March Madness and Covid-19

[steverocks35]

I got this in one of my emails today at work, thought you guys might find it interesting.

Subject: COVID-19 clinical observations
Copied from another group, firsthand accounts from other docs may be very helpful.
I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.
Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.
China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your

 

[WaymanFan]

That's not sound reasoning. If we go back to normal now, then the cases will explode and it will be even worse for the economy. Better to weather the storm until it's over. Not only will you save a lot of lives, but it will be better for the economy in the long run.

The whole quarantine / closing small businesses down is beyond hypocritical. Yeah, close down a small business that gets about 25-50 people a day, but let’s keep open Lowe’s, Home Depot, Walmart and Target which gets thousands of people visiting daily in each location so people like my neighbor can buy a floor mat for his house...yeah, that will get the numbers down .

 

[steverocks35]

The whole quarantine / closing small businesses down is beyond hypocritical. Yeah, close down a small business that gets about 25-50 people a day, but let’s keep open Lowe’s, Home Depot, Walmart and Target which gets thousands of people visiting daily in each location so people like my neighbor can buy a floor mat for his house...yeah, that will get the numbers down ��.

I totally agree!!! It's insane to keep those businesses open. They can do business on the internet and have curbside pickup!

The governor needs to act!

 

[sheepdogs1]

I totally agree!!! It's insane to keep those businesses open. They can do business on the internet and have curbside pickup!

The governor needs to act!

In what states are they closed? If they are not closed does that translate to "no governors are behaving responsibly."

 

[mict085]

That's not sound reasoning. If we go back to normal now, then the cases will explode and it will be even worse for the economy. Better to weather the storm until it's over. Not only will you save a lot of lives, but it will be better for the economy in the long run.

I didn’t say back to normal. We can still practice sensible social distancing without shutting everything down. We can’t shut down for more then 30 days. At some point, we need to bite the bullet and get everyone back to work. The numbers don’t justify tanking everything to save 200,000 people.

I know you think you’re the expert, but more people will die from the economy tanking than the virus if we’re not careful.

 

[steverocks35]

I didn’t say back to normal. We can still practice sensible social distancing without shutting everything down. We can’t shut down for more then 30 days. At some point, we need to bite the bullet and get everyone back to work. The numbers don’t justify tanking everything to save 200,000 people.

I know you think you’re the expert, but more people will die from the economy tanking than the virus if we’re not careful.

This is not just my opinion, this is the opinion of experts in the field all over the nation.

https://www.npr.org/sections/health-shots/2020/03/27/822146372/experts-say-the-u-s-needs-a-national-shutdown-asap-but-differ-on-what-comes-next

 

[mict085]

This is not just my opinion, this is the opinion of experts in the field all over the nation.

https://www.npr.org/sections/health-shots/2020/03/27/822146372/experts-say-the-u-s-needs-a-national-shutdown-asap-but-differ-on-what-comes-next

That article confirms what I just said. We can’t shut down everything for too long. It’s going to be 12-18 months before a possible vaccine. We should be ramping up manufacturing of PPE and ventilators to meet the demand, which it sounds like we’re doing. We have to get back to work soon or the economic catastrophe will be worse then the virus.

 

[steverocks35]

That article confirms what I just said. We can’t shut down everything for too long. It’s going to be 12-18 months before a possible vaccine. We should be ramping up manufacturing of PPE and ventilators to meet the demand, which it sounds like we’re doing. We have to get back to work soon or the economic catastrophe will be worse then the virus.

Depends on what you mean by "too long." The peak of this will be towards the end of April in a lot of places, but that doesn't mean we can just go back to work after the peak. If you open the country up too soon then you have a big repeat of what happened in the last few weeks, and you don't want that. My guess is that 60 more days is appropriate.

By the way, the cases here in Oklahoma are starting to go into the log phase. That's what worries me. I have a son with asthma, it could devastate him.

 

[sheepdogs1]

Depends on what you mean by "too long." The peak of this will be towards the end of April in a lot of places, but that doesn't mean we can just go back to work after the peak. If you open the country up too soon then you have a big repeat of what happened in the last few weeks, and you don't want that. My guess is that 60 more days is appropriate.

By the way, the cases here in Oklahoma are starting to go into the log phase. That's what worries me. I have a son with asthma, it could devastate him.

Convince him living in a bubble is in his best interests and his interests includes his caring family.

 

[coolm]

We have to get back to work. We have to find a way to combat the virus without tanking the economy and putting everyone out of work. I’m sorry if 100-200k people die, but we have to take care of the 330+ million other people that will survive.

Had you been in the bunker with us in Kuwait I know of 2 people who would be dead right now. awfully glad you weren't.

