Coronavirus Updates, Important Information, and Ancedotal Experience

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AngryGerbil

Poet Warrior
<Donor>
17,781
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I think it has to do with how many people are retarded and still partying on Bourbon St and shit. Without some sort of enforcement the idiots would spread this to all the other idiots. Not really sure what the government can do besides deploying military everywhere though. And I don't think that's a good option. People just need to be less dumb.

Of course, all of this.

But we either control the dumb people by becoming totalitarian cunts, or we live by our principals.

I acknowledge the danger of the dumb people, but I don't think the cost of controlling them is worth it to the rest of us in the bigger picture.

Social shaming. If you have a teenage/college age person in your life who went on spring break this year, give them some real social shit. Make them realize what selfish twats they are being. Do it in public. Make them feel actual shame. I know it won't solve all of the cases but it will makke a large dent and it will be a better alternative than lying down and waiting for the authorities to command us.

We are not slaves to be herded around at gun point.
 
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iannis

Musty Nester
31,351
17,656
And you've got to remember that 17-20 year olds think they're immortal.

They've got to see some real shit to convince them otherwise. Which they start to later.

The method for control is social shaming or strict discipline. As in "you don't do this right now because i'm older than you and I know better than you and as an adult you need to recognize the validity of that situation".
 
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Khane

Got something right about marriage
19,790
13,299
If only it was just teenagers and college students acting foolish. Unfortunately there are a lot of entitled, foolish people of all ages which is why we find ourselves in situations with mandated closures and shutdowns. It's not the Frat Bro Brunch Crew waiting shoulder to shoulder in hour long lines at Costco, hoarding all the TP and Purell, and then heading over to the new taco joint for a burrito and a margarita.
 
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Noodleface

A Mod Real Quick
37,961
14,508
Someone local posted a video of a fuckin parade a few towns over. Adult and children nuts to butts. It isn't just the teens and 20 something's.
 

Aychamo BanBan

<Banned>
6,338
7,144
Just wanted to share my experiences with COVID-19. I work in the ER so we are on the front lines of this stuff. My state has a large number of corona viruses but thankfully not NYC levels. Yet. I just want to share some thought processes with yall to see the struggles we are having.

The actual number of cases is much higher. For us, LabCorp is where we send our tests and they are 1-2 weeks behind. Tests that I sent out on 3/17/2020 have not yet resulted. Each shift that I work I see a minimum of 1-2 new patients with highly suspect coronavirus. There are very characteristic imaging and lab findings for coronavirus. For me, what I've seen is the patchy bilateral infiltrates on chest xray, and when you CT them you get the characteristic bilateral ground glass appearance. One today was so obvious the radiologist even basically called it. I'm also seeing on labs normal white blood cell counts with lymphopenia and elevated LDH levels, which fits the profile.

As for as how to treat these patients, basically what we are (a large number of us are on a facebook group) doing is if they don't need oxygen, then go home. So today I had a 72 year old female that had cough and fever for about 10 days. Seen by her doc originally with a negative chest xray and placed on antibiotics. Didn't feel any better, had a flu test that was negative, and then found out she had a known COVID-19 exposure via her friend at church who was a nurse that tested positive. Patient had a corona test sent off, but still has not resulted. Was sent for an outpatient chest xray today but somehow ended up in the ER. The ER showed the typical changes of coronavirus so I got a full workup on her while debating what to do as she had already been treated for a pneumonia and didn't get better (obviously because she was on antibiotics which do not help viral infections.) Her case doesn't count yet as a statistic because her test will take 1-2 weeks to come back. Her husband at home has similar symptoms. Thats two more cases that aren't even being counted yet.

