What do I need to know about coronavirus?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Status
Not open for further replies.
Members do not see this ad.
GeneralVeers said:
Well what numbers of dead are acceptable such that we can keep the country open? 500,000? 20,000? 1?

Bear in mind the 1,000,000 represents mostly extremely elderly people with comorbid conditions. Their annual mortality is high, and many likely would have succumbed to something else that year, or as Birdstrike has pointed out again and again they would possibly be DNR nursing home patients.

It will be interesting to see how much the suicide rate increases this year due to joblessness, social conflict, and depression.
Click to expand...

Pisses me off that more people don’t understand unintended consequences.
 
GeneralVeers said:
Well what numbers of dead are acceptable such that we can keep the country open? 500,000? 20,000? 1?

Bear in mind the 1,000,000 represents mostly extremely elderly people with comorbid conditions. Their annual mortality is high, and many likely would have succumbed to something else that year, or as Birdstrike has pointed out again and again they would possibly be DNR nursing home patients.

It will be interesting to see how much the suicide rate increases this year due to joblessness, social conflict, and depression.
Click to expand...

Good question. I don't have an exact number. I think if worst case scenario was say 200k? I admit I'm pulling that number out of a hat. As a comparison, H1N1 in 2009 caused 12,000 deaths in the US, although the elderly were mostly spared. Hope you feel that I'm being reasonable by allowing a nearly 20x increase in mortality worst case predictions.

@Birdstrike Just to clarify I was not one who called you anti-science. I respect your opinion and those of the experts who were surveyed. As always, I hope I'm wrong and I hope that the mortality numbers are not as bad.

Let's see how the next 2 weeks go, is my personal view point. If the curve starts to flatten, we can consider opening things back up in non hot-spots.

While I agree that economic impact is significant, I do believe once this has 'resolved' (either due to herd immunity or that mortality rates are not 'as bad' as other countries) the US economy will rebound to similar levels within a few years.
 
Last edited:
GeneralVeers said:
Applied to the US population, that's 72,000,0000 infected people with 1,008,000 deaths. That sounds like a lot, but in 2018 we had more than 2.8 million americans die from all causes NVSS - Mortality Data.

Definitely not numbers for which we should be shutting down our country.
Click to expand...

You're nuts. >1 million deaths by your estimate = no big deal to you
And you've only shown how big of a deal it is when you share with us that 2.8 million die from ALL CAUSES

Nuts. I really think right-wing ideology fries brains
 
Last edited:
GeneralVeers said:
As I've repeatedly said, the answer is in front of us with the Princess Cruise's ship. 3700 people on the ship in close quarters for weeks at a time. 696 tested positive for the virus. So WORST case is 18% infectivity. Of those 8 died, or 1.14%.

To me this represents the absolute worst case because certainly without close quarters, less than 18% of people will get the virus nationwide, and far less than 1.14% will die given the horrendous age/health profile of the average cruiser passenger.

Applied to the US population, that's 72,000,0000 infected people with 1,008,000 deaths. That sounds like a lot, but in 2018 we had more than 2.8 million americans die from all causes NVSS - Mortality Data.

Definitely not numbers for which we should be shutting down our country.
Click to expand...

I think it's hard to extrapolate from that, since the ship went on lockdown, and there likely wasn't a whole lot of contact between people once there were a few symptomatic cases. Say it's resonable worst case: the problem is that w/ an estimated mortality rate of 1.1 million, you're probably talking about 5 million or so ICU admits w/ most of those requiring a vent. With an average vent requirement of 10 days, we quickly run out. Then the mortality rate spikes up to 3-4%...

However, I'm actually cautiously optimistic that all the social distancing is going to blunt the increase in cases, and we'll essentially be looking at a really bad flu season over the next month or two. Work'll suck but it won't be overwhelming.

The 2nd wave this fall'll be worse though (barring a vaccine or miracle cure). You have to assume that a virus successful enough to spread wordwide is not just going to magically burnout.

As an aside, I think it's reasonable to extrapolate the cruiseship numbers to one particular location: the hospital. I think we'll be looking at massive healthcare related spread of this. From patients to staff, staff to patients, and staff to staff. I just don't think we has a healthcare "system" are capable of doing what needs to be done.
 
