What's your COVID-19 gameplan?

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View attachment 192528

I don't know how you expected me to deduce anything from your original post, but like I said,
I hope you're are right. Things will get much worse.
Because I said mortality rate, not number of cases.


"Curious to see mortality rates when the number of tested skyrockets... "
 
justhere4comm

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and me too... It will fall into (unfortunately a 3-5% window on average, but much higher for those over 65)
 
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and me too... It will fall into (unfortunately a 3-5% window on average, but much higher for those over 65)
Its at 4.5% in the World and dropping...and thats with a lack of testing.

Its at 1.4% in the US.

As a reference, there are an estimated 38-54 million flu cases for 2020 in the US alone....And that's for only 6 months of the year.
 
justhere4comm

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The flu mortality rate is 0.1 percent in the USA.
We will be at 3-5% mortality rate overall with older people taking the brunt of it, along with those with immune deficiency issues and conditions.

If it stays at 1% and does not climb but rests there for a few months...
My man. Do the math. This is a war of attrition and it can outlive us.

1 percent of the USA.
3,290,000 people will have died across the spectrum.

It could be 3-5x that...

Covid-19 is 10x as contagious as the common flu.

Edit:
Again, this is not an argument I want to win. I'd be happy to lose. I would do the jig, video it, and post it.
 
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The flu mortality rate is 0.1 percent in the USA.
We will be at 3-5% mortality rate overall with older people taking the brunt of it, along with those with immune deficiency issues and conditions.

If it stays at 1% and does not climb but rests there for a few months...
My man. Do the math. This is a war of attrition and it can outlive us.

1 percent of the USA.
3,290,000 people will have died across the spectrum.

It could be 3-5x that...

Covid-19 is 10x as contagious as the common flu.
The flu mortality rate is low because every doctor, urgent care, hospital, medical center has tests for the flu......

We are JUST NOW producing tests for COVID-19 and every day that more tests are being administered the percentage of people dying to actual cases is DROPPING.

Do the math? Yes, please try. Trends in virus's tend to go down over time, not up.
 
Godstrength

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The flu mortality rate is 0.1 percent in the USA.
We will be at 3-5% mortality rate overall with older people taking the brunt of it, along with those with immune deficiency issues and conditions.

If it stays at 1% and does not climb but rests there for a few months...
My man. Do the math. This is a war of attrition and it can outlive us.

1 percent of the USA.
3,290,000 people will have died across the spectrum.

It could be 3-5x that...

Covid-19 is 10x as contagious as the common flu.

Edit:
Again, this is not an argument I want to win. I'd be happy to lose. I would do the jig, video it, and post it.
There's no 3 to 5% being killed by this virus. so many people have it or have had it already and don't even know because they never got tested (symptoms confused with flu or sinus infection). This virus has been circulating in the u.s. for a couple months now at least. Any high percentages are coming from a place where they're taking death rates of those who have tested positive for the virus. A true percentage of people who will die is going to be nowhere near 3% to 5. Everybody panicking hyping this s*** up is what's making everybody batshit crazy
 
muscleupcrohn

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The flu mortality rate is low because every doctor, urgent care, hospital, medical center has tests for the flu......

We are JUST NOW producing tests for COVID-19 and every day that more tests are being administered the percentage of people dying to actual cases is DROPPING.

Do the math? Yes, please try. Trends in virus's tend to go down over time, not up.
There is the possibility that if hospitals become overwhelmed, mortality rates could rise, in a worst case scenario. But yes, considering there are likely many people who had it and were either asymptomatic or not symptomatic enough to get tested and recovered, the mortality rate is lower than what has been reported. That said, we know this is worse than the normal flu, but I get that you’re not claiming otherwise, only using the flu for context regarding testing and whatnot.
 
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There is the possibility that if hospitals become overwhelmed, mortality rates could rise, in a worst case scenario. But yes, considering there are likely many people who had it and were either asymptomatic or not symptomatic enough to get tested and recovered, the mortality rate is lower than what has been reported. That said, we know this is worse than the normal flu, but I get that you’re not claiming otherwise, only using the flu for context regarding testing and whatnot.

