COVID-19 2nd wave - Texas only - Stats and such

[Anastasis 23375]

1 hour ago, Sawbonz said:

I would volunteer.

Shit, I bet I could knock a dent in their enrollment target just by rolling through pongfest. 

 

 

[bschoolprof 6232]

26 minutes ago, bluto said:

Last part is interesting, is that a typical # for discharges?

It's not that uncommon.  Here's a picture of total hospitalizations (green line) and the portion that is COVID (blue and red) over the last month in Harris County.  You can see pretty large drops in hospitalizations from day to day.

 

[staboner 4955]

12 hours ago, Eastwood said:

It's being reported by several anonymous restaurant workers that large portions of their staff are testing positive and they aren't shutting down. They aren't even skipping a beat and the worst offenders are asking their staff to come in symptomatic. Symptomatic with this virus varies wildly. It could be anywhere from a light cough to ICU. So, if you're willing to roll the dice that the restaurant is following guidelines and being honest with their reporting and methods, by all means, roll the dice. But I'm way more concerned about other people's hubris, stupidity, and malice rather than the virus itself.

 

wait wut? where is this being reported?

i can't even imagine the lawsuits coming down the tubes. damn. 

[VolenteHawk 495]

9 hours ago, Captain Ron said:

On the too soon, I disagree.

I agree that Texas hadn't spiked because of quick action to prevent spread.

But just because there wasn't a spike, it's not like you guys were spared. You had ~30K cases when the reopen started. Along with that, you had yet to "flatten the curve".

Everyone sees growth post "shut down" because of how this spread pre-symptomatically, we are 2 weeks behind it. And when you look at any state that has "controlled" growth, they saw cases continue to climb a month after shut down before flattening the curve really started.

 That is based on the following data sources:

https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83

https://www.nytimes.com/interactive/2020/us/texas-coronavirus-cases.html

I would also say that this being inevitable? No way. Again, look at any controlled state, NY, NJ, Mass, Penn - they haven't seen spikes post Memorial Day.

* Looking at the Texas data, IMHO there is a very slight downturn of total cases in early April, which looks like the spike prevention from shutting down. You can also make out a slight downturn in mid/late May which looks like the beginning of maybe flattening the curve, before it just blows up.

We were shelter in place for 5x the incubation period. We had noisy spikes from meat packing and prison outbreaks, but there wasn’t a downturn during lockdown. Blame too broad of a definition of essential business or whatever, but there is no evidence the reopening would have been different if delayed. See California. NE states that got slaughtered aren’t the fair compare here.

[troph 24548]

Chuckled at this one ...

[After irth 1243]

2 hours ago, Johnny Sack said:

Today fore me: Central Market Houston - 100 percent masks.  Academy near Kirby off 59 - 100 percent masks.  Picking my kids up from Camp Ozark bus at St Luke’s - 100 percent masks.  
 

If you’re indoors in public in Texas and not wearing a mask you deserve to be shamed   Probably more than shamed but I’m not a violent man unless someone first gets violent with me.  
 

Where I frequent I’ve seen masks just about everywhere for months.   I’d like to see some data on mask wearing more than anecdotes by states   Because form what I’ve seen mask wearing is pretty common Especially the last week   

 

 

Lufkin, TX, Monday grocery run. Hardly any masks, even from store employees. Let’s be kind and say 15%
 

Today:  90% total. Employees and customers. 
 

I went ahead and bought some ice cream because it probably hadn’t been licked yet. 

[Anastasis 23375]

Glad the mask wearing if finally catching on. 

 

Wish that people would have realized that with mask wearing after we started re-opening we likely could have avoided a second shutdown and potential saturation of our hospital resources. 

[After irth 1243]

Thought this was interesting. 

Seems like a big middle finger from the medical establishment. Released late on a Friday. I wonder how many other systems react or what the response will be come Monday. 
 

https://www.christushealth.org/santa-rosa/about/news/covid-19

[After irth 1243]

4 minutes ago, Anastasis said:

Glad the mask wearing if finally catching on. 

 

Wish that people would have realized that with mask wearing after we started re-opening we likely could have avoided a second shutdown and potential saturation of our hospital resources. 

We haven’t exactly seen “saturation of hospital resources” here. Yet. 

You...?

[Eastwood 4394]

55 minutes ago, staboner said:

wait wut? where is this being reported?

i can't even imagine the lawsuits coming down the tubes. damn. 

"Reported" was a poor choice of words. Basically, my wife was in the restaurant business for a long time and still has many contacts in the industry. The word from reliable sources is that people are working COVID positive. Managers need the people to work and the people need to work because they're paycheck to paycheck to begin with. Lawsuits won't happen, IMO, for 2 reasons. 1.) you have to prove that you got sick there and in our CenTex counties COVID is spreading like wildfire. Can you prove that it was at the restaurant that you got sick and 2.) we have zero contact tracing, so even if someone gets sick, how in the world would they know it was from the restaurant to begin with?

[Anastasis 23375]

17 minutes ago, After irth said:

We haven’t exactly seen “saturation of hospital resources” here. Yet. 

You...?

