militaryPHYS

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If you are not on Twitter already I would recommend it. Search #covid4MDs and you will have real-time information from all over the world on what we know, how to treat illness and how to prevent spread in our hospitals while we treat. Spread the word.

Stay safe everyone!
 

DrMetal

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If you are not on Twitter already I would recommend it. Search #covid4MDs and you will have real-time information from all over the world on what we know, how to treat illness and how to prevent spread in our hospitals while we treat. Spread the word.

Stay safe everyone!
You can also follow
COVID-19 USA Physician/APP group
on Facebook.

or LITCovid on pubmed LitCovid - NCBI - NLM - NIH

or my personal thread: #damnitalltohellLetitspreadEvolutionatWork
 
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militaryPHYS

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These are great! The Facebook group makes sorting through the information a little easier than Twitter.
 
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Cooperd0g

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Or perhaps you could follow established guidelines from reputable sources and not practice medicine via social media hash tags.
 
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militaryPHYS

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This requires real time information from people going through hell having succeeded and failed treating a new virus amidst a pandemic. Adapt or die. This is all information from docs on the ground which we are verifying with known and evolving published papers (which are still not control trials and just case studies or observational data given quickly evolving disease).
 
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militaryPHYS

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Wuhan and Italy have released videos and information for their intubation team which shows how they rotate staff, protect with PPE, decrease aerosilized risk, etc. For example.

If you only rely on established sources and write off the things about social media that actually adds value to our generation then you’re missing out on incredible amounts of information for you and your patients.
 
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pgg

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What an unhelpful and counterproductive thing to say
No.

Tone was a little sharp, but there actually are people out there latching on to things they hear or read on the internet, that anecdotally, some person thought was helpful. Some of these interventions may turn out to be harmful. Some are causing a run on supplies (e.g. hydroxychloroquine), creating shortages that are harming people who need those things for actual proven indications. We shouldn't stop being scientists and doctors just because the world is on fire. Be the level head in the room.
 
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militaryPHYS

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Providers take real time updates and verify with available literature already published or new published data coming from the hard hit regions.

We are all verified healthcare professionals. We should be able to communicate and act like such.
 
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militaryPHYS

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Drive through testing centers. Who's doing them? What's your protocol?
There is a local unit that is doing this. Unfortunately criteria for testing seems flawed and frustrating that tests may be getting wasted on poorly indicated individuals
 
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I heard from an AF colleague their base is using surgeons and surgical subspecialists in the effing testing line instead of letting them order the tests ahead of time. Asinine. Absolutely asinine.
 
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militaryPHYS

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I heard from an AF colleague their base is using surgeons and surgical subspecialists in the effing testing line instead of letting them order the tests ahead of time. Asinine. Absolutely asinine.
Not sure what you are getting at here.

Most institutions (military and civilian) have cut back or halted all electives and therefore surgeons are being utilized elsewhere to help with the shortage of healthcare workers. I would hope that we are all willing to chip in wherever we are needed during these times.
 
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Not sure what you are getting at here.

Most institutions (military and civilian) have cut back or halted all electives and therefore surgeons are being utilized elsewhere to help with the shortage of healthcare workers. I would hope that we are all willing to chip in wherever we are needed during these times.
Oh sure sure, absolutely. But from my understanding, most institutions will require an order via telephone encounter before you're even allowed to be tested. At my friends base, they're saying the encounter has to be done face to face with a physician (ortho, ENT, general, vascular surgeons) in full PPE at time of testing in the car line. This seems like a highly unnecessary risk to place physicians in, especially when it can be done in a safer more efficient manner.
 
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militaryPHYS

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Oh sure sure, absolutely. But from my understanding, most institutions will require an order via telephone encounter before you're even allowed to be tested. At my friends base, they're saying the encounter has to be done face to face with a physician (ortho, ENT, general, vascular surgeons) in full PPE at time of testing in the car line. This seems like a highly unnecessary risk to place physicians in, especially when it can be done in a safer more efficient manner.
Gotcha. Yeah I agree. With so few tests there should be a coordinated effort to screen high risk exposure and/or symptomatic cases based on CDC guidelines.

As for exposure risk not sure. If proper PPE is used prob less risk of exposure out swabbing people than in the ED or ICU caring for the sick/confirmed cases.
 

Perrotfish

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No.

Tone was a little sharp, but there actually are people out there latching on to things they hear or read on the internet, that anecdotally, some person thought was helpful. Some of these interventions may turn out to be harmful. Some are causing a run on supplies (e.g. hydroxychloroquine), creating shortages that are harming people who need those things for actual proven indications. We shouldn't stop being scientists and doctors just because the world is on fire. Be the level head in the room.
I respectfully disagree. Useful professional society guidelines often lag months behind real time experiences in a crisis, and military/public health/CDC guidelines lag months behind society guidelines. At this time I think an ongoing dialogue with our colleagues on the front lines is critically important.

