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The Official CORONAVIRUS oh *&^! thread. Time to start stocking up on food?


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another update from my patient's swab on Saturday (3/21)...initially was told it would be 1-2 days for a result, then because the lab failed to send swab to state the results would be in by Wednesday (today...3/25), now upon checking in with the individual who receives all results I am told, "Typically takes at least a week according to lab."  This is from the same person who told me 1-2 days and then told me results by today!

This is infuriating beyond belief!

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https://nypost.com/2020/03/22/new-jerseys-first-coronavirus-patient-released-from-hospital-on-oxygen/

James Cai, the PA in New Jersey is out of the hospital and at home but on supportive oxygen at age 32.

He has lung fibrosis and no one knows if it will heal or heal completely.

Glad he survived. Sad to see this disease is going to leave behind long term disability for some.

Everyone out there - take care - hope you have PPE

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4 hours ago, Reality Check 2 said:

https://nypost.com/2020/03/22/new-jerseys-first-coronavirus-patient-released-from-hospital-on-oxygen/

James Cai, the PA in New Jersey is out of the hospital and at home but on supportive oxygen at age 32.

He has lung fibrosis and no one knows if it will heal or heal completely.

Glad he survived. Sad to see this disease is going to leave behind long term disability for some.

Everyone out there - take care - hope you have PPE

Good luck to him getting workers comp benefits.  Next step....get a SS lawyer and start trying to get SS disability which by default will be denied 3x before they consider approving it.  Tragic and very much could be the end of his career and financial future.  Welcome to healthcare in America.

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Have any of your FM workplace made any adjustments? My work is doing mostly virtual visits by phone (my coworker only saw one patient in person yesterday) which our patients are grateful for since they don't want to be exposed coming to clinic. We are checking temps of staff each morning, wearing surgical masks, and maintaining 6 feet distance whenever possible. We have relevant meetings at end of work for daily updates from admin. We also check temps of patients before the walk into clinic. Pharmacy now calls pt when meds are ready so that they don't walk and wait inside clinic; they also have a delivery of option available. We have closed all the small clinics (patients haven't really coming in past few weeks). Our specialists and peds are all furloughed as of now. Only OBGYN and adult medicine providers are trickling back to work.

 

It took one positive Covid19's case from about a week ago (we now have 4 confirmed so far), but I'm quite grateful for many of the radical changes we finally have.

 

We now have drive thru covid testing at two of our clinic sites that have a parking lot. We still follow CDC for the testing criteria.

 

As of yesterday, we have a rapid IgM-IgG antibody test available. This is a blood test with turn around time of 15 minutes and was widely used by Chinese CDC. The sensitivity is 88% and specificity is 90%. We will be performing the test along with the RNA PCR one. If this rapid test is reliable, we may in the future use this as a screening tool and only use RNA PCR as a confirmatory test. Has anyone heard of this or tried this yet?

 

 

 

 

 

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I work at a rural  health clinic in california as an extension of our local hospital (25 beds).  our next neighboring town is 50 miles north with a 17 bed hospital. beyond that our next closest medical care is 150 miles either north or south;   our first documented case locally (at the neighboring town)was Monday the 23rd;  there are now 8 total (2 from our car clinic and 6 from neighboring site).  two weeks ago we started a drive up clinic that is by appt only:  patient calls the clinic, triaged by nursing, given a "car appt" - we started scrubbing our visits last week effective this week:  no "non-essential" visits are conducted face to face.  phone visits enacted and we're starting telehealth next week.  our entire facility is only honoring essential visits or surgical procedures, even our lab and radiology services.  Patients are very grateful for these actions thus far.

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I work in a family practice clinic in a small town. I have been self quarantined all week due to international travel and just started with telehealth visits from my impromptu office. VPN rip-rarin to go :)

The other clinicians (1PA, 1NP, 2 MDs) are mostly doing face to face with the exception of one who is seeing any patients in clinic who are comfortable with it.

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4 hours ago, pavlovacloud said:

Have any of your FM workplace made any adjustments? My work is doing mostly virtual visits by phone (my coworker only saw one patient in person yesterday) which our patients are grateful for since they don't want to be exposed coming to clinic. We are checking temps of staff each morning, wearing surgical masks, and maintaining 6 feet distance whenever possible. We have relevant meetings at end of work for daily updates from admin. We also check temps of patients before the walk into clinic. Pharmacy now calls pt when meds are ready so that they don't walk and wait inside clinic; they also have a delivery of option available. We have closed all the small clinics (patients haven't really coming in past few weeks). Our specialists and peds are all furloughed as of now. Only OBGYN and adult medicine providers are trickling back to work.

