2020 Dumpster Fire (Enter at your own risk)

[southpaw]

14 minutes ago, Oxbow6 said:

 I see more sick people in a day than most of society sees in a month.

That's the point...

[UNDBIZ]

13 minutes ago, Walsh Hall said:

My anecdotal story this morning - Went to a nice local donut shop in Bismarck this morning around 8:00.  Typically it’s packed with a 10-15 person line at that time.  Literally not one person there.

I’m more concerned for consumer based small businesses than for the general public health.

Take the necessary reasonable precautions and live your life!

I guess I've never been to that establishment on a weekend. Is it usually as busy as it is on weekdays when people are buying for the office? 

[UNDfaninMICH]

4 minutes ago, keikla said:

 

All of that fear and unknown goes away if we could just get access to testing.  In the meantime, yeah, I think people should be more conservative in their actions.

I don't know that access to testing is going to be a panacea. Get tested now, be negative. Maybe your next illness is coronavirus. How many resources are we going to plow into repeatedly testing each person each time he or she has a cold?

[Oxbow6]

4 minutes ago, UNDfaninMICH said:

I don't know that access to testing is going to be a panacea. Get tested now, be negative. Maybe your next illness is coronavirus. How many resources are we going to plow into repeatedly testing each person each time he or she has a cold?

If no one comes in contact with anyone else ever will be ok.

[UNDfaninMICH]

Just now, Oxbow6 said:

If no one comes in contact with anyone else ever will be ok.

I'm more on the side of infection being pretty damn hard to prevent, but let's not get entire communities infected at once so that we don't run out of beds, staff, equipment, etc.

[yzerman19]

3 minutes ago, UNDfaninMICH said:

Supply: Here's what happens in my community: Get extensive training in medicine, become a practicing physician. Get put on a committee or two, do things that please the higher ups, like find ways to get the grunts to do even more work. Maybe have some connections to wealthy donors. Get sent to an MBA program at the expense of the hospital system (truly, at the expense of the general public who pay for it via their insurers). That MBA will be from a school that is not at all respected outside of our little community. Finish MBA, become a newly minted executive, abandon your clinical practice that you were heavily trained for and experienced in, double your salary. 

 

Demand: Who is creating this demand? The executives who want to decrease their workloads, so they find a few sub-executives? Again, the growth in executive positions in healthcare systems (including medical schools) is growing at a staggering rate, at least around here. Someone retires, and his job is then split into two brand new positions. Add in the executives at the medical board for each specialty, as well as the executives in professional organizations for each specialty. Oh, and look out for NEW subspecialties to be needlessly created so that people in academic medicine can have new ways to make money without seeing patients.

https://www.kevinmd.com/blog/2014/05/physician-regulators-paid-front-line-doctors.html

The bar chart In the link cherry picks a top ten vs average, but I don’t disagree on academic comp.  Physician comp is of course extremely disparate.  High volume procedurists making 7 figures and low volume PCPs making less than coders at Microsoft.  
 

 

[yzerman19]

3 minutes ago, UNDfaninMICH said:

I'm more on the side of infection being pretty damn hard to prevent, but let's not get entire communities infected at once so that we don't run out of beds, staff, equipment, etc.

Yes- that is the goal...slow burn vs explosion

[Cratter]

40 minutes ago, UND1983 said:

OK.  So the economy is more important than actually controlling the spread of the virus.  

As a society we decided that the 60,000 flu deaths last year was less important than the economy.

 

[Oxbow6]

2 minutes ago, keikla said:

To be clear, this is 100% where I'm coming from.  People are going to get sick.  There is no way to completely prevent that.  I just want them to get sick at a slow enough rate that the healthcare system doesn't collapse under the weight of it.

So anyone who works in the healthcare arena and their families can't not have any semblance of normalcy until when?

 

[iramurphy]

18 minutes ago, keikla said:

I don't mean this at you personally, but I think people are looking at this wrong, so I'm using you as an example.  It really shouldn't be "Am I going to get sick?".  It should be "Am I going to get others sick?"  Your daughter is young and presumably healthy.  That doesn't mean that she won't be infected from her recent outings and just asymptomatic.  You can't say there aren't many cases in MN and ND, because few people can get tested.

Let's say she spreads it to the rest of your family because you live together, and the rest of you also stay asymptomatic.  No big deal for your family.  Except for that fact that you work in healthcare, correct?  With direct contact to patients?  So if you are an asymptomatic carrier, I'm assuming not all the patients who walk through your door are young, healthy, and have fully-intact immune systems.  Do you wear a mask all day, every day at work?  Not to protect yourself but to protect others from you?  Does the rest of the staff in the office/hospital wear masks?