Exactly. As the number of tests skyrocket and the number of people tested skyrocket, I expect the mortality to drop...like it already has done by a very large margin just within the past 4 weeks.
 
poison

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Exactly. As the number of tests skyrocket and the number of people tested skyrocket, I expect the mortality to drop...like it already has done by a very large margin just within the past 4 weeks.
It's happening already:

 
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thebigt

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"Ferguson thus dropped his prediction from 500,000 dead to 20,000."
kind of a big difference there...Bernie sanders predicted more would die from coronavirus than died in WW2.
 
thebigt

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Please don't reference Bernie, lol.
these are hard times...Bernie is always good for a laugh---when i'm really down I put on joe bidens greatest hits, lol.
 
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kind of a big difference there...Bernie sanders predicted more would die from coronavirus than died in WW2.
Lol Bernie Sanders and Joe Biden are both fvcking idiots....Biden looks sedated half the time
 
manifesto

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And hes the best the Dems could do....wtf
 
thebigt

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Looks up several posts passed you. Oh. It’s now the political thread subset of the original.
EVERYTHING IS POLITICAL even a virus. might try looking at the news every now and then.
 

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Pretty crazy how fast it spreads. Just two or three weeks ago no one was really talking about the coronavirus and not that's all everyone is talking about.
wow, guess it really depends on your circle of friends. I’ve been living in covid-19 fear for months. I have family in China. to My boss and several colleagues are from Singapore with vivid memories of SARS circa 2002. So I could not believe the attitudes of “oh it’s just a flu”. How we still can’t get everyone tested and isolated is an absolute disaster.

My work has been temperature screening and social distancing for a month. Yet we try to go out for an isolated walk and there’s people STILL not taking this thing seriously.
 
thebigt

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wow, guess it really depends on your circle of friends. I’ve been living in covid-19 fear for months. I have family in China. to My boss and several colleagues are from Singapore with vivid memories of SARS circa 2002. So I could not believe the attitudes of “oh it’s just a flu”. How we still can’t get everyone tested and isolated is an absolute disaster.

My work has been temperature screening and social distancing for a month. Yet we try to go out for an isolated walk and there’s people STILL not taking this thing seriously.
you are right, it depends on circle of friends...if a supp company came out with a new stim even better than dmaa everyone on this forum would be talking about it, but the general public not so much.
 
Iwilleattuna

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By the “media” do you mean the CDC and its equivalent in literally every other developed country on earth?
I would never trust the CDC...

Didn't I already mention how I never get the flu vaccine ? lol Bill Gates and ebola :rolleyes:

You people can keep hating, but I know there is an agenda behind this
 
Iwilleattuna

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I love how they have no problem prescribing tons of other harmful medications but when there is something that may help rona aka hydroxychloroquine they won't allow it. Sorry , but I'd be trying anything for a pandemic.
 
Iwilleattuna

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There's no 3 to 5% being killed by this virus. so many people have it or have had it already and don't even know because they never got tested (symptoms confused with flu or sinus infection). This virus has been circulating in the u.s. for a couple months now at least. Any high percentages are coming from a place where they're taking death rates of those who have tested positive for the virus. A true percentage of people who will die is going to be nowhere near 3% to 5. Everybody panicking hyping this s*** up is what's making everybody batshit crazy
This is correct

How to trick the people into separation, conformity(toilet paper), fear and handing over their freedom effortlessly
 
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Iwilleattuna

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Stop spreading this nonsense and other conspiracy theories on Covid-19. Dave Palumbo knows **** about what is going on. He needs to stick to body building a d extended guts. And you need to stop believing every new thing you read from uncredible sources. You are not a detective.
Yeah well, it's not actually Dave, it's his guest....

I don't need sources to see that there is an agenda behind this
 
justhere4comm

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You do need sources, and then consider the agenda of (in this case) Dave's guest. That would be a good place to start for any digital detective.

There are a number of conspiracy theories. I don't subscribe to any one mode of thinking with regard to the pandemic, so also won't be spreading anything that isn't verified. Let's keep an even keel until we can identify and focus on what we can affect.

Some great people in here with their fingers on the pulse of the front lines, providing insight.
My wife shares with me information daily but it's a bit beyond my understanding.