Cuomo: We have to plan to 'pivot back to economic functionality'

Trump considers reopening U.S. economy despite coronavirus spread


Remember when I said we'll progress from 1) panic, to 2) apathy, to 3) amnesia?

We're between 1 and 2, right now. What Cuomo and Trump are doing here is, "Pacing" and "Leading." They getting us ready to move from #1 to #2. When you saw our leaders shift their tone from reassurance to match the public's panic, that's called pacing. It makes people feel you're with them and talking directly to them. Then, once they've gotten your attention and trust, by pacing you (mirroring what you're feeling), that allows them to lead you where they need you to go, which initially was to comply with infection precautions, but will soon be, to inexplicably move forward despite a virus they've told you was severe enough to shut down the world (which is it). These are persuasion techniques used by master persuaders including politicians, business leaders, marketing and sales people. It's all done by design. None of it is by accident or off the cuff.
 
So far our mortality rate of 1% is more like Germany than Italy and Spain. Admittedly it's early, and our incident rate is on tract to eclipse Italy. Some states like North Carolina has not had their first death yet.

But I would say, despite lukewarm compliance with social distancing by the public, there seems to be reason for hope that we won't be quiet like Italy.
 
Birdstrike said:
Trump considers reopening U.S. economy despite coronavirus spread
Click to expand...
Because when the UK delayed its lockdown, nothing bad happened...

As they say: smart people learn from other people's mistakes, stupid people don't learn even from their own.

nymag.com

Coronavirus in New York: Latest Updates

Mayor De Blasio is warning New Yorkers that they may have to “improvise” when it comes to their transportation.
nymag.com nymag.com
Thousands of new COVID-19 infections are now being reported in New York every day. As of Monday afternoon, there have been at least 20,875 confirmed cases of the coronavirus discovered in the state, including more than 12,305 in New York City. At least 157 people with COVID-19 have died in the state, which has the largest number — and more than half — of confirmed cases in the U.S. As of Sunday, the New York City region had around 5 percent of confirmed cases worldwide.
Click to expand...

23-nyc-COVID-19-chart.nocrop.w710.h2147483647.jpg


Everything is possible, but I am still betting on the virus.
 
Last edited by a moderator:
Perrotfish said:
this is the best summary of our political leadership I have seen.
Click to expand...
That the same people who had you convinced you had to shut down the world over an existential threat might kill us all, will be able to persuade you to move on despite that existential threat still being around, is no accident. It's master persuasion.
 
GeneralVeers said:
Well what numbers of dead are acceptable such that we can keep the country open? 500,000? 20,00
Click to expand...
I think for most people the answer is not a number, its the expectation that everyone to be given first world medical care. That means full court press intensive care if they don't have a DNR and are decompensating. People either want the infection rate to slow enough, or want us to increase our capacity enough, that no salvageable patient dies unattended on a gurney in the hallway.
 
Mr. Hat said:
And like I said yesterday, I'm still seeing people get together all over the neighborhood, and it's still elbow to elbow in the stores so it's not exactly like everyone is isolating. And we're just now getting ready to hit the 500 death mark. Not 5000. Not 50,000. Not 500,000. We're a solid month in from the time the alarm was raised with the Seattle nursing home patients, and we're not even halfway to 1000. A month in (and let's be honest, much more than that, it's been out there) we're at about 0.02% of the number of deaths we were told we'd have.
Click to expand...

I don't understand why people like to point out that are death rate is low RIGHT now, as an indication that we are overreacting to this pandemic.

There was a point during the Spanish Flu (which lasted Jan 1918 - Dec 2020: 35 months!)

There were only 500 dead.
Then 5000 dead.
Then 50,000 dead

shall I go on?

Then 500,000 dead
want any more?

next is 5,000,000 dead
Next up? you got it

50,000,000 dead


It took 3 years to get 50,000,000 dead.


Please people...it takes a little bit of time for coronavirus to kill.


