Coronavirus thread

[Nephrology]

For the docs -

An acquaintance is a senior scientist at Abbott Molecular here, she specializes in developing oncology therapies. But, for a few weeks now she’s been talking about a huge initiative at Abbott to deliver a massive number of COVID-19 tests - yesterday she mentioned they were on track to deliver almost 1 *million* tests this week, and sustain that volume indefinitely. Something about FDA fast-tracking this. I don’t know if this was a test developed by Abbott or if they are just being asked to produce it, at one point she mentioned other peer companies were doing the same.

I haven’t heard much about this in the media, have y’all? I would think this could be a game changer.

It depends on what they mean by "kits." There process of testing for COVID19 requires a number of individual reagents of which Abbott would be well poised to develop some of. However, as @pangloss pointed out earlier, one reagent they are very short on are the actual testing swabs themselves, as one of the major manufacturers of these swabs was was based out of Italy.

So it could be helpful depending on what they're making and where they're sending it too. That is why everyone is looking for the federal government to coordinate things and why everyone is mad they are coming up short. Without some kind of centralized attack plan, it's like a soccer game with 6 year olds - everyone is mobbing the ball.

[Tom Duffy]

Our local hospitals (owned by the same company) have banned staff from wearing masks, including their own personally purchased masks, unless they are with a patient because wearing masks "will scare patients and staff."

Needless to say the staff is livid. Extra livid because staff has been exposed to what turned out to be Covid patients with no PPE on two separate occasions.

Very different here. Per the local hospitals' protocol, ANY patient we bring in by ambulance must be masked and gloved, irrespective of their symptoms. At the hospitals I've been to, everyone on the staff is gowned, gloved, and masked.

[OlongJohnson]

Population density is high in NYC. Mass transit is the MO and packed like sardines. ...
It’s entirely possible that the lack of effective mass transit across the majority of this nations cities will be a benefit to slowing spread.

That could be another factor in Italy, which I haven't seen discussed elsewhere. I traveled around northern Italy a little, nearly 20 years ago. Everybody took trains between towns and then did a lot of walking. The road tolls, nevermind the cost of vehicle ownership and fuel, were comparable to traveling the same distance by train. You'd see groups of teenagers taking an hour trip without adult supervision on the trains, no problem, which was actually kinda cool.

[TGS]

I’m hearing reports from basically everyone I know that shit is blowing up in their units. Have multiple friends in MS4 being graduated early to help out (no details on if they’ll get paid or have insurance coverage as graduates which frankly I would insist upon). My sister is an ED RN in Westchester and she says she has never assisted on so many intubations. The small community hospital in my hometown has 26 COVID patients 11 of whom are intubated. Morgues in NYC are already filling up. It’s here.

They're using refrigerated trucks at the loading dock to store the dead for some of the hospitals in NYC.

[Nephrology]

They're using refrigerated trucks at the loading dock to store the dead for some of the hospitals in NYC.

Between this and the nurses wearing trash bags as improv PPE, this honestly feels more like a third world nation than the USA.

@Nephrology, totally off topic and random question, but are the little white dots on the top of your kidney cartoon the adrenal glands? Does a kidney transplant cause problems for the adrenal glands? When I was starting in grad school, I harvested a bunch of adrenal glands from mice because I mistook them for lymph nodes.

Yup, those are the adrenal glands! Honestly not really sure what happens to them with transplant. Never something that's been discussed with me before.

Also, sorry to any/all of you whom have quoted me and I haven't replied to, this thread moves really fast and I'm trying to limit my COVID screen time for the benefit of my mental health.

[Dr_Thanatos]

Yup, those are the adrenal glands! Honestly not really sure what happens to them with transplant. Never something that's been discussed with me before.

Also, sorry to any/all of you whom have quoted me and I haven't replied to, this thread moves really fast and I'm trying to limit my COVID screen time for the benefit of my mental health.

The Adrenals are removed during recovery along with the peri/para-renal adipose tissue. The kidney is not transplanted with the same amount of adipose tissue or it wouldn't fit in the pelvis. The adrenal glands are removed at that point.

[Nephrology]

The Adrenals are removed during recovery along with the peri/para-renal adipose tissue. The kidney is not transplanted with the same amount of adipose tissue or it wouldn't fit in the pelvis. The adrenal glands are removed at that point.

So presumably the native adrenals function independently of native kidneys?

On another note, got this email from my ER preceptor today:



And this was shared with me from a friend doing his residency in radiation oncology in NYS:

Three weeks feels like years when on any given day things change hour to hour. The transformation of our lives and jobs in caring for cancer patients has completely and utterly been remade in ways many of us never imagined. And the situation remains fluid and continuing to change further. It just happens that this is the first time in 3 weeks I have had time to reflect, even a little, on what has transpired.

As of March 25th [HEALTHCARE SYSTEM NAME REDACTED] has diagnosed 4,399 positive COVID-19 patients which is about 20% of NY State and 1.2% of all cases in the world. All cancer surgery was discontinued as of March 20th and all of our 23 hospitals are seeing COVID-19 admissions and ICU care become the primary focus of the entire system. As of today, we have reserved one floor in two hospitals for non-COVID care such as trauma. That's it.

[Dr_Thanatos]

They're using refrigerated trucks at the loading dock to store the dead for some of the hospitals in NYC.

I don't really know how to multi-quote, and now isn't the time to learn.

For hospitals, morgue space is an expensive commodity that only costs money and doesn't recoup it's costs. Unless a large hospital is part of a pathology residency or attached to a medical examiner's office, most of them have very limited morgue space. Everywhere I've worked with hospitals, adding refrigerated trucks to expand morgue capacity has been part of the plan since 2008 when pandemic planning was a thing.

Because it's a pandemic, all of the deaths associated are natural manner. Which means that if the cause of death is known, any physician can sign the death certificate. Some states have a public health mandate to the medical examiner system for public health emergencies, some don't. But even now, we're taking care of the people who didn't go to the hospital and died at home, or died in the ED without testing. Hospitals are signing the admitted patients, which means they have to store them. Funeral homes are not as able to process through cases as fast as normal, so the entire system backs up to the morgue.

[ranger]

They're using refrigerated trucks at the loading dock to store the dead for some of the hospitals in NYC.

I suspect similar things happen when we have unplanned mass casualty events such as tornadoes

[Dr_Thanatos]

So presumably the native adrenals function independently of native kidneys?

Yes. Renal disease doesn't affect the adrenals, unless it's something like pyelo which could feasibly damage an adrenal. But that's why we have two. Physiologic hypertrophy can have one adrenal support the body.

And we don't really have good tech for transplanting endocrine organs.