What do I need to know about coronavirus?

[DrSnips]

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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. 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 as hell don't want to copy everything they're doing.

That's not entirely a fair comparison given SK has on average over 5 times the population density of the US -- obviously a virus with such high infectivity is going to get exponentially harder to control as population density increases. It would be more interesting to contrast the deaths per capita in cities of similar population density.

 

[Birdstrike]

That's not entirely a fair comparison given SK has on average over 5 times the population density of the US -- obviously a virus with such high infectivity is going to get exponentially harder to control as population density increases. It would be more interesting to contrast the deaths per capita in cities of similar population density.

You're right about population density and I was editing that into my post before you quoted me and responded. I'm glad you brought that up.

There are obviously many more factors at play with COVID-19 than population density, but to the extent its a factor, here are a few to compare:

S. Korea 512
Italy 201
China 148
France 118
Spain 92
Iran 51
U.S. 35
Canada 4

The severity of COVID-19 doesn't correlate exactly with population density but it's pretty damn close.

Compare the densities here to the outbreak stats, here.

 

[thegenius]

In that case, I think we should putting on N95 at the beginning of our shift and leaving it on for the duration

I would do that if I didn't suffocate while being in those things. They are terrible for more than 5-10 minutes.

Does it induce relatively brief rhinitis in others as it does to me?

 

[thegenius]

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.

That is true. I have a small-to-medium beard (not like Jerry Garcia's big beard) and they told me N95 don't work for beards.
I believe them.
I haven't yet shaved my beard but I think I'm going to.

In the meantime I still wore an N95 a few times when indicated because I believe it's better (although not perfect as it's designed) than a surgical mask.

I think it's possible that (N95 without beard) is better than (N95 with beard) is better than (surgical mask w/wo beard)

 

[erdoc00]

I dont understand why we're testing non-hospitalized people at this point. The virus is being spread in the community. There is no reliable way to screen people or to contain the virus at this point; that window has already passed.

All we're doing at this point is having low acuity people clog up the ERs requesting testing and they are taking resources away from actual sick people, including our routine emergencies like MIs, CVAs, etc. Not only that but these low acuity people are also actively increasing exposure to healthcare workers and sick patients.

If the health department wants to set up community testing stations for epidemiological purposes then they should have at it. Having people come to the hospital for testing though makes no sense. At this point the only triage we should be doing is on severity of symptoms. I dont understand the benefit of testing people who we're going to send home to self quarantine.

 

[miacomet]

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.

My guess, and it's unproven, of course, is that we've had more deaths, but haven't tested for COVID in those patients, unlike South Korea, which probably tested every pneumonia/ARDS case.

 

[sensejae]

COVID Live Update: 143,722,259 Cases and 3,061,310 Deaths from the Coronavirus - Worldometer

Live statistics and coronavirus news tracking the number of confirmed cases, recovered patients, tests, and death toll due to the COVID-19 coronavirus from Wuhan, China. Coronavirus counter with new cases, deaths, and number of tests per 1 Million population. Historical data and info. Daily...

www.worldometers.info

It doesn't make sense to compare Korea and US right now. Korea has had peak incidence of cases in late February and early March. Their incidence has decreased significantly since. Korea was number two in incidence internationally just behind China for a while.

For the U.S., its incidence is at a rapid rise. Yes, Korea has had more deaths for now. Check back in 2 weeks and it will be very different.

 

[Dr Mantis Toboggan]

suspend EMTALA. today.

I dont understand why we're testing non-hospitalized people at this point. The virus is being spread in the community. There is no reliable way to screen people or to contain the virus at this point; that window has already passed.

All we're doing at this point is having low acuity people clog up the ERs requesting testing and they are taking resources away from actual sick people, including our routine emergencies like MIs, CVAs, etc. Not only that but these low acuity people are also actively increasing exposure to healthcare workers and sick patients.

If the health department wants to set up community testing stations for epidemiological purposes then they should have at it. Having people come to the hospital for testing though makes no sense. At this point the only triage we should be doing is on severity of symptoms. I dont understand the benefit of testing people who we're going to send home to self quarantine.

 

[sensejae]

COVID Live Update: 143,722,259 Cases and 3,061,310 Deaths from the Coronavirus - Worldometer

Live statistics and coronavirus news tracking the number of confirmed cases, recovered patients, tests, and death toll due to the COVID-19 coronavirus from Wuhan, China. Coronavirus counter with new cases, deaths, and number of tests per 1 Million population. Historical data and info. Daily...

www.worldometers.info

Also, mortality rate is generally quoted between 3-5%, at least among those that are tested; yes it does not account for mild cases that are not tested.

South Korea is reporting mortality rate less than 1%. It would be more fair to question why they are reporting such low mortality. It is likely due to the fact that they are screening many more mild cases, driving down the mortality rate.

