March Madness and Covid-19

[Eielson]

I will assume torsades is some kind of rhythm issue. that's way past my pay grade. I am still trying to understand the potassium chemistry. so you've taken an EKG on all your quinine patients? cool.

Yes, torsades is the feared complication of QTc interval prolongation. You should google it -- you don't have to know anything about EKGs to realize that's a terrifying thing to see on the strip.

And yes, all patients on hydroxychloroquine get an EKG. Honestly, I think every patient that ever steps foot in an ER should get a baseline EKG. It's one of the cheaper things we do in medicine, and even if they're not here for a cardiovascular problem, they may develop one during their stay -- and at that time you'll be happy you have a baseline to compare to their new one. Most physicians will get an EKG before starting plaquenil and periodically throughout their course. Personally, I don't delay giving plaquenil for an EKG, but I can get into that more later. I feel like I'm rambling and this is where my family's eyes glaze over.

 

[Eielson]

100% correct. The size of the apparatus woven by big pharma and the federal government cannot be exaggerated.

If they find something, they'll get it through at warp speed.....and they'll close the loopholes just as quickly.

True, but it's also a bit of a double-edged sword. Pharmaceutical companies have to jump through huge hurdles for (mostly) good reason. Jumping immediately into large-scale human experiments is incredibly dangerous, and should not be done outside the direst of circumstances (i.e. a pandemic).

Sure, big pharma isn't perfect, but neither is big anything. Very few things have saved more lives than big pharma.

 

[coolm]

Yes, torsades is the feared complication of QTc interval prolongation. You should google it -- you don't have to know anything about EKGs to realize that's a terrifying thing to see on the strip.

And yes, all patients on hydroxychloroquine get an EKG. Honestly, I think every patient that ever steps foot in an ER should get a baseline EKG. It's one of the cheaper things we do in medicine, and even if they're not here for a cardiovascular problem, they may develop one during their stay -- and at that time you'll be happy you have a baseline to compare to their new one. Most physicians will get an EKG before starting plaquenil and periodically throughout their course. Personally, I don't delay giving plaquenil for an EKG, but I can get into that more later. I feel like I'm rambling and this is where my family's eyes glaze over.

same thing Dr. Solomon says (about EKG's). glad to see you're wary of it. I am not nearly so confident about many of your professional colleagues. we'll just leave it there.

edit: here's an interesting article that a colleague noted earlier today.
https://www.atsjournals.org/doi/abs/10.1164/ajrccm/144.4.741

 

[steverocks35]

same thing Dr. Solomon says (about EKG's). glad to see you're wary of it. I am not nearly so confident about many of your professional colleagues. we'll just leave it there.

edit: here's an interesting article that a colleague noted earlier today.
https://www.atsjournals.org/doi/abs/10.1164/ajrccm/144.4.741

Excellent article,TB is the disease that every epidemiologist studies. I'm concerned about the "U-shaped curve" that could happen if we "open up the country" too soon.

Right now we have surpassed 600,000 confirmed cases in the United States (out of 2 million globally) and 26,000 deaths. I think the deaths have been under-counted though. In hotspots like New York and Detroit people are dying at home without ever being tested and people are dying in hospitals with all the symptoms, so they never bother to test them. This will be sorted out after the fact.

 

[SoonerJK12]

Here is an interesting article on the moral dilemma of opening the economy and the certainty of more deaths.

https://reason.com/2020/04/13/the-f...n-cost-of-sweeping-covid-19-control-measures/

 

[coolm]

Here is an interesting article on the moral dilemma of opening the economy and the certainty of more deaths.

https://reason.com/2020/04/13/the-f...n-cost-of-sweeping-covid-19-control-measures/

it's a quandry man. I dont dismiss the fact that both sides have legitimate complaints.

 

[steverocks35]

it's a quandry man. I dont dismiss the fact that both sides have legitimate complaints.

