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  1. Just got home from workin' the ER -Vegas- I'd be be shocked if the death numbers aren't crazy in about 7 days. Seeing twice as much covid as I was even in April. My first six people I saw tonight all had covid. Admitted 6 tonight,. Intubated a couple. It's strange though, back in April I was seeing 30% of the total volume I am now, people waited until they were half dead to come in for anything, almost all >50 years old, and almost everyone completely grateful and thanking you for being there for them. Now it's back to everyone coming in for everything, tons of psych, lots of young people coming with covid, some just coming in for a test (totally inappropriate obviously), the usual chronic drug seekers, and people are back to screaming at the nurses and complaining about nonsense. The hospitals are overrun and full of covid. Meanwhile Sisolak just closed the bars but there is so many loopholes it's useless (turning into "restaurants" with pretzels), and there are groups doing demonstrations about having to wear a mask. I must say I was super pissed and frustrated a few weeks ago and felt america was giving up and anxious that maybe we could still turn it around. A bunch of my colleagues have gotten sick, in fact i had to cover july 4th/5th for one of them. I've now accepted the fact that we have indeed given up, that I'm going to inevitably get infected at work no matter what I do, and just hope I'm not unlucky with it.
  2. ummmm....there is a protest planned in downtown vegas tomorrow at 0830 - an anti-mask rally. Saw it on twitter and it was confirmed by local news outlets. Background: NV Governor finally mandated masks thursday. Guess which political party they all belong to? I went to the "open up" protests at the same place (Grant Sawyer govt building) out of morbid curiousity in late april, but stayed in the car for obvious reasons. It was a bunch of idiots with a mixture of "I need a haircut" signs, bikers, and a few confederate flags. It's probably the same people.
  3. Well, another 8 hour shift in the ER and saw 10 more covids and I intubated 2. Trump, Pence, and all their science denying / mask hating followers claiming that "it's only because we are doing more tests" can just #### off. I was seeing zero or maybe 1 cases a shift a month ago. I didn't intubate anyone for about 3 weeks. The average age I'm seeing now is maybe 15 years younger, so I think that's the main reason why the hospitalization rate is lower. Also, we are more comfortable sending people home with hypoxia so that might be a factor. Anyway, we have completely failed as a nation. We allowed a reality TV idiot president to lead us to self inflicted slaughter.There will be 300K dead by election day. We allowed him to convince his followers that it's a hoax. He claimed hydroxychloroquine was going to be a miracle cure, because some aide or Jared told him there was some study out of Europe (which was a terrible study), and Trump made a bet it would pan out so he could look like a savior. We have somehow allowed him to make wearing a mask "unmanly" and an affront to our freedoms. Let's stop federal testing funding now because his poll numbers are bad. And now it's complete denial by the white house in a last ditch attempt to have people bury their heads in the sand and still vote for him. And holding rallys indoors?????? By the time this is over, we will be the worst country in the world as far as response to this pandemic. We are already a laughing stock to every reasonable country in the world. What a failure of the nation.
  4. i was at the large protests in downtwon vegas and it was greater than 80% masked - wife and I made a point to visually survey all night because we were going to bail if it was less not making a political point, just relaying a first hand data point
  5. Tell that to the two Covid patients I intubated in the ER tonight.
  6. I don’t think this will ultimately pan out. Steroids have been studied for ARDS and viral infections numerous times, generally a very mild treatment effect except in very specific circumstances. Hard to believe corona will be the exception given the track record. But I certainly hope it is. It’s very very important to keep mind that there is literally hundreds of studies being conducted of multiple different therapies. Just by random chance some will show an effect based on the usual p value that is required to have a “positive outcome” even if theoretically all the therapies are not actually truly helpful. I can’t stress how important this is. I would be shocked if there weren’t a dozen ongoing studies of steroids in Covid worldwide. Even if it’s not helpful at all, statistics will dictate that it’s possible one or some would be positive. It’s the confirmatory studies that truly matter.
  7. Just got home from a brutal ER shift. Saw 7 new covids myself, partners saw a bunch too.Huge huge jump from 2 weeks ago, when I was seeing zero to one a shift. didn’t have to intubate any but 3 of mine needed admitted for hypoxia I come home and see trumps rally remarks about “Kung flu” and slowing testing down to make him look better just infuriating. Why are healthcare workers risking our lives needlessly more so trump can tell people it’s a hoax? Why are we doing this for these anti mask anti science crusaders? So depressing. Good night y’all
  8. Been working overnights in the ED and big increase in COVID patients last two nights (vegas) it’s fairly clear to me the government made a decision early one not to recommend masks for the public because they didn’t want people to hoard them until healthcare workers and hospitals had supplies. That was a huge mistake in retrospect. Should have simply banned the sale of n-95 masks to the public and told everyone to buy cloth or surgical masks and for everyone to wear. It is very clear cut from the science that if everyone wears a mask that transmission goes down. Why does Taiwan have only 7 deaths? Masks. Why does japan have only 924 deaths? Masks. furthermore if you look at spray and droplet patterns done wearing various types of coverings it is clear that masks greatly help. Plus if you do catch it wearing a mask the initial viral load is likely reduced which almost certainly lowers your chance of severe illness or dying.
