Coronavirus/COVID-19

[Parliament10]

Read on Twitter

[zoyathedestroya]

I'll stay away from US politics.

[zoyathedestroya]

Read on Twitter

[denmuscles]

Unfortunately in this case money talks BS walks...I know these athletes are very healthy individuals but in their case their recovery rate is much more successful due to them having their own doctors and superb medical care that otherwise is not available to general public unless you have deep pockets and know someone...

[Froob]

Started a pick ems league with my friends where we watch a random old football game we can’t remember. Gotta find some fun in it all, just need to be creative.

[Parliament10]

I got a video that explains this WHOLE Damn thing!!!

Warning: Explicit Content

Spoiler:

Watch on YouTube

April Fool's Day!!!

[Slax]

Unfortunately in this case money talks BS walks...I know these athletes are very healthy individuals but in their case their recovery rate is much more successful due to them having their own doctors and superb medical care that otherwise is not available to general public unless you have deep pockets and know someone...

I'm confident there's some of this going on and I would rather have dedicated medical attention than not, but also they're young and there aren't that many of them. I have a handful of friends and coworkers with confirmed COVID-19, and while I wouldn't say they're all "fine", the worst I've heard about is fever, cough, loss of sense of smell, and one of them described more difficult than usual breathing like someone was putting weight on her chest. None of them were hospitalized or anything.

To be clear, I'm not saying that COVID-19 isn't EXTREMELY dangerous; my wife's hospital had to get a refrigerated truck for all the bodies that won't fit in the morgue, so I know full well this is REALLY BAD. It's just that the demographics of NBA players are favorable: if you know say 30 people with COVID-19, and they're all in their 20's and 30's with no underlying conditions, it's not surprising if none of them end up in critical care. A lot of the players who tested positive weren't even symptomatic.

[sam_I_am]

Unfortunately in this case money talks BS walks...I know these athletes are very healthy individuals but in their case their recovery rate is much more successful due to them having their own doctors and superb medical care that otherwise is not available to general public unless you have deep pockets and know someone...

I'm confident there's some of this going on and I would rather have dedicated medical attention than not, but also they're young and there aren't that many of them. I have a handful of friends and coworkers with confirmed COVID-19, and while I wouldn't say they're all "fine", the worst I've heard about is fever, cough, loss of sense of smell, and one of them described more difficult than usual breathing like someone was putting weight on her chest. None of them were hospitalized or anything.

To be clear, I'm not saying that COVID-19 isn't EXTREMELY dangerous; my wife's hospital had to get a refrigerated truck for all the bodies that won't fit in the morgue, so I know full well this is REALLY BAD. It's just that the demographics of NBA players are favorable: if you know say 30 people with COVID-19, and they're all in their 20's and 30's with no underlying conditions, it's not surprising if none of them end up in critical care. A lot of the players who tested positive weren't even symptomatic.

There is no treatment except oxygen if you need it. None of the medications talked about in news are proven to help and even if they do help a little they aren’t changing the avalanche of deaths worldwide. According to post from ER doctor in New Orleans, very few who get put on ventilator recover. It’s great for the the players they they have such great access to team doctors and resources .....but for this pandemic, doctors and nurses can only comfort and support you while your immune system either saves you or it doesn’t. I personally think that with coronavirus, the farther away from hospitals and doctors .... and all people for that matter .....you can be the better off you’ll be. Obviously if you get sick you have no choice .... but the reality is that everybody - rich, powerful, famous, poor - is in trouble if they get sick.

The only reason these players are any better off than other 20-30 year olds is that their bosses sent them home to socially isolate long before the rest of us were, and they should have more than enough money to ride this out.

[Parliament10]

Read on Twitter

Read on Twitter

Read on Twitter

Everything is getting more and more serious.

[canman1971]

Read on Twitter

Read on Twitter

Read on Twitter

Everything is getting more and more serious.