Regardless of population density, it is almost certain that the mortality rate in the U.S. will be higher because testing will be geared only toward patients with significant symptoms in the states. Also, general population has been pretty careless about adhering to social distancing recommendation (St. Patrick's day partying, concerts, etc). It's pretty likely that in a week or two, the total cases will be over twenty thousand in the states.

 

[doctalaughs]

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.

I’m not sure your mathematical model quite works.

The Initial growth curve wouldn’t be dependent on the initial size of the population (ie in a perfect doubling model 1, 2, 4, 8,16 etc) the initial curves would look the same even if country A was 1 million and country B was 100 million people.

however, country B would eventually outpace A (get more deaths) as country A would “run out of people to infect” earlier. Even if they handled things exactly the same.

But if they both started on day 1 with 1 patient infected, day 10 would be similar number of infections/deaths in the small + large countries.

 

[wholeheartedly]

They're asking us not to change N95s, but to reuse them. PAPRs are more robust and can be reused more easily.

Come up here and help us set up a drive through screening program. no cases in my county and i’ve got a PAPR for you 😉

 

[Birdstrike]

I’m not sure your mathematical model quite works.

The Initial growth curve wouldn’t be dependent on the initial size of the population (ie in a perfect doubling model 1, 2, 4, 8,16 etc) the initial curves would look the same even if country A was 1 million and country B was 100 million people.

however, country B would eventually outpace A (get more deaths) as country A would “run out of people to infect” earlier. Even if they handled things exactly the same.

But if they both started on day 1 with 1 patient infected, day 10 would be similar number of infections/deaths in the small + large countries.

This model you describe only works if one patient comes into each country and no others do. A larger country would likely have more points of entry for more seed cases to come in and spread anew. That's how a country with a larger population would expect to see higher numbers all things being equal. That being said, even if you assume your model, the total cases and therefore deaths should increase at the same rate and have the same numbers after a given time. If so, then why does S Korea have more deaths, even though they're "doing so much better" at fighting this outbreak?

 

[Birdstrike]

COVID Live Update: 143,722,259 Cases and 3,061,310 Deaths from the Coronavirus - Worldometer

Live statistics and coronavirus news tracking the number of confirmed cases, recovered patients, tests, and death toll due to the COVID-19 coronavirus from Wuhan, China. Coronavirus counter with new cases, deaths, and number of tests per 1 Million population. Historical data and info. Daily...

www.worldometers.info

It doesn't make sense to compare Korea and US right now. Korea has had peak incidence of cases in late February and early March. Their incidence has decreased significantly since. Korea was number two in incidence internationally just behind China for a while.

For the U.S., its incidence is at a rapid rise. Yes, Korea has had more deaths for now. Check back in 2 weeks and it will be very different.

View attachment 298667
View attachment 298668

If it doesn't make sense to compare US and S Korea right now, as you say, then why did you then move right along and compare them side by side?
Regardless, comparing your two graphs it looks like S Korea rose steeply between Feb 25th and 29th, then hit a peak of between 750-1000 daily cases, leveled off for a few weeks, then declined. Per your second graph, US has risen rapidly between March 11th and March 14th. Based on the two graphs you presented, are you predicting US will also level off then decline, i.e. the second graph (U.S.) will follow like the first (S. Korea), or some other pattern you've not presented?

 

[Birdstrike]

I dont understand why we're testing non-hospitalized people at this point. The virus is being spread in the community. There is no reliable way to screen people or to contain the virus at this point; that window has already passed.

All we're doing at this point is having low acuity people clog up the ERs requesting testing and they are taking resources away from actual sick people... I dont understand the benefit of testing people who we're going to send home to self quarantine.

You make some very good points here. But people have been told by the media, "experts," many doctors on social media and this public forum, that the coronavirus is a once-in-a-century near-extinction level event, they have mere days to see a doctor before it's too late because their hospital system's going to collapse any day due to coronavirus. They've been told 1.5 million Americans are going to die from coronavirus, which is the equivalent to no less than 15 nuclear bombs being dropped on our country (Hiroshima killed 100,000). They've been told the test is absolutely critical for anyone with cold symptoms, a travesty all 331,000,000 Americans haven't already been tested and their life is being put at risk due to coronavirus because the 'rich' are hoarding the tests for themselves.

And you may be right that not even testing
minor cases becomes the recommendation. It sounds like New York may actually be very close to telling everyone to assume their already exposed and stop even attempting to trace them.

But how likely is it that we're going to put that genie back in the bottle by telling people, "Get out of the ER, you're taking away resources from 'actual sick' people. Go home. You don't need a test or even to worry about it because what you might have Coronavirus which is ‘no big deal’”?

 

[Brigade4Radiant]

Probably will be a lockdown tomorrow similar to Italy

 

[miacomet]

Probably will be a lockdown tomorrow similar to Italy

Agreed. Not sure if it's the right thing- I think there were other measures that could have been taken ahead of time, but I agree with your prediction.

