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19 minutes ago, square_25 said:

 

A good friend who is running the COVID unit in her hospital told me they rewrote their protocols yesterday, subject to further change of course. MDs across the US are communicating directly with each other, adapting their practices, and finding new and better ways to help patients. 

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DS got home 3 hours ago!  ❤️❤️

Update-  my youngest is not only short of breath, coughing, dizzy, nausaues, and with headache-  she is also confused.  I called our doctor and talked with him and she is going to be going to the ER.

Thought I'd post a pic of my dd, getting ready to spend another day in a coronavirus triage tent!  

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🙂  @vonfirmath @Æthelthryth the Texan Texas https://abc7news.com/6087033/

“The brothers transformed their small batch distillery into a massive sanitizer operation.

As most small business owners closed their doors, these guys increased hours. They are now operating 24 hours a day, seven days a week.

They hired 30 furloughed bartenders to help bottle, package and distribute bottles to the public for free.

"This is a way for us to kind of get on the front lines and fight this thing with the rest of Houston," said Chris.

Being on the front lines, serving and giving back all comes naturally for these Iraq War veterans.

"Definitely being in those high pressure situations kind of helps with what we're doing today," said Travis.

That training and service prepared them for a very big call from Texas Children's Hospital, which was running low on its supply and in need.

"And then they said, 'Well, we need 6,100 gallons to get us through six months,' and I'm like, 'Okay, that's a lot of vodka basically in my terms,'" said Chris.

It's the biggest order the distillers have received yet, and one Chris could not turn down.

"So we called them back and said we're going to do it. We're going to do it on donation," Chris said. "We're just going to take care of you guys."

Chris explained that it is the least he can do for the doctors and nurses he credits with saving his daughter's life.

Three years ago, she came down with the flu and her health deteriorated after also contracting croup.

"It's where they're constantly gasping for air, it's a really horrible thing for a parent to deal with," explained Chris.

After a week in the hospital, he says she was released, but only for the infection to get worse.

"I remember... we took her back down and she had to go into the ICU at Texas Children's, and that was very scary," he said.

His 2-year-old spent another week in the ICU.

Chris watched the health care professionals work around the clock to keep her breathing.

"When you see them with crash carts and hooking them up to all these tubes and wires, and she's crying and there's nothing you can do, but they did it. They were her parent that day. And they took care of her."

He hopes this hand sanitizer will protect those same nurses, doctors and medical staff as they continue their work to save children.

It's hand sanitizer, bottled by furloughed employees, packaged at no profit, by two veterans, signing up to help on the front lines again.”

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Don’t we all live imperfect lives and do things that aren’t optimally healthy anyway? It’s easy to pick reasons for why someone is responsible for whatever bad happens but the reality is that it’s still luck.
 

People with COPD from smoking will still recover from covid. People who eat nothing but Dingdongs and Doritos can still recover. Nobody deserves it. Maybe I don’t run a mile a day while my very overweight friend runs 5. Maybe there’s more to people than their bad habits. Maybe the person with heart disease is the most fantastic teacher! Maybe the health nut kicks his dog. I regret detailing why I’m not a stereotypical high risk for asthma person because it really doesn’t matter and much of it isn’t anything I did anything special to achieve. 
 

I agree the typical American and American diets could be healthier but in many ways we are healthier than our ancestors who survived the common diseases of today when they were novel.

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42 minutes ago, Bootsie said:

I am not sure why you quoted me when you posted this.  In my saying that I am surprised at how different people's experiences with death are, I in no way was implying that people are disposable.  I was not intending to minimize anyone's loss or justify any deaths.  I was simply reporting my experiences.  

I do think people's experiences, however, impact how much they see death as a part of life, or how surprised they are when they experience it.  I just walked by a house which has a date from the 1600s on it.  There is also a religious panting and the words (when translated approximate) "Holy Mary, watch over this house, field, and barns, and protect it from weather, sickness, and attack".  I think people who experience seeing things like that on a daily basis view life as more fragile (and less predictable) and out of their control.

 

It was a jumping off point not about you, specifically. There's a certain resignation about the deaths of people with 'preexisting conditions' that fails to appreciate or understand the increased toll on specific communities that are already overrepresented in a variety of negative social outcomes, health, wealth, income, respect, opportunity, etc. All of these things are connected. None of these deaths had to happen, are necessary, or deserved.

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1 hour ago, Jaybee said:

I just read an article--and now don't know where it was 😞 --that doctors are seeing heart failure a lot, and are trying to figure out how the virus is related; i.e., they think someone is having a heart attack and has blocked arteries, only to take them in and there are no blockages and a positive covid test. They are currently sharing information to try to figure out if the virus is directly attacking the heart or ?? (I was quickly scanning, and I'm not sure I caught all that correctly, but I found it a sad but interesting twist.)

There is some evidence that some patients develop what appears to be a viral cardiomyopathy from having the virus. I read a dr in Seattle’s account and he said they had had the experience, a number of times, where the patient seemed to be recovering and their lungs improving, when suddenly their heart function would drastically deteriorate and they would develop a ventricular arrhythmia, have a cardiac arrest and die.

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6 minutes ago, kdsuomi said:

Stanford Medicine is doing a study to see if COVID-19 has been in CA much longer than the first confirmed case, which is what so many here suspect. https://www.ksbw.com/article/new-study-investigates-californias-possible-herd-immunity-to-covid-19/32073873?fbclid=IwAR1EGneaA6t7K7fQlhWbkKVzjxy087UjLLy2mB34LViXRxc-Nni1MMa2Aho#

I am 95% sure that I (and many others in my circle) got it in January/early February. Because of where I live, the circles of people I move around in, because of who spread the covid19-like symptoms in January, because of the severity of the illness which spread immediately to my entire family, and because of the many people around me who got it at the same time, I have the same hypothesis as well. I plan get an immunity test whenever it is available.