As long as some doctors are aware that testing for Covid-19 (specific) is not necessary as they have several factors they can have at their disposal when it comes to other tests that can narrow down the possibilities quite fast.

Here is a for instance:

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."

Stay safe.
 
justhere4comm

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This is correct

How to trick the people into separation, conformity(toilet paper), fear and handing over their freedom effortlessly
What's correct?
How do you conclude this?

Tricking people?
Who's tricking who? Was it a trick when Donald Trump called it a Hoax?
Are you saying he knew? Was he tricked? He was aware of this in December. Also, he fired Obama's Pandemic Response Team (Ebola). Is he tricking us all?

Conformity? (Toilet Paper)
Please explain this. Actually, please don't.

A few questions of "Freedoms"
What freedoms are being handed to whom?
Isn't it responsible to practice social distancing in order to assist our fellow man and protect one another?
To whom is this finger being pointed?

Freedom is an illusion.
It always has been, when you permit anyone to hold some kind of law over your head when it is in the betterment of society. I can think of a good few examples that make no sense, but they are laws. As long as those in power or can influence power, they will use that influence to limit societal 'rights' as long as it keeps them in power or their influence over those in power.

Are you free to go buy steroids on the corner without a script? No. Why not?
What about ephedrine? It's for asthma right? You need to give your ID at the pharmacy in the USA. 1st.
There is a limit and they track who buys it. Why? (I know)
Anyone care to add their own stupid non-consequentials to this that limit our power over our own bodies, or other? Be inventive. I'm game. I think all drugs should be legal. The former head of Scotland Yard and a great many former police officers agree with me here. (Maybe a discussion for another time.)

Freedom? I don't think so.

This is a pandemic.
It's happened before, and it will happen again.
I won't try to explain it's sources; reasons for being, or motivations if any behind it.
I really don't care. It exists. We aren't in much of a position to do anything else about it.
 
justhere4comm

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This is interesting:

"South Korea finished developing the 10 minute Covid-19 diagnostic kit and is now ramping up production. They plan to export 300.000 test-kits per week -"

192555


Where is the brain trust in the USA working on these and other things?
Why aren't the captains of industry taking charge of producing the ventilators?
Do they need to be commanded by the President of the USA to do something?

I'm sharing my excitement at this news, but also added frustrations about my own country.
We are well on our way to record numbers infected, which may also include recorded deaths attributed to Covid-19. A great many deaths due to Covid-19 in the world have gone unrecorded.
 
Iwilleattuna

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What's correct?
How do you conclude this?

Tricking people?
Who's tricking who? Was it a trick when Donald Trump called it a Hoax?
Are you saying he knew? Was he tricked? He was aware of this in December. Also, he fired Obama's Pandemic Response Team (Ebola). Is he tricking us all?

Conformity? (Toilet Paper)
Please explain this. Actually, please don't.

A few questions of "Freedoms"
What freedoms are being handed to whom?
Isn't it responsible to practice social distancing in order to assist our fellow man and protect one another?
To whom is this finger being pointed?

Freedom is an illusion.
It always has been, when you permit anyone to hold some kind of law over your head when it is in the betterment of society. I can think of a good few examples that make no sense, but they are laws. As long as those in power or can influence power, they will use that influence to limit societal 'rights' as long as it keeps them in power or their influence over those in power.

Are you free to go buy steroids on the corner without a script? No. Why not?
What about ephedrine? It's for asthma right? You need to give your ID at the pharmacy in the USA. 1st.
There is a limit and they track who buys it. Why? (I know)
Anyone care to add their own stupid non-consequentials to this that limit our power over our own bodies, or other? Be inventive. I'm game. I think all drugs should be legal. The former head of Scotland Yard and a great many former police officers agree with me here. (Maybe a discussion for another time.)

Freedom? I don't think so.

This is a pandemic.
It's happened before, and it will happen again.
I won't try to explain it's sources; reasons for being, or motivations if any behind it.
I really don't care. It exists. We aren't in much of a position to do anything else about it.


IMO, People are blowing this out of proportion. No, I can't prove anything I say neither can anyone here and I think every person on Earth is wondering what is going on right now.