Also FWIW South Korea, which has kept its case fatality rate at about 1/5th what Europe is seeing, is also the country that implemented a protocol for treating their patients with Hydroxychloroquine and Kaletra early in the course of their outbreak. Source: South Korea experts recommend anti-HIV, anti-malaria drugs for COVID-19 So the reputable sources for at least one country agree that early implementation of this regimen is a prudent and scientifically supported plan.
 
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sb247

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I respectfully disagree. Useful professional society guidelines often lag months behind real time experiences in a crisis, and military/public health/CDC guidelines lag months behind society guidelines. At this time I think an ongoing dialogue with our colleagues on the front lines is critically important.

Also FWIW South Korea, which has kept its case fatality rate at about 1/5th what Europe is seeing, is also the country that implemented a protocol for treating their patients with Hydroxychloroquine and Kaletra early in the course of their outbreak. Source: South Korea experts recommend anti-HIV, anti-malaria drugs for COVID-19 So the reputable sources for at least one country agree that early implementation of this regimen is a prudent and scientifically supported plan.
Not arguing here, genuinely trying to learn.

Is sk 1/5th the fatality because they tested soooo many more asymptotic people and had a much bigger asymptomatic denominator or is that stat using hospitalized covid confirmed as the denominator and they just treated them so much better?
 

DrMetal

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Not arguing here, genuinely trying to learn.

Is sk 1/5th the fatality because they tested soooo many more asymptotic people and had a much bigger asymptomatic denominator or is that stat using hospitalized covid confirmed as the denominator and they just treated them so much better?
That or they discovered a cure for COVID. Of course the former.

Mortality calculations are always suspect (viral outbreaks aside). You can always skew the mortality rate by 'not looking enough' (make the denominator small) or by 'looking too much' (make it big).
 
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Perrotfish

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Not arguing here, genuinely trying to learn.

Is sk 1/5th the fatality because they tested soooo many more asymptotic people and had a much bigger asymptomatic denominator or is that stat using hospitalized covid confirmed as the denominator and they just treated them so much better?

Honestly we don't know. Some of their success is obviously keeping the virus away from their elderly population, because a much smaller percentage of their elderly population is getting it, but even broken down by age their mortality is lower than ours and Italy's for each age group. It could be that there is just a large asymptomatic carriage rate we aren't appreciating, but Italy is swabbing heavily as well and isn't seeing it, and when we monitored the cruise ships we didn't see a very large asymptomatic carrier rate there either (it existed but was a minority of cases). Italy also isn't doing anything that differently from Korea, in terms of public health, and for some reason they are seeing their hospitals flooded in a way that isn't explained just by the age and health characteristics of their population. Even China has a lower case fatality rate for each age group than Italy despite having a fraction of the ventilators, and the only difference I can appreciate in China's favor is that China was also an early adopter of hydroxychloroquine.

My main point, though, wasn't to say that we definitely should or shouldn't use these therapies, it was to say that in the absence of definitive studies and recommendations its not wrong to develop a plan of care based on following other physician groups rather than waiting for CDC guidelines to catch up. At this point the situation is so fluid that chances are that if you do your best to make an informed decision chances are whatever you decide upon is endorsed by at least one 'reputable source' somewhere in the world.
 

sb247

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Honestly we don't know. Some of their success is obviously keeping the virus away from their elderly population, because a much smaller percentage of their elderly population is getting it, but even broken down by age their mortality is lower than ours and Italy's for each age group. It could be that there is just a large asymptomatic carriage rate we aren't appreciating, but Italy is swabbing heavily as well and isn't seeing it, and when we monitored the cruise ships we didn't see a very large asymptomatic carrier rate there either (it existed but was a minority of cases). Italy also isn't doing anything that differently from Korea, in terms of public health, and for some reason they are seeing their hospitals flooded in a way that isn't explained just by the age and health characteristics of their population. Even China has a lower case fatality rate for each age group than Italy despite having a fraction of the ventilators, and the only difference I can appreciate in China's favor is that China was also an early adopter of hydroxychloroquine.

My main point, though, wasn't to say that we definitely should or shouldn't use these therapies, it was to say that in the absence of definitive studies and recommendations its not wrong to develop a plan of care based on following other physician groups rather than waiting for CDC guidelines to catch up. At this point the situation is so fluid that chances are that if you do your best to make an informed decision chances are whatever you decide upon is endorsed by at least one 'reputable source' somewhere in the world.
Thanks
 

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My main point, though, wasn't to say that we definitely should or shouldn't use these therapies, it was to say that in the absence of definitive studies and recommendations its not wrong to develop a plan of care based on following other physician groups rather than waiting for CDC guidelines to catch up.
I agree. It's not wrong to try something reasonable (like plaquenil, or azithromycin, for their immunosuppressive/anti-inflammatory attributes) especially in desperate times. We can't wait for a RCT on everything. Now I wouldn't slam the patient with everything and the kitchen sink, but trying a couple reasonable things is ok in my book. Maybe COVID is teaching us how to have some courage and conviction!
 
