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2020 Dumpster Fire (Enter at your own risk)

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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?

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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. 

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1 minute ago, iramurphy said:

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. 

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.

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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. 

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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. 

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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.

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1 minute 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. 

They aren't at work once sick, but that doesn't mean others weren't exposed the day before.  You can spread the flu before you start to be symptomatic; this isn't any different.

I don't claim to have all the answers for who to test and when.  But I wish we could at least leave it to provider judgement, and not the county and/or state.  Maybe it should be able to mirror testing for the flu.  You test negative for flu and strep?  Great, now it's LIP decision whether to test for covid.  Maybe test if the person is a higher risk to others?  And if not, just send them home.

We have protocols in place, but since the government is calling all the shots, we don't really have much say in that protocol to begin with.  And yes, information is being blasted to patients and staff.

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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.

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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.

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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. 

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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.

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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.

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Here are some things that haven't really been mentioned here, but I have found to be the most unexpected (so far) from everything happening related to COVID.  For reference, I work in 2 different hospitals, both of which are currently treating multiple COVID patients as well as many "Patients Under Investigation" (PUI).  We're also past the point of knowing your direct contact for exposure.

1) Those who die from COVID in the hospital may die alone.  Why?  Cause any family they live with or visited with recently are under quarantine and can't come visit.  Maybe if the patient is lucky there will be someone who is a relative or close family friend who hadn't been in direct contact within 14 days of the patient getting sick.  But it means that most patients aren't able to be comforted by those closest to them, and critical healthcare decisions are being made by providers and family members over the phone.  That happens sometimes, but it's definitely not what anyone wants.  This has probably been the most upsetting thing for me.

2) Healthcare education for thousands of people is being put on hold.  Most healthcare programs have a year or two of clinical rotations, something that can't be converted to didactic learning online.  A lot of hospitals around here are banning students because 1) they want to limit the risk of spread/liability and, 2) there isn't PPE to spare on trainees.  So depending on how long this outbreak lasts, there will be a lot of healthcare students (med school, pharmacy school, PA, nursing, etc.) who won't have the required experiential hours to graduate on time. 

That has cascading effects because residencies go from July-June.  What happens if your current residents for MD/DO and pharmacists end their current residencies at the end of June but new residents can't step in because their graduation was delayed?  Larger hospitals and health-systems depend heavily on residents to handle the day-to-day workload, so I'm hoping we don't get to that.  Again, this is all dependent on how long an outbreak and student restrictions last, but we're not that far from those May graduation dates.

3) I've mentioned this before, but there isn't really much data yet on how long you are contagious AFTER you've had covid.  So, again, it's just kind of a guessing game for how soon after being sick can someone return to work without risking their coworkers and/or patients.  Last I saw, the CDC wants 2 negative covid tests before someone can return to work.  But what if a sick staff member never got tested in the first place?  Each institutional system is setting their own criteria.

 

And now, I need to take a COVID break for the day.  Obviously there are some majorly opposite opinions on this board, extreme to both sides, but it's nice to be able to have the discussions.

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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? 

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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. 

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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.
 

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I'm all for somebody (National Guard?) having resources (future events) to help handle the overflow of patients that hospitals cant seem to handle.

There seems to be two different issues at play.

1) Stay home. Dont spread the virus.

2) People will die unrelated to the virus because our healthcare systems are already at max capacity.

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1 minute ago, iramurphy said:

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. 

Where did I say that all people should be seeking care? I am not in a rural area, I accept patients from rural areas. When we’re very busy, patients sometimes wait hours in ER’s of rural hospitals for an EMS crew to transport them to us. Maybe things aren’t that way in MN/ND, but I didn’t realize the discussion was limited to specific geographic areas. 
 

100% agree that people shouldn’t call an ambulance to their homes for a large amount of the things they do call for, and that people go to the ED way too often when they have zero emergency, but that’s not changing. 

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7 minutes ago, keikla said:

Here are some things that haven't really been mentioned here, but I have found to be the most unexpected (so far) from everything happening related to COVID.  For reference, I work in 2 different hospitals, both of which are currently treating multiple COVID patients as well as many "Patients Under Investigation" (PUI).  We're also past the point of knowing your direct contact for exposure.

1) Those who die from COVID in the hospital may die alone.  Why?  Cause any family they live with or visited with recently are under quarantine and can't come visit.  Maybe if the patient is lucky there will be someone who is a relative or close family friend who hadn't been in direct contact within 14 days of the patient getting sick.  But it means that most patients aren't able to be comforted by those closest to them, and critical healthcare decisions are being made by providers and family members over the phone.  That happens sometimes, but it's definitely not what anyone wants.  This has probably been the most upsetting thing for me.

