2020 Dumpster Fire (Enter at your own risk)

[MafiaMan]

3 hours ago, Old Fella said:

Didn't mean to hurt your feelings/Sorry!

As I suspected, you wouldn’t have the guts to PM me your real thoughts.  Don’t worry, I won’t scream at the sky in protest of your PM, I’ll be fine.  You have a personal bone to pick with me, knock yourself out.  I’ll await your message.

[dynato]

Just now, Nodak78 said:

Keep that thought.  Check the results May 1st, June 1st, and July 1st.  You will see the model is BS.  GIGO

This is why I said the assumptions for the model must be clearly stated. I listed the two main models and their main assumptions yesterday. The models must also be updated frequently as new information/stats are documented to remain even close to valid. 

The IHME model, is the national model, is the one referenced above. This model, is the one projecting 60k national deaths, that a lot of you have referenced. As you can see, they assume that there will be no new COVID deaths nation wide after June 1st. To me, this is too bold of an assumption to use in terms of final death count. 

[Old Fella]

1 minute ago, MafiaMan said:

As I suspected, you wouldn’t have the guts to PM me your real thoughts.  Don’t worry, I won’t scream at the sky in protest of your PM, I’d be fine.  You have a personal bone to pick with me, knock yourself out.  I’ll await your message.

Nothing Personal/hardly knew ye.

You Win!

[The Sicatoka]

Philosophical conversation that's been raging in my head:

• Ask about any American and they'll say the US healthcare system was broken before any of this started. Yet, we're crushing about half the economy to save that broken sector (about 1/7 the economy). 
• When has America fixed anything recognized as broken by incremental measures? (We've done nothing with the postal service, or welfare, or other broken entities.) Something has to fail overtly and catastrophically before we act. Dare I call it the American way. 
• Part of me says we should've let the healthcare system be crushed, so it could be fixed. (<-- What is wrong with that posit, admittedly the flaw in my theory, is the system is not just a thing, but all the people who work in it and would've been swept up, destroyed as in killed by disease, in the destruction. I have relatives I'd have destroyed. I can't do that.) 

[MafiaMan]

11 minutes ago, Old Fella said:

Nothing Personal/hardly knew ye.

You Win!

By all means, continue this via PM, Old Fella.  

[Nodak78]

13 minutes ago, dynato said:

This is why I said the assumptions for the model must be clearly stated. I listed the two main models and their main assumptions yesterday. The models must also be updated frequently as new information/stats are documented to remain even close to valid. 

The IHME model, is the national model, is the one referenced above. This model, is the one projecting 60k national deaths, that a lot of you have referenced. As you can see, they assume that there will be no new COVID deaths nation wide after June 1st. To me, this is too bold of an assumption to use in terms of final death count. 

Well let's agree the model is BS.  That is what I have been saying from day one.  Garbage in garbage out.  One one projecting 60k also predicted 1 million not long ago.  

[Old Fella]

4 hours ago, UND1983 said:

Why would anybody go back to work when they can get nearly as much or more than they were making before?  

Mafia Man,

Not sure how this escalated.

My  initial response was to this stupid, insensitive post suggesting that everbody who was unemployed would rather accept unemployment insurance than work.

It was also insensitive of me to bring your name into it.

old fella

 

[rochsioux]

3 hours ago, southpaw said:

Fortunately, there are plenty of other ways to provide for people in a time like this and none of them involve billion dollar payouts to companies that have shown they don't care about their employees. 

It's incredible how predictable the responses from the Fox news watching contingent are. 

I get really tired of all the politically motivated attacks from both sides. 

Most of the 2008 bailouts were actually paid back to the government.  The government broke even or may have made a little money from “bailing out” the banks, auto companies, and mortgage lenders. 

One side complains about health care but has no good policy to fix it.  They complain about Obamacare and say they want to repeal it but never do even though they had control of all branches.

One side claims the rich should be taxed more.  When they had control of all branches did they do this ?  No.  Did they get rid of all the tax loopholes they like to complain about.  No. 

Me thinks that both parties would rather complain and point figures than actually do anything.  They’re too busy worrying about how they’re going to get re-elected.  It’s easier and safer to blame and complain then to actually implement a solution. 

[The Sicatoka]

46 minutes ago, keikla said:

I get it from a philosophical standpoint, but the thought of actually doing that makes me nauseous. 

Me as well, hence the last sentence of the post. 

[yzerman19]

1 hour ago, The Sicatoka said:

Philosophical conversation that's been raging in my head:

• Ask about any American and they'll say the US healthcare system was broken before any of this started. Yet, we're crushing about half the economy to save that broken sector (about 1/7 the economy). 
• When has America fixed anything recognized as broken by incremental measures? (We've done nothing with the postal service, or welfare, or other broken entities.) Something has to fail overtly and catastrophically before we act. Dare I call it the American way. 
• Part of me says we should've let the healthcare system be crushed, so it could be fixed. (<-- What is wrong with that posit, admittedly the flaw in my theory, is the system is not just a thing, but all the people who work in it and would've been swept up, destroyed as in killed by disease, in the destruction. I have relatives I'd have destroyed. I can't do that.) 