Should have added consumerism

People are conforming to social norms on stocking up toilet paper lol. Don't think anyone get's it, and I don't think toilet paper protects against corona

Well, I agree with you on freedom actually. I guess we're losing the rights we have been given which is still not free lol so I see your point

Honestly, this is just horrible what's going on. I hope we can just wake up and everything goes back to normal honestly
 
justhere4comm

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Come to think of it, my company has bought it's employees a great many things to help us in health.
One is a great application for mind and spirit: "The Mindful Minute"*

Another would be: "Calm"


Great for relaxation and meditation.
I highly recommend.

-M

*I say, 'bought' because some applications have subscriptions.
 
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justhere4comm

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muscleupcrohn

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I would never trust the CDC...

Didn't I already mention how I never get the flu vaccine ? lol Bill Gates and ebola :rolleyes:

You people can keep hating, but I know there is an agenda behind this
It’s not just the CDC though; it’s the equivalent in literally every developed country in the world...

Even countries that don’t like the US. For every country to all take this so seriously says something. Not to mention if the US was lying, China and/or Russia etc. could come out and make the US look terrible if they were. Just like the moon landing and the earth not being flat; if the US faked the landing and/or the earth was flat, surely a country that doesn’t like the US would expose the “truth” and make the US look like idiots and ruin all the people’s trust in their government.

But since that hasn’t happened, and since the world is unified in knowing the earth isn’t flat and that this virus is more serious than the flu, it’s most likely true.

You just spout off asinine drivel and say “well, I don’t know what to believe.” Man, just because you say you don’t know doesn’t mean some of the sh*t you post has any shred of credibility in the least.
 
DA_MOSS

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This is interesting:

"South Korea finished developing the 10 minute Covid-19 diagnostic kit and is now ramping up production. They plan to export 300.000 test-kits per week -"

View attachment 192555

Where is the brain trust in the USA working on these and other things?
Why aren't the captains of industry taking charge of producing the ventilators?
Do they need to be commanded by the President of the USA to do something?

I'm sharing my excitement at this news, but also added frustrations about my own country.
We are well on our way to record numbers infected, which may also include recorded deaths attributed to Covid-19. A great many deaths due to Covid-19 in the world have gone unrecorded.
https://www.biospace.com/article/releases/biomerica-begins-shipping-samples-of-10-minute-test-for-covid-19-virus-exposure-/?fbclid=IwAR1cR35UPG2N4NOP6bg3IKIT15WovReE3NMmOPRVt2DPPLAQPZgjok2LE3Q
 
poison

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What's correct?
How do you conclude this?

Tricking people?
Who's tricking who? Was it a trick when Donald Trump called it a Hoax?
He did not call it a hoax, he called the dem response to it 'another one of their hoaxes'. You've been lied to.


Are you saying he knew? Was he tricked? He was aware of this in December. Also, he fired Obama's Pandemic Response Team (Ebola). Is he tricking us all?
No, he did not fire Obama's pandemic response team. There was a restructuring, as recommended:

Tim Morrison, former senior director for counterproliferation and biodefense on the NSC, wrote in another Washington Post Op-Ed, “It is true that the Trump administration has seen fit to shrink the NSC staff. But the bloat that occurred under the previous administration clearly needed a correction. … One such move at the NSC was to create the counterproliferation and biodefense directorate, which was the result of consolidating three directorates into one, given the obvious overlap between arms control and nonproliferation, weapons of mass destruction terrorism, and global health and biodefense. It is this reorganization that critics have misconstrued or intentionally misrepresented. If anything, the combined directorate was stronger because related expertise could be commingled”

Conformity? (Toilet Paper)
Please explain this. Actually, please don't.

A few questions of "Freedoms"
What freedoms are being handed to whom?
Isn't it responsible to practice social distancing in order to assist our fellow man and protect one another?
To whom is this finger being pointed?
If gun stores are being closed, businesses are being forced to operate (or not) in certain manners, and your movements are being dictated, yes, freedoms are being surrendered.

Freedom is an illusion.
It always has been, when you permit anyone to hold some kind of law over your head when it is in the betterment of society. I can think of a good few examples that make no sense, but they are laws. As long as those in power or can influence power, they will use that influence to limit societal 'rights' as long as it keeps them in power or their influence over those in power.

