What do I need to know about coronavirus?

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Did ACEP just ask that all bull**** be suspended for the duration. What's that society, you might actually NEED doctors and nurses, not just administrators? What?

Also, a couple of docs are really sick. Be careful out there, use your PPE, and remember it's your facility's job to provide you with PPE that works and is appropriate. You should not sacrifice yourself.
 
Dear Fellow Physicians,

During the 2009 swine flu outbreak no one even talked about it until 1,000 American deaths when the President finally declared a national emergency. It then progressed to 5,000, 10,000 then 18,000 dead with nowhere near the hysterical, panicked overreaction we’re seeing right now. We worked through this, we took care of these patients, we lived through this. We didn’t panic or predict doom and gloom. 2 months and a countless doomsday predictions into the current outbreak, we’re at 40 COVID-19 deaths. You know what we as doctors did do back then?

We went to work, gloved up and took care of the patients. No one canceled schools, canceled the Masters, canceled leagues, mass gatherings or predicted the end of the world. Certainly no ER doctors did that I can remember. No one said, “But what about Italy?! What about China?!” No one said, “We can’t handle this.” No one made outlandish histrionic predictions like 1.5 million deaths or even 150,000 deaths and all kinds of unhelpful predictions that everyone knows are exceedingly unlikely to actually come true. No one that I know, no self respecting ER Doctor panicked like I’m seeing now. It’s pathetic. We’re supposed to be above this, calmer under pressure than the rest, not fighting people in the aisles of Costco for TP and plungers.

I don’t know what more to say, other than some people need to get themselves together. At some point, as grown men and women, we need to gather ourselves, put out heads down and go on with life, despite and through Coronavirus, which is our neighbor now, here to stay, forever, like every other virus we’ve learned to live with. We can’t go into panic-fueled hibernation forever and it’s not fair to expect those outside of Medicine that look to us for leadership to, either.

We don’t only need to move forward, we need to lead. Hearing some of you tell your families, coworkers and the public that the world is going to end is just plain unhelpful. And it’s wrong. Because as physicians and leaders (whether we like it or not) in our communities, we should know better. It’s unbecoming of people who should have the confidence that we can get through situations like this, because we’ve gone through similar things before. And if you haven’t, because you’re new to this, stop. Just stop, get out of the way, and let others lead.

If you’re a doctor and you’re still panicking about this, you need to snap out of it real quick and get it together, because your patients, families and communities need you, to. Right now, stop the doom-and-gloom Armageddon predictions and repeat this mantra to your families, your patients and yourselves, ”We’ve been through this before. We have a plan in place. We’ll get through this.” Say it, because it’s not the first nasty viral outbreak we’ve faced, and it won’t be the last. Say it, because it’s the right thing to do, and because it’s true.

You sound like the Hahnemann attendings that knew the hospital was going to close but told their residents and interviewees that everything was fine.

We have decent data from SK, which shows a much higher mortality than flu. And I doubt most places in the US will be able to handle the outbreak better than SK.

Will we be the next Italy? Probably not- but some parts of the US may come close to it.

Will the resulting unemployment cause more deaths than the virus itself? Possibly.

But should we go an internet forum telling medical professionals that this a hoax and they should laugh it off???? What's your real agenda????
 
Yeah. If they don't give me a PAPR, I don't enter the URI room. Period, end of discussion. Admin can come down and throw a fit. They can fire me on the spot. They can't force me to work without proper protection, and the board will uphold that easily.
Remember, every patient you save is 1 patient. Every doctor you save is thousands of patients. Every admin you save is, uh, one admin. Maybe.
 
I was just looking up law re: PPE when it comes to independent contractors, of which I am one. Apparently, OSHA laws do not apply to independent contractors, as they are not employees, so are hospitals legally accountable for providing us with PPE if it comes down to them being out of N95s? Do we have a legal duty to provide service to the patient if the hospital cannot provide an N95 to us, as independent contractors? (assuming most of us are ICs). I just want to see what sort of legal defense I would have for refusal to provide care in the case of me being unable to protect myself properly.

I am planning to locate the appropriate-sized N95 for myself as well as face shields as soon as I show up to my shift tomorrow to be ready to throw 'em on, as necessary.
 
