Coronavirus thread

[Aisin Gioro]

This was the Surgeon General on Fox this morning.
I'm sure I have confirmation bias on this subject, but, he gives 4 (?) reasons for not wearing a mask.
I heard.... BS... BS.... BS... Real Reason.

YMMV.

Surgeon General: Data doesn't back up wearing masks in public amid coronavirus pandemic

It's all relative. I was on the phone with a friend in Beijing yesterday, and one of the first things she said was, "I didn't sleep well. I woke up with a bad nightmare...I was on a train, and suddenly I realized that someone had gotten on who wasn't wearing a mask!"

[Glenn E. Meyer]

If you don't mind answering, my significant other asked me yesterday about how Morticians & related handle their job to minimize risk of infection.

I hate to divert but we might need one. Years ago, I was in Sacramento for a small conference. It was held in a crappy hotel across from a mall. The biggest thing to do in Sacramento was to visit the Hazelnut processing plant. I turn on the TV and they are covering a funeral parlor where the staff had been screwing the attractive dead. The sheriff was quote as saying it was damnedest and weirdest thing he ever heard off.

Now back to the horrors of 2020.

[Aisin Gioro]

From the above, sounds like you have a real leadership problem in the medical field. You have managers at a time when you need leaders.

These days, most people who are running your hospitals and clinics have MBAs, not MDs.

“Unhappy is the land that breeds no hero.”

"No, Andrea: 'Unhappy is the land that needs a hero.'"

One of the worst things that can happen in a medical organization is taking leadership away from actual medical practitioners (or former practitioners) and replacing it with management by governmental or corporate bureaucrats. Unfortunately, that's exactly what happens almost everywhere.

[Aisin Gioro]

Everyone is touting South Korea, but they haven't reached the other side either. Are we going to see a massive reinfection in South Korea?

Korea has been able to manage their outbreak largely without major stay-home orders, mostly because of their approach from the very beginning. As soon as their first case was detected, they instituted a very aggressive, wide-spread testing programme and combined it with equally (or even more) aggressive contact tracing and very strict isolation of potential contacts. That's one reason they were so ferocious about the Shincheonji religious sect, threatening murder charges when the leaders didn't comply quickly and completely with information about members and activities. Those protocols also combine with a cultural system that prioritizes an obligation to group safety over personal discretion. For example, while US officials worry about whether people will find ways to circumvent stay-home orders, or institute them gradually to avoid public backlash, in Korea just the "request" to limit contact/avoid large groups/keep distance carried with it a strong implicit message that people who don't are violating a strong social contract. In a society where extrinsic motivations are valued more than intrinsic ones, that can be very effective.

The system is a bit ad-hoc, but came together fast. For example, they collate phone GPS tracking, credit/bank card use location data, public and private surveillance camera footage, and tracking APPs. Some of it wouldn't be culturally applicable in Western countries, and frankly most of it I would feel very uncomfortable with since it has strongly negative implications for privacy, domestic intelligence gathering, and personal disclosure. While I can't really endorse all of their methods for those reasons, in practical terms it has been very effective.

[Nephrology]

Yeah I have been following two different modeling sights and the difference is 10X in hospital beds and deaths.

A lot of the modeling is a moving target so I wouldn't place a ton of faith in any one graph or forecast, but it is important to keep abreast of what people are saying to have a gestalt of the current consensus view. JAMANetwork has a lot of good material on their Covid page thats helped give me context to the forecasts, esp. the interviews with SMEs.

[Dr_Thanatos]

If you don't mind answering, my significant other asked me yesterday about how Morticians & related handle their job to minimize risk of infection.

I've known couple of morticians but never talked to them about that specifically and am out of touch with them nowadays. I realize a living person is far more infectious, but beyond that and assuming you use similar PPE as doctors/nurses not sure what you do to minimize risk.

I've also heard some crazy stories from a medical examiner/coroner that was a classmate in forensic anthropology, I was an Anthropology major with Criminology focus & he was there just for the forensic class as it related to his job. I made a point to be in small group with him for that class.

Two of my Anthropology profs there did Forensic Anthropology for the State when needed, and they knew all the other State level forensic specialist (Entomologists, Facial reconstruction from skulls, as well as the State Cops that investigated and coordinated with outside Forensic experts) and had all those other experts do lectures for Anthropology students & others interested.

