and a significant rise in the positive rates with an upward trend. Maybe it won’t be that bad, but all signs are pointing to a terrible couple of months.

My area is getting slammed, too. I've gotten fatalistic about it. But you're right, it's not fun, no matter how you look at it.

 

[VA Hopeful Dr]

How common is it to admit a hypoxic patient with infiltrates and get a viral respiratory PCR panel back? And, how often does a positive prove causality? I'm asking because I don't know.

My wife was a hospitalist a few years ago. It got to the point at her hospital where it was a standard test on admission along with the urinary antigen studies for pneumonia patients.

 

[AMEHigh]

How common is it to admit a hypoxic patient with infiltrates and get a viral respiratory PCR panel back? And, how often does a positive prove causality? I'm asking because I don't know.

I can’t speak from an ED standpoint but when I was doing inpatient it was pretty common to get VPR on most patients. It certainly helped with antibiotic stewardship at times. I know at the beginning of the pandemic in my area the hospital we sent most patients too was also doing the full VRP as well. I assume when flu/respiratory season resumes that it’ll go back to that as well.

 

[southerndoc]

I don't know the actual stats (I can probably get them), but our pulmonary guys have told us that a large percentage of COVID patients that are hypoxemic also have concomitant bacterial pneumonias. Therefore, we give them the first dose of antibiotics pending procalcitonin levels. If they have significant infiltrates, require ventilation, etc., then they continue the antibiotics even with low procalcitonin levels.

 

[thegenius]

Viral infiltrates can often look bacterial and bacterial can look viral. The only way to know the organism is with a grain stain & culture. You knew the organism of all your admitted hypoxic patients with chest x-ray findings, from bronchoalveolar lavage, gram stain and culture, either upon admission or that you followed to discharge?

regardless there has been an explosion of “whatever” hypoxic pneumonia over the past 6 months.

Whatever being bacterial, viral, NOS.

we just don’t see with any regularity bilateral hypoxic pneumonia in young people. It is extremely rare.

but over the past 6 months it hasn’t been. Now it’s common.

 

[RoyBasch]

How common is it to admit a hypoxic patient with infiltrates and get a viral respiratory PCR panel back? And, how often does a positive prove causality? I'm asking because I don't know.

This may have been something that has changed since you got out of EM. These studies are pretty common now. I've had them ordered fairly routinely at multiple different hospitals I've worked at the last few years. It's pretty standard to get PCR panels on CSF now to for suspected meningitis/encephalitis. Some hospitals I work at have a "virtual blood culture" as well where they do PCR for common bacterial and viral DNA/RNA in blood culture samples, which can give you positive bacteremia/viremia within hours.

 

[Birdstrike]

This may have been something that has changed since you got out of EM. These studies are pretty common now. I've had them ordered fairly routinely at multiple different hospitals I've worked at the last few years. It's pretty standard to get PCR panels on CSF now to for suspected meningitis/encephalitis. Some hospitals I work at have a "virtual blood culture" as well where they do PCR for common bacterial and viral DNA/RNA in blood culture samples, which can give you positive bacteremia/viremia within hours.

Holy crap, time flies. Nine years now (!) since I came on here and said, "I'm out." But thanks. You guys are the only reason I pass the Concert (or whatever it is they're going to call it now).

 

[wamcp]

My point is that the pandemic sure doesn’t seem over from a clinical standpoint. I’ve been doing this for about 10 years and can tell you that before this year I’ve never once admitted a hypoxic patient from a viral respiratory syndrome in July. Not once. To a full hospital no less. So nothing about this seems standard, even if 95% do go home in a few days.

Well, I think I have just been looking at this the wrong way. I suppose we should all still be in total lockdown because we might get to a worsening, widespread situation of a full ER, no beds, hospital on bypass due to this infectious respiratory virus. Lockdowns will really help us stop the spread and relieve the crush on hospital capacity - really an unprecedented happening.

These are actual quotes from a several reporting articles:

"Tallia says his hospital is 'managing, but just barely,' at keeping up with the increased number of sick patients in the last three weeks. The hospital’s urgent-care centers have also been inundated, and its outpatient clinics have no appointments available.”

"Dr. Bernard Camins, associate professor of infectious diseases at the University of Alabama at Birmingham, says that UAB Hospital cancelled elective surgeries scheduled for Thursday and Friday of last week to make more beds available"
“We had to treat patients in places where we normally wouldn’t, like in recovery rooms,” says Camins. “The emergency room was very crowded, both with sick patients who needed to be admitted”

"In CA… several hospitals have set up large 'surge tents' outside their emergency departments to accommodate and treat … patients. Even then, the LA Times reported this week, emergency departments had standing-room only, and some patients had to be treated in hallways.”

