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2020 Dumpster Fire (Enter at your own risk)

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13 minutes ago, MafiaMan said:

CNN interviewed Cuomo the other night - you could actually see the disappointment on her face when Cuomo said that he had a good conversation with Trump regarding how things were going in New York.

It’s nice to hear federal and state officials setting differences aside and working together on this.  But that doesn’t fit the narrative of conflict and orangemanbad that cnn’s business model is based on. 

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We have become a society where the loud minority is now more powerful than the silent majority. 

You guys can disregard conspiracy theories all you want but the fact is it doesn't take much these days to send our country into a complete tailspin. Other countries are well are of our political discord and climate.  

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3 hours ago, Siouxphan27 said:

Lol. The lengths some people will go to to avoid admitting they were wrong   Unbelievable.

image.gif.2fa735c6b5c7a96c88cb79a6a29f2686.gif

Show me where I've been wrong.

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26 minutes 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 tedts 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.

Scrubbing all "non-essential" visits.....wherever that line is drawn. Screening patients as they enter the doors of system at any location before they hit registration. Symptoms and travel questions. Temperature. If concerns raised during screening they are sent to a designated location for further eval....at least in theory that's the plan.  But yesterday I got a call from a LPN screener...…."Will you still see this patient. Blah blah blah....she's asymptomatic but just got off a cruise ship last Thursday". My response....."As long as the boat didn't come from Italy". :silly:  Was a 74 year old female.....an individual this whole crisis lockdown is trying to protect. Just clueless.

My buddy practices just outside of Vancouver, WA. Said late in the day yesterday a patient told him AS SHE WAS LEAVING her visit...…"I might  have been exposed by my daughter last this past weekend"....daughter has no confirmation but symptoms.

 

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2 minutes ago, TBR said:

Show me where I've been wrong.

 The conversation we were having before you replied was about whether or not President Trump referred to the coronavirus as a hoax.   He didn’t.  Read the entire thread if you have anymore questions   

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16 minutes ago, MafiaMan said:

CNN interviewed Cuomo the other night - you could actually see the disappointment on her face when Cuomo said that he had a good conversation with Trump regarding how things were going in New York.

We saw all we had to with the media the other day when they got mad at Donald for telling governors to "try to get ventilators yourselves" when the full quote included that they had the support of the Federal government but going directly to sellers as a State is likely faster than going through the Feds.

Newsom and Cuomo have both had good things to say about the Federal response.

If Donald tried to take big national lockdown action the same people who are complaining about him not taking that action now would be calling him a tyrant (literally Hitler) and not leaving any discretion to state and local leaders.

It's not difficult to figure out a lot of these people only have jobs/influence if they are lamenting about The Donald. Same goes for some right leaning folks whenever a Democrat is in charge of running things.

You wont find me complaining anytime the Feds give some room to the States to handle things their own way. Usually that's the best way to find what is working and what isn't anyway. New York City and Mandan should probably be handling this in different manners.

Rant over. Off my soapbox.

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15 minutes ago, Siouxphan27 said:

It’s nice to hear federal and state officials setting differences aside and working together on this.  But that doesn’t fit the narrative of conflict and orangemanbad that cnn’s business model is based on. 

I realize it is tough for CNN and MSNBC "reporters" to try and contain their excitement and hopes that things will get worse but hopefully they refrain from busting out the pom poms.

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30 minutes ago, Oxbow6 said:

Scrubbing all "non-essential" visits.....wherever that line is drawn. Screening patients as they enter the doors of system at any location before they hit registration. Symptoms and travel questions. Temperature. If concerns raised during screening they are sent to a designated location for further eval....at least in theory that's the plan.  But yesterday I got a call from a LPN screener...…."Will you still see this patient. Blah blah blah....she's asymptomatic but just got off a cruise ship last Thursday". My response....."As long as the boat didn't come from Italy". :silly:  Was a 74 year old female.....an individual this whole crisis lockdown is trying to protect. Just clueless.

My buddy practices just outside of Vancouver, WA. Said late in the day yesterday a patient told him AS SHE WAS LEAVING her visit...…"I might  have been exposed by my daughter last this past weekend"....daughter has no confirmation but symptoms.

 

WTF

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11 minutes ago, farce poobah said:

FDA approves Chloroquine for treatment of Covid-19.  

Let's hope this works on a wide-scale.

We need a break, hope this can be the break. 

 

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8 minutes ago, SWSiouxMN said:

Let's hope this works on a wide-scale.

We need a break, hope this can be the break. 

 

Enormous global production capacity.   A smart Pharma-Dr that I know describes it as a band aid while tailored therapeutics and vaccines work through the pipeline 

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37 minutes ago, farce poobah said:

FDA approves Chloroquine for treatment of Covid-19.  

 

I can't find anything from the FDA that confirms the approval.  What source?

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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. 

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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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19 minutes ago, keikla said:

 

I can't find anything from the FDA that confirms the approval.  What source?

Apologies if I jumped the gun, which I appear to have done.   I was going off general news sources, aka a Bloomberg channel headline.  

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3 minutes ago, farce poobah said:

Apologies if I jumped the gun, which I appear to have done.   I was going off general news sources, aka a Bloomberg channel headline.  

Did you have to stand on a box to read from that news source?  ;)

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21 minutes ago, UNDfaninMICH said:

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. 

I have a coworker on quarantine for a known exposure, now with respiratory symptoms, who can't even get tested.

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2 minutes ago, keikla said:

I have a coworker on quarantine for a known exposure, now with respiratory symptoms, who can't even get tested.

Unacceptable.  Too bad he/she doesn't play for the Brooklyn Nets.

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30 minutes ago, Siouxperfan7 said:

Siouxsports admins trying to enforce the “no politics” rule on this thread.....:D

0B0BA091-6087-41CF-B9AA-AE5B8E6EC1F5.gif

Your comment...is not a hoax...

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29 minutes ago, UNDfaninMICH said:

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. 

Stupid question but does the FDA have an emergency provision like the EPA does for herbicide registration?

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39 minutes ago, Siouxperfan7 said:

Siouxsports admins trying to enforce the “no politics” rule on this thread.....:D

0B0BA091-6087-41CF-B9AA-AE5B8E6EC1F5.gif

But this was refreshing to see....and what's needed right now.

Screenshot_20200319-121231.png

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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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2 hours 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.

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. 

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