Coronavirus thread

[Nephrology]

Michigan did a pretty good job at planning 10 years ago when they built their Children’s Hospital and designed a 30-bed, expandable RICU for pandemics that opened for the first time from March to May. I’m literally listening to the virtual hospital townhall regarding the institution’s COVID response as I type this. I full expect to be manning the RICU by November since it’s run by my division and will probably be sending my family back to our permanent home.

Despite what I wrote above, I still fall in the camp that some degree of economic re-opening is needed to prevent secondary morbidity/mortality from social distancing (undiagnosed conditions, suicides, substance abuse, etc.). However, titrating the right amount of economic activity with strain on the healthcare system is going to be very difficult on a national level for the next 1-2 years which is my estimation for how long this pandemic is going to last. Every municipality is different and can tolerate varying degrees of reopening. Moreover, I remain unconvinced that universal facial masking is doing much to slow this pandemic. This is especially true when it comes to cloth masks that are likely being worn for days without proper washing (N95s that are worn for up to 8 hours are another story).

Ultimately, I think that we need some very creative ways at caring for the COVID patients while minimizing the impact on hospitals that need to be able to maintain steady surgical revenue streams and address the other myriad of conditions that are not going to take a break. Most medical centers experienced negative margins for FYI20 that ended in June, and another year of losses due to COVID will devastate some of the marginally performing centers. One idea is to use the roughly 20K VA medical center beds as COVID care centers since they often affiliated with nearby academic medical centers and duplicate services that are already provided by civilian centers (often with better outcomes). However, we need to start planning these contingencies NOW since any major initiate will require massive staffing shifts. Otherwise, hospitals can expect to hemorrhage $3M/day for the entire Fall and Winter like they did for a couple of months this past Spring.

Yeah, I don't really have any sense as to what is the right thing to do. My institution is taking a big hit for certain. I know our pulmonary division's loss will be less than originally forecast but it will still be relatively significant, and pulm/crit care here has been very creative at capturing RVUs in the COVID era.

I'm also in touch with my CT anesthesia preceptor and she says volume has been picking up again, but suffice to say that her dept (plus entire dept of surgery) is hurting pretty bad. They've moved a lot of the lower ASA cases from our flagship out to satellite surgicenters which has helped but there are obvious limitations to that strategy, particularly for units like CT surgery/gas.

On the bright side our flagship hospital MICU did a very good job with management of these patients. IIRC mortality rates for ventilated COVID+/PUI was ~30%. Not sure if that has changed over time.

[Nephrology]

So I finally found some articles detailing the DARPA/USAMRIID project to create an ultra-rapid pipeline for vaccine development. I met James Crowe in 2018 and he talked about this fairly extensively, suggesting that his lab was able to go from pathogen sample to vaccine in about 6 months. This pipeline has obviously been activated. Wonder if this is why we are already at Phase 3 trials.

https://news.vumc.org/2019/07/09/van...science-prize/

https://www.twistbioscience.com/blog...ctious-disease

A recent (Jan 2020) interview with Crowe can be found here. More recent (April 2020) here.

He was kind of an asshole, not going to lie.... but at least he's our asshole

[UNM1136]

Due to a lack of patient visits generating revenue my wife's outpatient clinic put all staff to half time for the last month. If they wanted to maintain their income levels for the month they needed to use their accrued paid time off. Now our 25th anniversary trip is off until she accrues more time off. She is also unconvinced of the usefullness of the masks currently being used and the manner in which they are used. But this week the head of the CDC said that if we all wear masks for the next eight weeks or so the virus will be gone...so there is that....