Instead of worrying entirely about whether or not people will individually get sick, they should be doing everything they can to not be another "Patient 31" like in South Korea.  https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.html

It is incorrect to say “few people can get tested” in Mn or NDak. We have protocols in place in our rural clinic in a community of 1500. We have protocols in place at smaller clinics in the area. Why don’t you think you can get tested?  Testing everyone isn’t necessary and would be a waste of resources.
Why do you think Oxbow should wear a mask all day?   There is no reason for healthy, asymptomatic people to routinely wear masks. Those who do the evaluation and testing wear them and other protective gear when appropriate.  It isn’t that difficult to follow the daily communication from the CDC.  We do not need to start testing every asymptomatic person. People need to wash hands frequently, cover their coughs, stay away from large crowds when not necessary. People who think they are starting to feel sick should wear a mask and stay home. If they start to feel seriously ill, they should contact their health care provider for instructions. They should not go to the ER or clinic before calling for instructions. They should not call an ambulance for non-emergencies. If people do that we will be much less likely to overwhelm our medical facilities and resources. To question the need to close schools is a reasonable debate.  Thus far, children are least likely to get sick. The issues of proper nutrition, safe environments, family resources must be part of those discussions. We don’t have evidence to tell us whether or not closing schools will help or worsen the problem so right now you can reasonably argue both sides. 
 

[Oxbow6]

So let's me throw this wrench into all of this......my buddy just texted me. He's youngest of large family. Parents late 80s. Living in assisted living. He can't go into facility to see them but he's picking them up for lunch as they can voluntarily leave the facility.

But my daughter enjoying a couple days with friends at a hotel and MOA is going to collapse the healthcare system in the FM area.

[Ranger]

2 minutes ago, Oxbow6 said:

So let's me throw this wrench into all of this......my buddy just texted me. He's youngest of large family. Parents late 80s. Living in assisted living. He can't go into facility to see them but he's picking them up for lunch as they can voluntarily leave the facility.

But my daughter enjoying a couple days with friends at a hotel and MOA is going to collapse the health system in the FM area.

Roll those dice...  and good luck.  

[Oxbow6]

10 minutes ago, keikla said:

The decision of who can be tested is being left up to the county and state department of health.  If you feel confident that those in your community can get tested, then you live somewhere with way more resources than I do. 

New York currently has the highest number of confirmed cases in the country which, again, doesn't include anyone who hasn't been tested.  I have multiple coworkers who have a fever and respiratory symptoms, have ruled out flu and strep, and still do not qualify to be tested per the state guidelines.  The state wants a full respiratory panel done or have a known direct contact prior to testing for corona.  The problem with that is that 1) respiratory viral panels are expensive and many places don't/won't do them, and 2) we're at community spread here...it's a little past knowing your direct contact.

So when the 2nd death in NY occurs and we find out he was a 86 male with CHF who's on O2 we're going to place the blame on the nurse's son who went out to a movie with friends a few weeks ago........well because we can connect the dots?

[iramurphy]

1 minute ago, keikla said:

The decision of who can be tested is being left up to the county and state department of health.  If you feel confident that those in your community can get tested, then you live somewhere with way more resources than I do. 

New York currently has the highest number of confirmed cases in the country which, again, doesn't include anyone who hasn't been tested.  I have multiple coworkers who have a fever and respiratory symptoms, have ruled out flu and strep, and still do not qualify to be tested per the state guidelines.  The state wants a full respiratory panel done or have a known direct contact prior to testing for corona.  The problem with that is that 1) respiratory viral panels are expensive and many places don't/won't do them, and 2) we're at community spread here...it's a little past knowing your direct contact.

We don’t contact state or county.  We can coordinate with our specialty staff and I certainly wouldn’t test everyone with a fever and respiratory symptoms. If people are following protocols, those people should stay home.  I wouldn’t want them in my clinic or ER. If they stay home where they belong,  they won’t infect people coming and going to the clinic.  I believe that is how the attorney in New Rochelle exposed so many people. If people aren’t that ill we are going to send them home anyway so they shouldn’t leave home just to be tested. 

[iramurphy]

1 minute ago, keikla said:

Lucky on that one, because we are mandated to.  We can only test with their specific approval on every single case, including those who need to be admitted.

