The ultimate COVID thread

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anbuitachi said:
All our ICUs are already full. We are keeping these tubed patients on the floors/stepdown areas until those fill up
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What about your ORs? They being used for overflow?
 
pjl said:
While I understand your point, and the answer is no, what would you have done differently if you were Emperor?

Quarantine when?
Ramp up production of vents when?
Ramp up masks when?
Get tests from where?

I think Trump has done a poor job of this, but really question what could have been done differently that actually would have mattered. Hindsight is good, but aside from my super anxious wife who bought me n95 masks a year ago, and stocked us for the apocalypse in early January, most people didn’t see this unfolding in this manner.
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Testing. The answer was and still is testing. That was fumbled badly at the start of this. Who is at fault for that is up for debate, but if you wanted any chance at containment then you needed to test. We still need to test, but the tests are not available. If you want to open up segments of our economy again then you need broad and aggressive testing.

I won’t get into how this was politicized by the administration because that is well documented.

I do think it is unacceptable that the richest country in the world doesn’t have enough PPE for the healthcare workers. I blame that on the hospital administrators.

We can also discuss how over the past decade or two the trend has been for hospitals to reduce capacity, live hand to mouth off borderline unnecessary elective surgery, and keep beds full. How many hospitals were closed in NYC in the past 10-15 years? I bet they are wishing they had a couple of them back right now.

There are a lot of failures to discuss, and to be fair, Trump and his administration only played a small role in those failures. However, it is completely fair to criticize the President’s immediate response to this because those early days of the pandemic are the most critical.
 
Wkrdoc said:
100%

I’m not going to sit here and say this was masterfully planned and carried out. But he has done a lot more than Obama, and that’s not taking a shot at Obama

Was Obama wrong for not instituting social distancing? Would it have saved more lives? Who knows. But we lost 12,500 lives and the TRUE mortality rate will be comparable. Anyone who thinks we’ve only had 28k COVID cases is fooling themselves

At any rate, if you guys want a “bash Trump” aka political thread, make a new one. I’m here for blades/others opinions on stocks/markets
Click to expand...

I thought you were looking toward the future and not the past? Why are you talking about Obama?
 
GravelRider said:
Testing. The answer was and still is testing. That was fumbled badly at the start of this. Who is at fault for that is up for debate, but if you wanted any chance at containment then you needed to test. We still need to test, but the tests are not available. If you want to open up segments of our economy again then you need broad and aggressive testing.

I won’t get into how this was politicized by the administration because that is well documented.

I do think it is unacceptable that the richest country in the world doesn’t have enough PPE for the healthcare workers. I blame that on the hospital administrators.

We can also discuss how over the past decade or two the trend has been for hospitals to reduce capacity, live hand to mouth off borderline unnecessary elective surgery, and keep beds full. How many hospitals were closed in NYC in the past 10-15 years? I bet they are wishing they had a couple of them back right now.

There are a lot of failures to discuss, and to be fair, Trump and his administration only played a small role in those failures. However, it is completely fair to criticize the President’s immediate response to this because those early days of the pandemic are the most critical.
Click to expand...

Nobody could’ve handled this perfectly man.

If you wanna get pissed off at someone, be pissed at China.

Had they not suppressed the gravity of the situation world could've had time to prepare and save lives.
 
Wkrdoc said:
Nobody could’ve handled this perfectly man.

If you wanna get pissed off at someone, be pissed at China.

Had they not suppressed the gravity of the situation world could've had time to prepare and save lives.
Click to expand...

Ah he did his best, man.

Is this Little League? Let’s give Trump a participation trophy because he tried really hard. Nobody’s perfect, man.

Are you serious? Please tell me you’re not serious.
 
MoMoGesiologist said:
@BLADEMDA, we can’t even treat male pattern baldness (a disease afflicting millions if not billions). How do you seriously believe we are we gonna treat COVID by the end of the summer?
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Umm, yes we can. Several drugs that work for that plus procedures.
 
Monty Python said:
Just for the sake of conversation, how might you theorize? Totally socialized healthcare in the US? Financial calamity which takes a decade or more to recover from? Massive social unrest, with foundational changes in our political structure? Do we follow the path of other prior world powers (Rome, Spain, the UK) and become just another has-been country?
Click to expand...

I think we’re seeing a decline in the global competitiveness of democracy/capitalism/freedom. Just as nationalism and monarchy could not withstand globalization last century (and this was seen in WWI, WWII, etc.), the trend may be reversing. It seems that countries that mix markets with authoritarianism are able to respond to crises much better than truly free countries. China and South Korea could stop the flow of COVID-19, because they are not afraid to strip people of their rights and quarantine them indefinitely. If we cling to rights/freedom, it could be our downfall.
 
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Wkrdoc said:
Nobody could’ve handled this perfectly man.

