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

justhookit

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whithou
whithou

It has been a disheartening journey and it is only starting. I did not realize how there really is no definitive treatment for the illness until we got COVID patients. When they first come on our unit

South Austin
South Austin

He didn't get COVID.  He just ran out of immunity.

safe sex
safe sex

I cannot stress this enough for anyone who lives in Austin (although this really applies to pretty much everywhere at this point) BE SAFE. What this means is don't get on your motorcycles. D

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Sawbonz

Sawbonz 27436

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Posted
3 hours ago, trauma babe said:

Most teens will be fine. Most isn't all, especially when it's your family member that is the exception. I don't have links to any science of a high level of evidence for my feelings on this, just a lot of personal experience and anecdotal evidence from other nurses and former patients who have kept in touch with our COVID unit. I will also say that I have not had a COVID patient in their teens yet (most go to DCMC), but I have taken care of patients in their early-mid twenties with no pre-existing medical issues that would normally hamper their bodies' ability to heal. 

The amount of damage and that COVID does to your lungs and the time it takes for a healthy person to recuperate seems to be closely correlated with how much oxygen support you require, and how early you started receiving oxygen therapy. There are many different methods for use to give you oxygen, but after the first one (nasal cannula, what you've all seen in medical TV shows/movies), they become quickly and increasingly uncomfortable to cooperate with. 

Max rate for a basic nasal cannula is 6L/min. After that, we may try a simple mask, or a non-rebreather mask (depending on your respiratory rate) to increase that to 10L/min. If you still can't maintain your oxygen saturation but your breathing pattern is acceptable, we'll put you on what's called high-flow nasal cannula. This lets us push up to 60L/min of up to 100% FiO2 through your nostrils. We heat and moisturize the oxygen, but it's still dries the fuck out of your nostril mucosa, is loud, and limits your movement. If all of that doesn't start to help, we may try BiPAP, which is a full face mask that forces air into your lungs at high pressure. Some people can tolerate it okay, some can't. There's also evidence that BiPAP should be contraindicated in COVID patients. I haven't seen a COVID pt on BiPAP in a long while. Failing all of those options, you will be intubated, and with COVID there's a good chance you will not be coming off of that ventilator with our current treatment standards. You might, but we will do our best to arrange virtual communications with family members before we tube you, because there's a significant chance it will be the last time you see or speak with them. We might not be able to do so, because you might be decompensating too quickly. If we are unable to get you off of the ventilator, you will receive a tracheostomy (and possibly a PEG tube) as an additional step to help that process. If you have made it this far, your kidneys are almost certainly failing. Your skin is swollen with extravascular fluid, leading to your skin tearing and sores forming in places where skin is stretched tightly over bony parts of your body. We try our best, but they are not 100% preventable. Your blood looks almost black and is quite thick. You might throw a clot and it might give you a stroke or end up being a PE, both of which, when you're a COVID patient, will result in either death or even more serious impairment because we cannot treat you as quickly as we otherwise would. There is no emergency in a pandemic. Not even for CPR. You are stuck in a nightmare of delirium (and possibly chemically paralyzed), where maybe every time we have to catheterize you (if you aren't on dialysis already) your mind compensates for the sedated experience in your brain and tells you you are being raped. Or that we're skinning you while bathing you. 

Your lungs probably look like rotting raisins at this point.

Most teens will not require intubation. Most isn't all. Some will require just nasal cannula, and some will require every intervention up to a vent and trach/PEG. From what patients and nurses have told me, even having minor respiratory issues (requiring no oxygen or just a spit of it) has left them unable to function at their previous levels. One of my close friends at one of my gigs is a long-distance runner, and following her minor case of COVID (no O2 required), she is no longer able to jog more than a block at a time. She can no longer work three shifts in a row. She is in her mid twenties and the (formerly) healthiest person I know. Imagine what is being done to your lungs by the disease when you require 60L/min of oxygen at 30% FiO2, much less 100%. Everyone will be affected by COVID in some way, but there will be a generation of young people with complicated respiratory issues as they age.

A minor symptomatic case of COVID is much more dangerous for anyone than a minor case of the flu.

 

 

I get this. But you can’t prevent all covid and you can’t prevent all deaths from covid. Or any communicable disease. Last fall there was a 16 yo at bishop lynch in Dallas who had gotten her flu shot. She still got the flu.  Positive flu test. Her father is a pediatric ER doc. She went to bed and never woke up. My daughter knew her through social media (which still bottles my mind). Do we want to prevent ALL deaths not from old age?  What are we willing to give up to attain that goal? I don’t have the answers. I know the answer isn’t what trump and his sycophants have been doing. I also know it’s not hiding in a cave until this is all over. 