 

[sheepdogs1]

Had you been in the bunker with us in Kuwait I know of 2 people who would be dead right now. awfully glad you weren't.

Do you believe he is telling people in need of medical attention to not seek it.

 

[coolm]

Do you believe he is telling people in need of medical attention to not seek it.

I see many people who have this idea that it will be this limited number from this limited group and they're wrong. it will be a bigger number from a group including people more personal to them and they'll regret what they've said. much like those who complained about social distancing being "too severe" and are now quiet about their past error.

 

[sheepdogs1]

I see many people who have this idea that it will be this limited number from this limited group and they're wrong. it will be a bigger number from a group including people more personal to them and they'll regret what they've said. much like those who complained about social distancing being "too severe" and are now quiet about their past error.

I understand exactly what you are saying but it appeared that you were suggesting that those you know, who are ill, would have perished because of what micto85 suggested. That's all.


Secondly, in desperate economic times there will, invariably, be those who die due to differing reasons. Could be suicide or even accidental overdose. If this occurs how do you go about "not knowing" these people.

 

[stormspencer]

https://twitter.com/EconTalker/status/1244645436188692484

 

[mict085]

I see many people who have this idea that it will be this limited number from this limited group and they're wrong. it will be a bigger number from a group including people more personal to them and they'll regret what they've said. much like those who complained about social distancing being "too severe" and are now quiet about their past error.

80% have mild or no symptoms with no hospitalization. The remaining 20% require hospitalization with only about 5% requiring ICU/ventilator management.

What I’m saying is, yes it’s a devastating virus but shutting everything down beyond May will cause more damage than the virus. High risk patients should absolutely take the highest precautions. Those that are not in High risk groups should get back to work as soon as the nationwide shutdown is over. The peak is April 17th or close to that.

We can still get back to work while practicing common sense and social distancing. I never said back to “normal”. However, we need to get back to work and keep the economy from tanking. We may have to rethink our unskilled labor and put then to work in other areas.

 

[coolm]

I understand exactly what you are saying but it appeared that you were suggesting that those you know, who are ill, would have perished because of what micto85 suggested. That's all.


Secondly, in desperate economic times there will, invariably, be those who die due to differing reasons. Could be suicide or even accidental overdose. If this occurs how do you go about "not knowing" these people.

In desperate economic times? so which is it ... is trump a "wartime president" or not? because when it comes to war and taking sniper fire we don't leave people behind. but I am seeing people who lack that same conviction when it comes to paychecks back home. so you're darn right I suggested that. I know an IC1 from California and a Marine Corporal who would be dead now had we followed that rule in Iraq. you dont cut and run with lives hanging there. you don't "leave 200,000 behind".

 

[thebigabd]

Is there any sort of compromise option between the two groups?

Group A: Shut everything down for a period of time to stop people from catching and being killed by the virus.

Group B: Open things back up, practice good hand hygiene and social distancing, get a lot of ventilators, and protect the economy and try to minimize damage of the virus.

 

[sheepdogs1]

In desperate economic times? so which is it ... is trump a "wartime president" or not? because when it comes to war and taking sniper fire we don't leave people behind. but I am seeing people who lack that same conviction when it comes to paychecks back home. so you're darn right I suggested that. I know an IC1 from California and a Marine Corporal who would be dead now had we followed that rule in Iraq. you dont cut and run with lives hanging there. you don't "leave 200,000 behind".

My response was not poiitical in nature. I apologize if I misunderstood what you said. I saw micto85 make a statement about the virus. Then I saw you respond and I thought your response was related to knowing 2 people with the virus who would be deceased if micto85 got his way. Apparently your response was not related 2 people with the virus. Oh well!

 

[steverocks35]

Is there any sort of compromise option between the two groups?

Group A: Shut everything down for a period of time to stop people from catching and being killed by the virus.

Group B: Open things back up, practice good hand hygiene and social distancing, get a lot of ventilators, and protect the economy and try to minimize damage of the virus.

Group B sounds good in theory, but human nature is undefeated. Like Coolm said, everybody thinks what they are doing is more important than what anyone else is doing.

 

[sheepdogs1]

Is there any sort of compromise option between the two groups?

Group A: Shut everything down for a period of time to stop people from catching and being killed by the virus.

Group B: Open things back up, practice good hand hygiene and social distancing, get a lot of ventilators, and protect the economy and try to minimize damage of the virus.

Depends on whether people, if any, will perish due to the economic calamity or not. Past history says yes it will. To what extent is an unknown. It is not a situation where the only deceased people will be those who succumbed to the virus. Make sense?