A thread for medical professionals
[Nota bene: It hasn't escaped me that there are a fews ways in which a message like this can be self-serving. However, this board - and America in general - seems to need more like this, to hear confirmation from experts, not mouthpieces, and I'm at peace with my balancing of the pros/cons of this O.P.]
The mainstream media is not sensationalizing COVID-19. What you are seeing on television is well tuned to the crises in our wards and clinics. Let's hope that turns. And, better than hoping, keep harnessing the agency you have to do better for the vulnerable: stay inside. Stay clean. Stay smart. Do it for every great person who isn't you. Self-isolation can be a challenge of many kinds. Try to take this challenge in stride and, if you're healthy, be thankful your challenges are not worse. Those who keep up this sacrifice of self-isolation display crucial service (and great respect) to their country.
Genuinely yours,
One of mgoblog's graduating MD/PhD students
At this point, to my knowledge (as we say) there is no hard science behind it. But the longer this continues, the more data that will be available to get those answers.
Likewise, there is still uncertainty as to the accuracy and value of various serological tests. In a perfect world, it would be great to have additional data, but at what cost and time? Are we going to test millions of patients, most of whom have not sought medical attention? That type of data won't start to be available for months. Pay attention to what the true medical experts suggest that we do, not the politicians who are all trying to out do each other. BTW, the medical "experts" that you see interviewed on the TV news shows are usually average in their respective specialties, and while informative in a general sense, are there for entertainment/ratings purposes.
March 29th, 2020 at 10:37 AM ^
I’ve seen Plaquenil 200mg two twice a day for day one then one twice a day for 4 days and a z pack.
Also in NJ a coronavirus party was broken up over the weekend. 47 people in a small apartment.
March 29th, 2020 at 12:50 AM ^
The mainstream media sensationalizes everything, but you can't really hold that against them. On that note it's worth pointing out that the only reason we called it the Spanish Flu is because Spain was the only national mainstream media discussing the issue during ww1 due to the major powers existing under government wartime censorship. Its also worth noting, further, that many estimates say as many as 1/10th of the planet's population died due to that epidemic, far more than died during the Great World War, and most of the recorded deaths were under 40, because it was a particularly potent strain, and the elder generations had lived through outbreaks of weaker strains, such as the one we're currently experiencing, and were (relatively) immune to its catastrophic effects.
March 29th, 2020 at 12:55 AM ^
Girlfriend is an RN and she says it’s drastically gotten worse with each passing week. However once we have the proper supplies in place (estimated sometime late April-May) things will get better over the summer. They are worried about the potential second wave come fall but still optimistic that with modern medicine and good preparation we can fend it off best we can. Objective remains the same, get through May and things should improve a good amount. Lasting affects will last all 2020 however so I’m doubting any fall sports.
So what's up with Sweden?
DairyQueen, good point. The Swedish government has delayed mandatory social distancing and now their COVID-19 cases are three times their closest demographic neighbor Finland that has chosen a lockdown approach. Moreover, Sweden only tests in hospital settings (unlike most of its European neighbors) so the rate of infection is probably even higher than its neighbors.
I know some viewed Sweden's overall level as low compared to European countries, notably in Southern Europe. Personally, I have spent time working in Sweden and would argue that compared to Naples or Madrid, Swedes already practice social distancing in their lives and even without a government edict are much more likely to avoid public spaces during an epidemic.
now their COVID-19 cases are three times their closest demographic neighbor Finland that has chosen a lockdown approach.
A bit of clarification: Until recently, Finland and Sweden were using the same "herd immunity" approach. Finland has recently changed course and locked down the province in which Helsinki is located. Sweden now appears to be inching in that direction too (gatherings of over 50 people now outlawed and rumors of a Stockholm lockdown).
Not gonna lie, I envy those with no medical personnel in their house right now. You just have to stay home and relax. Meanwhile, my wife is removing her clothes in the garage when she gets home and if it gets bad in my area is consider sleeping in a seperate room. I'm taking care of our 9m old, 6+9 y old solo. To be able to just stay home care free is a luxury,I'm on edge. She told me our counties first death looks like itll be a 39 y old male.....same age as me, who she read xrays on the week prior.