 

[zurned]

For context, Influenza kills approximately 500,000 people worldwide per year. There are healthy 40-50 year olds dying from influenza as well. Only half a year is considered flu season (so 180 days). So that means this thing needs to kill 2,777 daily to be equally deadly. (Not death percentage, I'm talking about total deaths) It has killed about 6,000 in 2 months and this includes spreading through one of the most populated countries in the world.

Deaths will likely increase the next few weeks and months. But 2777 a day to equal the flu. 2,777 per day. If anything, this highlights that we should care more about the flu than we do.

Not saying it's not a big deal. Any potentially deadly infection is important even if it only kills hundreds or thousands. But one person dying from flu is equally bad as one person dying from coronavirus is equally bad as one person dying in a car crash. One vent used on a drunken MVA is equal to one used on a coronavirus patient.

 

[thegenius]

I think the reason why we think little about the flu are the following:
- we can predict when it's going to happen
- we have > 100 years of dealing with the consequences
- we have a rapid test
- we have some level of immunity against a variety of strains
- we have a vaccine
- we have treatment
- 999/1000 infected people survive it
- we have capacity to handle the wintertime surge in most cases

The flu is deadly and kills hundreds of thousands a year. But I'm not scared of it.

Same reason why I'm not scared of driving a car. There are > 100 deaths a day on our roads. Driving can kill you. It's dangerous. But I don't fear it.

 

[zurned]

I think the reason why we think little about the flu are the following:
- we can predict when it's going to happen
- we have > 100 years of dealing with the consequences
- we have a rapid test
- we have some level of immunity against a variety of strains
- we have a vaccine
- we have treatment
- 999/1000 infected people survive it
- we have capacity to handle the wintertime surge in cases

The flu is deadly and kills hundreds of thousands a year. But I'm not scared of it.

Same reason why I'm not scared of driving a car. There are > 100 deaths a day on our roads. Driving can kill you. It's dangerous. But I don't fear it.

Even WITH vaccines and treatments, 20,000 people die, sometimes even 50,000 or more. It's just because we are used to it I think. Humans are weird

 

[anonperson]

Trying to test every mildly symptomatic patient is a fool's errand at this point. If someone in the general public has symptoms, they should just self quarantine now. People are complaining online about the lack of testing, but for mildly symptomatic patients, how is it going to change management?

What we need to know is which critically ill patients have the disease.

In addition, we need to test symptomatic health care workers so if they are positive, they can appropriately self quarantine.

The general public hates dealing with the unknown which is contributing to the current situation.

But the slow response is going to cost us.

In any clinical situation, it is always better to be over prepared and then ramp down versus trying to ramp up. Then it is a losing battle.

My hope is with the school closures, restaurant/bar closures, and social distancing we can blunt the daily rise in cases. We will see what happens in these next 2 weeks.

 

[zurned]

I think the reason why we think little about the flu are the following:
- we can predict when it's going to happen
- we have > 100 years of dealing with the consequences
- we have a rapid test
- we have some level of immunity against a variety of strains
- we have a vaccine
- we have treatment
- 999/1000 infected people survive it
- we have capacity to handle the wintertime surge in cases

The flu is deadly and kills hundreds of thousands a year. But I'm not scared of it.

Same reason why I'm not scared of driving a car. There are > 100 deaths a day on our roads. Driving can kill you. It's dangerous. But I don't fear it.

I mean, can you imagine if CNN reports in January 2021:

"50,000 Americans have died of COVID-19. A vaccine has been invented that is only 50% effective. It will probably be equally dangerous this year".

 

[NJWxMan]

For context, Influenza kills approximately 500,000 people worldwide per year. There are healthy 40-50 year olds dying from influenza as well. Only half a year is considered flu season (so 180 days). So that means this thing needs to kill 2,777 daily to be equally deadly. (Not death percentage, I'm talking about total deaths) It has killed about 6,000 in 2 months and this includes spreading through one of the most populated countries in the world.

Deaths will likely increase the next few weeks and months. But 2777 a day to equal the flu. 2,777 per day. If anything, this highlights that we should care more about the flu than we do.

Not saying it's not a big deal. Any potentially deadly infection is important even if it only kills hundreds or thousands. But one person dying from flu is equally bad as one person dying from coronavirus is equally bad as one person dying in a car crash. One vent used on a drunken MVA is equal to one used on a coronavirus patient.

I agree with most of this, BUT considering what just happened overnight in Italy, I suspect (and so do many) that the Chinese and Iranians have severely under-reported their mortalities. There have been reports of the Chinese incinerating their deceased. I honestly would not be surprised if the Chinese have lost 50k of its people to COVID.

 

[bravotwozero]

The way the Iranian government handled the situation was atrocious. Their MINISTER OF HEALTH showed up on live TV with an obvious active coronavirus infection, coughing and diaphoretic, adamantly arguing against any quarantine measures, and coughing and spreading infection during live interviews with TV journalists. God help you if you have to face an epidemic in a country with an authoritarian government.