If our goal is to have just 50,000 dead worldwide, and just 5,000 dead in the US, then we have to do **** like we are doing now. It will always be up for debate whether we are doing too much, or too little...I would hate to be the president of a country or governor of a large state and have to make these decisions quickly as the virus moves quickly. These are hard decisions to make. Not easy. It's easy for us to say "let all the old people die and get this over with"....but seriously you would get up on stage during a presidential nomination debate and say that?
 
thegenius said:
I don't understand why people like to point out that are death rate is low RIGHT now, as an indication that we are overreacting to this pandemic.

There was a point during the Spanish Flu (which lasted Jan 1918 - Dec 2020: 35 months!)

There were only 500 dead.
Then 5000 dead.
Then 50,000 dead

shall I go on?

Then 500,000 dead
want any more?

next is 5,000,000 dead
Next up? you got it

50,000,000 dead


It took 3 years to get 50,000,000 dead.


Please people...it takes a little bit of time for coronavirus to kill.


If our goal is to have just 50,000 dead worldwide, and just 5,000 dead in the US, then we have to do **** like we are doing now. It will always be up for debate whether we are doing too much, or too little...I would hate to be the president of a country or governor of a large state and have to make these decisions quickly as the virus moves quickly. These are hard decisions to make. Not easy. It's easy for us to say "let all the old people die and get this over with"....but seriously you would get up on stage during a presidential nomination debate and say that?
Click to expand...
But, but, but... this virus is Made In China. It will break way before 3 years pass.
 
Birdstrike said:
We all know this is not the flu. We are all taking this seriously. Being skeptical and question assumptions is exactly the definition of science. Blindly accepting assumptions, like "2.2 million Americans will die" without demanding proof, is the opposite of science. Putting a bunch of periods after every word, also isn't science.
Click to expand...

If someone were to talk outloud in a manner consistent with reading a passage with periods after every word, it would sound really silly and insulting.

I. Cannot. Believe. I. Am. Sitting. Around. Listening. To. You. Talk. Because. It. Is. Taking. Too. Long. For. You. To. Make. A. Point. Because. You. Are. Inserting. Periods. After. Every. Word.
 
FFP said:
Our current epidemiologic models and data suggest that there is a high probability that at least 1% of Americans will die, should we do nothing and let the disease take its natural course. They may be wrong, too (e.g. the virus could mutate into a milder strain), but it's less likely FOR NOW.
Click to expand...

1% of infected americans. Not all Americans will get this. Spanish Flu, about 30-35% of people contracted it over 3 years.
According to Dr. Andrew Morris (ID physician at Univ. of Toronto) said in a podcast on Emergency Medicine Cases that historically pandemics never infect more than 30-35% of people in the world. (around timestamp 46:00 of episode 137)
 
thegenius said:
1% of infected americans. Not all Americans will get this. Spanish Flu, about 30-35% of people contracted it over 3 years.
According to Dr. Andrew Morris (ID physician at Univ. of Toronto) said in a podcast on Emergency Medicine Cases that historically pandemics never infect more than 30-35% of people in the world. (around timestamp 46:00 of episode 137)
Click to expand...
Agree. I corrected myself a few posts later (you're the second person to notice). I'll edit the original post.
 
Birdstrike said:
Although any suggestion that this shutdown at some point must end, and moving on with life with this virus living among us, has clearly been established as blasphemy here on SDN-EM, leaders on both sides of the political aisle are starting to plan exactly that. Which flavor of blasphemy, do you prefer today?
Click to expand...

I don't think that is true. I've read this entire thread too. Although I'm not a very good reader so what do I know.

We look at Hubei Provence and that is probably what we should do, since I believe it's too late to do what S. Korea, Japan, Taiwan, and Hong Kong has done.

The problem is without mass, easy testing, how do you re-open the economy as you did before? I don't think it's as easy as "keep all people >= 60 in their homes, and let the rest of society go mingle and share secretions."

It's going to happen slowly I reckon.
 
thegenius said:
That is a bit high. I think worst case scenario is probably 40-50%, but it will end up being about 10-15% with everything we are doing.
My prediction.
Click to expand...

I mostly agree. I think the measures we are taking are helping, although where it falls on the spectrum is never going to be able to be determined.
 
