2020 Dumpster Fire (Enter at your own risk)

[TheFlop]

Ironic that the doom and gloomers thought that not enough beds/vents would be what collapsed the medical infrastructure.....in the end it's not the widely alleged late/undereaction that did the harm......it's the financial collapse caused by the overreaction that did it.   

[UNDBIZ]

4 minutes ago, yzerman19 said:

Sooooo...it would take an extreme genius to shutdown the Subway system in NYC...SF shut down everything including Bart while NYC kept subways and schools open.  

my point is that political finger pointing aimed at the federal government ignores 2 states that for all intents and purposes respond to DC in the same way...yet for one it’s been the flu and for the other a disaster...

I think one of the stated reasons in NYC was the need to get the medical professionals and other "essential" employees to their workplace.  I'm not familiar enough with either city to say whether their commuting situations are comparable or not though.

The 2 cities/states certainly didn't react in the same manner at the same time.  Politicians will politic though.

[yzerman19]

21 minutes ago, keikla said:

Preferably no (or major limits) on the elective surgeries since medication supply chains are so tight, but I don't see why imaging departments in non-affected areas can't be running like normal.

They sure should be...and are in CA.  
 

There are no actual stresses on the system in CA in terms of care delivery.  Tons of capacity, no supply chain issues.  Only stress on the system is collapsing revenue from fewer services...and in CA that’s even blunter because of the preponderance of the capitated model.  Some have bitched about PPE, only to find warehouses full of it, or tests...to what avail unless it’s an antibody test or for a healthcare professional.

I realize that isn’t the case everywhere, and Kiekla is in the heart of the storm, but regional administration of government policy and regional healthcare administration seems to be the fundamental difference in success and disaster.  

[TheFlop]

Question for the outpatient doctor community (Oxbow and whoever).  How often during a routine visit/elective procedure do you find an unexpected condition that requires immediate attention?  I.e. something that can be dealt with if it's acted upon soon.....but that can turn into a big deal (including possible death) if delayed more than a couple weeks/months?  Or is that a non-factor when determining the negative effects of the lockdown. 

[Oxbow6]

6 hours ago, Walsh Hall said:

I realize that the studies should be subject to scrutiny, but it's estimated that between 30K-50K death occur annually as a result of EACH percent increase in unemployment.  It's a difficult metric to quantify, but something to consider.

 

43 minutes ago, keikla said:

How do they project something like that?  I'm honestly curious, as I have absolutely no idea.  Based on death rates of previous economic downturns?

What I heard might be a little lite........

[Siouxperman8]

Some good news here in MN.

MN Gov address today states to allow businesses to open Monday that aren't public facing.  

State officials say 20,000 MN businesses could re-open under relaxing of restrictions. They must be "non-public facing".

Walz: Relaxing some business restrictions means 80-100,000 MN workers may be able to go back to their jobs on Monday.

 

[lawkota]

The line Pitt says was not in Michael Lewis' book.  Here is a BBC podcast that tries to fact check it. 

[SWSiouxMN]

Just now, lawkota said:

The line Pitt says was not in Michael Lewis' book.  Here is a BBC podcast that tries to fact check it. 

Still was a damn good movie.  

[Goon]

2 hours ago, keikla said:

  Based on death rates of previous economic downturns?

Not totally related, but A New Covid-19 Crisis: Domestic Abuse Rises Worldwide. I am not so sure this flatten the curb lockdown is healthy. 

Quote

Now, with families in lockdown worldwide, hotlines are lighting up with abuse reports, leaving governments trying to address a crisis that experts say they should have seen coming.

 

[Cratter]

2 hours ago, keikla said:

Honestly this article is just more clickbait.  The sunshine info is based on the flu virus, 

More clickbait studies?

Sunlight destroys coronavirusvirus quickly, new tests find

Quote

results from government lab experiments show that the coronavirus does not survive long in high temperatures and high humidity, and is quickly destroyed by sunlight, providing evidence from controlled tests of what scientists believed — but had not yet proved — to be true.

Quote

 “Outdoor daytime environments are lower risk for transmission,” the briefing states.

Quote

 “Sunlight destroys the virus quickly,” reads the briefing.

Indoor air circulation spreads the virus.

People being outdoors are at low risk transmission.

Why aren't governors using more science to base their decisions?

[Nodak78]

2 hours ago, keikla said:

What do you suggest as the solution?  In situations like NYC metro area where hospital beds are still very hard to come by.

That may be true, but he was talking about how things were done in NY.  NY does not have excess capacity and is still functioning at above normal capacity.

