What do I need to know about coronavirus?

[TwoHighways]

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Public Health Responses to COVID-19 Outbreaks on Cruise Ships...

More than 800 cases of laboratory-confirmed coronavirus disease 2019 cases occurred during outbreaks on three cruise ship voyages, and cases linked to several additional cruises have been reported...

www.cdc.gov

Looking further at the diamond princess data, one infected guy was on the ship five days prior to getting off in Hong Kong. Normal cruise ship activities continued for an additional five days prior to the ship entering “quarantine” (air quotes used to emphasize that crew members were not quarantined). 18% infection rate. Of those infected, 10% were admitted to an ICU and about 1% of the total infected died (in a population skewed towards the elderly).

 

[Rekt]

Public Health Responses to COVID-19 Outbreaks on Cruise Ships...

More than 800 cases of laboratory-confirmed coronavirus disease 2019 cases occurred during outbreaks on three cruise ship voyages, and cases linked to several additional cruises have been reported...

www.cdc.gov

Looking further at the diamond princess data, one infected guy was on the ship five days prior to getting off in Hong Kong. Normal cruise ship activities continued for an additional five days prior to the ship entering “quarantine” (air quotes used to emphasize that crew members were not quarantined). 18% infection rate. Of those infected, 10% were admitted to an ICU and about 1% of the total infected died (in a population skewed towards the elderly).

An epidemiological wet dream that everyone wants to ignore.

 

[TooMuchResearch]

They're backordered.

Do your RTs know how to use an MDI with spacer?

 

[thegenius]

Another sensible website about the future of COVID
Updated COVID-19 statistics and analysis | Nucleus Wealth

A synopsis:

Key COVID-19 Questions

1. Which COVID-19 statistics can be trusted? We are looking at South Korea, the Diamond Princess and Singapore as being the best indicators as they are the largest affected countries that have shown to be the most transparent. China, Iran and Italy all have significant question marks over their COVID-19 statistics.
2. Is Winter an issue? Maybe. Summer and Tropical countries haven’t yet seen sustained outbreaks which may mean a heat/light/humidity factor. But, this appears to be changing now.
3. How fast is it spreading? The case numbers are still catching up from earlier undiagnosed cases which might make the spread seem faster than it really is. South Korea, Singapore, Hong Kong and Taiwan seem to be resisting. Most of Europe, the US and Iran look out of control.
4. How deadly is it? If contained, our best estimate is in the 0.4% to 1.0%. It is probably closer to 5% if not contained as in Wuhan, Italy and Iran. It is significantly more deadly for older people.
5. How long will it last? At a local level, prior epidemics suggest six weeks in an unconstrained environment (Iran?). In areas with quarantines and shutdowns much longer. At least 3-4 months, more likely double or triple that.

Basically....they say China can't be trusted at all among a few other things.

 

[ShockIndex]

We don't have MDIs at my hospital. They never used to carry them as they would always do nebs. Our hospital has now ordered them, but they are backordered indefinitely. So essentially at this point in time, no albuterol treatments for anyone.

They're backordered.

Yeah, that doesn’t surprise me too much. The per unit cost of MDIs is much more than an ampule of albuterol for a nebulizer.

We once had a problem with some providers feeding the bears a couple of years ago by sending lots of people home with an MDI and costing the hospital a lot of money. This caused recidivism among some patients who would register in the ED with complaints of an asthma attack just to get a free MDI. The hospital removed the MDIs from the ED and put them in central pharmacy.

 

[thegenius]

Dude...this hasn't really hit India yet. At least that we know of.

If you were PM of India, would you consider locking it down entirely now! Everybody! They have over 1,000,000,000 people

Well three days later my prediction came true. Modi locked down the entire country. And they only have 562 cases and 10 deaths.

It’s a country of 1.3B!!!!!!

 

[bravotwozero]

Well three days later my prediction came true. Most locked down the entire country. And they only have 562 cases and 10 deaths.

It’s a country of 1.3B!!!!!!

Yeah I'm not sure if they're going to be able to lock down the entire country. It's just the beginning there, wait and see what happens to them in 4 weeks. They don't have the infrastructure or resources to deal with the fallout.