Absolutely, there is a tension here and this is a moral dilemma that I don't think anyone has ever envisioned

 

[steverocks35]

An eye-opening, sobering article that puts Covid-19 in context and shows why comparing it to other causes of death falls flat.

https://www.thenewatlantis.com/publications/not-like-the-flu-not-like-car-crashes-not-like

 

[steverocks35]

I realize that it's counter-intuitive, but mortality rates actually go down during economic downturns. During the Great Depression and the Great Recession mortality rates decreased. There is no reason to believe that the recession/depression happening now will be any different, outside of deaths due to the virus.

https://www.pnas.org/content/106/41/17290

https://www.npr.org/2018/01/09/576669311/hidden-brain-great-recession-deaths

 

[Stikboy]

This is such good news. Bring on another depression! And don't let me catch you saying Covid-19 deaths are going down!

 

[steverocks35]

This is such good news. Bring on another depression! And don't let me catch you saying Covid-19 deaths are going down!

That’s because they aren’t, who told you they were going down? In fact we had a surge in deaths overnight in Oklahoma, +15. Yesterday we had almost 2,000 deaths in America from Covid-19, probably more because they’re being under-counted in hot zones.

 

[Stikboy]

Actually it's more likely the opposite. Hospital administrators are being told to code more than they should as Covid-19. And, many of these deaths are people that were very old and didn't have much longer, and it may not even have been Corona that killed them. Studies are flowing in showing parts of the world with segments of people that already have antibodies for this, meaning they had it and never had symptoms. Massive amounts of people have already had this, there's just not been the testing available. This will make the mortality rate of this go way, way down.

We're going to look back on this massive overreaction with extreme embarrassment, I think. Of course many doctors and other so called experts will somehow hedge and never admit anything. I hope cooler and sane heads prevail and start opening this thing up ASAP.

 

[steverocks35]

Actually it's more likely the opposite. Hospital administrators are being told to code more than they should as Covid-19. And, many of these deaths are people that were very old and didn't have much longer, and it may not even have been Corona that killed them. Studies are flowing in showing parts of the world with segments of people that already have antibodies for this, meaning they had it and never had symptoms. Massive amounts of people have already had this, there's just not been the testing available. This will make the mortality rate of this go way, way down.

We're going to look back on this massive overreaction with extreme embarrassment, I think. Of course many doctors and other so called experts will somehow hedge and never admit anything. I hope cooler and sane heads prevail and start opening this thing up ASAP.

None of what you said is backed up by evidence. There are no antibody tests that have widespread availability yet.

 

[vbdad]

They are coding people with covid19 if it is questionable.

 

[mict085]

At some point, we have to get back to work. We can wear masks, gloves, social distance, as best we can and still go to work. We have flattened the curve. Many hospitals aren’t even at 50% capacity. ICU beds sit empty. Ventilators are at 30-40% capacity. Many different diseases kill people every year. This disease hits the elderly especially hard. It sucks, but we can’t stop everything forever.

We are increasing production of PPE. We have antibody testing that should be available everywhere soon. We should be able to identify pockets that need to be quarantined and those that don’t very soon. Then, we can relax some of these restrictions. We should ease back into it. I think that’s still a few weeks away tho.

 

[steverocks35]

At some point, we have to get back to work. We can wear masks, gloves, social distance, as best we can and still go to work. We have flattened the curve. Many hospitals aren’t even at 50% capacity. ICU beds sit empty. Ventilators are at 30-40% capacity. Many different diseases kill people every year. This disease hits the elderly especially hard. It sucks, but we can’t stop everything forever.

We are increasing production of PPE. We have antibody testing that should be available everywhere soon. We should be able to identify pockets that need to be quarantined and those that don’t very soon. Then, we can relax some of these restrictions. We should ease back into it. I think that’s still a few weeks away tho.

