Covid-19 (not gnr related)

[pilferk]

Here is a good take on how we got to where we are now. Didn't have to be this way.

https://www.youtube.com/watch?v=v_2omrmqPNs&feature=youtu.be&fbclid=IwAR3cTxwL90o5pEnAl09PXkRYAb-qhJ9mGxYjf6VTlnsT5IX-_VCgXeRv1F8

Regulations save lives.....in times of normal care.  Period.  If you don't work in healthcare...honestly....you have no idea.

In a time of pandemic, they are hurdles.  And the CDC Pandemic Response Team made this clear awhile back.  And they issued a plan to relax those regulations at the beginning of any potential pandemic, to speed up the process.

Trump and his administration ignored that plan early on.  If, when he was briefed in December and updated in January, he had followed that plan...we would have been in much better shape than we are now.  Instead of campaigning against the virus like it was a political opponent (or a manufactured hoax of his political opponents).

But he didn't.  That's the truth in all this.  People begged him to.  The WHO offered tests to help bridge the gap in our production while he did.  And he flatly refused.  So our response was lagged, late, and ultimately not robust enough, for the situation.  We should have modeled our response after South Koreas, right from the get go.  It's what the medical community all told the fed and state governments to do.  Some state's listened earlier than others......but couldn't get fed support til early-mid March.

Now we wait.

[pilferk]

If anyone has contacts in healthcare that are struggling with this, and caring for patients, I have a tiny bit of information to share:

We've found "proneing" patients (aka putting them on their stomachs for a period of time) has been effective in treatment.  I can't explain the clinical reasons why, but it's been working for us.  It's not comfortable for the patients, especially on a vent, but......we have seen verifiable results.

https://www.jwatch.org/fw116486/2020/03/25/covid-19-update-prone-positioning-comorbid-cancer-when

Hartford Hospital has found a way to split a single vent to work for 2 patients, without a loss of pressure, or increased risk of infection.  I believe we are trialing this in our health system, too.

https://www.nbcconnecticut.com/news/local/fear-of-ventilator-shortage-prompts-search-new-methods/2244634/

[pilferk]

Evidence of chaos in the CDC and administration regarding response:

https://www.propublica.org/article/internal-emails-show-how-chaos-at-the-cdc-slowed-the-early-response-to-coronavirus

Also, Howie is a colleague of mine, is a SUPER smart guy, and has a lot of good information on the spread and outbreak...and not just in CT:

https://twitter.com/thehowie

[tim_m]

If anyone has contacts in healthcare that are struggling with this, and caring for patients, I have a tiny bit of information to share:

We've found "proneing" patients (aka putting them on their stomachs for a period of time) has been effective in treatment.  I can't explain the clinical reasons why, but it's been working for us.  It's not comfortable for the patients, especially on a vent, but......we have seen verifiable results.

https://www.jwatch.org/fw116486/2020/03/25/covid-19-update-prone-positioning-comorbid-cancer-when

Hartford Hospital has found a way to split a single vent to work for 2 patients, without a loss of pressure, or increased risk of infection.  I believe we are trialing this in our health system, too.

https://www.nbcconnecticut.com/news/local/fear-of-ventilator-shortage-prompts-search-new-methods/2244634/

Interesting, i'm glad we are starting to find something that works.

I believe New York has also found a way to do this. Are they just allowed to go ahead and do it? Is there any kinda regulation or approval they have to get through to to be able to split it between 2 patients?

[tim_m]

Miami Dade has now enacted stay at home as well as a curfew.

[Dr. Blutarsky]

Here is a good take on how we got to where we are now. Didn't have to be this way.

https://www.youtube.com/watch?v=v_2omrmqPNs&feature=youtu.be&fbclid=IwAR3cTxwL90o5pEnAl09PXkRYAb-qhJ9mGxYjf6VTlnsT5IX-_VCgXeRv1F8

Regulations save lives.....in times of normal care.  Period.  If you don't work in healthcare...honestly....you have no idea.

In a time of pandemic, they are hurdles.  And the CDC Pandemic Response Team made this clear awhile back.  And they issued a plan to relax those regulations at the beginning of any potential pandemic, to speed up the process.

Trump and his administration ignored that plan early on.  If, when he was briefed in December and updated in January, he had followed that plan...we would have been in much better shape than we are now.  Instead of campaigning against the virus like it was a political opponent (or a manufactured hoax of his political opponents).

