Day care is open? We're looking at like, maybe summer camp...Originally Posted by Grey
Day care is open? We're looking at like, maybe summer camp...
Mine currently is but I havent been sending my son since this all kicked off...
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And back then they didn’t even know what was “necessary”. I also should have written “tested *sick staff”. Not just any staff. They had it bad. I really need to start proof reading; sorry about that. Trying to get all my coworkers dates for when they started feeling sick and when they had the blood drawn. I’ll post it when I have a few.
You wouldn’t by chance happen to be a Christian Scientist, would you?
Some may remember about 25 or 30 years ago the doctors went on strike in parts of California. During this time the death rate declined. Perhaps an interested member can dig up the details.
{Sigh} And here I am, out of popcorn.
If we have to march off into the next world, let us walk there on the bodies of our enemies.
There's been another hypothesis, which is that darker skin, produces vitamin D when exposed to sunlight at lower rates roughly correlating to the darkness. Vitamin D is important for immune system function. Lighter skin produces more, which is one of maybe a handful of known evolutionary advantages, and why it tends to be seen in peoples whose recent (thousands of years) ancestors did their evolving in places with less sunlight.
Not saying it's an either/or, but that there may be at least one real factor that is significant and has nothing to do with cultural issues.
Any of our MDs here have information to support or reject this hypothesis?
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Not another dime.
Just finished another week. The unit was almost half census last week. Don't know what the fuck happened (probably the nicer weather driving people outside) but we filled all the way up a few days ago and I am reminded just how ill these patients can get.
Interestingly enough, our intensivists have stopped using hydroxychloroquine after some research they've read has shown it as being same as placebo. Any word on that @Nephrology? Remdesivir is a no go as well. There is some rumbling in the medical field that Gilead knew this.
So we're back to basically Tocilizumab and convalescent plasma. And good luck getting any plasma.
I am getting stir crazy not being able to make it to BJJ.
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So far all of the HCQ data I've read is negative, and anecdotes from here suggest potential for harm (mostly cardiac disrhythmia). Re: Remdesivir, I haven't had the time to really dive into the studies, but the most recent big Gilead sponsored trial was nominally positive. It seems like it probably works at least as well as Tamiflu (lol), but certainly is very far from a silver bullet.
They moved the ID tx algorithm onto a different server I don't have access to, but our ICU Teams page the most recent Tx guidelines suggest that HCQ is no longer SOP for tubed patients. Seems that providers are encouraged to enroll patients in ongoing clinical trials (includes HCQ and remdesivir among others), and that their use outside of clinical studies should be limited to those with severe hypoxemia (eg, ETT'd or on the way) or those who meet exclusion criteria for sponsored trials (eg Hx of transplant, malignancy, ESRD/ESLD).
Our institution seems to be handling these patients pretty well in general. On our divisional call yesterday, the chair suggested that while the virus was novel and different, he feels that clinically it isn't so different from good old fashioned ARDS as we thought. Seemed to imply to me that antiviral therapy wasn't really a big part of our success so far, and that most of it comes down to good interdisciplinary ICU management. Also, in more good news, we decannulated 4 people on ECMO last week - down to 2 on circuit from 6. Assuming they were decannulated for step down, not d/c to Jesus.... but they didn't specify either way so 🤷
Speaking of which, here are our university system numbers as of yesterday. A little concerned by the trajectory given that shelter in place order is set to expire on Monday. edit: for context, the graph with the different colored lines is just our big brand name university hospital, not system wide.
The study you refer to has been very thoroughly refuted, many, many times. It was pretty clearly a puff piece.
Last edited by Nephrology; 05-02-2020 at 02:12 PM.
Scott Gottlieb's twitter feed is not encouraging regarding this. NJ/NYC/CT cases are dropping (good), but since they make up the bulk of US cases, the national plateau is misleading. When you exclude the tri-state area data, we are getting worse, not better.
He has great insight and has shown to be very prescient.
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