 

[zurned]

The way the Iranian government handled the situation was atrocious. Their MINISTER OF HEALTH showed up on live TV with an obvious active coronavirus infection, coughing and diaphoretic, adamantly arguing against any quarantine measures, and coughing and spreading infection during live interviews with TV journalists. God help you if you have to face an epidemic in a country with an authoritarian government.

This is how humanity handles illness before medical science, which is 99% of human history. Makes you really appreciate how far we have come.

 

[Siggy]

I think the reason why we think little about the flu are the following:
- we can predict when it's going to happen
- we have > 100 years of dealing with the consequences
- we have a rapid test
- we have some level of immunity against a variety of strains
- we have a vaccine
- we have treatment
- 999/1000 infected people survive it
- we have capacity to handle the wintertime surge in cases

The flu is deadly and kills hundreds of thousands a year. But I'm not scared of it.

Same reason why I'm not scared of driving a car. There are > 100 deaths a day on our roads. Driving can kill you. It's dangerous. But I don't fear it.

This is exactly how I describe this to other people. Think of the flu... now imagine you know nothing about it. You don't know that all most people do is sit at home and drink lots of water self isolating themselves in their room. Imagine you hear about this disease coming towards your country that most people get, there's no treatment, no vaccine, and people are dying. I mean... that's pretty much the flu (yes, COVID has a higher mortality rate than the flu, but I've proned plenty of flu patients this year, including a few younger patients), but if you knew nothing about it you'd freak out.

COVID doesn't scare me. COVID scaring other people scares me. To quote Men in Black, " A person is smart. People are dumb, panicky dangerous animals and you know it. "

 

[Perrotfish]

This is exactly how I describe this to other people. Think of the flu... now imagine you know nothing about it. You don't know that all most people do is sit at home and drink lots of water self isolating themselves in their room. Imagine you hear about this disease coming towards your country that most people get, there's no treatment, no vaccine, and people are dying. I mean... that's pretty much the flu (yes, COVID has a higher mortality rate than the flu, but I've proned plenty of flu patients this year, including a few younger patients), but if you knew nothing about it you'd freak out.

There is a certain kind of denial that those of us who have lived on the gulf coast got to deal with every few years.

"That hurricane doesn't scare me, we get storms all the time"
This is more dangerous than a normal storm

"I don't understand why everyone's more worried about that storm that hasn't hurt anyone than the other problems that we have right now"
It hasn't made landfall yet. It will be wore than those other things when it gets here

"Its raining NOW and its not that bad. Its not a bad storm"
The edge of the storm isn't as strong as the center. The storm will get worse with time.

"Yeah I'm doing all the common sense stuff, I bought toilet paper and water and cleaned out my drains"
That's common sense for normal storms. For a big storm like this you need to board up all your windows and leave town.

"All the 'experts' were worried about the last one and it ended up being nothing"
And this time we are going to be trying to airlift you off your roof.

If we follow Italy's trajectory landfall is in about a week.

 

[thegenius]

This is exactly how I describe this to other people. Think of the flu... now imagine you know nothing about it. You don't know that all most people do is sit at home and drink lots of water self isolating themselves in their room. Imagine you hear about this disease coming towards your country that most people get, there's no treatment, no vaccine, and people are dying. I mean... that's pretty much the flu (yes, COVID has a higher mortality rate than the flu, but I've proned plenty of flu patients this year, including a few younger patients), but if you knew nothing about it you'd freak out.

COVID doesn't scare me. COVID scaring other people scares me. To quote Men in Black, " A person is smart. People are dumb, panicky dangerous animals and you know it. "

I hear ya. It scares me a little bit, but absolutely not freaking out about it. I'm not freaking out and didn't buy two reams of TP and alcohol sanitizer. but I'm more careful around patients who I think might have it. I'm gowning and gloving and masking and everything. I basically never do that during flu season.

 

[y123]

Wow this thread is eye opening. I will come back in 2 months and see how you guys feel about covid-19 then.

 

[ShockIndex]

I hear ya. It scares me a little bit, but absolutely not freaking out about it. I'm not freaking out and didn't buy two reams of TP and alcohol sanitizer. but I'm more careful around patients who I think might have it. I'm gowning and gloving and masking and everything. I basically never do that during flu season.

Once again, my experience in real life is vastly different than what people describe on SDN. I’ve not seen anyone freak out. I suppose the internet video of 2 Australian women fighting over a roll of TP might be a mini-freak out, but I thought that was pretty weak compared to American Walmart shoppers on Christmas Eve.

In fact, I’ve yet to see what I’d consider live hysterics in my daily routine. Is there a run on essentials and non-perishables? Sure. But is that really a freak out? I’d call prudent behavior for a population being told to prepare for 2 weeks of self-quarantine if exposed. If I’m going to be stuck face-to-face with my wife for 14 days, then pardon me if I make sure that she doesn’t have a raw butt.

