Are you hunkering down?

There are two sites I watch daily:
an interactive map for US counties.
The total number of cases, new cases, deaths and new deaths, etc.

Each of these is updated at 00:00 Universal Co-ordinated Time.

I agree that the number of cases World is way under reported, and have felt that for some time. No new cases in China in the last 24 hours??? (and basically has had minimal new cases for several weeks. (Apple opened their Chinese stores based on that information.) Now USA is reported as having the most cases of any country. Note that currently other countries have more in "serious condition" however..The curve of new cases in the World is going almost straight up....
 
Amazing. Governor Quomo of NY orders a shelter-in-place lockdown to reign in an infection raging out of control in his state, threatening to overwhelm the State’s health care system. Comes on the news daily with dire warnings and passionate pleas for federal assistance. All good moves IMO, demonstrating strong leadership. And now there’s some evidence it may actually be working! Then, (apparently), he begins Publicly second-guessing the wisdom of the above strategy and tactics. I can now say confidently I’ve seen it all.
 
Thank you Dr. Bob for showing these two sites to watch. As the U.S. does more testing for this virus the numbers will increase. I find it hard to believe any of the numbers reported from China right now. The Doctors who first reported this virus to their government were put in jail because of their reports and their evidence of the virus was destroyed. It will take some work, but we as a nation will become stronger as a people as we work together to resolve this issue facing out nation.
 
Thanks Jay for your encouragement. Idaho is now under a shelter in place order as of yesterday. Basically all this means is use some common sense. It does not mean stay in your home and wait for the world to end by destroying our economy. We spent a beautiful day hiking the White Bird Battle Field with friends discussing the plight of Chief Joseph and the Nezperce.

We are blessed to live in a great country with some very talented people who will figure this thing out. Yes we need to take some precautions, particularly to protect those who are at high risk. I choose to believe as a friend stated that fear and faith both believe in a future that hasn't yet happened. Fear believes in a negative future. Faith believes in a positive future. There will be some good that comes out of this temporary event. Friends, families and to some some degree even elected officials are coming together to support each other. The reader board on our old small town walk-in theater says it best: “Temporarily closed until things get better”.
 
My brother's friend in WI who is in his early 50's has contracted Covid-19. Ambulance had to go to two hospitals before they found one that would receive him. His SpO2% is less than 90% and he had no pre-existing conditions. They are debating whether to ventilate him or not due to the ventilator shortage.

They suspect his wife had it but with minor symptoms which they took to be normal seasonal flu, not coronavirus.

This is not something to mess about with.
 
Our prayers for the friend. I suspect we still don't know the extent, and the "shortage?" of hospitals who would take him is certainly concerning.
 
My apologies for missing the last couple of days here. I spent a fair part of yesterday volunteering at a local food bank, and the day before had some really weird hours due to an essential service part time job.

Thanks to Dr Bob for continuing the discussion, education and keeping it current.

Making life choices in serious medical cases is not new to the medical community. A level of triage of sorts, going through various committees or decision trees, prior to implementation. Having a DNR decision made prior to the time of need is very important. How that is recorded is also important and should be based (somewhat) on your local medical provider and local organizations. DNR = Do Not Resuscitate, is a very common term. I have seen it on multiple typed or printed forms, I have seen it twice as a tattoo on a chest, and on medical ID necklaces and bracelets.

There are some variations of DNR. Another one, DNR/DNI = Do Not Resuscitate and Do Not Intubate is not uncommon. It essential means not to do CPR or artificial ventilation by the patients choice. Another term I have seen/heard more recently and seems to be more in-hospital use is "AND" meaning Allow Natural Death. There is some variation from facility to facility as to the inclusive or exclusiveness of the AND status. Variations will range from Pain control and hydration to various medication administration.

Here is a link to a good concise article on the language.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241061/

DNR, DNAR, or AND? Is Language Important?
Joseph L Breault, MD, ScD, MPH, CIP

Harvey
SleepyC:moon
 
smckean (Tosca)":3v597vkh said:
hardee":3v597vkh said:
Right now, the US is on the verge of not having the number of Ventilators needed for meeting the projected needs unless we get the Virus curve flattened.
Click to expand...
This statement, and having heard about ventilator shortages on the news, really struck me that covid19 can not be "just another flu" or that covid19 isn't much more serious than the seasonal flu we are used to (as some have said).

Correct me if I'm wrong, but I don't remember anything like a nationwide, or even a statewide, severe shortage of ventilators in any flu situation in my lifetime. For that matter, I don't remember such a storage even under SARS or MERS. That tells me better than any other evidence I've seen so far that we indeed must take covid19 very seriously (and this observation doesn't even consider the shortage of medical staff, hospital beds, protective gear, and so on we are also seeing). I'm presuming covid19 is either far more easily spread, or far more life threatening, than the seasonal flu to explain this ventilator shortage.

