Covid 3rd wave JAWM

[wathe]

This is a pure JAWM, please.  Please don't quote.

We are really struggling with covid here.

Our third wave is the worst one yet, and is well en route to becoming a true catastrophe.

Covid hospitalizations and Covid ICU admissions are at an all-time high. Provincial ICU admissions for Covid peaked at 410 last wave. Yesterday's number was 659. Today we are at 725.  It's only going to get worse.  Greater Toronto Area ICUs are full.  They've been shipping patients out to peripheral hospitals for weeks.   The peripheral hospitals are in turn filling up and shipping out further afield.  It's only going to get worse over the next 3 weeks or so.  Paediatric tertiary care hospitals have opened their ICUs to adult patients - this is unprecedented.  The SickKids adult ICU unit filled within days.  There has been a formal request to have HCW sent from other provinces.  True healthcare system collapse is a real possibility, maybe even probable.

Vaccine supply remains a problem.  Just over 2% in the province are fully vaccinated, and just over 20% have had their first shot.  Eligibility is still restricted to 60+ year-olds and certain high-risk groups.

Our provincial government is decidedly lacking in backbone.  This wave was entirely predictable (and was predicted by the smart people our government hires to predict such things) and preventable.  They've ignored their own science table's policy recommendations,  and dragged their heels and waffled on decisions.  They like to make announcements announcing that there will be announcements.  Then leak details.  Then make policy based on public reaction to leaked plans.   Then walk-back policy within 24 hours when people complain (in the case linked, complaints are legitimate, I think).  It's exasperating.

It's been a year - we know how to prevent this.  It's heartbreaking.

Health care workers are so tired.  It's beyond burnout for many of us at this point.  "Moral Injury" is the term I'm hearing - it's apt.

Edited April 18, 2021 by wathe

[Melissa Louise]

I'm so sorry 😞

[SoCal_Bear]

I am so very sorry. I have been watching what is happening from my little corner. It's so hard to see this happen because you are absolutely right. We should know better by now. 

 

[Ausmumof3]

😢. I hope you can stay safe.  I’m sorry things are so rough there now.

[Jean in Newcastle]

I am so terribly sorry. 

[Catwoman]

I’m so sorry. You must be so frustrated and exhausted.

[Laura Corin]

I'm so sorry. 

[kiwik]

I hope things get better.

[TexasProud]

I am so so sorry.  Just isnt fair.

[Melissa in Australia]

thank you for what you do. hugs

All my in-laws live in the greater Toronto area. my MIL99 is fully vaccinated, in a retirement home. she is shut in her room in lockdown. She finds it very lonely, especially as her phone keeps on stopping working for days on end.

my SIL 65 is a city bus driver. she wants to get vaccinated, but doesn't fall into the high risk work group ( which is a bit of a mystery as she is exposed to public all day every day)

[Innisfree]

I'm so sorry. You're right, we know how to reduce spread. It's beyond maddening when people won't do so.

[regentrude]

I am so sorry. It's infuriating. 

[Starr]

I've been thinking about you folks a lot. We sit here with 400 plus dose appointments on the books every day. I wish you could pop over the border. 

[KungFuPanda]

I'm soooo sorry you're living through this right now.  The stress is unreal.  My personal freak-out moment was when they turned  local ice rink into an overflow morgue, and that was back when there were no vaccines.  It just feels endless and the fatigue of just keeping your family alive is real and palpable.  I hope y'all can get a handle on it before it gets much worse.  It's a horrible, horrible disease.

[happi duck]

I am so sorry

Many (hugs)

[mommyoffive]

I am so sorry.  I wish that your vaccine supply would increase substantially and roll out really quickly.  I know that isn't a fast fix. 

Have you been in lockdown for a long time?  I haven't been following closely to what is going on there. This year has been so hard, long, scary, and heart breaking. 

I am sending lots of prayers you stay safe.

[sangtarah]

I am so so sorry. I’m praying. 

[TCB]

I am so sorry! I am crying here with you my friend. I’m praying for strength for all of you who are exhausted and yet must continue on, and praying that it improves quickly. 

