What do I need to know about coronavirus?

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Anyone seeing any vague substernal dull chest discomfort associated with positive cases?
 
At my shop:
-NIPPV is a No No
-No nebs outside of neg pressure rooms
-Intubations are done by anesthesia (they happily come down...I happily leave the room). VL only. No BVM.
-We are given one N95 / shift. I wear mine all day. There is a large variance in staff usage of PPE, which makes me nervous.
 
It's super gross in these N95s all day, and I get very thirsty. Beats 3 weeks on the vent followed by death though.
TheSingularity said:
At my shop:
-NIPPV is a No No
-No nebs outside of neg pressure rooms
-Intubations are done by anesthesia (they happily come down...I happily leave the room). VL only. No BVM.
-We are given one N95 / shift. I wear mine all day. There is a large variance in staff usage of PPE, which makes me nervous.
Click to expand...
 
TooMuchResearch said:
If we could test, then I bet we would. But are they asymptomatic and just having chest pain? Unclear.
Click to expand...
Non specific URI symptoms (runny nose, post nasal drip, minor sore throat), afebrile, starting to feel better, then developed this nonspecific dull chest pain.

Also, I've been reading a lot of resources online about symptomology, and it doesn't help that they define a fever as "over 99F" or "over 99.6F." At least one actually specified greater than 99.5 axillary, which may correlate better to 100.4 oral. But MDM in the absence of good data is driving me nuts.
 
The USNS Comfort and Mercy are just going to see trauma, I think.
 
IMGASMD said:
Plaquenil? Antiviral? Steroids?
Whatever out there that “may” help....?
Click to expand...
My wife has an rx for plaquenil due to Sjogrens with joint involvement. So, we have a 60 tab bottle of this sitting on the shelf. Am I taking it for prophylaxis? No. Would I take it if I got some mild symptoms, runny nose, mild cough? Probably not. If I started getting fever, cough, more severe symptoms, would I take it along with a Z-pack? Hell yes. Are people going to be hoarding it and will that possibly create a shortage in hospitals? Maybe. If that happens, and I have to get hospitalized with COVID-19 and they're short on plaquenil, will I have a secret stash in my room and be taking it on the sly? Hell yeah.
 
wholeheartedly said:
Where’d the ~70% come from?
Click to expand...

It's the sensitivity of NP/OP NAAT testing from China compared to their ultimate case definition (determined by clinical course and CT findings). Anecdotal evidence from Italy also reveals a high initial false negative rate.

I haven't seen anything reported on the actual sensitivity of the Cepheid testing, but their influenza and RSV testing shows a comparable sensitivity to PCR based assays (ie much better than the rapid antigen tests that most of us rely on).
 
www.thedailybeast.com

L.A. Docs Will Stop Testing Some Patients for Coronavirus

Local public health officials believe it's now too late to contain the spread of the virus.
www.thedailybeast.com www.thedailybeast.com

Also reported in the LA Times.

Cases have remained relatively steady this past week while deaths have slowly crept up in LA county.

I had predicted this outcome earlier this week. We'll see when we can really ramp up testing. Our current situation is pitiful.
 
Okay, since the other thread about quitting our jobs b/c of this, is anyone else getting seriously sick about the exposure hysteria?

Granted, I'm in my 30s and healthy, so when (not if) I catch this, I'm pretty sure I'll do okay. But I am getting really tired of overhearing others talk about calling off or just refusing to see PUIs. For the vast majority of us, this is not a private-health concern (obviously, I believe it remains a major public health concern).

The other day, another doc at one of my sites intubated a patient w/o an N95 (who later turned out to have mutilobar pna). She flipped out and refused to see any other patients for the rest of her shift. Absolutely flummoxed by this response.

Highly recommend, this article by Atul Gawande:

Keeping the Coronavirus from Infecting Health-Care Workers
 
turkeyjerky said:
It's the sensitivity of NP/OP NAAT testing from China compared to their ultimate case definition (determined by clinical course and CT findings). Anecdotal evidence from Italy also reveals a high initial false negative rate.