Sure as shit looks like the potential is certainly ramping up in various areas of the state.  As all these new cases still have to mature a bit before their full impact is felt.

Austin solidly in stage 4, Harris appears to be close to entering their ICU surge capacity, text pushed out by bexar county today:

STAY HOME. The COVID-19 virus is spreading rapidly across Bexar County. Local hospitals are approaching capacity. Protect yourself and your family. Stay home except for essential activities, wear a face covering and avoid gathering with people outside your household. STAY SAFE. For more info visit www.covid19.sanantonio.gov

 

 

But that is all entirely beside the point.  We could have avoided this.  We could have had our re-opening, we just had to broadly do some basics like wear masks, practice distancing, and reduce non-essential interactions when possible. 

[staboner 4955]

10 minutes ago, Eastwood said:

"Reported" was a poor choice of words. Basically, my wife was in the restaurant business for a long time and still has many contacts in the industry. The word from reliable sources is that people are working COVID positive. Managers need the people to work and the people need to work because they're paycheck to paycheck to begin with. Lawsuits won't happen, IMO, for 2 reasons. 1.) you have to prove that you got sick there and in our CenTex counties COVID is spreading like wildfire. Can you prove that it was at the restaurant that you got sick and 2.) we have zero contact tracing, so even if someone gets sick, how in the world would they know it was from the restaurant to begin with?

damn man. thats rough. i would have assumed this i guess from my own work in the area when I was younger, but damn. seeing it like the way you state it is just frightening. 

[After irth 1243]

24 minutes ago, Anastasis said:

Sure as shit looks like the potential is certainly ramping up in various areas of the state.  As all these new cases still have to mature a bit before their full impact is felt.

Austin solidly in stage 4, Harris appears to be close to entering their ICU surge capacity, text pushed out by bexar county today:

STAY HOME. The COVID-19 virus is spreading rapidly across Bexar County. Local hospitals are approaching capacity. Protect yourself and your family. Stay home except for essential activities, wear a face covering and avoid gathering with people outside your household. STAY SAFE. For more info visit www.covid19.sanantonio.gov

 

 

But that is all entirely beside the point.  We could have avoided this.  We could have had our re-opening, we just had to broadly do some basics like wear masks, practice distancing, and reduce non-essential interactions when possible. 

I get it. I totally do. Not everyone lives in Bexar, Travis, Harris, and Dallas counties, though. Doesn’t mean we’re not doing our part. Doesn’t mean we’re not ready. Doesn’t mean we haven’t been ready for 3 months now. But still...just sayin. No saturation here. Yet. Maybe. 

Edited June 28, 2020 by After irth
Damn typos

[Buzzrock 14867]

Today fore me: Central Market Houston - 100 percent masks.  Academy near Kirby off 59 - 100 percent masks.  Picking my kids up from Camp Ozark bus at St Luke’s - 100 percent masks.  
 
If you’re indoors in public in Texas and not wearing a mask you deserve to be shamed   Probably more than shamed but I’m not a violent man unless someone first gets violent with me.  
 
Where I frequent I’ve seen masks just about everywhere for months.   I’d like to see some data on mask wearing more than anecdotes by states   Because form what I’ve seen mask wearing is pretty common Especially the last week   
 
 

But this is the Texas only thread.

[BradInATX 9208]

2 hours ago, After irth said:

Thought this was interesting. 

Seems like a big middle finger from the medical establishment. Released late on a Friday. I wonder how many other systems react or what the response will be come Monday. 
 

https://www.christushealth.org/santa-rosa/about/news/covid-19

 

I have heard that Dell Seton is doing the same thing (keeping electives open despite Abbott's order). Third hand info on this one though, so I'm not 100% confident in it. Maybe someone else can verify.

Edited June 28, 2020 by BradInATX

[justhookit 4174]

1 hour ago, Anastasis said:

Sure as shit looks like the potential is certainly ramping up in various areas of the state.  As all these new cases still have to mature a bit before their full impact is felt.

Austin solidly in stage 4, Harris appears to be close to entering their ICU surge capacity, text pushed out by bexar county today:

STAY HOME. The COVID-19 virus is spreading rapidly across Bexar County. Local hospitals are approaching capacity. Protect yourself and your family. Stay home except for essential activities, wear a face covering and avoid gathering with people outside your household. STAY SAFE. For more info visit www.covid19.sanantonio.gov

 

 

But that is all entirely beside the point.  We could have avoided this.  We could have had our re-opening, we just had to broadly do some basics like wear masks, practice distancing, and reduce non-essential interactions when possible. 

Next 10 days to 2 weeks will tell the story. Again. It’s Groundhog Day just with a virus. We definitely could have avoided this but we refused to do those things the first time. Let’s see what happens this time. My money is on another rollback and probably something that should have been done from the get-go and that’s banning non-essential travel.

[justhookit 4174]

On 6/23/2020 at 8:14 PM, justhookit said:

Nueces was really late reporting tonight for some reason. 71 new cases so it’s the 2nd highest total we’ve had. Hospitalizations steady. Positive rate still climbing fast.  The 20-40 age group is going to fuck this up for all of us. We are going to see some absolutely huge new case numbers later this week and weekend.