Truth be told, I’m surprised at how level headed everyone seems in real life despite the big (and overdue) bear market and looming economic slowdown. Nobody around me is claiming an near-extinction level event, threatening hospital administration if demands aren’t met, or doing anything near what I’d call freak out. Instead, I see an appropriate level of concern for a potential worst case scenario.

Perhaps the reality of the forthcoming austerity measures haven’t sunk-in on the masses. Feel free to tell me, “I told you so” if in 2 weeks we are run’en and gun’en in the streets to avoid The Purge.

 

[deleted836128]

It’s an embarrassing situation at my hospital. N95s are getting to be nonexistent and it is getting hard to even find enough surgical masks. Ans today I had a nurse try to BS me out of getting an N95 when I needed it. I had a patient today come in with five days of a cough and fever. Last week he went on a work trip with six coworkers; one of which just tested positive for COVID-19 and the other was a presumed positive. The nurse in this patient’s zone was pregnant, and she was also charge today and was quite busy, so I offered to go in and do the swabs. I couldn’t find N95s anywhere. Yesterday there were a total of FIVE N95s right up front being kept under lock down by the charge nurse but today there were none there. I asked one of the nurses nearby, “I need an N95. I am examining and swabbing the sick guy who was exposed to COVID. Where are the masks?” She tells me, “Oh, sorry, we are all out.” I said, “How we we all out?” She shrugged and said “I dunno.” I asked, “What am I supposed to do?” She said, “The hospital says to just use a regular surgical mask.” I said, “For obtaining respiratory specimens? For intubating patients? These are aerosol generating situations.” She confirmed that, yes, all we had were the stupid yellow flimsy masks (and even THOSE are not readily available; I’ve had to search for them all day). She reiterated that we were TOTALLY OUT OF N95s. I said, “That is ridiculous. That’s not proper protocol. I can’t be getting the swabs without protection.” I was getting mad and as I was leaving to go find the charge nurse to ask what the hell was up, this nurse all the sudden opened a drawer right next to her and immediately said “Oh, never mind, here are some....” and lo and behold, there was a box of N95 masks in there. I could tell she knew damn well they were there the whole time and pretended like we didn’t have any. Which disgusts me. Anyway, I am just venting. I am at a loss, incredibly discouraged. As ER staff, we should be upholding the highest standards for infection control and... this is just a joke. And to think that one of my supposed teammates didn’t think I was worthy of an N95 and tried to hide them from me is insulting. Don’t mean to be negative but with the way things are going in our department, there’s a good chance we are all gonna get sick and then who’s going to take care of the patients...

 

[Birdstrike]

Once again, my experience in real life is vastly different than what people describe on SDN. I’ve not seen anyone freak out.

Oh, really? You haven't seen anyone other than people on SDN 'freak out'?" You think stock market panic-sell off of 30% is a usual and helpful response to a virus that indicates no underlying panic in the population? You think nationwide hoarding of pantry items and surgical masks to shortage levels is a usual and helpful response to a virus?

Those are not normal, rational or helpful reactions to a virus that's killed 0.00002% of the population (69/331,000,000) half of whom were in a single nursing home. They won't be normal, rational or helpful even if the problem gets 10 or even 100 times worse. But it is the expected response, when the population is told the equivalent of 16 nuclear bombs are going to be dropped on the population killing 1,600,000 Americans, and people who should know better, can't immediately recognize it as false.

Maybe, just when coronavirus has started to wane, someone will go on cable news, show pictures of some patients in isolation, a healthcare worker in personal protective gear and say, "GET READY! CDC predicts 15,000 Americans will die from this contagious PLAGUE in the next few months!!!!" and start a panic, and it'll spread on social media, and doctors will say, "Yeah it's bad it's real bad. I saw a patient with it once, it's contagious and it'll tear your insides out! It'll definitely kill tens of thousands. Hell, maybe if we have a bad year, 1 million could die. Worst case scenario, who knows?" And we'll shut down schools, flights and sports leagues again for two more months, then, once the stock market is down another 30%, and the price of toilet paper is so priceless and Holy that people are using squares of it as currency, you'll tell them it's....C. Dificile. And you'll tell them that it is contagious, requires isolation, that it is going to kill 15,000 Americans this year, and that it does every year and why haven't they noticed? Then we'll look and say, "Panic? I don't see anyone panicking."

Again, I agree with the current precautions, and recommendations for a period of time. but we're not going to be able to do this, to shut down a whole nation, every time there's a communicable disease going around. We're just not. It's just not sustainable.

 

[Birdstrike]

But are you ready for this shiny gem? Because you know it's coming?