I'm right there with you. My wife is a ehhh midwife and she's been talking about staying at the hospital on call residence, but settled on showering and changing clothes after the shift and dumping the clothes into the washer ASAP. Clorox wipe everything down that she touches in the car and into the house.
They are rationing PPE as best they can but its just starting to hit seriously in upsate NY.
I'm crushed for my kids softball season (travel maybe but school ball definitely since school will be toast IMO).
March 29th, 2020 at 11:23 AM ^
My daughter plays softball, too. Junior in high school. It's been very difficult, mentally, to suddenly have no practice, work outs, teammates, games, etc...Son, too, with baseball.
Same boat here. Wife is a dermatologist who is about to get “drafted” to the ER by her medical group as they’ve already moved all elective derm procedures to telemedicine and they need more support in the front lines. Some of her colleagues have already gone. She is changing her clothes and showering the second she is home from derm surgeries. Preventative measures will increase once she is shifted to support ER personnel.
19 month old son is at home with me. This is already pretty damn intense and all indications in SE is that it will only worsen over the next 2-3 weeks minimum.
I'd like to refer everyone to an organization in Seattle, the Institute for Health Metrics and Evaluation (IMHE) at healthdata.org. They seem like a real organization - apparently somehow affiliated with the Univ of Washington and funded by Gates and the State of Washington.
They've prepared models on a state-by-state basis which address best-case, worst-case, and most likely scenarios for resource usage (covid19.healthdata.org). The Michigan model shows that we ran out of ICU beds last Wednesday (March 25); that we'll run out of beds available tomorrow (March 30); and that we'll need about 1,800 ventilators (it doesn't say how many we have). It doesn't address the granular problem of having a bed, ICU bed, or ventilator in Grand Rapids when you need it in Warren.
The interesting thing (to me) is that the model seems to show that the peak (here in Michigan) should be April 8, that we should have things under control by the week of April 20, and that we should be out of the woods by the end of the month. Buckle up for the next three weeks or so, but (to the extent the model is accurate) the end seems to be in sight.
On another, anecdotal note, my daughter and son-in-law live in NYC. They were very sick in early March - reporting symptoms that were more severe than they remember from other illnesses (they're only 30, so they don't have deep experience in this regard). They were not tested and, if it was COVID-19, they are not included in any statistic. They believe they got it from some friends in DC who underwent a similar, serious respiratory event. The DC folks tested negative for flu, but weren't tested for COVID-19. Everyone seems to be fine now - so that's a scary step in the right direction.
March 29th, 2020 at 11:30 AM ^
My brother and his wife live in Illinois, and his four grown children came home to live during this crisis. Three are from NYC, and they left knowing things would get bad there and there would be a lockdown. All three of them have since gotten sick with mild respiratory symptoms, and all recovered, and not tested. Then my brother's wife got sick with fever and respiratory symptoms. She got tested this past week and was positive for COVID-19. So they think the kids brought the virus from NY. The fourth kid came home from college in New Orleans and has now also gotten sick, but is better. The only one left is my brother, although he's had minor respiratory with no fever. They have all been quarantining for two weeks.
My daughters an RN on the front line. God bless all of you. She was running a low grade fever but it only lasted a few hours. Allergies kick her ass this time of year and a fever is usually part of the deal. She’s doing 3, 12’s and then 2 off. We faced time last night and she looks like hell, stressed to the max. Luckily Toledo isn’t seeing much in terms of cases.
Extra prayers to any of you or your family members on the front lines right now. If you guys go down we are all screwed as a nation as there isn’t enough backup in place for normal issues let along a pandemic.
On a positive note the three of us in our house had all had the symptoms lasting a full three weeks in January. Only our 15-yo daughter got tested for a/b flu and strep (all negative) as she had it the worst of us with difficulty breathing and being able to take deep breaths without feeling “waterlogged”. She was taking a lot of Ibuprifen for the headache that never left and the sore throat at the beginning before the dry cough set in for the three weeks. Not sure what to believe on the Ibuprofen vs Tylenol thing out there right now, but neither wife nor I took any ibu/tyl for headaches and daughter took it daily FWIW. We were concerned she had pneumonia - and after three weeks it all disappeared like we never had it.