*WARNING: READER DISCRETION ADVISED, MAY BE DISTURBING TO SOME READERS*



Los Angeles Times, 3/22/20

"Why this Nobel laureate predicts a quicker coronavirus recovery: 'We're going to be fine'"

"Michael Levitt, a Nobel laureate and Stanford biophysicist, began analyzing the number of COVID-19 cases worldwide in January and correctly calculated that China would get through the worst of its coronavirus outbreak long before many health experts had predicted.

Now he foresees a similar outcome in the United States and the rest of the world.

While many epidemiologists are warning of months, or even years, of massive social disruption and millions of deaths, Levitt says the data simply don't support such a dire scenario — especially in areas where reasonable social distancing measures are in place.

"What we need is to control the panic," he said. In the grand scheme, "we're going to be fine."

But he also blames the media for causing unnecessary panic by focusing on the relentless increase in the cumulative number of cases and spotlighting celebrities who contract the virus. By contrast, the flu has sickened 36 million Americans since September and killed an estimated 22,000, according to the CDC, but those deaths are largely unreported.

He fears the public health measures that have shut down large swaths of the economy could cause their own health catastrophe, as lost jobs lead to poverty and hopelessness. Time and again, researchers have seen that suicide rates go up when the economy spirals down."

This unintended experiment in coronavirus spread will help researchers estimate the number of fatalities that would occur in a fully infected population, Levitt said. For instance, the Diamond Princess data allowed him to estimate that being exposed to the new coronavirus doubles a person's risk of dying in the next two months. Most people have an extremely low risk of death in a two-month period, so that risk remains extremely low even when doubled.

That doesn't mean complacency is acceptable. Levitt said the social-distancing mandates are critical — particularly the ban on large gatherings — because the virus is so new that the population has no immunity to it and a vaccine is still many months away. "This is not the time to go out drinking with your buddies."

news.yahoo.com

Why this Nobel laureate predicts a quicker coronavirus recovery: 'We're going to be fine'

A Nobel laureate predicted China's recovery weeks before it happened. Analyzing the numbers, he sees a much brighter global outcome than many experts.
news.yahoo.com news.yahoo.com
 
Does anyone have any statistics on death percentage based on if the tests were done outpatient vs. as part of a hospitalization? For example, my ED still only tests admissions.
 
Mr. Hat said:
Yeah but weren't we told one month ago that we'd be seeing the exponential growth in 2 weeks? And then 2 weeks ago that we'd be seeing the exponential growth now? And now we're being told we'll see the exponential growth in 2 weeks........ This can keeps getting kicked down the road and no one says anything about it, meanwhile people's lives and livelihoods are going to hell. Meanwhile my hospital is cutting our hours because it's such a ghost town in our ED's. And no, we're not in a state with only a small number of cases.

And like I said yesterday, I'm still seeing people get together all over the neighborhood, and it's still elbow to elbow in the stores so it's not exactly like everyone is isolating. And we're just now getting ready to hit the 500 death mark. Not 5000. Not 50,000. Not 500,000. We're a solid month in from the time the alarm was raised with the Seattle nursing home patients, and we're not even halfway to 1000. A month in (and let's be honest, much more than that, it's been out there) we're at about 0.02% of the number of deaths we were told we'd have.

So fine, let's keep doing what we're doing. But here's a proposal to put to everyone. If another two weeks goes by and April 6 rolls around, and we're still not at even 0.1% of the deaths predicted, can we agree that maybe, just maybe, it's time to ease up a bit...
Click to expand...

What is going to happen is people are going to see the numbers not be as overwhelming and then be like well that was blown overboard. But in reality the social distancing actually did work and people won’t recognize that.

And I’m not sure where you live but in my city there are tons of cases and the ICUs are starting to reach max capacity so it’s good that some people are at least taking this seriously.
 
Look...right now there is lots of uncertainty. That's fine. For things in life where there is little uncertainty, like climate change, 95% of scientists believe humans are causing climate change.

Right now, most epidemiologists are not on the same page as this. So posting things by Ioannidis or Levitt doesn't help. There are very smart epidemiologists who think otherwise.

So I'm cautiously optimistic. I still stand by about 10-15% infected in the US and deaths will be somewhere between 25-50K, kind of like a flu season.