Well that was my post on Tuesday and 71 was a number of concern. Things change quickly and I wish my prediction of huge numbers was wrong.

Two things here - I’m becoming more and more convinced that what we are seeing is the initial “wave” here. And that term bothers me somewhat but whatever. Everywhere in the country is going to see this at some point. We are late to the party in Texas but we aren’t seeing anything different than what happened in NY and the other early hotspots. Fortunately we’ve got a better idea of how to handle it now.

The other thing and I think it’s more important is the reason we are seeing our spike. It’s opening. Covid just wasn’t widespread here during our first shutdown. Texas definitely had it but we got somewhat lucky and caught it in time because of what was happening in other areas of the country. Fortunately we are walking the opening back now. Of course I’ll be watching us but my eye is more on what happens in NY as they continue to open. Particularly how they handle bars/restaurants or really basically anything other than going to work. My concern is they will start to spike again and I guess it will be slower since they’ve already had to adapt to masks. TEXAS HAS TO ADAPT TO MASKS.

Social distancing is how we control this. And stop touching your face even though we know we all can’t. But seriously it’s social distancing.

Anyway, this sucks but it’s a long way of saying that our new normal is probably being stuck around phase 1 of reopening and we are going to have to regress back to that and hold there until a vaccine.

Edited June 28, 2020 by justhookit

[justhookit 4174]

3 hours ago, BradInATX said:

 

I have heard that Dell Seton is doing the same thing (keeping electives open despite Abbott's order). Third hand info on this one though, so I'm not 100% confident in it. Maybe someone else can verify.

Well let’s be honest it’s what should happen until the hard decisions have to be made. We don’t seem to be there yet. If we get there though this will at least partially fall on Abbott’s lap.

[justhookit 4174]

10 hours ago, Anastasis said:

Jesus man. 

It’s actually worse than I thought. I keep saying it’s from the beginning of June but reality is as best I can tell from looking at my old posts is that 331 number was right around the 10th. We are 1700ish now so doubled twice already and looking at our next double probably by mid-week at the latest.

[htown85 159]

8 hours ago, After irth said:

Thought this was interesting. 

Seems like a big middle finger from the medical establishment. Released late on a Friday. I wonder how many other systems react or what the response will be come Monday. 
 

https://www.christushealth.org/santa-rosa/about/news/covid-19

Methodist in Houston is still doing elective surgeries 

[justhookit 4174]

11 hours ago, Sawbonz said:

My understanding is to get to herd immunity without a vaccine you need 80% of the population exposed. The most optimistic mortality rate I’ve seen is 5 in 1000 which is over a million dead and 10 times that with long term sequelae. Masks, testing tracing and isolation are the only way out of this

 

Or a Hail Mary vaccine

I think I had it around 700,000-800,000 (this assumes no herd immunity, no vaccine, and 100% exposure) when they first started coming out with the antibody percentages from NY and CA a few months ago. I still sure hope I’m wrong but this trend is not encouraging. We also are pretty sure that test is somewhat inaccurate.

i’d have to revisit that though because it’s looking like it would take years to get to 100% exposure. This is spreading fast for sure but not what it first looked like and we have proven we will take measures to slow it.

[Captainant 27311]

13 minutes ago, justhookit said:

This is spreading fast for sure but not what it first looked like and we have proven we will take measures to slow it.

What measures are those? We still don't have a mandate to wear masks in public, and it's becoming a political statement to refuse to do so. 

We have large groups of Americans who are actively and knowingly doing the WRONG thing. We aren't trending in the right direction, in case you haven't noticed

[Johnny Sack 8397]

9 hours ago, Anastasis said:

Glad the mask wearing if finally catching on. 

 

Wish that people would have realized that with mask wearing after we started re-opening we likely could have avoided a second shutdown and potential saturation of our hospital resources. 

Maybe.  Cali is spiking hard too. And I understand from some lawyers I work with — Bay Area and LA - they aren’t really open and everyone wears masks.  

[justhookit 4174]

2 minutes ago, Captainant said:

What measures are those? We still don't have a mandate to wear masks in public, and it's becoming a political statement to refuse to do so. 

We have large groups of Americans who are actively and knowingly doing the WRONG thing. We aren't trending in the right direction, in case you haven't noticed

Do you actually read anything I post? Literally everything I’ve posted on this thread is that we are trending in the wrong direction.

We’ve shutdown once already. We are in the process of doing another one. In Texas. I’m sorry that wherever jackass place you call home doesn’t have a mask mandate, but we’ve got one here in bumbfuck Port A. It’s not perfect but every small thing we do slows this down.  Despite whatever political argument you want to make this, we fight this locally.

[SydneyCarton 47809]

18 minutes ago, Captainant said:

What measures are those? We still don't have a mandate to wear masks in public, and it's becoming a political statement to refuse to do so. 

We have large groups of Americans who are actively and knowingly doing the WRONG thing. We aren't trending in the right direction, in case you haven't noticed

Everyone knows, fuckface. For the 500th time take it to the cloak room so you can get the attaboy and spike the football you so desperately seem to need and won’t get here. 