Are you free to go buy steroids on the corner without a script? No. Why not?
What about ephedrine? It's for asthma right? You need to give your ID at the pharmacy in the USA. 1st.
There is a limit and they track who buys it. Why? (I know)
Anyone care to add their own stupid non-consequentials to this that limit our power over our own bodies, or other? Be inventive. I'm game. I think all drugs should be legal. The former head of Scotland Yard and a great many former police officers agree with me here. (Maybe a discussion for another time.)

Freedom? I don't think so.

This is a pandemic.
It's happened before, and it will happen again.
I won't try to explain it's sources; reasons for being, or motivations if any behind it.
I really don't care. It exists. We aren't in much of a position to do anything else about it.
That's your right. But it doesn't have to happen, or we can reduce the chances. A large part of minimizing future epidemics is correctly identifying what happened now, how, from where, and why.
 
justhere4comm

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I hope Dyson's Ventilator works better than this 500 Canadian Pesos thing.
Warning: This guy speaks like a Canadian Sailor... So, if you are at work, wait.

 
thebigt

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What's correct?
How do you conclude this?

Tricking people?
Who's tricking who? Was it a trick when Donald Trump called it a Hoax?
Are you saying he knew? Was he tricked? He was aware of this in December. Also, he fired Obama's Pandemic Response Team (Ebola). Is he tricking us all?

Conformity? (Toilet Paper)
Please explain this. Actually, please don't.

A few questions of "Freedoms"
What freedoms are being handed to whom?
Isn't it responsible to practice social distancing in order to assist our fellow man and protect one another?
To whom is this finger being pointed?

It always has been, when you permit anyone to hold some kind of law over your head when it is in the betterment of society. I can think of a good few examples that make no sense, but they are laws. As long as those in power or can influence power, they will use that influence to limit societal 'rights' as long as it keeps them in power or their influence over those in power.

Are you free to go buy steroids on the corner without a script? No. Why not?
What about ephedrine? It's for asthma right? You need to give your ID at the pharmacy in the USA. 1st.
There is a limit and they track who buys it. Why? (I know)
Anyone care to add their own stupid non-consequentials to this that limit our power over our own bodies, or other? Be inventive. I'm game. I think all drugs should be legal. The former head of Scotland Yard and a great many former police officers agree with me here. (Maybe a discussion for another time.)

Freedom? I don't think so.

This is a pandemic.
It's happened before, and it will happen again.
I won't try to explain it's sources; reasons for being, or motivations if any behind it.
I really don't care. It exists. We aren't in much of a position to do anything else about it.
I would not be defending Obama's pandemic [ebola] response team if I were you?
 
HIT4ME

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There's no 3 to 5% being killed by this virus. so many people have it or have had it already and don't even know because they never got tested (symptoms confused with flu or sinus infection). This virus has been circulating in the u.s. for a couple months now at least. Any high percentages are coming from a place where they're taking death rates of those who have tested positive for the virus. A true percentage of people who will die is going to be nowhere near 3% to 5. Everybody panicking hyping this s*** up is what's making everybody batshit crazy
This is speculation. We have no evidence that anyone is infected that has not been tested. As a matter of fact, locally, we had reports originally of a 8 people being infected, then it turned out to be 3 (because we were reporting people who had symptoms and the doctors assumed it was Covid and it wasn't). Since we lack testing, and maybe even some of the people being treated aren't getting tested, it is really hard to say.

Without testing, we can only go on the best data we have available and it could go in either direction. We also don't know 100% what number of people in the population are asymptomatic. It could be an extremely small number of people and we're acting like it would bring down the numbers dramatically. That's wishful thinking with no evidence. I'm not saying you are wrong, and you are certainly in the majority here as far as what people are thinking - so this isn't directed at you specifically - but rather just questioning the assumption since I guarantee that not everyone in the hospital, or being sent home from the hospital, has actually been tested.

I would never trust the CDC...

Didn't I already mention how I never get the flu vaccine ? lol Bill Gates and ebola :rolleyes:

You people can keep hating, but I know there is an agenda behind this
That's cool not to trust the CDC or Bill Gates - but where is your skepticism with even less credible sources? If you are going to question authorities, why are you not questioning other sources? Does being an authority alone make them wrong and being not-an-authority alone make them right?