I think the only thing that remains is whether we could have achieved those results without shutting down the economy, or shutting it down less. that can be debated until the end of time.
 
thegenius said:
I think the only thing that remains is whether we could have achieved those results without shutting down the economy, or shutting it down less. that can be debated until the end of time.
Click to expand...

And it will be. We will have no way of knowing how many infections and deaths the measure prevented.
 
thegenius said:
So I'm cautiously optimistic. I still stand by about 10-15% infected in the US and deaths will be somewhere between 25-50K, kind of like a flu season.
Click to expand...

That means a 0.15% (50k over 32 mil) case fatality rate. I'm cautiously optimistic as well, but I think that's just wishful thinking.
 
turkeyjerky said:
That means a 0.15% (50k over 32 mil) case fatality rate. I'm cautiously optimistic as well, but I think that's just wishful thinking.
Click to expand...

Haha yea I noticed that after I posted it. I'm more confident about the 25-50K dead over a span of 18-24 months than I am 10-15% infected in the US. I just think it's not going to be that bad.

I think hospitals will be dealing with many sick and vented COVID patients for the next 18-24 months, don't get me wrong. But I believe in American ingenuity.

However...on the flip side, Americans are stubborn f&#$ing idiots and I can see us just ignoring social distancing after a 2-4 weeks. Other people have said that as well. The only thing right now keeping this from exploding is social distancing.
 
Anyone like the Financial Times website on this Coronavirus stuff? It's pretty good. Interesting and (fairly) easy to read.

Some good news...the Chinese economy, at least parts of it, seem to be recovering quickly:

China Economic Activity.jpg
 
Mr. Hat said:
I just don’t get it any more. Roast me all you want but I don’t. And maybe this is just my meltdown. I don’t know.

Decided to go for a walk today in my typical upper middle/ middle class neighborhood. First few minutes saw a few other people, we’d cross to opposite sides of the road if needed, no big deal. But then. Oh then. Like walking a gauntlet. Groups of kids playing together and riding bikes, like 10 or 20 to a group. People starting a BBQ. Groups of 6 or 8 adults standing together and talking. All over the place. I called a buddy of mine, lives in a different location, brought it up and he was like “oh yeah, that’s how it is in my neighborhood too”. Then my wife gets back from the store, it was a zoo, she was shoulder to shoulder with people.

I don’t get it. We’re stopping kids getting an education, tanking our entire economy, for what?! No one is sheltering in their houses, kids aren’t avoiding each other. What are we doing here?!

But what about the old and sick? Well first of all most of the adult groups I saw today had old people among them, and those people are still going to the store. Then there’s people like my 90 year old grandparents who are staying in their house and having everything delivered. If the world decided to re-open they’d continue to stay in their house and have everything delivered. Half of the people I know losing jobs and life savings isn’t going to change their exposure.

Sorry, I just feel like I’m coming to wits end here. Hmmm maybe time for beer.
Click to expand...
I was thinking the same thing today. It makes me incredibly sad because it feels like a wasted effort. It reminds me of the time I watched my husband use a leaf blower to blow off flowers from a tree in our front yard (stay with me here, ha). As he was trying to clear out the flowers from the gravel, he didn’t notice that gusts of wind were causing more flowers to shower down. Within an hour the front yard was again covered in flowers. Ha. Wasted effort.

No lie, I had a 70 year old patient come in this week for a “fall during social distancing block party; had 3 drinks tonight.” She said that the block party “was supposed to be kind like how they are in Italy with everyone six feet apart, but then we got to drinking and dancing... I know, it was stupid.” She fell down and was helped up by a few people also participating in the party WHO ARE NURSES. The irony is this lady used to be a head honcho at a hospital and was now the head honcho of her assisted living facility, and the one throwing the party...
 
Mr. Hat said:
Come on man, we’re going to be Italy in 2 weeks. For real this time.


Not that I want anyone to die. But it's amazing how many people will call you heartless for "allowing 1,000,000 people to die", most of them elderly or otherwise ill, yet won't bat an eye at the idea of 30,000,000 or 40,000,000 or 100,000,000 people having their lives completely ruined by our economy being destroyed.