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1 hour ago, Jaybee said:

I just read an article--and now don't know where it was 😞 --that doctors are seeing heart failure a lot, and are trying to figure out how the virus is related; i.e., they think someone is having a heart attack and has blocked arteries, only to take them in and there are no blockages and a positive covid test. They are currently sharing information to try to figure out if the virus is directly attacking the heart or ?? (I was quickly scanning, and I'm not sure I caught all that correctly, but I found it a sad but interesting twist.)

And this is one reason why we don’t have a complete picture of what this novel illness is doing. We may find out that the death rate is higher in certain demographics than we even knew. 

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30 minutes ago, mathnerd said:

I am 95% sure that I (and many others in my circle) got it in January/early February. Because of where I live, the circles of people I move around in, because of who spread the covid19-like symptoms in January, because of the severity of the illness which spread immediately to my entire family, and because of the many people around me who got it at the same time, I have the same hypothesis as well. I plan get an immunity test whenever it is available.

 

I hope you will let us know results!!!

 

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40 minutes ago, TCB said:
1 hour ago, Jaybee said:

I just read an article--and now don't know where it was 😞 --that doctors are seeing heart failure a lot, and are trying to figure out how the virus is related; i.e., they think someone is having a heart attack and has blocked arteries, only to take them in and there are no blockages and a positive covid test. They are currently sharing information to try to figure out if the virus is directly attacking the heart or ?? (I was quickly scanning, and I'm not sure I caught all that correctly, but I found it a sad but interesting twist.)

There is some evidence that some patients develop what appears to be a viral cardiomyopathy from having the virus. I read a dr in Seattle’s account and he said they had had the experience, a number of times, where the patient seemed to be recovering and their lungs improving, when suddenly their heart function would drastically deteriorate and they would develop a ventricular arrhythmia, have a cardiac arrest and die.

 

We had a relatively near area case that presented as a heart attack.

 Rumor is that because it seemed to be “just “ heart attack not respiratory sickness EMT people didn’t have full PPE. 

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50 minutes ago, Pen said:

 

I hope you will let us know results!!!

 

Oh, I will. My DH cannot wait to get the test because he was the worst affected in my family and he now figures that he could go back to his workplace immediately if he had the antibodies (he can do his job more effectively if he were let into his workplace as there is a hands-on component to it with specialized equipment).

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This is an absolutely gut-wrenching, heartbreaking FB post from a nurse.  Please send this to any friends or relatives who are claiming that hospitals are mostly empty, or it's not has bad as the media are portraying it, or we should just let a few "old people" die so we don't wreck the economy.... 


I haven't posted a true update in days because I could not find anything positive to say. I tried since Thursday to change my perspective and be a ray of light in this dark time, but I just keep being beat down. I have never seen anything like this before, never taken care of someone that is so healthy but at the same time so deathly sick. I've been working in a makeshift ICU for days now because there were no other nurses to staff the area. There are not enough staff even though we get new people daily, not enough experienced staff (because who on earth can be experienced for this level of sick?!), not enough supplies. I can't count the times I have heard "well we could try and do this but we don't have this". I'm not an ICU nurse at all, but neither is hardly anyone else working these units now.

I've told Julio Macias 2 days in a row that I want to come home. But he talks me back off the edge each time because he knows how much I would regret leaving because at this point anybody at all helps. So I'm still here. Day 11 is done. Of course we can't share patient info, but being in an ICU setting I am keeping my same patients day after day until they die.

No one has left our unit yet except in a body bag.

I've struggled to find my purpose being here, but strangely enough Julio knew why before I ever did. I have been translating Spanish for days for these people, in my own broken Spanish because anything is better than them understanding nothing. I've seen patients arrive on our unit not yet sedated or vented but in extreme respiratory distress and beyond frightened. I have explained what COVID is doing to their body, what the risks are of being intubated vs not, and I have listened as these people have called their family members for the very last time prior to being intubated. If I can leave here with anything at all, I can know that I helped give them those last moments with their family.

After they are sedated, their personal belongings are still there. Their phones still ring. That's the worst is listening to the phones ring knowing someone is calling and praying they will answer just one more time.

These people are not old. They are young. Many with no medical problems. Strong people, physically fit. One who even worked 5 jobs at a time until Covid ravaged his body. This virus kills people. They all die at some point, it's just been a game of seeing how long we can keep them half alive. I feel like our efforts are futile, but I still try so hard and get so upset because I know that if it were Julio or anyone in my family laying there I would want the same done. When their bodies finally give up fighting, we place them in a body bag.

I've seen hundreds of people die as a nurse, but they are usually surrounded with loved ones or we give family time to see them to say their goodbyes. Not with COVID. There is no closure for anyone in this. I can't explain to you how bad this hurts, how real this is, and how afraid I am knowing that it could get like this in my own hometowns. I can't make you guys do anything, but I am literally begging you to listen to us healthcare workers and take this seriously. My heart hurts so bad tonight for these families who have lost people entirely too soon, for those who are sick and absolutely terrified, and for all of us who will surely have some form of PTSD after this is over.

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8 minutes ago, StellaM said:

 

One of the worst things about this virus is that it's made clear just how many people are prepared to write off others, and blame them for their own illnesses, as if illness is an individual character flaw.

Like you, my illness is not 'lifestyle acquired'...but even if it was, to blame the individual is a vast over-simplification of a complex set of interactions.