Also, my wife just finished 6 rounds of ABVD chemo in August last year and had some noticeable streaking in her lungs that were damage from the chemo - BUT she was able to fight this off with essentially a brand new immune system and did not need to be treated during the three weeks of being sick. We were initially terrified the cancer had returned with her relentless cough and fevers. Thankfully, her six month scan came back NED - Thank you God!
There is hope out there for even those with compromised immune systems. Just radically infuse your bodies with as much immune boosting nutrition as you can pack in and stay out of public until this blows over.
Again, Blessings to all of you putting your lives on the line for all of us - you are all heroes in my book!
I know a 30 year old on life support right now. He got COVID-19 from going to a wedding that should have been canceled. This is not sensational at all and we shouldn’t turn the economy back on until there’s a treatment, a vaccine, or at least mass testing. People on this blog are going to get it. Their wives, children, and parents are going to get it. Many will die. I’d like to see some sober realism and compassion from the MGoBlog community right now—aka...perspective.
March 29th, 2020 at 11:53 AM ^
Full disclosure; I’m an orthopedic surgeon. For you medical professionals you know that means I left my medicine brain behind me long ago.
My question for those of you more in the know: if this is as contagious as it appears and it has been stateside since at least mid January. How on earth has this not made its way through the majority of population at this point?
in my hospital we have been struggling with capacity issues since January. (This isn’t atypical for us during flu season) and my medicine colleagues have mentioned this being a “bad” flu season.
We all have stories of having a bad cold or family and friends who had a bad cold this year. Isn't it possible (or even likely) that this was corona?
With only 12% of infections requiring hospitalization and less than 3% the icu (my numbers may be off. I saw these from New York earlier this week) the vast majority of positive tests are likely from people who would have never presented for medical care with their illness had there not been a huge health crisis or would have just seen their PCP. Instead these people are flooding hospitals and ERs and we are utilizing all available resources just to tell them to go home and quarantine. Which is a huge double edged sword on 1 hand we get much needed info on the other hand we utilize our scarce PPE resources on people who don’t “need” it
Obviously more widespread testing is helpful from a policy standpoint. Likewise we would love to be able to get antibody testing up and running to know who has had this already and help to guide quarantine timelines
None of this is to say we aren’t being appropriate in our quarantine measures, since e don’t know these answers we can’t assume, just some questions I have and some food for thought.
Anyway, to my ER and medicine colleagues. Keep your heads up and keep plugging along. And keep yourselves safe. We’re gonna need you! No one wants this orthopedic surgeon managing their lung issues!
March 29th, 2020 at 12:02 PM ^
I’m an Critical Care Doc in Cleveland. I am surprised it really hasn’t hit us very hard relative to SE Michigan. We are definitely preparing for the inevitable surge to hit.
The main challenge over the past few weeks from a medical standpoint has been making sure not to miss the myriad of other/ non-COVID illnesses that make folks critically ill.
My parents live in SE Michigan and are adhering to social distancing. I worry about them. The OP’s message is on point.
Michigan has mirrored Ohio's policies, usually one day later.
The difference between the two in cases probably comes down to Detroit being a major international airport hub. I suspect that we got it relatively early and it went undetected due to lack of testing. Right after our first confirmed case was announced (in March) we got news of the Detroit Police Department having multiple positive tests, which suggests there had already been significant community spread. We really needed to get out in front of this in February, but couldn't test for it.
March 29th, 2020 at 12:29 PM ^
I created this account just to post this here.
I am an outpatient doc practicing in Ann Arbor. In the middle of the maelstrom you are reading about on the news, our practice is... dead. With good reason. We have canceled all routine visits, limited sick visits only to things that we can definitively diagnose and treat (so no Covid19 visits, no colds or stomach bugs, rashes can be done over Zoom). I know though that hospitals, ERs, urgent cares, and public health departments are overburdened. I have been using my time more effectively by working at a drive-through testing site, and I've also volunteered as a contingent to help out in the ER if/when needed. My inpatient experience was many years ago, though, so I don't know if I will be much use there.