 

[rokshana]

Yeah I'm not sure if they're going to be able to lock down the entire country. It's just the beginning there, wait and see what happens to them in 4 weeks. They don't have the infrastructure or resources to deal with the fallout.

they have been dealing with ALL kinds of infectious diseases and outbreaks for decades without infrastructures or resources...they are going to be better prepared to deal with their third world country than we are dealing with our third world country...

 

[bravotwozero]

Also, anyone see the AAEM position on doctors supplying their own PPE? Once again, they're the only ones who have proven they give a crap about us.

AAEM Position Statement on Use of Self-Supplied PPE

 

[southerndoc]

Hope they got you guys some PAPRs. As the elective joint volume has dried up here we appropriated some from the OR.

I think that's overkill. N-95, gown, and a Glidescope are what I use. Glidescope keeps my face away from their face. If I was doing traditional laryngscopy, then yea, I would probably insist on a PAPR.

 

[bravotwozero]

I think that's overkill. N-95, gown, and a Glidescope are what I use. Glidescope keeps my face away from their face. If I was doing traditional laryngscopy, then yea, I would probably insist on a PAPR.

What about when you're seeing a known/suspected COVID patient that's stable? N-95 or surgical mask?

 

[thegenius]

I’m using a surgical mask. COVID is considered droplet transmission. Only humans can aerosolize it with machines

 

[Brigade4Radiant]

No. 202.10: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency

No. 202.10: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency

www.governor.ny.gov

 

[bravotwozero]

I’m using a surgical mask. COVID is considered droplet transmission. Only humans can aerosolize it with machines

And by coughing and sneezing too....


Sent from my iPhone using Tapatalk

 

[Money-Moniker]

I work at a hospital outside of NYC and about 3/4 of the ED visits are COVID related. No extreme surges but our hospital is steadily filling with COVID cases. Sustainable for another 2 weeks? Sure. Sustainable for a month? Unlikely. I have co-workers that tested positive and attempted to push through it at home and ended up admitted.I'm beginning to suspect that Italy has a mutated strain, which may have been transmitted to NYC during that Friday rush back to the US. Thousands of people in the airports crowded together.

Are those coworkers who ended up hospitalized under 40 and fit, or over 40 and/or not in the best shape? There is so much contradictory information floating out there that it's hard to make heads or tails of what's really going on.

 

[evilbooyaa]

Public Health Responses to COVID-19 Outbreaks on Cruise Ships...

More than 800 cases of laboratory-confirmed coronavirus disease 2019 cases occurred during outbreaks on three cruise ship voyages, and cases linked to several additional cruises have been reported...

www.cdc.gov

Looking further at the diamond princess data, one infected guy was on the ship five days prior to getting off in Hong Kong. Normal cruise ship activities continued for an additional five days prior to the ship entering “quarantine” (air quotes used to emphasize that crew members were not quarantined). 18% infection rate. Of those infected, 10% were admitted to an ICU and about 1% of the total infected died (in a population skewed towards the elderly).

~10% of those infected required intensive care, correct (as per your link)? In a stable, non-overwhelmed health care system, that leads to ~10% of those (1.2% mortality rate in those infected) patients, dying. That is still 10% higher than influenza.

The primary concern here is when that 10% of infected folks require intensive care and completely overwhelms the capabilities of the health care system to take care of them, will that death rate go higher? Italy suggests that yes, it will, as equipment and manpower availability start to drop off.

Someone else said state of NY has 3k ICU beds? To be conservative, let's say all 3k of those are in NYC. Let's say with emergency measures they can triple the number of ICU beds.

NYC population listed as 8.62m per Google. 19.2% infection rate between passengers and crew (per the link you posted) = 1.65m. If 10% of those require intensive care, that is 165k people solely in NYC that require intensive care. 165k people who need ventilators for 9k ICU beds. Let's say average length of ICU admission is 7 days, either to recovery and moving out of ICU or to death. That means you need 1.155m ICU-days for those 165k people. I will presume that anybody who does not have a ventilator available when they need it will die.

If those people come over the course of 1 month, that is 270k ICU-days available. 3/4 of people will not have a ventilator available to them. That means an extra 120k people will die.
If those people come over the course of 3 months, that is 810k ICU-days available. 30% of people will not have a ventilator available to them. That means an extra 43.5k people will die.
The break even point (with my admittedly back of the envelope predictions) is 128.3 days, or just over 4 months, for all folks to have a ventilator available to them.