My mental debate: we know that around 80% of people with corona infections have mild illnesses, and around 14% need oxygen in the hospital, and around 6% are fucking *sick* that end up intubated and/or dead. And we know that people can have characteristic changes on imaging and be totally fine, and then within hours worsen and end up intubated, and die by the next day. So the challenge I face is anytime I have one, how do I safely discharge them home, and what can I tell them to do at home and when to return to the hospital? Because we can't really just admit everyone with corona virus to the hospital just because they have coronavirus. Like the lady above, if I admitted here there is nothing to do for her. You would just feed her and watch her, maybe give her oral meds for her fever and cough, and you could go whichever way you want with chloroquine / azithro / kaletra depending on which studies you read (to be honest, I haven't dived into this yet because I don't do inpatient medicine.) We also know that the virus is worse in older patients, and this lady is 72.

So what do I do? What I did was cover her with two different antibiotics for a possible bacterial pneumonia, even though I know this is a coronavirus pneumonia and the antibiotics won't do anything, but I could be wrong, I counseled on home quarantine, making sure she has people that can bring her food / groceries, recommend getting a simple oxygen saturation monitor for home, and counseled her to return immediately if she starts to feel much worse or if her oxygen levels are consistently below 92%.

This has been the same situation for multiple patients. They come in, they have this disease that can wipe them out rapidly, and you send them home with instructions to return if anything gets worse. It's terrifying to discharge these people knowing they could crap out and die on you at home. But this is the standard that all of us are doing across the country. We simply don't have the resources to admit people to the hospital just to watch them "in case" they worsen.

Another issue we are all having is personal protective equipment. It fucking sucks. For me to enter a room that I am concerned of coronavirus, I wear a N95 mask, a surgical mask on top of it, eye goggles, a surgical hat, a gown, double gloves, and booties. This pales in comparison to the outfits they have in china, etc. Even the fucking janitor tonight had a better suit than I'm being given in the ER. We try to batch everything with the patient, and we are a lot less personal. For instance a patient may be sitting in the bed, and we will wear our N95s and open the door to the room and talk to them from the hallway without going in the room, to get basic patient history, etc. I will go in the room one time only to tell the patient what I found and what I think and what the plan is, because I can't waste all the PPE (personal protective equipment) to go back in a second time.

And hospitals are ran by idiots. One hospital I work in is trying to really ration out the most basic PPE, and are putting everyone at risk in doing so. For example, any patient that checks in to the ER with any type of upper respiratory infection complaint should be immediately masked and either bedded immediately or placed somewhere that isolates them from other patients. This hospital tonight isn't doing that, so a patient checks in with cough and fever, they sit there and infect everyone around them until they are in a bed. My coronavirus patient tonight, when I came on shift, she was already in the room and had no mask on. Who knows how many people she infected before I went in there and masked her. Insanity.

Another problem we are all facing is stress. This is very stressful for all of us. I know it's stressful for all of you too. We all have kids that are out of school now and placing more stress on out of work life. Work life is terrible. We all are worried about seeing these patients and don't want to get coronavirus. I'm at the age where I could easily be one of those that dies from this virus. We are stressed because we know our systems in place aren't perfect and that these people are just needlessly exposing us. And despite all this, we still have regular sick patients and patients with all sorts of other medical problems coming into the ER, and we also have all the trolls coming in for all of their bullshit (back pain, anxiety, toothaches, chronic pain, hemorrhoids, med refills, etc.) Everyone of them I ask them if they are aware we are in a pandemic situation, and if they've been watching the news that tells them to stay home. Sometimes it's unbelievable how stupid patients are.

And on top of the stress, everything outside of work is coronavirus too. It's constant emails from the state changing their testing guidelines and recommendations, constant emails from hospitals changing their policies daily, constant changes to how to workup and treat these patients, etc. I had three days off last week with my daughter and I neglected her half the time because we had constant coronavirus conference calls and had a coalition of physicians that met from all the local hospitals to figure out how we can come together as a community to help out.