What the outlandish media predictions of 1.6 million Americans dying will do, is allow those in charge to declare a massive, unprecedented success when it's done. When ultimately, the death toll is far less than that, they'll be ecstatic to go out and declare victory. I can already hear it now, "The experts, even Obama's former CDC Director Tom Frieden said, '1.6 million would die.' But look! Due to our overwhelming response and prudent actions we have saved 1.59 million American lives! Lives successfully saved on a scale never seen before in history!" And the tens of millions of people that hoarded Charmin will believe every bit of it.

 

[TwoHighways]

What the outlandish media predictions of 1.6 million Americans dying will do, is allow those in charge to declare a massive, unprecedented success when it's done. When ultimately, the death toll is far less than that, they'll be ecstatic to go out and declare victory. I can already hear it now, "The experts, even Obama's former CDC Director Tom Frieden said, '1.6 million would die.' But look! Due to our overwhelming response and prudent actions we have saved 1.59 million American lives! Success on a scale never seen before!" And the tens of millions of people that hoarded Charmin will believe every bit of it.

On point! Meanwhile, the diabesity pandemic (an abject public health failure) and it’s downstream effects will continue unchecked and bankrupt us.

 

[lifeisamystery]

You just joined today.

And your point is? Is that relevant somehow? Wow, I hope some of you have better skills in logic when practicing medicine than you do trying to make an argument.

 

[Birdstrike]

Probably will be a lockdown tomorrow similar to Italy

At 11:48 PM last night the National Security Council released a statement that someone was spreading fake text messages and rumors about a national quarantine "lockdown." It's just more people spreading needless panic, just like the "1.6 million of you will be dead soon" garbage.

 

[ShockIndex]

Oh, really? You haven't seen anyone other than people on SDN 'freak out'?" You think stock market panic-sell off of 30% is a usual and helpful response to a virus that indicates no underlying panic in the population? You think nationwide hoarding of pantry items and surgical masks to shortage levels is a usual and helpful response to a virus?

Those are not normal, rational or helpful reactions to a virus that's killed 0.00002% of the population (69/331,000,000) half of whom were in a single nursing home. They won't be normal, rational or helpful even if the problem gets 10 or even 100 times worse. But it is the expected response, when the population is told the equivalent of 16 nuclear bombs are going to be dropped on the population killing 1,600,000 Americans, and people who should know better, can't immediately recognize it as false.

Maybe, just when coronavirus has started to wane, someone will go on cable news, show pictures of some patients in isolation, a healthcare worker in personal protective gear and say, "GET READY! CDC predicts 15,000 Americans will die from this contagious PLAGUE in the next few months!!!!" and start a panic, and it'll spread on social media, and doctors will say, "Yeah it's bad it's real bad. I saw a patient with it once, it's contagious and it'll tear your insides out! It'll definitely kill tens of thousands. Hell, maybe if we have a bad year, 1 million could die. Worst case scenario, who knows?" And we'll shut down schools, flights and sports leagues again for two more months, then, once the stock market is down another 30%, and the price of toilet paper is so priceless and Holy that people are using squares of it as currency, you'll tell them it's....C. Dificile. And you'll tell them that it is contagious, requires isolation, that it is going to kill 15,000 Americans this year, and that it does every year and why haven't they noticed? Then we'll look and say, "Panic? I don't see anyone panicking."

Again, I agree with the current precautions, and recommendations for a period of time. but we're not going to be able to do this, to shut down a whole nation, every time there's a communicable disease going around. We're just not. It's just not sustainable.

First, I’ve not seen any reputable source claim that 1-2 million WILL die as if its foregone conclusion. I’ve seen plenty of reports that 1-2 million is a plausible but worst case scenario. I agree with those numbers unless America implements the austere social distancing and travel restrictions that experts have suggested to our leadership.

Second, you claim to agree with the current isolation precautions. That’s good. It means that you are not freaking out. However, part of that process is a major downturn in economic activity that is expected to hammer the markets which were likely over-valued in the first place. Again, and normal and predictable reaction.

Finally, freaking out is a term most rational people use when we have lost social order. A good example would be the LA riots when people set fire to their own communities and then took potshots at the firefighters trying to save them. That was a 5-alarm freak out. A 10-alarm freak out was an insurgent throwing a grenade at a group of Iraqi kids for accepting candy from US soldiers, or an Afghan soldier killing my friend because she wore shorts to the gym in front of him. A 2-alarm was the post-Katrina rioting. So, call me when the Chinese dudes are on the rooftops with rifles.

 

[thegenius]

just bought 30K in stock today. I'm willing to bet 30K that it will be substantially higher in 1 year.