I haven't seen anything reported on the actual sensitivity of the Cepheid testing, but their influenza and RSV testing shows a comparable sensitivity to PCR based assays (ie much better than the rapid antigen tests that most of us rely on).
Click to expand...

Ok. Thanks for the info. I’ve read the technical documentation for the Cepheid, but it’s a bit different than what I’m used to looking at for diagnostics.
 
turkeyjerky said:
Okay, since the other thread about quitting our jobs b/c of this, is anyone else getting seriously sick about the exposure hysteria?

Granted, I'm in my 30s and healthy, so when (not if) I catch this, I'm pretty sure I'll do okay. But I am getting really tired of overhearing others talk about calling off or just refusing to see PUIs. For the vast majority of us, this is not a private-health concern (obviously, I believe it remains a major public health concern).



Keeping the Coronavirus from Infecting Health-Care Workers
Click to expand...

Agree completely. I work with a bunch of hysterical doctors who run around either wearing an N-95 or the PAPR (they look like spacemen) for the entire shift, even while in the doctor's area away from patients. They constantly spout anecdotes about this or that young person who ends up in the ICU, although we haven't had any young people in our area critically ill with this yet.

Is there data on how what percentage of people under 50 end up intubated? We know the death rate is a fraction of a percent.
 
turkeyjerky said:
Okay, since the other thread about quitting our jobs b/c of this, is anyone else getting seriously sick about the exposure hysteria?

Granted, I'm in my 30s and healthy, so when (not if) I catch this, I'm pretty sure I'll do okay. But I am getting really tired of overhearing others talk about calling off or just refusing to see PUIs. For the vast majority of us, this is not a private-health concern (obviously, I believe it remains a major public health concern).

The other day, another doc at one of my sites intubated a patient w/o an N95 (who later turned out to have mutilobar pna). She flipped out and refused to see any other patients for the rest of her shift. Absolutely flummoxed by this response.
Click to expand...
First ER doctor dies of SARS-CoV2 in Oise, France. 67 years old.

I know there is a certain level of risk inherent in this work, but I won’t risk my personal safety without the appropriate PPE.

Granted, I make $31.75 an hour as a nurse on a busy Medicine unit. That might have something to do with it.

I’m not paid nearly enough to even consider this.
 
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BingoBaby123 said:
First ER doctor dies of SARS-CoV2 in Oise, France. 67 years old.

I know there is a certain level of risk inherent in this work, but I won’t risk my personal safety without the appropriate PPE.

Granted, I make $31.75 CAD an hour as a nurse on a busy Medicine unit. That might have something to do with it.

I’m not paid nearly enough to even consider this.
Click to expand...

Then stay home.
 
turkeyjerky said:
Then stay home.
Click to expand...

I'm in the same demographic as you, and I try to put myself in the experiential shoes of the older docs. I don't know how I would feel coming to work right now in my mid-60s, and because of that I have empathy for a wide range of responses to this problem, including staying home (although I haven't seen that in real life yet).

I do agree that if you're refusing to see patients after intubating a potential Covid case, you're likely not helping things.
 
(Moved post since more appropriate for this thread)

I just went for a run and it made me think. I was trying to think of when was the last time I saw this much fear in the medical community over a communicable disease. I don't remember anyone getting too worried about SARS, Bird Flu or Zika. We just didn't have enough cases for that to create much if any fear among my colleagues. Ebola created a lot of fear among the general population, but again, we didn't have enough cases here to cause widespread fear among anyone I worked with. None of the flu seasons, even though some of them killed 10's of thousands of people, seemed to cause any fear among the medical community, because that's something we're used to, and we've all lived with since birth.

The only thing I can remember causing this much fear among co-workers was during the early days of the AIDS epidemic in the late 80's early 90's. People were dying horrible, long, wasting deaths from a new disease. There was no cure. The death rate was very close to 100%, if not 100%, and there was no vaccine and no cure. In the early days, people weren't even really sure how it spread. People wondered, could you get it from a cough, sneeze, touch?! That turned out to be false. Can you get it from blood splatter on your hand?! That turned out to be false. No one seemed sure of anything, as this was literally a new disease that had emerged out of a foreign land, having originated in an animal (sound familiar?)