Edited June 28, 2020 by SydneyCarton

[Captainant 27311]

10 minutes ago, justhookit said:

Do you actually read anything I post? Literally everything I’ve posted on this thread is that we are trending in the wrong direction.

We’ve shutdown once already. We are in the process of doing another one. In Texas. I’m sorry that wherever jackass place you call home doesn’t have a mask mandate, but we’ve got one here in bumbfuck Port A. It’s not perfect but every small thing we do slows this down.  Despite whatever political argument you want to make this, we fight this locally.

My dude, I am not peddling politics here. And you should really slow your roll if you're this angry at 8 in the morning after staying up all night and posting at 4AM. I have read your posts, which is why I was confused and challenged your assertion that "we have shown we will follow preventative measures". 

I 100% agree we fight COVID locally, but local authorities only have as much power as the state of Texas lets them have. There's still zero enforcement or penalty, and some cities have actively gone the other direction and are keeping bars/restaurants open. 

If you don't like me, that's fine, but don't shout me down for doing something I haven't done. Y'all are too eager to screech "POLITICS!!!" everytime you disagree. 

[justhookit 4174]

3 minutes ago, Captainant said:

My dude, I am not peddling politics here. And you should really slow your roll if you're this angry at 8 in the morning after staying up all night and posting at 4AM. I have read your posts, which is why I was confused and challenged your assertion that "we have shown we will follow preventative measures". 

I 100% agree we fight COVID locally, but local authorities only have as much power as the state of Texas lets them have. There's still zero enforcement or penalty, and some cities have actively gone the other direction and are keeping bars/restaurants open. 

If you don't like me, that's fine, but don't shout me down for doing something I haven't done. Y'all are too eager to screech "POLITICS!!!" everytime you disagree. 

And now you are misquoting me too. Your previous post yesterday - you know the one that got deleted - is why I don’t want you on this thread. I’ll happily- or not - engage you in CR but you absolutely can’t help yourself injecting political things that we’ve somehow completely avoided on this thread. Until you show up. And you know there is actually a thread for that in CR with the nifty title of Texas Reopening Announced. I doubt you’ve read this thread much, but if you had you might see we actually do discuss a lot of what you mention, but in a non political way.

what do you do for a living? My “job” is fishing and yes sometimes I stay up all night, sometimes I don’t sleep for 24 hours, sometimes I sleep 6, sometimes well over 12, etc. heck it’s not unusual for me at all to stay up 48 hours during our tournament season. 

In short, go fuck yourself.

[B00M 6278]

13 hours ago, Bill Brasky said:

do you piss the bed at night or hide under your bed and piss on the floor? 

You understand the only road back to normal, prior to a vaccine, is contact tracing and suppression of the virus? Herd immunity is a pipe dream. People getting tests right now are waiting 7-10 days for results and getting a ton of false negatives. That's pointless. Adler said yesterday that only those with symptoms will be tested because we lack capacity... 5+ months in, we can't test people to properly contact trace. As a proud American that thinks we can accomplish anything we dedicate ourselves to, the testing debacle from February until now is outrageous.

[Iceman 2628]

Mental wellness posts bleeding into this thread.

Wow.

Edited June 28, 2020 by Iceman

[Llano Estacado 1257]

Anecdotal - Heard music about 9:30 last night, assume it’s a SxS or golf cart cruise which has become even more the rage in the hood during Rona. Bro country thumping continues. Nope, it is a motorized picnic table / bar hoping house to house vectoring the neighborhood all to shit.

“Can’t close this bar! Get some roadies Llanos we’re headed to the [ redacted’s ]”

Uhhhh, No thanks. Miss y’all, but don’t think that’s wise we’ve got newborn and olds in this house.

Wife says “WTF?!Well at least Facebook comment section should be interesting in the morning” 38 comments and counting.

You are so dumb.gif

[safe sex 11659]

Some elective surgeries are less "elective" than others, and those patients are unfortunately unable to wait this peak out. Sucks for them and sucks for us.

COVID ICU is full. COVID M/S units, already expanded twice, are full. ED has plenty of PUIs. My trauma ICU is full, and the traumas themselves are all sick af. Most are for reasons completely avoidable or unnecessary. The rest of our m/s floors are full, so the handful of stable patients we do have in my ICU are taking up precious ICU beds. We are short staffed. Everyone is tired and stressed the fuck out. I've managed around fifty-five thousand steps over the last three nights and I want to saw my feet off.

If any of you Surly 1%ers want to do a good deed tonight, send food to the ICUs at my hospital. Free food tastes hollow and bitter when it comes from management, but quite the opposite from any of y'all, and we could use it tbh. PM me if you're interested, and I can give you info later this afternoon.

(It still feels weird to refer to this place as Surly. It will always be ShaggyBevo in my heart)

[Mitch Cumsteen 18517]

San Antonio with 795 cases reported last night. Not a typo 795. A new daily record by about 160 cases with the previous record coming 2 days ago. We're so fucked. I can't even imagine two weeks from now. Next stop: herd immunity. 