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Anastasis

Anastasis 23394

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Posted
1 minute ago, Sawbonz said:

I don’t have the answers. I know the answer isn’t what trump and his sycophants have been doing. I also know it’s not hiding in a cave until this is all over. 

I don't have all the answers, but they rhyme with "accurate and accessible point of care testing", "mask wearing", and "social distancing".   

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Sawbonz

Sawbonz 27436

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3 minutes ago, Anastasis said:

I don't have all the answers, but they rhyme with "accurate and accessible point of care testing", "mask wearing", and "social distancing".   

Well, yeah. But in the absence of a central directive for that are you self isolating? Maybe I’m too cavalier because of what I do, plus I started my training (in ortho- VERY high risk for exposure) at the hight of the AIDS crisis, but I’m at the point of taking what precautions I can and living my life. I had a consult today on a (covid negative) ICU patient, but 80% of the ICU was covid positive. My access surgeon has covid. Odds are I will get it if I haven’t already. I would love for our leaders not to be morons. But here we are

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Anastasis

Anastasis 23394

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Posted
Just now, Sawbonz said:

Well, yeah. But in the absence of a central directive for that are you self isolating? Maybe I’m too cavalier because of what I do, plus I started my training (in ortho- VERY high risk for exposure) at the hight of the AIDS crisis, but I’m at the point of taking what precautions I can and living my life. I had a consult today on a (covid negative) ICU patient, but 80% of the ICU was covid positive. My access surgeon has covid. Odds are I will get it if I haven’t already. I would love for our leaders not to be morons. But here we are

We don't need central directives, imo.  We need regionalized response led by adults and scientists, backboned by American industry and a functional regulatory structure. We don't have any of those things atm.

We're pretty holed up ourselves, but I can do my thing from behind the computer screen. Basically the things that we are engaging in are mental health activities. 3v3 soccer, outdoors activities with family, boating, etc. If I had to be in the world to make a living, I would be doing what I had to do.  

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Hefeweizen

Hefeweizen 5307

Posted
Posted
23 minutes ago, Anastasis said:

I don't have all the answers, but they rhyme with "accurate and accessible point of care testing", "mask wearing", and "social distancing".   

Lol a reasonable take.  But we can't have those on Surly or even in the US of fucking A these days.

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atomheartbevo

atomheartbevo 89449

Posted
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1 hour ago, BradInATX said:

Imagine being such a spoiled, disconnected silver spooner that you think every high-risk person on Earth can just retire to their spread in Colorado for the next 12-18 months while this blows over.

No shit, we recently too a little hit to our income, and had to swap our bidet over to regular fucking tap water.  After several years of coconut water-powered bidet, switching to regular tap water is like "here, let me shoot liquid sandpaper up my ass!"

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safe sex 11684

Posted
Posted

 

 

 

Do we want to prevent ALL deaths not from old age?  What are we willing to give up to attain that goal? I don’t have the answers. I know the answer isn’t what trump and his sycophants have been doing. I also know it’s not hiding in a cave until this is all over. 

 

I agree that we can't hide away in a cave either, but we can take the situation with the gravity it demands and at least try to not actively encourage the spread of the virus. We are sadly failing even that in a significant portion of our population.

 

For some additional perspective (and this is not directed at you,[mention=20]Sawbonz[/mention] ) while I type this on my lunch break through the plastic bag I keep my phone in, the patient in the ICU room next to one of mine tonight is an otherwise healthy 19-22yo who is on high flow nasal cannula at 60L/min with an FiO2 of 80%, while also requiring a vasopressor to maintain blood pressure at an acceptable level (which will slowly destroy their kidneys). Not too much more room to maneuver before intubation. They are currently too weak to even lift their butt onto a bedpan.

 

You know, typical flu shit.

 

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Sawbonz

Sawbonz 27436

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44 minutes ago, trauma babe said:

 

 

 

 

 

I agree that we can't hide away in a cave either, but we can take the situation with the gravity it demands and at least try to not actively encourage the spread of the virus. We are sadly failing even that in a significant portion of our population.

 

For some additional perspective (and this is not directed at you,[mention=20]Sawbonz[/mention] ) while I type this on my lunch break through the plastic bag I keep my phone in, the patient in the ICU room next to one of mine tonight is an otherwise healthy 19-22yo who is on high flow nasal cannula at 60L/min with an FiO2 of 80%, while also requiring a vasopressor to maintain blood pressure at an acceptable level (which will slowly destroy their kidneys). Not too much more room to maneuver before intubation. They are currently too weak to even lift their butt onto a bedpan.

 

You know, typical flu shit.