And on top of all of this, you have malpractice to worry about. We all want to make the right decisions, but god forbid a novel virus comes in and infects a patient and you make a bad call and the person dies and now they want to sue you for not being able to accurately predict how a horrible virus was going to act in one specific person. There is no real "standard of care" for coronavirus patients. We've all mostly adopted a similar way to practice, but at this point it's just what seems reasonable. We may be completely wrong. It's stressful!

60679036661__6ADF549D-972A-49EB-B56B-81F126F64A63 2.jpeg
 
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Hateyou

Not Great, Not Terrible
<Bronze Donator>
16,207
42,096
Just wanted to share my experiences with COVID-19. I work in the ER so we are on the front lines of this stuff. My state has a large number of corona viruses but thankfully not NYC levels. Yet. I just want to share some thought processes with yall to see the struggles we are having.

The actual number of cases is much higher. For us, LabCorp is where we send our tests and they are 1-2 weeks behind. Tests that I sent out on 3/17/2020 have not yet resulted. Each shift that I work I see a minimum of 1-2 new patients with highly suspect coronavirus. There are very characteristic imaging and lab findings for coronavirus. For me, what I've seen is the patchy bilateral infiltrates on chest xray, and when you CT them you get the characteristic bilateral ground glass appearance. One today was so obvious the radiologist even basically called it. I'm also seeing on labs normal white blood cell counts with lymphopenia and elevated LDH levels, which fits the profile.

As for as how to treat these patients, basically what we are (a large number of us are on a facebook group) doing is if they don't need oxygen, then go home. So today I had a 72 year old female that had cough and fever for about 10 days. Seen by her doc originally with a negative chest xray and placed on antibiotics. Didn't feel any better, had a flu test that was negative, and then found out she had a known COVID-19 exposure via her friend at church who was a nurse that tested positive. Patient had a corona test sent off, but still has not resulted. Was sent for an outpatient chest xray today but somehow ended up in the ER. The ER showed the typical changes of coronavirus so I got a full workup on her while debating what to do as she had already been treated for a pneumonia and didn't get better (obviously because she was on antibiotics which do not help viral infections.) Her case doesn't count yet as a statistic because her test will take 1-2 weeks to come back. Her husband at home has similar symptoms. Thats two more cases that aren't even being counted yet.

My mental debate: we know that around 80% of people with corona infections have mild illnesses, and around 14% need oxygen in the hospital, and around 6% are fucking *sick* that end up intubated and/or dead. And we know that people can have characteristic changes on imaging and be totally fine, and then within hours worsen and end up intubated, and die by the next day. So the challenge I face is anytime I have one, how do I safely discharge them home, and what can I tell them to do at home and when to return to the hospital? Because we can't really just admit everyone with corona virus to the hospital just because they have coronavirus. Like the lady above, if I admitted here there is nothing to do for her. You would just feed her and watch her, maybe give her oral meds for her fever and cough, and you could go whichever way you want with chloroquine / azithro / kaletra depending on which studies you read (to be honest, I haven't dived into this yet because I don't do inpatient medicine.) We also know that the virus is worse in older patients, and this lady is 72.

So what do I do? What I did was cover her with two different antibiotics for a possible bacterial pneumonia, even though I know this is a coronavirus pneumonia and the antibiotics won't do anything, but I could be wrong, I counseled on home quarantine, making sure she has people that can bring her food / groceries, recommend getting a simple oxygen saturation monitor for home, and counseled her to return immediately if she starts to feel much worse or if her oxygen levels are consistently below 92%.

This has been the same situation for multiple patients. They come in, they have this disease that can wipe them out rapidly, and you send them home with instructions to return if anything gets worse. It's terrifying to discharge these people knowing they could crap out and die on you at home. But this is the standard that all of us are doing across the country. We simply don't have the resources to admit people to the hospital just to watch them "in case" they worsen.