 

It took one positive Covid19's case from about a week ago (we now have 4 confirmed so far), but I'm quite grateful for many of the radical changes we finally have.

 

We now have drive thru covid testing at two of our clinic sites that have a parking lot. We still follow CDC for the testing criteria.

 

As of yesterday, we have a rapid IgM-IgG antibody test available. This is a blood test with turn around time of 15 minutes and was widely used by Chinese CDC. The sensitivity is 88% and specificity is 90%. We will be performing the test along with the RNA PCR one. If this rapid test is reliable, we may in the future use this as a screening tool and only use RNA PCR as a confirmatory test. Has anyone heard of this or tried this yet?

 

 

 

 

 

Sent from my Pixel 3 using Tapatalk

 

 

 

 

 

 

 

 

Wow, I didn’t realize an antibody test was becoming that readily available.  I think that’s amazing.  Seems logical to screen with the antibody test (provided of course you have enough) before doing confirmatory PCR testing of the RNA itself.

Is the antibody test looking for both IgM and IgG, or just IgM? I’m sure here in the future we’ll all pretty much have a positive IgG test

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In an attempt to help relieve some of the tension surrounding the unknown with this novel virus:

Flu season in the US is typically Oct-May. Here are some numbers to consider:
2017-2018: 80,000 flu-related deaths in US
2018-2019: 60,000 flu-related deaths in US
2019-2020: 23,000-59,000 current estimate of flu-related deaths by CDC (in 6 months; estimates thru 3/14/2020, and we still have two months to go! This year's vaccine has only been 45% effective.)
2019-2020: 1,300 Coronavirus-related deaths in US (in two months since first confirmed case in Jan)

As an old attending once said, "Start with what you know and then work your way toward the unknown."

Stay safe, people. But be mindful and take solace in the fact that we encounter more deadly things on a day-to-day basis than a novel virus, unless some of these "guesstimates" are found to indeed be accurate. So here's to hoping that all these efforts to shut down the economy and "flatten the curve" as well as the associated collateral damage are all worth it in the end. Please don't take this the wrong way as I, too, am concerned about the future regarding the uncertain implications of this virus. But I also don't want to see what's left when the smoke clears from these drastic measures... Maybe my goal to retire early in 5 years is too strong and losing my job is making me jaded? But I digress...

Cheers! Going back to eating my rice and beans... 

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You know, @Sed, I know you mean well, but "total fatalities" is a sucky metric, because 1) it doesn't account for the exponential rate of, as yet unchecked in the U.S., growth, and 2) doesn't account for the relative burden of hospital days.

Unless what we're hearing from New York is completely made-up (um, yeah), the impact of Covid-19 on the healthcare system cannot adequately be captured by death stats alone.

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5 hours ago, pavlovacloud said:

 

As of yesterday, we have a rapid IgM-IgG antibody test available. This is a blood test with turn around time of 15 minutes and was widely used by Chinese CDC. The sensitivity is 88% and specificity is 90%. We will be performing the test along with the RNA PCR one. If this rapid test is reliable, we may in the future use this as a screening tool and only use RNA PCR as a confirmatory test. Has anyone heard of this or tried this yet?

 

Where and how to get?????

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16 minutes ago, rev ronin said:

You know, @Sed, I know you mean well, but "total fatalities" is a sucky metric, because 1) it doesn't account for the exponential rate of, as yet unchecked in the U.S., growth, and 2) doesn't account for the relative burden of hospital days.

Unless what we're hearing from New York is completely made-up (um, yeah), the impact of Covid-19 on the healthcare system cannot adequately be captured by death stats alone.

Agreed. Does anyone know the financial burden of the seasonal flu? What happened if the economy shut down once 100 people started dying from the flu? People were told to stay home for 2 weeks? We're a consumerism based economy. We can't shut down. And yet people still die by the tens of thousands every year and we don't shut down every year because of that. 

The financial burden of this coronavirus is already astronomical given the fact that the economy was shut down for quarantine periods and already over-burdened hospital systems are now getting an influx plus lack of workforce plus lack of resources. And that's the point I'm trying to make... People aren't going to work, manufacturing has been slowed down, etc etc etc. This is going to make the financial burden even higher than it already is and we're going to have a worse recession than we did in 2008 PLUS a bunch of deaths and morbidity. I can't compare the "what ifs," unfortunately, so we'll never know if this was all worth it in the end... I'm just rambling at this point. But trying to keep the "other side" of the coin still alive amidst all this doom and gloom with getting or transmitting the virus and trying to stop the economy in hopes it's enough. We won't have an economy left when this is all over if we don't start back up in some capacity...