I love how they have no problem prescribing tons of other harmful medications but when there is something that may help rona aka hydroxychloroquine they won't allow it. Sorry , but I'd be trying anything for a pandemic.
I think this logic cuts both ways. Sometimes taking things you think will help will actually do harm. A good case - Lisinipril is on the list of drugs being investigated for treatment. But it is also on a list of drugs that could potentially make this worse. We don't know - so if someone is told it is a cure and it actually makes things worse and everyone starts taking it, where are we then? Almost all medications can be harmful. I mean, they are saying Ibuprofen may even make this worse.

Yeah well, it's not actually Dave, it's his guest....

I don't need sources to see that there is an agenda behind this
Again, being skeptical is great - but don't you need evidence to see anything? How do you see an agenda without evidence?
 
HIT4ME

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You do need sources, and then consider the agenda of (in this case) Dave's guest. That would be a good place to start for any digital detective.

There are a number of conspiracy theories. I don't subscribe to any one mode of thinking with regard to the pandemic, so also won't be spreading anything that isn't verified. Let's keep an even keel until we can identify and focus on what we can affect.

Some great people in here with their fingers on the pulse of the front lines, providing insight.
My wife shares with me information daily but it's a bit beyond my understanding.

As long as some doctors are aware that testing for Covid-19 (specific) is not necessary as they have several factors they can have at their disposal when it comes to other tests that can narrow down the possibilities quite fast.

Here is a for instance:

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."

Stay safe.
This is great - is this your wife's log? Great entry. This is a great example of how medicine works - sometimes you just don't have a solid diagnosis. You can back into a diagnosis by eliminating everything else. So if this could be flu or covid - and I test for flu and it is negative, I can be more certain that it is Covid. Sure, maybe not 100% but with every elimination of a possibility, the remaining possibilities become more and more likely. And given the limited testing available vs. the number of cases popping up, I'm sure this method of uncertain diagnosis is the best we have in many areas.
 
HIT4ME

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This is interesting:

"South Korea finished developing the 10 minute Covid-19 diagnostic kit and is now ramping up production. They plan to export 300.000 test-kits per week -"

View attachment 192555

Where is the brain trust in the USA working on these and other things?
Why aren't the captains of industry taking charge of producing the ventilators?
Do they need to be commanded by the President of the USA to do something?

I'm sharing my excitement at this news, but also added frustrations about my own country.
We are well on our way to record numbers infected, which may also include recorded deaths attributed to Covid-19. A great many deaths due to Covid-19 in the world have gone unrecorded.
I do believe that Elon Musk is trying to ramp up some production for respirators, etc. himself. I mean, he can be a mess and always jumps on this stuff like he is a hero, but he does seem to make some progress often times (even if PR is overblown). It seems like some other industries are working on it as well.

My boss shared this with me and my team.

View attachment 192556
Screw you pal. No, wait, I love you, come back!

Nah, in reality, we often forget this and it is 100% true.

I hope Dyson's Ventilator works better than this 500 Canadian Pesos thing.
Warning: This guy speaks like a Canadian Sailor... So, if you are at work, wait.

Me too. And I bet he took more than 10 hours to develop that hair drier.
 
jswain34

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That's cool not to trust the CDC or Bill Gates - but where is your skepticism with even less credible sources? If you are going to question authorities, why are you not questioning other sources? Does being an authority alone make them wrong and being not-an-authority alone make them right?
This is precisely my problem with this guy. He, and many others quick to believe any and all conspiracies, just says “oh this credible source must be sipping the kool-aid and trying to get me to sip it to, THEY LIE!!! But this dude over here who has been proven to be a quack and has multiple of their outlandish ideas disproven says ‘insert random bit of alt news contrary to what all experts are saying’ so he must be actually be the correct one in all of this”.

It just leaves me scratching my head. I am a huge fan of skepticism, but when you’re only skeptical of the government agencies where some of the best scientists in the world work but not remotely skeptical of someone who doesnt even study infectious disease and barely made it out of high school i just cant follow the logic.
 

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