But he didn't.  That's the truth in all this.  People begged him to.  The WHO offered tests to help bridge the gap in our production while he did.  And he flatly refused.  So our response was lagged, late, and ultimately not robust enough, for the situation.  We should have modeled our response after South Koreas, right from the get go.  It's what the medical community all told the fed and state governments to do.  Some state's listened earlier than others......but couldn't get fed support til early-mid March.

Now we wait.

Not all regulations are bad but some create a big headwind against progress and efficiency.  Ive dealt with government agencies in my business and I can tell you from personal experience this happens more often than it should.

Agree we should have followed the South Korea model. But we didn't ( or couldn't)

 

[pilferk]

Interesting, i'm glad we are starting to find something that works.

I believe New York has also found a way to do this. Are they just allowed to go ahead and do it? Is there any kinda regulation or approval they have to get through to to be able to split it between 2 patients?

Yup, they can just do it.  They might need a 3-d printer to print the parts that allow it to be done. I know Hartford Hospital is sharing those templates...I think some other centers are too.  But, from what we understand, its not a process that would fall under regulations or approvals.  I know there are a NUMBER of hospitals that are starting to do it.

If nothing else, this process seems to be leading to a period of extensive (and needs based) medical innovation.

[Dr. Blutarsky]

Miami Dade has now enacted stay at home as well as a curfew.

I'm surprised it took that long as they have the most cases in FL. Osceola and Orange Co ( Kissimmee- Orlando) enacted a stay at home order yesterday with fewer cases reported than Miami.

[tim_m]

Interesting, i'm glad we are starting to find something that works.

I believe New York has also found a way to do this. Are they just allowed to go ahead and do it? Is there any kinda regulation or approval they have to get through to to be able to split it between 2 patients?

Yup, they can just do it.  They might need a 3-d printer to print the parts that allow it to be done. I know Hartford Hospital is sharing those templates...I think some other centers are too.  But, from what we understand, its not a process that would fall under regulations or approvals.  I know there are a NUMBER of hospitals that are starting to do it.

If nothing else, this process seems to be leading to a period of extensive (and needs based) medical innovation.

That is excellent news but now the obvious questions are do we have the beds, space and personnel.

[pilferk]

Not all regulations are bad but some create a big headwind against progress and efficiency.  Ive dealt with government agencies in my business and I can tell you from personal experience this happens more often than it should.

Agree we should have followed the South Korea model. But we didn't ( or couldn't)

I won't comment on other industries.  I know construction folks hate them.  I can't comment on their effect or effectiveness in that, or most other, industries.

I've worked in the medical/healthcare field, in data analytics, for 20+ years.

Regulations save lives.  Specifically some of the regulations talked about in the posted video.  

If you're not in the medical field, you have no clue.  I'm not saying that to be an ass....it's just the truth.  It's like no other industry when it comes to this.  

I will go toe to toe with the FDA on the lag in approving drugs, and especially in using existing, approved, drugs in off book ways.  Their operational process is too slow by half.  But the laws and regulations on the books aren't the problem. They are there to save lives, and they DO!  The FDA's process (and borderline incestuous relationship with Big Pharma) is.

[tim_m]

Miami Dade has now enacted stay at home as well as a curfew.

I'm surprised it took that long as they have the most cases in FL. Osceola and Orange Co ( Kissimmee- Orlando) enacted a stay at home order yesterday with fewer cases reported than Miami.

I think your governor needs to get more involved. He has been very reluctant to do anything like this.

[pilferk]

That is excellent news but now the obvious questions are do we have the beds, space and personnel.

It makes things more efficient.  Your respiratory therapists are more efficient because they can tend to two patients at once on the vents.  Same with your ICU nursing staff (who could probably adjust vent pressures...they just don't because they don't want to overstep Respiratory Therapy).  Easier to monitor 2 patients on one machine.

The other questions you asked...it depends.  It will help in overrun places, but you are still going to run out of resources.  It's not going to get you more beds or rooms...it's just going to mean you need ONE vent in the room, and not 2.  It's also not going to get you more ECMO machines, to help with cardio-pulmonary issues.  But it's SOMETHING that makes the shortage of vents less than it would otherwise be.

