iramurphy

The epicenter. No reason for any of us in Northern Mn to feel sorry for ourselves. My daughter and family are hunkered down in Mamaronek. Take care of yourself and thanks for what you are doing.

Hang in there

Where in NY are you?

I would hope when we get through this, the Ohio State Board of Medical Examiners reviews the providers who did this. This is egregious. Worse than hoarding TP.

I would think reasonable to try in known cases. We will have the crazy TP hoarders crawling out of their bomb shelters demanding prescriptions “just in case”. It should be saved for hospitalized patients until we gather more information. Keep us posted on your experience.

3 sport HS athlete who got into the weight room. Good example for kids who want to play college hockey. Studies show the kids who play one sport year round have more injuries and peak earlier.

I believe the rest of the story is that that department was combined with 2 others in a cost cutting efficiency move to improve collaboration and efficiency. Some said it accomplished that. So the Pandemic and Bioterrism group is still around. I’m not defending Trump no condemning him. There are scientists and medical experts advising this administration and have been. The other misinformation passed on by some is the claim that the US refused test kits. The WHO didn’t offer. I’m not sure I understand the need for some to assign blame in the middle of a crisis. I’ve seen these people while preparing to go into combat as we learned of deficiencies and lack of supplies and equipment. I’ve seen them as an emergency room physician dealing with mass casualties. Those folks become part of the problem rather than part of the solution. Sometimes you want them to understand they need to get the hell out of the way and let others do their job as best we can. There will be time later to point fingers and assign blame. There will be plenty of blame to go around. When the time comes we can reflect on what we did to help or we can talk to other like minded folks about how we whined and criticized every step of the way. Which group do we want to associate with? Stay healthy.

The plight of the lady and her husband is because their clinic and hospital failed her and her husband. The lack of test kits is no excuse to not know what to do.

I’m not an anti-Trump guy. I have reviewed these reports and they were discussed yesterday and today via the Mayo webcast by hundreds of physicians from around the country. When able most of us will be willing to use these meds in combination but if we are wrong, we could cause harm and the anti-Trump lawyer guy would probably want to file class action lawsuit.

I didn’t say he was right or wrong. I’m not a fan of the media. I have to deal with facts. The hydroxychloroquine combo looks promising. We will learn more day by day.

Um... Then they should be the ones reporting. As of noon today, we have zero results from studies about the use of hydroxychloroquineazithromycin. The reports are anecdotal. Same report from 3 presenters at The Mayo Clinic Clinical Reviews 2020 completed at noon today. We have multiple studies going right now studying the antiviral agent Remdesivir but studies aren’t complete yet. The President isn’t responsible for our problems. When we do an after action review, there will be a long list for people to criticize. The President’s mistake has been to speak on medical issues that he has no knowledge about and must rely on what he is told by others. If I were advising him I would tell him to allow his medical advisors to brief the nation on the medical details including potential helpful medications or vaccines. He can talk about gearing up the nation to produce more of the required medical supplies. Business is his area of expertise.

Let us know what you learn. Good luck.

You are correct in that as of right now we have no studies to support use of hydroxyxhloroquine with or without Azithromycin. We have some isolated, unsubstantiated reports. No one should be prescribing for friends or health care workers anymore than people should hoard TP or PPE. It should be saved for hospitalized patients who have either tested positive or are highly suspicious for COVID-19. I will say exactly what I said before going into combat. This is what we signed up for. Let’s do our job, no complaining, watch out for one another and have each other’s backs. The new standard for community acquired pneumonia was just changed. It’s back to Amoxicillin 1gm tid or Doxycycline 100mg bid x 5d or longer if Sx persist. They don’t need to be hospitalized unless they need oxygen or fluid resuscitation or have other complications. Zosyn isn’t on the list no should it have been with few exceptions. Remdesivir is part of multiple ongoing studies. China as of 2/6, And multiple studies in the US starting 2/21. Hoping for results early May. I would guess if early results are excellent they will ramp up production and start widespread use. Stay safe. Thanks for your work.

Yup. Especially before this spreads. Few cases in this area leaves a window for donations.

I don’t think the significance of testing is overblown at all. It’s a moot point until we have the resources to do so. Give us the ability to test and we can test everyone. Right now we don’t have the capacity to do so, therefore we tell people with milder symptoms to stay home in order to protect others. Data analysis will have to wait until we have the resources to test everyone. In the meantime we deal with patients with the resources we have.

I am doing an online Mayo Webcast so not in clinic today or tomorrow. I attended our briefing yesterday. We were still doing elective surgeries but will likely stop after this week to preserve supplies. Outpatient clinics still open. Discussing designating “clean clinics” for OB visits and patients without symptoms or risks but the problem is you may have it and not know. We tell people with respiratory symptoms to stay home. Adults no longer need to be tested for strep because antibiotics are no longer used in adults. Kids would be cultured. If patients have had flu symptoms more than 72 hours no reason to screen because Tamiflu hasn’t been shown to be efficacious. The Minnesota Department of Health stopped our testing except for travelers, health care workers or NH etc. We tell patients with URI to call before coming to ER, Hospital or clinic. Every employee enters by separate entrance and signs in, answers questionnaire and takes temp. We screen every clinic patient or select hospital visitors at the entrance with interviews and take temp. Most hospital visitors are turned away. As of last night, the Minnesota cases were in Twin Cities 200 miles away. The NDak cases are 70 miles away. We are trying to make sure we have day care for our employees children. We deal with difficult patients who want to be tested “just to be safe”. I’m sure it’s still coming if not here already. Our drive up testing is on hold til MDH eases restrictions. We have test kits but State labs are backed up with testing. State and regions are working to determine resources and how the different organizations will work together. Stay healthy. Thanks for the work you do.