People don't make 'choices' in a vacuum. 

 

I can't parse out what in my life is "my fault" and what isn't.  I mean, we all make a mix of choices.  Obviously I believe in healthy choices.  I wouldn't make the good diet choices that I make if I didn't.  I wouldn't push myself to exercise especially when chronic pain means that it's not "no pain, no gain" but "more pain when you push until you push too much and then it's so much pain that you just can't stand it any more".  I can't blame my parents.  My dad's family all live into their 90's.  My mom is 95 and still going strong.  They fed me right and exercised me.  When I got sick at at 21 (ish) I wasn't overweight.  I walked miles a day.  I ate a mix of good and bad food but didn't have a diet of Twinkies or anything.  I didn't smoke, do drugs.  I had quit drinking by then.  (Perhaps someone wants to blame my drinking in my teens? )

I have had people blame me for my health all my adult life.  They throw diets and herbs and essential oils and supplements at me and when they aren't the magical elixir then it's obviously something I've done to sabotage things or to make myself ill to begin with.

But guess what, despite chronic illness my kids have benefited from my being their mom (even if my teen won't admit it right now).  The kids I've taught over the years have benefited.  The people I have ministered to have benefited.  My husband has benefited.  The non-profit that I run has benefited.  Not saying that any of these people in my life would say that I was perfect or anything.  I'm not.  Just saying that my chronically ill self hasn't been this boil on the backside of life and that my life has had some impact on the world.  And I'm not alone in this.  I know a lot of people all over the world and while some people are lovelier than others, they all have value. 

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We're straying from the purpose of this thread with this unpleasant, little, rabbit trail. 

If anyone needs to talk about pre-existing conditions, keep it impersonal, please. Nobody should be feeling the need to justify their existence.

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43 minutes ago, StellaM said:

 

Yes. It's not new, just exposed.

I think it's part of the human condition. It isn't necessarily writing other people off, it is...preventing panic or anxiety by rationalizing why something like that won't happen to me. It is callous when the reasoning it won't happen to me that I'm crowing about applies to someone else in the same room, but I don't think that people mean to say others are expendable because of whatever the reasoning is.

If you read The Right Stuff by Tom Wolfe about test pilots in the '50s and '60s it talks about this concept a lot. A lot of those guys died testing rockets and whatnot, but when someone in the squadron died, one of the other guys would always pipe up with,  "Well, of course he crashed; he didn't do X when he was supposed to," or, "if he hadn't panicked and done Y he would have been fine." When you say it out loud in front of the guy's widow it is horrible, versus saying it in a meeting discussing how to avoid the problem in the future. I think here sometimes it's trickier; discussing these risk factors for death from covid is clinical and self-protective but you're still talking about it in front of the widow, so it is harsh or comes off as uncaring. I am confident, or would rather give the benefit of the doubt, that when people say stuff along those lines they aren't saying those people are expendable or not valuable. I think some of it is clinical discussion and some of it is people wanting to feel like it can't happen to them (which honestly might be necessary to get through the day).

 

ETA: Typing this while Rosie posted. It took me awhile to consider it and type it up so I'm not deleting, but I understand if a mod feels they need to. 

Edited by EmseB
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Worldometers numbers indicate that US deaths will surpass Spain's tonight (not that either country is capturing them all), maybe Italy's in two more days. Frustrating, because we didn't make rapid, well-organized use of information that would have helped.

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5 hours ago, bolt. said:

That's hard to hear, but I'm doing math... five employees have confirmed cases... they are obviously not supposed to come to work... but, also, neither is anyone who had direct contact with them. In a care facility of 90 beds, what kind of staff numbers would it have? I think that "Stay home if you were anywhere near 'these five people' in the last two weeks."  is the right message, but I can also see why it would easily lead to almost the entire staff saying, "Yes, I'm supposed to stay home because I saw 'so-n-so' in an elevator last week."

The quotes seem to cast the staff as slackers who are choosing to stay home (of their own will) out of self-preservation while the elderly go without care. That's unlikely. I think probably they were nearly all plausibly-exposed to the confirmed cases, which means staying home is right, not wrong. And so is relocating the patients to where they can receive care.

This is what happened in Spain.  Army ended up going into a nursing home and finding dead people. It turned out that almost the entire staff were sick or quarantined so the patients had effectively been abandoned.  

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5 hours ago, Jean in Newcastle said:

I don't.  This is the same NHS which has wanted to do nothing and let the chips fall as they may because of a lack of resources.  But that is all I will say because of the "no politics" rule. 

We have the weird situation here where private hospitals were actually looking at having to lay off health care workers . The cancellation of all elective surgery effects them much more than the public system.  I think the latest I heard the public system were going to handle Covid and the private would handle non Covid stuff so they are effectively working together.

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3 hours ago, TCB said:

There is some evidence that some patients develop what appears to be a viral cardiomyopathy from having the virus. I read a dr in Seattle’s account and he said they had had the experience, a number of times, where the patient seemed to be recovering and their lungs improving, when suddenly their heart function would drastically deteriorate and they would develop a ventricular arrhythmia, have a cardiac arrest and die.

I wonder if this links to the blood think linked up thread 

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11 minutes ago, Ausmumof3 said:

I wonder if this links to the blood think linked up thread 

I am guessing that it could be a disease-induced version of takotsubo cardiomyopathy. It's usually stress-induced, but the stressor can be a physical one. It can cause death and arrhythmia, but when it doesn't, recovery is usually complete. 

