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Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away

InkaUtexas

By InkaUtexas
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gmr548

gmr548 16590

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healthy old people are never as healthy as they seem.
there is a medical concept of "reserve" and no matter how healthy you are, as you age, it just goes down.

I'm not saying their olds aren't vulnerable. The opposite, actually. Italy is right up there with Japan in terms of health metrics and we see what's going on there.

Newdoc's assessment of overall public health here is obviously correct. We may not be as old as Japan or Italy, but we're significantly worse off with underlying conditions. We also have the added element of a healthcare caste system when it comes to insured vs not. Lower average age isn't likely to save us.
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Uncle Boobs
Uncle Boobs

Against my better judgment and several beers deep, I have taken you up on this, potentially ending my streak of totally worthless posts. I have done 3 and 7 day averages only on the Worldometer data. 

Brisketexan
Brisketexan

Daughter’s home. A little PTSD, we’re picking up Whataburger to help.

Coelenterate Fuccboi
Coelenterate Fuccboi

Just try and imagine GreenspointTexas being the person to intubate you as you fight for your life against COVID-19. You’re laying there gasping for air while he chastises you for all the things you li

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naija

naija 2869

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Letter from Seattle: Amid COVID-19 pandemic, time to act is long past due

We live in unprecedented times. On Jan. 19, patient zero arrived in the United States at Seattle-Tacoma International Airport after returning from a visit to his family in Wuhan, China. He tested positive for COVID-19 on Jan. 20. Fast forward one month, and the heroic efforts of Helen Chu, MD, at the University of Washington, who, despite running against a cease-and-desist order by the federal government, ran COVID-19 tests on 2,500 sputum samples being used for another study on the flu virus. She found the first community-acquired case in a 17-year-old asymptomatic boy who was about to return to high school in Renton, Washington. The school was closed immediately after the information was verified.

By March 9, 11 days ago, there were 172 confirmed cases in Seattle and an alarming 22 deaths due to an outbreak in a skilled nursing facility in nearby Kirkland. On that day, Dean Paul Ramsey, MD, and the leadership of UW Medicine decided to cancel all work-related travel from university employees. Three days later, on March 12, UW Medicine made the decision to cancel all elective surgeries. On that day, there were 387 confirmed cases—despite minimal testing—and 30 deaths in the Seattle metropolitan area. Our hospital began to conserve masks, eliminate medical students and nonessential observers from using surgical masks to observe our cases.

 

As chief and associate chief of the division of vascular surgery at the University of Washington, we immediately made the decision to continue to offer surgery to abdominal aortic aneurysm (AAA) patients with diameters over 5.5cm, dialysis access and surgery for critical limb-threatening ischemia (CLTI) with a potential for limb loss. That decision quickly changed. On Sunday, March 15, when the case count was by now 642 cases and 40 deaths, we made the decision to call two friends in Italy, a country hard-hit by COVID-19 and in a state of lockdown and panic. Pierantonio Rimoldi, MD, and Germano Melissano, MD, based in Milan in the country’s north, gave us the terrifying news. Their healthcare system was completely overrun. These are the notes we took away from that phone call:

  • 90% of the workload in all hospitals is related to COVID-19. The remaining 10% involves urgent/emergent patients. He carried out a ruptured AAA yesterday (March 19)
  • Every intensive care unit (ICU) is filled with COVID-19 patients
  • They have cancelled all surgeries except true emergency cases—they do not carry out elective AAA, CLTI patients or dialysis patients
  • Everyone is isolated at home. The only places people are allowed to go are local pharmacies or food markets. If caught on the street without permission papers, they receive a large fine or three months in jail
  • The Italian doctors say the only way to control COVID-19 is for people to stay home
  • Their very first case—patient zero—was Feb. 20, some 24 days ago. Our first reported case in the U.S. was Jan. 21, and first death Feb. 29
  • They said they do not have enough ventilators for all who require them. We asked what their triage criteria were:
    • Age 80 and older—do not resuscitate (DNR)
    • Age 70 to 80—if there are any significant comorbidities (congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, diabetes): DNR. For all others, a decision is made on a case-by-case basis
    • All ventilators are reserved for people who have a strong chance of survival
  • Almost all deaths are among the elderly
  • They said surgeons do nothing except urgent or emergent cases. They are not being utilized in ICUs or wards because they simply get in the way. It’s like a pediatrician volunteering to come scrub-in on a case to “help”—they would just get in the way outside their area of expertise