"In Fenton, Missouri, SSM Health St. Clare Hospital has opened its emergency overflow wing, as well as all outpatient centers and surgical holding centers, to make more beds available to patients who need them. Nurses are being “pulled from all floors to care for them,”

“it’s making their pre-existing conditions worse,” she says. “More and more patients are needing mechanical ventilation due to respiratory failure”

“From Laguna Beach to Long Beach, emergency rooms were struggling to cope with the overwhelming cases… and had gone into 'diversion mode,' during which ambulances are sent to other hospitals.”

“Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones for fear they’ll spread… Others are canceling surgeries and erecting tents in their parking lots to triage the hordes of… patients.”

“There’s a little bit of a feeling of being in the trenches. We’re really battling these infections to try to get them under control,” McKinnell said. “We’re still not sure if this is going to continue … “

"At Parkland Memorial Hospital in Dallas, waiting rooms turned into exam areas as a medical tent was built in order to deal with the surge of patients. A Houston doctor said local hospital beds were at capacity”

“Dr. Anthony Marinelli says they've seen a major spike in… cases. It's so overwhelmed the community hospital that they've gone on bypass at times -- that means they tell ambulances to bypass this ER and find another.”

“Dr. Atallah, the chief of emergency medicine at Grady, says the hospital called on a mobile emergency department based nearly 250 miles away to help tackle the increasing patient demand. "At 500-plus patients a day you physically just need the space to put a patient in. “

Oh I forgot to mention- all of the above quotes are taken from articles written on the 2018 flu season.

We should have been in lockdown since 2018, am I right?

Hospitals Overwhelmed by Flu Patients Are Treating Them in Tents

Overwhelmed By Flu Cases, Some ERs Having To Turn Ambulances Away
California hospitals face 'war zone' of flu patients, and are setting up tents to treat them


Flu patients leave Texas hospitals strapped

At least three Chicago-area hospitals have told ambulances to go elsewhere so often the state launched an investigation, Tribune reporting reveals
Hospitals overwhelmed with flu patients

 

[Rendar5]

I assume you work in a hospital as an EM doc? What state? It’s really state or area dependent. I work in Florida and we are surging again. ER isn’t inundated but my hospital is. Got about 80-100 patients all with the exact. same Illness in the hospital right now. Never had those numbers before with any illness including In years with bad influenza epidemics. I honestly don’t wanna go back into a lockdown state but it was clearly necessary in my area in the beginning. Without it I know we would have been overwhelmed. With it we bought enough time to get adequate ppe , rapid testing and setting up of multiple covid floors and icus isolated from the rest of the hospital. Got lucky to only have one resident one ED nurse and one attending get seriously ill ( the latter now trached, dialyzed, and significant cns issues).

I think my area can get out of this without a second lock down in my area as long as we don’t fully re-open yet and people stop being crybabies about simple things like wearing a mask indoors around other people . I realize it’s not the bubonic plague, but it’s more than a simple flu, even in years with bad flu outbreak’s

 

[thegenius]

Well, I think I have just been looking at this the wrong way. I suppose we should all still be in total lockdown because we might get to a worsening, widespread situation of a full ER, no beds, hospital on bypass due to this infectious respiratory virus. Lockdowns will really help us stop the spread and relieve the crush on hospital capacity - really an unprecedented happening.

These are actual quotes from a several reporting articles:

"Tallia says his hospital is 'managing, but just barely,' at keeping up with the increased number of sick patients in the last three weeks. The hospital’s urgent-care centers have also been inundated, and its outpatient clinics have no appointments available.”

"Dr. Bernard Camins, associate professor of infectious diseases at the University of Alabama at Birmingham, says that UAB Hospital cancelled elective surgeries scheduled for Thursday and Friday of last week to make more beds available"
“We had to treat patients in places where we normally wouldn’t, like in recovery rooms,” says Camins. “The emergency room was very crowded, both with sick patients who needed to be admitted”

"In CA… several hospitals have set up large 'surge tents' outside their emergency departments to accommodate and treat … patients. Even then, the LA Times reported this week, emergency departments had standing-room only, and some patients had to be treated in hallways.”

"In Fenton, Missouri, SSM Health St. Clare Hospital has opened its emergency overflow wing, as well as all outpatient centers and surgical holding centers, to make more beds available to patients who need them. Nurses are being “pulled from all floors to care for them,”

“it’s making their pre-existing conditions worse,” she says. “More and more patients are needing mechanical ventilation due to respiratory failure”

“From Laguna Beach to Long Beach, emergency rooms were struggling to cope with the overwhelming cases… and had gone into 'diversion mode,' during which ambulances are sent to other hospitals.”

“Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones for fear they’ll spread… Others are canceling surgeries and erecting tents in their parking lots to triage the hordes of… patients.”