 

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😞 Alameda County, California 

https://sanfrancisco.cbslocal.com/2020/04/08/coronavirus-update-85-people-east-bay-nursing-homes-6-dead/

“HAYWARD (CBS SF) — Alameda County health officials reported Wednesday a growing outbreak of coronavirus infections among staff and residents at two senior care facilities in Hayward and Castro Valley, leading to six deaths.

Gateway Care & Rehabilitation Center in Hayward currently has 59 people infected with COVID-19 – 35 residents and 24 staff, according to Alameda County Public Health Department spokesman Neetu Balram. Six of the infected residents have died.

East Bay Post-Acute Healthcare Center in Castro Valley currently has nine residents and 17 staff members who have contracted the novel coronavirus, said Balram. There have been no deaths attributed to the illness at the Castro Valley facility.

Health officials announced the outbreak on Tuesday, originally saying 12 healthcare professionals and nine patients at the center had tested positive. One of the patients had been hospitalized while the other eight were isolated at the center. The infected staff members were isolating at home with mild symptoms.

Balram said Wednesday the new infection count among the two care centers may be updated and should be considered a “point-in-time” count.”

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21 minutes ago, square_25 said:

I think it actually was in NY first. The percentage of CA’s tests coming back positive doesn’t support this hypothesis, either.

By the way, the Hoover Institute is not affiliated with the med school, so I’m not sure why they are getting involved.

They seem to have a rather intense interest in getting the economy reopened ASAP. They published the absurd essays (which are still up) by Richard Epstein, who predicted that deaths in the US would not exceed 500, and then when we passed that number like 2 days after he published the article, he claimed he "meant" to say the maximum would be 5,000. He is still claiming that it's no worse than the flu, and insists that it will become much less lethal very quickly because that's how viruses work. (He is a law professor with no background in medicine or even biology.) He is very much in favor of letting the old & infirm, who aren't productive workers anyway, die to avoid crashing the markets and tanking the economy. His essays have reportedly had a significant impact on administration policy. And the person from the Hoover Institute that was interviewed in that linked article, Victor Davis Hanson, is even less qualified — he is a military historian and professor of classics!

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2 minutes ago, square_25 said:

I would really like people who say things like this to at least grapple with the significant risks to 50+ year olds. I understand that appeals to our common humanity don't seem to be working, but it's not even the case that we'd only be losing the "old and infirm." 

The second death in my state yesterday was a 62 year old woman.  According to the health minister she had a mild pre existing condition as would be expected of most 62 year olds.  

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42 minutes ago, Corraleno said:

They seem to have a rather intense interest in getting the economy reopened ASAP. They published the absurd essays (which are still up) by Richard Epstein, who predicted that deaths in the US would not exceed 500, and then when we passed that number like 2 days after he published the article, he claimed he "meant" to say the maximum would be 5,000. He is still claiming that it's no worse than the flu, and insists that it will become much less lethal very quickly because that's how viruses work. (He is a law professor with no background in medicine or even biology.) He is very much in favor of letting the old & infirm, who aren't productive workers anyway, die to avoid crashing the markets and tanking the economy. His essays have reportedly had a significant impact on administration policy. And the person from the Hoover Institute that was interviewed in that linked article, Victor Davis Hanson, is even less qualified — he is a military historian and professor of classics!

 

Ugh. 

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6 hours ago, Mainer said:

 I was just expressing my opinion that I wish our country could have one medical system, to make coordination between hospitals easier, to make insurance less confusing for everyone, etc.

I'm not extremely informed about the nitty gritty of other countries' universal health systems, 

And if everyone was just enrolled in health insurance because they... are citizens.

I am also not familiar with the nitty gritty of healthcare systems, but, I think that the way our healthcare is designed is due to a combination of the American brand of Capitalism (where lobbyists for insurance companies and pharma giants control most of the decisions made in health care in order to keep stock prices up for their investors) and the political decisions made by politicians. Both of these topics are irrelevant to the WTM chat board, and also might derail this helpful thread, so, no comments from me.

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@Ausmumof3@StellaM

https://www.channelnewsasia.com/news/world/australia-ruby-princess-cruise-ship-covid-19-coronavirus-12623580

“SYDNEY: Australian police raided the coronavirus-stricken Ruby Princess cruise ship and seized its black box as part of a criminal investigation after thousands of passengers were allowed to disembark in Sydney and 15 people later died of the illness.

Police wearing protective suits and masks boarded the vessel in Port Kembla, about 80km south of Sydney, on Wednesday (Apr 8  ) night, New South Wales (NSW) Police said on Thursday.

"Police officers entered the Ruby Princess to gather evidence ... ships have a black box very similar to international planes and that and other evidence has been seized," NSW Police Commissioner Mick Fuller told media.

The Ruby Princess berthed on Monday after weeks stranded at sea to allow doctors to assess sick crew members and take the most serious cases ashore for medical treatment.

Police have launched a criminal investigation into operator Carnival Australia over the circumstances that led to thousands of passengers disembarking in mid-March despite some exhibiting flu-like symptoms.

Hundreds of passengers were later diagnosed with coronavirus and at least 15 have died, accounting for nearly a third of Australia's death toll of 51. The country has recorded more than 6,000 confirmed cases of COVID-19.

Over a thousand crew members remain on the vessel and the majority wanted to stay onboard, Fuller said, adding: "They feel safe on the ship."

The Ruby Princess could remain at port for up to 10 days to refuel and restock before leaving Australia, but authorities said crew would not be allowed off unless it was an emergency.”