I would stand up and say the healthcare system is not broken.  It all depends on what you want to measure.  It’s riddled with inequality, but so is the rest of the USA.  We’ve got access to techniques, devices, Diagnostics, equipment and medicines that are the greatest the world has ever seen in all its history.  
 

we have poverty, substance abuse, obesity and the chronic diseases which follow, but that’s not the healthcare system’s fault.  
 

the biggest issue with healthcare is cost, and it’s not even that expensive if you have decent insurance.  People just don’t want to pay for it...how many people have a combined monthly car and cell phone payments of $700 but bitch about a $1000 deductible.

system is imperfect, but I’d rather get healthcare here than anywhere else in the world.  
 

I know many disagree, but I truly believe the issue isn’t the healthcare or even what it costs, but the simple fact that people don’t want to pay for it...kinda like parking.
 

it doesn’t bring prestige and you don’t love it, so you don’t want to spend money on it.

[UND1983]

37 minutes ago, Old Fella said:

Mafia Man,

Not sure how this escalated.

My  initial response was to this stupid, insensitive post suggesting that everbody who was unemployed would rather accept unemployment insurance than work.

It was also insensitive of me to bring your name into it.

old fella

 

What's insensitive about simple math?  

[The Sicatoka]

29 minutes ago, yzerman19 said:

People just don’t want to pay for it...how many people have a combined monthly car and cell phone payments of $700 but bitch about a $1000 deductible.

Dare I say people value the outward 'stuff' more than they value themselves as human persons body and soul, and as such are more willing to pay to support the outward fixtures more than their own health and well-being? 

That's a major problem we as a society face. And a most conversation ... on Easter Sunday. 

[southpaw]

55 minutes ago, UND1983 said:

What's insensitive about simple math?  

If you're more concerned about the people that might scam the system vs the people that need the financial support, you need to figure out your priorities. 

[UND1983]

5 minutes ago, southpaw said:

If you're more concerned about the people that might scam the system vs the people that need the financial support, you need to figure out your priorities. 

When did I say either of those?  Wut?

[rochsioux]

16 hours ago, keikla said:

Sometimes it feels like there are two totally different viruses.  You have the 'good' virus that feels like a bad cold (if at all) and only requires hospitalization for those who have significant comorbidities.  And then there's the 'bad' virus that drops O2 sats in the blink of an eye, requires ventilation (if you're lucky the vent was planned and not during a code), and usually leads to extensive multi-organ failure in just a couple days.  The bad virus is unforgiving to those of all ages, even without comorbidities, and is wholly unlike anything I have ever seen.

It feels weird to talk about overall mortality, because it might not be that bad when looking at everything altogether.  I'd be interested to see data on the mortality of those who code and/or require intubation, because that looks very, very bleak.  We're several weeks in, and my hospital still has single digit numbers of those who have improved and come off a ventilator. We talk daily with dept leaders of the nearest hospital to us, and their numbers are similar.

Just curious if you are seeing any success in treating patients with any specific drugs ?

There seem to be a few drugs that may help like hydroxychloroquine, remdesivir, and leronlimab. 

Good luck and thank you for all your good work. 

[UND92,96]

It appears that northeast North Dakota has fared better than nearly any other part of the country so far in terms of positive tests. Collectively, Grand Forks, Traill, Steele, Griggs, Nelson, Ramsey, Walsh, Cavalier and Pembina Counties have a population of about 120,000. There have been a total of 17 positive tests so far, and the rate of positive tests is just 1.23% (17/1318).

[farce poobah]

During any pandemic its important to stay hydrated.

 

[iramurphy]

32 minutes ago, keikla said:

We can't get our hands on remdesivir or leronlimab.  Mixed results with toci.  Haven't seen a lot of benefit with hydroxychloroquine though, admittedly, I've been focusing significantly more on the course of critical patients than those in med surg.  So it's quite possible it serves a bigger role in intermediate level care.

The biggest thing we're playing with right now is using heparin drips.  We saw a noted improvement in several ICU patients after they were started on aggressive anticoag.  Still a lot to figure out there, though...what lab cut-offs to use to qualify, protocol intensity, duration, etc..

Thanks for your updates. I tried to address the issue with our clinic administrators and I doubt they had a clue why I was asking. It was clear they didn’t like questions and the answer was a brisk “it’s in the protocol”. Of course I can’t find the protocol but the information you have shared is invaluable. Thanks and thanks for your heroic and exhausting work. You and your colleagues are saving lives and giving comfort to so many whose families can’t be there. God bless and God speed. 

