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*** OFFICIAL *** COVID-19 CoronaVirus Thread. Fresh epidemic fears as child pneumonia cases surge in Europe after China outbreak. NOW in USA (13 Viewers)

I’m a long time reader, but have rarely (if ever?) taken the time to write in. I’m an emergency physician at a hospital in the Bay Area … Perhaps this is all common knowledge and not informative – but I find the disconnect between what I see at work and in the news disconcerting so figured I’d add my two cents.

Everyone I work with seems resigned to a sense of impending doom, and an expectation that we will all be infected in the weeks ahead, and that we have no alternative course of action without abandoning our patients.

Many coworkers live with their parents, immunocompromised family members, etc, and are terrified about what they will do when they get sick. Live in a call room? stay in a hotel? not go home for 2 months? We’re slowly changing our operations, adding staffing, infectious screeners, etc – but there is organizational resistance to make the big changes that are already necessary. Despite near-daily reports from Italy of WWII-era triage decisions, shortages of key equipment, PPE, etc – we are still operating as if we can add a couple shifts to the schedule and otherwise operate normally. We’re not isolating URI patients from other patients in the waiting room, nor keeping them out of the “clean” areas of the hospital. We still have zero ability to test anyone who isn’t critically ill. We’re still using PPE for individual patients, discarding it, then using a new set for every patient. This would obviously be appropriate under any other circumstances, however we have recently been told that we will run out of PPE, most likely masks, within several days. Colleagues in the NYC area report that in the last few days there has been a surge of ill ARDS/covid patients, including one facility which intubated 5 of these patients in a single 12 hour stretch. In addition they have been told only to wear masks if intubating because of shortages … Reports from China suggest Covid patients typically require ventilators for 2+ weeks before improving.

There are reports coming out of South Bay that hospitals there are inundated in covid patients – but everything is being kept hush-hush for no discernible reason. All the staff I work with (MD, RN, tech, etc) are quite certain that we are headed for a catastrophe of somewhat epic proportions. Some people in the news have been saying we can do it better than Italy – I think the opposite is likely true. We have less beds per capita than any other industrialized society, and a completely inadequate number of ventilators, prone beds, ECMO circuits, perfusionists, etc for the wave that seems to be coming. We have a population that is half-heartedly pursuing social distancing measures, and no capacity to truly isolate the infected (home quarantine is a joke. the majority of the cases in China were transmitted via family clusters). We have national leadership that is both arrogant, incompetent, and seemingly determined to pursue political advantage regardless of the price to the nation. There will be some extremely difficult decisions ahead for our leaders, and I have less than zero faith they will be able to nimbly guide us out of a crisis.

We are used to dealing with regional disasters in the US: hurricane in NO: send aid from the rest of the country. Fires in CA: send in firefighters from the other regions. We haven’t faced a crisis that occurs in every state simultaneously since…? WWII?
I think our leaders, health departments, hospitals, emergency managers, etc have grown complacent that any shortcoming will be resolved when the cavalry arrives in the form of a federal/national response. In this case I think there will be very limited reinforcement. This will hit WA, northern CA, and NY first, then the rest of the country will follow within 2-4 weeks due to the lack of testing capability and governmental inaction. I find myself daily wondering how we have had a less effective public health response than China, South Korea, New Zealand, Italy, etc. Our persistent lack of testing capability is incomprehensible, crippling, and infuriating at this stage of the crisis.

I’ve cared for loads of patients in situations that were plenty scary. I don’t think I’ve ever been as scared for myself, my colleagues, my neighbors, and our country as a whole.

Sorry if this is a bit scattershot, lots of long shifts this past week with not enough sleep – and the wave hasn’t even hit yet.
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For whatever you think it's worth.  It's anonymous reader mail from Talking Points Memo.

 
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AAABatteries said:
Someone explained very well why keeping schools opened for another day or two made sense - I see no possible explanation for why Disney didn’t close up immediately.
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The easy answer is $ but I am sure there were logistical issues as well.

The question is, do those other issues outweigh having a park full of people during a rapidly escalating pandemic?

 
shuke said:
Ohio governor press conference at 3:00.  Local radio reporting he is shutting down bars and restaurants.  Could be rumor though 
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New Orleans mayor Latoya Cantrell is addressing the media at 3:00 CDT. She's imposing some new restrictions, unknown to me what they'll be, though. Really need to start showing tourists the door, get the locals out of the bars, and end business-as-usual for the duration.

EDIT: Oh yeah ... and the cruise ships need to be addressed as well.