Edited by Arcadia
8) date becomes emoticon
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@TCB

https://www.hhs.gov/about/news/2020/04/08/hhs-statements-on-authorizing-licensed-pharmacists-to-order-and-administer-covid-19-tests.html

“Earlier today, the Office of the Assistant Secretary for Health issued new guidance under the Public Readiness and Emergency Preparedness Act authorizing licensed pharmacists to order and administer COVID-19 tests that the U.S. Food and Drug Administration has authorized.

HHS Secretary Alex Azar issued the following statement:

"Giving pharmacists the authorization to order and administer COVID-19 tests to their patients means easier access to testing for Americans who need it. Pharmacists play a vital role in delivering convenient access to important public health services and information. The Trump Administration is pleased to give pharmacists the chance to play a bigger role in the COVID-19 response, alongside all of America's heroic healthcare workers."

HHS Assistant Secretary for Health Brett P. Giroir, M.D. issued the following statement:

"In an effort to expand testing capabilities, we are authorizing licensed pharmacists to order and administer COVID-19 tests to their patients. The accessibility and distribution of retail and independent community-based pharmacies make pharmacists the first point of contact with a healthcare professional for many Americans. This will further expand testing for Americans, particularly our healthcare workers and first responders who are working around the clock to provide care, compassion and safety to others."

OASH's Guidance for Licensed Pharmacists, COVID-19 Testing, and Immunity under the PREP Act is available here - PDF.

FDA's Emergency Use Authorizations for diagnostic and therapeutic medical devices to diagnose and respond to public health emergencies is available here.

Priorities for testing patients with suspected COVID-19 infection are available here - PDF.”

 

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U.S. Deaths
 
April 8 14,800 5 days to double (14592)
April 3 7400 3 days to double (7296)
March 31 3900 3 days to double (3648)
March 28 2200 3 days to double (1824)
March 25 1030 2 days to double (912)
March 23 550 3 days to double (456)
March 20 250 3 days to double (228)
March 17 110 3 days to double (114)
March 14 57
 
A slowdown in the doubling rate for the first time.
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Chicago, Illinois https://www.channelnewsasia.com/news/world/us-man-covid-19-spread-chicago-social-distancing-12623618

“WASHINGTON: Back in late February, when the United States thought it had sealed itself off from the coronavirus, a Chicago resident with mild respiratory symptoms went to pay his respects at a funeral as a friend of the family.

Three days later, he attended a birthday party with his relatives.

The man, who was unaware he had the COVID-19 illness, set off a chain of transmissions that infected 15 other people, three of whom died, the Centers of Disease Control and Prevention (CDC) said on Wednesday (Apr 8).

"INDEX PATIENT"

It all started when the man, referred to as the "index patient," enjoyed a takeout meal using shared plates the night before the funeral with two members of another family he was friends with.

Over dinner, which lasted about three hours, and the funeral, which lasted about two hours and involved a shared "potluck-style" meal, the man reported embracing four people, including the two he met the night before to express condolences.

Three developed COVID-19 symptoms within two to six days, including one who had to be hospitalised and eventually died almost a month later.

The other two were managed as outpatients and recovered.

While the patient who eventually died was being treated in intensive care, they were visited by another member of their family who had been in contact with the index patient at the funeral.

This individual, who did not wear protective gear, later developed a cough and fever but recovered.

CHAIN REACTION

Three days after the funeral, the index patient went to a birthday party that was attended by nine members of his own family, and came into close contact with all of them over the course of three hours.

Seven subsequently developed COVID-19 three to seven days after the event. Two were hospitalised and required ventilation, and both died.

Two people involved in caring for one of the people who died, including a family member and a home care professional who was not related, both developed probable COVID-19.

The family member likely transmitted the virus to another relative, who did not attend the party.

Three of the birthday attendees who had symptoms went to church six days after developing their first symptoms, where they likely infected an unrelated healthcare professional.

The healthcare worker sat in close proximity and conversed with them over a period of 90 minutes.

The CDC wrote that the patients ranged in age from five to 86 years.

"Extended family gatherings (a birthday party, funeral, and church attendance), all of which occurred before major social distancing policies were implemented, might have facilitated transmission of SARS-CoV-2 beyond household contacts into the broader community," it said.”

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I don't know if I'm on information overload or what. But is anybody else a little confused by mixed messaging? It seems that over the past few days I'm picking up on a lot of "Oh, it really isn't going to be so bad," conflicting with "This is what is actually happening, and it's horrible," and it's making me feel more confused as to what to expect. We live in an area where everything has been slower to take off--responses and cases. Maybe it really won't get too bad here, because we've had more time to prepare, population density is less, etc. But people haven't been great until this week to actually follow distancing and staying home guidelines very well. I'm watching figures, but with lack of testing, then lots of testing, then ??--it's just hard to follow what the real situation is.

ETA: A couple more things: I read about the chloroquine treatment, and how it is very promising, and how it's just anecdotal, and how it should be used, and why it shouldn't, and it drives me nuts.

Then there is the confusion I refer to above, and I'm getting the feeling, especially here, that people are becoming really impatient over it all. Maybe because I've taken this seriously all along, I find it disturbing that they will be saying, "See, it was all just a big overreaction so that gov't/whoever could tank our economy and cause everybody to panic so they could take away our liberties, and the virus wasn't anything as bad as they said." Then it will cause that suspicion which seems pretty rampant to grow even more so. So...I don't want to be right and have a bunch of people sick and dying here--not by any means! But I don't want the conspiracy theorists to mock (even more than they already are) and grow even more confident in their theories. Am I even making any sense at all?