[wathe]

Thanks everyone.  ICU's at 741 today (up from 725 yesterday)

We've been in an "emergency-brake" pseudo-lockdown since April 1 (that felt like a bit of a joke, really), a stay-at-home order since April 8, and enhanced measures since April 16.  Schools closed April 12.  All have been initiated way too late.  The definition of "essential" remains very broad.  Our next 2-3 seeks are already carved in stone, so to speak.  There has also been more public resistance this time - both protests and people just not complying.  The virus is still ripping through workplaces - most working people don't qualify for vaccine yet (too young).

Public health in my area is overwhelmed.  Contact tracing is falling apart.  Two months ago, 80-90% of positive cases were contact traced within one day.  That fell to 70"s in March, 43% in the past week, and now "The percentage of newly reported cases reached within one day is temporarily unavailable due to changes in case management".  Public Health is also asking positive cases to notify their contacts themselves.

We are keeping up with testing, locally at least. 57% resulted by the next day, and 96% withing two days in my health unit

[wathe]

5 hours ago, Melissa in Australia said:

thank you for what you do. hugs

All my in-laws live in the greater Toronto area. my MIL99 is fully vaccinated, in a retirement home. she is shut in her room in lockdown. She finds it very lonely, especially as her phone keeps on stopping working for days on end.

my SIL 65 is a city bus driver. she wants to get vaccinated, but doesn't fall into the high risk work group ( which is a bit of a mystery as she is exposed to public all day every day)

Hmm.  60+ have been eligible province-wide for at least a week now.  55+ have been eligible for AZ at "select pharmacies" for longer, though access has been a big issue.  Actually scoring an appointment is a different story altogether.

The provincial vaccine strategy has mostly used age as the deciding factor to distribute, along with some social groups (congregate living, nursing homes, retirement homes, Indigenous peoples), and  then certain medical conditions.  There aren't very many occupations that qualify.  Front-line  and patient-facing HCW and people working in congregate living settings are pretty much it.

There has been a lot of criticism about this.  Some think that younger workers should be prioritized next, because the virus is ripping through work places that's what's propogating the wave, rather than 60+, who are at higher medical risk if they get sick, but are more likely to be able to stay home and haven't been contributing to spread in the population as much.  Vaccinating to protect society as a whole (young workers) vs vaccinating to protect individuals most at risk of bad outcomes individually (older people).  We've chosen the latter.  It's a thorny problem without an easy answer.

Edited April 18, 2021 by wathe

[WildflowerMom]

I'm so sorry.  I think the ball has been dropped so many times wrt this virus.   Big hugs and many prayers...  💛

[KathyBC]

11 hours ago, wathe said:

This is a pure JAWM, please.  Please don't quote.

We are really struggling with covid here.

Our third wave is the worst one yet, and is well en route to becoming a true catastrophe.

Covid hospitalizations and Covid ICU admissions are at an all-time high. Provincial ICU admissions for Covid peaked at 410 last wave. Yesterday's number was 659. Today we are at 725.  It's only going to get worse.  Greater Toronto Area ICUs are full.  They've been shipping patients out to peripheral hospitals for weeks.   The peripheral hospitals are in turn filling up and shipping out further afield.  It's only going to get worse over the next 3 weeks or so.  Paediatric tertiary care hospitals have opened their ICUs to adult patients - this is unprecedented.  The SickKids adult ICU unit filled within days.  There has been a formal request to have HCW sent from other provinces.  True healthcare system collapse is a real possibility, maybe even probable.

Vaccine supply remains a problem.  Just over 2% in the province are fully vaccinated, and just over 20% have had their first shot.  Eligibility is still restricted to 60+ year-olds and certain high-risk groups.

Our provincial government is decidedly lacking in backbone.  This wave was entirely predictable (and was predicted by the smart people our government hires to predict such things) and preventable.  They've ignored their own science table's policy recommendations,  and dragged their heels and waffled on decisions.  They like to make announcements announcing that there will be announcements.  Then leak details.  Then make policy based on public reaction to leaked plans.   Then walk-back policy within 24 hours when people complain (in the case linked, complaints are legitimate, I think).  It's exasperating.

It's been a year - we know how to prevent this.  It's heartbreaking.

