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

[MediMike]

How many times has the flu overwhelmed the healthcare system of a major city? Require the deployment of hospital vessels? The taking over of convention centers for makeshift hospital beds?

Nobody is saying the flu isn't a terrible disease and burden on the system. It's a different creature than what we're dealing with now.

[mgriffiths]

14 minutes ago, MediMike said:

How many times has the flu overwhelmed the healthcare system of a major city? Require the deployment of hospital vessels? The taking over of convention centers for makeshift hospital beds?

Nobody is saying the flu isn't a terrible disease and burden on the system. It's a different creature than what we're dealing with now.

This is because we know the flu.  We are prepared for the flu, or at least as well as we can be.  This is new and therefore we weren't prepared (and I don't even mean the poor planning and preparing as things were unfolding).

[SedRate]

55 minutes ago, MediMike said:

How many times has the flu overwhelmed the healthcare system of a major city? Require the deployment of hospital vessels? The taking over of convention centers for makeshift hospital beds?

Nobody is saying the flu isn't a terrible disease and burden on the system. It's a different creature than what we're dealing with now.

Yes, I understand that this novel virus is a "different creature." As you can see, my post was in response to Cideous who was directing his comment to those who "downplayed" the virus in a proverbial, "I told you so," which is unhelpful and trolling. Yes, I downplayed it (although kept my distance and maintained my practice of strict hygiene to the best of my ability) for a while until last week when my hospital dedicated two units to COVID-19. I truly thought it would be just another cold that would burn through the community and only hospitalize some. I didn't think it would burn through at a BLISTERING speed and send people to the ICU left and right nor that our economy would be shut down to mitigate it, creating a double whammy effect. What a mess it's caused. 

As I said, it's unfortunate to see the detrimental effects this novel virus has caused. But put in perspective, it still hasn't killed as many as the flu worldwide. The flu has killed significantly more this year (thus far) despite having a vaccine. "CDC estimates that so far this season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 deaths from flu."I think you guys have gotten the idea by now.

As many have pointed out, you included, COVID-19 was unexpected and therefore our response was unplanned, resulting in overwhelming our already-overburdened health care system, compounded by the dramatic, fast spread which has inundated hospital systems. It's scary to know our country can be held hostage this way. It really makes you think, could this virus be some sort of bioterrorism attempt that backfired on its own creator? But that's a whole other conversation and I'm not keen on conspiracies. 

Please don't misunderstand me when I post other data to keep things in perspective. I think keeping a perspective helps get us through these uncertain times when all there seems to be around us is doom and gloom that we're all going to get it and die, as is the reaction by some. Maybe it isn't being well received and not achieving the effect I was going for.

I'll end with this: when we step back and look at the big picture, we encounter risks every day from the moment we wake. A novel virus is yet another risk. Driving to work is also a risk. And so forth. We do not know when our time is up, whether by a freak accident, natural death, or pandemic, but we must go on. 

Stay safe out there! 

[AbeTheBabe]

2 hours ago, SedRate said:

CDC estimates that so far this season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 deaths from flu."

Please don't misunderstand me when I post other data to keep things in perspective. I think keeping a perspective helps get us through these uncertain times when all there seems to be around us is doom and gloom that we're all going to get it and die, as is the reaction by some. Maybe it isn't being well received and not achieving the effect I was going for.

The flu kills something like 25-75 thousand people in the US a year. But this isn't the flu, the death rate is much higher (anywhere from 2 to 10 times higher) and it's brand new and spreads easily. This creates a compounding effect. The more people get sick all at once, the less percentage of people we can care for, the more the death rate climbs. Over 80? No ventilator. Over 60 with COPD or DM or CVD? No ventilator. That's what it would come down to. No one has any immunity. There is no vaccine. It's already killed 9K people even with lockdowns and increased hygeine and we're barely getting started. I'm sure the real number of people that have died is much, much higher due to lack of testing. We won't know for sure until the dust settles and we compare deaths to prior yearly averages.