The, when I was a pre-med in the early '90s, Magic Johnson was diagnosed and all Hell broke loose. I remember hearing about older orthopedic doctors retiring due to fear that they'd inhale blood splatter during the bone-sawing portion of total joint replacements. That turned out to be false. I remember ER docs saying, if they got a needle stick from an HIV positive patient, "It's a death sentence. 100% you're dead." That turned out to be mostly false (0.3% chance of transmission with positive needle stick). This was when HIV drugs were in their infancy and we weren't even sure if they'd work, of if they did, how well. The panic was real. People, medical people, were freaking out. Some of it was 100% justified. Some of it was overreaction out of fear, and uncertainty.

But in the end, the occupational hazard didn't turn out as bad as we had feared. In those past 25+ years I can't remember knowing a single colleague that died from an HIV needle stick. I'm sure there were some. I know of a few that got Hep C and died, which never seemed to create the same fear. I can remember people I knew and worked with that died of a bunch of other things since then: Car accidents, cancer, heart attacks, overdoses, you name it. But none of them feared dying of those things nearly as much as we all feared dying from HIV and AIDS due to a needle stick in those early days.

My point is not that COVID-19 and AIDS are the same. They're not. My point is not that COVID-19 isn't bad. COVID-19 is bad. It's real bad. And I'm not saying fear of it, is unjustified. Fear of it, is justified. But what I am saying is, as a medical community, we got through the initial very scary days of HIV/AIDS. It turned out to be a bad thing, real bad. A lot of people died. But as far as risks of contracting the disease while taking care of the patients, we got through it a lot better than we initially feared. And I'm hoping that COVID-19 turns out to be the same. That we get through this legitimately scary time, better than we had initially feared. I could be wrong. But I think there’s a good chance we will.
 
In 2015, NY Gov Cuomo was told NY was 16,000 short on ventilators and decided not to buy them.

"New York's Ventilator Rationing Plan

...After learning that the state's stockpile of medical equipment had 16,000 fewer ventilators than New Yorkers would need in a severe pandemic, Gov. Andrew Cuomo came to a fork in the road in 2015. He could have chosen to buy more ventilators. Instead, he asked his health commissioner, Howard Zucker to assemble a task force and draft rules for rationing the ventilators they already had."
 
hoot504 said:
I'm in the same demographic as you, and I try to put myself in the experiential shoes of the older docs. I don't know how I would feel coming to work right now in my mid-60s, and because of that I have empathy for a wide range of responses to this problem, including staying home (although I haven't seen that in real life yet).

I do agree that if you're refusing to see patients after intubating a potential Covid case, you're likely not helping things.
Click to expand...

I agree with you. Some of our older collegues should probably sitting this one out. Departments with a higher proportion should figure out a zoning system and have the older docs take non respiratory cases. [At my prior full time shop, I supported not requiring those >55 to work overnights, despite the policy resulting in me having to work a higher number of more difficult night shifts]

However, my experience is a large number of young healthy people freaked out. Or the type who comes in and voices concern about bringing it home to their kids.

bigtruckguy3500 said:
There's a new study looking at Viagra.

ClinicalTrials.gov

clinicaltrials.gov clinicaltrials.gov
Click to expand...

I for one will be taking it prophylactically before every shift
 
Don't know if anyone has posted this already, but here are links to proper donning and doffing of PPE. I don't think the importance of donning and doffing can be overstated, folks, so be as anal retentive about this as you possibly can. Not a single healthcare provider who followed this protocol in Taiwan got sick. Stay Safe on the frontlines and God speed.

Donning Technique

Doffing Technique 1

Doffing Technique 2

As for Italy, clearly the country is a huge outlier. Like I said before, when you completely give up on treating anyone over 65 for a disease that primarily targets the elderly in a country full of old people and a low birth rate.....
 
Perrotfish said:
So Italy's mortality rate might be several times what is actually being reported: Uncounted among coronavirus victims, deaths sweep through Italy's nursing homes

It turns out that they only swab people who live long enough to get to the hospital, and they are seeing an enormous number of deaths in nursing homes that don't even make it into the ER.
Click to expand...