This is why flattening the curve with shelter-in-place is beneficial. ~16.5k people are going to die in NYC unless we can lower the infection rate regardless. The goal is to avoid how many of them died because they could not get the intensive care that was necessary. I've taken multiple liberties to appease those who are minimizing this (not all 3k ICU beds are in NYC, to be determined if a tripling of ICU bed capacity is feasible). I will say that current shelter-in-place lockdown may reduce the overall infection rate (which is good) which then changes the rest of those numbers.

To say that maybe social distancing is enough and otherwise people should get back to work is reasonable. To suggest that all churches should be packed by Easter or anything else that eliminates social distancing is dangerous.

*DISCLAIMER* - I am not a trained epidemiologist. This is just something to counterpoint those who say "Look at Princess Cruise, the mortality rate was only 1%!"

 

[evilbooyaa]

Which line is NYC going to take?

View attachment 299676

I think #2

I think it'll be 1.

Good to see California doing well though.

 

[TwoHighways]

~10% of those infected required intensive care, correct (as per your link)? In a stable, non-overwhelmed health care system, that leads to ~10% of those (1.2% mortality rate in those infected) patients, dying. That is still 10% higher than influenza.

The primary concern here is when that 10% of infected folks require intensive care and completely overwhelms the capabilities of the health care system to take care of them, will that death rate go higher? Italy suggests that yes, it will, as equipment and manpower availability start to drop off.

Someone else said state of NY has 3k ICU beds? To be conservative, let's say all 3k of those are in NYC. Let's say with emergency measures they can triple the number of ICU beds.

NYC population listed as 8.62m per Google. 19.2% infection rate between passengers and crew (per the link you posted) = 1.65m. If 10% of those require intensive care, that is 165k people solely in NYC that require intensive care. 165k people who need ventilators for 9k ICU beds. Let's say average length of ICU admission is 7 days, either to recovery and moving out of ICU or to death. That means you need 1.155m ICU-days for those 165k people. I will presume that anybody who does not have a ventilator available when they need it will die.

If those people come over the course of 1 month, that is 270k ICU-days available. 3/4 of people will not have a ventilator available to them. That means an extra 120k people will die.
If those people come over the course of 3 months, that is 810k ICU-days available. 30% of people will not have a ventilator available to them. That means an extra 43.5k people will die.
The break even point (with my admittedly back of the envelope predictions) is 128.3 days, or just over 4 months, for all folks to have a ventilator available to them.

This is why flattening the curve with shelter-in-place is beneficial. ~16.5k people are going to die in NYC unless we can lower the infection rate regardless. The goal is to avoid how many of them died because they could not get the intensive care that was necessary. I've taken multiple liberties to appease those who are minimizing this (not all 3k ICU beds are in NYC, to be determined if a tripling of ICU bed capacity is feasible). I will say that current shelter-in-place lockdown may reduce the overall infection rate (which is good) which then changes the rest of those numbers.

To say that maybe social distancing is enough and otherwise people should get back to work is reasonable. To suggest that all churches should be packed by Easter or anything else that eliminates social distancing is dangerous.

*DISCLAIMER* - I am not a trained epidemiologist. This is just something to counterpoint those who say "Look at Princess Cruise, the mortality rate was only 1%!"

I think infection rate was artificially high on a cruise ship. Also, I would assume the average age of the people on the ship is higher than that of the population of New York, which would lend itself to a disproportionate amount of bad outcomes in comparison to a younger population.

 

[evilbooyaa]

I think the infection rate will be in the ~10 range as long as we continue practicing social distancing, up to let's say 15% (still lower than the cruise ship) if we don't.

Even if it's a 5% (half) ICU rate, the break even point is going to be somewhere around 2 months to not get excess mortalities. I think it's dangerous to point to something as an epidemiology and then make a bunch of assumptions that real life will not be as bad. Not impossible, and you're probably right, but generally the worry is over the worst case scenario, not the best case scenario.

