Corona Virus, general conversation

From The Atlantic. The author, Kerry Kennedy Meltzer is an internal medicine resident physician in New York City.

On Friday night, I worked a 12-hour shift in the designated COVID-19 area of my hospital’s emergency department in New York City. Over the
course of the night, I examined six patients who were exhibiting common symptoms of the novel coronavirus; five of them were in their 20s or
early 30s.

I am 28 years old. Up until Friday, when people asked me whether I was scared, I would tell them yes—for my country, my colleagues, my 92-year-old grandmother, and all the people most vulnerable to getting seriously ill from the virus, but not for myself. I, like many others, believed that young people were less likely to get sick, and that if they did, the illness was mild, with a quick recovery.

I now know that isn’t the case. The fact is that young people with no clear underlying health conditions are getting seriously ill from COVID-19 in significant numbers. And young Americans—no matter how healthy and invincible they feel—need to understand that.

My first patient was in their early 20s. (To protect their confidentiality, I’m referring to my patients without mentioning their gender.) They had a dry cough and a 102-degree fever, but their chest X-ray came back clear and their oxygen levels were safe. I wanted to test them for COVID-19, but they weren’t sick enough to require admission to the hospital, which meant I couldn’t do so. We desperately want to be able to test and take care of everyone, from the seriously ill to the mildly sick and worried, but with our current capacity, we simply can’t. I told them that they needed to assume they had the virus, and gave them instructions on how to quarantine at home.

I changed my gown and gloves, checked my mask and goggles, and moved on to my next patient: a student who had been coughing and feeling fatigued for multiple days. They had been with a friend before getting sick, and that friend had since fallen ill with symptoms of COVID-19, including a fever. The patient was having trouble catching their breath, but their symptoms were not severe or acute—as confirmed by a chest X-ray and a test of their oxygen levels—so I recommended discharge and quarantine, and they understood.

My next patient was a young professional. For the past week they’d had a dry cough and chest pain. They had no underlying health conditions, and
they’d tried to follow the current guidelines by staying at home (the right thing to do, given the overwhelmed state of hospitals like mine) but that evening their breathing had become so labored that they called an ambulance. When I saw them, however, they were breathing comfortably, their chest X-ray was clear, and their oxygen levels were safe. They were visibly upset when I told them they would not be admitted. They wanted to be tested. I explained why we couldn’t do that, and completed their discharge paperwork.

I collected myself and approached my next patient: a young person who’d been suffering with a fever, cough, and extreme fatigue for the past three days. Their boss didn’t believe they were sick, so they’d continued to complete long shifts working with customers at a local business. After examining the young patient, I determined that they were in the same category as the previous three I’d seen—sick, but not sick enough to be given a precious hospital bed or COVID-19 test—so I gave them fluids, Tylenol, and a note for their employer confirming that they were indeed ill, and needed to stay home.

Late in the night, another young patient came in with a high fever and no underlying health conditions. They’d had a dry cough for the past four days. They’d come to the hospital after finding they were unable to walk a few feet without getting severely short of breath. On their chest X-ray, I saw lungs that were almost completely whited out, indicating a significant amount of inflammation. It was clear how uncomfortable they were, and how desperately they were trying to catch their breath. They were in a different category from the previous patients I’d seen that night. They needed to be admitted. They needed testing. They needed close monitoring.

I called the Intensive Care Unit team, and they admitted the young patient to the hospital. I finished my shift not long after, walked home, and got in bed, feeling unsteady. When I woke up a few hours later, I logged into our electronic medical record system and learned that in the time I’d been asleep, my patient’s oxygen levels had dropped severely. A breathing tube had been placed down their throat. A ventilator was now keeping them alive.

Recent statistics suggest that what I saw that night is not unusual. On Tuesday, California Governor Gavin Newsom said that half of the 2,102 people who had tested positive for COVID-19 in his state were ages 18 to 49. The Centers for Disease Control and Prevention published data showing that, from February 12 to March 16, nearly 40 percent of American COVID-19 patients who were sick enough to be hospitalized were ages 20 to 54. Twelve percent of patients with the most critical cases, requiring admission to an ICU, were ages 20 to 44.

There are some caveats worth noting: The CDC was not able to determine whether the young people included in its report had underlying health
conditions. And all of this is early data. We know that we are still not testing nearly enough people in the United States. The numbers may change.

