Cool County...eesh.Originally Posted by YVK
It has been 20 years for me as well, but you don’t easily forget thousands of hours managing vents for trauma, burns, acute pancreatitis and all the other surgical ICU disasters You get during training. I listened to a podcast in management of ARDS recently. Not a heck of a lot has changed at least on the vent side of things.
9pm 3/28/2020 https://www.worldometers.info/coronavirus/
With my hospital cutting out various levels of elective surgery, we have quite a few anesthesiologists not working much and that's just at my facility. Around the Phoenix area we have DOZENS of surgery centers that aren't really operating now, so hopefully those facilities' ventilators, along with hundreds of anesthesiologists, will be able to help keep some kind of lid on our forthcoming shitstorm.
That was absolutely gut-wrenching. Lot of healthcare workers going to be, or are already are, going through the kinds of horror and stress generally only encountered on battlefields. I'm guessing psych degrees are going to be paying out handsomely for their recipients for years to come.
Yep, at the eventual end to this, the front line staff will be needing assistance, while the CEOs and middle management types will get the bonuses and accolades.
(I'm just a little jaded)
cc
NYC is spiraling out of control. Not just the medical infrastructure, either...4000 of New York's finest are either sick or quarantined, from what I'm hearing.
I don't think I'm an alarmist sort of dude and I try to not pass speculation in these sort of things, but I think it's entirely possible that martial law could be declared in NYC within the next two weeks; at the very least, some sort of "enhanced military presence", if you will.
ETA: It blows my mind that anyone could possibly still think this is an over-hyped virus, or "it's just the flu."
Last edited by TGS; 03-28-2020 at 11:12 PM.
"Are you ready? Okay. Let's roll."- Last words of Todd Beamer
More evidence of fuckery afoot in China
https://time.com/5811222/wuhan-coronavirus-death-toll/There were 56,007 cremations in Wuhan in the fourth quarter of 2019, according to data from the city’s civil affairs agency. The number of cremations was 1,583 higher than those in the fourth quarter of 2018 and 2,231 higher than the fourth quarter of 2017.
This seems to be a pretty thorough and objective collection and review of the Chloroquine developments. Working hypothesis:
https://docs.google.com/document/d/1...Gs/mobilebasictreating early to prevent admission is better than treating late at admission in selected high risk patients, or patients who are very symptomatic, or some subset of patients yet to be determined, or all patients with favorable benefit/risk ratios. Like HIV, or cancer, or appendicitis, or pneumonia, or influenza, or almost any other viral infection, early treatment is better. Prevent cytokine cascade and superinfections with pneumonia? Stop viral reproduction early? Stop shedding early? Decrease R0 value? Outpatient doctors will discover HCQ/chloroquine works anecdotally before inpatient doctors/hospitalists, and then studies will come out over the next few weeks.
Something to consider: EKG prior to and after HCQ and azithromycin treatment. But is QT prolongation risk and other medicine risks risker than the potential complications from the illness, and riskier than the benefit to potentially for decrease viral shedding and cutting the spread down, and the resultant devastation to the economy? Check LFT and BMP and potassium if patient dips into hypokalemia (very common apparently), high dose ascorbate (vitamin C).
https://www.nytimes.com/2020/03/28/n...PmdHBRoelmHvy0
N.Y.C.’s 911 System Is Overwhelmed. ‘I’m Terrified,’ a Paramedic Says.
With coronavirus cases mounting, emergency workers are making life-or-death decisions about who goes to a hospital, and who is left behind.
“I’m terrified,” said Mr. Suarez, who has been a paramedic in New York City for 26 years and had assisted in rescue efforts during the Sept. 11, 2001, terror attacks and later served in the Iraq war. “I honestly don’t know if I’m going to survive. I’m terrified of what I’ve already possibly brought home.”
Even as hospitals across New York become inundated with coronavirus cases, some patients are being left behind in their homes because the health care system cannot handle them all, according to dozens of interviews with paramedics, New York Fire Department officials and union representatives, as well as city data.
In a matter of days, the city’s 911 system has been overwhelmed by calls for medical distress apparently related to the virus. Typically, the system sees about 4,000 Emergency Medical Services calls a day.
On Thursday, dispatchers took more than 7,000 calls — a volume not seen since the Sept. 11 attacks. The record for amount of calls in a day was broken three times in the last week.
Because of the volume, emergency medical workers are making life-or-death decisions about who is sick enough to take to crowded emergency rooms and who appears well enough to leave behind. They are assessing on scene which patients should receive time-consuming measures like CPR and intubation, and which patients are too far gone to save.
I have absolutely no doubt there is monumental fuckery going on in Wuhan/Hubei, though the city statistics the article links to don't actually support it. They cite the increase in cremations (which are essentially mandatory in Chinese cities, due to the population density) for Q4 2019 compared to the past few years, but Wuhan has been a relatively fast-growing city during that time. Also, the elderly population has increased significantly in that area as rural people moved in, prospered, and a few years later were able to bring their parents in from the countryside (a common practice in China). For example, in the same city stats, it shows that the number of people in the city receiving pensions roughly similar to US Social Security rose almost 7.25% in just the past year, which would significantly influence the number of cremations, since more elderly = higher mortality among the population. If anything the rate of increase in cremations has been lagging the population growth and demographics, probably in part because, before this, Wuhan had an improving quality of life for a while.
HOWEVER, the deliveries of new urns right now and the scale of those is pretty suspicious. While I'm sure some of that is due to delayed processing during the lockdown and the fact that it's being relaxed now, my thinking is that the jump in quantities is only part of the actual "cremation curve", so to speak. It's pretty certain that the crematoriums in Wuhan/Hubei were running at and over capacity for weeks during the worst of the outbreak, so my guess is that they were also stacking bodies aside for cremation later. They probably don't represent earlier deaths from late 2019-early 2020, but it's very likely the worst days were much, much worse than reported, and that it lasted longer.
China's original plan was to re-open schools around the first of April, but it required 14 days of no new cases first. Well, wouldn't you just know...new cases started dropping rapidly three weeks before, and by 14 days before, we were starting to see "no new local cases". Perhaps significantly though, now school is not going to open at the first of April, even in provinces that were not badly affected, such as Yunnan. That tells me the government knows full well that the "no new cases" line is false. They don't want to admit that publicly, but they also don't want the risk of opening schools, so they are sticking with the official line while doing something completely different (which is pretty common in China..."You must understand, facts are different here".)
Aviation is not an area where I have contacts, but I did talk to the only well-placed person I know in civil aviation in China (who also flew in the US) to no avail. They said they would ask around and get back to me if anything changed, but at this point, there is just nothing they can do.
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