[ventana]

please lets stop the flu v covid comparisons

 

They are not the same - obviously - and to compare the two makes not sense

one is a recurrent annual problem where over a 6-9 time frame it inflicts enormous damage - but we are prepared for it

 

Covid on the other hand is brand new, is far more deadly, and we are racking up the deaths in a very short time - heard an interesting podcast from an intensivist that felt this was more like altitude sickness then PNA 

 

 

The point is the devil you know versus the devil you don't

 

 

Both are the devil and will extract a price - but differently.....

[ventana]

On 4/3/2020 at 10:16 PM, OneoftheseDrsNPsPAs said:

Dear colleagues,

 

I am one of these self-made successful professionals, who, until yesterday,  had a happy pool of patients, thought that their work had a meaning, and their destiny was to make a difference in the lives of their patients. Now, it is all gone. Except for the same nagging feeling that the destiny IS to make a difference, the difference between life and death.
 

So, I have had enough. Is it just me, who is NOT looking in awe at COVID19 but staring at the symptoms that are suspiciously resembling a long defeated enemy- WALKING PNEUMONIA?! 

But no, all the limelight is on this “novel virus”, while a strikingly familiar constellation of symptoms remains unrecognized, despite the classic features: fatigue, dry cough, and/ or uni/bilateral patchy infiltrates in lower lobes on X-ray films. 

 

 Now, let’s review CDC checklist for COVID19: fever, cough, shortness of breath- not very descriptive, is it? Let’s take a look at Mayo Clinic website: in addition to aforementioned “trio”, they list tiredness, aches, runny nose, and sore throat. Also, it is emphasized that “the severity of COVID19 symptoms can range from very mild to severe. Some people have no symptoms.”

 

So, given the presentation, why clinicians are not seeing this “monster” for what it is- a walking pneumonia, its course somehow accelerated by coronavirus through some mechanism or interaction?  

 

Then, for crying out loud, why are people left to die from an untreated case of a walking pneumonia, while there is a laundry list of appropriate tried and true medications! Why patients with relatively mild symptoms that could have been addressed with azythromycin early on, quarantine until, literally, blue in their faces, due to “difficulty breathing”- LATE SIGN!- and only then, they are deemed to be candidates for COVID19 testing and, “experimental” treatment with “promising” hydroxychloroquine. Promising what? It has delivered on its promise a long time ago! Hydroxychloroquine has been known to be effective in preventing ARDS, an inflammatory response of an infected body, caused by the body’s awkward attempt to “patch up” the  damaged (by bacteria or viruses) architecture of lungs.  Resulting dense fibrous structure does not allow lungs to properly carry out their functions and people die, as if from drowning, while their lungs are filling with water. 

On the other hand, if patient is fortunate to receive hydroxychloroquine prior to irreversible cascade of events, he/she may have a chance at survival. Since conditions that may lead to developing ARDS are well researched, misrepresenting the medication as “experimental drug” is perplexing, at the best.

 

Meanwhile, the proper treatment is withheld until it is way too late, because the COVIDiotic criteria does not allow early detection and intervention, forcing patients to seek medical attention at a far advanced stage. Why to delay effective treatment until people begin to experience “difficulty breathing” signaling that irreversible end- organ damage is impending? From there, it is a heroic but futile effort to save lives. I mean, how common is it to survive a multi-organ failure? 

 

I have nothing against conventional measures implemented to contain epidemic, including social distancing and a personal or public place hygiene. However, to throw the entire country under the bus, in the name of saving lives, and to make it sound acceptable to let so many people die anyway? Is staying home, really, saving lives? How? If I was not infected and you were not infected, and millions of us were not infected AND we isolated ourselves, in a joint effort to protect our beloved grandmas and grandpas, then why the residents of nursing homes were dying in packs? Our economy is going south, we are out of good steady jobs, and yet, people are dying right and left! Then, what is the point in our collective sacrifice of epic proportions?! For some authorities to cover their behinds, so nobody would accuse them of negligence, for others- to pacify their political ambitions, with a 2024 in sight,  for yet others-  to expose a sheer stupidity ( in Nevada, a governor banned hydroxychloroquine because an unfortunate couple had poisoned themselves to death w/ aquarium cleaner, containing what they thought to be a pharmacy-grade hydroxychloroquine). Indeed, a sad story for the two unfortunate souls. This sad story had turned into a tragedy of hundreds, whose chances for a survival had been nullified, due to the governor’s ignorance.