Another issue we are all having is personal protective equipment. It fucking sucks. For me to enter a room that I am concerned of coronavirus, I wear a N95 mask, a surgical mask on top of it, eye goggles, a surgical hat, a gown, double gloves, and booties. This pales in comparison to the outfits they have in china, etc. Even the fucking janitor tonight had a better suit than I'm being given in the ER. We try to batch everything with the patient, and we are a lot less personal. For instance a patient may be sitting in the bed, and we will wear our N95s and open the door to the room and talk to them from the hallway without going in the room, to get basic patient history, etc. I will go in the room one time only to tell the patient what I found and what I think and what the plan is, because I can't waste all the PPE (personal protective equipment) to go back in a second time.

And hospitals are ran by idiots. One hospital I work in is trying to really ration out the most basic PPE, and are putting everyone at risk in doing so. For example, any patient that checks in to the ER with any type of upper respiratory infection complaint should be immediately masked and either bedded immediately or placed somewhere that isolates them from other patients. This hospital tonight isn't doing that, so a patient checks in with cough and fever, they sit there and infect everyone around them until they are in a bed. My coronavirus patient tonight, when I came on shift, she was already in the room and had no mask on. Who knows how many people she infected before I went in there and masked her. Insanity.

Another problem we are all facing is stress. This is very stressful for all of us. I know it's stressful for all of you too. We all have kids that are out of school now and placing more stress on out of work life. Work life is terrible. We all are worried about seeing these patients and don't want to get coronavirus. I'm at the age where I could easily be one of those that dies from this virus. We are stressed because we know our systems in place aren't perfect and that these people are just needlessly exposing us. And despite all this, we still have regular sick patients and patients with all sorts of other medical problems coming into the ER, and we also have all the trolls coming in for all of their bullshit (back pain, anxiety, toothaches, chronic pain, hemorrhoids, med refills, etc.) Everyone of them I ask them if they are aware we are in a pandemic situation, and if they've been watching the news that tells them to stay home. Sometimes it's unbelievable how stupid patients are.

And on top of the stress, everything outside of work is coronavirus too. It's constant emails from the state changing their testing guidelines and recommendations, constant emails from hospitals changing their policies daily, constant changes to how to workup and treat these patients, etc. I had three days off last week with my daughter and I neglected her half the time because we had constant coronavirus conference calls and had a coalition of physicians that met from all the local hospitals to figure out how we can come together as a community to help out.

And on top of all of this, you have malpractice to worry about. We all want to make the right decisions, but god forbid a novel virus comes in and infects a patient and you make a bad call and the person dies and now they want to sue you for not being able to accurately predict how a horrible virus was going to act in one specific person. There is no real "standard of care" for coronavirus patients. We've all mostly adopted a similar way to practice, but at this point it's just what seems reasonable. We may be completely wrong. It's stressful!

View attachment 256439

OMG what a whiner. Do you know how hard it is to work from home and watch Netflix for three weeks?















Jk. Hang in there, we appreciate you front liners.
 
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Kuriin

Just a Nurse
4,046
1,020
We were sending our CV19 tests to Stanford or Labcorp - depending on if they were going to be inpatient or outpatient. This was also when no tests were readily available. Now there's the 12-24 hour test (thankfully). We are luckily not seeing as much bullshit coming into the ED (I want a hospital pregnancy test, I may have a STD, I have a laceration...) - though the patients that do walk into the ED are definitely more sick than normal.
 
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Aychamo BanBan

<Banned>
6,338
7,144
We were sending our CV19 tests to Stanford or Labcorp - depending on if they were going to be inpatient or outpatient. This was also when no tests were readily available. Now there's the 12-24 hour test (thankfully). We are luckily not seeing as much bullshit coming into the ED (I want a hospital pregnancy test, I may have a STD, I have a laceration...) - though the patients that do walk into the ED are definitely more sick than normal.

We don't have any rapid test available to us yet unfortunately. One hospital I'm at has the Cephied machine that can do the PCR tests and supposedly they have a COVID-19 test coming out but who knows when that will be available, or if the cartridges will be available. Our state has a lab but has extremely strict requirements for who can be tested.