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21 minutes ago, Arcadia said:

Chicago, Illinois https://www.channelnewsasia.com/news/world/us-man-covid-19-spread-chicago-social-distancing-12623618

“WASHINGTON: Back in late February, when the United States thought it had sealed itself off from the coronavirus, a Chicago resident with mild respiratory symptoms went to pay his respects at a funeral as a friend of the family.

Three days later, he attended a birthday party with his relatives.

The man, who was unaware he had the COVID-19 illness, set off a chain of transmissions that infected 15 other people, three of whom died, the Centers of Disease Control and Prevention (CDC) said on Wednesday (Apr 8).

"INDEX PATIENT"

It all started when the man, referred to as the "index patient," enjoyed a takeout meal using shared plates the night before the funeral with two members of another family he was friends with.

Over dinner, which lasted about three hours, and the funeral, which lasted about two hours and involved a shared "potluck-style" meal, the man reported embracing four people, including the two he met the night before to express condolences.

Three developed COVID-19 symptoms within two to six days, including one who had to be hospitalised and eventually died almost a month later.

The other two were managed as outpatients and recovered.

While the patient who eventually died was being treated in intensive care, they were visited by another member of their family who had been in contact with the index patient at the funeral.

This individual, who did not wear protective gear, later developed a cough and fever but recovered.

CHAIN REACTION

Three days after the funeral, the index patient went to a birthday party that was attended by nine members of his own family, and came into close contact with all of them over the course of three hours.

Seven subsequently developed COVID-19 three to seven days after the event. Two were hospitalised and required ventilation, and both died.

Two people involved in caring for one of the people who died, including a family member and a home care professional who was not related, both developed probable COVID-19.

The family member likely transmitted the virus to another relative, who did not attend the party.

Three of the birthday attendees who had symptoms went to church six days after developing their first symptoms, where they likely infected an unrelated healthcare professional.

The healthcare worker sat in close proximity and conversed with them over a period of 90 minutes.

The CDC wrote that the patients ranged in age from five to 86 years.

"Extended family gatherings (a birthday party, funeral, and church attendance), all of which occurred before major social distancing policies were implemented, might have facilitated transmission of SARS-CoV-2 beyond household contacts into the broader community," it said.”

 

😞🤔😞

Sounds like several other asymptomatic (or presymptomatic) “superspreader” reports from other countries. 

 

And is a reason why “it’s just a family gathering “ becomes a problem. 

There seemed to be some sort of family party going on across street this past weekend— I sure hope there wasn’t an asymptomatic spreader there. 

 

Edited by Pen
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26 minutes ago, Jaybee said:

ETA: A couple more things: I read about the chloroquine treatment, and how it is very promising, and how it's just anecdotal, and how it should be used, and why it shouldn't, and it drives me nuts.

I think is because there is just no way to know yet.  Unfortunately we don't have the time right now to do a good double blind study to find the truth.  It might work, it might now, it might work sometimes.  

 

28 minutes ago, Jaybee said:

Then there is the confusion I refer to above, and I'm getting the feeling, especially here, that people are becoming really impatient over it all. Maybe because I've taken this seriously all along, I find it disturbing that they will be saying, "See, it was all just a big overreaction so that gov't/whoever could tank our economy and cause everybody to panic so they could take away our liberties, and the virus wasn't anything as bad as they said." Then it will cause that suspicion which seems pretty rampant to grow even more so. So...I don't want to be right and have a bunch of people sick and dying here--not by any means! But I don't want the conspiracy theorists to mock (even more than they already are) and grow even more confident in their theories. Am I even making any sense at all?

  I fully understand this and feel the same way. 

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New York Times--NYC outbreak tied to Europe, not Asia.

New research indicates that the coronavirus began to circulate in the New York area by mid-February, weeks before the first confirmed case, and that it was brought to the region mainly by travelers from Europe, not Asia.

https://www.nytimes.com/2020/04/08/science/new-york-coronavirus-cases-europe-genomes.html


 

Edited by Acadie
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14 minutes ago, kdsuomi said:

How bad it is currently is highly location dependent. It's not turning out to be terrible where I live but has been worse in the big population centers of the state. If I were in a state where it hasn't taken hold yet, I withhold want to be a CA, OR, or WA and not say a NY or NJ numbers wise. The problem is that no one knows for sure why it's hitting all these places so differently. 

 

Although there is around 3 - 5 weeks delay to see effects, it seems to be quite responsive to actually having significant Physical Distancing and Stay Home.  Not so much the official rules as the actual actions in real life.  (There often seems to be 3-5 weeks delay to see effects of Social closeness as well— parties and the like.) 

Some places Physical Distancing  is harder even if the Willingness is there, like in high rise apartments, where elevators become small spaces used by many.  I hope that mask wearing will also help significantly including in those types of situations, but it will still be hard if virus drops out around mask and then dries and then takes to the air. 

 

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I feel the same way,  and have noticed a marked difference in opinion since the beginning of the week.  I live rural and there is currently 1 case in my county, 4 in the county next to us.  Having everything shut down feels like a big overreaction when there are no cases.  Now, there are just 12 ICU beds, so it wasn't a bad decision to shut down!  I'm not arguing that point, but I do think that there is a perception here that it's a political hoax totally overblown by the media, only a problem in big cities, we are almost protected bc of where we live.  (Again *I* am not saying these things, but going by what others are posting, this is the sentiment.)   We are already the second highest poverty rate in my state, and keeping people from work is going to really hurt- for a long time.  Without a long term plan, there isn't going to be adherence to any rules.  Until we know sick people and some younger ones have died, it really isn't going to sink in- unfortunately.   