These represent frightening statistics, altering our mentality completely. We immediately implemented the following changes to our service line:

  • Cancelling all elective cases, including the ones listed above. Our patients fall into the category of high risk when contracting COVID-19. So exposing them and using up resources was not the right thing to do
  • We will perform only emergent cases. Cases performed over the weekend were a ruptured AAA and a gunshot wound to a carotid artery
  • Cancelling clinic to avoid exposure of our patients, staff and surgeons to COVID-19. If we are exposed and need to quarantine for two weeks, that could quickly decimate a vascular service
  • Restructuring our faculty and residents such that one attending surgeon and resident will cover for a week at a time, with back-up as required for those that contract or are exposed to COVID-19—as well as the potential for multiple operations at the same time
  • Eliminating any unnecessary time in the hospital. We have a daily Zoom morning report. Our weekly division conference, monthly faculty meeting and resident conference are also staged via Zoom
  • Understanding our role in preserving the “3Ss,” as they say here at UW (staff, space and stuff). The projections at our hospital for the peak in three weeks’ time is sobering—potentially close to 1,000 inpatients in our system. We would imagine this is the same in other cities
  • Preparing our residents to understand that some may be called to assist in ICU roles if our medical colleagues require the help
  • Accepting that this is a crisis and truly understand what an emergent case is. We have never crashed a patient from clinic to the operating room. So any patient who is seen in the clinic is not an emergent case
  • We may have patients who will rupture their AAA or suffer an amputation. We need to accept that today’s mentality is not the same as a week ago—and certainly not a month ago

 

As of the time of writing, here in Washington state we have 1,376 confirmed cases and 74 deaths, which we believe is just the tip of the iceberg. We expect our hospitals to experience a surge in COVID-19 patients by April 9 (see Figure 1). As two vascular surgeons with extensive combat military experience and experience working in resource-constrained environments, we desperately plead with all service chiefs across the United States to act this minute in order to conserve our resources and save lives. Don’t sit on your hands.

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naija

naija 2869

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Above is from the Vascular Division at UW. If you are looking for why Seattle might be doing better. I can tell you firsthand that their reactions were among the most rigid in the nation compared to other academic centers and considered controversial. 

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Elmer_Fudd

Elmer_Fudd 22308

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2 minutes ago, mulletpelini said:

Didn't look to see if posted, but all those dummies that bought toilet paper....

https://www.ebay.com/itm/12-48-Mega-Charmin-Ultra-Soft-/283819715146?hash=item4214f92a4a%3Ag%3AiHwAAOSw6v1ecq1a&LH_Auction=1&nma=true&si=Ij8qnTwLy68ffTVZ6SVtt9KiWaY%3D&orig_cvip=true&nordt=true&rt=nc&_trksid=p2047675.l2557

12 pack of charmin someone is trying to sell for $100.  Plus $20 in shipping.

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Auto Driller

Auto Driller 2506

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3 minutes ago, GreenspointTexas said:

Fucking idiot

This doesn’t seem like the time for trial and error.

Honestly, what is the downside for a SIP order right now? Do they think that they’ll save the economy by allowing people to still go to work? That ship has sailed.

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closetojumping

closetojumping 62765

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6 minutes ago, B00M said:

@closetojumping so you don't see any possibility New York becomes like Milan? 

Isn’t it already? NY residents can’t really go anywhere or do anything unless they’re deemed “essential”. They have a high list of infections. If you mean in terms of dead people, I assume the reason we’re all isolating ourselves and ducking for cover is because we realize death is a real risk here, and we’d all like to avoid it for the time being. 

If you mean the “we’re Italy in two weeks!” stuff, the point of contention when that was being discussed here was that we already were in that range in different places, and claiming a chart overlay was silly. We identified sick patients before Italy and people have been walking around with it for weeks/months. 

Also, I have more faith in America and our doctors and scientists and other factors about our demographics to believe that all other things equal, we’re not any better prepared than Italy. I know thinking that is borderline heresy on this thread, but I’ll live with the Surly doomsdayer gloating if they’re incinerating bodies en masse in NY in a few weeks. 