I agree about how lovely the decreased ER volumes are. I think if we had normal ER volume with the added stress of COVID-19, it would be a breaking point for sure. I "jokingly" told multiple patients tonight that we literally just had a COVID-19 patient in the bed you are in. And I ask each of them if they are aware of the pandemic, then ask them what the government tells them they should be doing "stay at home" and see if it sinks in. It's passive aggressive, but the day of people using the ER as a walk in clinic have to end. That's a whole other topic that I could write for days about!

Another good thing all our hospitals are doing is not allowing visitors in the ER / hospital. Visitors / family members are, to me, by far the worst sources of drama in the ER. Patients and families feed off each other, start crap with staff, demand unnecessary tests, etc. And the infection control of not allowing all these random people back is amazing. Honestly it should *always* be like this.
 
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Qhue

Trump's Staff
7,465
4,413

It's a long-ish read but I had been looking for such a 1st-person account of what it's like to have a non-life-threatening case of the COVID. Bottom-line being that it looks pretty damn awful and long lasting even if you aren't bad enough to be hospitalized. Certainly this family's experience is more than 'I had the sniffles and quaffed some NyQuil for a couple days'
 
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Kuriin

Just a Nurse
4,046
1,020
"jokingly" told multiple patients tonight that we literally just had a COVID-19 patient in the bed you are in.

Even as a joke, we are required to not even say anything about CV19 patients or PUI. We took in numerous passengers from the cruise liner that docked in Oakland and if we mentioned to anyone that we had a CV19/PUI, we'd be at risk for termination.

Are you a physician? Or?
 

Aldarion

Egg Nazi
8,818
24,058
If only it was just teenagers and college students acting foolish. Unfortunately there are a lot of entitled, foolish people of all ages which is why we find ourselves in situations with mandated closures and shutdowns. It's not the Frat Bro Brunch Crew waiting shoulder to shoulder in hour long lines at Costco, hoarding all the TP and Purell, and then heading over to the new taco joint for a burrito and a margarita.
I wish it was only stupid frat boys.

I found out yesterday my family, including both 70-yr old parents one of whom is fighting cancer and has had pneumonia multiple times, are its just a fluers. They read somewhere on the internet this was just a flu and the liberal media is hyping it to take down Trump, so they're not gonna be fooled.

Fuck everyone who has made this political, and fuck everyone who thinks their "getting on with living their life" is more important than human lives. Regardless of their age.

Its definitely not just teenagers being idiots :(
 
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Aychamo BanBan

<Banned>
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Even as a joke, we are required to not even say anything about CV19 patients or PUI. We took in numerous passengers from the cruise liner that docked in Oakland and if we mentioned to anyone that we had a CV19/PUI, we'd be at risk for termination.

Are you a physician? Or?

EM doc. I fully want my patients to be aware of the risk they are putting themselves at for coming into the ER for ridiculous things. Thankfully we don't have any rules like that. I've seen some docs on the FB group say how they aren't allowed to wear masks because it scares patients. They should be scared! This is a terrible virus and people are treating it like a joke. I explain how it can aerosolize, live in the air for up to 3 hours, on surfaces for prolonged period of time. The hospital I was at last night is a dump, it used to be the most desirable place to work in the city but a large named company bought it and stripped it down to a shell. So we are rationing PPE, there's barely any janitors, etc. I work there just part time, I hadn't been since all the coronavirus stuff started. My first night there for this stretch they were letting visitors back, nobody had masks, etc. Total disaster, I had to throw a small fit and get their infection control back in line. The nurses are all burnt out because the staffing matrix used to have about 4-5 per shift, now it's 2-2.5. So nobody even bothered to take a remotely decent history on the coronavirus patient I had last night. She had a known exposure and had symptoms, nobody bothered to ask if she had an exposure, which is basically the only screening question worth asking these days, and nobody masked her. So she's sitting there infecting everything while nobody gave a damn. Kills me inside!
 