Our real problem patients have been those 70+, which is what you would expect.  The younger, respiratory compromised, patients DO BETTER.  Of the deaths we've seen 91% were over 70.  4.5% were over 50 (and extremely respiratorily compromised prior to infection).  The rest were younger, but ALL had extreme COPD/ARDS comorbidities prior to infection.  I don't know if EVERYONE across the country is seeing those statistics/demographics....but we are.

We have severe SYMPTOMS in younger age brackets, but so far no deaths.  I don't know, yet, about functional discharge status.  We'll see when they recover.

[pilferk]

I think your governor needs to get more involved. He has been very reluctant to do anything like this.

He wouldn't even fucking close the beaches during spring break. Municipalities had to take it on themselves ,and even then not all closed.  Stupid, stupid, stupid.

[pilferk]

Looks like the UK PM, Boris Johnson, tested positive for Covid today.

[Dr. Blutarsky]

Miami Dade has now enacted stay at home as well as a curfew.

I'm surprised it took that long as they have the most cases in FL. Osceola and Orange Co ( Kissimmee- Orlando) enacted a stay at home order yesterday with fewer cases reported than Miami.

I think your governor needs to get more involved. He has been very reluctant to do anything like this.

I dont think it needs to be statewide, county by county depending on the amount of cases makes more sense I think.

One thing that pisses me off  abt DeSantis is that he said there would be natl guard and state officials to meet those who flew in from NYC area as they needed to self quarantine for 14 days. This is not happening at Orlando Intl Airport, people get off the planes grab their luggage and leave and there is no one there to meet.

[tim_m]

That is excellent news but now the obvious questions are do we have the beds, space and personnel.

It makes things more efficient.  Your respiratory therapists are more efficient because they can tend to two patients at once on the vents.  Same with your ICU nursing staff (who could probably adjust vent pressures...they just don't because they don't want to overstep Respiratory Therapy).  Easier to monitor 2 patients on one machine.

The other questions you asked...it depends.  It will help in overrun places, but you are still going to run out of resources.  It's not going to get you more beds or rooms...it's just going to mean you need ONE vent in the room, and not 2.  It's also not going to get you more ECMO machines, to help with cardio-pulmonary issues.  But it's SOMETHING that makes the shortage of vents less than it would otherwise be.

Our real problem patients have been those 70+, which is what you would expect.  The younger, respiratory compromised, patients DO BETTER.  Of the deaths we've seen 91% were over 70.  4.5% were over 50 (and extremely respiratorily compromised prior to infection).  The rest were younger, but ALL had extreme COPD/ARDS comorbidities prior to infection.  I don't know if EVERYONE across the country is seeing those statistics/demographics....but we are.

We have severe SYMPTOMS in younger age brackets, but so far no deaths.  I don't know, yet, about functional discharge status.  We'll see when they recover.

There's also a company, Prisma who has developed a ventilator that can take 4 patients at once..

Those numbers are pretty much inline with what i have been hearing. If there is one small silver lining if you regularly check the tracker via John's Hopkins, the recovered rate worldwide at least seems to be going up faster then new infections. Even in the US it has climbed quite a bit in the last few days. I take that with a pinch of salt because we are well behind other countries. Not saying we are in anyway getting out of the woods here or abroad but small glimmers of hope. I'm also curious just what exactly the recovered numbers are. Certainly higher then what is reported simply because not everyone with symptoms get tested or even have to go to the hospital.

[tim_m]

Looks like the UK PM, Boris Johnson, tested positive for Covid today.

Yep it is all over the news.

[tim_m]

Miami Dade has now enacted stay at home as well as a curfew.

I'm surprised it took that long as they have the most cases in FL. Osceola and Orange Co ( Kissimmee- Orlando) enacted a stay at home order yesterday with fewer cases reported than Miami.

I think your governor needs to get more involved. He has been very reluctant to do anything like this.

I dont think it needs to be statewide, county by county depending on the amount of cases makes more sense I think.

One thing that pisses me off  abt DeSantis is that he said there would be natl guard and state officials to meet those who flew in from NYC area as they needed to self quarantine for 14 days. This is not happening at Orlando Intl Airport, people get off the planes grab their luggage and leave and there is no one there to meet.

That is just literally asking for trouble.

[tim_m]

Governor Cuomo says today the apex is expected in about 3 weeks.

[COMAMOTIVE]

STIMULUS JUST PASSED BY HOUSE - HEADING TO TRUMP'S DESK NOW - JUST AN FYI