 

[ShockIndex]

It’s an embarrassing situation at my hospital. N95s are getting to be nonexistent and it is getting hard to even find enough surgical masks. Ans today I had a nurse try to BS me out of getting an N95 when I needed it. I had a patient today come in with five days of a cough and fever. Last week he went on a work trip with six coworkers; one of which just tested positive for COVID-19 and the other was a presumed positive. The nurse in this patient’s zone was pregnant, and she was also charge today and was quite busy, so I offered to go in and do the swabs. I couldn’t find N95s anywhere. Yesterday there were a total of FIVE N95s right up front being kept under lock down by the charge nurse but today there were none there. I asked one of the nurses nearby, “I need an N95. I am examining and swabbing the sick guy who was exposed to COVID. Where are the masks?” She tells me, “Oh, sorry, we are all out.” I said, “How we we all out?” She shrugged and said “I dunno.” I asked, “What am I supposed to do?” She said, “The hospital says to just use a regular surgical mask.” I said, “For obtaining respiratory specimens? For intubating patients? These are aerosol generating situations.” She confirmed that, yes, all we had were the stupid yellow flimsy masks (and even THOSE are not readily available; I’ve had to search for them all day). She reiterated that we were TOTALLY OUT OF N95s. I said, “That is ridiculous. That’s not proper protocol. I can’t be getting the swabs without protection.” I was getting mad and as I was leaving to go find the charge nurse to ask what the hell was up, this nurse all the sudden opened a drawer right next to her and immediately said “Oh, never mind, here are some....” and lo and behold, there was a box of N95 masks in there. I could tell she knew damn well they were there the whole time and pretended like we didn’t have any. Which disgusts me. Anyway, I am just venting. I am at a loss, incredibly discouraged. As ER staff, we should be upholding the highest standards for infection control and... this is just a joke. And to think that one of my supposed teammates didn’t think I was worthy of an N95 and tried to hide them from me is insulting. Don’t mean to be negative but with the way things are going in our department, there’s a good chance we are all gonna get sick and then who’s going to take care of the patients...

I do not believe that collecting respiratory samples falls under the list of aerosol-inducing procedures (intubation, deep suctioning, etc.). According to the CDC guidance in Section 5, surgical masks are an acceptable alternative to a N95 if respirators are not available. Our nurses are collecting samples with a surgical mask instead of N95s due to shortages.

Coronavirus Disease 2019 (COVID-19)

Coronavirus disease 2019 (COVID-19) is a virus (more specifically, a coronavirus) identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.

www.cdc.gov

My recommendation is that your facility needs better accounting for its supply of N95s. Perhaps it should designate someone familiar with the CDC guidelines as well as your real-time inventory to handle these disputes. Otherwise, I fear you will run out of this vital equipment when you really need it.

 

[Birdstrike]

So, call me when the Chinese dudes are on the rooftops with rifles.

Your definition of "not freaking out" apparently is any behavior less extreme than "Chinese dudes being on rooftops with rifles." That's great to know. I'll be on the lookout and you'll be the first I call when I spot some!

 

[deleted836128]

I do not believe that collecting respiratory samples falls under the list of aerosol-inducing procedures (intubation, deep suctioning, etc.). According to the CDC guidance in Section 5, surgical masks are an acceptable alternative to a N95 if respirators are not available. Our nurses are collecting samples with a surgical mask instead of N95s due to shortages.

Coronavirus Disease 2019 (COVID-19)

Coronavirus disease 2019 (COVID-19) is a virus (more specifically, a coronavirus) identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.

www.cdc.gov

My recommendation is that your facility needs better accounting for its supply of N95s. Perhaps it should designate someone familiar with the CDC guidelines as well as your real-time inventory to handle these disputes. Otherwise, I fear you will run out of this vital equipment when you really need it.

The CDC recommends an N95 for obtaining the respiratory specimens if it is available. It was available. The nurse was just hoarding for themselves. The main issue was when I asked her “what about if a patient needs to be intubated” and she claimed that we had no N95s and the hospital wanted us to use regular surgical masks for that.

 

[Birdstrike]

double post

 

[ShockIndex]

The CDC recommends an N95 for obtaining the respiratory specimens if it is available. It was available. The nurse was just hoarding for themselves. The main issue was when I asked her “what about if a patient needs to be intubated” and she claimed that we had no N95s and the hospital wanted us to use regular surgical masks for that.

Yep, hoarding essential equipment is not acceptable. Your director needs to handle that. Like I said, accurate inventory of essential equipment is vital to any functional leadership. The fact that you got to the point where nobody could account for the N95s tells me that you’ve got a problem.

 

[TwoHighways]

Video laryngoscopes ought to be standard equipment in every emergency room. No need to get your face down in there for a view of the vocal cords when you can visualize them on a larger screen.

 

[wysdoc]

The CDC recommends an N95 for obtaining the respiratory specimens if it is available. It was available. The nurse was just hoarding for themselves. The main issue was when I asked her “what about if a patient needs to be intubated” and she claimed that we had no N95s and the hospital wanted us to use regular surgical masks for that.

Please write up an incident report on that lyin' idiot. I'm sure she would do the same to a doctor for much less cause.