There's not case law on this that I'm aware of.
But at the same time, if you get a needlestick, they have to cover it even though you're an IC. This is no different.

At the same time, maybe you can bring down the terrible IC laws pertaining to physicians as well.

Fight the good fight.
 
You sound like the Hahnemann attendings that knew the hospital was going to close but told their residents and interviewees that everything was fine.

We have decent data from SK, which shows a much higher mortality than flu. And I doubt most places in the US will be able to handle the outbreak better than SK.

Will we be the next Italy? Probably not- but some parts of the US may come close to it.

Will the resulting unemployment cause more deaths than the virus itself? Possibly.

But should we go an internet forum telling medical professionals that this a hoax and they should laugh it off???? What's your real agenda????

This is a serious matter. The public’s concern is appropriate. Remember there are more measures of devastation than dying. Getting Coronavirus means missing work and losing pay. Some of us actually need that next paycheck. The concern is also when will this end? It’s hard to see an end because this just started.
Bird... usually like you but gotta disagree with what you said.


Those worried about masks... when push comes to shove, you might have to sacrifice yourself.

Just got back from buying all the rice I could buy... just kidding
 
Those worried about masks... when push comes to shove, you might have to sacrifice yourself.
Negative. The world needs helpers. Helpers shouldn't kill themselves.

I liken it to running to a code. I've known 4 doctors getting injured running to codes. I've never met anyone saved by running to a code. HEMS nurses/paramedics don't run, and they fly to the scene of the accident. There are times to rationalize the greater good. Saving a 70 year old nursing home patient at the expense of a doctor is not one of those times. Saving a kid? Sure, maybe. But we can't determine that time of.
 
Negative. The world needs helpers. Helpers shouldn't kill themselves.

I liken it to running to a code. I've known 4 doctors getting injured running to codes. I've never met anyone saved by running to a code. HEMS nurses/paramedics don't run, and they fly to the scene of the accident. There are times to rationalize the greater good. Saving a 70 year old nursing home patient at the expense of a doctor is not one of those times. Saving a kid? Sure, maybe. But we can't determine that time of.

Agree with this completely. I walk briskly but never run. RT can manage airway and nurses can do CPR when I get there.

In regards to sacrificing myself that's a big nope. This is a job and a paycheck. Not worth risking life, or health to help people.
 
Amazing how underprepared our country is for this crisis. We don't even have enough masks, let alone ventilators. This could get real bad if it follows trends in other countries...
 
Amazing how underprepared our country is for this crisis. We don't even have enough masks, let alone ventilators. This could get real bad if it follows trends in other countries...

While this is true, we also have the capacity to respond and adapt, something that developing nations, like Iran, don't even have as a possibility. masks and ventilators can be manufactured, new tests/techniques are being developed already, etc..
 
What I have seen in this thread is senior attending physicians dismiss COVID 19 because at this current, extremely early phase along its geometric growth curve it has only caused a relatively small amount of deaths. I have seen these senior attendings insist that this current pandemic is comparable or even actually less serious than things like SARS and the Swine Flu and when confronted by irrefutable facts such as the collapse of healthcare systems during this current crisis dismiss these facts with literal "I don't know brah but who cares lol". It's eye opening.

I am 5+ years out of residency (senior attending status?) but I agree with you: the anti-science vibe is disturbing.
 
While this is true, we also have the capacity to respond and adapt, something that developing nations, like Iran, don't even have as a possibility. masks and ventilators can be manufactured, new tests/techniques are being developed already, etc..

Yes, but we are weeks behind due to the initial anti-science stance taken by the administration.
Also, it is very sad what is happening in Iran, a result of the crushing and inhumane sanctions placed on it. I wonder if anyone will ever be held to account for this.
 
Yeah. If they don't give me a PAPR, I don't enter the URI room. Period, end of discussion. Admin can come down and throw a fit. They can fire me on the spot. They can't force me to work without proper protection, and the board will uphold that easily.
Remember, every patient you save is 1 patient. Every doctor you save is thousands of patients. Every admin you save is, uh, one admin. Maybe.

My institution is going with the CDC guidance of just a surgical mask instead of N95 for all contact except those likely to produce aerosols such as intubation. That is of course in addition to goggles, gloves, gown, etc. However, I’m pretty sure they would balk if I demanded a PAPR since it would need to be changed between patients.