Since I'm already on the crap list of all the people who "passed grade level math" on here anyway, I'm going to bring this up too. As I've already said, at my shop we are really slow right now. Like 30% of normal volumes. We're sending residents home early, cutting attending hours, and cutting nursing and tech hours. I saw 7 patients on a recent 10 hour shift. And yet looking at the social media profiles of many of our nurses and physicians, you'd think we were all working in a war zone every day. "Another exhausting day at work, I don't know how much longer we can keep this up". "It's hell here, don't come in unless you're truly having an emergency!" "Trying to keep up the good fight on the front lines, we'll make it through together". #thestruggleisreal #erwarzone #notallheroswearcapes and so on and so forth

So I'm a little wary when I read about hospitals "barely able to meet capacity, no vents left, yadda yadda yadda". People like to feel important, and they'll grossly exaggerate a lot of things to look and feel that way.
Click to expand...
You make a point. Today one of our ERs had ZERO patients at one point. And then a just a few trickled in later. You don’t even get that lucky on Christmas, for God’s sake.

One of the few patients I saw today came in for: “Felt hot in work truck; needs work note.” Healthy dude with ZERO symptoms and no recent travel or exposures was in a work truck with his boss and mentioned, “It’s hot in here!” Because the AC took a while to kick in, it was 85 degrees today, and it’s a freaking work truck sitting in the son. JUST BASED ON THAT the boss said “you feel hot? FEVER?” And SENT THE ENTIRE COMPANY HOME AND TOLD THE GUY HE CANNOT COME BACK TO WORK WITHOUT A NOTE, ansowwnwhwowkwru72929292?;?;!: I have no words.
 
I just got off a Board of Directors conference call for my group. We have PAs down from 20 patients per day to 2, specialists and PCPs down 30-50%. I'm down about 30-40% and dropping. My group (multi-specialty, 40+ providers, inpatient & outpatient) is starting to have mass cancellations which is forcing us to go to a 4 day work week until this blows over. The goal is to reduce expenses and avoid lay offs. If that doesn't work, the axe starts to fall, and layoffs will be needed to weather the shutdown storm. I'd say the odds are >50% layoffs will happen. This is after 1 positive patient in a group of 40 providers with tens of thousands of patients, and 16 positives total in the county, with zero deaths.
 
I posted 2 weeks ago I thought this virus was a big deal. I also noted it was more like 4-6 weeks in my area before predicted growth curves suggested things getting to dire straights or at least serious operational impacts.

We show our impatience when we note only a dozen cases in our area (with incredibly limited testing!) and saying it is no big deal, considering what they will spread to become if unimpeded.

But I guess so of you haven't seen this disease in the flesh, haven't seen the CTs of your patients, haven't had your friends directly affected yet... maybe it is abstract to you?

It's one thing to grid through ED shifts taking care of the largely anonymous masses. It is another thing when your colleagues and people you love start dropping. HCW-associated illness and death rates are significant in this disease.

But I hear the pragmatists. I understand the economy is important. Gotta crack some eggs to make an omelette, right? Was it right to drop an atomic bomb on civilians to end a war more quickly?

We are lucky to be alive in a time where we even have knowledge of this beast, and the chance to discuss options to stop it...
 
Birdstrike said:
I just got off a Board of Directors conference call for my group. We have PAs down from 20 patients per day to 2, specialists and PCPs down 30-50%. I'm down about 30-40% and dropping. My group (multi-specialty, 40+ providers, inpatient & outpatient) is starting to have mass cancellations which is forcing us to go to a 4 day work week until this blows over. The goal is to reduce expenses and avoid lay offs. If that doesn't work, the axe starts to fall, and layoffs will be needed to weather the shutdown storm. I'd say the odds are >50% layoffs will happen. This is after 1 positive patient in a group of 40 providers with tens of thousands of patients, and 16 positives total in the county, with zero deaths.
Click to expand...
Back to the ED?
 