I'm typically a risk taker......but this time I'm taking the "Fauci" type precautions very seriously.

thataway":3v597vkh said:
Should all elderly COVID19 patients be Do Not Resuscitate?
Click to expand...
WOW.....what a thought! A fascinating philosophical consideration if it wasn't such a serious issue. I can't fathom an answer.
Click to expand...

Right now, Washington State is getting 6,000 new ventilators, NOT the 40,000 requested. (It's a step.) Also, we are getting a National Guard set up (FEMA) provided Field Hospital with ~250 beds. It might be into Century Link Center in Seattle.

Back to the Vents, I don't know where they are coming from or who made them. Until recently ventilators were made by only a few manufactures and to very strict standards. As a former RT with thousands of hours of ventilator management time, somehow the idea of seeing "Ford", "GMC" or "Tesla" instead of Bennet, Siemans, Philips, or Hamilton would be, for me, a rather scary experience.

When 10 - 40 thousand new ventilators hit the floor, they will need to be managed on the patients. Who is going to do that? Where are those Respiratory Therapist going to come from? Maybe other places (states) will do what Washington's Governor did. Last night he requested help from past medical professionals, Doctors, Nurses, Physicians Assistants, (and maybe others) to contact the state via a special phone number to get past licences reactivated in a rapid fashion.

There is hope coming down the road. WE will get through this, but to do it we are going to have to do a couple of things. ONE, take the virus, COVID19, serious, and be very careful about exposure. And TWO, flatten the curve -- by staying home, staying isolated, and keeping distance as much as possible. It is not a suggestion, it is our duty, until this bug passes.

Harvey
SleepyC :moon

0_God_s_Pocket_Anchorage.thumb.jpg
 
There is preliminary evidence that Washington State is approaching its spike and things could be leveling off. This is not 'victory'. Evergreen hospital who bore the brunt of this is seeing things leveling down. Ninety five EMS people who were the front line have reported only one person testing positive. Our shipyard, working full bore seems to be doing OK, people are isolated as needed and paid. We owe it to all of those great workers on the front line to continue isolating. Every person who does not get sick means one more hospital bed available that many less medical people exposed. We need to get cash to those suddenly unexployed - they were doing valuable work and need financial protection.
 
I am reading all these discussions from my fellow Cbrats and feel the need to chime in. I am an Anesthesiologist, still practicing, and my wife is a dentist. My wife's practice and the surgical centers I work at have all closed here in PA. I am not surprised at all by the difficulty our healthcare professionals are having finding the necessary equipment. Prior to this pandemic, our docs and nurses had many days where they faced equipment, drug and available bed shortages. Hospital systems are run lean on staff, supplies and beds. It takes very little to overwhelm an ER, operating room or ICU. It is my hope, that there is a rethinking of our healthcare system moving forward. I would hope more consideration is given to implement changes that are for the public good, not the interest of a healthcare systems stock price or dividend to shareholders. We are the best and richest nation on earth, its sad we don't have a better PUBLIIC healthcare system. God Speed to all of our colleagues doing the best with what they have, may you all stay healthy.
 
Vanadams, You are right on and I hope your wishes come true, however, the people who are running the hospitals now, (and I say that because when I started, 40 years ago, it was some different), because then, there were more medical people involved in management decisions -- at least in the hospitals and systems I worked in. Most places I worked, from a 250 to 300 bed city hospital to a small town 20 bed hospital, we had enough ventilators to cover 75% of the ICU beds, and access to rental units if we got down to only 3 left in the closet. But, as the times went by, 1990's and later, and the hospitals became business centers, and the docs were replaced with bean counters in the management areas, the supply chain became tighter, and the staffing became much more clock oriented rather than patient care oriented. It was sad to see and hard to swallow, but it was $$$ based and if you wanted the job, you dealt with it in the best way you could.

Maybe it would be good for the hospital system to adopt the Boy Scout motto, "Always Be Prepared".

And a Salute to all the practicing medical professional who are putting it all on the line right now.

Harvey
SleepyC :moon

0_God_s_Pocket_Anchorage.thumb.jpg
 
We have had several interactions with the health care system in the last 48 hours. Marie has a severe infection of her R Ring finger, with cellulitis. She was reluctant to seek medical care for risk of CV19 exposure. Sunday the ER's were swamped and we felt there was too great a risk. Monday AM we arrived at a hospital affiliated urgent care center 30 minutes before it opened. They had a triage desk maned outside of the doors, and only because I am a physician was I allowed to accompany Marie. All personal in this center were wearing "surgical masks". Because of our personal great risks, we wear N95 masks when interacting with anyone. The doctor felt that Marie was ill enough that she needed IV medication and the urgent care center did not have that capability (I used to give IV's in my office routinely.).