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notdeadyet

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Or perhaps you could follow established guidelines from reputable sources and not practice medicine via social media hash tags.
That became a lot harder when the CDC clinical guidelines started down adjusting to match equipment availability rather than sound medicine.

I’m now apparently supposed to treat COVID with less caution than last years flu.

I’m looking at research (shared on some of these sites) and finding a lot more of value than anything coming from the feds at this point.
 
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DrMetal

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I'm curious when they're going to start pulling IRR folks back
Not likely. I haven't even heard talk about involuntarily activating the SELRES (drilling reservists). I think the DoD would rather everybody just stay put. They'll deploy small AD bodies if needed (hospital ships, fields hospitals, etc).
 

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Hopefully. But what the DoD wants might be different than what DJT wants, where it's a nice soundbite to say "we have activated x# of additional physicians to combat this virus."
 
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Can mil residents be taken off rotation to be sent to areas of greater need? For now, my program is sheltering us as much as possible. But, feel like we can be more useful elsewhere.
 

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Not likely. I haven't even heard talk about involuntarily activating the SELRES (drilling reservists). I think the DoD would rather everybody just stay put. They'll deploy small AD bodies if needed (hospital ships, fields hospitals, etc).
I have a close O-6 friend headed from SELRES status to the Mercy. Note, she is waayy up in the CNRF medical chain at Norfolk so I take her intel at face value. Majority of Navy folks will be AD with some SELRES added, although CNRF put out an ALNAVRES message seeking volunteers for a “wait-and-see” roster. No intel about any IRR movement.

I volunteered before the message came out. ”Thanks, we have your contact info.” Unfortunately as a retiree I have no CAC, no current BUMED credentials, etc. Plus at my rank I am expensive labor and they’d much rather have JOs. To pull a retiree back onto AD takes a lot of effort and paperwork, exponentially more than activating a current SELRES :-/ (at least I am spared that tutorial on Information Awareness).
 
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Monty Python

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Give it another week and the tone of those emails will change.
Yeah, when I got my retirement orders and blue DD-2 retiree ID card (note: not a DD-214) I was politely informed that the pension was technically a retainer and came with a hook, called “potential involuntary recall if needed.”

The only way to avoid that is to decline the pension and benefits, and take the DD-214 discharge. But in a worst case I suppose you could still be drafted ???
 
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I got that email a couple of days ago as well. More interestingly, I received a phone call asking if my activation would disrupt my hospital or community and if I wanted to volunteer to mobilize.
 

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I wouldn't sweat getting pulled off IRR too much if you have a hospital job.

At least on the Guard side, they are not activating docs involuntarily or those with active hospital jobs. And activating us is like flipping a switch. Can't imagine the pain in getting retirees up and at 'em.

I wouldn't worry about involuntary activations until after the military has already burned through activating all the Guard and Reserve folks and that hasn't even been broached.

Besides, an aggressive federal response to this thing would be VERY atypical.
 

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Drive through testing centers. Who's doing them? What's your protocol?
I’m operating one: only for patients seen by other local doctors and telemedicine screened folks. I swab my own patients in the office, unless they’re kind enough to call first. I scored an appointment as the county’s drive through testing center, and as we’re rural; I’m the only place doing these in the county. The hospital only tests people being admitted or people who present to the ER, but no community gen-pop testing is being done there.


Our protocol is pretty simple: patient gets pre-screened; then told to drive to us. An order and screening question form is faxed. The patient pulls into a designated area of our parking lot, our lab tech dons the PAPR and contact/droplet gown and gloves and goes out and runs the test. If patient’s doc isn’t up to speed and just faxes an order without pre-screening form, I screen them and if the algorithm permits it, we run the test.

100% of tested patients are told to go into immediate quarantine, along with all household contacts. Nobody else in the home is tested. They can come off together if testing is negative.

So far we have no positives within a few county radius of our clinic.

I hand them CDC quarantine instructions; I give them CDC guidelines on when to come off quarantine if they test positive and I fax those to their provider, and tell the patient to be in contact with their ordering provider by phone going forward. I also tell them that if worsening to the point of moderate to severe dyspnea, or self care is impossible, to alert the ED ahead of time of their situation and pending arrival. And alert EMS as well if going that route.

I also tell everyone that even if their test is negative, the neighborly thing to do is to quarantine until better, that this goes for any communicable disease. And I strongly encourage them to do so.
 
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