 

Obviously not typical flu shit. But as you know it’s also not typical covid shit for an otherwise healthy person in their late teens/early 20’s. No more typical than the girl I mentioned who died of influenza.  We can go back and forth all day with anecdotes of young people getting really sick or dying from things they should easily get over based on probability. Each time it happens it’s a tragedy. That’s not helpful IMO. The reality is covid is soon to be (maybe already is) endemic in the US due to our incompetent leaders, and we have to figure out how to live with that new reality until we have a vaccine. 

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Anastasis

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8 minutes ago, Sawbonz said:

The reality is covid is soon to be (maybe already is) endemic in the US due to our incompetent leaders, and we have to figure out how to live with that new reality until we have a vaccine. 

Man, I really hope that we actually get a vaccine.  The preliminary data look promising, but fuck. Kind of an all our eggs in one basket moment. Some of the therapeutics looking promising, but if the vax options fail we are looking at nothing approach normalcy for a while. Shit, even if the vax shake out normlacy looks like late 2021/early 2022 at best. 

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Posted
Posted
10 hours ago, Chewbacca said:
11 hours ago, Telegraph_it said:
If I derive income from property in another state can I technically claim I live there?
Checking with you since you seem like an authority on this. 

Not sure why anyone would want to claim they live somewhere they don't.

different subject, but talk to any school administrator...

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safe sex

safe sex 11684

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14 hours ago, BehoId, The Underminer! said:

did you pick your username because of the trauma people get from reading your posts?

The American public as a whole does not understand how awful and debilitating it can be to require ICU-level care for more than a couple of days. COVID amplifies every negative aspect of ICU-level care, both for the patients and nurses. Barring the unlikely rapid development and deployment of an effective vaccine, something in the way we are handling this pandemic as a country must change. We cannot continue on this path.

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Captainant

Captainant 27467

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Posted
16 minutes ago, bolverk said:

Given how many usernames you've blown through, one would think you'd be the expert on the frequency of the mutation of a disease.

Wait, is high side the new stone oak sock? I wasn't sure because it wasn't following me around the board and negging every post I made

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BrazilHorn

BrazilHorn 6576

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Daily change for Travis County - 10-19 nearly double the % of yesterday's cases than their total case share. IMO a combo of summer vacation & camps.

Nice low case count yesterday (202). Would love to see Travis drop <200 for the 1st time in a long time.

Age Bracket <1 1 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 >80 Total
New Cases 8/5 vs 8/4 0 6 27 48 44 39 19 10 9 0 202
% of Daily Change 0.00% 2.97% 13.37% 23.76% 21.78% 19.31% 9.41% 4.95% 4.46% 0.00%  
% of Total Cases 0.52% 2.80% 7.88% 26.81% 21.69% 16.42% 11.68% 6.46% 3.23% 2.51%   22,024
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Liquor and Poker

Liquor and Poker 3659

Posted
Posted
2 minutes ago, dcar00 said:

actually the death rate is much lower for older now than it was in March/April in the Northeast shitshow.

Yeah, but the huge increase in infected millenials and zoomers makes me think it's just going to slow burn the riskier folks forever.

Plus I still think that at the margins, "high risk" is anecdotal, post-hoc and blurry.  And the margins are wide.

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dcar00

dcar00 14035

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1 hour ago, Liquor and Poker said:

Yeah, but the huge increase in infected millenials and zoomers makes me think it's just going to slow burn the riskier folks forever.

Plus I still think that at the margins, "high risk" is anecdotal, post-hoc and blurry.  And the margins are wide.

high risk is anecdotal?

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dcar00

dcar00 14035

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Posted
13 minutes ago, DefinitelyNotHollywoodColt said:

Well yeah, but let’s not get bogged down in the details here.

I actually gave him the fact that death rates in olds are much lower than they were in April, which he agreed with and then said what he thinks is going to happen.  so who is not getting bogged down in the details?

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Neonmoon

Neonmoon 38127

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Isn’t it pretty obvious the reopen wave is hitting  deaths now? It’s already passed case count, and hospitalizations, that’s why they are decreasing now. It’s hitting deaths now. We should see a decline in those in a few weeks. 

(Obviously a school wave could start thing up again, who knows)
 

 

 

 

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Liquor and Poker

Liquor and Poker 3659

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Posted
1 hour ago, dcar00 said:

high risk is anecdotal?

It is when there's no clear definition of the exact factors (CDC, Mayo and JH have different lists and even different categories, for example), what they mean (is 125/81 "hypertensive"?  is your asthma "mild" or "moderate"?), or what "evidence" needs to be present to establish the risk (is it just one note on one doctor's chart?  does it require a full battery of tests?).