In my state her royal highness the governor has moved the goal posts from flattening the curve so the hospitals are not overwhelmed to keeping things locked up until the infection rate is down by some amount only she knows. Hospitalizations and deaths are both down, but the infection rate is climbing. We have just over 2 million people, and small business are falling like flies. We are traditionally one of the poorest states, and counties with single digit covid cases are shut down just as thoroughly as the national hotspot 2 hours west of me. The state is revoking the business licenses of restaurants who allow people to dine in and have been following the state's guidelines until Monday when permission to dine in was revoked. The mayor of a nearby town was fined $5,000 for his 4th of July protest that looked like a parade. All guidelines were followed, and it was called a protest because her highness (who is special enough she does't have to follow the rules regarding hair appointments and having non-essential businesses open up so so she can make purchases when the rest of the state was shut down) warned all the state that they could not have parades. Just weeks after she commended the non mask wearing, non social distancing, gathering in groups greater than 10 protesters for their courage in standing up against systemic racism and social justice. Who gathered and paraded through the streets for hours at a time.

Very frustrating. I am having to field calls from busibodies who want to call and report my officers for not wearing masks while driving around in thier units. And I have staff at a local hospital calling 911 for violent people that need to be sorted out, but rather than letting us get on with the call for service, they complain because we don't stop at the checkpoints for screening. While responding to thier facility's call for help.

pat

[Nephrology]

And I have staff at a local hospital calling 911 for violent people that need to be sorted out, but rather than letting us get on with the call for service, they complain because we don't stop at the checkpoints for screening. While responding to thier facility's call for help.

pat

That's really dumb. Continue to ignore them. It's not like you're going to just stand outside and wait in if your temp reads high.

Hospitals employ a pretty surprising number of useless people, sounds like you're getting to know them.

[ccmdfd]

Finally saw my first post-covid pneumonia patient yesterday.

In her mid-40's, no co-morbid conditions, was hospitalized at a small community hospital back in early April for 1 week. No ICU or ventilation.

Still not fully recovered in terms of symptoms, x-ray, and pulmonary function testing.

Will have to keep an eye on her.

[Nephrology]

Finally saw my first post-covid pneumonia patient yesterday.

In her mid-40's, no co-morbid conditions, was hospitalized at a small community hospital back in early April for 1 week. No ICU or ventilation.

Still not fully recovered in terms of symptoms, x-ray, and pulmonary function testing.

Will have to keep an eye on her.

Any persistent symptoms besides SOB? Assuming PFTs were consistent with restrictive lung dz.

Can PM if you prefer.

[ccmdfd]

Any persistent symptoms besides SOB? Assuming PFTs were consistent with restrictive lung dz.

Can PM if you prefer.

Primarily SOB, but also some generalized feeling poorly, weak, tired, etc.

Yes, restrictive pattern, and a CT with mixed alveolar and interstitial markings.

[David S.]

I'm wholly unqualified to offer an opinion. This is just an observation I heard on The Survival Podcast that seems to hold up.

There seems to be a 6 - 8 week cycle of this running through a region, then it peters out. Italy, Sweden and New York, for instance, all took very different protective measures, but the cycle seems fairly consistent.

CA, TX, GA, ID and FL all seem to be about three or four weeks into their cycle. AZ looks to be about 6 weeks in. If the cycle holds true, they should be done with it in the next week or two.

[Borderland]

I'm wholly unqualified to offer an opinion. This is just an observation I heard on The Survival Podcast that seems to hold up.

There seems to be a 6 - 8 week cycle of this running through a region, then it peters out. Italy, Sweden and New York, for instance, all took very different protective measures, but the cycle seems fairly consistent.

CA, TX, GA, ID and FL all seem to be about three or four weeks into their cycle. AZ looks to be about 6 weeks in. If the cycle holds true, they should be done with it in the next week or two.

It may cycle but it returns. It started here, almost flat lined middle of Apr thru middle of May. Now we have more new cases than we ever did by 33%.

It doesn't just disappear as the adm has suggested.

[blues]

It may cycle but it returns. It started here, almost flat lined middle of Apr thru middle of May. Now we have more new cases than we ever did by 33%.

It doesn't just disappear as the adm has suggested.

He must've been speaking from the poop deck.