 

[Birdstrike]

From now on, I've changed my thinking on this. I'm doing a total 180. I have to. I need to, and am going to, view this in a more positive way. I'm only viewing this from a "lives saved" standpoint. I will no longer focus on the negatives, the morbidity and mortality. I will only view this in the most positive, optimistic, light possible. I'm going to assume as fact, the worst case scenario of 1.6 million dead as stated by the Fmr Director Tom Freidman may well have happened, would have happened, if we had done nothing. Therefore, I will only view this from a "American lives saved standpoint." That number currently is: 1,600,000 potential US deaths - 69 US deaths =

1,599,931 American lives saved,

due to our COVID-19 response plan. I honestly can't look at it any other way. Anything else is too negative and too intolerable to my brain.

We've saved 1,599,931 American lives due to our actions and we need to keep them up until this is 100% stopped. I can't view it any other way. That's the most positive outlook on this and that's my viewpoint from now on. There's nothing to be gained by, and it makes no sense, to view it any other way. We're following a plan, preventing a worst case scenario and saving 1.599 million lives by doing it. It's the only thing my brain can handle at this point.

 

[y123]

Those are not normal, rational or helpful reactions to a virus that's killed 0.00002% of the population (69/331,000,000) half of whom were in a single nursing home.

I will come back infrequently to update this data.
I'll call today D1.
3/16/2020

 

[turkeyjerky]

It’s an embarrassing situation at my hospital. N95s are getting to be nonexistent and it is getting hard to even find enough surgical masks. Ans today I had a nurse try to BS me out of getting an N95 when I needed it. I had a patient today come in with five days of a cough and fever. Last week he went on a work trip with six coworkers; one of which just tested positive for COVID-19 and the other was a presumed positive. The nurse in this patient’s zone was pregnant, and she was also charge today and was quite busy, so I offered to go in and do the swabs. I couldn’t find N95s anywhere. Yesterday there were a total of FIVE N95s right up front being kept under lock down by the charge nurse but today there were none there. I asked one of the nurses nearby, “I need an N95. I am examining and swabbing the sick guy who was exposed to COVID. Where are the masks?” She tells me, “Oh, sorry, we are all out.” I said, “How we we all out?” She shrugged and said “I dunno.” I asked, “What am I supposed to do?” She said, “The hospital says to just use a regular surgical mask.” I said, “For obtaining respiratory specimens? For intubating patients? These are aerosol generating situations.” She confirmed that, yes, all we had were the stupid yellow flimsy masks (and even THOSE are not readily available; I’ve had to search for them all day). She reiterated that we were TOTALLY OUT OF N95s. I said, “That is ridiculous. That’s not proper protocol. I can’t be getting the swabs without protection.” I was getting mad and as I was leaving to go find the charge nurse to ask what the hell was up, this nurse all the sudden opened a drawer right next to her and immediately said “Oh, never mind, here are some....” and lo and behold, there was a box of N95 masks in there. I could tell she knew damn well they were there the whole time and pretended like we didn’t have any. Which disgusts me. Anyway, I am just venting. I am at a loss, incredibly discouraged. As ER staff, we should be upholding the highest standards for infection control and... this is just a joke. And to think that one of my supposed teammates didn’t think I was worthy of an N95 and tried to hide them from me is insulting. Don’t mean to be negative but with the way things are going in our department, there’s a good chance we are all gonna get sick and then who’s going to take care of the patients...

I'm sorry for the unsolicited advice, but here it is anyway.

You need to settle the **** down.

You are high risk for this thing, and nearly guaranteed to be seropositive by the end. Picking and promulgating inane arguments at work is counterproductive.

In your case, I would've just discharged those patients. The ER is not the place for answers. If they're coming in just for a test, they don't need to be here.

 

[y123]

just bought 30K in stock today. I'm willing to bet 30K that it will be substantially higher in 1 year.

We shall see in 1 year

 

[GeneralVeers]

The Las Vegas strip has been shut down for the first time ever. Casinos are closing today, and the largest operator, MGM resorts is shutting down everything as of tomorrow.

This is unprecedented.

So far we we have ~ 30 cases in the entire county (2 million people). We are now testing everyone walking through the door with even the mildest sniffle and it's getting worse. So far we really aren't seeing a lot of bad elderly respiratory cases. What will really break our system is having to do an EMTALA-mandated screening on the walking-worried who demand testing.

I wish we could just put a "GTFO nurse" to sit up front. She'd screen them and tell them to "GTFO".

 

[miacomet]

The Las Vegas strip has been shut down for the first time ever. Casinos are closing today, and the largest operator, MGM resorts is shutting down everything as of tomorrow.

This is unprecedented.

So far we we have ~ 30 cases in the entire county (2 million people). We are now testing everyone walking through the door with even the mildest sniffle and it's getting worse. So far we really aren't seeing a lot of bad elderly respiratory cases. What will really break our system is having to do an EMTALA-mandated screening on the walking-worried who demand testing.

I wish we could just put a "GTFO nurse" to sit up front. She'd screen them and tell them to "GTFO".

Agreed. MSEs by nurses in PAPRs. Perfect.