Health care workers are so tired.  It's beyond burnout for many of us at this point.  "Moral Injury" is the term I'm hearing - it's apt.

Since this is JAWM I cannot respond to the many political points in this point.
I do want to acknowledge the very real place GTA is at right now, though, and let you know you are seen and heard. This is the nightmare we have been hoping to avoid for 13 months, and I will be thinking of you in the space between vaccination and the virus variants over the next few weeks.

[melmichigan]

I will certainly agree with you, and it's sad to see other others following in Michigan's footsteps.  The rationale behind decisions is maddening.  Our hospitals are at 48% covid, and our local hospitals are full, but there are a beds somewhere in the state, so it isn't bad. 🙄  Our schools opened this week because my county went from 30%+ to 28% positivity and standardized testing is scheduled for this week. 🤬

Edited April 18, 2021 by melmichigan

[DoraBora]

I'm so sorry to read this.  So frustrating and scary. 

You are in my thoughts today.

[Happy2BaMom]

My local county is now Purple Alert (Level 4 - the highest it can go). "We" may be done with Covid, but Covid is most assuredly not done with us.

On 4/18/2021 at 1:34 PM, melmichigan said:

I will certainly agree with you, and it's sad to see other others following in Michigan's footsteps.  The rationale behind decisions is maddening.  Our hospitals are at 48% covid, and our local hospitals are full, but there are a beds somewhere in the state, so it isn't bad. 🙄  Our schools opened this week because my county went from 30%+ to 28% positivity and standardized testing is scheduled for this week. 🤬

Good Lord. I was unaware of what was happening in MI and just took a look. It's worse for y'all than it was in Nov/Dec!!

 

ETA: Wathe, you have my empathy. The human race is a notoriously stupid one, whatever our other redeeming qualities may be. I really wonder what it will be like when we hit a pandemic with a 5% death rate (one will arrive at some point). We can't even handle one with a 0.4% rate.

Edited April 20, 2021 by Happy2BaMom

[Junie]

(((wathe)))  I am so sorry.  

[Ottakee]

14 minutes ago, melmichigan said:

I will certainly agree with you, and it's sad to see other others following in Michigan's footsteps.  The rationale behind decisions is maddening.  Our hospitals are at 48% covid, and our local hospitals are full, but there are a beds somewhere in the state, so it isn't bad. 🙄  Our schools opened this week because my county went from 30%+ to 28% positivity and standardized testing is scheduled for this week. 🤬

Michigan is bad.   We are returning to full in person learning this week....after a week of quarantine, a week of spring break and then a week of virtual as we didn't have enough bus drivers and staff for our special needs program.

Our numbers are higher than Nov/Dec.

On positive, my friend that is a covid ICU doc said she has zero patients that are fully vaccinated   At least in our area in Michigan you can get the vaccine ages 16+ if you want one.

[bolt.]

I feel for you in your province with the lockdown.

I'm in a different province with higher per-capita rates, and I'm in the hot-spot city. Our positivity rate is loud-and-clear that things *will* keep getting worse. I don't know why people aren't freaking out. Maybe it's because the raw numbers aren't so intimidating as yours?

Our provincial government is way too reluctant to restrict anyone more than we already have. (At least they allowed schools to go online in my city. That's something.)

[Jean in Newcastle]

14 minutes ago, kand said:

What’s the border situation between Michigan and Ontario right now? It doesn’t seem like I’ve been hearing much about the relationship between these two bad outbreaks in Ontario and Michigan, but their geographic relationship makes me wonder if both are sharing a more transmissible variant. Which makes me wonder whether Washington state will also start seeing spill over from what’s happening in Vancouver, BC. Vancouver has been having a big P1 (Brazil) outbreak. Seems like the situation in Washington could change rapidly if that crosses the border. And I’m not sure why it wouldn’t. 

The border between the US and Canada is still closed.  It was just extended to April 21 but I don't know what will happen after that.  (There is some "essential" travel allowed.) 

[wathe]

28 minutes ago, kand said:

What’s the border situation between Michigan and Ontario right now? It doesn’t seem like I’ve been hearing much about the relationship between these two bad outbreaks in Ontario and Michigan, but their geographic relationship makes me wonder if both are sharing a more transmissible variant. Which makes me wonder whether Washington state will also start seeing spill over from what’s happening in Vancouver, BC. Vancouver has been having a big P1 (Brazil) outbreak. Seems like the situation in Washington could change rapidly if that crosses the border. And I’m not sure why it wouldn’t. 