Birdstrike said:
I just got off a Board of Directors conference call for my group. We have PAs down from 20 patients per day to 2, specialists and PCPs down 30-50%. I'm down about 30-40% and dropping. My group (multi-specialty, 40+ providers, inpatient & outpatient) is starting to have mass cancellations which is forcing us to go to a 4 day work week until this blows over. The goal is to reduce expenses and avoid lay offs. If that doesn't work, the axe starts to fall, and layoffs will be needed to weather the shutdown storm. I'd say the odds are >50% layoffs will happen. This is after 1 positive patient in a group of 40 providers with tens of thousands of patients, and 16 positives total in the county, with zero deaths.
Click to expand...

Uh oh Bird.... that's less beans for you. I guess it's time to dust off those scrubs and start picking up a few shifts back in the ED, eh? 😵 😀

Don't worry, I already picked a gif for your response.

giphy.gif
 
Janders said:
I posted 2 weeks ago I thought this virus was a big deal. I also noted it was more like 4-6 weeks in my area before predicted growth curves suggested things getting to dire straights or at least serious operational impacts.

We show our impatience when we note only a dozen cases in our area (with incredibly limited testing!) and saying it is no big deal, considering what they will spread to become if unimpeded.

But I guess so of you haven't seen this disease in the flesh, haven't seen the CTs of your patients, haven't had your friends directly affected yet... maybe it is abstract to you?

It's one thing to grid through ED shifts taking care of the largely anonymous masses. It is another thing when your colleagues and people you love start dropping. HCW-associated illness and death rates are significant in this disease.

But I hear the pragmatists. I understand the economy is important. Gotta crack some eggs to make an omelette, right? Was it right to drop an atomic bomb on civilians to end a war more quickly?

We are lucky to be alive in a time where we even have knowledge of this beast, and the chance to discuss options to stop it...
Click to expand...
We started with an epidemiological crisis. We now have and epidemiological crisis and an economic crisis. Managing only one of the two is not enough. The challenge is going to be how to manage both optimally at the same time. It's not going to be easy.
 
Last edited:
Mr. Hat said:
Come on man, we’re going to be Italy in 2 weeks. For real this time.


Not that I want anyone to die. But it's amazing how many people will call you heartless for "allowing 1,000,000 people to die", most of them elderly or otherwise ill, yet won't bat an eye at the idea of 30,000,000 or 40,000,000 or 100,000,000 people having their lives completely ruined by our economy being destroyed.

Since I'm already on the crap list of all the people who "passed grade level math" on here anyway, I'm going to bring this up too. As I've already said, at my shop we are really slow right now. Like 30% of normal volumes. We're sending residents home early, cutting attending hours, and cutting nursing and tech hours. I saw 7 patients on a recent 10 hour shift. And yet looking at the social media profiles of many of our nurses and physicians, you'd think we were all working in a war zone every day. "Another exhausting day at work, I don't know how much longer we can keep this up". "It's hell here, don't come in unless you're truly having an emergency!" "Trying to keep up the good fight on the front lines, we'll make it through together". #thestruggleisreal #erwarzone #notallheroswearcapes and so on and so forth

So I'm a little wary when I read about hospitals "barely able to meet capacity, no vents left, yadda yadda yadda". People like to feel important, and they'll grossly exaggerate a lot of things to look and feel that way.
Click to expand...

My hospital’s ED is also seeing about 30-40% less volume this week. I’m sure it’s just a statistical aberration that will correct itself next week given ACEP’s insistence that only 4% of ED visits are avoidable.😉
 
ShockIndex said:
My hospital’s ED is also seeing about 30-40% less volume this week. I’m sure it’s just a statistical aberration that will correct itself next week given ACEP’s insistence that only 4% of ED visits are avoidable.😉
Click to expand...
EM Admin/Leadership,

2 months ago: "Greater than 90% of patients in ED, absolutely need to be here. It's unavoidable."

Now: "Greater than 90% of you COVID patients, don't need to be in the ED."
 
d2305 said:
Back to the ED?
Click to expand...
You know what, maybe I will. Since it's been 8 years since my last ED shift I'll probably only be able to see less than 1 patient per hour and I'll spend most of that rest of the time alternating between asking the PGY1's, "What would you do with this one?" and, "Hey. Did you see what that guy posted on SDN? Can you believe that ---?"
 