Screening outside of the ER was more intense, and there was an armed security guard present. There were no patients waiting (about 9:30AM). There were 3 triage stations immediately in the ER--and again masks and gloves were the order of the day. The ER physician did blood tests and gave Marie IV antibiotics, plus oral to take at home. He was critical of the urgent care facility for sending us to the ER, and increasing our exposure risk. (again it may only because we are retired health care providers?). There were 3 CV19 patients in the hospital. But many had come to the hospital after finding that they were positive from the drive thru testing service. Most of these were mild cases, who would do fine with supportive care and monitoring at home. About 75% of symptomatic patients can do well at home, 20% need hospital, or at least some relatively intense therapy, and 5% are critical, needing ICU, and Ventilator therapy.

Today I had an appointment with my cardiologist. He normally sees patients in a crowded medical office tower attached to the hospital. For only certain patients (I had an episode of pulmonary edema during the Hontoon trip) he was seeing limited patients one day a week, in a facility where there was direct outside access to the waiting room. Schedule was such that no patients were waiting, but went directly to the exam room. Each exam room was cleaned after a visit. Starting tomorrow, all visits will be via teleconference using "Zoom".

We discussed several items I had read yesterday, including an ER doc in New Orleans who stated that he was sending home CV19 patients with bilateral pneumonia to be monitored twice a day by nurses or paramedics. There were no hospital beds for these patients. The other information which was confirmed was that the mortality of those put on a ventilator was between 70 and 90%--

There are patients who are recovering after being put on extracorporeal membrane oxygenation (similar to heart lung machine) in the hospital my cardiologist works out of. Unfortunately there are a very limited number of these machines. It is also very expensive and labor intensive for the monitoring.

There are drugs and methods for combatting the cytokine storm: which is an overwhelming response by the body's immune system that causes massive exudate outpouring into the lungs, and will not allow oxygenation. One of the more promising anti cancer drugs is about $70,000 per dose.

Yes, our system was unprepared--both government and private. There is not reason, nor is it the time to point fingers. These events seem to come around about once a generation or less. The last one of this magnitude being the 1918 Flu. Hopefully this event will trigger more research and avoid another world wide catastrophe.

Be safe, stay at home, practice the best hygiene possible.
 
Dr Bob, I am diabetic producing no insulin, but because I keep A1cs below 5 (for other complications) I am constantly being told I am not diabetic. After a somewhat disastrous ER visit two years ago for a finger cellulitis I have managed to stockpile a small supply of Cephalexin. My prayers for your wife. This is definitely something not to let (bad pun) out of hand.
 
I'm glad they deployed the hospital ships where they did. I'm wondering if they too will fill up. Lots of cruise ships sitting around, they'd make great floatels that could be turned into makeshift patient room if moored next to a hospital ship.
 
We are now about 10 days into our lockdown here on the ranch. We brought my 88 year old mother from Calgary to come live with us here in seclusion. She is settling in well. It is still very much winter here in Alberta. I had planned to go to Vancouver Island to get a little taste of spring tomorrow, but decided to stay home. BC Ferries has shut down to all but essential travel. With Washington State being a hot spot and Vancouver being once the worst hit spots in Canada, we feel its better to just stay on the ranch. I have lots of left over projects and finally am getting the winch installed on my truck after sitting in the garage for two years. Upgrades are planned on the camper and when the snow goes and it warms up enough the C-Dory will come out of the shed. I still have a few upgrades including a Wabatso heater install and a solar vent. With all the parks and boat ramps closed, I am not sure if and where I might put Mistaya in the water this year. I should still be able to find some water for my Canoe and Kayaks. There is always something to do on the ranch and the bison calves should start coming in about there weeks. Right now I plan to only go to town for essentials about once every 7 to 10 days. Covid-19 cases are growing as are deaths here in Canada, but not to the same rate as they are south of the border. Most of the cases can be linked to travellers coming home. Canadians are very good at doing what they are told and the lockdown is being well respected across the country. We are afraid of the effects of the pandemic not only for cases coming north, but also the economic effects of our largest trading partner. The tourism sector will be very quiet this year with the border closed to travellers, especially Americans. I just read an interesting article that I will link below if you are interested what is happening in the great white north.

Stay safe and stay healthy.

https://www.cbc.ca/news/canada/coronavi ... -1.5514497
 
My boat is in the winter storage lot run by operated by the county. The location was shit down and closed to all vehicle traffic before I could get the boat out and the state governor has imposed a lock down on all non essential travel until June 10th (so far). Moving a recreational boat is not on the list of acceptable activities. Probably won't see my boat till mid summer at the earliest.
 
Back
Top