But in spite of these alarming figures, too many young Americans have been slow to give up the false belief that they are safe from COVID-19.

The day after the CDC report was released, college students began responding to a poll. Only 50 percent said that they were concerned about contracting COVID-19. Fifty-three percent admitted that they or their friends had gone to social gatherings in the previous week.

At the same time as I was seeing the flurry of young patients on my overnight shift, a resident friend of mine at a hospital on the West Coast was placing a patient in their 20s on a ventilator. A 26-year-old woman who was hospitalized with COVID-19 recently told her story in The New York Times. A doctor at my own hospital said that he has never seen so many young people in the ICU as he’s now seeing with COVID-19.

This isn’t the type of evidence that we like to talk about as scientists—anecdotes, instead of hard data—but doctors are people too.

We listen to the stories of our patients and our colleagues. We pay attention to the trends that we see on the ground. We connect the dots.

We still need better data to fully understand how young people are being affected by COVID-19, but until we can get it, we have to spread the word, and ask friends and family—no matter their age—to stay at home.
 
Today marks the start of week 3 since my wife was sampled, no test results yet

Talking to my neighbor yesterday, at a proscribed safe distance. Neighbor thinks only the elderly and sick need to be quarantined, the rest just need to go about our regular business. Neighbor is in general good health, 80's intelligent. Neighbor leans more right than me, so asks my opinion on things for a more center-left view. Neighbor was not interested in hearing why this virus is much different than the flu (facts not opinion).
 
The New York Post reports that another 500 cops called out sick yesterday, leaving the NYPD with only 89% of it's patrol officers available for duty.

https://nypost.com/2020/03/26/500-more-cops-call-out-sick-nypd-without-11-percent-of-patrol/

Meanwhile, the FDNY Commissioner reports that 170 members of the Fire department have tested positive for COVID-19. He further reports that they have long range plans to scale back if they have to.

https://nypost.com/2020/03/26/170-fdny-members-have-coronavirus-commissioner-says/

The New York State Nurses Association reports that every hospital in NYC has between 3 and 6 nurses who have tested positive for COVID-19 for a total of 65 nurses. Only 7,000 out of 42,000 members responded to the poll so it could be higher.

https://nypost.com/2020/03/26/65-ny-nurses-have-tested-positive-for-the-coronavirus-survey-claims/
 
Today marks the start of week 3 since my wife was sampled, no test results yet

Talking to my neighbor yesterday, at a proscribed safe distance. Neighbor thinks only the elderly and sick need to be quarantined, the rest just need to go about our regular business. Neighbor is in general good health, 80's intelligent. Neighbor leans more right than me, so asks my opinion on things for a more center-left view. Neighbor was not interested in hearing why this virus is much different than the flu (facts not opinion).
A new poll shows that 72% of American VOTERS now believe that coronavirus will impact their personal lives.

https://thehill.com/hilltv/what-ame...of-voters-now-believe-coronavirus-will-impact

If true, that means that 28% of voters are idiots.
 

Road

Adventurist
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Dang. Not to derail from Coronavirus general chat, here's what worries me about this:

The temporary policy, for which EPA has set no end date, would allow any number of industries to skirt environmental laws, with the agency saying it will not “seek penalties for noncompliance with routine monitoring and reporting obligations.”

Cynthia Giles, who headed EPA’s Office of Enforcement during the Obama administration, called it a moratorium on enforcing the nation's environmental laws and an abdication of EPA’s duty.
...
In a 10-page letter to EPA earlier this week, the American Petroleum Institute (API) asked for a suspension of rules that require repairing leaky equipment as well as monitoring to make sure pollution doesn’t seep into nearby water.

Other industries had also asked to ignite the “force majeure” clauses of any legal settlements they had signed with EPA, allowing for an extension on deadlines to meet various environmental goals in the face of unforeseen circumstances.

But Giles and others say the memo signed Thursday goes beyond that request, giving industries board authority to pollute with little overnight from the agency.

“Incredibly, the EPA statement does not even reserve EPA's right to act in the event of an imminent threat to public health,” Giles said.

Feels like this sort of thing has happened in the past . . . extenuating circumstances allowing for lessening of laws and regulations, then when things return to 'normal' the less restrictive regulations benefiting oil or whoever, continue.