Since you will not likely have access to sameday CoV-2 testing for a few weeks, I suppose that you will want a new PAPR for every febrile respiratory illness while you await confirmation? Keep us posted on how your hospital reacts to this request.
 
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But should we go an internet forum telling medical professionals that this a hoax and they should laugh it off????
No, which is why I didn’t do that and instead I’ve said this:
.
.
.
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... we should wash hands, isolate presumed positives and make sure we have adequate ED/ICU staffing, preparation and equipment.


I agree that telling patients this right now... so they take virus precautions seriously.


we know that we need to wash hands, stay home when sick, develop a vaccine and make our hospitals formulate a plan for surges of the walking well, while shoring up supplies of ventilators, ED and ICU staff.



I didn’t say it wasn’t a serious thing. It is serious. ...

We should take Coronavirus seriously

I see that the President has suspended travel from Europe (except UK) for a month to go along with the bans from Iran and China. Good...

And canceling ball games,... mass gatherings ... is good too. They can all be rescheduled, and if they hold the games without fans, that's great too, ...

... It will probably many thousands of lives ...Get coronavirus under control ...
 
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My institution is going with the CDC guidance of just a surgical mask instead of N95 for all contact except those likely to produce aerosols such as intubation. That is of course in addition to goggles, gloves, gown, etc. However, I’m pretty sure they would balk if I demanded a PAPR since it would need to be changed between patients.


Since you will not likely have access to sameday CoV-2 testing for a few weeks, I suppose that you will want a new PAPR for every febrile respiratory illness while you await confirmation? Keep us posted on how your hospital reacts to this request.

At our ED we have PAPRs available, but reused and cleaned after each patient encounter by a tech...


Sent from my iPhone using Tapatalk
 
I was just looking up law re: PPE when it comes to independent contractors, of which I am one. Apparently, OSHA laws do not apply to independent contractors, as they are not employees, so are hospitals legally accountable for providing us with PPE if it comes down to them being out of N95s? Do we have a legal duty to provide service to the patient if the hospital cannot provide an N95 to us, as independent contractors? (assuming most of us are ICs). I just want to see what sort of legal defense I would have for refusal to provide care in the case of me being unable to protect myself properly.

I am planning to locate the appropriate-sized N95 for myself as well as face shields as soon as I show up to my shift tomorrow to be ready to throw 'em on, as necessary.

Will it be different if my S corp is the 1099 of a cmg and I'm the w2 employee of my s corp?

This is the only time I'm regretting not being an employee.
 
I also just want to throw this out there.

Chughtailab, the equivalent of labcorp in Pakistan. Not only has next day results, but they are going to your home to test you. You can easily arrange a test through a call, or Whatsapp message or filling out a form on their website.

Cost of at home testing - $60

This is so shameful. We're the richest country in the world, our test turn around times are 3-4 days, it's ridiculously difficult to get a test. While a poor developing country has the option of a $60 test that they come to your home, swab you, and you get results the next day.

This is truly shameful for the US.

 
My institution is going with the CDC guidance of just a surgical mask instead of N95 for all contact except those likely to produce aerosols such as intubation. That is of course in addition to goggles, gloves, gown, etc. However, I’m pretty sure they would balk if I demanded a PAPR since it would need to be changed between patients.


Since you will not likely have access to sameday CoV-2 testing for a few weeks, I suppose that you will want a new PAPR for every febrile respiratory illness while you await confirmation? Keep us posted on how your hospital reacts to this request.

What do you guys think about the new CDC guidance about surgical mask only? But N95 for “aerosol” generating procedures. Seems to me if someone is coughing that would be aerosol-generating not just droplet.... where is that evidence coming from or are they just trying to conserve/triage supplies with zero evidence?
 
What do you guys think about the new CDC guidance about surgical mask only? But N95 for “aerosol” generating procedures. Seems to me if someone is coughing that would be aerosol-generating not just droplet.... where is that evidence coming from or are they just trying to conserve/triage supplies with zero evidence?

Conserving supplies.

I don't know what the answer is here. The N95s are designed for one USE, meaning one room and then in the trash. We would be out within a day.
 