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I think that part of the gloom/doom approach that one hears in the media is dependent upon which part of the country you're talking about.  When you live in a sardine container environment like NYC or the west coast then things are going to appear worse than what they do in the midwest.  When over half of the national cases are in NYC I have to adjust my thought process on this.  Why such a big boost in La.?  Hmm, nothing ever happens there except for every soul packed in just like in NYC, etc. for Mardi Gras.

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1 hour ago, GetMeOuttaThisMess said:

I think that part of the gloom/doom approach that one hears in the media is dependent upon which part of the country you're talking about.  When you live in a sardine container environment like NYC or the west coast then things are going to appear worse than what they do in the midwest.  When over half of the national cases are in NYC I have to adjust my thought process on this.  Why such a big boost in La.?  Hmm, nothing ever happens there except for every soul packed in just like in NYC, etc. for Mardi Gras.

Right. States that are more spread out should theoretically fair better, I would think. But none of us have a crystal ball. Which is better: to overreact/extensively prepare and decimate the economy, underreact and try to preserve resources/economy while giving way to transmission/spread, or is there somewhere in the middle which may not be able to flatten the curve thereby lending to overburdening an already over-burdened healthcare system? 

Flattening the curve SHOULD help. Right? Sure, you're safely quarantined away from everyone who could infect you and your family, but would you still be able to put food on the table because you got fired for not showing up to work?

And during this quarantine period (how long? Still TBD), what if that means our economy collapses as a result and we lose our jobs? (Think of all the pilots, food/restaurant, service industry workers, maids, entertainment industry/casino workers, healthcare, etc.) It's already happening. 

On the flip side, what if everyone starts walking away from their shifts because they don't want to take the risk? Who's going to pick up the pieces? Larger workloads, more exposure, higher burnout... Higher stress level and less sleep = lowered immunity? 

Once again, rhetorical questions. Obviously, take precautions. Duh. But, what I'm more concerned about is what's left when the smoke clears... And to me, that's scarier than an unknown virus... Maybe I'm more accepting of my own mortality than most? 

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28 minutes ago, Sed said:

Right. States that are more spread out should theoretically fair better, I would think. But none of us have a crystal ball. Which is better: to overreact/extensively prepare and decimate the economy, underreact and try to preserve resources/economy while giving way to transmission/spread, or is there somewhere in the middle which may not be able to flatten the curve thereby lending to overburdening an already over-burdened healthcare system? 

Flattening the curve SHOULD help. Right? Sure, you're safely quarantined away from everyone who could infect you and your family, but would you still be able to put food on the table because you got fired for not showing up to work?

And during this quarantine period (how long? Still TBD), what if that means our economy collapses as a result and we lose our jobs? (Think of all the pilots, food/restaurant, service industry workers, maids, entertainment industry/casino workers, healthcare, etc.) It's already happening. 

On the flip side, what if everyone starts walking away from their shifts because they don't want to take the risk? Who's going to pick up the pieces? Larger workloads, more exposure, higher burnout... Higher stress level and less sleep = lowered immunity? 

Once again, rhetorical questions. Obviously, take precautions. Duh. But, what I'm more concerned about is what's left when the smoke clears... And to me, that's scarier than an unknown virus... Maybe I'm more accepting of my own mortality than most? 

We keep seeing comparisons of COVID vs the flu. I have no numbers to back this up, but doesn't it seem that COVID is spreading like wildfire compared to the flu? I would be curious to see transmission rates of COVID compared to the flu. I couldn't find any good data online regarding this. Again, I have no numbers, but isn't COVID putting a greater percentage of people affected by the disease in the ICU vs the flu? Or is it just the fact that so many more people are being affected by COVID at one time compared to the flu so it seems like more people are needing ICU beds because everyone is getting being affected by the disease in a relatively short amount of time? Just some questions that have been floating in my head the last few days.

It also brings up the debate that this whole event shows the weaknesses of not having a single payer healthcare system and the possibility of a universal basic income. Perhaps people would be less fearful of all this happening if they knew they had healthcare coverage regardless of their employment status and a basic income stream no matter what. Perhaps this $2 trillion stimulus package could have been our practice run at a universal income to see how things would work. Clearly, something has to change with our idea of classic capitalism and how it's being executed. If 2 weeks of limited consumerism is enough to tank many major corporations in the country, I think we have a much larger, systemic problem on our hands in regards to our economy.