2) Healthcare education for thousands of people is being put on hold.  Most healthcare programs have a year or two of clinical rotations, something that can't be converted to didactic learning online.  A lot of hospitals around here are banning students because 1) they want to limit the risk of spread/liability and, 2) there isn't PPE to spare on trainees.  So depending on how long this outbreak lasts, there will be a lot of healthcare students (med school, pharmacy school, PA, nursing, etc.) who won't have the required experiential hours to graduate on time. 

That has cascading effects because residencies go from July-June.  What happens if your current residents for MD/DO and pharmacists end their current residencies at the end of June but new residents can't step in because their graduation was delayed?  Larger hospitals and health-systems depend heavily on residents to handle the day-to-day workload, so I'm hoping we don't get to that.  Again, this is all dependent on how long an outbreak and student restrictions last, but we're not that far from those May graduation dates.

3) I've mentioned this before, but there isn't really much data yet on how long you are contagious AFTER you've had covid.  So, again, it's just kind of a guessing game for how soon after being sick can someone return to work without risking their coworkers and/or patients.  Last I saw, the CDC wants 2 negative covid tests before someone can return to work.  But what if they never got tested in the first place?  Each institutional system is setting their own criteria.

 

And now, I need to take a COVID break for the day.  Obviously there are some majorly opposite opinions on this board, extreme to both sides, but it's nice to be able to have the discussions.

It is a mistake for medical schools or residencies  to change rotations for students and residents. This is how they learn. This is exactly where they should be. 

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15 minutes ago, iramurphy said:

It is a mistake for medical schools or residencies  to change rotations for students and residents. This is how they learn. This is exactly where they should be. 

Agreed, but the decision is being made at the hospital levels, not the schools.  As far as I know, residents are still working as normal because they are employed staff, but students are being kept off hospital/clinic campuses.  We actually begged to be able to keep our students, because they play a vital role in patient education and other tasks.

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I'm impressed and amazed that some of you intelligent and reasonable posters continue to debate this on this thread. I don't know how you do it.

This isn't political. It's also not the time to armchair quarterback everything, or to become an amateur epidemiologist.

To those who are calling this an extreme over-reaction - have you made any effort to educate yourselves about what's happening in Italy? Even if there are underlying reasons that the virus MAY spread differently here, these measures are absolutely worth it. To ignore data like a parabolic rate of infection/death occurring in a highly modernized Western country and to proceed as though things will be different here would be reckless. There are many reports of ICUs running out of beds, ventilators, etc.

https://www.worldometers.info/coronavirus/country/italy/

This link is data about the situation. Look at the graphs.The infection/death rate is acting like a quadratic equation, and without taking extreme measures this could be historically bad.

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13 minutes ago, iramurphy said:

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. 

I hope employers everywhere are reviewing their HR policies immediately.  In our system, if an employee calls out, it counts as "one occurrence".  If an employee calls out for two consecutive days without a note from an LIP, it counts as "two occurrences".  If they have a note, however, it still counts as one.  A certain number of "occurrences" leads to discipline.  Since it's a hospital, you're basically saying that Dr, nurse, pharmacist, etc. can't trust their own clinical judgment of whether or not they need to be seen or just stay home because now it's tied into HR and discipline.

There are also payroll implications.  Sick for 4 days without a note from an LIP?  Enjoy losing 32 hrs of PTO.  Sick for 4 days with a note from an LIP?  That time comes from a long-term illness bank, and you keep your PTO.

Side note...if anyone is bored senseless because everything has been canceled, "The Pharmacist" on netflix was a pretty good short series.  The regionals, semi-finals, and natty game from 2016 are also on youtube (I've watched them more times than I probably should admit).

Okay, now I'm really taking a break for the day.  Mostly cause I still have like 11 call-out shifts for which I need to find coverage in the upcoming week.

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7 minutes ago, keikla said:

Agreed, but the decision is being made at the hospital levels, not the schools.  As far as I know, residents are still working as normal because they are employed staff, but students are being kept off hospital/clinic campuses.

Around here students on clinical rotations are still attending them.

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3 minutes ago, UNDfaninMICH said:

Around here students on clinical rotations are still attending them.

Yes, I didn't mean to imply that this was already happening nationally.  It is happening locally in the tri-state area and may spread in conjunction with the virus spread.

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It’s interesting how our views change when we think it is all about those other people when we get affected and those other people are us.

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