 
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AAABatteries said:
Someone explained very well why keeping schools opened for another day or two made sense - I see no possible explanation for why Disney didn’t close up immediately.
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I think it's so they can prepare the kids and staff. Kids are getting packets to take home and some are being set up for lessons on a local tv station like PBS. Also gives a little more time for people who can't stay home to figure out daycare. 

Money is why such businesses aren't shutting down immediately. 

 
AAABatteries said:
Someone explained very well why keeping schools opened for another day or two made sense - I see no possible explanation for why Disney didn’t close up immediately.
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As Wildcat would say:

"I don’t get your take on this.  They're a business owner and trying to earn a living.  Those tourists have a choice to go to the park.  So every business owner should just close?"

 
Anarchy99 said:
If this takes months and months to resolve, what should be done with people / families involved in the businesses? Should creditors be expected to let them miss loan payments because their income was suspended? Should they lose their houses because they can't open? If the businesses are sacrificing their livelihood for the health of others, should others sacrifice financially for the good of businesses? There will be plenty of people that companies can't pay to work from home and the government won't have provisions for. People will lose jobs or businesses will have to close. And if things are still locked down, people won't be able to go out and get new jobs, and they could lose their health insurance. Does that all fall under the category of OH WELL? Or should they all just file for bankruptcy?
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Yes, much of that falls into the category of "OH WELL". Business as usual is finished for the duration. Yes, a whole slew of hated-by-conservatives social safety nets will have to be put in place. Yes, a bunch of "we can't pay for that!" stuff has to get rammed through. It's all going to be Terra Incognito for folks who have benefited for years from the status quo -- working hard for years and saving your pennies won't end up being sufficient protection from the effects of a pandemic. New rules and new protocols for new times.

 
A friend had a St. Pats party at his house last night. Probably about 25 people. Do it if you want but please don't insult the rest of us with pictures on facebook, all moved in tight for the shot, arm in arm, having a party. Congrats, you are all more brave than the rest of us. So you think.

 
Alex P Keaton said:
Disturbing story from a good friend who lives in Westchester.  His wife became ill on Thursday - fever, sore throat, cough.  He rushed home from work, picked up kids, they are all quarantined at home now.

Scary part - this was his text message about what his experience was with hospitals/govt:

”we called several clinics and hospitals as well as the NY State corona hotline.  The message was the same: we don’t have many test kits.  And those are prioritized for anyone who traveled abroad or who has come in to contact with a known case.  So they told us to just huddle in place and assume that it is coronavirus.”

So many things wrong with the above.  His wife is a nurse, and could easily have been exposed.  How can we trust the official statistics if nobody is being tested?
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If her symptoms are mild and they are self quarantining what's the difference?

 
Rodrigo Duterte said:
[icon] said:
Crawfish boil was relatively small (15 folks) and we took precautions like standing 5-6 feet apart. 
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Sorry, but I can't picture some crawfish boil with everybody standing 6 feet apart from each other.
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Been to a zillion of them down here ... you can fill a backyard with 100+ people at a big boil, yes. Or you can tone it down to a dozen or so (or even less). I can picture what [icon] and crew were doing. You don't have to be cheek-to-cheek.

 
Capella said:
They have to. This country is chock full of stupid people not willing to be reasoned with. 
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Being from OH but living in SC now, I still have a lot friends from OH on FB. One of them posted about DeWine possibly closing down the whole state today and I’m guessing 90% of the responses are “but mah freedom!” People don’t get it, just like the schmuck in KY that refused to isolate after testing positive. 

Personally I think we are past the tipping point but haven’t come to the realization yet because we are so woefully behind in testing  :wall: If you want to come through this you’re going to need to take responsibility for yourself because chances are the numbnutz to either side of you won’t.

 
Weebs210 said:
What are you guys doing if wfh isnt available and your work is not cancelling? I work downtown Houston...
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I actually am expected to go into work over the next week. However, I drive in alone, walk from the parking garage to the office alone, go up the elevator usually alone, etc. I will either be alone in my office or else seated ~10 feet away from someone who won't be facing me. I will bring lunch and eat it alone. Loads of hand cleaning and sanitizing all day long. Basically for me, social distancing on the job will be easy. Even when I go into other offices to talk to co-workers, I kind of keep the 6-foot distance naturally ... now I am 10x as aware of the distance.