The sick staff should stay home, yes.  But what about all the staff they worked with leading up to getting sick?  If we knew the sick worker had covid, some others in the dept would be quarantined.  If we knew the sick worker didn't have covid, we would continue on as normal.  So what do we do when we don't know either way cause they can't get tested?  As of right now, those with direct contact to the sick workers just keep working, with direct contact to patients.  And you just hope that it wasn't actually covid and that we're not spreading it to vulnerable patients.  This isn't like the flu where if we realize someone got exposed we can just throw some tamiflu prophy dosing at them and have them keep working.

Your co-workers who have cough and fever shouldn’t be at work in the first place. Testing for for COVID-19, if negative, only means it was negative that day. That is why you shouldn’t routinely test. It may give some a false sense of security. What is your protocol for routine testing?  Every week?  Every cough?  Makes no more sense than your pulmonary testing. This is what happens as the government takes over health care. They take away providers authority to act appropriately and promptly. You should have protocols and triage system in place. When you have that your state and county authorities should authorize someone in your clinic and hospital to proceed with testing. Public service announcements and communication to your patients about the importance of hand washing, minimizing unnecessary exposure to groups or high risk areas, covering coughs etc. Staying home when sick and calling for instructions before coming to clinic or hospital are more important than making Oxbow wear a mask all day. 

[Siouxperman8]

57 minutes ago, keikla said:

To be clear, this is 100% where I'm coming from.  People are going to get sick.  There is no way to completely prevent that.  I just want them to get sick at a slow enough rate that the healthcare system doesn't collapse under the weight of it.

This is exactly the goal of the groups that are canceling events with large gatherings. It is not because large numbers have died in a particular area.  This tactic fits the direction from the CDC but gets roundly criticized here. 

[UNDfaninMICH]

54 minutes ago, Cratter said:

As a society we decided that the 60,000 flu deaths last year was less important than the economy.

 

Can we stop with this? It is recognized that viruses will kill people, and to stop that from happening would require virtually complete isolation. People who have died from influenza in recent years have by and large died while receiving maximum therapy for their degree of illness, assuming they didn't elect personally to just let the flu kill them without intervention. The H1N1 outbreak may be an exception, and one could argue that more should have been done back then.

The concern with a pandemic from a novel virus strain is that the volume of patients needing major interventions to keep them alive will be greater than the number of beds, staff, and equipment available to provide them that care. EMS transport crews may be overwhelmed, requiring people chill at home for a while if they have rapid onset of symptoms, or requiring people to wait in their doctor's office or rural hospital for hours until a crew can transport them. Yes, this stuff is already happening far more than it should happen, but there is potential for a huge increase in these issues, leading perhaps to people dying not because there was nothing more technology and medical care could do for them, but because we ran out of technology for them.

[UNDfaninMICH]

6 minutes ago, iramurphy said:

Your co-workers who have cough and fever shouldn’t be at work in the first place. Testing for for COVID-19, if negative, only means it was negative that day. That is why you shouldn’t routinely test. It may give some a false sense of security. What is your protocol for routine testing?  Every week?  Every cough?  Makes no more sense than your pulmonary testing. This is what happens as the government takes over health care. They take away providers authority to act appropriately and promptly. You should have protocols and triage system in place. When you have that your state and county authorities should authorize someone in your clinic and hospital to proceed with testing. Public service announcements and communication to your patients about the importance of hand washing, minimizing unnecessary exposure to groups or high risk areas, covering coughs etc. Staying home when sick and calling for instructions before coming to clinic or hospital are more important than making Oxbow wear a mask all day. 

I have grave concern about fever being the marker that should lead to quarantine/isolation/testing. Chinese data showed 84% of their patients who were positive for Covid-19 had fever. I don't know to what degree they were testing the ambulatory person with simple cold symptoms. If we could be confident that fever is the indication that a person is shedding, we could get back to business as usual aside from screening everybody for fever as they're queuing up for whatever public gathering they're wanting to attend. People don't want to hear this message because it's a nightmare for hospital staffing. Fortunately it sounds like my hospital system will have on-site testing soon, so I'm hopeful that's true for other areas as well.

[yzerman19]

5 minutes ago, UNDfaninMICH said:

Can we stop with this? It is recognized that viruses will kill people, and to stop that from happening would require virtually complete isolation. People who have died from influenza in recent years have by and large died while receiving maximum therapy for their degree of illness, assuming they didn't elect personally to just let the flu kill them without intervention. The H1N1 outbreak may be an exception, and one could argue that more should have been done back then.

