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About Terminalxylem

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  1. Good to know, but I think you are too pessimistic wrt contact tracing. Just like not overloading hospitals, it is an inexact science, but still useful in controlling the pandemic.
  2. Just received an email from a friend of mine. He's a cardiologist, who just happened to take a 6 month sabbatical starting in December. The original plan was to travel through Europe then Asia with his wife and kids. That was quickly short-circuited, so they abbreviated the European segment and hightailed it to Korea (his wife is Korean). Anyway, here is an excerpt from his message: A few things I thought were interesting, reinforcing things we've already touched upon: 1. Korea is way more on top of this than most other place in the world, largely because they have employed tried and truth public health measures like widespread testing and contact tracing. 2. I don't know the age of the student, but I'm sure kids and young people will be playing a significant role in C-19 resurging when schools, bars, clubs reopen...regardless of how mildly it affects them. 3. Because our healthcare system is largely financed by elective procedures, the people who do those procedures are incentivized to do a lot, whether they are needed are not. Cardiac stress tests are a great example. Because they are ordered in low risk patients (where disease prevalence is low, remember Baye's theorem?) a lot of false positives result, followed by unnecessary cardiac catheterizations. Thankfully, there are some good doctors out there, who place their patient's wellbeing above financial gain.
  3. I linked a site which explained it in detail pages ago. In short, many factors influence testing, and probability must be applied to interpret results. While characteristics like sensitivity and specificity are inherent to a given test, positive predictive value (the likelihood a positive result is a true positive, and not a spurious result) is greatly influenced by disease prevalence in the community. If a disease is rare, test specificity must be really high to lessen the likelihood of false positives. We believe Covid is still pretty rare in most communities, maybe 5% or less of any given population has been infected. If that is accurate, a test with 95% specificity (generally considered pretty good) is predicted to yield false positives 50% of the time. You really need a test with 99+% specificity to have results that are believable. Some antibody tests are this good, but many aren’t, so you need to be aware of testing limitations. These ideas apply to all medical tests BTW, and is one reason “VIP care” with unnecessary bloodwork and radiographic studies actually leads to worse outcomes. It’s also one of the risks of practicing defensive medicine, where CYA testing is used as a surrogate for clinical judgement.
  4. When a death certificate is filed, there is a principal cause of death and secondary diagnoses contributing to death. Even though it isn't always immediately obvious, clinicians are encouraged to list specific diagnoses like covid-19, rather than descriptors like cardiopulmonary arrest (ultimately, we all die from this). If your mom contracted SARS-CoV-2 and died of pneumonia/ARDS, COVID-19 would likely be the correct principal cause of her death. Ovarian cancer would be a contributing factor to her death. It becomes less clear if she died of another condition linked to SARS-CoV-2 infection, like stroke, kidney failure or pulmonary embolus. Either way, I seriously doubt clinicians are cooking the books. I wouldn't be surprised if hospital-employed coding specialists are gaming the system a bit, to maximize revenue at the behest of hospital admin. But they don't fill out death certificates. And most importantly, there are far more reasons to believe covid-19 deaths are being undercounted, so I wouldn't lose too much sleep over the prospects of fraudulent death certificates.
  5. Yeah, I should've read to the end of the thread. But even when debunked, the damage from these nonsense stories is already done. Look no further than the anti-vaxxer movement.
  6. Probably a reasonable assumption. Fortunately, orthopedists are among the highest paid sub specialists, so they should be able to weather a downturn in business.
  7. Not surprising. And another specialty whose workload has decreased, with little to no involvement in the actual care of COVID-19 patients.
  8. They certainly are entitled to their opinion, but I'd trust the docs who actually care for these patients during hospitalization: infectious disease, intensivists, hospitalists and ER physicians, in order of descending credibility.
  9. From what I've seen, I don't agree. While NYC never got to the point of Lombardy, providers were still overworked and exhausted. We know people from all walks of life make mistakes when they are tired, including healthcare workers. And PPE was in short supply, so transmission was more likely, both to healthcare providers and the (vulnerable) patients they cared for. Lastly, I wouldn't be surprised if the threshold for futility was lowered in the face of throngs infected with C-19, so standards of care may have been compromised by the crisis.
  10. Kidney damage is common among hospitalized patients, but I've not seen anything suggesting long term kidney damage is so prevalent. At this point, there is really no way to know (too early to be commenting on sequelae among COVID survivors), but I'd be much more concerned about the lungs and heart.
  11. It's great that people are coming around to the mental health crisis in this country. And while they're finding associations, they might want to peruse the data on firearm ownership.
  12. 52/4 = 13. They've seen 13 times the number of attempted suicides? Considering our nationwide shortage of inpatient psych beds, I'm wondering why we aren't seeing articles about overflowing wards? Would you mind providing a source for your statement?
  13. Probably should add: what are the odds I catch it and unknowingly spread it to another person who gets sick? Or more accurately, what are the odds I promote transmission which ultimately harms someone else?