 

In Michigan, a governor threatened hospital healthcare workers with “administrative action”(no less!) to stop them from self-prescribing hydroxychloroquine as a prophylaxis against COVID19. The very people who have been left by the state authorities, practically, defenseless against a deadly infection, without a proper protective gear and with a shortage of the masks and respirators; “the front liners” who were forced to re-use disposable items that were manufactured for a single use!

 

Has anybody noticed that the only group of people at risk for dying from the infection, regardless of the age or the presence of pre-existing conditions,  were healthcare providers? 

A dying from COVID19 Florida doctor said that he knew that he was infected, the minute he put on his already used mask. 

 

How dare the politician to use her power against people who are risking their lives because of this very governor’s incompetence in dealing with the disaster?!

 

Instead of learning about the illness, all these mayors and governors focus on stomping their feet on low risk populations and gambling with our lives and our well-being . 

 

Apparently, it is so much easier to destroy businesses and to send healthy majority into a spin of a despair,  than to promote early recognition, social distancing, isolation, and effective treatment among VULNERABLE groups. I am convinced that the results would have been substantially more encouraging, if in addition to social distancing and isolation, the approriate treatment with azithromycin, Cipro, etc. would have been initiated in a higher risk category of people at the “quarantine stage”, followed by the judicious use of hydroxychloroquine (in case, an infection would continue to progress, despite timely initial treatment with antibiotics).

However, such a change in the approach would mean that the currently accepted paradigm for understanding of COVID19 would have to be revised as well. Why the heck not?

 

By itself, social distancing or isolation measure is nonsensical to the infected person. If it looks like a walking pneumonia, let’s treat it as such. No time to waste!

 

Unfortunately, an educated guess regarding  a coexisting “partnership” of the virus and bacterium in COVID19 driven infection remains to be a hypothesis, unless proven. Although, in China, later in epidemic, scientists came up with guidelines, that would allow clinicians to prescribe azithromycin (and its alternatives) to people even with mild symptoms (hm, based on which scientific evidence, they have started recommending this approach? Or is the hypothesis regarding dual invasion is right on the money? On the other hand, in all honesty, who would believe a socialist China? After all, along with other desinformation, they denied that COVID19 was discovered to be prone to mutations. 

 

So, in America, we are patiently awaiting for the  ”one to two” hundred thousands(!) to die, as calculated and as expected by infectious disease gurus, while standard remedies, such as vaccines and novel medications, are not expected to become available in the immediate future. 

 

Why to surrender, when early treatment may save lives? Please, help to get this message across to decision-makers and let us stop this despicable torture of our nation! We the people are adult enough to take care of ourselves and smart enough to cut through the politics. 
 

Best regards,

 

One-of-these-DrsNPsPAs

 

 

wow

 

so you as an anonymous poster is smarter then everyone in the trenches, all the researchers an all he brain power looking at this problem?  I think you FAR overestimate your value.....

 

The one point you bring up is that lack of a unified government back testing policy.

THAT one issue is what put us here...... has the Feds aggressively been empowered to developed rapid testing for both current infection and past infection I surmise we would be in a TOTALLY different place right  now....  But that office got shut down in 2018 for no good reason other then to consolidate power with those that are not scientists.  I think out government failed us!  and by US I meant the country but also all the front line medical workers who are risking their lives every shift..... sad indeed

 

Back to your rant - sorry to long, to much ill conceived ideas, and to much drivel...