If you wanna get pissed off at someone, be pissed at China.

Had they not suppressed the gravity of the situation world could've had time to prepare and save lives.
Click to expand...
He handled it horrifically badly though. Because of his painting of the illness as no big deal and something people can go to work with I still have to argue with colleagues and patients on the regular that yes, this is a big deal. Since it takes so damn long to die with it, we don't know how big of a deal yet. He fired the people that could have given a timely report and guidance with regard to the situation in 2018, being penny wise and pound foolish by saving a few million dollars of CDC pandemic spending at the cost of trillions to the American public now. And then couple that with his early and continued inaction and we have the makings of a crisis on our hands.

It is hard to imagine anyone that is capable of being elected POTUS handling the situation worse than he has.
 
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FFP said:
There we go, as predicted:

www.propublica.org

Lupus Patients Can’t Get Crucial Medication After President Trump Pushes Unproven Coronavirus Treatment

Trump’s unproven claim that hydroxychloroquine could be used to treat COVID-19 has led to hoarding, putting Lupus patients and others at even greater risk. As of Saturday afternoon, Anna Valdez had 27 pills left. That number is now down to 25.
www.propublica.org www.propublica.org
Click to expand...
Plaquenil is being used in the treatment algorithm at MGH among other places. If it’s good enough for them, it’s good enough for me. That being said I am only taking the prophylactic dose (400 mg/week). Definitely not going to take the full lupus dose of BID....
We will likely be intubating patients with COVID. I will be directly in the line of fire and would like some (possible) protection....
 
GravelRider said:
Ah he did his best, man.

Is this Little League? Let’s give Trump a participation trophy because he tried really hard. Nobody’s perfect, man.

Are you serious? Please tell me you’re not serious.
Click to expand...

Oh how cute, twisting words now?

You people are exhausting
 
Mad Jack said:
He handled it horrifically badly though. Because of his painting of the illness as no big deal and something people can go to work with I still have to argue with colleagues and patients on the regular that yes, this is a big deal. Since it takes so damn long to die with it, we don't know how big of a deal yet. He fired the people that could have given a timely report and guidance with regard to the situation in 2018, being penny wise and pound foolish by saving a few million dollars of CDC pandemic spending at the cost of trillions to the American public now. And then couple that with his early and continued inaction and we have the makings of a crisis on our hands.

It is hard to imagine anyone that is capable of being elected POTUS handling the situation worse than he has.
Click to expand...
This thing is bigger then trump. I it keeps up for any amount of time it will be the defining story of our lifetime. What do you think Obama or Clinton would have done differently? We live in a free society with easy international travel. By the time China realized it had a problem this virus was already here....
Europe is not doing any better and they don’t have trump....
 
dannyboy1 said:
This thing is bigger then trump. I it keeps up for any amount of time it will be the defining story of our lifetime. What do you think Obama or Clinton would have done differently? We live in a free society with easy international travel. By the time China realized it had a problem this virus was already here....
Europe is not doing any better and they don’t have trump....
Click to expand...
He should nationalize the health care system per the emergency plan that was drafted for just such a scenario and lock down the country. And Europe is making huge strides in control compared to the United States. Despite our less prevalent testing we still had nearly as many new cases of COVID as the entirety of the rest of the world combined so far today. If that doesn't tell you we're doing something wrong I don't know how the hell to convince you.
 
anbuitachi said:
ORs not being used for covid yet. i think the main issue is who will staff them
next up i believe is PACU
Click to expand...


How easy is it to convert positive pressure ORs to negative or neutral pressure rooms? Or is the protocol other places are using to tube elsewhere and then transport into the OR to use the vent?

Or just moving OR vents to other rooms throughout the hospital? We’ve had several intubations already but haven’t quite gotten as dire as other places quite yet...
 
dannyboy1 said:
Plaquenil is being used in the treatment algorithm at MGH among other places. If it’s good enough for them, it’s good enough for me. That being said I am only taking the prophylactic dose (400 mg/week). Definitely not going to take the full lupus dose of BID....
We will likely be intubating patients with COVID. I will be directly in the line of fire and would like some (possible) protection....
Click to expand...
how do you take it? 400mg at a time or 200mg twice a week?
 
Mad Jack said:
He should nationalize the health care system per the emergency plan that was drafted for just such a scenario and lock down the country. And Europe is making huge strides in control compared to the United States. Despite our less prevalent testing we still had nearly as many new cases of COVID as the entirety of the rest of the world combined so far today. If that doesn't tell you we're doing something wrong I don't know how the hell to convince you.
Click to expand...


On our current trajectory, we will surpass Italy and China in 1-2 weeks and the USA will be #1.
 