I agree somewhat, but I would say it will be a few months. The problem with the antibody testing is we don't know for sure what that means. We don't know if it means you're immune, or how long the immunity would last. For example, for the seasonal flu immunity lasts less than a year. Also, you can be immune and still be out there spreading the virus around, so you need "herd immunity" which will be almost impossible if the immunity wears off in a few months. So much is unknown and won't be known until this disease can be studied which takes times. It can't be done in a few weeks. We need a vaccine, but that's not even a sure thing. Scientists have been attempting to develop a vaccine for HIV for decades with no success.

So I agree that at some point we will have to go back to work, but it won't be in a few weeks.

 

[sheepdogs1]

At some point, we have to get back to work. We can wear masks, gloves, social distance, as best we can and still go to work. We have flattened the curve. Many hospitals aren’t even at 50% capacity. ICU beds sit empty. Ventilators are at 30-40% capacity. Many different diseases kill people every year. This disease hits the elderly especially hard. It sucks, but we can’t stop everything forever.

We are increasing production of PPE. We have antibody testing that should be available everywhere soon. We should be able to identify pockets that need to be quarantined and those that don’t very soon. Then, we can relax some of these restrictions. We should ease back into it. I think that’s still a few weeks away tho.

It was discussed when the chit started to hit the fan, but all precautions which should have been taken for the elderly and high risk groups should have become a priority, first and foremost. With the level of money and effort thrown at the situation henceforth shows how much easier the problem could have been minimized.

 

[paboomersooner]

Just like Puff Daddy said, "It's all about the Benjamin's."

https://dailycaller.com/2020/04/14/nyc-numbers-coronavirus-death-toll/

And before anyone says, "But it's the Daily Caller...", they got their info from The Holy BIble itself, The New York Times.

The city decided to add 3,700 people to its death tolls, who they “presumed” to have died from the virus, according to a report from The New York Times. The additions increased the death toll in the U.S. by 17%, according to the Times report, and included people who were suffering from symptoms of the virus, such as intense coughing and a fever.

Makes one question ALL of the "statistics".

 

[WTSooner]

At some point, we have to get back to work. We can wear masks, gloves, social distance, as best we can and still go to work. We have flattened the curve. Many hospitals aren’t even at 50% capacity. ICU beds sit empty. Ventilators are at 30-40% capacity. Many different diseases kill people every year. This disease hits the elderly especially hard. It sucks, but we can’t stop everything forever.

We are increasing production of PPE. We have antibody testing that should be available everywhere soon. We should be able to identify pockets that need to be quarantined and those that don’t very soon. Then, we can relax some of these restrictions. We should ease back into it. I think that’s still a few weeks away tho.

Agreed. Open some things back up and just have some pretty strict rules about masks/gloves and whatever else might make sense. If you open up places like barber shops, have strict limitations on how many folks can be in there at a given time.

And they HAVE to get the testing done quicker. That would solve so many issues if they could test and get results within an hour or so.

 

[steverocks35]

Agreed. Open some things back up and just have some pretty strict rules about masks/gloves and whatever else might make sense. If you open up places like barber shops, have strict limitations on how many folks can be in there at a given time.

And they HAVE to get the testing done quicker. That would solve so many issues if they could test and get results within an hour or so.

Yes quicker tests would be ideal, even running them here the actual test takes about 2 hours, but that doesn't factor in the time it takes to collect the test, transport it to the lab, process it, and set up the test. And then the other problem is capacity. We can run 16 at a time, but more than that and you have them waiting for an empty slot on the instrument. But the inhouse testing here is extremely limited. We are reserving it for inpatients only. We have only 14 tests left here and the kits are on back-order we *might* get some next week. Also, we only have about 400 collection swabs left, there is no date certain on when those will be shipped, there is a national shortage. Usually we buy prepared viral transport media, but we can't get that either. We bought the raw materials to make our own viral transport media but we need new swabs to pair it with. A real crazy situation.

So we end up sending out testing to RML, the turnaround time for RML is about 2.5 days, which is not ideal but it is better than LabCorp, which is about 7-8 days.