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DaysOff

DaysOff 7965

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Posted
This doesn’t seem like the time for trial and error.
Honestly, what is the downside for a SIP order right now? Do they think that they’ll save the economy by allowing people to still go to work? That ship has sailed.
I have a large for pickup Spec's order for tomorrow. Can we wait until then. I've been out flying idiots around.
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Loco

Loco 3753

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15 minutes ago, closetojumping said:

Actually, I haven’t claimed anything about sources. I’ve said I have a friend that is in the military and works in the White House. He’s support and doesn’t claim to know much and probably couldn’t say much, and I haven’t been coming on here hinting about some hidden knowledge. 

 

Read those first two sentences again slowly.    You posted that he has told you about the inner workings of the White House's response implying they have been working all out for weeks... during a time-frame that would seem incredibly inconsistent with the official response from the President.   Who apparently naps all day according to your "Friend"   Now suddenly he doesn't know much?    Are you just making some shit up to fit a narrative or to feel important?  Because I have to tell you, that's how it looks.

And yup congratulations, you cracked the code... I'm a Gator.  Been around since 2008...  Came to shaggy based on a link to Thujone's paint...  enjoyed the witty comedy and irreverent posts.   Is it ok if I stick around Mr HOA president?

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naija

naija 2869

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27 minutes ago, PenelopeWitherspoon said:

From NBC NY on NYC and NYS deaths.

114 deaths in the state out of 15,168 cases (0.75% rate).

Specifically should be noted:
 

 

When it comes to it, this is what will make the decision to avoid economic catastrophe easier to bear.

But quoting the case fatality rate in isolation fails to illustrate why the disease is still a problem for the healthcare system. If it was a case of you contract the disease and it was pretty clear in 24-48hrs whether you were going to die and it had a 1-2% fatality rate, it wouldn't be too much of a problem.

The issue is that the reports in the journals from the Wuhan experience are saying they had to keep ventilated patients on the machines from a period of 3-6 weeks which is a wild range, and therein lies the issue.

If each critically ill patient required support for about a week, much less of a problem. If our experience turns out to be 3 weeks on average, then big problem.

It's not the people its killing; it's the effort it takes to keep that number at 1-2%.

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GreenspointTexas

GreenspointTexas 9662

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2 minutes ago, naija said:

When it comes to it, this is what will make the decision to avoid economic catastrophe easier to bear.

But quoting the case fatality rate in isolation fails to illustrate why the disease is still a problem for the healthcare system. If it was a case of you contract the disease and it was pretty clear in 24-48hrs whether you were going to die and it had a 1-2% fatality rate, it wouldn't be too much of a problem.

The issue is that the reports in the journals from the Wuhan experience are saying they had to keep ventilated patients on the machines from a period of 3-6 weeks which is a wild range, and therein lies the issue.

If each critically ill patient required support for about a week, much less of a problem. If our experience turns out to be 3 weeks on average, then big problem.

It's not the people its killing; it's the effort it takes to keep that number at 1-2%.

Which is why i have been saying that itll be much higher than 1% when the shit hits the fan

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Loco

Loco 3753

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4 minutes ago, Casual Encounter said:

I believe CTJ was saying the president only naps, meaning he’s not getting meaningful sleep.

I asked him point blank to clarify...  no response to the quote or question.  I left it alone, because it doesn't make sense.  If his friend was in the White-house and running his mouth that's a problem.  Most likely its FW FW FW FW stuff being represented as insider info...  You know facebook mom shit

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Nice Guy Eddie

Nice Guy Eddie 13516

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45 minutes ago, PenelopeWitherspoon said:

From NBC NY on NYC and NYS deaths.

114 deaths in the state out of 15,168 cases (0.75% rate).

Specifically should be noted:
 

 

The .75% rate is a ridiculous number. Until NY actually has 1 person that has recovered, no one should be creating death rates.

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Guest Lobo

Guest Lobo

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^Harvey...

Now that's fucking awesome.  I told him to finish off the guard with his hand...not his pock-marked cum dumpster of a mouth.  This is what you get fuckface.  

Doesn't help you've been walking around the prison with your ass sticking out in that walker, you fucking shit for brains

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InkaUtexas

InkaUtexas 26026

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2 minutes ago, Lobo said:

^Harvey...

Now that's fucking awesome.  I told him to finish off the guard with his hand...not his pock-marked cum dumpster of a mouth.  This is what you get fuckface.  