[mgriffiths]

2 hours ago, ventana said:

wow

 

so you as an anonymous poster is smarter then everyone in the trenches, all the researchers an all he brain power looking at this problem?  I think you FAR overestimate your value.....

 

The one point you bring up is that lack of a unified government back testing policy.

THAT one issue is what put us here...... has the Feds aggressively been empowered to developed rapid testing for both current infection and past infection I surmise we would be in a TOTALLY different place right  now....  But that office got shut down in 2018 for no good reason other then to consolidate power with those that are not scientists.  I think out government failed us!  and by US I meant the country but also all the front line medical workers who are risking their lives every shift..... sad indeed

 

Back to your rant - sorry to long, to much ill conceived ideas, and to much drivel...

[rev ronin]

1 hour ago, mgriffiths said:

This was actually a carefully engineered ploy to create the illusion that moderators are human and not part of some vast conspiracy to oppress posters we collectively decide we don't like,

[rev ronin]

@SedRate , or anyone else who might know because I genuinely do not:

- What's the relative rate of influenza hospitalization, both in overall cases and fatalities only, vs. Covid-19?
- What's the relative length of influenza hospitalization, again for both overall cases and fatalities only, vs. Covid-19?
- What's the relative length and rate of ICU and ventilator use in hospitalized influenza patients, vs. Covid-19?

Because I fundamentally agree that your question makes sense: What is worse about Covid-19 that poses a risk of healthcare collapse, if it's not raw fatalities?  I would guess that it's based on hospital bed, ICU bed, and ventilator use, which I suspect to be more frequent and/or longer in Covid-19 hospitalized cases overall and in fatalities.... but we're data-driven here, and I'm wondering if anyone else has done the leg work already?

[Reality Check 2]

Has anyone been using nitric oxide in pulmonary tx of COVID?

Article even mentions using the gas prophylactically in health care workers - it slowed viral replication and it died.

Curious if this is a viable treatment/prevention.

[MediMike]

We don't use NO, it's dang near prohibitively expensive for long term use, but we will use inhaled epoprostenol as a pulmonary vasodilator to increase perfusion to the oxygenated regions of the lung, reduce RV workload in the setting of hypoxic pulmonary vasoconstriction.

Haven't heard about it's actual effect on the virus.

[SedRate]

1 hour ago, rev ronin said:

@SedRate , or anyone else who might know because I genuinely do not:

- What's the relative rate of influenza hospitalization, both in overall cases and fatalities only, vs. Covid-19?
- What's the relative length of influenza hospitalization, again for both overall cases and fatalities only, vs. Covid-19?
- What's the relative length and rate of ICU and ventilator use in hospitalized influenza patients, vs. Covid-19?

Because I fundamentally agree that your question makes sense: What is worse about Covid-19 that poses a risk of healthcare collapse, if it's not raw fatalities?  I would guess that it's based on hospital bed, ICU bed, and ventilator use, which I suspect to be more frequent and/or longer in Covid-19 hospitalized cases overall and in fatalities.... but we're data-driven here, and I'm wondering if anyone else has done the leg work already?

Very good questions that I too would be interested to know. I'll see if I can find anything. After all, I'm away from family right now for my current rural job and now also "sheltering in place" so have plenty of time. You know what they say about idle hands... 

[SedRate]

Hospitalization rates for covid:

"Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. "

"Among 508 (12%) patients known to have been hospitalized, 9% were aged ≥85 years, 36% were aged 65–84 years, 17% were aged 55–64 years, 18% were 45–54 years, and 20% were aged 20–44 years. Less than 1% of hospitalizations were among persons aged ≤19 years (Figure 2). The percentage of persons hospitalized increased with age, from 2%–3% among persons aged ≤19 years, to ≥31% among adults aged ≥85 years."

"Among 121 patients known to have been admitted to an ICU, 7% of cases were reported among adults ≥85 years, 46% among adults aged 65–84 years, 36% among adults aged 45–64 years, and 12% among adults aged 20–44 years (Figure 2). No ICU admissions were reported among persons aged ≤19 years. Percentages of ICU admissions were lowest among adults aged 20–44 years (2%–4%) and highest among adults aged 75–84 years (11%–31%) (Table).