Yes the hospital's were probably full or close to full.  The Gov said he needed 30k ventilators.  And someone had to pick which 26k was going to die.  Now we know that was a huge overstatement to be mild.  Yet he never suggested a solution to protect the most at risk.  No solutions.  That is his job.  He received 4 emails from a child of one of the residents exposed and died from his inaction.  What should have Gov Cuomo have done is the question.  Certainly not expose at risk seniors.

[SIOUXFAN97]

4 hours ago, yzerman19 said:

I find it interesting that two heavily populated states with very left governors have seen such dramatically different results...CA and NY...

If the Federal government is so culpable, why are these otherwise similar states having such different results?  NYC is more dense than The Bay Area and LA, but not on the order of magnitude of the covid delta...

could it be that healthcare is local and local decision making, such as the mayor of SF shutting things down immediately is actually the driver?

I mean the USA is bigger than Europe...I say you compare States to Coubtries over there...Germany much different results than Italy, just like CA and NY....

subway lines....get on grab a hand rail...still tired so rubbing your eyes and mouth and yawning ...on there for 20,40, 60 minutes with people being replaced at every stop.

[Cratter]

Why Sunlight Is Actually Good For You

Quote

Since regular sun exposure is one of the most robust ways to up active Vitamin-D levels in your body, it can help beef up your immune system as well. “Inadequate levels of this vitamin have been associated with an increased rate of infection, cancer, and mortality rate after surgery,” he adds.

 

[Cratter]

On TV right now:

Paraphrased

"Georgia governor is going to have blood on his hands for allowing people to go bowling and get haircuts tomorrow."

Not paraphrased: "a deadly mistake."

Funny how they dont say:

"Cuomo has blood on his hands by forcing people to stay inside recirculated air buildings all day."

Of note: Georgia reopening some businesses but still illegal go sit outside on a blanket.

[Cratter]

Interesting timing:

 William Byron in front of the podium with a chart at the White House press briefing now discussing how temp, humidity,  and sunlight affect Covid19 half life.

Biggest takeaway: solar kills it almost immediately (90 seconds or so).

[Cratter]

Isopropyl alcohol kills the virus 10x faster than bleach.

[Cratter]

22 minutes ago, Cratter said:

Interesting timing:

 William Byron in front of the podium with a chart at the White House press briefing now discussing how temp, humidity,  and sunlight affect Covid19 half life.

Biggest takeaway: solar kills it almost immediately (90 seconds or so).

CNN right after Byron got off stage...

Wolf Blitzer: "If you believe" (the data he presented)

His guest: "Yes, If you believe..."

CNN getting in on the conspiracy theories.

[Cratter]

 

[Oxbow6]

3 hours ago, TheFlop said:

Question for the outpatient doctor community (Oxbow and whoever).  How often during a routine visit/elective procedure do you find an unexpected condition that requires immediate attention?  I.e. something that can be dealt with if it's acted upon soon.....but that can turn into a big deal (including possible death) if delayed more than a couple weeks/months?  Or is that a non-factor when determining the negative effects of the lockdown. 

1) Not often but have capabilities to deal with any urgent care issue that pops up even in this environment.

2) Definitely a negative factor for many patients that have had appointments or procedures pushed back and delayed.

Specialties vary though on urgent or emergency needed care....ENT is different than Derm which is different than Rheumatology which is different then Neurology.........

Care needed for sudden loss of vision is different than a 3 month skin check with a history of skin cancer which is different from an increase in migrainous events over the past 2 months.

[UNDlaw80]

1 hour ago, Cratter said:

Interesting timing:

 William Byron in front of the podium with a chart at the White House press briefing now discussing how temp, humidity,  and sunlight affect Covid19 half life.

Biggest takeaway: solar kills it almost immediately (90 seconds or so).

 

So, basically, Coronavirus follows the seasonality of the flu, H1N1, etc.  .  

This is what many scientists expected, but could not verify considering this virus has not been around long enough to collect evidence. 

 

[Cratter]

Why hasnt the media talked more about stuff like this before?

It was only hiding in plain sight.

2009 article from American Journal of Public Health:

The Open-Air Treatment of Pandemic Influenza

Quote

A combination of fresh air, sunlight, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff (spanish flu).

Quote

However, more might be gained by introducing high levels of natural ventilation or, indeed, by encouraging the public to spend as much time outdoors as possible. 

 

[yzerman19]

2 hours ago, SIOUXFAN97 said:

subway lines....get on grab a hand rail...still tired so rubbing your eyes and mouth and yawning ...on there for 20,40, 60 minutes with people being replaced at every stop.