 
IvanKaramazov said:
For the past week or so, I've been mostly staying in my office, sitting away from other people in meetings without being weird about it, and washing my hands a lot.  That's easy for me to do because I have a private office and my job doesn't involve a lot of social interaction.  I think people who work in open offices are screwed.
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Yes, pretty much this. A lot depends on the specifics of workplace set-up, frequency and type of interactions with other employees, lunch and breaktime activities, etc.

 
all bars and restaurants deemed closed (take out available) ...just announced by governor of Ohio

starts as of 9pm today EST in Ohio

 
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Weebs210 said:
Yeah I work at a cubical around 3 other people in the same room who think this is a joke and constantly touch their eyes and face and don't wash their hands. The owners ar boomers who would be the ones most likely effected the worst is the ironic part.
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:(

Any way at all you can set up your laptop (or whatever) to work in another part of the floorspace? Unused office, conference room when not in use? If WiFi is available, is there empty, unlocked office space nearby (this is the case at my office -- I use unrented office space on our floor to make private calls sometimes).

 
Doug B said:
:(

Any way at all you can set up your laptop (or whatever) to work in another part of the floorspace? Unused office, conference room when not in use? If WiFi is available, is there empty, unlocked office space nearby (this is the case at my office -- I use unrented office space on our floor to make private calls sometimes).
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Nope I work at a old school investment firm so I only have my desktop.

 
DallasDMac said:
Kudos to our local grocery chain. Changed their hours from 6-11 to 8 to 8 to give them more time to restock shelves overnight. Put limits on everything from soap to TP to eggs and milk. We showed up at 7:45 and the line was around the building already. We heard a lady come out and say there would be no milk, chicken or eggs. So we bolted to WalMart and were able to get eggs and milk (already had meats). Came back to the local grocery store after dropping the WalMart stuff at home and was able to get soap, hand wipes and TP. They are doing well in overcoming irrational panic to distribute what they have smartly. Oh, they also had security on hand in case. I think the longer this goes on, the better these grocers will learn to deal with it.
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Don’t get it. Been sitting in the Walmart parking lot and the closest spot to the front door just filled after 5 minutes. I’m in the 3rd. Lowest and 2, 4, and :5 are open.  Everyone coming out is carrying a bag or two. This may be the least busy a Walmart has ever been

 
Ilov80s said:
I just don't understand why our leaders seem to be so slow on this. I really feel like if you aren't watching on social media, the message isn't really getting out seriously enough. 
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Maybe just my impressions on it all ... but I would also say that "old school" social media, like message board forums, are doing a much better job of aggregating good information than newer social media like Twitter, Facebook, Reddit, etc. Good info can (with effort) be found on all these media, but I think the signal-to-noise ratio is better on a lot of long-standing message boards than it is anywhere else.

 
Doug B said:
Maybe just my impressions on it all ... but I would also say that "old school" social media, like message board forums, are doing a much better job of aggregating good information than newer social media like Twitter, Facebook, Reddit, etc. Good info can (with effort) be found on all these media, but I think the signal-to-noise ratio is better on a lot of long-standing message boards than it is anywhere else.
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I agree and I think it is almost always that way. Twitter is the only new social media that I really use and I thought it has been excellent. Now of course that all depends on who you follow.

 
Patrick Bateman said:
Leadership. https://twitter.com/GovMikeDeWine/status/1239275883560648705?s=20
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I'm in Cleveland area.  People are losing their minds about this situation.  It is going to absolutely crush the economy.  Seems like we either have the folks who believe this is real and we need to make drastic measures or those who believe it is fake news or a conspiracy.  I've heard that this is Trump keeping black people from voting and I've heard that it is a ploy by the WORLD to get Trump out of office.  

I am exhausted.  I can't take it anymore.  Thank God DeWine isn't messing around with this.  I honestly didn't like him but dude will have my vote for anything he ever runs for again. 

 
top dog said:
I'm in Cleveland area.  People are losing their minds about this situation.  It is going to absolutely crush the economy.  Seems like we either have the folks who believe this is real and we need to make drastic measures or those who believe it is fake news or a conspiracy.  I've heard that this is Trump keeping black people from voting and I've heard that it is a ploy by the WORLD to get Trump out of office.  

I am exhausted.  I can't take it anymore.  Thank God DeWine isn't messing around with this.  I honestly didn't like him but dude will have my vote for anything he ever runs for again. 
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It's a tough call, but sometimes you have to save people from themselves. 