Amazing how underprepared our country is for this crisis. We don't even have enough masks, let alone ventilators. This could get real bad if it follows trends in other countries...

If there is a bright spot for the US here, it is that we actually might have enough ventilators. We have fewer physicians and hospital beds per capita than Italy, but three TIMES as many ICU beds. Our decades long habit of overusing ICU interventions might finally pay off.
 
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If you haven't read this White Paper yet, read it now. It is EM specific and has very useful and specific information to keep everyone safe and know how to be confident in providing care during these uncertain times.

"Coronavirus Update and Clinician Guide to Diagnosis Management and Disposition"
 

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"No one canceled schools, canceled the Masters, canceled leagues, mass gatherings or predicted the end of the world."

[/QUOTE]

I had to dig through all these posts...

Basically, I think we need to do what we can to prevent spread by shutting down mass gatherings like NBA etc. Likely this virus will continue to have outbreaks in the future but for the first outbreak, we need to be extra cautious. Maybe there will be vaccine development....is there talk of vaccines anyone...


v/r

PC.
 
This is a serious matter. The public’s concern is appropriate. Remember there are more measures of devastation than dying. Getting Coronavirus means missing work and losing pay. Some of us actually need that next paycheck. The concern is also when will this end? It’s hard to see an end because this just started.

I think the first major step to ending this is providing a test that can be run in 30 mins (or less) for SARS-COV2. Once we have that, we can isolate/quarantine only those with the virus. Hopefully that test, and the speed of it too, will come out in the next month or two. Apparently the FDA just approved a Roche test that takes 4 hours to run. Good first step.

Next is either to get a vaccine which is probably more likely than efficacious treatment. If we pump out treatment like oseltamivir then won’t get anywhere quickly. I’m more excited about getting a proper vaccine. But I read that will take a minimum 1.6 years.

But the social distancing doesn’t have to last that long. IMO
 
"No one canceled schools, canceled the Masters, canceled leagues, mass gatherings or predicted the end of the world."


I had to dig through all these posts...

Basically, I think we need to do what we can to prevent spread by shutting down mass gatherings like NBA etc. Likely this virus will continue to have outbreaks in the future but for the first outbreak, we need to be extra cautious. Maybe there will be vaccine development....is there talk of vaccines anyone...


v/r

PC.
You disagree with that post? You disagree that during the 2009 swine flu epidemic the Masters, sports leagues were not canceled? That's literally a fact statement. They weren't canceled. Forgive me if I wrong, but were they canceled? Because that's all I said. And I did not disagree with the current cancellations. In fact, I agreed with them multiple times.


In post #274 above, I posted that I agreed with the cancellations:
I see that the President has suspended travel from Europe (except UK) for a month to go along with the bans from Iran and China. Good...

And canceling ball games... is good too. They can all be rescheduled, and if they hold the games without fans, that's great too...

All this is great because...It will probably many thousands of lives from the ongoing flu pandemic that's causing 20,000 American deaths ...and 3) Get coronavirus under control before it...

Then, in above post 467 I again agreed with the cancellations.

I am again, for the third time in this thread agreeing with the current cancellations. How many times will I need to agree?

Please, let's set aside the petty arguing, and read the White Paper I posted 4 posts above. It's the best and most useful thing on this whole thread.
 
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You disagree with that post? You disagree that during the 2009 swine flu epidemic the Masters, sports leagues were not canceled? That's literally a fact statement. They weren't canceled. Forgive me if I wrong, but were they canceled? Because that's all I said. And I did not disagree with the current cancellations. In fact, I agreed with them multiple times.


In post #274 above, I posted that I agreed with the cancellations:


Then, in above post 467 I again agreed with the cancellations.

I am again, for the third time in this thread agreeing with the cancellations. How many times will I need to agree?

Please read the White Paper I posted 4 posts above. It's the best and most useful thing on this whole thread.
You're so arrogant.

/sarcasm
 
You're so arrogant.

/sarcasm
Yes, you're right. And on that note. Let me share with you an email my 76-year-old, coronasucepitble, Dad sent me today: "Despite all the social distancing being recommended right now, don't forget that nature is still open. Use this as an excuse to get outdoors. Go for a hike, a run, bike ride or a walk at a (secluded) beach or park." I think it's great advice.