 

[TwoHighways]

My entire issue with this was the lack of quality data, lack of widespread testing early, the dire predications predicated on crappy data, the media and government induced paranoia, and the idiots within the general public that freaked the hell out and hit the grocery stores as if nuclear Armageddon was imminent. If social distancing measure continue for months (I hope that isn’t the case), the recession we’ve been overdue for will only increase in severity.

 

[Angry Birds]

PAPR's can be sterilized and reused... What is the turnaround time on that cleaning process?

 

[miacomet]

Uh, this sounds bad: "It's Spreading Throughout The Hospital": NYC Healthcare Workers Describe Dire Conditions As Coronavirus Patients Flood Wards

 

[BoardingDoc]

PAPR's can be sterilized and reused... What is the turnaround time on that cleaning process?

10 minutes. We literally take ours off, wipe them down with normal purple wipes and hang them back up for use.

 

[Fox800]

No PAPRs at my dysfunctional FSEDs. I tried wearing an N95 yesterday for 4 hours and it was torture - just ripping in to the back of your scalp. Will probably start wearing my own respirator with P100 filters.

Hospital I work at uses 90% locums/firefighters from out-of-state. Admin has said that any physicians recently in CA, WA, or NY need to quarantine in-town for 14 days before working a clinical shift. That's basically our entire roster. Quarantine in a hotel, where they don't live, for 2 weeks, at their own expense. When we told them that this would be impossible/a total non-starter, we were told "figure it out". This is what I'm up against. Idiots.

My buddy is an intensivist at a large academic MICU in the Midwest. Has one patient in early 40s, no PMHx, on VV ECMO. Multiple people intubated under 40 years old. I barely got a flight home from a locums assignment yesterday. It's getting hairy out there.

 

[Birdstrike]

Uh, this sounds bad: "It's Spreading Throughout The Hospital": NYC Healthcare Workers Describe Dire Conditions As Coronavirus Patients Flood Wards

Interesting article. Thanks for posting it. There's some bad stuff in there, no doubt. I also found it interesting that while listing all the bad things like: Dwindling resources, lack of protective equipment for staff, tents set up outside to house the expected corpses, DNR orders are being force signed against patients' will, seasoned ER and ICU docs are worried they'll run out of vents like in times of war...But that's nothin', that's nothin' compared to the fact that an "NP was sad." They felt the need to put in the article an NP was sad she couldn't spend more time with her patient.

 

[Angry Birds]

10 minutes. We literally take ours off, wipe them down with normal purple wipes and hang them back up for use.

Thanks!

No PAPRs at my dysfunctional FSEDs. I tried wearing an N95 yesterday for 4 hours and it was torture - just ripping in to the back of your scalp. Will probably start wearing my own respirator with P100 filters.

So, this was actually my next question: is it a good idea to just wear an N95 throughout one's shift and just throw on a surgical mask on top which is switched out between patients?

I guess I didn't think about this about the N95 tearing at the back of the scalp, etc. I've seen people wear a surgical mask the whole shift but I wanted to know how it would feel to do the same with an N95...

Of course, I am assuming we need to throw out N95's if we go into a room with a Covid positive patient (or someone who is high risk for it)...

 

[Fox800]

Thanks!



So, this was actually my next question: is it a good idea to just wear an N95 throughout one's shift and just throw on a surgical mask on top which is switched out between patients?

I guess I didn't think about this about the N95 tearing at the back of the scalp, etc. I've seen people wear a surgical mask the whole shift but I wanted to know how it would feel to do the same with an N95...

Of course, I am assuming we need to throw out N95's if we go into a room with a Covid positive patient (or someone who is high risk for it)...

CDC has said we can wear the same N95 between multiple patients as long as it isn't grossly soiled/soaked and in good condition due to the shortage. Don't need to change it out unless it's ruined or like someone spits all over you or something like that.

 

[Fox800]

Interesting article. Thanks for posting it. There's some bad stuff in there, no doubt. I also found it interesting that while listing all the bad things like: Dwindling resources, lack of protective equipment for staff, tents set up outside to house the expected corpses, DNR orders are being force signed against patients' will, seasoned ER and ICU docs are worried they'll run out of vents like in times of war...But that's nothin', that's nothin' compared to the fact that an "NP was sad." They felt the need to put in the article an NP was sad she couldn't spend more time with her patient.