The concern with a pandemic from a novel virus strain is that the volume of patients needing major interventions to keep them alive will be greater than the number of beds, staff, and equipment available to provide them that care. EMS transport crews may be overwhelmed, requiring people chill at home for a while if they have rapid onset of symptoms, or requiring people to wait in their doctor's office or rural hospital for hours until a crew can transport them. Yes, this stuff is already happening far more than it should happen, but there is potential for a huge increase in these issues, leading perhaps to people dying not because there was nothing more technology and medical care could do for them, but because we ran out of technology for them.

I’d celebrate those we would be able to save as opposed to mourning those lost.  We can not save everyone.

[UNDfaninMICH]

Just now, yzerman19 said:

I’d celebrate those we would be able to save as opposed to mourning those lost.  We can not save everyone.

WTF. If my loved ones are going to die I want them to die on the utmost amount of support that they choose, within reason. I sure as hell don't want them to die because there was no ICU bed, or no ventilator, or because the ER wait time was too long. 

[Cratter]

12 minutes ago, UNDfaninMICH said:

Can we stop with this?

Nice tirade.

All I did was answer a question that, yes as a society we have decided the economy is sometimes more important than stopping the spread of a virus.

As a society we have to decide where that line is.

[yzerman19]

Just wait until some junky on a speedball dies because we ran out of vents...the moral outrage!  If we just had more control and more govt services we could save the world!  
 

snowflake mentality.  Nobody is special, we are carbon, hydrogen, and oxygen (splattering of most other elements)brilliantly organized for a nanosecond in space time as we propel towards entropy.

Love one another, live each minute as if it’s your last, and accept What cannot be controlled.

[UNDfaninMICH]

5 minutes ago, yzerman19 said:

Just wait until some junky on a speedball dies because we ran out of vents...the moral outrage!  If we just had more control and more govt services we could save the world!  
 

snowflake mentality.  Nobody is special, we are carbon, hydrogen, and oxygen (splattering of most other elements)brilliantly organized for a nanosecond in space time as we propel towards entropy.

Love one another, live each minute as if it’s your last, and accept What cannot be controlled.

So why do we have medical care at all? 

[iramurphy]

2 minutes ago, UNDfaninMICH said:

Can we stop with this? It is recognized that viruses will kill people, and to stop that from happening would require virtually complete isolation. People who have died from influenza in recent years have by and large died while receiving maximum therapy for their degree of illness, assuming they didn't elect personally to just let the flu kill them without intervention. The H1N1 outbreak may be an exception, and one could argue that more should have been done back then.

The concern with a pandemic from a novel virus strain is that the volume of patients needing major interventions to keep them alive will be greater than the number of beds, staff, and equipment available to provide them that care. EMS transport crews may be overwhelmed, requiring people chill at home for a while if they have rapid onset of symptoms, or requiring people to wait in their doctor's office or rural hospital for hours until a crew can transport them. Yes, this stuff is already happening far more than it should happen, but there is potential for a huge increase in these issues, leading perhaps to people dying not because there was nothing more technology and medical care could do for them, but because we ran out of technology for them.

Canceling unnecessary gatherings is important in minimizing the spread of this virus. Thinking everyone infected with COVID-19 should go to a clinic or hospital is flawed. That is the type of behavior that is more likely to overwhelm our system and spread the disease. People who are ill especially with cough and fever should stay home. The shouldn’t call an ambulance for non-emergencies. They should not go to ER or hospital until directed to unless they are experiencing a serious or life threatening emergency. They should not go to their clinics unless told to come in. There is no treatment yet for this virus except supportive care for serious cases that may need ventilators/oxygen/IV fluid resuscitation.  That is why the 85% of people without serious symptoms should stay home. That is how we will have the resources to care for the other 15%. If you aren’t sick you likely won’t need to be tested. Stay away from hospitals and clinics where you are more likely to be exposed. I’m in a rural area and no one sits in the waiting room waiting. You are taken to an isolation room and evaluated by medical staff wearing appropriate protection. Please stop the scare tactics. If the public follow the advice to stay home when ill, wash hands and call before coming to clinic or hospital we can do a lot to further slow this thing. 

[yzerman19]

Just now, UNDfaninMICH said:

So why do we have medical care at all? 

To alleviate human suffering when we can.  
 

operative words being when we can.  You do your best.  
 

gotta take the personal and emotional out of it if you are making difficult decisions.