.
 
Trump Outlines Plan to Issue Coronavirus Risk Levels for Every County in the U.S.

President Trump sent a letter to the nation’s governors Thursday notifying them that his administration plans to classify every county in the U.S. based on its risk for a coronavirus outbreak.

The plan appears to be part of Trump’s controversial mission to get the U.S. economy back up and running by Easter — a proposal that health
experts say could exacerbate the spread of the virus.

Trump said counties will be graded as “high-risk, medium-risk, or low-risk" and that “guidelines” will be disseminated to states as to whether they should lift social distancing guidelines or keep them in place.

The “data-driven” criteria will be developed by “public health officials and scientists," according to Trump. It will be largely based on testing results, Trump said.

As we enhance protections against the virus, Americans across the country are hoping the day will soon arrive when they can resume their normal economic, social and religious lives,” Trump wrote in the letter.

The president did not offer a timeline for when the classifications will be unveiled.

Earlier this week, Trump said he hoped to scrap social distancing guidelines and “open” the country back up by Easter Sunday, even though most health experts say many parts of the country may need to remain in lockdown mode for weeks or even months in order to slow the spread of the virus.

But Trump, whose bid for reelection is squarely focused on the strong state of the economy, has insisted the price of keeping the country stalled could be worse than the virus itself.

“You’re going to lose more people by putting a country into a massive recession or depression,” Trump said at the White House on Tuesday.

"You’re going to have suicides by the thousands.”

The virus has already infected some 80,000 people in the U.S. and more than 1,000 have died, with the death toll climbing higher by the day.

Trump appeared to suggest in the letter to the governors that the most impactful way to “honor” people who have died from the virus is to open
the country back up.

“We mourn alongside those who have lost loved ones, and we send our prayers for the recovery of all who are still sick,” the president wrote. “In their honor, we pledge to marshal every resource and power we have to overcome and vanquish this threat.”
 

Road

Adventurist
Today marks the start of week 3 since my wife was sampled, no test results yet

Talking to my neighbor yesterday, at a proscribed safe distance. Neighbor thinks only the elderly and sick need to be quarantined, the rest just need to go about our regular business. Neighbor is in general good health, 80's intelligent. Neighbor leans more right than me, so asks my opinion on things for a more center-left view. Neighbor was not interested in hearing why this virus is much different than the flu (facts not opinion).
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3 weeks is outrageous, when luminaries and officials can get results in hours. I sincerely hope that is resolved soon for you.

*** As for what your neighbor thinks, I predict that is exactly what is going to happen around Easter, if not before in some places. A lessening of the Stay At Home orders for most in America with strong, possibly much stronger than now, restriction on movements by elderly and folks with known underlying health problems, and known immunocompromised such as chemo patients.

Growing evidence seems to indicate that clusters of infection are often the problem in increasing spread to the greater population, and that clusters often happen among families living together.

Also strong evidence from places like S Korea and Singapore--who quickly separated anyone with elevated temps (done publicly everywhere; at subway stops, entrances to building, etc) to a Fever Center (NOT the hospital) for further testing, then isolated/quarantined all who tested positive, even if it meant separating elders or children from family--that a more aggressive isolation of those actually sick, no matter how severe or not and even if only mild symptoms present, has been immensely effective in slowing down the virus resulting in a much less severe death rate than countries who have not.

- You know what's bugging me right now, especially as an "elder," is that there seems to be a pervasive feeling, because of all the news about covid-19 attacking elderly in more severe ways, that even healthy elderly among us are more likely to be carriers, that we're more contagious and dangerous than other healthy folks, so therefore should be almost shunned.

I've seen it when out walking alone or even just standing in front of my own home, looks of almost horror from people driving by that I am outside. People take an even wider berth around me at the grocery or on a sidewalk, with looks I don't take as being out of concern I might get sick, but that I must already be, so should be recoiled from in all haste.

Folks who are 60, healthy, and cautious about washing up and who/what they touch are no more likely to get infected than someone who is 59, healthy and does the same. Or someone who is 29, healthy and does the same. The older one gets, yes, they may be more likely to have severe symptoms and complications IF infected. That does NOT mean we ARE infected, are more likely to BE infected, or are asymptomatic carriers.

.
 