[homer]

3 hours ago, The Sicatoka said:

Dare I say people value the outward 'stuff' more than they value themselves as human persons body and soul, and as such are more willing to pay to support the outward fixtures more than their own health and well-being? 

That's a major problem we as a society face. And a most conversation ... on Easter Sunday. 

No.  Prices of diabetes supplies have exploded in 2015.  I can speak to that one first hand.  I’m not sure about any other conditions but can’t imagine they are much different.  Has nothing to do with choice.  

[yzerman19]

4 minutes ago, homer said:

No.  Prices of diabetes supplies have exploded in 2015.  I can speak to that one first hand.  I’m not sure about any other conditions but can’t imagine they are much different.  Has nothing to do with choice.  

No doubt costs continue to go up- diabetes management has probably jumped the most (as you mention).  There are many health plans out there that greatly lower the out of pocket costs for diabetes.  Many State’s Medicaid programs also offer zero $ co-pays for drugs, insulin, and test strips.  

[Nodak78]

I have been type 2 diabetic for about 4 years.  Just taking pills metformin and Now Jardiance for about a year.  On Medicare, blue cross and another plan for the drugs.  So on a plan to reverse the type 2 since Thanksgiving.  I started exercising just walking once and sometimes twice a day.  Reduced my carbs big time.  Lost 17 pounds in 3 months.  Dropped my A1C from 7.0 to 6.4. In that timeframe.  I was due for refills and the Jardiance was $550 for the next 3 months.  I told the pharmacy. To keep them.  Now just metformin until I drop another 15 to 20 with the exercise and killing the carbs.   wonderful that the gov't food pyramid promoted bread, pasta, rice.  Loved those carbs for years.  But then the gov't knows best.  Follow the money.

[Oxbow6]

16 minutes ago, Nodak78 said:

I have been type 2 diabetic for about 4 years.  Just taking pills metformin and Now Jardiance for about a year.  On Medicare, blue cross and another plan for the drugs.  So on a plan to reverse the type 2 since Thanksgiving.  I started exercising just walking once and sometimes twice a day.  Reduced my carbs big time.  Lost 17 pounds in 3 months.  Dropped my A1C from 7.0 to 6.4. In that timeframe.  I was due for refills and the Jardiance was $550 for the next 3 months.  I told the pharmacy. To keep them.  Now just metformin until I drop another 15 to 20 with the exercise and killing the carbs.   wonderful that the gov't food pyramid promoted bread, pasta, rice.  Loved those carbs for years.  But then the gov't knows best.  Follow the money.

Let's just take any personal accountability out of everything and blame it on the government??  Come on now!

BTW your current A1C is better than a vast majority of T2s out there. Good work.

[BarnWinterSportsEngelstad]

There are over 2.8M people in US that tested for this virus of which over 559,000 tested positive.
I would imagine some tested negative and later on were tested again as positive.

22,000 confirmed virus tested deaths in the US, that's close to a 4% death rate of the positive tests.

There is talk about #'s not all being reported correctly.
People may have died at home form this virus and have not counted in these deaths, because they were not confirmed with the virus.
People that never felt any symptoms or minimal symptoms may have not even been tested.
People may have had other health problems and report of cause of death may be debatable.

This brings me to the guy that died when the 5G tower fell over and killed him.
And, people are over dosing on drugs and etc.
People are losing jobs and jumping on message boards in a rage.
Mental break downs and etc. and etc.
May there be riots, and therefore more deaths.

Less people dying of car accidents.
Less smog for time being.
Some people may even be eating healthier foods.
Some people quit smoking and etc. and etc.

Economy taking a big hit.

Then back to the 4%, after everything else considered?
Going to take some time to get things back to the way they were.

[UNDlaw80]

2 hours ago, keikla said:

We can't get our hands on remdesivir or leronlimab.  Mixed results with toci.  Haven't seen a lot of benefit with hydroxychloroquine though, admittedly, I've been focusing significantly more on the course of critical patients than those in med surg.  So it's quite possible it serves a bigger role in intermediate level care.

The biggest thing we're playing with right now is using heparin drips.  We saw a noted improvement in several ICU patients after they were started on aggressive anticoag.  Still a lot to figure out there, though...what lab cut-offs to use to qualify, protocol intensity, duration, etc..

From your experience is hydroxychloroquine frequently used in intermediate care?   I was under the impression, due to side effects, it's primarily used as a last resort after the kitchen sink has been thrown at the patient.  

[iramurphy]

20 minutes ago, UNDlaw80 said:

From your experience is hydroxychloroquine frequently used in intermediate care?   I was under the impression, due to side effects, it's primarily used as a last resort after the kitchen sink has been thrown at the patient.  

I will let Keikla answer for herself, but I believe across the country most providers use it early in the disease. We still are getting mixed reports as to the efficacy, but from what I have gathered if used it should be used early.