There are going to be so many inaccurate numbers when this pandemic is over. I've read some of the history behind the Spanish Flu and how difficult it was to count all those infected, those that died, etc. And I chalked most of it up to that it happened 100 years ago.

Now, I wouldn't be surprised if there is more US private testing than public testing. Private companies don't have to report their results. So the numbers will very quickly become inaccurate.

At some point it's not gonna matter. As long as hospitals can handle the general flux of patients, I would start easing social-distancing guidelines (but not today)
 
So my oldest son (15) is sick. He developed an in-between wet and dry cough about 8 days ago. 4 days ago developed a fever 102. He's been blowing his nose. No SOB. So not only are we following state guidelines for shelter-in-place, we are isolating him in his room. The fever is gone but he has this terrible sounding cough.

Now my other son (13) is mildly sick. he developed a dry cough yesterday. We are putting a mask on him around the house, but I wonder at this point if it's even worth it. My wife is worried because she has asthma, and she doesn't want it to flare up. I don't want it mainly because I want to work and don't want to go on quarantine or isolation if I have any symptoms.

The absolute biggest problem with all of this is having our kids take this semi-seriously. They don't take it seriously at all. They joke around, I point out how my older son coughs in his forearm then he immediately rubs his hair back. Then one minute later he touched a doorknob. I'm trying to tell these dinguses that they have to be careful because I'm gonna get sick or someone is going to get sick. They don't get it. I probably don't expect them to get it but they just don't.

Now I'm not worried about them medically on any level. But I wish I could get them tested, or me tested if I develop some respiratory symptom. Because there is a ZERO% chance I will be able to work if I have even a whiff of a respiratory symptom.
 
thegenius said:
Now I'm not worried about them medically on any level. But I wish I could get them tested, or me tested if I develop some respiratory symptom. Because there is a ZERO% chance I will be able to work if I have even a whiff of a respiratory symptom.
Click to expand...
My understanding is that in my county we are now testing healthcare workers. We still have very limited testing but they have at least figured out how to get healthcare workers back to work within a couple of days.
 
Perrotfish said:
It turns out that they only swab people who live long enough to get to the hospital, and they are seeing an enormous number of deaths in nursing homes that don't even make it into the ER.
Click to expand...
Yes, the DNR patients. Why am I the only one that is pointing out that so many of these infections are likely survivable, but are in DNR patients, which skews the death rate astronomically in patients the elderly, and the numbers overall? It also skews the perceived severity to people who are willing and able to fight this thing and it skews the fear factor, big time. The DNR patients have to be a huge number of the deaths (1/3, 1/2, more?) And before someone comes back at me with a "But what about this young guy?" anecdote, let me point out, this is a country of 331,000,000 people, and a world of 7,500,000,000 people. Single patient anecdotes mean nothing, when you're talking about finding the right-sized epidemiological response.

I'm not "minimizing" this thing. I know COVID-19 is serious (for the 1 millionth time). I know we have to fight the virus and take common sense, appropriate measures. I know "experts" have predicted "2.2 million Americans will die from this plague!" and we need to "flatten the curve." But we're 2 months in and 99.999858% of Americans have not died from this thing (471 deaths out of 331 million). If the problem gets 100 times worse (47,100 out of 331,000,000), 99.98577% of Americans will not have died from this. If the problem gets 1000 times worse (471,000), 99.86% of Americans will not have died from it. Yes, yes, yes, I know, we don't want to (and won't) let it get that bad. And yes, for the 1,000th time I agree with the aggressive measures being taken.


But, considering we're two months in and 99.999% of us have made it this far and like I asked early in this thread when all these shutdowns started happening: Considering this virus is not going away, and never was going to go away, what's the plan for moving forward, living with this virus?
 
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I just called my local senators office to request what is being done about temporary (god forbid forever) malpractice issues!!! It seems like an appropriate time during an emergency crisis that those in the front line shouldn’t have to worry about litigation bullshizzz!!! I would suggest many of you call your senators or congresspeople and request the same!!! Be advocates for yourself. Not sure why acep etc can’t get this stuff done but individually we can try!!!
 
thegenius said:
So my oldest son (15) is sick. He developed an in-between wet and dry cough about 8 days ago. 4 days ago developed a fever 102. He's been blowing his nose. No SOB. So not only are we following state guidelines for shelter-in-place, we are isolating him in his room. The fever is gone but he has this terrible sounding cough.