These severe restrictions will be no good to us if they aren't accompanied by a significant ramping up of our ability to test and to do contact tracing. We are hearing "test, test, test", but the test results need to be followed by robust contact tracing, follow-up testing, and isolation. Otherwise we're just delaying the catastrophe, and not preventing it, when we start relaxing these restrictions. In fact, it seems that getting our testing and tracing systems ramped up may end up being a precondition for lifting our current restrictions.
Doctors, nurses, and MAs, in a variety of clinical situations, can do the testing. The tracing and follow-up is done by the health departments. And there is no way they are up to the task without help. WE CAN HELP. They are looking for volunteers. They say anyone with any kind of clinical or "community organizing" background. That seems pretty broad to me. I currently have the time and so I'm volunteering. Consider doing it too. It only takes a computer and a phone.
Here is the link
I am fairly certain that the Feds are using testing data along with people's cell phones/email addresses to digitally track peoples' movement using their mobile devices. I am guessing that all reasonable privacy on our mobile devices is out the window at this point so they can watch said movement. I know this is the case in Israel right now.
My guess is that this was likely a biological weapon released into the world and that is why they quarantined and watched the cruise ships very early on to learn from what was happening in a contained environment on ship at a micro scale. Now they are watching digitally - nationally, and perhaps globally. Something is definitely different about this one in response to lock down and cancellation of events on a global scale compared to other viruses that have come before this one.
Does anyone know if they are taking people's cell phone numbers when they are doing the drive through testing? I'm guessing they already have people's emails and told them to watch for results - so needing phone numbers probably isn't necessary as 95% of the population checks emails from their phones and there is gps tracking tied to our devices. Anyone inside a medical facility has already provided their contact data into the system.
Just my 2 cents, but there is probably a great deal of learning/tracing going on even though it probably doesn't look like it. Kind of spooky from a privacy standpoint, and yet necessary as well. Data runs the world - especially during a "war". Any data scientists out there that would care to chime in?
Holy shit this post is something.
His user name does not check out. Not a lot of actual thinking going on.
Think again, and my username does check out with two credible sources of information.
“Israel’s government has approved emergency measures to track people suspected or confirmed to have been infected with the coronavirus by monitoring their mobile phones, immediately raising privacy concerns in the country….”
“Several countries have used technology to digitally track the virus’s spread, although with different degrees of invasiveness. Iran has been accused of asking people to download an app alleging to help identify the coronavirus symptoms, but instead it collected location data.”
“China expanded its already-intense mass surveillance, with telecom operators tracking people’s movements while companies have rolled out facial recognition technology.”
“In South Korea, the government sent messages out to the public that detail the movement of people who have recently been diagnosed with the virus.”
My question to all of you is do you really think we lack the technology to do this in our own country? Or, do you disagree that this was possibly a biological weapon to begin with?
And… don’t get me started on the topic of a “Digital Dollar Wallet” that completely bypasses the banking system and goes directly to the Federal Reserve System for dispersement of funds to the public. This was absolutely presented in session while the Senate was debating the 2T Stimulus Package and was removed from the final bill - for now. This was literally reported in Forbes this week as well, and not in some conspiracy blog:
So roll your eyes all you want, or dig your heads out of the sand and get more informed. Things are not as they seem.
March 30th, 2020 at 10:56 PM ^
Private corporation already have the means to track people via cell phones https://xmode.io/blog/. Heat maps of cellphone location data.
March 29th, 2020 at 12:59 PM ^
Thank you to all of the medical professionals here, and those working in the hospitals right now to save lives. You are all heroes.
I work as an ICU nurse at two hospital systems in SE Michigan. I can definitely tell you this shit is real. I was at one hospital anon Tuesday, and it was complete and utter chaos. There was one available vent by the time I left in the AM. They had already converted areas of their PACU and a few ORs to ICU beds.
I've also heard more codes called overhead (from other areas in the hospital, they don't call overhead codes in the ICU) in the past two weeks than in the 6 months preceding this shit storm.
I cannot speak to how people who don't end up in the unit are doing, but the ones who get to my neck of the woods are beyond sick. They are requiring more vent support than most other patients I've seen in my career. I've heard stories of multiple lungs blown from the stupid high amounts of inspiratory pressure these patients are requiring just to maintain oxygen levels compatible with living.