Birdstrike said:
We started with an epidemiological crisis. We now have and epidemiological crisis and an economic crisis. Managing only one of the two is not enough. The challenge is going to be how to manage both optimally at the same time.
Click to expand...

We had an smoldering economic crisis brought on by decades of horrible fiscal and monetary policy before the pandemic. This virus is just doing a great job of exposing our bull****.

Before you go off on a rant, I do not blame Trump for our $22T debt, artificially low interest rates, and over reliance on quantitative easing. I blame us - you and me...our citizens who elected these nincompoops over the past 40+ years. It is our citizenry that is addicted to an artificially inflated lifestyle not seen in any other part of the world and cannot seem to wrap its collective mind around the task at hand.

Now, 2 weeks into this “crisis” Americans are starting wring their hands wondering how we are going to get back to “normalcy.” If our culture cannot handle 2-3 months of voluntary, extreme austerity to defeat this very vulnerable virus, how are we going to fair when the austerity is not voluntary?

This virus is very beatable. The Chinese and S. Koreans have shown us how it’s done. The Italians have shown us what happens if we screw it up. It takes 2-3 months of extreme social isolation, not 2-3 weeks.

I strongly suggest that we reset our economic and cultural barometer away from the old normalcies and toward something that allows us to match our Asian counterparts stride-for-stride. Otherwise, we are screwed when a mushroom cloud appears over NYC or the Big One cause CA to float off into the Pacific.
 
Last edited:
Janders said:
haven't had your friends directly affected yet... maybe it is abstract to you?

... It is another thing when your colleagues and people you love start dropping.
Click to expand...
We're all in different hospitals, states, cities, and towns. Some are in urban areas, others rural. Some are in large urban EDs, mid-sized suburban, and some are in small EDs, urgent cares, or other settings. All of us are going to be affected personally, differently.

How has COVID-19 directly affected you and your friends? You allude to "colleagues and people you love dropping." Is that happening to you?
 
This is bizarre. Can anyone that's seen COVID-19, confirm this:


"Care home nurse tells of terrifying and sudden ways coronavirus struck her patients

The veteran registered nurse started her own mental checklist: cough, rapid breathing and the red eyes -- all the sickest patients seemed to have the red eyes.
For Chelsey Earnest it was the eyes that became the single most important sign as she and other staff at the Life Care Center in Kirkland, Washington, struggled with the new coronavirus that was sweeping the nursing home even before it became feared across the country.

Chelsey Earnest says she has never experienced anything like the outbreak in Kirkland in 20 years as a registered nurse.
"It's something that I witnessed in all of them (the patients). They have, like ... allergy eyes. The white part of the eye is not red. It's more like they have red eye shadow on the outside of their eyes," Earnest said."

www.cnn.com

Inside the first coronavirus outbreak in the US

A nurse from the Life Care Center in Kirkland, Washington, tells of the war-like struggle as it became the epicenter of the first coronavirus outbreak inside the US. "There's lots of casualties and ... you can't see the enemy," Chelsey Earnest said.
www.cnn.com www.cnn.com
 
Birdstrike said:
We're all in different hospitals, states, cities, and towns. Some are in urban areas, others rural. Some are in large urban EDs, mid-sized suburban, and some are in small EDs, urgent cares, or other settings. All of us are going to be affected personally, differently.

How has COVID-19 directly affected you and your friends? You allude to "colleagues and people you love dropping." Is that happening to you?
Click to expand...

I don't know anyone personally that has died, but yes people I know, a wide variety from sick at home to sick in the ICU.
 
Status
Not open for further replies.

Similar threads

DocEspana
AITA? A thread for when you just need to know
2
Replies
69
Views
6K
DocEspana
DocEspana
EthylMethylMan
What to do about petty nurse
2
Replies
63
Views
6K
GassYous
GassYous
O
No incentive to be full-time ED doc? What to do
Replies
19
Views
3K
AlmostAnMD
AlmostAnMD
WitchDoctor
Advice needed: starting work as 1099, what do I need to do?
Replies
21
Views
6K
PianoMedic
PianoMedic
O
If you could go back in time knowing what you know now, what specialty would you choose?
2 3
Replies
136
Views
16K
miacomet
M
Top