And on that note, I'm going to do that right now, put on some Nike Vaporfly shoes, headphones, great music and go for a nice long run in the wide open outdoors and breathe some fresh, virus-free air. Adios amigos!
 
The ID doctors at Kaiser i work at reuses her N95 regularly. She says it’s OK.... I duno

1) Its not OK. Or at least its not guaranteed to work if you've used it more than once. Even the papers that have studied 'extended use' have studied use extended for 8 hours in a single day, not over multiple days.
2) If you are going to use it over an over again there are dozens of studies on how to best clean them and extend functional life. Putting paper masks over the N95 an cleansing regularly with UV light are two of the better intervention.

A pretty easy intervention to set up in your hospital is to create a station to cleanse used PPE that you need to reuse. You can't make new PPE appear but you can at least try to minimize the risk of reuse.
 
This seems to be the happening thread for corona so I have a question. Can somebody tell me why we don't hear more about using immune serum for treating this? I know it's old science but it has worked for other viral diseases. Is it just because some big Pharma can't patent it and make a bundle? I know if I was at high risk for complications I would sure want some of it. Bonus for the people who have fought the disease and recovered, they could make bank as plasma donors.
 
This seems to be the happening thread for corona so I have a question. Can somebody tell me why we don't hear more about using immune serum for treating this? I know it's old science but it has worked for other viral diseases. Is it just because some big Pharma can't patent it and make a bundle? I know if I was at high risk for complications I would sure want some of it. Bonus for the people who have fought the disease and recovered, they could make bank as plasma donors.

We are hearing about everything and everyone is studying everything. They are studying novel and existing antivirals, every subset of anti-inflammatory drug and immunomodulator, there are a dozen companies competing to get a vaccine to market, and they're even studying anti-malarials that have no good reason to work but that worked once in vitro. And yes, they are also studying convalescent serum. Serum will likely play a bigger role as we get more convalescents.

If you don't think there are enough people working on this particular intervention please do get an IRB together. First physician to find anything useful for this virus gets a MacArthur award and tenure at the university of their choice
 
Therapeutic ketosis is a powerful immunomodulator.
 
What do you guys think about the new CDC guidance about surgical mask only? But N95 for “aerosol” generating procedures. Seems to me if someone is coughing that would be aerosol-generating not just droplet.... where is that evidence coming from or are they just trying to conserve/triage supplies with zero evidence?

I suspect they are basing in the resPECT Trial (covered in Jan 2020 EMA).

N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial Radonovich LJ, Simberkoff MS, Bessesen MT, et al. JAMA. 2019;322(9):824-833.

Although the primary outcome looked at acute influenza events, secondary outcome looked at all other acute respiratory events. So, I suppose there is some applicability to our current situation.

Personally, I don’t care if people go with the CDC guidance (mask, gown, goggles, etc.) or PAPR provided that the PAPRs are being properly decon’ed between patients and people know how to properly don and doff them - a two person gig no matter what system you decide to use. My understanding is that N95s should not be reused and PAPRs need to be decon’ed, so we need to make sure that we are doing this properly. I suspect that our infection control would be better with the CDC method where everything except the goggles goes in the garbage. Just my dos pesos.
 
One thing to note about the CDC guidance is that it still recommends PAPR or N95 until you run into a shortage situation then you can downgrade for non aerosol generating procedures, but when the supply issue is resolved you’re supposed to go back to the N95 and PAPRs.

They’ve left open the option of reusing N95s but it was very clear on the COCA call Friday that they really only recommend that as a last resort because it’s hard to take on and off without contaminating it in the process.
 
One thing to note about the CDC guidance is that it still recommends PAPR or N95 until you run into a shortage situation then you can downgrade for non aerosol generating procedures, but when the supply issue is resolved you’re supposed to go back to the N95 and PAPRs.

They’ve left open the option of reusing N95s but it was very clear on the COCA call Friday that they really only recommend that as a last resort because it’s hard to take on and off without contaminating it in the process.
In that case, I think we should putting on N95 at the beginning of our shift and leaving it on for the duration
 
I was off most of last week but worked overnight last night at a smaller hospital in the sticks. Had a possible case come in near the end of my shift. Old guy, looked well but was profoundly hypoxic, afebrile, dry cough. WBC normal. CXR w/ streaky bilateral opacities, CT (hospitalist requested) showed bilateral ground glass opacities.