The funeral homes have their own set of guidelines for how to embalm positive patients. Traditionally, they have eschewed PPE during that process, they are embracing more PPE now. Depending on what procedures they are doing, they may have risk, they may not. Many are recommending direct cremation with a funeral at a later time. I can't speak to their procedures much more than that.

For our field (Medicolegal Death Investigation e.g. Medical Examiners/Coroners), we are exposed to the same set of risks as other doctors. When our death investigators respond to a scene, they are interacting with family or roommates who have been sharing living conditions with the decedents. Additionally, the environment is contaminated. Once we are in the morgue, much of our processes involve aerosolizing blood and bone dust during the examination. We do use similar PPE as the hospital staff. We see all sorts of nasty diseases that we can catch from the decedents. When possible, we are trying to diminish the procedures required. However, it hasn't changed much of our routine business. The COVID cases are in addition to our usual work.

As a Italian physician said, you don't go into medicine if you are afraid of getting sick.

[AKDoug]

The difference is one is homicide while the other is death from natural causes.

Inverting that same philosophical exercise, why do we allow drinking, smoking, & junk-food eating? Far more than 1,000 a day die from these preventable deaths.

You could say those vices usually only kill those engaged in the activity, but what about private transportation? Why not do away with automobiles and rely on trains, trolleys, & other forms of more sustainable forms of public transportation? You'd save thousands of lives from auto crashes, many of those deaths not the fault of the driver. And you'd also prevent pollution related deaths both from poor local air quality and climate change.

Which do you value more, individual freedom or collective security?

Thanks, @0ddl0t, that pretty much covers my response. I've been a little busy today to respond. Back to work for me.

[Paul D]

Thanks, man. Our org, just like many others, says don't use them during routine on-campus activities. They made our PSRs to remove the masks, assholes. The party line is to stay as "a united front", everyone does the same thing.

Myself and most of our partners are wearing the surg masks anyway. Easily 80% of our patients are high risk for bad COVID outcomes. Not one person so far dared to say anything. I wanna see them try.

That blows man! On our hospital campus, everybody is told to wear a mask. All nurses are to come in with their street clothes, get into hospital scrubs, work, and leave them in the hospital hamper when leaving. No going home in 'dirty' scrubs or coming to work in personal scrubs. I issue all of my echo techs a N95 mask daily (I tell them to wear a mask over them to minimize contamination of the face of the mask) and to save them even though they will get a new one the next day. All respiratory techs in the the ICU have space suits that a electric powered air filter. So far everything has been pretty quiet. We normally have 200 patients in our hospital on a busy day. Currently we have 150 because we have been clearing out anybody who doesn't need to be hospitalized. I have even made agreements with my competitor cardiologists to cover each other if we start going down with illness or quarantine (and I hate those guys!!! --- strange bedfellows, et al) According to our calculations, the COVID barbarians will at our gates en mass over the next 2-3 weeks.

[Stephanie B]

[I]One of the worst things that can happen in a medical organization is taking leadership away from actual medical practitioners (or former practitioners) and replacing it with management by governmental or corporate bureaucrats. Unfortunately, that's exactly what happens almost everywhere.

The same thing basically happened to Boeing, with the results that we now see.

[Dov]

The funeral homes have their own set of guidelines for how to embalm positive patients. Traditionally, they have eschewed PPE during that process, they are embracing more PPE now. Depending on what procedures they are doing, they may have risk, they may not. Many are recommending direct cremation with a funeral at a later time. I can't speak to their procedures much more than that.

For our field (Medicolegal Death Investigation e.g. Medical Examiners/Coroners), we are exposed to the same set of risks as other doctors. When our death investigators respond to a scene, they are interacting with family or roommates who have been sharing living conditions with the decedents. Additionally, the environment is contaminated. Once we are in the morgue, much of our processes involve aerosolizing blood and bone dust during the examination. We do use similar PPE as the hospital staff. We see all sorts of nasty diseases that we can catch from the decedents. When possible, we are trying to diminish the procedures required. However, it hasn't changed much of our routine business. The COVID cases are in addition to our usual work.

As a Italian physician said, you don't go into medicine if you are afraid of getting sick.

Thanks for the quick response!