UNDfaninMICH
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Posts posted by UNDfaninMICH
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8 minutes ago, UND1983 said:
It's called Bison Pride. you guys wouldn't understand.
Great. Add that to the Jeep things I don’t understand.
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9 minutes ago, Cratter said:
Washington Governor: Hold my Beer.
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?
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2 minutes ago, Oxbow6 said:
One thing not being mentioned is the severe loss in revenue to the healthcare systems in this country. Most systems will lose roughly a third or more of their revenue during the fight against COVID due to most outpatient visits are most non-existent. No elective or non-essential procedures are being done. If a multi-billon dollar system which operates on a small margin +/- 3% loses that much revenue it becomes a challenge moving forward.
Maybe yzerman and/or UND...MICH can speak more to this.
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.
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1 minute ago, Oxbow6 said:
Interesting........I have heard a number of people with similar symptoms from late November to early January. Main symptoms........fatigue and cough.
Most of those got influenza testing that was of course negative
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.
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Just now, Oxbow6 said:
Symptoms?
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.
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5 hours ago, SIOUXFAN97 said:
lets say you had the rona two weeks ago and didn't know it and showed no symptoms and you were tested today what would your test show/say?
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.
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16 hours ago, Kab said:
Why is it some states are prepared and some aren’t?
so now we hear NY had the chance to buy 16000 ventilators in 2015 and chose not to.
you get them 40000 ventilators and who is going to run them
how does a state plan for something like this
i can’t see where the US can have a stockpile of everything for every state.
when this is over there will be hearings until the election on everything trump did wrong, not on what went right
If state or federal governments are to pay for and maintain equipment and supplies for potential future catastrophes, isn’t that the dreaded socialism?
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1 hour ago, Smoggy said:
OK so I'm going to preface this with I rarely get sick. Like haven't taken a sick day in years (yes I'm dumb bc I don't get anything for not using them).
Is it normal to have the flu for 4 days? Doesn't that make you question things??? I know my brother and his family all had it for like 5 days this winter and he was saying how he's never been that sick for that long.
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.”
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11 minutes ago, keikla said:
I doubt they had a stockpile, but Bayer just donated 3M tabs of chloroquine.
Also, the Joint Commission, one of the accrediting bodies for hospitals, has suspended visits to allow hospitals to focus on the outbreak. The FDA has done the same (yes, they visit hospitals). Other authorities are also loosening some of their requirements for inpatient pharmacies secondary to the massive PPE shortage. It's nice to see regulatory bodies showing some grace here.
JCAHO can keep their visits suspended for eternity.
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25 minutes ago, MafiaMan said:
I already said I didn't believe I had it, so why give into the panic and waste a test? My symptoms are very much that of the flu. After a not-so-great day yesterday, I'm feeling significantly better today, although not nearly 100%. I'll be fine.
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.
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24 minutes ago, keikla said:
I agree with this in general, but I struggle with it when it's a HCP. Per current state guidelines (prone to change at any minute), anyone who worked with the positive employee and continues to work while asymptomatic needs to wear a mask for 14 days post-exposure. We can't spare the masks unless we know the symptoms were really covid.
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.
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1 minute ago, TBR said:
Well, I wasn't referencing testing for what we already know. I was alluding to gaining insight into details of the virus that we don't know.
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.
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18 minutes ago, keikla said:
Valid question about the utility. I know everyone says "stay home if you're sick", but I don't know of a single health system (inpatient or outpatient) that can afford to have every employee with a common cold stay home for the entire duration of the cold.
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.
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4 minutes ago, iramurphy said:
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.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.
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12 minutes ago, NDSU grad said:
Stupid question but does the FDA have an emergency provision like the EPA does for herbicide registration?
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.
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22 minutes ago, keikla said:
I have a coworker on quarantine for a known exposure, now with respiratory symptoms, who can't even get tested.
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?
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20 minutes ago, keikla said:
I can't find anything from the FDA that confirms the approval. What source?
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.
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1 hour ago, keikla said:
Question for you outpatient PCPs or specialists in this thread. What is your system doing or planning to do about patients with symptoms?