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From The Atlantic. The author, Kerry Kennedy Meltzer is an internal medicine resident physician in New York City.

On Friday night, I worked a 12-hour shift in the designated COVID-19 area of my hospital’s emergency department in New York City. Over the
course of the night, I examined six patients who were exhibiting common symptoms of the novel coronavirus; five of them were in their 20s or
early 30s.


I am 28 years old. Up until Friday, when people asked me whether I was scared, I would tell them yes—for my country, my colleagues, my 92-year-old grandmother, and all the people most vulnerable to getting seriously ill from the virus, but not for myself. I, like many others, believed that young people were less likely to get sick, and that if they did, the illness was mild, with a quick recovery.

I now know that isn’t the case. The fact is that young people with no clear underlying health conditions are getting seriously ill from COVID-19 in significant numbers. And young Americans—no matter how healthy and invincible they feel—need to understand that.

My first patient was in their early 20s. (To protect their confidentiality, I’m referring to my patients without mentioning their gender.) They had a dry cough and a 102-degree fever, but their chest X-ray came back clear and their oxygen levels were safe. I wanted to test them for COVID-19, but they weren’t sick enough to require admission to the hospital, which meant I couldn’t do so. We desperately want to be able to test and take care of everyone, from the seriously ill to the mildly sick and worried, but with our current capacity, we simply can’t. I told them that they needed to assume they had the virus, and gave them instructions on how to quarantine at home.

I changed my gown and gloves, checked my mask and goggles, and moved on to my next patient: a student who had been coughing and feeling fatigued for multiple days. They had been with a friend before getting sick, and that friend had since fallen ill with symptoms of COVID-19, including a fever. The patient was having trouble catching their breath, but their symptoms were not severe or acute—as confirmed by a chest X-ray and a test of their oxygen levels—so I recommended discharge and quarantine, and they understood.

My next patient was a young professional. For the past week they’d had a dry cough and chest pain. They had no underlying health conditions, and
they’d tried to follow the current guidelines by staying at home (the right thing to do, given the overwhelmed state of hospitals like mine) but that evening their breathing had become so labored that they called an ambulance. When I saw them, however, they were breathing comfortably, their chest X-ray was clear, and their oxygen levels were safe. They were visibly upset when I told them they would not be admitted. They wanted to be tested. I explained why we couldn’t do that, and completed their discharge paperwork.


I collected myself and approached my next patient: a young person who’d been suffering with a fever, cough, and extreme fatigue for the past three days. Their boss didn’t believe they were sick, so they’d continued to complete long shifts working with customers at a local business. After examining the young patient, I determined that they were in the same category as the previous three I’d seen—sick, but not sick enough to be given a precious hospital bed or COVID-19 test—so I gave them fluids, Tylenol, and a note for their employer confirming that they were indeed ill, and needed to stay home.

Late in the night, another young patient came in with a high fever and no underlying health conditions. They’d had a dry cough for the past four days. They’d come to the hospital after finding they were unable to walk a few feet without getting severely short of breath. On their chest X-ray, I saw lungs that were almost completely whited out, indicating a significant amount of inflammation. It was clear how uncomfortable they were, and how desperately they were trying to catch their breath. They were in a different category from the previous patients I’d seen that night. They needed to be admitted. They needed testing. They needed close monitoring.

I called the Intensive Care Unit team, and they admitted the young patient to the hospital. I finished my shift not long after, walked home, and got in bed, feeling unsteady. When I woke up a few hours later, I logged into our electronic medical record system and learned that in the time I’d been asleep, my patient’s oxygen levels had dropped severely. A breathing tube had been placed down their throat. A ventilator was now keeping them alive.

Recent statistics suggest that what I saw that night is not unusual. On Tuesday, California Governor Gavin Newsom said that half of the 2,102 people who had tested positive for COVID-19 in his state were ages 18 to 49. The Centers for Disease Control and Prevention published data showing that, from February 12 to March 16, nearly 40 percent of American COVID-19 patients who were sick enough to be hospitalized were ages 20 to 54. Twelve percent of patients with the most critical cases, requiring admission to an ICU, were ages 20 to 44.

There are some caveats worth noting: The CDC was not able to determine whether the young people included in its report had underlying health
conditions. And all of this is early data. We know that we are still not testing nearly enough people in the United States. The numbers may change.