Now my other son (13) is mildly sick. he developed a dry cough yesterday. We are putting a mask on him around the house, but I wonder at this point if it's even worth it. My wife is worried because she has asthma, and she doesn't want it to flare up. I don't want it mainly because I want to work and don't want to go on quarantine or isolation if I have any symptoms.

The absolute biggest problem with all of this is having our kids take this semi-seriously. They don't take it seriously at all. They joke around, I point out how my older son coughs in his forearm then he immediately rubs his hair back. Then one minute later he touched a doorknob. I'm trying to tell these dinguses that they have to be careful because I'm gonna get sick or someone is going to get sick. They don't get it. I probably don't expect them to get it but they just don't.

Now I'm not worried about them medically on any level. But I wish I could get them tested, or me tested if I develop some respiratory symptom. Because there is a ZERO% chance I will be able to work if I have even a whiff of a respiratory symptom.
Click to expand...
Test them. Call Labcorp or one of the private labs near you, take them there and swab them. Pay cash, get a test.

That being said, my whole family has been walking around with runny noses and sneezing for two weeks, telling ourselves "It's just the pollen" and I haven't swabbed any of us. No cough or fever, though. And this time of year the pollen is bonkers and it does make your nose run.
 
turkeyjerky said:
Okay, since the other thread about quitting our jobs b/c of this, is anyone else getting seriously sick about the exposure hysteria?

Granted, I'm in my 30s and healthy, so when (not if) I catch this, I'm pretty sure I'll do okay. But I am getting really tired of overhearing others talk about calling off or just refusing to see PUIs. For the vast majority of us, this is not a private-health concern (obviously, I believe it remains a major public health concern).

The other day, another doc at one of my sites intubated a patient w/o an N95 (who later turned out to have mutilobar pna). She flipped out and refused to see any other patients for the rest of her shift. Absolutely flummoxed by this response.

Highly recommend, this article by Atul Gawande:

Keeping the Coronavirus from Infecting Health-Care Workers
Click to expand...

I'm beyond sick of the hysterics outside and INSIDE our own profession regarding this pandemic. I'm constantly reminded just how easily our own ranks are brainwashed and the power of herd mentality. I have a lot of concern for COVID-19 and I don't mean to minimize it, but to me, this is truly akin to another flu. Before we get into arguments about mortality 0.1 (flu) vs 1-1.5% (COVID), I could easily redirect to statistics on previous flu epidemics or historically earlier cases of seasonal flu where the mortality rose to a much higher number. There are many more commonalities between the two viruses than differences and I'm aghast at the draconian measures being enacted that place businesses, individuals and patients at secondary risk. For instance, we're being pressured to use MDI with spacers for moderate to severe asthma exacerbations for fear of aerosolization of the virus (on NON PUIs!). Ever tried using a MDI on a severe asthma exacerbation? Let me tell you how it ends...you end up having to intubate the pt which just raised their mortality significantly higher than if they had caught COVID in the first place!

I'm really relaxed during this pandemic and haven't changed anything about how I approach work. If I catch this thing and it kills me, then so be it. That's natural selection for you. We take these chances every year as human beings, exposed to a myriad of pathogens on an annual basis. Viruses are here to stay and if we plummet our economy into an economic depression and enact martial law to enforce home quarantines while ballooning unemployment to 20-25% or greater every time there is a new (low mortality) virus, we're not going to be able to sustain ourselves. You can't thrust people out of work for weeks and months at a time anytime something like this happens. Some people are living paycheck to paycheck and there's no stimulus bill that's going to cover someones rent, food, diapers, medicines for 6 months of unemployment. We're very lucky in that we can continue to work and earn income during this crisis.

The reality is that many of us have already caught this virus and recovered and never even knew it which mimics the clinical course for the vast majority of people that will become infected. I hope things settle down once more therapies and vaccines make it to market. As for quitting EM or taking a long leave of absence d/t COVID...I find that notion absurd.
 