They didn't include critical care medicine or complex medical ethical decision-making while they were busy writing papers about nursing leadership theory and learning how to inject fillers and Botox. Real-life medicine is hard, Jenny McJennyson!

 

[Birdstrike]

Meanwhile, back to @miacomet 's Gothamist article. I went to the front page of Gothamist.com and saw this. Right next to the New York Hospital Armageddon article, is another article about "social distancing" in New York.

That picture was taken in Carl Schurz Park, which is literally steps from Mayor De Blasio's house, Gracie Mansion. If you turn to your left, you can literally see it, if not for the trees. It's literally only a few feet away.

Zoom out and guess what's also walking distance away? At least one of the hospitals mentioned, NY Presbyterian (several hospitals are mentioned, ranging in distance from a few blocks to a few miles away) is also walking distance, less than one mile away from the Mayor and from where people are crowding together like sardines on park benches in the sun, banging in to each other playing sports while sweaty, bros throwing down yoga mats, and sneezing on past each other ranging in ages from babies to the elderly.

I mean, I feel bad for anyone having to work in an NYC hospital right now, as it appears it's likely not a very fun time for them right now, but WTF is going on here? I find it hard to believe the world is ending just down the street, yet the Mayor doesn't give enough of a s**t to enforce some social distancing and disperse crowds in his own frickin' back yard. I mean, that's literally his freakin' yellow house with the white trellis-thing on the roof that you can see through the trees in the last picture above. And by the way, what's up with corona-yoga-bro in the last pic?

But seriously, what's really going on here? Is it bad as reported? And if so, does the Mayor even give a s**t? Where's the Governor on this?

Or, are the reports exaggerated?

Something doesn't smell right here. Set the record straight, New York.

 

[thegenius]

Meanwhile, back to @miacomet 's Gothamist article. I went to the front page of Gothamist.com and saw this. Right next to the New York Hospital Armageddon article, is another article about "social distancing" in New York.

View attachment 299715

That picture was taken in Carl Schurz Park, which is literally steps from Mayor De Blasio's house, Gracie Mansion. If you turn to your left, you can literally see it, if not for the trees. It's literally only a few feet away.



View attachment 299716

Zoom out and guess what's also walking distance away? At least one of the hospitals mentioned, NY Presbyterian (several hospitals are mentioned, ranging in distance from a few blocks to a few miles away) is also walking distance, less than one mile away from the Mayor and from where people are crowding together like sardines on park benches in the sun, banging in to each other playing sports while sweaty, bros throwing down yoga mats, and sneezing on past each other ranging in ages from babies to the elderly.

View attachment 299719

View attachment 299720


View attachment 299721

View attachment 299722
View attachment 299723



View attachment 299726


I mean, I feel bad for anyone having to work in an NYC hospital right now, as it appears it's likely not a very fun time for them right now, but WTF is going on here? I find it hard to believe the world is ending just down the street, yet the Mayor doesn't give enough of a s**t to enforce some social distancing and disperse crowds in his own frickin' back yard. I mean, that's literally his freakin' yellow house with the white trellis-thing on the roof that you can see through the trees in the last picture above. And by the way, what's up with corona-yoga-bro in the last pic?

But seriously, what's really going on here? Is it bad as reported? And if so, does the Mayor even give a s**t? Where's the Governor on this?

Or, are the reports exaggerated?

Something doesn't smell right here. Set the record straight, New York.

Oh boy. I went to NYP for residency I’m really familiar with Carl Schurz Park. The only thing I can say is people should just live in their home for 1 MONTH....it’s not that hard. We are failing miserably.

BTW, even though that’s the state appointed mayor of NYC home, it’s actually rarely used by mayors. They usually go there for parties and receptions but don’t live there. That’s what I recall. Perhaps De Blasio is different. I don’t know.

 

[evilbooyaa]

Maybe that's why California is beating New York right now? Statewide lockdown (outside of essentials) including all public areas. Wowza, I cannot believe that folks in NYC are so brazenly stupid to still be doing **** like that as their city and state is going down in complete flames. Of course it's a small proportion of the population, but I was under the impression NYC was already on complete lockdown. Those pictures, if taken recently, sure as hell don't seem like it.

