quote:

Originally posted by AirmanJeff:
I was following a thread on Twitter about the British scientist who predicted 2 million dead / 18 months of global quarantine who is now saying - ehh I was wrong, we'll be good in 2 or 3 weeks.

A friend of 30+ years, wife was an RN her whole life, he has two RN daughters working in the immediate area, he tells me it is not easy to get infected among casual interactions. Heck, if someone is sneezing in the air, do you stand anywhere near them?

Time will tell. There should be a leveling off in 7-10 days. Except on my block, where hordes of single-to-zero-parent-household kids cavort like they're in a Little Rascals remake.

quote:

Originally posted by parabellum:
This is silly. We're just going to have to wait to see how this plays out.

THANK YOU!!! I've gone to skimming as there seem to be a lot of folks on both sides continuing to trumpet stuff that they think bolsters their viewpoint.

It seems to me that it is possible that this could be really bad IFF it is as bad as has been stated and it runs away across the country. It also seems possible that it may not be as bad as has been stated and it may not going to run away all over the country. It looks like densely populated areas may be ugly, but really it is going to take time to see what happens.

Getting too spun up in any direction now given the paucity of real information seems a little silly. I don't believe ANYBODY *knows* what is going to happen. Different folks have different guesses, but guesses is all they are.

I work for a large national bank. Just got notified that in my area we are running a test and closing lobbies in the vast majority of our area’s branches tomorrow. About 10% will stay open. Drive throughs will continue to be open in the branches closing their lobby. Branch employees will still be at the branch, speaking to clients on phone and email.

Most of us expect all lobby nationwide to be closed shortly after this test.

Most existing client activity can be done by website, mobile app, or over the phone. Main issues will be more complicated transactions, some new accounts that can’t be opened online, notary, safe box access, etc.

My area has a very small # of cases so interesting they are testing it here. About 20% of our branches are already closed, mostly in the hotspot cities. I’ll post more info as I’m able.

CEO of GM is Mary Barra

from 2014: General Motors CEO Mary Barra, the first woman ever to captain an American automaker, will attend tonight’s SOTU speech as a guest of Michelle Obama

So you know how Barra leans

https://theconservativetreehou...osition/#more-187623

Until today, most companies voluntarily adjusted their manufacturing systems and networks to assist; so forced compliance was not needed.

However, General Motors now states an inability to meet their prior commitments for the manufacture of ventilators



President Trump has just triggered the Defense Production Act to force General Motors to comply with their initial promise.


The White House
Office of the Press Secretary
FOR IMMEDIATE RELEASE
March 27, 2020

Statement from the President Regarding the Defense Production Act

Today, I signed a Presidential Memorandum directing the Secretary of Health and Human Services to use any and all authority available under the Defense Production Act to require General Motors to accept, perform, and prioritize Federal contracts for ventilators. Our negotiations with GM regarding its ability to supply ventilators have been productive, but our fight against the virus is too urgent to allow the give-and-take of the contracting process to continue to run its normal course. GM was wasting time . Today’s action will help ensure the quick production of ventilators that will save American lives.

My sister sent me this video from one of her friends who is a pulmonologist at Weill Cornell Hospital in NYC. He is basically a full time Covid-19 doctor now. He talks about how to avoid the disease, what it looks like, how its treated, etc. I thought it was interesting and informative without all the hype you get on the news.

It's hosted at Vimeo, and I'm not sure how to embed it but here's the link:

Video

It's almost an hour long and worth watching. But if you're short on time, the one major takeway is to be religious about washing your hands.

Don't act sleazy with our wartime Preezy and you won't get your narrow ass kicked.

[Lt. Aldo Raine] Soooound good?! [/Lt. Aldo Raine]

Babylon Bee (satire) hits it out of the park again:

upload foto share link

A little mood-lightener...

quote:

Originally posted by parabellum:
2.2 million dead in the US? I'm telling you- some of these people who are making these ridiculous predictions just need to be hung. Coronavirus is not damaging this nation; hysterical, posturing, egotistical, incompetent know-it-alls with an agenda are damaging this nation.