Did they say why???

Happy St. Patrick’s Day. It’s a great day to be Irish and always a great day to be an American. We are just getting started but stick together and we will get through this.

You are correct in stating this has to be considered. I believe the hope is that we get lucky with one of the treatments being tested or lucky with speed of vaccine. Our area schools were told 2-4 weeks. If we stem the tide somehow they may loosen the recommendations. Like it or not as time goes on the economy becomes a big part of the health of our people and no longer just about money.

My guess would be the producers wouldn’t price gauge at least for awhile.

I agree. I think we are “shotgunning” a bit but losartan should be relatively safe.

Should have been scholarship kid especially after all-star game.

I don’t listen to Trump cuz I can’t stand to listen to him. You seem to think when I expect normal intelligent people to act civilized I am making any supportive/critical comment about Trump or our other politicians. I’m not because it’s not the time or place. The issue is how best to deal with this virus. You have zero basis to claim we wouldn’t be in the situation we are in if not for him. It is divisive and counterproductive. In answer to your question, yes we can be tested. One of my colleagues was tested last week because of possible exposure. One of my patients was tested yesterday and we didn’t ask the state for permission. We are setting up a drive up testing station and will soon be able to do the testing in our small rural hospital here in Minnesota. I have no idea what people in the metro area are doing, but if we can do these things in rural hospitals in Minnesota then the big city physicians should be able to figure it out. There is no indication for everyone to be tested. We follow the guidelines recommended by Infectious Disease specialists and the CDC. I’ve only taken care of over 100,000 patients over the years. I have ER, ICU, Combat experience and I don’t know how the response team acted and reacted. How do you know so much. How many patients do you care for? Are you on the Trump team with first hand info? I don’t have all of the answers, but I’m learning. I will attend a briefing at 7 am to update our local protocols and evaluate what we are doing well and where we need to improve. I am going to log in to a live Mayo Clinic presentation tomorrow afternoon that includes an Infectious Disease update. My sister in law is a recognized world authority on tuberculosis and has a lengthy list of publications on TB but also other Infectious Diseases including Ebola. She has done contract work for the CDC and speaks to government health departments all over the world on tuberculosis. I get my info from those sources not the Star Tribune. With all of that, you seem to know more about all of this than I and other medical people. We would be happy to pay you to come here and give us a presentation on COVID-19.

Let me start by admitting I’m not a Trump fan but that doesn’t mean I would support people continuing to regurgitate misinformation. Nobody knows what would happen if testing was available earlier. If you do the minimum research, you would learn that the WHO did not offer nor did the US refuse test kits. A laboratory in Germany and the CDC both developed the first test kits on January 21. No one new that production of the test kits in the US would be complicated and slowed by problems with a reagent used in these tests. The other problem was that on February 4 the head of Health and Human Services declared a “public health emergency “. That meant that capable labs across the country were prohibited by legislation passed in 2009, to produce test kits. That meant those labs had to petition the FDA to get permission to produce test kits. One of the labs in Wadsworth,NY received permission on February 28. Other labs also received permission. His mistake was the early comments understating the seriousness of this disease and later overstating our ability to test. Trump did not fire “everyone with experience handling this”. He did close down the National Security Council’s office assigned responsibility for “Pandemics/“Bioterrorism”. There are many who worked there who felt then, and now, that was a mistake. There was also a recent article where a former Obama administration official stated that Trump closed the office, but he consolidated those responsibilities to another office in a move consolidating 3 departments in order to decrease costs and improve efficiency. I couldn’t verify that article about consolidation nor if true if they are effective. Having said that the CDC has the personnel with the training and experience to deal with this. To criticize and insult those who disagree with your opinions is exactly what helped Trump get elected in the first place. We tested a patient yesterday. Where do you live where you don’t think you can be tested. If you mean you can’t get tested because you are “afraid” but have no symptoms or exposure, that is because routine testing for asymptomatic patients with no known risks is not medically indicated. We will get through this better if people put their politics aside and wait to point fingers and blame until we get through this.

Things there are different. Especially concerning are the outbreaks in major population areas. Restaurants closing today in rural Mn where there have been no outbreaks yet. Schools here and neighboring NDak closed though CDC has logarithm that did not recommend closing. Hopefully we can “flatten the curve” and come up with a comprehensive plan to allow schools to reopen and some evidence based guidelines for people to get back to work. Stay safe and thanks for your work. Your lessons learned will be valuable to the rest of us as this spreads.