[Guest Lobo]

That's a great point trauma babe.  There's two nurses on my street and I'm gonna talk to them this evening at street sunday happy hour about how we can send/dropoff food to their colleagues.  

 

Edited June 28, 2020 by Lobo

[Bartles 769]

7 minutes ago, Mitch Cumsteen said:

San Antonio with 795 cases reported last night. Not a typo 795. A new daily record by about 160 cases with the previous record coming 2 days ago. We're so fucked. I can't even imagine two weeks from now. Next stop: herd immunity. 

Ouch, that's like 200 more than Philly ever got in a day. Still, there's a decent chance the recent hotspot numbers will plateau in about a week and then slowly come back down. Despite incompetence from local and fed governments, and despite so much anecdotal evidence of dumbassery...a ton of people have taken notice and are adjusting their behavior. Basically staying home.

[Message Board User 12389]

12 minutes ago, Mitch Cumsteen said:

San Antonio with 795 cases reported last night. Not a typo 795. A new daily record by about 160 cases with the previous record coming 2 days ago. We're so fucked. I can't even imagine two weeks from now. Next stop: herd immunity. 

 

[Bartles 769]

20 minutes ago, trauma babe said:

If any of you Surly 1%ers want to do a good deed tonight, send food to the ICUs at my hospital. Free food tastes hollow and bitter when it comes from management, but quite the opposite from any of y'all, and we could use it tbh. PM me if you're interested, and I can give you info later this afternoon.

(It still feels weird to refer to this place as Surly. It will always be ShaggyBevo in my heart)
 

Quoting to get this on the new page. How would this food delivery work, for any hospital? Is there enough food storage so you don't get bombarded all at once?

Edited June 28, 2020 by Bartles
Food not foot delivery lol

[Covri 6229]

9 hours ago, BradInATX said:

 

I have heard that Dell Seton is doing the same thing (keeping electives open despite Abbott's order). Third hand info on this one though, so I'm not 100% confident in it. Maybe someone else can verify.

[Newdoc 3429]

There is wiggle room for elective surgeries in the order. You can do them in the main hospital if you are not at surge capacity. Ambulatory surgery centers and those type facilities can still go on with elective surgeries.

Nobody has fix the funding mess so quite frankly, if the elective surgeries don’t go on with regularity our hospital systems are screwed, nurses and doctors will continue to be laid off.

[Newdoc 3429]

16 minutes ago, Bartles said:

How would this food delivery work, for any hospital? Is there enough food storage so you don't get bombarded all at once?

Great question, usually small little batches of food can be taken at any time. There is likely a point person at each hospital who coordinates the bigger food deliveries. You can call the main hospital line and ask for that person or get with the administrative offices during the week.

[DDD Dad 14167]

https://www.dallasnews.com/news/commentary/2020/06/28/we-went-inside-parklands-covid-unit-during-its-worst-week-as-coronavirus-cases-spike-in-north-texas/

 

 

Let me know if the link is behind pay wall and I will spoiler post.

[Captain Ron 12789]

12 minutes ago, DDD Dad said:

https://www.dallasnews.com/news/commentary/2020/06/28/we-went-inside-parklands-covid-unit-during-its-worst-week-as-coronavirus-cases-spike-in-north-texas/

 

 

Let me know if the link is behind pay wall and I will spoiler post.

Paywall. 

[DDD Dad 14167]

Paywall. 

Ok. Will try to do it on Tapa.

[babysdaddy 2711]

https://www.dallasnews.com/news/commentary/2020/06/28/we-went-inside-parklands-covid-unit-during-its-worst-week-as-coronavirus-cases-spike-in-north-texas/
 
 
Let me know if the link is behind pay wall and I will spoiler post.

Paywall

[ABSR 5289]

14 hours ago, Sawbonz said:

My understanding is to get to herd immunity without a vaccine you need 80% of the population exposed. The most optimistic mortality rate I’ve seen is 5 in 1000 which is over a million dead and 10 times that with long term sequelae. Masks, testing tracing and isolation are the only way out of this

 

Or a Hail Mary vaccine

Per this Johns Hopkins site https://coronavirus.jhu.edu/data/mortality the death rate per 100,000 in the US is 38.37.   Now blatant disregard of precautions could drive that up, but if we just use that number then it equal .0003837 per 100,000.  So not 5 in 1,000 people, but this is across the entire population.  I do see you 5% number as well, but that is for confirmed cases and not the overall population and doesn’t include the 10:1 asymptomatic cases the CDC recently stated to get the 5%.   Also, if we can better protect vulnerable populations, this should go down as the average age of infected drops and so should the mortality percent of confirmed cases.

Still not good, but not as doom and gloom as it appears at first glance.

[DDD Dad 14167]

1 hour ago, DDD Dad said:

https://www.dallasnews.com/news/commentary/2020/06/28/we-went-inside-parklands-covid-unit-during-its-worst-week-as-coronavirus-cases-spike-in-north-texas/

 

 

Let me know if the link is behind pay wall and I will spoiler post.