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Always remember that the more you look for something, the more likely you are to find it.  More testing, more positive cases; a small percentage of which at present time warrant intensive care.  These are the facts that the media likes to bring attention to.  It isn't that these folks aren't sick or don't matter, it's just the epidemiology of the matter.  Current death rates based on confirmed cases are higher than with influenza, however if one were to test the entire population and were to find the actual number of confirmed positives, regardless of symptomatology, then I think the fatality rate would be much lower.

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50 minutes ago, SirScottric said:

We keep seeing comparisons of COVID vs the flu. I have no numbers to back this up, but doesn't it seem that COVID is spreading like wildfire compared to the flu? I would be curious to see transmission rates of COVID compared to the flu. I couldn't find any good data online regarding this. Again, I have no numbers, but isn't COVID putting a greater percentage of people affected by the disease in the ICU vs the flu? Or is it just the fact that so many more people are being affected by COVID at one time compared to the flu so it seems like more people are needing ICU beds because everyone is getting being affected by the disease in a relatively short amount of time? Just some questions that have been floating in my head the last few days.

It also brings up the debate that this whole event shows the weaknesses of not having a single payer healthcare system and the possibility of a universal basic income. Perhaps people would be less fearful of all this happening if they knew they had healthcare coverage regardless of their employment status and a basic income stream no matter what. Perhaps this $2 trillion stimulus package could have been our practice run at a universal income to see how things would work. Clearly, something has to change with our idea of classic capitalism and how it's being executed. If 2 weeks of limited consumerism is enough to tank many major corporations in the country, I think we have a much larger, systemic problem on our hands in regards to our economy.

Yes, it seems to be of a higher mortality rate, but difficult to note since some authorities are starting to actively DISCOURAGE testing, so we don't know the accurate number. The spread seems to be high for COVID-19, but remember, 9-45 million Americans get the flu every year... The CDC also estimates 140,000-810,000 hospitalizations per year due to the flu alone. Somewhere around $10.4 billion in direct costs and total economic burden $87.1 billion related to the flu. The numbers for COVID-19 will be skewed or difficult to calculate because so many people are being sent home or told to self-quarantine. 

The reason I use the flu for comparison is because it's an annual thing that we don't really bat an eye at (comparatively to novel viruses) yet it kills lots of people, yields a heavy financial and healthcare burden, comes back year-round, etc... And yet we even have a vaccine for it! But yet it still causes a significant impact without any additional drastic measures such as the ones we're following for this novel one. 

Before all this, our healthcare system was already over-burdened as you allude to. Our infrastructure and our economy can't handle something like COVID-19, and shutting down our economy is the splinter that will break the camel's back. 

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A big difference between the two seems to be viability outside the host. Flu only lasts a few hours, maybe. Some reports are suggesting COVID-19 lasts anywhere between 2-5+ days on certain surfaces. This is another huge concern. Possibility of airborne sucks, but we've already seen that we can still get it despite PPE. So I think that in a lot of these cases, it is actually being spread via surfaces. Think about it: once your PPE armor is off, all it takes is itching your nose or rubbing your eye after touching your mouse when charting. Think of all the other possible places of transmission: credit card machines, gas pumps, phones, pens, clip boards, keyboards, badges, door knobs, arm rests, watches, shoes, purses, tables, chairs, hospital lounge fridges (who cleans those?), sink handles... 

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Wow, I didn’t realize an antibody test was becoming that readily available.  I think that’s amazing.  Seems logical to screen with the antibody test (provided of course you have enough) before doing confirmatory PCR testing of the RNA itself.
Is the antibody test looking for both IgM and IgG, or just IgM? I’m sure here in the future we’ll all pretty much have a positive IgG test
Hi it looks for both IgG and IgM!

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As many on this thread are well aware, I was pretty cavalier about this disease when we first started hearing about it.  I've been working critical care medicine for ~5 years now and I can honestly say I've never seen a unit fill up with influenza cases as fast as we are filling up with vented patients who are COVID+. 

It's not just the old or the folks with a load of comorbidities, I'm seeing otherwise healthy 45 year old, 50 year old who are walky talky when I do a pulm consult on Tuesday getting paralyzed and proned on Thursday.  Yeah this thing is novel and new, and the media is calling either the end of the world or a giant hoax...but what I'm seeing is pretty concerning. 

My wife has 4 co-workers (3 of them PAs) who are laid up with it at the moment. Be safe and be careful folks.

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