Closed for non-essential travel.  There is still quite a lot of traffic back and forth despite the closure - hundreds of thousands of vehicles per month nationally.  Essential reasons include work, commerce, trade, medical care, and citizens returning home.  Lots of snowbirds still found a way to go south this year, and are now coming home.  And quite a few are using land border taxi services to avoid mandatory quarantine hotels for air-travelers.

 

[Jean in Newcastle]

14 minutes ago, wathe said:

Closed for non-essential travel.  There is still quite a lot of traffic back and forth despite the closure - hundreds of thousands of vehicles per month nationally.  Essential reasons include work, commerce, trade, medical care, and citizens returning home.  Lots of snowbirds still found a way to go south this year, and are now coming home.  And quite a few are using land border taxi services to avoid mandatory quarantine hotels for air-travelers.

 

I'm sorry that the border is still so porous especially without compliance with quarantines etc.

[73349]

I'm sorry. It's so frustrating that people know what to do and can't or won't do it. I hope you see improvement soon.

[melmichigan]

5 hours ago, wathe said:

Closed for non-essential travel.  There is still quite a lot of traffic back and forth despite the closure - hundreds of thousands of vehicles per month nationally.  Essential reasons include work, commerce, trade, medical care, and citizens returning home.  Lots of snowbirds still found a way to go south this year, and are now coming home.  And quite a few are using land border taxi services to avoid mandatory quarantine hotels for air-travelers.

 

I'm on the border.  Closed for non-essential travel is definitely a misnomer.  There is plenty of travel, even with the risk of such a steep fine.  I'm surprised they haven't announced an extension yet, the current closure is supposed to expire in just a few days.  

[wathe]

2 minutes ago, melmichigan said:

I'm on the border.  Closed for non-essential travel is definitely a misnomer.  There is plenty of travel, even with the risk of such a steep fine.  I'm surprised they haven't announced an extension yet, the current closure is supposed to expire in just a few days.  

I believe it.  The definition of the word "essential" seems to have drifted during this pandemic.

[Halftime Hope]

Wathe, how are you all doing on early ambulatory treatment?  Any traction on that? We are having growing success in my area with doctors referring immediately for outpatient monoclonal antibody infusions for high-risk patients. (Doesn't do a thing for lower-risk patients, to protect them against long-covid, but it would have kept dh's friend from dying, had it been widely available six weeks ago.) 

I'm so sorry...one of the things that has mattered the most to me, aside from putting dh at risk, is not adding to the burden on healthcare workers.  

 

[wathe]

12 minutes ago, Halftime Hope said:

Wathe, how are you all doing on early ambulatory treatment?  Any traction on that? We are having growing success in my area with doctors referring immediately for outpatient monoclonal antibody infusions for high-risk patients. (Doesn't do a thing for lower-risk patients, to protect them against long-covid, but it would have kept dh's friend from dying, had it been widely available six weeks ago.) 

I'm so sorry...one of the things that has mattered the most to me, aside from putting dh at risk, is not adding to the burden on healthcare workers.  

 

It's not standard of care here, nor is it available in the community.  Yet.

ETA a link to current local treatment guidelines, for interest.

Edited April 19, 2021 by wathe

[SeaConquest]

I have no idea what they define as "essential" because we live at a campground in San Diego and there were still tons of Canadian snowbirds, as usual. I also follow a FB group for people living in Mexico (we used to live there) and the Canadians are still going back and forth there as well. My husband's Quebecois parents stayed at home this year (they usually come during the winter) and left SD to return to Quebec as soon as Covid hit last year. They are in their 70s and only recently received their vax at the beginning of April. I am so so sorry for what you are experiencing up there. Sending much love.

I am currently in East Texas, working in an ICU, and this place is maddening. The entire unit has had Covid -- some twice because of new variants. Nobody gives two sh*ts around here about it. If masks are required, people have them hanging half off their faces. Everything is wide open like a pandemic doesn't exist at all. I pray to G-d that my immune system and the vax holds. 