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nimbus said:
On our current trajectory, we will surpass Italy and China in 1-2 weeks and the USA will be #1.
Click to expand...
Looks like the numbers were bugged there for a minute, cases were showing as 14,000+ for the US instead of 8,000+. We're still #1 for new cases, and soon to beat China like Trump always wants to do
 
Mark my words, people. It will be a sh-tfest! Just a couple of weeks from now, we'll need as much psych support as the millennials.

Patients will be dying in droves, we'll be denying care to senior citizens to save the younger ones, and we'll be running out of all kinds of resources, including human ones, unless some miracle happens and the idiots in charge curfew the cities. Even then, it will take a month to really feel the results.
 
FFP said:
Mark my words, people. It will be a sh-tfest! Just a couple of weeks from now, we'll need as much psych support as the millennials.

Patients will be dying in droves, we'll be denying care to senior citizens to save the younger ones, and we'll be running out of all kinds of resources, including human ones, unless some miracle happens and the idiots in charge curfew the cities. Even then, it will take a month to really feel the results.
Click to expand...

Disagree with that one. First come first served. Out of fear of the consequences of making those types of judgement.
 
dr doze said:
Disagree with that one. First come first served. Out of fear of the consequences of making those types of judgement.
Click to expand...
It **** hits the fan, we have to operate like the military. Focus limited resources to the younger healthier ones who have a chance to live and a whole lot of living to do.
Are you seriously going to focus your efforts on 80 year old grandma or grandpa and give him/her resources as you let 40 year old dad die?
 
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FFP said:
Mark my words, people. It will be a sh-tfest! Just a couple of weeks from now, we'll need as much psych support as the millennials.

Patients will be dying in droves, we'll be denying care to senior citizens to save the younger ones, and we'll be running out of all kinds of resources, including human ones, unless some miracle happens and the idiots in charge curfew the cities. Even then, it will take a month to really feel the results.
Click to expand...

Let’s hope you’re wrong

That hasn’t happened anywhere else in the world, not even Italy or China
 
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chocomorsel said:
It **** hits the fan, we have to operate like the military. Focus limited resources to the younger healthier ones who have a chance to live and a whole lot of living to do.
Are you seriously going to focus your efforts on 80 year old grandma or grandpa and give him/her resources as you let 40 year old dad die?
Click to expand...

Who is going to make those decisions? The families? The overworked physicians? We can’t get docs to talk about advanced directives for 89 year old granny in easy times, and now we’re going to do it under these circumstances?

This is going to get ugly.
 
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GravelRider said:
Who is going to make those decisions? The families? The overworked physicians? We can’t get docs to talk about advanced directives for 89 year old granny in easy times, and now we’re going to do it under these circumstances?

This is going to get ugly.
Click to expand...
Proof:
www.jpost.com

Israeli doctor in Italy: No. of patients rises but we get to everyone | The Jerusalem Post

Dr. Gai Peleg told Israeli television that in northern Italy, patients over 60 tend to receive less treatment with anesthesia and artificial respiratory machines.
www.jpost.com www.jpost.com
 
chocomorsel said:
It **** hits the fan, we have to operate like the military. Focus limited resources to the younger healthier ones who have a chance to live and a whole lot of living to do.
Are you seriously going to focus your efforts on 80 year old grandma or grandpa and give him/her resources as you let 40 year old dad die?
Click to expand...
How about a 65yr anesthesiologist vs a 40yo healthy homeless with 3 kids?
 
narcotics999 said:
How about a 65yr anesthesiologist vs a 40yo healthy homeless with 3 kids?
Click to expand...
How about who’s the one with the higher comorbidities and higher chance to live?
Focus resources on the ones likely to survive.
That's the reality of what happens when resources are scarce.

Oh, totally didn’t see the healthy 40 year old part. I would tell the anesthesiologist to spend his last hours with his loved ones or find a way to transfer to a far away hospital with better resources.
 
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GravelRider said:
Who is going to make those decisions? The families? The overworked physicians? We can’t get docs to talk about advanced directives for 89 year old granny in easy times, and now we’re going to do it under these circumstances?

This is going to get ugly.
Click to expand...
Well, if we are in operation military mode, then the docs make those decisions. No one will fault us. The ones who will will be outnumbered.
No one will go to jail. But since this is America I am sure someone will get sued.
Deal with that **** later if we survive.
 
dr doze said:
The don’t have the rule of lawyers.


Sent from my iPhone using SDN mobile
Click to expand...
Screw the lawyers. Let them sue! What are the chances of them winning? Let them threaten to sue while I hold the key to their survival. I dare them.

But Seriously, you’d worry about lawyers at a time like this?
 