The antidote is hemp, properly knotted and utilized.

Do any of you honestly think for one single second that such an estimate is anything more than fantasy? And we're listening to these boobs?? I don't care how many degrees they have or how well-regarded they are in their field. A prediction of 2.2. million US deaths from this bug is outrageously false.

Oh, but now, you see, we've "taken the necessary precautions", so he can now "downwardly revise" this figure. Oh, come on. You are fooling a lot of people but you are not fooling all of us.

All this is a test run.....all I've to say at this point.

Pure sadness

quote:

Originally posted by ChicagoSigMan:
Collier County in Florida had a meeting of the Commissioners today to vote on a proposed Stay-at-Home/Business Shutdown order.

The meeting went for about 3 hours, with testimony from reps from the local hospitals, various folks from the business community and members of the general public.

Ultimately, they unanimously decided not to adopt the order. They decided instead to monitor the situation and continue following the various orders and recommendations of the Governor and the CDC.

I submitted written testimony opposing the order, so I was pleased.

Sure wish your folks would call our folks here in Orange County and try and help them understand what the hell is going on. Of course your folks would have to brush up their stupid before making that call given the morons they'll be talking to.

quote:

Originally posted by parabellum:
The antidote is hemp, properly knotted and utilized.

Agreed. Just make sure you bring enough to include a majority of the media filth gleefully trumpeting this BS. They to need to be 'dealt' with.

Let's keep that media driven, anti-Trump, dire, doomsayer, Wuhan death march pedal to the metal! Eh!?

Cause clearly all this economic destruction is completely necessary.

Just look at these Wu Flu ravaged survivors.

I'm surprised their return (and apparent recovery) was allowed to be revealed. All I hear about are infections and deaths. People who recover from the Commie Cold generally aren't newsworthy. Bad for the brand.

Unless you're Forest Gump I suppose.

quote:

Originally posted by mbinky:

Unless you're Forest Gump I suppose.

Or Michael Sullivan (Road to Perdition).

Hehe. "'Half' Whitmer." Love it.

Trump is activating the Military Non-Active Ready Reserve...
https://www.whitehouse.gov/pre...-forces-active-duty/

By the authority vested in me as President by the Constitution and the laws of the United States of America, including the National Emergencies Act (50 U.S.C. 1601 et seq.), and in furtherance of Proclamation 9994 of March 13, 2020 (Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak), which declared a national emergency by reason of the threat that the novel (new) coronavirus known as SARS-CoV-2 poses to our Nation’s healthcare systems, I hereby order as follows:

Section 1. Emergency Authority. To provide additional authority to the Secretaries of Defense and Homeland Security to respond to the national emergency declared by Proclamation 9994, the authorities under section 12302 of title 10, United States Code, and sections 2127, 2308, 2314, and 3735 of title 14, United States Code, are invoked and made available, according to their terms, to the Secretaries of Defense and Homeland Security. The Secretaries of the Army, Navy, and Air Force, at the direction of the Secretary of Defense, and the Secretary of Homeland Security with respect to the Coast Guard when it is not operating as a service in the Navy, are authorized to order to active duty not to exceed 24 consecutive months, such units, and individual members of the Ready Reserve under the jurisdiction of the Secretary concerned, not to exceed 1,000,000 members on active duty at any one time, as the Secretary of Defense and, with respect to the Coast Guard when it is not operating as a service in the Navy, the Secretary of Homeland Security consider necessary. The Secretary of Defense or the Secretary of Homeland Security, as applicable, will ensure appropriate consultation is undertaken with relevant state officials with respect to the utilization of National Guard Reserve Component units activated under this authority.

Sec. 2. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

DONALD J. TRUMP

THE WHITE HOUSE,
March 27, 2020.

This was posted (re-posted from another group) by a friend who is an RN and retired last year from the ER. Although I can understand some of the lingo, if one of the Docs on the forum could break it down a little it would be appreciated.
Thanks

"Repost from another group. Interesting read.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Treatment
Supportive

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

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

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

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

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

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

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

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

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

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

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

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

Well, NOAA had to get involved.