Among 44 cases with known outcome, 15 (34%) deaths were reported among adults aged ≥85 years, 20 (46%) among adults aged 65–84 years, and nine (20%) among adults aged 20–64 years. Case-fatality percentages increased with increasing age, from no deaths reported among persons aged ≤19 years to highest percentages (10%–27%) among adults aged ≥85 years"

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

 

Death by covid vs all-cause vs PNA (influenza excluded):

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm

 

Disease burden influenza 2018-2019 season:

"Our estimates of hospitalizations and mortality associated with the 2018–2019 influenza season continue to demonstrate how serious influenza virus infection can be. We estimate, overall, there were 490,600 hospitalizations and 34,200 deaths during the 2018–2019 season. More than 46,000 hospitalizations occurred in children (aged <18 years); however, 57% of hospitalizations occurred in older adults aged ≥65 years. Older adults also accounted for 75% of influenza-associated deaths, highlighting that older adults are particularly vulnerable to severe outcomes resulting from an influenza virus infection. An estimated 8,100 deaths occurred among working age adults (aged 18–64 years), an age group that often has low influenza vaccination uptake."

For >65yo:

279,384 hospitalizations; 25,555 deaths

For 50-64:

97,967 hospitalizations; 5,676 deaths

For 18-49:

66,869 hospitalizations; 2,450 deaths

https://www.cdc.gov/flu/about/burden/2018-2019.html

[ERpa2014]

9 hours ago, SedRate said:

I post other data to keep things in perspective. I think keeping a perspective helps get us through these uncertain times when all there seems to be around us is doom and gloom that we're all going to get it and die, as is the reaction by some. Maybe it isn't being well received and not achieving the effect I was going for.

I'll end with this: when we step back and look at the big picture, we encounter risks every day from the moment we wake. A novel virus is yet another risk. Driving to work is also a risk. And so forth. We do not know when our time is up, whether by a freak accident, natural death, or pandemic, but we must go on. 

Stay safe out there! 

I remember a lot of my colleagues having a similar perspective in early January and February.   The first time I noticed difference in opinion was when I went to the hospital disaster committee meeting in February.  The feeling was so different. There was genuine fear at that time regarding our PPE situation.  I had heard the manufacturing centers in China were closed in the news but not specifically the ones producing masks.  I'd go to work later that day, and EVERYONE including doctors PA's, nurses, techs, etc dismissing it and acting normal. We also do not work in a major city, we're a smaller regional medical center away from the big cities.  It wasn't until Washington was really ramping up in early March that our mood shifted, and several of our docs were traveling still, not listening to colleague advice to cancel their trips.  As a result, they came into contact with several positive folks and were quarantined once back home.  Mid march now, and still there's a few comparing this to the flu but none in the provider group anymore. At that point Italy was all over the news and social media, and some of our docs were talking to docs from Italy and washington and it was nightmarish what they were experiencing. We can compare numbers all day, and rant about our delayed response, but in the end, a lot of people felt the same way that my ER did in the beginning. We forgot that we don't need to stop our daily lives for the flu, that there a vaccine and Tamiflu, and that we have whole research divisions dedicated to predicting the next strains of the flu to create vaccines for the world.  

There's so many layers to this pandemic, while we're trying to catch up in the science of this killer, our resources are shot and we can point fingers at china not being honest and sounding the horn too late, but we just don't know enough.  While some countries are faring better, others have 10% case fatality rate.  What would it really be without the lockdowns, even though some of them were implemented late? 20%? MORE? What if our hygiene was like the middle ages, would it be closer to black plague numbers?

I only have one detractor now in the ER, and she watches fox news, wears a Trump hat and she ain't ever going to change. The numbers can't be compared between this and influenza.  The situations are totally different at every level.  I hope that the deaths will start going down, but I think we're just ramping up here in the states. 