NYC folks, can you comment on how common it is to see people still out and about (and obviously not staying 6 feet away from each other)?

 

[bravotwozero]

Other articles from docs in NYC were saying city looks like a ghost town outside, so I don't know

 

[Birdstrike]

Those pictures, if taken recently, sure as hell don't seem like it.

NYC folks, can you comment on how common it is to see people still out and about (and obviously not staying 6 feet away from each other)?

The article which was published today, says the pictures were taken yesterday.

 

[lifeisamystery]

I'd encourage each of you to purchase a reusable respirator on eBay, at a hardware store like Lowe's or Home Depot, a paint supply store, or an industrial safety supply store along with multiple pairs of filters. N95 or P95 rating or better. I'm having my friends and colleagues do the same.

Colleagues are being written up/disciplined for wearing respirators on shift despite the fact that OSHA and CDC regulations specify we should be wearing a respirator (not a surgical mask) for any patient with suspected COVID, and CDC/NIH data that it's present in infectious quantities in the air for at least 3 hours.

Last night my colleague asked for an N95 and was refused by a nurse because "you aren't intubating".

Administrators care more about the fact that we "look scary". Utterly insane. F them, protect yourself and your family. If they try to discipline you, threaten to quit on the spot. Get your disciplinary measures in writing so you can complain to OSHA and provide them to an employment attorney and for the local news.

Hospitals. Do. Not. Care. About. Us. At. All.

Amen.

 

[Birdstrike]

Checked NYC live webcams and found this two minutes ago. Lol
It is usually full of people there, though. Not today.

Times Square Street Cam

Watch Times Square live with EarthCam's webcams. See NYC's iconic bright lights, music, and arts scene that attracts millions of tourists 24/7.

www.earthcam.com

Other NYC live cams including Columbus circle and others show pretty empty streets compared to the norm in Manhattan. I saw a few stragglers here and there, but nothing like the above pics from Gothamist. Although the weather looks pretty crappy up there today, compared to the sunny and mid 50's on the waterfront yesterday. Could it be fake news? I don't know. Maybe.

Columbus Circle Cam

Live streaming webcam of Columbus Circle, NYC. Watch the hustle and bustle near Central Park and Time Warner Center with shops and entertainment.

www.earthcam.com

5th Avenue:

EarthCam - Webcam Network

EarthCam is the leading network of live streaming webcams for tourism and entertainment around the world with 4K streaming technology.

www.earthcam.com

Other NYC Live Cams: Webcam Search Results - EarthCam

 

[miacomet]

Maybe that's why California is beating New York right now? Statewide lockdown (outside of essentials) including all public areas. Wowza, I cannot believe that folks in NYC are so brazenly stupid to still be doing **** like that as their city and state is going down in complete flames. Of course it's a small proportion of the population, but I was under the impression NYC was already on complete lockdown. Those pictures, if taken recently, sure as hell don't seem like it.

NYC folks, can you comment on how common it is to see people still out and about (and obviously not staying 6 feet away from each other)?

Do you read the news? People were crowding beaches, National Parks, you name it. They had to shut the parks in LA.

 

[Birdstrike]

BTW, even though that’s the state appointed mayor of NYC home, it’s actually rarely used by mayors. They usually go there for parties and receptions but don’t live there. That’s what I recall. Perhaps De Blasio is different. I don’t know.

De Blasio lives there. Bloomberg didn't. Giuliani did.

Today’s Lead: De Blasio to Live in Gracie Mansion

After weeks of uncertainty Mayor-Elect Bill de Blasio announced yesterday that he would move his family into Gracie Mansion and out of their home in Park Slope. De Blasio announced the move in a letter posted to his website and signed by his wife and two children....

www.gothamgazette.com

 

[NJWxMan]

Are those coworkers who ended up hospitalized under 40 and fit, or over 40 and/or not in the best shape? There is so much contradictory information floating out there that it's hard to make heads or tails of what's really going on.

Healthy. 30-50.

 

[miacomet]

Healthy. 30-50.

Why are they ill? No PPE?

 

[Birdstrike]

New York density control measures apparently working: governor


"NEW YORK (Reuters) - New York state measures to control the coronavirus appear to working as the rate of hospitalizations has slowed in recent days, New York Governor Andrew Cuomo said on Wednesday.