But in spite of these alarming figures, too many young Americans have been slow to give up the false belief that they are safe from COVID-19.

The day after the CDC report was released, college students began responding to a poll. Only 50 percent said that they were concerned about contracting COVID-19. Fifty-three percent admitted that they or their friends had gone to social gatherings in the previous week.

At the same time as I was seeing the flurry of young patients on my overnight shift, a resident friend of mine at a hospital on the West Coast was placing a patient in their 20s on a ventilator. A 26-year-old woman who was hospitalized with COVID-19 recently told her story in The New York Times. A doctor at my own hospital said that he has never seen so many young people in the ICU as he’s now seeing with COVID-19.

This isn’t the type of evidence that we like to talk about as scientists—anecdotes, instead of hard data—but doctors are people too.

We listen to the stories of our patients and our colleagues. We pay attention to the trends that we see on the ground. We connect the dots.

We still need better data to fully understand how young people are being affected by COVID-19, but until we can get it, we have to spread the word, and ask friends and family—no matter their age—to stay at home.
john- If you read the article carefully only one of his patients “could” have come down with Covid-19. The rest of the people did not come close to meeting the parameters for the virus. IMHO people on the greater NYC area are getting so spun up that even a minor throat irritation or slight temperature is now a major crisis. In “normal” times these people would have taken some NyQuil and gone to bed.

Another point to keep this in perspective is that as of this am there have been about 1300 deaths from Covid-19 but over 36,000 from the regular flu...think about that for a minute....

In my home town a nurse we know has been issued ONE mask to use for her entire shift....guess how many Covid-19 patients they have in the hospital...ONE. How in the hell can one patient cause massive shortages in PPE. It can’t. It’s a massive over reaction to a potential issue that all hospitals should have had contingency plans for...but apparently most didn’t. It seems that the hospital admins should be fired and use their massive salaries (the one in our neck of the woods makes over $1 million a year (city population of ~100K)) to purchase more PPE.

Sorry to get so worked up about this but the facts don’t support the actions being taken in except a couple of places...

Yes, we should all practice social distancing when possible. As another example of over reaction I am sitting here 22 miles off the NC Coast on Hatteras Island. As I mentioned in another post the County has closed access to anyone except full time residents...BUT full time residents are free to leave the island, drive to Raleigh or Norfolk, go shopping at Costco with 5000 of their closest friends and come back to infect their neighbors....Makes zero sense. Yes, we should always wash our hands more, but No you don’t need 200 rolls of TP.
Just a little common sense will go along way...
 
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.
Dang. Not to derail from Coronavirus general chat, here's what worries me about this:




Feels like this sort of thing has happened in the past . . . extenuating circumstances allowing for lessening of laws and regulations, then when things return to 'normal' the less restrictive regulations benefiting oil or whoever, continue.

.
Road this is not quite correct...
‘All the rules and consent orders will remain in full effect. I would expect that any company that tries to sneak something by will get their asses handed to them.
Here’s the actual policy..

https://www.epa.gov/newsreleases/epa-announces-enforcement-discretion-policy-covid-19-pandemic
 
john- If you read the article carefully only one of his patients “could” have come down with Covid-19. The rest of the people did not come close to meeting the parameters for the virus. IMHO people on the greater NYC area are getting so spun up that even a minor throat irritation or slight temperature is now a major crisis. In “normal” times these people would have taken some NyQuil and gone to bed.

Another point to keep this in perspective is that as of this am there have been about 1300 deaths from Covid-19 but over 36,000 from the regular flu...think about that for a minute....

In my home town a nurse we know has been issued ONE mask to use for her entire shift....guess how many Covid-19 patients they have in the hospital...ONE. How in the hell can one patient cause massive shortages in PPE. It can’t. It’s a massive over reaction to a potential issue that all hospitals should have had contingency plans for...but apparently most didn’t. It seems that the hospital admins should be fired and use their massive salaries (the one in our neck of the woods makes over $1 million a year (city population of ~100K)) to purchase more PPE.

Sorry to get so worked up about this but the facts don’t support the actions being taken in except a couple of places...