Staff there doesn't ****ing get it. When I walked in his room 6 people were in there w/o masks on, patient unmasked, wife sitting in the hallway (this hospital is still mandating 14 days home quarantine for HCWs exposed to patients w/o PPE). Meanwhile every idiot who comes in with a cold requesting to be tested "just to safe and can you test my baby too" gets immediate masked and called to the county health department
 
large droplet transmission
  • COVID-19 transmission can occur via largedroplet transmission (with a risk limited to ~6 feet from the patient)(Carlos del Rio 2/28).
  • This is typical for respiratory viruses such as influenza.
  • Transmission via large droplet transmission can be prevented by using a standard surgical-style mask.
airborne transmission ??
  • It's controversial whether COVID19 can be transmitted via an airborne route (small particles which remain aloft in the air for longer periods of time). Airborne transmission would imply the need for N95 masks (“FFP2” in Europe), rather than surgical masks. This controversy is explored further in Shiu et al 2019.
  • Airborne precautions started being used with MERS and SARS out of an abundance of caution (rather than any clear evidence that coronaviruses are transmitted via an airborne route). This practice has often been carried down to COVID19.
  • Guidelines disagreeabout whether to use airborne precautions:
    • The Canadian Guidelines and World Health Organization guidelines both recommend using only droplet precautions for routine care of COVID19 patients. However, both of these guidelines recommend airborne precautions for procedures which generate aerosols (e.g. intubation, noninvasive ventilation, CPR, bag-mask ventilation, and bronchoscopy).
    • The United States CDC recommendsusing airborne precautions all the time when managing COVID19 patients.
  • Using airborne precautions for all patients who are definitely or potentially infected with COVID19 will likely result in rapid depletion of N95 masks. This will leave healthcare providers unprotected when they actually need these masks for aerosol-generating procedures.
  • In the context of a pandemic, the Canadian and WHO guidelines may be more sensible in countries with finite resources (i.e. most locales). However, infection control is ultimately local, so be sure to follow your hospital's guidance regarding this.

source: COVID-19 - EMCrit Project
 
Do we know for certain that the virus can be transmitted from an asymptomatic carrier, or do they need to develop symptoms first?
 
One thing to note about the CDC guidance is that it still recommends PAPR or N95 until you run into a shortage situation then you can downgrade for non aerosol generating procedures, but when the supply issue is resolved you’re supposed to go back to the N95 and PAPRs.

They’ve left open the option of reusing N95s but it was very clear on the COCA call Friday that they really only recommend that as a last resort because it’s hard to take on and off without contaminating it in the process.

My institution is only using airborne precautions with N95s for aerosol-producing procedures because they feel that we are effectively in a time of shortage, and routine use would rapidly deplete the hospital supply.
 
Do we know for certain that the virus can be transmitted from an asymptomatic carrier, or do they need to develop symptoms first?

I think that we are pretty certain that people are contagious for several days before becoming symptomatic.
 
My institution is going with the CDC guidance of just a surgical mask instead of N95 for all contact except those likely to produce aerosols such as intubation. That is of course in addition to goggles, gloves, gown, etc. However, I’m pretty sure they would balk if I demanded a PAPR since it would need to be changed between patients.
They're asking us not to change N95s, but to reuse them. PAPRs are more robust and can be reused more easily.

Since you will not likely have access to sameday CoV-2 testing for a few weeks, I suppose that you will want a new PAPR for every febrile respiratory illness while you await confirmation? Keep us posted on how your hospital reacts to this request.
You definitely like to put words in people's I've learned.
Either way, still no.
And N95 don't fit with facial hair, including even 8 hours of growth. So I would be forced to shave on shift which isn't going to happen, and they're not going to reduce our shift lengths for sure.
 
"No one canceled schools, canceled the Masters, canceled leagues, mass gatherings or predicted the end of the world."

I had to dig through all these posts...