Even so, new cases rose by more than 5,000 in the past 24 hours, giving the state more than 30,000 positive cases, roughly 10 times the number in the state with the next highest total, New Jersey, Cuomo said.

Cuomo also announced new measures designed to halt the virus, agreeing with New York City officials to begin a pilot program of closing streets to automobile traffic and banning close contact sports at city parks.

Hospitalizations were doubling every two days as of Sunday, but by Monday the trend showed hospitalizations were doubling every 3.4 days, and by Tuesday the rate was 4.7 days, Cuomo said.

“Now that is almost too good to be true... This is a very good sign and a positive sign, again not 100% sure it holds, or it’s accurate but the arrows are headed in the right direction,” Cuomo told a daily news conference."

New York density control measures apparently working: governor

New York state measures to control the coronavirus appear to working as the rate of hospitalizations has slowed in recent days, New York Governor Andrew Cuomo said on Wednesday.

www.reuters.com

 

[bravotwozero]

Thank goodness.

 

[thegenius]

De Blasio lives there. Bloomberg didn't. Giuliani did.

Today’s Lead: De Blasio to Live in Gracie Mansion

After weeks of uncertainty Mayor-Elect Bill de Blasio announced yesterday that he would move his family into Gracie Mansion and out of their home in Park Slope. De Blasio announced the move in a letter posted to his website and signed by his wife and two children....

www.gothamgazette.com

Well maybe he can't see out his windows. The people are right there!

 

[thegenius]

And by coughing and sneezing too....


Sent from my iPhone using Tapatalk

Coughing and sneezing produces droplets, no? aerosolize means it just floats in the air for hours and can be carried off by the wind to far away places.

 

[turkeyjerky]

No PAPRs at my dysfunctional FSEDs. I tried wearing an N95 yesterday for 4 hours and it was torture - just ripping in to the back of your scalp. Will probably start wearing my own respirator with P100 filters.

Hospital I work at uses 90% locums/firefighters from out-of-state. Admin has said that any physicians recently in CA, WA, or NY need to quarantine in-town for 14 days before working a clinical shift. That's basically our entire roster. Quarantine in a hotel, where they don't live, for 2 weeks, at their own expense. When we told them that this would be impossible/a total non-starter, we were told "figure it out". This is what I'm up against. Idiots.

My buddy is an intensivist at a large academic MICU in the Midwest. Has one patient in early 40s, no PMHx, on VV ECMO. Multiple people intubated under 40 years old. I barely got a flight home from a locums assignment yesterday. It's getting hairy out there.

Great example of how our cluster**** of a system is almost perfectly set up to **** this thing up. What you get when you combine a toxic level of CYA medicine, admin more concerned w/ the bottom line and metrics than w/ good patient care, and a population both distrustful of medicine and convinced that there's a quick fix and easy cure. (I really cannot wait for the negative trials of chlorquine and hydroxychlorquine to come out so I can confidently tell people there's no treatment beyond supportive care). Every hospital I work at has an unnused tent set up outside. I had thought the plan would be to use this for non-ED based screening/testing of the worried well, but I think they just put them up to grab emergency money from CMS. One place is having every employee sign a form denying they've had a fever or cough before they're allowed in the hospital. Mind you, they're not actually checking temps, they just want plausible deniability.

I'm optimistic that this won't be as bad as originally forecasted--I do think the combination of weather patterns, early social distancing and cancelling elective cases will give us enough time and space to avoid scenes like early Wuhan or Bergamo. That means no dead bodies laying in the hallways and mass graves, but still a major strain on us.

The next couple of months are gonna suck at work.

Last week was a dream. Half the usual volumes, plenty of downtime. This week things are starting to pick up. Decent number of people w/ febrile viral illnesses (like the peak of flu season) but negative workups. More nervous nellies coming in for testing (or sent from urgent care). Midlevels incapable of telling the worried well no and sitting on people for hours. Had an OHCA yesterday--the guy had sat at home w/ chest pain for 3 days because he was scared to come in. His wife was pretty broken up. Next week comes the wave of sick people w/ viral pneumonia, then the week after we're full of ARDS.

Think about how painful it'll be once our hospitals' floors are full of recovering old people w/ nowhere to go. Too weak to go home and no SAR willing to accept.