Yes, we should all practice social distancing when possible. As another example of over reaction I am sitting here 22 miles off the NC Coast on Hatteras Island. As I mentioned in another post the County has closed access to anyone except full time residents...BUT full time residents are free to leave the island, drive to Raleigh or Norfolk, go shopping at Costco with 5000 of their closest friends and come back to infect their neighbors....Makes zero sense. Yes, we should always wash our hands more, but No you don’t need 200 rolls of TP.
Just a little common sense will go along way...
The shortage of tests and the length of time the samples take to be processed has created a very narrow criteria for a test to be done.
 
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john- If you read the article carefully only one of his patients “could” have come down with Covid-19. The rest of the people did not come close to meeting the parameters for the virus.
The rest of the people didn't meet the parameters to be TESTED to see if they have the coronavirus. We have no way of knowing how many of those other five are going to back in a week needing to be put in ICU and intubated. And in the end, does it really matter whether they have the coronavirus or just a really bad case of the flu if they are tying up one of a limited number of ICU beds and breathing machines.

Another point to keep this in perspective is that as of this am there have been about 1300 deaths from Covid-19 but over 36,000 from the regular flu...think about that for a minute....
Did the 36,000 flu deaths all occur in the last month, and mostly in a few densely packed hot spots? Does the flu routinely cause us to run out of ICU beds and breathing machines so that we have to allow people to die untreated? Think about that for a minute....

I
n my home town a nurse we know has been issued ONE mask to use for her entire shift....guess how many Covid-19 patients they have in the hospital...ONE. How in the hell can one patient cause massive shortages in PPE. It can’t.
I'm old enough to remember when HIV came on the scene and the introduction of "Universal Precautions". Medical professionals began to assume that EVERY patient they saw had it, and they protected themselves accordingly. Under Universal Precautions, doctors and nurses are supposed to change their protective gear between every patient they see, not wear the same mask all day long. It's not just to protect themselves, but also to avoid transfering the virus between patients. I certainly don't want them coming in to examine me wearing the same mask and other gear they were wearing while dealing with a really infected patient.
 
From The Atlantic. The author, Fred Milgrim, is an emergency-medicine resident physician in New York City, currently working at Elmhurst Hospital.

America, Learn From NY

In the emergency-department waiting room, 150 people worry about a fever. Some just want a test, others badly need medical treatment. Those
not at the brink of death have to wait six, eight, 10 hours before they can see a doctor. Those admitted to the hospital might wait a full day for a bed.

I am an emergency-medicine doctor who practices in both Manhattan and Queens; at the moment, I’m in Queens. Normally, I love coming to work
here. Even in the best of times, my co-residents and I take care of one of New York City’s most vulnerable, underinsured patient populations.

Many have underlying illnesses and a language barrier, and lack primary care.

These are not the best of times; even for my senior attendings, it is the worst they have ever seen. Here, the curve is not flat. We are overwhelmed. There was a time for testing in New York, and we missed it.

China warned Italy. Italy warned us. We didn’t listen. Now the onus is on the rest of America to listen to New York. For many people around the
country, the virus is still an invisible threat. But inside New York’s ERs, it is frighteningly visible.

Every day, in our hastily assembled COVID-19 unit, I put on my gown, face shield, three sets of gloves, and N95 respirator mask, which stays on for the entirety of my 12-hour shift, save for one or two breaks for cold pizza and coffee. Before the pandemic, I would wear a new mask for every new patient. Not now. There are not enough to go around. The bridge of my nose is raw, chapped, and on the verge of bleeding. But I consider myself one of the lucky ones. My hospital still has a supply of masks—albeit a dwindling one—to protect me and my colleagues.

Many of my patients clearly haven’t received the message to stay home unless they’re in immediate need of professional medical assistance.

Their fevers and coughs alone are not enough to even earn a test. I hand them discharge paperwork and a printout about how to prevent the spread of the coronavirus, tell them to self-isolate, and then I move on to the next person. If they didn’t have the coronavirus before coming to our
hospital, they probably do now. So much for gatherings of 10 people or fewer.

Meanwhile, my colleagues tend to patients in the critical-care bay with dipping oxygen levels, patients who can barely speak and may need breathing tubes.

Earlier in the month, we were told that positive-pressure oxygen masks, such as CPAP machines, were risky, as they would aerosolize the virus,
increasing health-care workers’ risk of getting infected. But in recent days, running dangerously low on ventilators, we have attempted using CPAP machines to stave off the need for medically induced comas.