I don't get it. I have only left my house, alone, 3 times since March 16. And it was quick and just for food and stuff. One place. And yes, being at home with a 6 year old is really challenging, yet, I do it because I need to. My wife goes to work because she's a nurse. I feel bad for her as she comes home and doesn't get much chance to relax as she is getting another online degree. Yet, you havet these a holes who, after finding out the beaches are being closed, have to go out there one last day like it's **** Labor Day weekend.

[CeltsfanSinceBirth]

The stream of news is taking its toll on me. I keep reading to stay informed, and hoping to see some good news, but it looks like we are months away from seeing anything positive. The Canadian government just announced that the social distancing measures will be in place for awhile. My province just announced that school is cancelled indefinitely. I saw a news segment on how ineffective ventilators really are (20% success rate in North America, lower elsewhere), and how hooking patients up to them puts health care workers at such a risk. The bad news keeps coming, and it is getting harder and harder for me to cope. Forgive me if I disappear from this thread as I will be just posting in non-covid threads as a means of keeping my sanity. Just know that I'm sending positive vibes to everyone in here affected by this pandemic. I got love for all of you. See you guys around.

[Captain_Caveman]

Out here chilling the Sierra Foothills. Hope everyone is well.

Spoiler:

[zoyathedestroya]

In our country, we're taking this pandemic seriously. You either die by the disease, because of hunger, or with the bullet. FML.

https://www.nytimes.com/2020/04/01/world/coronavirus-news.html

[Mr_Mojo_Risin]

Please forgive me if this has already been posted. Also, please forgive the length. I have a friend who is a nurse who [re]posted this on Facebook and it had some potentially useful information:

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."

Your post comes to mind when reading this given the presentation of a Cytokine storm:
https://www.nytimes.com/2020/04/01/health/coronavirus-cytokine-storm-immune-system.html

Hopefully these discoveries helps reduce the mortality rate. I have no end of respect for the medical community. Don't misunderstand me because I'm not saying there are no military heroes, but often it can be tricky defining heroes when people are trying to kill each other. There is no grey area about the medical heroes of this world right now.

[djFan71]

In our country, we're taking this pandemic seriously. You either die by the disease, because of hunger, or with the bullet. FML.

https://www.nytimes.com/2020/04/01/world/coronavirus-news.html

Damn, stay safe Zoya.

[Parliament10]

Read on Twitter

Read on Twitter

[threrf23]

This link has a good state by state and county by county break down of cases, deaths, and growth trends per capita:

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

Taking stats at face value, I find it interesting that in Westchester County NY, where there was an early-ish breakout of cases and more than 1,000 confirmed cases to date, we see a mortality rate of 0.2% (based on reported deaths versus confirmed cases). Whereas in New York City, we see a mortality rate of 2.4%. Amongst all counties with at least 600 confirmed cases, we see a 0.17% mortality rate in Orange County NY (3 deaths vs 1756 cases), versus a 6.5% mortality rate in King County WA (152 deaths vs 2332 cases).

[Captain_Caveman]

Watch on YouTube

Ah, man. Dude from this band just died from the rona.

[Mr_Mojo_Risin]

This link has a good state by state and county by county break down of cases, deaths, and growth trends per capita:

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

Taking stats at face value, I find it interesting that in Westchester County NY, where there was an early-ish breakout of cases and more than 1,000 confirmed cases to date, we see a mortality rate of 0.2% (based on reported deaths versus confirmed cases). Whereas in New York City, we see a mortality rate of 2.4%. Amongst all counties with at least 600 confirmed cases, we see a 0.17% mortality rate in Orange County NY (3 deaths vs 1756 cases), versus a 6.5% mortality rate in King County WA (152 deaths vs 2332 cases).

I've often thought the air quality of the location people live in general will have a mortality impact because of the health of people's lungs. However after reading your post I was curious and did a search on whether that is something:

https://www.theguardian.com/environment/2020/mar/17/air-pollution-likely-to-increase-coronavirus-death-rate-warn-experts

[Parliament10]

Read on Twitter