It is unbelievable to me that my shop is still doing elective cases, and we are not too far from NYC.
 
chocomorsel said:
Well, if we are in operation military mode, then the docs make those decisions. No one will fault us. The ones who will will be outnumbered.
No one will go to jail. But since this is America I am sure someone will get sued.
Deal with that **** later if we survive.
Click to expand...

www.nytimes.com

The Deadly Choices at Memorial (Published 2009)

The aftermath of Hurricane Katrina at Memorial Medical Center in New Orleans.
www.nytimes.com www.nytimes.com

We’ve been down this road. There will be arrests of physicians, lawsuits, careers and reputations ruined. To suggest that we just go into “military mode” doesn’t take into account how truly difficult that is and what the consequences of that will be.
 
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dr doze said:
Disagree with that one. First come first served. Out of fear of the consequences of making those types of judgement.
Click to expand...
Agreed. You see a patient in respiratory failure requiring mechanical ventilation. Your recommendation is intubate and ventilate. Can’t be like “well someone might come in later and need it more “...
Someone higher up will have to make blanket rules ( no tube for >70 years old).
 
FFP said:
Mark my words, people. It will be a sh-tfest! Just a couple of weeks from now, we'll need as much psych support as the millennials.

Patients will be dying in droves, we'll be denying care to senior citizens to save the younger ones, and we'll be running out of all kinds of resources, including human ones, unless some miracle happens and the idiots in charge curfew the cities. Even then, it will take a month to really feel the results.
Click to expand...


Washington state is already officially discussing/planning for this.


www.nytimes.com

‘Chilling’ Plans: Who Gets Care as Washington State Hospitals Fill Up? (Published 2020)

Fearing a critical shortage of lifesaving resources as the coronavirus spreads, Washington State is engaged in grim discussions to determine which dying patients would get priority.
www.nytimes.com www.nytimes.com
 
chocomorsel said:
Screw the lawyers. Let them sue! What are the chances of them winning? Let them threaten to sue while I hold the key to their survival. I dare them.

But Seriously, you’d worry about lawyers at a time like this?
Click to expand...

What if the sickest person in your unit is a 60 year old who has been on a vent for a week and is starting to improve, but still needs mechanical ventilation and now a healthy 40 year old comes in and needs a vent? What are you going to do? Extubate the 60 year old and give the vent to the 40 year old?
 
GravelRider said:
Didn’t NY pass a “shelter in place“ starting today?
Click to expand...

im not sure how they are enforcing it, other than closing down non essential businesses. i have yet to see any cops stop anyone on the streets.


Monty Python said:
Washington state is already officially discussing/planning for this.


www.nytimes.com

‘Chilling’ Plans: Who Gets Care as Washington State Hospitals Fill Up? (Published 2020)

Fearing a critical shortage of lifesaving resources as the coronavirus spreads, Washington State is engaged in grim discussions to determine which dying patients would get priority.
www.nytimes.com www.nytimes.com
Click to expand...
GravelRider said:
What if the sickest person in your unit is a 60 year old who has been on a vent for a week and is starting to improve, but still needs mechanical ventilation and now a healthy 40 year old comes in and needs a vent? What are you going to do? Extubate the 60 year old and give the vent to the 40 year old?
Click to expand...

over next couple weeks, what may happen is we run out of vents, and there will be a list of people who need intubations down in the ED/floor. at that time you can triage. the recommendation is INTUBATE early if possible, not wait until they are peri-code. here it seems like the medicine teams are asking us to intubate when their patients get to saturation of 80s, on non rebreather. therefore you usually have time to choose who to intubate. my hospital isnt triaging since we still have vents and supplies, but even then i am seeing a lot of 40s yr olds needing intubation.
 
GravelRider said:
What if the sickest person in your unit is a 60 year old who has been on a vent for a week and is starting to improve, but still needs mechanical ventilation and now a healthy 40 year old comes in and needs a vent? What are you going to do? Extubate the 60 year old and give the vent to the 40 year old?
Click to expand...
Yeah. And ask the family members of the 60year old to hold the fort and hand ventilate. Haha.
But seriously, when that happens, some people may have to be early extubated. Or some forty year olds may have to die. That’s where it gets murky.
If they come in at the same time, tube the one with the highest probability of living. If that means a 60 year old healthy patient over a 40 year old morbidly obese diabetic, HTN
smoker, then the 60 year old wins.
 
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dannyboy1 said:
Agreed. You see a patient in respiratory failure requiring mechanical ventilation. Your recommendation is intubate and ventilate. Can’t be like “well someone might come in later and need it more “...
Someone higher up will have to make blanket rules ( no tube for >70 years old).
Click to expand...
The discussion now is when all the ventilators are in use. Then what?
At that point we just wait for attrition and search from the ventilators. And then triage based on comorbidities.
 
www.wsj.com

How South Korea Solved Its Acute Hospital-Bed Shortage

During the darkest days of South Korea’s coronavirus outbreak, patients were dying while waiting for hospital beds. The country managed to turn the rapidly deteriorating situation around by reserving beds for those most in need.
www.wsj.com www.wsj.com
 
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