 

We went inside Parkland’s COVID unit during its ‘worst week’ as coronavirus cases spike in North Texas

As the pandemic wears on, caregivers working around the clock to save critically ill patients are facing their toughest test yet

Dr. Matt Leveno assesses an intubated patient as he does daily rounds checking in on the most critically ill patients of the intensive care unit in the Parkland Hospital COVID-19 Tactical Care Unit on Saturday, June 27, 2020 in Dallas.(Ryan Michalesko / Staff Photographer)

By Sharon Grigsby

7:00 AM on Jun 28, 2020

 

The critically ill patients in Parkland’s COVID-19 Tactical Care Unit couldn’t wear masks even if they wanted to. They each have a plastic tube jammed down their throats, straight to their lungs. The other end of each tube coils like a translucent snake, tethering the inert form in the bed to a gleaming machine — and, with luck, to life.

It’s eerily quiet on this long, open ward and the 30 patients on ventilators seem frozen in place. They’re unconscious, sedated with powerful drugs, in part to prevent them from ripping out the lines that are keeping them alive.

Surrounded by nurses and respiratory therapists, Dr. Matt Leveno makes rounds in Parkland’s COVID-19 Tactical Care Unit.(Ryan Michalesko / Staff Photographer)

Not one would hesitate for a nanosecond to trade the invasive plastic tubes for the masks that we, breathing free on the outside, get to wear.

Not the 52-year-old man in one bed or his 77-year-old mother a few beds down. Not the man who went on a ventilator Friday night or the one who has been on a machine for more than two months.

A cross, rosary and prayer card provided by a patient’s family rest on the person’s blanketed back.(Ryan Michalesko / Staff Photographer)

 

 

 

In this low-ceilinged space, crammed full of a maze of medical equipment, the two rows of beds stretch farther than you want to look.

Many of the intubated patients lie on their stomachs to make breathing easier. On one man’s back lie a rosary, a cross and a prayer card, placed there by the staff at the family’s request. On another is a pocket prayer shawl with the words “May you be reminded of God’s unending love for you.”

Death stalks the rows of beds as surely as the legion of caregivers struggling to fend it off. They navigate around dialysis machines and IV poles buried in drips, tubes and electronic equipment. Often they are running out of options for lungs that have failed to respond day after day.

Certified Registered Nurse Anesthetist Steven Vela calls out for an extra set of hands as he and nurse Bianca Castillo work to improve the critically low oxygen level of an intubated patient.(Ryan Michalesko / Staff Photographer)

The eyes of the world are on Texas right now for all the wrong reasons — as the state sets one shameful record after another for coronavirus cases and hospitalizations. But the 300 women and men working inside Parkland’s “red box” — the nickname given to the brightly painted Tactical Care Unit and its spillover wards on floors 14 and 16 — are too busy, and too tired, to see beyond the next patient.

Dr. Matt Leveno, the Tactical Care Unit’s medical director, paused for a long time Saturday when asked how much worse things were than two weeks ago.

“I have not done anything other than take care of critically ill COVID patients since the end of February, and I’m just resigned that this is what I’m going to be doing all day for the foreseeable future,” he said.

“The plan right now is just to run, run, run, run, run — until you just can’t. So I’m just going to go as fast as I can and do as much as I can until I can’t do it anymore.”

Leveno talked to me at the bedside of a 45-year-old man who has been on a ventilator for two weeks despite maximum breathing therapy. His kidneys are failing.

 

“There’s simply nothing more that I can do,” Leveno said. “I don’t think he’s going to survive, whether it’s today or tomorrow.”

The patient in the next bed was a 60-year-old man admitted April 26 and put on a ventilator two days later. Nurse Joe Krais, who normally works in Parkland’s ICU burn unit but has been with the COVID team since March, has been his caregiver for weeks.

“You develop a relationship with even an unconscious patient and you get emotionally attached,” Krais said. “Right now, we’re taking it day by day and sometimes hour by hour as far as him doing better or worse.”

Krais also pointed to the swelling numbers of the last two weeks. “Is it affecting us? Yes. With the toll, the workload, it’s a challenge.”

 

Nurse Bianca Castillo investigates a patient’s critically low oxygen level.(Ryan Michalesko / Staff Photographer)

The conversations, even as Leveno and his team made their rounds with the most critical patients, were hushed. The quiet was broken only by the putt-putt-putting of hand-held vibrating treatments on patients’ chests, occasional ventilator alarms — and the coughs.

 

Each time I walked the ward, a nurse or respiratory therapist was at nearly each bed, double-checking the digitally controlled medication drips, adjusting the ventilator, smoothing a pillow or turning a patient.

One seriously ill man, not on a ventilator but aided by two extra oxygen sources, labored mightily to breathe. His belly contracted sharply in rapid bursts while his face contorted in pain.

That’s “air hunger,” Samantha Rowley, senior vice president of nursing and surgical services, told me as a nurse checked on the patient. “That’s a lot of work for the body to handle.”

A monitor displays an oxygen saturation level of 57% — critically low.(Ryan Michalesko / Staff Photographer)

As the Parkland executive responsible for the COVID-19 unit, Rowley seems to be everywhere on the ward to make sure everyone has what they need.

“This has been the worst week,” Rowley said Saturday. “It’s been rough. It can be hard to come back when you lose two people in a day. But we have to.”