 

[miacomet]

Hospitals don't want to shell out for PPE and don't want to code COVID patients: https://www.washingtonpost.com/heal...bignews6_resuscitate-425pm:homepage/story-ans

 

[thegenius]

Great example of how our cluster**** of a system is almost perfectly set up to **** this thing up. What you get when you combine a toxic level of CYA medicine, admin more concerned w/ the bottom line and metrics than w/ good patient care, and a population both distrustful of medicine and convinced that there's a quick fix and easy cure. (I really cannot wait for the negative trials of chlorquine and hydroxychlorquine to come out so I can confidently tell people there's no treatment beyond supportive care). Every hospital I work at has an unnused tent set up outside. I had thought the plan would be to use this for non-ED based screening/testing of the worried well, but I think they just put them up to grab emergency money from CMS. One place is having every employee sign a form denying they've had a fever or cough before they're allowed in the hospital. Mind you, they're not actually checking temps, they just want plausible deniability.

I'm optimistic that this won't be as bad as originally forecasted--I do think the combination of weather patterns, early social distancing and cancelling elective cases will give us enough time and space to avoid scenes like early Wuhan or Bergamo. That means no dead bodies laying in the hallways and mass graves, but still a major strain on us.

The next couple of months are gonna suck at work.

Last week was a dream. Half the usual volumes, plenty of downtime. This week things are starting to pick up. Decent number of people w/ febrile viral illnesses (like the peak of flu season) but negative workups. More nervous nellies coming in for testing (or sent from urgent care). Midlevels incapable of telling the worried well no and sitting on people for hours. Had an OHCA yesterday--the guy had sat at home w/ chest pain for 3 days because he was scared to come in. His wife was pretty broken up. Next week comes the wave of sick people w/ viral pneumonia, then the week after we're full of ARDS.

Think about how painful it'll be once our hospitals' floors are full of recovering old people w/ nowhere to go. Too weak to go home and no SAR willing to accept.

What city/state do you work in?

 

[AMEHigh]

Maybe that's why California is beating New York right now? Statewide lockdown (outside of essentials) including all public areas. Wowza, I cannot believe that folks in NYC are so brazenly stupid to still be doing **** like that as their city and state is going down in complete flames. Of course it's a small proportion of the population, but I was under the impression NYC was already on complete lockdown. Those pictures, if taken recently, sure as hell don't seem like it.

NYC folks, can you comment on how common it is to see people still out and about (and obviously not staying 6 feet away from each other)?

It's a ghost town where I am.
I walked to work today.
Dog park empty. Rest of park pretty empty. Both usually pretty full even on colder days.

 

[Birdstrike]

Here's study out of Oxford’s Evolutionary Ecology of Infectious Disease group estimating that 36-68% of the U.K. population and 60-80% of Italy likely have already have been infected with COVID-19, that COVID-19 was around longer than we thought, that fewer than 1 in a 1000 of those infected will become ill enough to need treatment in a hospital, while also agreeing with the social distancing measures enacted.

Here's the study itself.
Here's a layman's summary from @thegenius 's fave, Financial Times.

 

[zurned]

It's a ghost town where I am.
I walked to work today.
Dog park empty. Rest of park pretty empty. Both usually pretty full even on colder days.

 

[GeneralVeers]

I said early on in this thread that I thought COVID-19 was probably already around longer than we thought, many were likely already infected and didn't know it and weren't diagnosed, that herd immunity would reduce the proportion of susceptible individuals before the worst case scenarios would come true for us, and that despite that I agreed with the social distancing measures enacted.

Well, here's study out of Oxford’s Evolutionary Ecology of Infectious Disease group estimating that 36-68% of the U.K. population and 60-80% of Italy already have been infected with COVID-19, that COVID-19 was around longer than we thought, that fewer than 1 in a 1000 of those infected will become ill enough to need treatment in a hospital, while also agreeing with the social distancing measures enacted.

Here's the study itself.
Here's a layman's summary from @thegenius 's fave, Financial Times.

That's the article I was trying to post. If their antibody assay study indeed shows a high degree of existing herd immunity, it will be great evidence for relaxing the draconian measures that are destroying our economy.