Basically, I think we need to do what we can to prevent spread by shutting down mass gatherings like NBA etc. Likely this virus will continue to have outbreaks in the future but for the first outbreak, we need to be extra cautious. Maybe there will be vaccine development....is there talk of vaccines anyone...


v/r

PC.
[/QUOTE]
Masters postponed...postponed...not cancelled...cancelled means my tix are worthless...postponed means hopefully I get to go later this year...🙂
 
  • large droplet transmission
    • COVID-19 transmission can occur via largedroplet transmission (with a risk limited to ~6 feet from the patient)(Carlos del Rio 2/28).
    • This is typical for respiratory viruses such as influenza.
    • Transmission via large droplet transmission can be prevented by using a standard surgical-style mask.
  • airborne transmission ??
    • It's controversial whether COVID19 can be transmitted via an airborne route (small particles which remain aloft in the air for longer periods of time). Airborne transmission would imply the need for N95 masks (“FFP2” in Europe), rather than surgical masks. This controversy is explored further in Shiu et al 2019.
    • Airborne precautions started being used with MERS and SARS out of an abundance of caution (rather than any clear evidence that coronaviruses are transmitted via an airborne route). This practice has often been carried down to COVID19.
  • Guidelines disagreeabout whether to use airborne precautions:
    • The Canadian Guidelines and World Health Organization guidelines both recommend using only droplet precautions for routine care of COVID19 patients. However, both of these guidelines recommend airborne precautions for procedures which generate aerosols (e.g. intubation, noninvasive ventilation, CPR, bag-mask ventilation, and bronchoscopy).
    • The United States CDC recommends using airborne precautions all the time when managing COVID19 patients.
source: COVID-19 - EMCrit Project

I believe the CDC recommendations in the USA have changed since that article was published on Mar 2.

According to the CDC website, USA protocols were changed on Mar 10 and now reflect those in Canada (droplet/contact for routine care of COVID19 patients, airborne precautions for aerosol-generating procedures).

Source: Coronavirus Disease 2019 (COVID-19)
 
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In regards to the comments comparing South Korea to U.S.A. and how "great of a job" some people think S. Korea is doing in comparison to U.S.A it appears that both the United States and S. Korea had their first reported cases of COVID-19 within 24 hours of each other (source: Johns Hopkins). That being considered, fast forward to today, 54 days later they have 75 COVID-19 deaths compared to 62 here in the states (Johns Hopkins). Considering they have more deaths from this disease in a population roughly 1/6 the size of ours, they have > 6 times more deaths from COVID-19 than the United States, per population (7.7 times or 770% more to be exact). They may have tested more, but they're also dying more, despite have had first cases at almost exactly the same time. What explains the greater deaths per population (Not shutting down their border effectively? Greater population density?) I'm not sure. Regardless, while S. Korea may be testing better, they're clearly not doing everything better, because they're losing lives >7 times faster than us. Maybe we should copy the testing they're doing, but we sure don't want to copy everything they're doing.
 
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They're asking us not to change N95s, but to reuse them. PAPRs are more robust and can be reused more easily.


You definitely like to put words in people's I've learned.
Either way, still no.
And N95 don't fit with facial hair, including even 8 hours of growth. So I would be forced to shave on shift which isn't going to happen, and they're not going to reduce our shift lengths for sure.

My apologies. I was trying to subtly suggest that the idea of demanding a PAPR and anything less was dangerous might run into some problems with current CDC guidance that recommends droplet/contact precautions with a simple face mask and goggles for most interactions. I should have been more direct.

By all means, if someone has some hirsute issues that keeps them from obtaining a proper seal with a N95 more than 8 hours after shaving, or if people insist on going full beard, then by all means - get a PAPR. Otherwise, the vast majority of people will get a good N95 seal simply by shaving before a shift. There is no need to suggest that the average EP demand a PAPR before going into a room or play employment chicken with hospital administration.

Also, for those who insist on wearing a PAPR for the first time, I highly suggest that they at least practice intubating with one using a Fred the Head. It will be different experience. These intubations are likely to get a little dicey as patients will have essentially no apnea time and you may be lucky to get their sats above 80% before induction.
 
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..is there talk of vaccines anyone...


v/r

PC.
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"First dose of potential coronavirus vaccine to be delivered for trial monday: Official"

 
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