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Blazin

Creative Title
<Nazi Janitors>
6,379
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EM doc. I fully want my patients to be aware of the risk they are putting themselves at for coming into the ER for ridiculous things. Thankfully we don't have any rules like that. I've seen some docs on the FB group say how they aren't allowed to wear masks because it scares patients. They should be scared! This is a terrible virus and people are treating it like a joke. I explain how it can aerosolize, live in the air for up to 3 hours, on surfaces for prolonged period of time. The hospital I was at last night is a dump, it used to be the most desirable place to work in the city but a large named company bought it and stripped it down to a shell. So we are rationing PPE, there's barely any janitors, etc. I work there just part time, I hadn't been since all the coronavirus stuff started. My first night there for this stretch they were letting visitors back, nobody had masks, etc. Total disaster, I had to throw a small fit and get their infection control back in line. The nurses are all burnt out because the staffing matrix used to have about 4-5 per shift, now it's 2-2.5. So nobody even bothered to take a remotely decent history on the coronavirus patient I had last night. She had a known exposure and had symptoms, nobody bothered to ask if she had an exposure, which is basically the only screening question worth asking these days, and nobody masked her. So she's sitting there infecting everything while nobody gave a damn. Kills me inside!

All people who need tested should not be in the hospital, this is amateur hour shit. Do you not have testing tents set up outside?
 

Kithani

Blackwing Lair Raider
1,032
1,266
Falxy sounds like good people and I would subscribe to your newsletter.

I had a few patients admitted to me last week with vague SOB/URI complaints that maybe don’t perfectly fit for COVID but still they got a rapid flu (negative) and I guess nobody thought GEE WHAT ELSE MIGHT THIS BE? Thankfully they were negative but still it’s a matter of time before a bunch of poor ER staff gets exposed because these people aren’t placed on precautions.
 
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Aychamo BanBan

<Banned>
6,338
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All people who need tested should not be in the hospital, this is amateur hour shit. Do you not have testing tents set up outside?

Unfortunately nope! I totally agree with you. At my main hospital our volume wouldn't make it worth it. But this other hospital just sucks and doesn't have the nursing staff to spare to do anything like that, or have a spare NP to go out and see these patients without violating EMTALA. The hospital is so dumb they have two empty fast track rooms up front out of the main ER they aren't using for this and are still bringing URI patient to the back. It's really bad.
 

Blazin

Creative Title
<Nazi Janitors>
6,379
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At minimum they should be put in negative air flow areas. I'm sure there are smaller hospitals that aren't at all prepared for this but hopefully for small town America this does not become a major issue for them.
 
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Aychamo BanBan

<Banned>
6,338
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Falxy sounds like good people and I would subscribe to your newsletter.

I had a few patients admitted to me last week with vague SOB/URI complaints that maybe don’t perfectly fit for COVID but still they got a rapid flu (negative) and I guess nobody thought GEE WHAT ELSE MIGHT THIS BE? Thankfully they were negative but still it’s a matter of time before a bunch of poor ER staff gets exposed because these people aren’t placed on precautions.

Absolutely! Our state was preaching "if flu negative, then test for COVID-19", I think they were basing that on some early data that said less than 2% co-infection rate, but now they just recommend anyone with fever and cough to test for COVID-19. From talking with other em docs around the country they are seeing co-infection with everything, flu, bacterial pneumonia, rhinovirus, coronavirus nl63 (a common cold coronavirus), even reports of a coronavirus meningitis. I feel like in light of any obvious diagnosis they should be considered COVID-19 + until proven otherwise.
 
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Aychamo BanBan

<Banned>
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At minimum they should be put in negative air flow areas. I'm sure there are smaller hospitals that aren't at all prepared for this but hopefully for small town America this does not become a major issue for them.

This is a challenge we are facing at my main hospital. We have one negative flow ER room, and one negative flow inpatient room.