I suspect that if you just went by the broadest definition of the "high risk" groups, a whole lot of people fit into them who have no idea.  Certainly that doesn't make sense, but where should the lines be drawn?  It's kind of important to be sure when you're saying "high risk" stay home and everyone else reasonably go about their business.

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Anastasis

Anastasis 23394

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Posted (edited)
8 hours ago, kevwun said:

It apparently can't mutate to the extent the flu does because of it's makeup.  They think a vaccine for it will last because of that.

Most of the vax are targeting the spike protein. Supposedly this is suppose to be a highly conserved region, maybe due to the essential nature to bind cells?  But what if it can wiggle out a modified the spike enough but preserved its function without undermining its infectious ability?  That would suck. 

*I don't really know if any of this is based in what we know about the virus, but my biggest fear is that aren't able to mount a good vax. 

Edited by Anastasis
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C-Man

C-Man 27058

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Posted

We just got notice from the school district that on 9/8, the high school will go to a hybrid attendance schedule. We are virtual-only starting 8/20 and then the school will be broken into A and B groups based on first letter of last name. The A's will go to campus on M-W-F in Week 1 and do virtual learning on T-TH. Meanwhile, the B's will go to campus T-TH and do virtual learning on M-W-F. It will flip-flop in Week 2. I believe this will be the arrangement for the entire fall semester.

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dcar00

dcar00 14035

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Posted
3 minutes ago, Anastasis said:

Most of the vax are targeting the spike protein. Supposedly this is suppose to be a highly conserved region, maybe due to the essential nature to bind cells?  But what if it can wiggle out a modified the spike enough but preserved its function without undermining its infectious ability?  That would suck. 

*I don't really know if any of this is based in what we know about the virus, but my biggest fear is that aren't able to mount a good vax. 

well for gods sakes lets get south austin's mom on this, stat!  she should be able to mount one

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atomheartbevo

atomheartbevo 89449

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Posted (edited)

Remember how Abbott hastily awarded the no-bid $295 million contact tracing contract without the legislature's approval?  Said company then hired two acquaintances of his?  Well, legislators are suing him, and they have a pretty good case.

https://www.kxan.com/news/local/austin/republican-lawmakers-sue-gov-greg-abbott-over-states-295-million-contact-tracing-contract/

Quote

The lawsuit claims Abbott exceeded the additional power he was granted during the COVID-19 disaster declaration.

“The first reason to invalidate the contract is that DSHS materially failed to follow competitive bidding rules in awarding the Texas-MTX contract,” the lawsuit states. “The second reason to invalidate the contract is that the Texas Constitution requires a separation of powers, and that separation leaves policy-making decisions with the Texas legislature.”

@Brisketexan or one of the other 100+ Surly attorneys can chime in, but newsworthy for this thread because this will probably end whatever state-level contact tracing was going on (and I haven't heard that there is much of an effort, but others may chime in).

Is there even any state-level contact tracing in significant numbers?  All I heard was that they quickly setup a call center, but haven't heard them doing the kind of contact tracing that South Korea, etc. were doing.

Edit: Not posting this for discussion (go to CR for that), just saying that we will probably see the end of statewide contact tracing fairly quickly.

Edited by atomheartbevo
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atomheartbevo

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https://www.kxan.com/kxan-live/news-notes-positive-test-rate-for-covid-19-hit-record-high-in-texas-other-stories-to-know/

Quote

The positive test rate for COVID-19 hit a record high in Texas Wednesday. 

Almost 40% of tests came back positive, but it’s from a smaller pool of 23,000 tests. That is the smallest number of daily tests reported in the state since late June.

 

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atomheartbevo

atomheartbevo 89449

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Posted
6 minutes ago, DDD Dad said:

Texas was contact tracing? Who knew?

Best I could find was that back in June, we were still short-handed.

https://www.texastribune.org/2020/06/30/texas-cut-contact-tracing/

Quote

As Texas becomes a national hot spot for the new coronavirus, the state is still falling short on the governor’s months-old goal to employ up to 4,000 contact tracers — and the number of virus detectives dropped recently when the state health agency reassigned hundreds of state workers.

Earlier this month, 400 Texas Department of State Health Services employees who had been temporarily assigned to contact tracing were directed to other roles, including other COVID-19 response jobs, because there were sufficient personnel to track all the cases they were covering, spokesperson Lara Anton said.

Now, about 2,800 contact tracers are at work in Texas, even as the state has routinely reported more than 5,000 new COVID-19 cases each day. In early June, the state’s contact tracing workforce numbered about 2,900, and it reached almost 3,200 later in the month before dropping again.

It seems like a lot of the tracing was done by local communities.

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