 
Weebs210 said:
Nope I work at a old school investment firm so I only have my desktop.
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Dang. Well, if I were in your shoes, I'd stay locked at my desk avoiding co-workers as much as humanly possible given the conditions. Hand sanitzer and/or bathroom trips to handwash after any public touching (coffeepot handles, refrigerator door, random railings, other desks, etc.). Probably would be good for you to bring a bottle of hydrogen peroxide to work, wet a paper towel with it and wipe down you nose and mouth area maybe twice an hour, or anytime someone is close in on your personal space (leaning over to look at something on your computer screen, etc.).

 
BassNBrew said:
Don’t get it. Been sitting in the Walmart parking lot and the closest spot to the front door just filled after 5 minutes. I’m in the 3rd. Lowest and 2, 4, and :5 are open.  Everyone coming out is carrying a bag or two. This may be the least busy a Walmart has ever been
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It's going to be a matter of timing. Maybe the general rush in your area is over? Hard to think it hasn't started yet.

 
culdeus said:
Having to reimagine my garage as a home gym.  Must not let corona stop my gainz.  Thing is if I get this to a certain level what's the protocol for letting others use it?
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I know you are a smart dude with a sizeable knowledge of physiology from our discussions in the Otis diet thread. I struggled with even posting this because I don't want to create panic, based on speculation from someone not even qualified. However...

I've read about cardiomyopathy developing in seemingly recovered patients, which seems to be linked to ACE-2 receptors from the virus.  If it were me, I'd take a hiatus from strenuous physical activity after recovery from a possible infection. And monitor my heart rate periodically over the next several days. Any signs of funky rhythms (resting rate that hits >110, palpitations, etc.) or signs of HF like edema (swelling in feet or hands from fluid overload) and I'd be in getting an EKG in the local ER or Urgent Care ASAP.

Could be I am overreacting, but felt compelled to say something. Glad you're feeling better and GL.

 
jplvr said:
Honestly, I've been one of the more cautious people following this for a couple of months, and I'm heading to the beach this afternoon and planning to eat at a restaurant while there. 
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I feel similarly.  Life must go on, but NOT exactly as it did before.  We need to flatten the curve by make smart choices, much more frequently.  But unless you are in a hotzone I think the prudent thing to do is NOT stop commerce.  Businesses are dependent on sales, people are dependent upon those businesses for $ and healthcare.  If everyone cut back:

  • 70% on going to bars
  • 50% on going to restaurants
  • 50% on mass transit
  • 100% on large social gatherings
it would have a huge impact on the spread, but only a modest impact on the economy.  Everyone can't stop working for a month, that's crazy.  This was my fear as I have been tracking this for 6 weeks:  that we'd do nothing, and then grossly over-react.  Unfortunately the lack of testing has made this problem sig worse than it should have been.  WIth proper testing we'd have been able to do what South Korea did:

  • Outbreak cluster containment (i.e. what is happening in New Rochelle)
  •  Extreme monitoring for slef-quaranting of sick and recent close contacts thereof (i.e. hello Muffley, this is the CDC.  We understand that you met with ____ last week and as he is now Covid positive we'd like you self-quarantine for 14 days.  Along with anyone else in your close orbit.
  • Social distancing (hygiene, elbow bumps, no large gatherings, 3-6 foot distancing at the office, if you can work from home then please do so)


It's a balancing act.  Yes, some will take advantage by not changing at all or deciding to grab cheap flights to Mexico while the rest of us do our part to flatten the curve, but with good federal leadership they should be rightly seen at this time as unamerican.

Anyway, just my 2 cents

 
I think I heard that the state is waiving the normal 1 week waiting period to apply for unemployment benefits ...can you imagine what those offices are going to look like tomorrow?  

CAN YOU IMAGINE!!!!

Fewer taxes being paid and gigantic hits to the benefits programs ...ouch looking forward.  

 
Grace Under Pressure said:
Good for OH. Since those businesses are still doing takeout, if people can socially distance safely and support them by getting takeout I hope they do so. Support locally and safely. 
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I’m more worried about the infected cook than the table 10 feet away. 

top dog said:
I'm in Cleveland area.  People are losing their minds about this situation.  It is going to absolutely crush the economy.  Seems like we either have the folks who believe this is real and we need to make drastic measures or those who believe it is fake news or a conspiracy.  I've heard that this is Trump keeping black people from voting and I've heard that it is a ploy by the WORLD to get Trump out of office.  

I am exhausted.  I can't take it anymore.  Thank God DeWine isn't messing around with this.  I honestly didn't like him but dude will have my vote for anything he ever runs for again. 
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Please keep the politics out of here. There’s another forum to share your love/hate of trump 

 
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