And as discussed the NYC subway system is massive and widely used, so it doesn’t take a genius to see it as a major vector for spreading the disease.  BART is also a major metro public transit system, and it was closed early....SF is akin to a mini NYC in all regards, is home to the largest Chinatown in the country, and is home to the major airport between Silicon Valley and Asia....outcome has been completely different.  NYC govt flat out blew it. Fortunately they’ve got warriors like Keikla fighting in the trenches or it would be worse.

sidenote:  I’ve lived in both NYC and The Bay Area and have no bias...like to visit both

 

[Nodak78]

58 minutes ago, keikla said:

No, the hospitals were over-full.  There was no 'full or close to full' anywhere near NYC except that useless ship that refused to take more than 20 patients for the first week and a half it was here.  And even working at 150%-200% for inpatient capacity, there was always a huge long line of patients in the ER who needed to be admitted, waiting for more beds to become available.  So let's think of the various options for this problem: 

1. Covid patients who came from or now need to be admitted to a long-term or short-term facility have to stay in the hospital because no one will accept them.  This creates a huge issue with the availability of inpatient beds for new patients coming in sick (including those arriving from nursing homes).  It was already an issue with patients dying in the ER while waiting for an inpatient room, but now those deaths get multiplied.

2. Covid patients who came from or now need to be admitted to a long-term or short-term facility have to go to a designated facility post-discharge.  This creates a huge logistical nightmare as all the current residents of said facility will need to be transferred elsewhere, and that process is not a quick one, dependent on insurance, wards of the state, etc..  Logistically, I'm not 100% certain this would even be possible, but let's say that it is possible, though would undoubtedly be very difficult.  Unless they made the Javitz center the designated facility.  I'm not familiar with how things were structured inside there to know if this could have been a legitimate option.

3. Covid patients who came from or now need to be admitted to a long-term or short-term facility go back to the facility that they came from.  The facility can rearrange patient room assignments to have a designated ward for covid patients (much as hospitals did before covid patients overtook the vast majority of the hospital).  Doing so is the responsibility of each facility.  If the facility does not have a ward with negative pressure capabilities, they can rent a portable HVAC unit that creates a negative pressure area.  Again, this is what hospitals had to do and are currently doing.

Now that I think about it, number 3 seems like the most feasible option.  So if hospitals were responsible for figuring out on their own how to deal with the infection to minimize the risk to other patients (including those of older age who are most at risk), how are nursing homes not responsible for the same?  The mandate that long-term care facilities be required to take covid patients post-hospital discharge primarily helped to eliminate situation #1.  If I were a family member, I'd be pissed at the facility for not taking proper precautions, not the governor.  Another thing to consider, given the high percentages noted in the early antibody testing, is that the spread of covid within facilities could have come from employees and their outside lives, not a connection through a recovering resident.

Many people on this site seem to be praising the Las Vegas mayor, and she openly said that she had zero involvement or responsibility in figuring out how to do things safely.  According to her, it's the casinos/businesses/hospitals/medical professionals, etc. that are responsible for figuring out how to get everything done.*  But Cuomo** is responsible for not micromanaging the safety precautions put in at each individual facility?

*For the record, I do not like AC at all or his interviewing tactics.  But I think they both made fools of themselves in that interview for totally different reasons.

**I'm actually not a huge fan of Cuomo's policies coming into this epidemic, but I think he has made some decent decisions given the circumstances.  Fights with Trump aside (cause it's all politics), when he asked for ventilators and the ships and testing and PPE, the rate of covid hospitalizations in the state were doubling every two days.  That's absurd.  He asked for supplies that were based on projections of what was currently happening.  No one knew at that point whether or not the lockdown would work to help reduce the spread of the virus.  Thankfully, it did, and now all those requests look extremely excessive.

I agree this is a horrible situation and hospitals overwhelmed.  Cuomo was warned and neglected the conditions.  Nursing home are set up to deal with this anymore than hospitals.  No fear now after the factor Cuomo will have the AG investigate.  He is great for blame but very short on leadership.

[SWSiouxMN]

10 minutes ago, keikla said:

I REALLY hope proves to be true.  It looks likely based on the environmental studies, but we don't know until we know.  IIRC, H1N1 petered out in June.  That would (hopefully) give us five months to figure out what to do in case this becomes seasonal.

I hope it does too.

Pray for a hot and humid May.

I hope we can get lucky. 

[yzerman19]

That’s it!  That’s why CA has been spared...all that sunshine!