“There’s a little bit of a feeling of being in the trenches. We’re really battling these infections to try to get them under control,” McKinnell said. “We’re still not sure if this is going to continue … “

"At Parkland Memorial Hospital in Dallas, waiting rooms turned into exam areas as a medical tent was built in order to deal with the surge of patients. A Houston doctor said local hospital beds were at capacity”

“Dr. Anthony Marinelli says they've seen a major spike in… cases. It's so overwhelmed the community hospital that they've gone on bypass at times -- that means they tell ambulances to bypass this ER and find another.”

“Dr. Atallah, the chief of emergency medicine at Grady, says the hospital called on a mobile emergency department based nearly 250 miles away to help tackle the increasing patient demand. "At 500-plus patients a day you physically just need the space to put a patient in. “

Oh I forgot to mention- all of the above quotes are taken from articles written on the 2018 flu season.

We should have been in lockdown since 2018, am I right?

Hospitals Overwhelmed by Flu Patients Are Treating Them in Tents

Overwhelmed By Flu Cases, Some ERs Having To Turn Ambulances Away
California hospitals face 'war zone' of flu patients, and are setting up tents to treat them


Flu patients leave Texas hospitals strapped

At least three Chicago-area hospitals have told ambulances to go elsewhere so often the state launched an investigation, Tribune reporting reveals
Hospitals overwhelmed with flu patients

Why are you acting like an asshat?

 

[IMGASMD]

Got lucky to only have one resident one ED nurse and one attending get seriously ill ( the latter now trached, dialyzed, and significant cns issues).

I doubt the attending felt lucky.

 

[WheezyBaby]

Maybe you all have cheaper viral panels than my institution. They're well over $1000 here. Unless I think they're going to change management I'm disinclined to use them. If they have URI sx on top of their pulmonary pathology just stick them in droplet precautions unless you're actually going to discontinue abx for a positive result. Meningoencephalitis panel PCRs I use more liberally because they're already undergoing an invasive procedure to get the results, the stakes are higher, and the results more commonly change management, but for lower probability cases I'll often wait for basic studies to come back and avoid doing the PCR if theyre stone cold normal

 

[wholeheartedly]

Maybe you all have cheaper viral panels than my institution. They're well over $1000 here. Unless I think they're going to change management I'm disinclined to use them. If they have URI sx on top of their pulmonary pathology just stick them in droplet precautions unless you're actually going to discontinue abx for a positive result. Meningoencephalitis panel PCRs I use more liberally because they're already undergoing an invasive procedure to get the results, the stakes are higher, and the results more commonly change management, but for lower probability cases I'll often wait for basic studies to come back and avoid doing the PCR if theyre stone cold normal

I reallycan’t make sense of price which is very very different apparently from actual cost. our big tertiary places charges$3000 for a 20 pathogen panel and the health department across the street charges $85 for an 18 panel. I know the health department gets grants, etc. and tries to keep costs low. But there should not be that big of a difference in price.

 

[VA Hopeful Dr]

I reallycan’t make sense of price which is very very different apparently from actual cost. our big tertiary places charges$3000 for a 20 pathogen panel and the health department across the street charges $85 for an 18 panel. I know the health department gets grants, etc. and tries to keep costs low. But there should not be that big of a difference in price.

You have no idea.

6 years ago I got quest to quote me a cash price, clinic billed, for their respiratory PCR panel. $125.

 

[wholeheartedly]

You have no idea.

6 years ago I got quest to quote me a cash price, clinic billed, for their respiratory PCR panel. $125.

Our in house ID Now Flu test is billed at $500. Patients get pissed and complain and admins want me to help them justify it explaining that it’s a more accurate test than the old one. I said what’s the actual cost of the test with analyzer, reagents, controls, calibrators, tech time etc. like they taught us how to calculate it in lab tech school. Nobody could tell me or had any idea. I said, then how do we set the price? Our CFO said well we just set it to be 20% more than blue cross will reimburse. Which i’m sure they think helps their bottom line but probably doesn’t because our own employees will go to the neighboring town to get lab work done because ours is so expensive.

 

[VA Hopeful Dr]

Our in house ID Now Flu test is billed at $500. Patients get pissed and complain and admins want me to help them justify it explaining that it’s a more accurate test than the old one. I said what’s the actual cost of the test with analyzer, reagents, controls, calibrators, tech time etc. like they taught us how to calculate it in lab tech school. Nobody could tell me or had any idea. I said, then how do we set the price? Our CFO said well we just set it to be 20% more than blue cross will reimburse. Which i’m sure they think helps their bottom line but probably doesn’t because our own employees will go to the neighboring town to get lab work done because ours is so expensive.

That's the PCR one, right?

I do bet that's more than the roughly $40 I paid to order the old flu tests but I bet its not an order of magnitude more.