I'm asking because one of the major outpatient clinic networks in Westchester is closing offices and doing telemedicine, including urgent care. This works for many issues, but not when tests are required.
How do patients rule out flu and/or strep? Are they supposed to hunker down at home and not have treatment for treatable issues? Are they supposed to go to the ER (please no)?
I'm genuinely interested in how this will be handled, since you can't swab remotely.
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. -
15 minutes ago, keikla said:
Same.
The rules are changing by the hour around here. When this started, anyone who had contact with covid pt (will call that patient Z), within 14 days prior to Z showing symptoms, was quarantined.
When I talked to DOH (repeatedly) over the weekend, they said only people who were in extended contact with Z on the day Z started showing symptoms needed quarantine. Brief contact didn't warrant quarantine, nor did extended contact the day before Z showed symptoms. I'm not 100% certain if this change was for everyone or only healthcare personnel, since I'm primarily worried about staff needing quarantine.
Today, the state DOH said that healthcare workers with a known exposure can continue to work with a facemask until 14 days post-exposure so long as the exposed worker remains asymptomatic. Ideally these staff should work with patients who already have covid and not immunocompromised patients, though as the pandemic grows that is not an official requirement. Apparently the state realized that the quarantines were decimating our staff.
All healthcare workers have been instructed to self-monitor for symptoms and do temp checks twice a day, regardless of known exposure.
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.
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20 minutes ago, keikla said:
I think some of it is the message of "Stay home if you don't need to go to the hospital." And while that message is definitely valid to some extent, I think it is being misinterpreted by patients in terms of what warrants going to the hospital. I'd rather have patients at least call the ER for clarification than just assume that they should to stay home.
Hopefully these people have PCP’s to call rather than the ER. Virtual visits are getting amped up here quite a bit.
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9 hours ago, keikla said:
I just found out tonight that one of my staff members is positive. She had a fever and body aches for 5 days before respiratory symptoms showed up. It's possible she was already infected with something else and then got covid in addition, but it's impossible to know. I don't think we can say yet that fever isn't the marker. Today is day 8 with symptoms (only day 3 of respiratory symptoms), and her fever still hasn't dropped below 100.
I live in Westchester County (actually just moved out of New Rochelle 4 months ago) and work in both Westchester County and Rockland County. We aren't overwhelmed YET. That being said, this one positive staff member is taking out 5 other people for 6 days because they worked with her on the day she developed systems. DOH's current guideline is to quarantine anyone who had extended close contact with the person on or after the day he/she develops symptoms. Anyone else who had brief contact can continue to work but should closely monitor for symptom development. I have a relatively small dept (45-50 people) that was short 6 FTEs to begin with. Now we're taking out another 6 people? Staffing resources are about to get really tight, really quick.
New York-Presbyterian, ranked #5 in the list of nation's best hospitals, just announced today that effective Monday all elective procedures and surgeries will be postponed. It's common opinion around here that most hospitals will follow suit fairly soon.
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.
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23 minutes ago, The Sicatoka said:
That looks like the classic “band aid” curve to me: Do you pull it off slowly with low threshold or fast with peak threshold?
Either way the area under the curve is about the same.
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
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5 minutes ago, The Sicatoka said:
Fear sells.
So do conspiracy theories and science denial.
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12 minutes ago, iramurphy said:
Fever isn’t the marker. I said people with cough and fever should stay home. Testing depends on many factors, including recent, travel, occupation, known exposure, sore throat, cough, fever etc. I do believe every medical facility should have protocols in place that allow the health care providers to test without waiting time with some county administrator
I can’t vouch for this source, but if you google www.worldometers.info it compares different counties from 3/14.
The USA has one of the lower number of cases per million population (7.5/million). Of the present 2395 cases 10 were listed as critical. USA death rate was 2.2%.Some talk about hospitals overwhelmed with cases and no resources to care for the sick. I have family in the New Rochelle NY area which is the epicenter of one of their outbreaks and that isn’t the info they are hearing. For those of you experiencing that where are you?
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.
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Buy or Sell
in Football
Posted
Sell. Mostly because I hope the offense shares the wealth so well that this doesn’t happen.