Doesn't help you've been walking around the prison with your ass sticking out in that walker, you fucking shit for brains

Yet somehow that fuckstick gets a test? 

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VABuckeye

VABuckeye 2472

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Listening to Cuomo speak.  He's not playing the political blame game.  Quite the opposite.  He's saying that the parties are working together and that the political red tape needs to be cut.  He also emphasized that a bill about Coronavirus needs to be about relief only with no pork.  Money where money needs to go to those in need.

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Guest Lobo

Guest Lobo

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Just now, InkaUtexas said:

Yet somehow that fuckstick gets a test? 

Well to be fair to the uber wealthy---the cheek swab wasn't taken with a traditional medical-grade absorbent sponge.  It was taken with Jerome's mushroom cock.  

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Newdoc

Newdoc 3448

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7 minutes ago, Nice Guy Eddie said:

The .75% rate is a ridiculous number. Until NY actually has 1 person that has recovered, no one should be creating death rates.

That back end recovery rate will be a fluid and unreliable number until comprehensive follow-up and accurate testing is in place preferably with IGM, IGG and antibody levels tested.

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closetojumping

closetojumping 62765

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15 minutes ago, Loco said:

Read those first two sentences again slowly.    You posted that he has told you about the inner workings of the White House's response implying they have been working all out for weeks... during a time-frame that would seem incredibly inconsistent with the official response from the President.   Who apparently naps all day according to your "Friend"   Now suddenly he doesn't know much?    Are you just making some shit up to fit a narrative or to feel important?  Because I have to tell you, that's how it looks.

And yup congratulations, you cracked the code... I'm a Gator.  Been around since 2008...  Came to shaggy based on a link to Thujone's paint...  enjoyed the witty comedy and irreverent posts.   Is it ok if I stick around Mr HOA president?

 

12 minutes ago, Casual Encounter said:

I believe CTJ was saying the president only naps, meaning he’s not getting meaningful sleep.

 

4 minutes ago, Loco said:

I asked him point blank to clarify...  no response to the quote or question.  I left it alone, because it doesn't make sense.  If his friend was in the White-house and running his mouth that's a problem.  Most likely its FW FW FW FW stuff being represented as insider info...  You know facebook mom shit

It’s clear that you were indeed too stupid to comprehend plainly written English, as evidenced here even after CasualEncounter tried to help you out. You’re not worth the bullet if you are that stupid. You also don’t seem to understand how support staff works. They’re not in the planning sessions or calls to the foreign leaders or governors. They make sure things like conference calls and rooms are ready, food is flowing, agendas are set, etc. That’s not “inside level information”, you jort-wearing rube. My friend knows things like sleep patterns and stress levels because he’s part of the personal and health support staff directly for the president in a non-partisan way in a non-partisan role. If I’d been on here claiming that I was tight with the chief of staff or some shit, you would have had some sort of point. Instead, you’ve highlighted the level of your unsophisticated stupidity. 

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Hagbard Celine

Hagbard Celine 10903

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51 minutes ago, naija said:

The piecemeal rollout of surgery cancellations illustrates the problem with the decentralized way the management of this been going on.

Some places, it comes from the Gov. Others, the CEO of the hospital system. Some, the Department Chairs. In more than a few places, left up to the individual doctors. Meanwhile its been the recommendation from the Surgeon General for how long now..

https://globalnews.ca/news/6706941/sean-penn-coronavirus-cnn/

"There is no greater humanitarian force on the planet than the United States Military."

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XYZ

XYZ 2154

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26 minutes ago, naija said:

When it comes to it, this is what will make the decision to avoid economic catastrophe easier to bear.

But quoting the case fatality rate in isolation fails to illustrate why the disease is still a problem for the healthcare system. If it was a case of you contract the disease and it was pretty clear in 24-48hrs whether you were going to die and it had a 1-2% fatality rate, it wouldn't be too much of a problem.

The issue is that the reports in the journals from the Wuhan experience are saying they had to keep ventilated patients on the machines from a period of 3-6 weeks which is a wild range, and therein lies the issue.

If each critically ill patient required support for about a week, much less of a problem. If our experience turns out to be 3 weeks on average, then big problem.

It's not the people its killing; it's the effort it takes to keep that number at 1-2%.

You forgot to mention that 95% of people put in assisted breathing machines in Wuhan died.

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