She said Parkland is lucky to have had a staff that can flex from other departments to the COVID unit, but she’s unsure how long that is sustainable. The hospital is taking in more coronavirus patients — and they are sicker when they arrive than they were in the past.

She and her team are feeling increasingly anxious about doing their job in a way that is safe for the patients and the Parkland team.

“Either our community pulls together or we tip,” she said. “People either focus on the masking, the social distancing, the handwashing or things will get worse. Who knows what that looks like?”

 

I walked with Leveno part of Saturday morning as he made his daily rounds of the most critical patients, conversations that included both nurses and respiratory therapists in the ward and staffers communicating through a Zoom meeting.

Respiratory therapist Morgan Davis (left) and Certified Registered Nurse Anesthetists Brian Farrell and Brittany O’Toole take notes as Dr. Padmaja Reddy (on-screen) virtually assists in a round of checks on coronavirus patients at Parkland Memorial Hospital.(Ryan Michalesko / Staff Photographer)

It was a drone of concerning reports: “Hospitalization, day 27; ventilator, day 2.” “Overnight, a decreased urine output.” “Not a whole lot of headway with lungs.” “Watch this 200 blood pressure.”

Leveno observed a 73-year-old woman whom the medical team was trying to bring out of anesthesia in order to remove her from the ventilator. “She’s doing very well,” he said. “And this would be the lady who I thought wouldn’t make it. But no, COVID is not like that.”

 

A 73-year-old woman holds a nurse’s hand while coming off sedatives before the removal of her breathing tube.(Ryan Michalesko / Staff Photographer)

As we moved on, a nurse continued to comfort the tiny woman, whose eyes anxiously assessed the anonymous PPE-clad health workers.

 

What makes the coronavirus so challenging is its still-mysterious progression, Leveno said. A patient can have symptoms for many days before the situation becomes bad enough to require supplemental oxygen and hospitalization.

“Then even with all the oxygen we can supply, the patient can’t do the work of breathing and ends up on mechanical ventilation,” Leveno said.

“It’s a waiting game: Is this a person who will turn the corner and get better or the patient who will be the next one we have to put on a ventilator?”

He said that even though he’s taken care of every critically ill Parkland COVID-19 patient since February — probably more than 100 — “I still can’t figure out who those patients, regardless of age, are going to be.”

“It’s very humbling,” he said.

Like Rowley, Leveno tries to stay clear of the politics of the coronavirus. But he acknowledged that it’s hard to watch when people aren’t doing things that are simple — wearing a mask or social distancing when possible.

 

“It’s different if you are the sole breadwinner for a household and have to take these risks for my family,” he said. “But ‘I don’t want to,’ ‘I don’t like it,’ that is more challenging for me to accept. It’s not a big sacrifice.”

The Tactical Care Unit provides 66 beds for the most critical patients; 58 of those beds were filled Saturday. The “red box”extensions, on floors 14 and 16, provide about 100 more, primarily for the least ill COVID-19 patients; 63 of those beds were in use.

While most of the Tactical Care Unit houses what would be classified in normal times as the ICU, some of the beds are designated for “progressive care” COVID-19 patients, meaning those who could flip, at a moment’s notice, into critical distress.

In one of these beds was a pregnant 23-year-old woman who, with fever and shortness of breath, had tested positive for the coronavirus. A plan was devised to ensure that the baby could be delivered safely in this ward, but after the child’s premature birth, the mother wound up on a ventilator for two weeks.

Leveno noted that the woman, who smiled repeatedly, had just come off the machine the day before my visit. “I don’t celebrate until they are back at the house, but I couldn’t be happier for her to be in this shape right now.”

Victor Salazar, 53, who had been in the progressive care unit for almost a week, spoke with me from his bed. “It’s been like hell” to have this disease,” he said. “It’s an ugly feeling to not be able to breathe.”

 

Victor Salazar lies in the COVID-19 ward’s progressive care unit as he works toward recovery. Salazar, 53, came in on Father’s Day, and the first test was negative, so he went home. He returned Tuesday night because of a terrible cough and difficulty breathing.(Ryan Michalesko / Staff Photographer)

The Grand Prairie truck driver had to pause repeatedly as he talked; an alarm monitoring his oxygen level regularly blared to remind him that he needed to take a few deep breaths.

“I don’t wish this on nobody because it’s bad,” he said.

While the staff is learning more all the time about COVID-19, Rowley said the 12-hour “wave” that often accompanies the disease makes it unique in her years of nursing. “Even if a patient seems stable and improving … something happens in their body and you just cannot stop it from shutting down, organ by organ. When that cycle starts, it’s unstoppable.

“You feel helpless.”

And never more so than when Rowley escorts a family into a special “red box” room to see a loved one for probably the last time. When I checked in with her by phone late Saturday afternoon, she was in tears — having just been a part of two of those goodbyes.

 

At one bedside, an 18-year-old brought his high school diploma for his unconscious 45-year-old father to see. At the other, a mother begged her 32-year-old, “Fight, little one, fight.”