 

 

[busymama7]

15 minutes ago, SeaConquest said:

I have no idea what they define as "essential" because we live at a campground in San Diego and there were still tons of Canadian snowbirds, as usual. I also follow a FB group for people living in Mexico (we used to live there) and the Canadians are still going back and forth there as well. My husband's Quebecois parents stayed at home this year (they usually come during the winter) and left SD to return to Quebec as soon as Covid hit last year. They are in their 70s and only recently received their vax at the beginning of April. I am so so sorry for what you are experiencing up there. Sending much love.

I am currently in East Texas, working in an ICU, and this place is maddening. The entire unit has had Covid -- some twice because of new variants. Nobody gives two sh*ts around here about it. If masks are required, people have them hanging half off their faces. Everything is wide open like a pandemic doesn't exist at all. I pray to G-d that my immune system and the vax holds. 

 

 

Including medical personnel or do you mean in the public?

[SeaConquest]

2 minutes ago, busymama7 said:

Including medical personnel or do you mean in the public?

I don't understand your question. Do you mean about not caring about Covid? I meant the public. People working in Covid units certainly care about it. I am still a student, so I am not allowed to work in a "Covid" unit. All of the patients in our ICU are screened for Covid before admission. There is a different area for Covid patients that I am not allowed to work in. I am in a very small town in East Texas and they had 16 positives in the ED when I was on shift the other night, waiting to be seen. My preceptor told me that it used to be around 70ish. 

[KathyBC]

9 hours ago, Jean in Newcastle said:

The border between the US and Canada is still closed.  It was just extended to April 21 but I don't know what will happen after that.  (There is some "essential" travel allowed.) 

I can't remember the exact interval but the closure extensions seem to be a formality. The last impression I had was Biden was hoping to open for July, our Prime Minister said September, and I'm sure with rates the way they are currently no one will press for sooner than that. In fact, I think the US currently has a travel advisory against Canada. For all the good any of that seems to be doing.

Edited April 19, 2021 by KathyBC

[Jean in Newcastle]

1 hour ago, KathyBC said:

I can't remember the exact interval but the closure extensions seem to be a formality. The last impression I had was Biden was hoping to open for July, our Prime Minister said September, and I'm sure with rates the way they are currently no one will press for sooner than that. In fact, I think the US currently has a travel advisory against Canada. For all the good any of that seems to be doing.

All I know is that our family in BC has not been down for the past year.  But they are very Covid cautious.  (As is the family down here in the US).

[busymama7]

2 hours ago, SeaConquest said:

I don't understand your question. Do you mean about not caring about Covid? I meant the public. People working in Covid units certainly care about it. I am still a student, so I am not allowed to work in a "Covid" unit. All of the patients in our ICU are screened for Covid before admission. There is a different area for Covid patients that I am not allowed to work in. I am in a very small town in East Texas and they had 16 positives in the ED when I was on shift the other night, waiting to be seen. My preceptor told me that it used to be around 70ish. 

Yes that's what I meant. I couldn't tell if you meant that the doctors and nurses weren't taking it seriously. Good to know that's not what you meant.  

[TexasProud]

7 hours ago, SeaConquest said:

 

I am currently in East Texas, working in an ICU, and this place is maddening. The entire unit has had Covid -- some twice because of new variants. Nobody gives two sh*ts around here about it. If masks are required, people have them hanging half off their faces. Everything is wide open like a pandemic doesn't exist at all. I pray to G-d that my immune system and the vax holds. 

 

 

Just curious, the numbers they are posting numbers that show positivity very low (3%) and numbers like 3 per 100,000 with plenty of hospital availability.  Is that not what you are seeing?

[SeaConquest]

6 hours ago, TexasProud said:

Just curious, the numbers they are posting numbers that show positivity very low (3%) and numbers like 3 per 100,000 with plenty of hospital availability.  Is that not what you are seeing?