[SedRate]

40 minutes ago, ERpa2014 said:

 The numbers can't be compared between this and influenza.  The situations are totally different at every level.  I hope that the deaths will start going down, but I think we're just ramping up here in the states. 

I appreciate your entire post and agree.

And sigh... I know they're different. My reasoning for why I make a comparison is lost on the fact that we can't get past the differences. At this point, I'll quit wasting my time and all of yours. Plus, I think I now have De Quervain's. Lol

[ERpa2014]

11 minutes ago, SedRate said:

I appreciate your entire post and agree.

And sigh... I know they're different. My reasoning for why I make a comparison is lost on the fact that we can't get past the differences. At this point, I'll quit wasting my time and all of yours. Plus, I think I now have De Quervain's. Lol

I was actually trying let you know I don't believe you are alone in your thinking, not make you get carpal tunnel ! We're in the same boat, learning with the same goal while trying to not get to overwhelmed with the mass hysteria.  I don't think your wasting time.   

2 weeks ago my dad thought nothing of it except his retirement, and yesterday I had to calm him down from a 30 minute panic attack that his daughter was working in an ER 2000 miles away. In the end I had to send him a selfie of myself in full PPE. It's what happens to our thinking in a short span of time, one day we believe one thing, and the landscape totally changes weeks later. 

Edited April 6, 2020 by ERpa2014

[rev ronin]

32 minutes ago, SedRate said:

At this point, I'll quit wasting my time and all of yours. Plus, I think I now have De Quervain's. Lol

Well, use Dragon if you need to, but while I've been on the "this is probably going to be bad and I sure hope I'm wrong but exponential math..." bandwagon from the beginning, I think there's a fundamentally different take between "This is just like the flu only different" and "What makes this worse than the flu?" when the latter is asked honestly.  The raw R number doesn't tell the whole story.

We need people asking intelligent questions that, if answered, make us all smarter; we end up with people asking "How do we know vaccines work?"

[rev ronin]

BTW, as of this evening, we have now passed 0.1% lab confirmed prevalence in the U.S. And tomorrow, we're going to blow right through 10,000 confirmed fatalities.

[SedRate]

8 hours ago, rev ronin said:

Well, use Dragon if you need to, but while I've been on the "this is probably going to be bad and I sure hope I'm wrong but exponential math..." bandwagon from the beginning, I think there's a fundamentally different take between "This is just like the flu only different" and "What makes this worse than the flu?" when the latter is asked honestly.  The raw R number doesn't tell the whole story.

We need people asking intelligent questions that, if answered, make us all smarter; we end up with people asking "How do we know vaccines work?"

I appreciate that and agree.

 

8 hours ago, ERpa2014 said:

I was actually trying let you know I don't believe you are alone in your thinking, not make you get carpal tunnel ! We're in the same boat, learning with the same goal while trying to not get to overwhelmed with the mass hysteria.  I don't think your wasting time.   

2 weeks ago my dad thought nothing of it except his retirement, and yesterday I had to calm him down from a 30 minute panic attack that his daughter was working in an ER 2000 miles away. In the end I had to send him a selfie of myself in full PPE. It's what happens to our thinking in a short span of time, one day we believe one thing, and the landscape totally changes weeks later. 

Thanks for clarifying. And totally agree. Trying to keep a level of sanity amongst so much unknown and unexpected is difficult as is taking a step back to evaluate the whole picture and consequences, including economic impact. I expected unemployment and the such as a result of shutting down, but I didn't see health care providers being part of the fallout. Ouch. This economic crash will be bigger than the Great Recession. Our infrastructure isn't robust enough to support non-consumerism so we've gotta figure something out. This half-assed lockdown isn't working. Maybe a strict two-week lockdown and then a staggered release? Or two weeks on, two off?

 

And apparently I'm already out of likes today.

[DarwinStarwin]

I don't know what all the fuss about facemasks is about.  Here's one that I'm going to get just to wear around my wife and when I'm out at the store.   