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Groove said:
I'm beyond sick of the hysterics outside and INSIDE our own profession regarding this pandemic. I'm constantly reminded just how easily our own ranks are brainwashed and the power of herd mentality. I have a lot of concern for COVID-19 and I don't mean to minimize it, but to me, this is truly akin to another flu. Before we get into arguments about mortality 0.1 (flu) vs 1-1.5% (COVID), I could easily redirect to statistics on previous flu epidemics or historically earlier cases of seasonal flu where the mortality rose to a much higher number. There are many more commonalities between the two viruses than differences and I'm aghast at the draconian measures being enacted that place businesses, individuals and patients at secondary risk. For instance, we're being pressured to use MDI with spacers for moderate to severe asthma exacerbations for fear of aerosolization of the virus (on NON PUIs!). Ever tried using a MDI on a severe asthma exacerbation? Let me tell you how it ends...you end up having to intubate the pt which just raised their mortality significantly higher than if they had caught COVID in the first place!

I'm really relaxed during this pandemic and haven't changed anything about how I approach work. If I catch this thing and it kills me, then so be it. That's natural selection for you. We take these chances every year as human beings, exposed to a myriad of pathogens on an annual basis. Viruses are here to stay and if we plummet our economy into an economic depression and enact martial law to enforce home quarantines while ballooning unemployment to 20-25% or greater every time there is a new (low mortality) virus, we're not going to be able to sustain ourselves. You can't thrust people out of work for weeks and months at a time anytime something like this happens. Some people are living paycheck to paycheck and there's no stimulus bill that's going to cover someones rent, food, diapers, medicines for 6 months of unemployment. We're very lucky in that we can continue to work and earn income during this crisis.

The reality is that many of us have already caught this virus and recovered and never even knew it which mimics the clinical course for the vast majority of people that will become infected. I hope things settle down once more therapies and vaccines make it to market.
Click to expand...
For some perspective, we're 2 months in and 99.99% of Americans have not died from this thing (471 deaths out of 331 million). If the problem gets 100 times worse (47,100 out of 331,000,000), 99.98% of Americans will not have died from this.
 
The Hong Kong flu killed 100K in the US in *68-69. A few schools closed, but nothing else.
 
Birdstrike said:
For some perspective, we're 2 months in and 99.99% of Americans have not died from this thing (471 deaths out of 331 million). If the problem gets 100 times worse (47,100 out of 331,000,000), 99.98% of Americans will not have died from this.
Click to expand...

Exactly, the problem is that most docs don't analyze the data or think about it from a broad historical perspective. I'm currently inundated with a group text and group email chain from docs at my hospital with constant frenzied, reckless construction of idiotic protocols born out of knee jerk reactions to the current level of hysteria. Docs wanting to perform zero physical exams and keep 6 ft away from all pt's, proliferation of CT scan rates and radiation exposure because they don't want to lay hands on the actual patients. Others wanting a full PAPR for each patient, etc.. It's insane.

I called to make an appt with my vet to take a look at a mole on my dog's ear that looks suspicious for melanoma and I have to park in the parking lot while a vet tech comes and gets him and then wait for a call from the vet to my cell phone where we discuss his exam and my concerns. Then they bring him back out to me. I'm sure they are spraying this vet tech down with $10 worth of decontamination products every time they enter or exit the building. How long will this insanity continue?
 
Groove said:
How long will this insanity continue?
Click to expand...

Well, for those of us who have tried to educate themselves even a little bit, 3-18 months depending on many factors.

How do you not get that the main issue with this pandemic is that hospitals, including your hospital, are going to be utterly, utterly overwhelmed. Like at the minimum, 200% over capacity.

www.covidactnow.org

For most areas, the peak may still be a month away. Just because you don't see it now doesn't mean it isn't coming.

I admire the docs in your group who are at least trying to prepare.
 
Groove said:
. How long will this insanity continue?
Click to expand...
Not for long. Like I said very early in this thread people are going to swing from panic to apathy, like they always do. I give it another 2 weeks until good old fashion American apathy sets in. The speed at which COVID apathy sets in will = boredom x brokeness.
 
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