  9. I'm so sick of the anti-mask people. An ER tech I've worked with for 17 years died of covid two weeks ago. One of my colleagues spent 12 days in the ICU and is only 43 Why are healthcare workers putting themselves at risk for these "freedom fighters" that don't want to be bothered with a minor annoyance? I find school zones an annoyance. I'm going to quit slowing down BECUZ MA FREEDUM USA USA USA Maybe someone can put out a directive that I can see your twitter and facebook posts on the subject before I risk my life to intubate you. I am all for reopening even though it will inevitably increase some deaths, but it's the morons that are needlessly being idiots that are going to screw it up for everyone and kill even more people needlessly wear a GD mask
  10. To the "Cuomo is a murderer" crowd - there is something like 1.4 million people in nursing homes and around 900K total hospital beds. It's unsustainable for hospitals to just keep nursing home covid patients in the hospital because the nursing home doesn't want them back My understanding of the Cuomo directive is that nursing homes have to take covid patients back if the attending physician deems them stable to go back. That could potentially include patients who maybe are sick but are made hospice, comfort measures only, etc but there is no longer any acute care needs. It could also include asymptomatic patients with a positive test that the nursing home just doesn't want to deal with. I would love love love a directive that I can force a nursing home to take patients back if they are stable forever, not just for covid. That way when the night shift sends some demented patient to my ER after they throw a tray or something, and either outright refuse or won't answer the phone from the ER (they do that) I don't have to admit the patient uselessly, especially when to send patient to another facility requires a 72 hour stay per medicare rules This whole criticism is so stupid it has to be some right wing talking point people are parroting, No sane person with acute care hospital experience would ever be upset about this directive either during corona or not, people arguing this are just jumping on the latest political shiny ball
  11. Even Pre-Covid, nursing homes are notorious for dumping patients into the ER. They do this for all sorts of reasons. Low staffing, they are scared to deal with a problem, perceived behavioral problems, difficult family, I’ve heard all these numerous times and many more. I get patients transferred from nursing homes that are in hospice, literally DNR “comfort care only” papers in the chart, patient has trouble breathing and they call an ambulance anyway. I’ve had patients discharged from the hospital and the patient has perhaps dementia, patient get confused and mad and throws a tray, they call 911 after they have been there three hours and say they won’t take the patient back. I’ve had stories that were far more ridiculous than these. I’ve learned to pick my battles, I typically can’t change their minds even by yelling at them so wind up just readmitting them for placement somewhere else in a few days. With Covid, the new thing was refusing to take the patient back for “staff or other resident safety”. Early on, if the patient had a positive test, even asymptomatic the nursing home would call 911 and then refuse to take the patient back. So now we are going to admit these people to an active care hospital for 14 days even if they aren’t sick and don’t get sick? What a waste of $$$ Complex situation and surely all locally variable/ dependent as well I’m giving my experience over 20 years Bizarre to call this murder when i suspect you know nothing of any of these issues and I assume aren’t in healthcare or at least direct patient care
  12. Nah. It was a pretty average flu season in Vegas. And vegas ER volumes were average in january / february overall. I think it's a major stretch to say covid "swept though" CES. There is speculation in the media, but SNHD has never said anything close to that statement to my knowledge. There was report of flu like illnesses, but that isn't unusual for a convention with 180K people from all over the world in january. Some people have positive antibodies that attended, but no one has proved to my knowledge that any active covid cases came directly from CES. There was no spike of ER visits 10-14 days later and even though the vast majorities of attendees are from out of town, you would still expect an influx of employees and exposed locals in such a scenerio.
  13. I'm one of the people that signs death certificates and you are just plain wrong about almost every word here
  14. I have mixed feelings about opening up. I have seen an uptick over the last week in cases, but that's anecdotal. On the other hand, I don''t think it's practical to stay totally closed indefinitely for economic reasons. If more people come in, I'll treat 'em. If the numbers go up, we increase staffing. The PPE situation is far from ideal, but it is better than it was. But i say this as a front line doc, not as a public health official. The rush to open is clearly going to kill tens of thousands of people. That's not politics, just facts. The two things that infuriate me is first - the anti-mask crusaders - the masks in public protect other people, not so much you. But if everyone wears a mask, then everyone is much better protected. I mean, we are all in this together. The pictures of nutjobs with the AR-15s don't infuriate me because they are right wing nutjobs. They infuriate me because they stand in front of police without a mask yelling at them, endangering their lives. Then they stand around for hours protesting together not wearing a mask because american excellence is their protection or some other misguided idiocy.. The second thing is that when these ###-hats come to my ER in 2 weeks I have a small risk to my life intubating them, for a dumb choice they made. I frankly never considered that aspect too much, in that it's a part of what I signed up for becoming a doctor, but I had to admit one of my friends and ICU doctor colleagues to his own ICU two nights ago and I'm still depressed about it and frankly a little bit anxious about it happening to me too
  15. Really hard to say - depends how you define "serious medical condition". Example: I used to see several people a shift with vomiting / diarrhea. When they come in, i can give fluids and meds and make them feel massively better in a couple hours. The vast majority of these patients would eventually feel ok in a couple days if they hadn't come in. Are these visits "unnecessary"? I don't know, depends how you look at it. Going to work next day vs having to call in for 2 days? That's huge to people who live paycheck to paycheck. I guess they could have gone to an urgent care, but frankly urgent cares can sometimes be really bad, I get a lot of bounceback misses from urgent cares. A small % of these dehydrated patients have kidney failure and need to be admitted. Presumably those people are still coming in eventually, because they aren't recovering at home. Presumably some of the people I see early in the illness have their kidney failure prevented by me giving them fluids. The earlier these people are hydrated the quicker they recover in the hospital So bottom line, is I'm just pointing out that it's really a complex question that you are asking. That said, a stab in the dark is 25%? I've had at least 2 or 3 people who died of non-covid issues that I think would have lived if they came in earlier. I don't follow up on the charts or hear the outcome of everyone I admit, so I'm sure the real number is much higher. They might be part of the excess deaths that everyone is arguing about (with no actual factual knowledge btw) in the other thread What I do reject categorically is the crazy right wingers arguing that nursing home people who die of covid shouldn't count because "they would have died soon anyway". What a ridiculous heartless argument