Still, the increasing frequency of intubations we need to perform is alarming. Our ventilators are almost all in use, and the ICUs are at
capacity. Our hospital has already received extra vents here and there from other hospitals in the region that can spare them, but those few
additions are merely a stopgap. Will we soon have patients sharing vents? We wouldn’t be the first hospital to attempt that unusual and suboptimal practice, which gained traction after the Las Vegas shooting, when scores of young trauma patients were vented in pairs. But these COVID-19 patients have delicate lungs, which makes vent-sharing far more dangerous. Nevertheless, we’ve already started studying the mechanics of how to make this happen, as a last-ditch effort.

By next week, we may simply have no choice. Those hundreds of relatively healthy patients we sent home may return to the hospital en masse in
respiratory failure.

On Wednesday, I greeted a patient I had discharged only one week prior. When I saw his name pop up on the board, my heart sank. He is just shy of 50, with hardly any past medical history, and he had seemed fine. Now he was gasping for air. His chest X-ray was no relief—COVID-19 for sure.

I needed to admit him to the hospital, and set him up with oxygen, heart monitoring, and a bed.

Last week, I saw an elderly woman on dialysis. She had arrived with a mild cough. But her vital signs were normal—no fever. After her chest X-ray came back clear, we decided to send her home. But before her ride came, she spiked a fever to 102. Change of plans. With her age and complex medical problems, she would need to be admitted.

The next night, I saw a rolling bed wheeling past me with a resident riding on top, performing chest compressions on the patient.

Only after we pronounced the patient dead did I learn her name. She was my patient from the night before. She went into cardiac arrest before she even got a bed in the ward. My first COVID-19–positive death. The numbers have been mounting ever since.

A few days ago, FEMA finally arrived to help with this crisis. It has brought more tests, hopefully more vents, and a morgue in the form of a truck to help with the ever-growing number of dead bodies. I wonder if this help will be enough. My colleagues and I discuss this pandemic with a sardonic sense of helplessness. Some of us are getting sick. Our reality alters by the moment. Every day, we change our triage system.

Each day could be the day that the masks run out. There is much we think but are too afraid to say to one another.

I do not want to see you in my hospital. I do not want you to go to any hospital in the United States. I do not want you to leave your home, except for essential food and supplies. I do not want you to get tested for the coronavirus, unless you need to be admitted to a hospital.

For those of us at the forefront, knowing who has COVID-19 won’t change our ability—or inability—to treat patients. The problem is, and will be,
our shortage of healthy personnel, personal protective equipment, beds, and ventilators. A nasal swab is not the answer anymore.

If you have mild symptoms, assume that you have the coronavirus. Stay home, wash your hands, call your doctor. Don’t come to the emergency
department just because of a fever or cough. Receiving a test won’t change our recommendation that you remain in self-isolation. We don’t
want you to expose yourself to those who definitely do have the virus.

Social distancing, while still crucial, came too late in New York to prevent a crisis. Maybe, just maybe, extreme measures can prevent this from happening in other cities around the country.

In spite of all this morbidity, the doctors at the hospital received one piece of good news yesterday. A coronavirus patient was successfully
taken off a ventilator after two weeks, a first for our Medical ICU and a victory for the staff and, of course, the patient.
 
^^^
The third paragraph from the bottom succinctly states my argument...A little common sense goes a long way with Covid-19 and pretty much anything else in life.
 
Today marks the start of week 3 since my wife was sampled, no test results yet

Talking to my neighbor yesterday, at a proscribed safe distance. Neighbor thinks only the elderly and sick need to be quarantined, the rest just need to go about our regular business. Neighbor is in general good health, 80's intelligent. Neighbor leans more right than me, so asks my opinion on things for a more center-left view. Neighbor was not interested in hearing why this virus is much different than the flu (facts not opinion).
Kevin-
i’m sorry to hear that your wife hasn’t had her test results shared with you. Clearly something is FU’ed.
More importantly ....how is she doing?
 
Kevin-
i’m sorry to hear that your wife hasn’t had her test results shared with you. Clearly something is FU’ed.
More importantly ....how is she doing?
Getting better, as far as we can tell. Thank you for asking. There is just too much we do not yet know about this virus, future immunity and recovery.
 
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