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FYI, weekly Stanford Medicine COVID Grand Rounds are available online:  

https://medicine.stanford.edu/education/medicine-grand-rounds.html
 
 
Here are some notes from this morning:  
 

Wednesday, 8 April 2020

13 total COVID patients, 5 in ICU on ventilators

54 open ICU beds  

 

Surge Capacity teams are deactivated at this time, not needed.

Staffing is full and readily available

 

Employees tested this week  - 300, only 1 was positive

Total tested 1800, 68 are positive (3.5% positive rate)

 

Deaths in Santa Clara County - 66% male, 79% have comorbidities

  

Peak is expected at approx. April 15th; Stanford has more than enough beds/resources to handle this. "Peak" is going to be quite small at current rate. Very few cases.

 

 

PCR Testing, Clinical Lab Update

 

  •  
  • Current capacity - 2K tests/day
  • E gene PCR assay, multiple workflows to protect against supply chain issues; TAT is 9hrs mean
  • Cepheid GeneXpert test - 45 min test, TAT 90min; sample goes into cartridge, which goes into instrument.
    • Most of slow down is time for sample to get from draw to lab
    • Limited number of these tests; so using patient priority for this test
  • Evaluating the 15min Abbott test 
  • Serology test went live yesterday for early evaluation/testing  
  • Elisa against SARS-Cov2 Spike Receptor binding domain protein (RBD) which has low crossreactivity with other coronaviruses
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1 minute ago, square_25 said:

It makes sense, because NY was largely driving the rate, and we're locked down. 

Now the question is whether the IHME projections are actually about right and no one else will have things seriously take off, or whether they are way too optimistic and we're going to have serious explosive growth elsewhere :-/. 

 

My thoughts are that if it’s taking 3-4 weeks from onset of symptoms to many of these deaths, then the numbers we are seeing now should be the deaths of those who were infected right before the big lockdowns started. Of course, not all areas have been locked down from 3-4 weeks.... but it does seem like a move in the right direction. 

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9 minutes ago, square_25 said:

It makes sense, because NY was largely driving the rate, and we're locked down. 

Now the question is whether the IHME projections are actually about right and no one else will have things seriously take off, or whether they are way too optimistic and we're going to have serious explosive growth elsewhere :-/. 

Unfortunately I think that we're going to have explosive growth elsewhere.  I would be more than happy to be wrong on this, though. 

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5 minutes ago, kdsuomi said:

The first confirmed case in CA was in January, and ours came from China. I wonder if there's a difference in the strains that is also contributing to differences we're seeing. 

 

“They” afaik still say no, but from what I have read it seems that there is.  The Asian strain seems less bad than the European.  However, I have to keep remembering to toss all the China statistics out of my brain as unreliable.  

I think west coast USA has also had some come in from Italy and other parts of Europe 

Anecdotally, I think quite a lot more people on west coast seemed to personally “get it” and start some Distancing even before SIP  /Stay Home rules.  More than in New York.    And I think the Distancing is much harder because of density in NYC than even SF.  So that could be more relevant than where the virus arrived from. Maybe.

But there did seem to be differences in the descriptions of cases out of Asia versus Italy . 

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On 4/4/2020 at 3:08 PM, Plum said:

This plus vent shortage (eta plus the PPE required to intubate, the danger to HCW during intubation), plus the struggle to get intubated patients off the ventilator is why many are looking at how to avoid intubation completely through high oxygen nasal cannula, non-invasive ventilation helmets, positive airway pressure units, and anything else they can figure out to avoid it. 

You have a 50/50 chance to get off of a ventilator once put on. (see MedCram #49) 

Yeah, but that 50/50 chance is under "normal" disease conditions, right?  I'm reading that 80%+ of coronavirus patients on ventilators are dying.  There is speculation that ventilators are actually harming those patients instead of helping.

https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

Honestly, I don't understand the push for great quantities of ventilators (seems it is constantly on the news) if they are ineffective, at best, for 8 out of 10 critically ill covid19 patients.

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21 minutes ago, Cecropia said:

Yeah, but that 50/50 chance is under "normal" disease conditions, right?  I'm reading that 80%+ of coronavirus patients on ventilators are dying.  There is speculation that ventilators are actually harming those patients instead of helping.

https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

Honestly, I don't understand the push for great quantities of ventilators (seems it is constantly on the news) if they are ineffective, at best, for 8 out of 10 critically ill covid19 patients.

 

I had posted before YouTube link to a plea from an ICU Doctor, Cameron Kyle-Sidell, who thinks the ventilators need to be set at the lowest possible pressure setting , and that might help hugely he thinks, and apparently other doctors think too.  

Edited by Pen
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50 minutes ago, Jean in Newcastle said:

Unfortunately I think that we're going to have explosive growth elsewhere.  I would be more than happy to be wrong on this, though. 

We have around 10,000 cases in one county here.  Detroit and Wayne County report individually but Detroit is in Wayne County.  Our local numbers are starting to climb and if you look at all these little counties that has just a few cases, they now have 100+.  Unless something drastically changes it’s only a matter of time, and sadly a large majority of people here want back to work regardless of the consequences.

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5 minutes ago, Cecropia said:

Yeah, but that 50/50 chance is under "normal" disease conditions, right?  I'm reading that 80%+ of coronavirus patients on ventilators are dying.  There is speculation that ventilators are actually harming those patients instead of helping.

https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

Honestly, I don't understand the push for great quantities of ventilators (seems it is constantly on the news) if they are ineffective, at best, for 8 out of 10 critically ill covid19 patients.

I got that from ICNARC (Intensive Care National Audit & Research Center) report that was featured in both MedCram and Dr. John Campbell. I have heard recently the numbers are as high as 75% chance of never getting off of the ventilator. Those numbers can get skewed especially if they are more successful at helping patients avoid the ventilator to begin with. 