“It was just awful,” Rowley said. “We put our hearts and souls into this fight and we still can’t stop this tsunami from coming. It’s just killing us all.”

How we did the reporting

Metro columnist Sharon Grigsby and photographer Ryan Michalesko spent Saturday morning in Parkland Memorial Hospital’s Tactical Care Unit with the permission of the hospital. They were allowed to speak with patients in the unit only with a patient’s consent.

Before entering the unit, where the hospital’s sickest COVID-19 patients are treated, Sharon and Ryan donned the same personal protective equipment ― and with the same procedures — that Parkland’s health care workers use in the coronavirus wards.

That involved, with the help of the unit’s specially trained “donning team,” dressing in scrubs, a plastic gown, mask and face shield, hair bonnet, shoe covers and two pairs of gloves. After their morning in the Tactical Care Unit, they followed a similarly meticulous and supervised “doffing,” which included cutting off the gowns and rolling the used items to prevent potentially shaking loose any disease particles.

 

Edited June 28, 2020 by DDD Dad

[Guest Lobo]

Good lord, that was necessary but gut-wrenching to read.  Thank you for sharing.  

I hope that every denier reads that and adjusts their lives accordingly.  If the heat was gonna take it away, it would have done so already.  that's a lot of awful scenes of death that occurred during 100 degree days in Texas.  

Edited June 28, 2020 by Lobo

[dcar00 14023]

48 minutes ago, ABSR said:

Per this Johns Hopkins site https://coronavirus.jhu.edu/data/mortality the death rate per 100,000 in the US is 38.37.   Now blatant disregard of precautions could drive that up, but if we just use that number then it equal .0003837 per 100,000.  So not 5 in 1,000 people, but this is across the entire population.  I do see you 5% number as well, but that is for confirmed cases and not the overall population and doesn’t include the 10:1 asymptomatic cases the CDC recently stated to get the 5%.   Also, if we can better protect vulnerable populations, this should go down as the average age of infected drops and so should the mortality percent of confirmed cases.

Still not good, but not as doom and gloom as it appears at first glance.

it is estimated a third of the US pop was infected(not close to 80%) during Spanish flu and there was no vaccine.  It eventually slowed.  its herd could be closer to 60% or less.  spanish flu targeted mid age, while this one targets much older.  there is some theory that certain age populations may have higher resistance therefore you won't need  60% to get to herd. it doesn't mean people won't continue to get it but the "hot spots" won't pop up.

[elfenix 34168]

herd immunity is dependent upon Rnaught.  the lower the Rnaught, the lower the herd immunity %.   so if Rnaught is 2, herd immunity is 50%.  if 5, 80%.  if measles and >10,  then it's >90%

Edited June 28, 2020 by elfenix

[atomheartbevo 89362]

Apparently they didn't realize that by playing stupid games, they won a stupid prize.

https://www.kvue.com/article/news/health/coronavirus/texas-bar-nightclub-alliance-file-suit-over-governors-bars-order/269-3a115d64-19c5-4c10-8c64-a630ce9ba549

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The Texas Bar and Nightclub Alliance (TBNA) isn't happy about the governor's decision to force bars to close.

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TBNA is planning to file a suit this week against the state over the executive order.

It sent a letter to its members saying, "We support our members in the constitutional right to protest by keeping your businesses open."

The letter called Gov. Greg Abbott’s order “irresponsible and shameful” and said members have expressed anger about being closed while other businesses such as salons and restaurants remain open.

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TABC visited 628 bars across Texas on Friday night, finding 30 bars open in violation of the order.

It said 28 of those bars agreed to shut their doors, while two remained open. Those two bars – The Whiskey Girl in Abilene and Outlaws Longview in Longview – have had their liquor permits suspended for 30 days.

The salons and restaurants are at least trying to pretend to follow the established guidelines, but for fuck's sake, far too many bars seemed to be running full-tilt like nothing was going on.

[atomheartbevo 89362]

HEB putting in limits again.

https://www.kvue.com/article/money/business/heb-purchasing-limits-update/273-a97ac2c9-3954-4834-8843-a7c7190bc36d

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Below is the list of current purchasing limits on other products:

• Bath tissue multipack: 2
• Bath tissue singles: 2
• Paper towels: 2
• Acetaminophen: 2 total (including baby, trial and travel sizes)
• Acid controller/famotidine and pepcid, 50-count and larger: 1
• Acid controller/famotidine and pepcid, smaller than 50-count: 2
• Disinfecting/antibacterial sprays: 2
• Disinfecting/antibacterial wipes: 2
• Trial and travel-sized disinfecting and antibacterial sprays and wipes: 2
• Hand sanitizer: 10
• Hand soap: 4
• Hydrogen peroxide: 2
• Rubbing alcohol and swabs: 2
• First aid and cleaning gloves: 2

Oh, and @Brisketexan

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The limits are mostly limited to non-food items. The only food limit that is in place at all H-E-B stores as of Saturday is brisket, of which customers can buy no more than two products. 

On a side note, our little neighborhood Randall's had plenty of toilet paper and hand sanitizer.  It was actually odd how much they had - either people are shopping there much (lol) or they have been watching the news and are pushing out as much as they can.