It's hard to say because I am not from here and don't follow the trends in this area. I live in San Diego and our Covid numbers are very low. Just to give you an example, we had 149 Covid positives reported yesterday in SD, a city of over 2 million people, out of over 10K tests. https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/COVID-19_Daily_Status_Update.pdf 

I am currently in Lufkin (near Nacadoches), working in one small hospital in this tiny town (population 35k), and when I was on shift the other night and we peeked at the ED, there were 16 positives in triage at that moment in time. That seemed like a lot of Covid from my POV, but my preceptor said that it was way down from its peak. Our ICU was completely full (of non-Covid patients; I don't know how many they had in the Covid unit) when I was last on (I am on the next two nights) and the step-down unit was full. My colleagues in med-surg were totally slammed and the ED was discussing going on divert. To what extent that is Covid-related, I don't know.

My patients are all very sick, obviously, but not because of Covid. What I see here is rural medicine -- poor folks with lack of access to health care and the havoc that wreaks on the body over time, people marinating in sweet tea over the course of their lives with out of control diabetes, hypertension, hyperlipidemia, etc. having STEMIs or stroking out. One of my patients has literally been living in a storage facility for the past 3 years with his GF with no access to a bathroom or kitchen. They finally moved into a trailer and she was thrilled. I asked her if she had applied for Medicaid or gotten a Covid vaccine and she said, "I don't know anything about all that." I tried to connect her with a social worker, but it's very sad. My patient had gone septic from cellulitis, but he was on a vent from respiratory failure, had diabetes, fatty liver, was positive for meth, you name it. I lost another patient yesterday. He coded, so they tried to bring him back, which involved some cracked ribs because he was a small man. His family finally told the code team to stop and let him pass. I said a prayer. That's all you can do sometimes.       

 

Edited April 19, 2021 by SeaConquest

[TexasProud]

5 minutes ago, SeaConquest said:

It's hard to say because I am not from here and don't follow the trends in this area. I live in San Diego and our Covid numbers are very low. Just to give you an example, we had 149 Covid positives reported yesterday in SD, a city of over 2 million people, out of over 10K tests. https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/COVID-19_Daily_Status_Update.pdf 

I am currently in Lufkin (near Nacadoches), working in one small hospital in this tiny town (population 35k), and when I was on shift the other night and we peeked at the ED, there were 16 positives in triage at that moment in time. That seemed like a lot of Covid from my POV, but my preceptor said that it was way down from its peak. Our ICU was completely full (of non-Covid patients; I don't know how many they had in the Covid unit) when I was last on (I am on the next two nights) and the step-down unit was full. My colleagues in med-surg were totally slammed and the ED was discussing going on divert. To what extent that is Covid-related, I don't know.

My patients are all very sick, obviously, but not because of Covid. What I see here is rural medicine -- poor folks with lack of access to health care and the havoc that wreaks on the body over time, people marinating in sweet tea over the course of their lives with out of control diabetes, hypertension, hyperlipidemia, etc. having STEMIs or stroking out. One of my patients has literally been living in a storage facility for the past 3 years with his GF with no access to a bathroom or kitchen. They finally moved into a trailer and she was thrilled. I asked her if she had applied for Medicaid or gotten a Covid vaccine and she said, "I don't know anything about all that." I tried to connect her with a social worker, but it's very sad. My patient had gone septic from cellulitis, but he was on a vent from respiratory failure, had diabetes, fatty liver, was positive for meth, you name it. I lost another patient yesterday. He coded, so they tried to bring him back, which involved some cracked ribs because he was a small man. His family finally told the code team to stop and let him pass. I said a prayer. That's all you can do sometimes.       

 

So sad. You are in deep East Texas. Yes, that is a very small hospital. I am very familiar with the area and they have been slammed harder than ours. 

[SeaConquest]

7 minutes ago, TexasProud said:

So sad. You are in deep East Texas. Yes, that is a very small hospital. I am very familiar with the area and they have been slammed harder than ours. 

I know that I have derailed Wathe's thread enough, but let me just say that I wouldn't be graduating on time without their generosity in opening their hospital to students. We were completely shut down in CA and the Texas branch of my nursing school has really saved the day for us. As sad as it is, I am seeing first-hand the importance of social determinants of health. I am very grateful to these kind folks for opening their hospital to us and agreeing to precept these crazy Californians. I will always remember their kindness. 

Edited April 19, 2021 by SeaConquest