UNDfaninMICH

Sell. Mostly because I hope the offense shares the wealth so well that this doesn’t happen.

Great. Add that to the Jeep things I don’t understand.

WTF. If that happens here, will I be allowed to go to my cottage and put my boat in, as long as I don't dare drop a line?

Many outpatient visits here are being done by telemedicine. I'm sure the number pales in comparison to the usual, but there's probably an uptick in calls about routine respiratory stuff because people are concerned they have the Covid. As for ill visits, patients who otherwise would be told to come in (or would come in on their own) for fevers and coughs are now staying home. Some of these people may learn that they don't need to run to the doctor for viral symptoms, which would be good for them, bad for urgent care centers and the like. Further, social distancing will keep a lid on many of the other viruses which prompt office visits and hospital stays. I've long been convinced that when we have years with more school breaks related to snow, our inpatient pediatric numbers are lower. For health maintenance stuff and follow-up on chronic conditions, there can be some concern that people will end up in worse shape after this and need more care. A terrible way to make money, which is one of the many reasons I'm uncomfortable with the model of healthcare as a business enterprise. I'm not sure about elective procedures, I feel like most of these will have to be caught up on over time? This could end up putting a strain on OR space and staff, as people are trying to get their delayed care rescheduled.

Yeah, I'm hearing a lot of the same. I have a hard time believing that many of those people had Covid-19 at that time, because hospitals in the US weren't overrun with critically ill patients until just the last couple of weeks. Some years there have been pretty nasty strains of parainfluenza around, and that was another possibility I considered for my illness a while back.

My wife started with it first, runny nose and dry cough. I remember her saying she had some chills. She gets terrible sore throats with colds, but this time no sore throat. I had some aches, fatigue, briefly wondered if I had fever, prominent dry cough. I also had GI symptoms. My kid had a fever. At the time I thought we had flu modified by the vaccine, which still may be true. My cough lingered for weeks and even 3-4 weeks after the initial symptoms I remember coughing up a little bit of sputum. There's a confounder there that I have mild asthma, but I never really felt like it was an asthma flare. I've felt short of breath when climbing stairs but I attributed that to weight gain. I don't remember loss of smell or taste, but I do remember no food seemed appealing to me except for spicy stuff, which was weird considering I had some GI symptoms. I haven't been able to find when first cases were found in Florida, but I also have to keep in mind we were in some tourist areas. Not massively crowded stuff like Disney, but we went to zoos and aquariums, that sort of thing.

There are not enough data to know right now, there are likely some people who will still test positive weeks after having their acute symptoms. Whether those people are infectious or not at that point is also not well known. Antibody testing should be helpful in evaluating people for past infection. I'm anxiously awaiting antibody testing. I think it's possible I had it back in early February after air travel to and from Florida.

If state or federal governments are to pay for and maintain equipment and supplies for potential future catastrophes, isn’t that the dreaded socialism?

The real flu, influenza can absolutely make a healthy person feel like total garbage for four days. A week or more is not uncommon. The stomach “flu”? Four days would indeed be long for that. We need to stop calling that illness “flu” because of the people who say, “Nah, I don’t need a flu shot. If I get flu I’ll only be sick for a day or two anyway.”

JCAHO can keep their visits suspended for eternity.

I’ll give a concurring opinion. You may have it. We don’t have enough knowledge of the range of symptoms yet. However, there’s no real need to test. My employer just released their latest testing guidelines and say no testing for mild to moderate illness. They say stay home for seven days or until three day after symptom resolution, whichever is longer.

if the incubation period is up to 12 days and infected people may start shedding before symptom onset, it would take way more that one test to clear the exposed person from mask use. Unfortunately there’s not an easy answer, given the PPE shortage.

Yeah, right now the approach of testing people who seem like they have it isn’t all that helpful, especially in locales where results are taking nearly a week to come back. I work with a lot of learners and I always talk with them about how we are prone to overusing tests simply because of the gratification that comes with thinking your patient has a particular virus, then being proven correct by a test.

This is entirely true but demonstrates we need massive numbers of tests with quick turnaround, as people with Covid may present with common cold. Barring that, serologic test for previous infection along with evidence that infection confers immunity. In the case of symptoms plus known exposure, quarantine is a must.

We were told yesterday that our state lab is capable of running 72 tests per day. Health systems are developing their own tests which are coming online soon. Watch for the number of cases in Michigan to blow up soon, related to results coming back and not necessarily spread of disease.

That is probably not a stupid question but I don’t know anything about the EPA and herbicides so I don’t know what that means. Since hydroxychloroquine is already approved by the FDA, prescribers are free to use it for any reason they choose, even if it’s complete nonsense. That is off-label use. Ideally some well-designed studies would show a benefit before off-label use happens, but FDA approval isn’t needed for those studies to my knowledge.

I continue to wonder about the utility of testing people in this situation. Assume they have it and quarantine appropriately vs do a test that has an unknown specificity? Unless of course some treatment is found helpful and we have enough of it to use for ambulatory exposure. Otherwise reasons to test might be related to workplace exposure and worker’s compensation could apply?

I will be shocked if FDA would approve it without more data. It can and will be used off-label without any action from the FDA. Drug companies would have to ramp up production massively, which could have downstream effects on other meds. Hopefully those meds will be the BS stuff they push out for cash, like minor tweaks of their existing meds people take daily. Funny how those tweaks come right before their original drug is about to come off patent. *Edit. I see they approved it for “use in testing”. I don’t think they need to approve meds for that once they are on the market. Once their on the market for a given indication they can be used off-label. Just not marketed for that use. Any medical providers who haven’t read up on the marketing history of Neurontin are encouraged to do so, for a view into how pharma companies try to skirt that rule.

Inpatient guy, but I would say treat empirically for flu if treatment is indicated. That’s what outpatient docs are supposed to do anyway, because the rapid flu is poorly sensitive. For strep, there are a lot of valid questions related to the need to treat people (especially adults) anyway. I would still advocate for treating empirically for those as well. Drive-thru testing for Covid-19 if indicated and available. My group’s outpatient primary care stuff is going largely to telemedicine right now. Primary care peds is incredibly slow around here. I’m more concerned about necessary “elective” procedures than the typical illnesses. I’m interested to hear from Ira, but maybe that won’t happen until later today.

There goes my belief that healthy people over the age of about six months don’t need thermometers. I guess I better see about getting one.

Hopefully these people have PCP’s to call rather than the ER. Virtual visits are getting amped up here quite a bit.

Ira’s words were taken out of context. He had previously stated that people with fever and cough should stay home. I thought he meant that people who had colds but no fever could freely spread their germs. He was in fact saying that people who simply have cough and fever need to not clog up medical offices and ER’s. People without fever are almost certainly capable of spreading coronavirus. Edited to add: hopes for speedy recoveries for your staff.

From the source article, the cumulative excess death rate in Philly was about double that of St. Louis. I tried to copy and paste the relevant passage but it got flagged for an illegal emoji. https://www.pnas.org/content/pnas/104/18/7582.full.pdf

So do conspiracy theories and science denial.

I don't know that anybody in the US is experiencing shortages of resources, but we're told that's true in Italy. It "could" happen here, but if people are careful it shouldn't.