At the beginning of this, the only treatment for this was time on the ventilator to give time for the lungs to rest and recover. Traditionally, ARDS is treated with low tidal volume and high PEEP and proning. Now, it looks like high flow oxygen might be better. The important difference between having to sedate and paralyze in order to ventilate and keeping someone sitting up in one of those helmets or on high oxygen is that you can communicate with the awake patient, you can easily see when they are struggling and help them more quickly.

 

Quote

 

Ventilators have been seen as critical to treating coronavirus patients because the devices are very successful when used to treat common forms of pneumonia, says Hajizadeh.

"We treat patients for several days, and then we get the antibiotics into the body and the patient recovers," she says. "Unfortunately with this COVID-associated pneumonia, there are no treatments that we know work for sure."

Also, the coronavirus often does a lot more damage to a person's lungs than pneumonia associated with the flu. "There is fluid and other toxic chemicals, cytokines we call them, raging throughout the lung tissue," she says.

In some patients, the damage is so bad that even ventilation won't help. So doctors have sometimes tried an even more extreme measure called extracorporeal membrane oxygenation, or ECMO, which delivers oxygen directly to a patient's bloodstream.

But this is still a stopgap measure. "Remember, ECMO too is a life-supporting treatment," Hajizadeh says. "So it's a bridge while we are allowing the lung to heal itself from a pneumonia."

Ventilators Are No Panacea For Critically Ill COVID-19 Patients

 

ECMO is basically a heart lung bypass. It's last resort stuff. 

 

Dr. Fauci has been saying he's puzzled why some patients young, with no underlying conditions suddenly take a turn for the worse. He keeps mentioning it could be genetic. Which reminded me of something I read a long time ago about ancestors of plague survivors having markers in their DNA. Just something to think about. 

Quote

 

One immune-related cluster included three altered genes, making it the most obvious candidate for closer perusal. The cluster, called TLR2, was already known to be involved in building the receptors on the surface of leukocytes, immune cells that recognize and destroy foreign invaders.

Because plague was such a widespread and devastating event in Europe, Netea and his colleagues reasoned that the Black Death outbreak, which occurred after the Roma arrived, might have put pressure on this gene cluster to evolve. To test the idea, they looked at how cells engineered to express TLR2 would hold up against Y. pestis and Yersinia pseudotuberculosis, an ancestor of Y. pestis. They found that TLR2 caused a heightened immune response when exposed to both bacteria.

Other diseases could have altered the same genes, Netea said, but plague is a strong candidate, because it affected Europe and not northwest India, and because it had such a widespread, devastating influence. The findings could have medical implications even in today's world, where plague is no longer such a danger. For example, autoimmune disorders, in which the body attacks its own tissues, may arise because of immune systems programmed by epidemics to respond strongly to the threat of invasion, Netea said.

Humans "were modified, basically, by the infections," he said.

https://www.livescience.com/43063-black-death-roma-evolution.html

 

 

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9 hours ago, Acadie said:

 

A good friend who is running the COVID unit in her hospital told me they rewrote their protocols yesterday, subject to further change of course. MDs across the US are communicating directly with each other, adapting their practices, and finding new and better ways to help patients. 

Dh said he gets several studies a day in his email that are from all over the world and he isn't even a frontline HCW. It's good we're all working together to figure this thing out. 

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8 hours ago, Jean in Newcastle said:

People in NY clap for the Heroes every night.  People here across the country on the West Coast do the same.  There are YouTubes, Memes etc. that all thank the heroes. 

Is there one for grocery store workers? They've been through a battle on multiple fronts. 

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@square_25@kdsuomi@Jean in Newcastle@Pen@Plum@TCB@mathnerd

https://www.nbcbayarea.com/news/local/difference-between-covid-19-cases-in-ca-vs-ny-is-likely-sheer-luck-experts/2269934/

Experts in disease control say the main difference between California and New York isn’t density or area, but when people started staying home and sheer luck.

All in all, New York has had nine times as many cases, seven times the people in hospitals and 14 times the deaths.

...

UCSF Epidemiologist George Rutherford said that when it comes to New York, some of it is simply a matter of bad luck.

“In New York, one of the very original patients was a so-called super spreader,” said Rutherford. “A man in New Rochelle and it was something like 113 people who became infected.”

Then, there are social distancing differences. Bay Area leaders ordered residents to shelter-at-home starting March 17, five days before New York and before a major social event.

“One of the things I think the health officers deserve a lot of credit for was that we went to shelter-in-place before St. Patrick’s Day,” said Rutherford.

Other researchers are looking at environmental differences. In a new Harvard study, they found New York County’s long-term air pollution levels were 42% higher than San Francisco County’s.

While we cannot say for certain that air pollution caused the differences in any two counties' COVID-19 outcomes, we can say that on average, we would expect a county with long-term exposure of 13.5 to have an 82% increase in COVID-19 mortality rate compared to a county with exposure 9.5," said the study's lead author Rachel Nethery, of the Harvard T.H. Chan School of Public Health.”

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4 hours ago, Ausmumof3 said:

We have the weird situation here where private hospitals were actually looking at having to lay off health care workers . The cancellation of all elective surgery effects them much more than the public system.  I think the latest I heard the public system were going to handle Covid and the private would handle non Covid stuff so they are effectively working together.

Dh has to take a PTO day off a week until this is over starting this week. That goes for all admin and it's corporate-wide. They've managed to keep most of their staff this way so far. But it's only the first week. At least he gets 3 day weekends again. 

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