The real question is: pink or blue?

[GetMeOuttaThisMess]

9 hours ago, rev ronin said:

Well, use Dragon if you need to, but while I've been on the "this is probably going to be bad and I sure hope I'm wrong but exponential math..." bandwagon from the beginning, I think there's a fundamentally different take between "This is just like the flu only different" and "What makes this worse than the flu?" when the latter is asked honestly.  The raw R number doesn't tell the whole story.

We need people asking intelligent questions that, if answered, make us all smarter; we end up with people asking "How do we know vaccines work?"

And now it's associated with 5G wireless transmissions!  I know this because I saw it on the internet and W. Harrelson spoke up about it between bowls of Mary Juwana over on Maui.

[GetMeOuttaThisMess]

Well, welcome to the party Texas, and TAPA:

Hello TAPA Members - 

As you are more than likely aware of, the TAPA Board of Directors sent a letter to Governor Greg Abbott a couple of days ago asking him to lessen restrictions on PAs in Texas. We are pleased to announce that yesterday, Governor Abbott has temporarily waived certain regulations to expand the health care workforce to assist with Texas' COVID-19 response.  

Although there is mention on the Governor's Website, TAPA expects a formal announcement by the Governor soon regarding the waiver of restrictive supervising requirements during COVID-19:

• PAs will not have to formally designate to the Texas Medical Board whom their SP is/will be
  It will be a verbal agreement and can be any Physician in good standing. This will allow PAs to move around to other areas of medicine without hassle (Medical Director of Hospitals could be SP for the PAs going into these facilities to help during the crisis)
• There will be no limit as to how many PAs or NPs an SP can supervise. (Formerly in Texas this was 7 total)
• There will not be a requirement for written delegation of prescriptive authority (standard of care should still be met)
• Students that only lack the PANCE as the final step of licensure will be granted temporary licenses

Additionally, the following changes have been implemented since the emergency declaration on March 13, 2020: 

• Telemedicine unrestricted (Source)
• PAs can volunteer without a Supervising Physician. If you would like to volunteer, follow this link.
• Retired PAs can return to active status (Source) 

[SedRate]

47 minutes ago, GetMeOuttaThisMess said:

Well, welcome to the party Texas, and TAPA:

Hello TAPA Members - 

As you are more than likely aware of, the TAPA Board of Directors sent a letter to Governor Greg Abbott a couple of days ago asking him to lessen restrictions on PAs in Texas. We are pleased to announce that yesterday, Governor Abbott has temporarily waived certain regulations to expand the health care workforce to assist with Texas' COVID-19 response.  

Although there is mention on the Governor's Website, TAPA expects a formal announcement by the Governor soon regarding the waiver of restrictive supervising requirements during COVID-19:

• PAs will not have to formally designate to the Texas Medical Board whom their SP is/will be
  It will be a verbal agreement and can be any Physician in good standing. This will allow PAs to move around to other areas of medicine without hassle (Medical Director of Hospitals could be SP for the PAs going into these facilities to help during the crisis)
• There will be no limit as to how many PAs or NPs an SP can supervise. (Formerly in Texas this was 7 total)
• There will not be a requirement for written delegation of prescriptive authority (standard of care should still be met)
• Students that only lack the PANCE as the final step of licensure will be granted temporary licenses

Additionally, the following changes have been implemented since the emergency declaration on March 13, 2020: 

• Telemedicine unrestricted (Source)
• PAs can volunteer without a Supervising Physician. If you would like to volunteer, follow this link.
• Retired PAs can return to active status (Source) 

Wow!

[Joelseff]

This made me [emoji23] so much harder than it should have but mrgriffiths u win the internet today! [emoji23] [emoji23] [emoji23]

Sent from my SM-G975U using Tapatalk

[ERpa2014]

Ugh, so now there 200ish Americans dying a day at home in New york. For more (or less depending on your view of journalism) info, see article below.  

And the stock market rallied because of ' a slowdown'. 

https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths