Report from the trenches

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Tortoise
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Re: Report from the trenches

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ochotona wrote: Wed Mar 25, 2020 8:31 am My sis is 66 years old, a retired MD with medical conditions herself. Her hubby is older and more frail than her. The County called her and asked her if she was available for service. She did not accept, the last time I heard.
My parents (retired doctor and nurse, both in their mid-70s) were also called up last week to ask if they can provide surge medical care when the wave hits. :-\
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Re: Report from the trenches

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Since this report is only the latest of many focusing on a real potential scarcity of beds and ICU doctors, I can’t help but wonder:

What if a natural disaster hits before the virus burns out?

It’s already a tough choice between putting patients or the economy on a ventilator. It’s a dark thought, I know, but it showed up uninvited late this morning. It’s probably going to happen somewhere in the world. Hopefully not a Storm Sandy type scenario, not a large metropolis.
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Re: Report from the trenches

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dualstow wrote: Wed Mar 25, 2020 11:52 am Since this report is only the latest of many focusing on a real potential scarcity of beds and ICU doctors, I can’t help but wonder:

What if a natural disaster hits before the virus burns out?

It’s already a tough choice between putting patients or the economy on a ventilator. It’s a dark thought, I know, but it showed up uninvited late this morning. It’s probably going to happen somewhere in the world. Hopefully not a Storm Sandy type scenario, not a large metropolis.
Salt Lake City was hit by a 5.71 earthquake last week. Looks like they're dealing with it well.
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Re: Report from the trenches

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Yup, that’s a good example of an early one. It may get drastically harder (or easier) next month, of course.
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Re: Report from the trenches

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Please elaborate (conspiracy-theory?)

Also, just curious...is your avatar photo an actual photo of a house/cabin that you own?
I detest the term "conspiracy" because it continues to be used whenever a viewpoint differs from the approved narrative. That said, here are a few things that simply don't add up for me:

1. The writing has been on the wall (at least for those who have been willing to see it) for at least three months now. Only now are we seeing anything resembling a serious response to a pandemic in the making, and that response, in an increasing number of states, has been a total and draconian lockdown. Yet as recently as last week, the borders remained open, and college students were freely traveling in and out of the country on "dream vacations." People with known, active infections (including entire cruise ships full of sick people) have been brought into the U.S. with little, if no, supervision. None of the self-quarantines (which were violated over and over without consequence) were sufficiently long to make any sense given the likelihood of cross-transmission and the fact that many, if not most, cases are asymptomatic.

2. There's no good explanation for why testing was not implemented early and widely. A number of other countries had robust testing programs up and running months ago. To this day, the hoops that people are required to jump through in order to get tested (at least in my region) make the purported testing effort laughable. Meanwhile, we are supposed to believe that the fatality rates they're citing--notwithstanding the lack of any reliable actual case count) not only have meaning, but that they should make us very, very afraid.

3. We've been actively dissuaded, if not actually prevented, from taking action that would protect us. We've been told that wearing masks doesn't do any good. (This is an outright lie. Of course masks are not foolproof, but if viral load has any significance at all, anything that reduces the amount of your exposure is beneficial.) Today, the governor of Nevada actually ordered that Chloroquine--a mostly harmless drug that is showing great promise as a potential cure--NOT be made available in his state.

4. The action we've seen from state governments has in many cases seemed almost calculated to bring about extreme economic hardship, ifnot total collapse. People whose jobs involve absolutely no human contact are being prevented (at least in my region) from working. Banks have closed their doors and put limits on cash withdrawals. Try calling the mayor's office. The phone just rings. In many areas, it's actually being broadcast that the police will not respond to petty crimes, including thefts, with the predictable consequence that people will take things into their own hands.

5. The distribution of medical supplies and personal protective equipment needed by hospitals is being actively thwarted. Amazon has, according to number of Amazon third-party sellers, simply refused to allow these items to be sold on its forum. Anyone can go to Amazon's Seller Forums and see for themselves that sellers are howling about the fact that they've got entire warehouses full of medical supplies and PPEs that are going nowhere.

EDIT: 6. In today's news, at least a dozen states are releasing convicts into the general population. And Hillary is telling people NOT to take chloroquine.

That's only a partial list of things that don't add up for me, but it's a pretty good start.

On another subject, no, my avatar is not my actual place. Mine is also in the forest, but it's cuter and has lots of bird houses with swallows diving all around them, and a big garden!
Last edited by Maddy on Wed Mar 25, 2020 7:09 pm, edited 1 time in total.
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Re: Report from the trenches

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Couldn't it (top part of your list) just be ascribed to incompetence?
As for Amazon, they're trying to discourage- shut down- price gouging.

But, setting aside the C-word, what is your theory, Maddy?
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Re: Report from the trenches

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Kriegsspiel wrote: Wed Mar 25, 2020 12:03 pm
dualstow wrote: Wed Mar 25, 2020 11:52 am Since this report is only the latest of many focusing on a real potential scarcity of beds and ICU doctors, I can’t help but wonder:

What if a natural disaster hits before the virus burns out?

It’s already a tough choice between putting patients or the economy on a ventilator. It’s a dark thought, I know, but it showed up uninvited late this morning. It’s probably going to happen somewhere in the world. Hopefully not a Storm Sandy type scenario, not a large metropolis.
Salt Lake City was hit by a 5.71 earthquake last week. Looks like they're dealing with it well.
I saw a bulletin regarding that on the Weather Channel's home page last week. That was it. Not a peep about it elsewhere (that I've heard or seen). Until reading what you wrote I was wondering if it was some form of hoax.

Vinny
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Re: Report from the trenches

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Maddy, I'm a conspiracy theory "hobbyist" ;) . I occasionally dabble in reading up on various conspiracy theories and I think it's perfectly healthy for people to have a default mistrust of the state. But it can also lead to going down a rabbit hole, wasting a ton of your time that could be otherwise better spent, because you usually never find a true "smoking gun."

Conspiracy-theories aside, I've already lost way too much productivity over the last few weeks just reading all of the non-conspiracy-theory discussions. So, I'm interested in hearing different ideas from people, but at the end of the day, if there isn't something actionable I can do that benefits me or my family, I usually try to remind myself of that, and stop myself before I find myself too far down a rabbit hole.

As dualstow stated, several of your points could also be ascribed to incompetence. In addition to incompetence, I'll add:

- Lots of people, government officials, and complete governments were of the "the flu is worse" perspective, until the death counts started piling up, and they started to worry about whether their hospitals could support it.

- Some public statements (e.g.. advising people not to get N95 masks) were half-truths (lies) told because they realized that they didn't have enough of them. My wife already placed her order before the proclamation was given. I do feel bad for people who may need them more than we do *today*, but who knows if I or someone in my family/friends might need one *tomorrow*, so we're keeping them.

- The state is a parasite that always wants to grow. And "Republicans are just socialists driving the speed limit." And "Never let a crisis go to waste" (Rahm Emanuel). And we don't have free market capitalism in the USA, we have crony capitalism. Combine those things, and it's no big surprise that some are taking advantage of this crisis (whether with conscious intent, or just because it's the nature of the state "animal") to further reduce individual rights and grow the state.

- Little was known about the virus early on, and it still seems like not enough is known (If you catch it and recover, are you now immune, or can you catch it again? Can/Has it mutated into multiple strains? What long-term consequences does it have on survivors? What's the best treatment? Can you catch it from packages or food that were handled by someone who has the virus? If so, how long do those things remain infected?). That's a *LOT* of uncertainty (STILL - several weeks later), and uncertainty results in people/governments going into protective mode (possibly, in hindsight, ultra-over-protective mode).

So, it wouldn't shock me if there was a global conspiracy behind this. It also wouldn't surprise me if it's just a really awful pandemic that caught people unprepared. There are likely several components that fall somewhere in-between those extremes.

All I can do is ask myself, how should I act today, knowing what I know, and knowing what I don't know? We took, and are taking, precautionary steps and an over-abundance of caution. My wife and I were already full-time work-at-home, and we both feel pretty secure that we won't lose our jobs. So that puts us in a pretty privileged position to act in certain ways (protect our wealth, and even look for opportunities to come out ahead). But if we had lost our jobs (or feared losing them soon), our course of action might be very different.
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Re: Report from the trenches

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I'm also a licensed MD with a hospital accreditation in New York City, and I'm still sitting at home still waiting for The Call. In this AM's broadcast to staff, our hospital reiterated that no one would be asked to do something out of their skill set. And our dept chair made it clear that we are not even allowed to "volunteer" and that all re-deployments will go through him. If I get called I'll probably be asked to staff a testing clinic or something along those lines. Frankly, in an ICU I'd probably be less than useless.

I would guess that while our hospital has its act together and has been planning for weeks, not all have done this. I know that some hospitals only cancelled elective procedures a few days ago. This one must be poorly run. 20% of beds occupied by patients with respiratory illness from a virus - that is A NORMAL FLU SEASON!!!! If they're panicking already that's not a good sign. We haven't gone over the cliff yet...YET.

The good news is that the rate of new cases is beginning to slow, AND the acuity is less as a proportion of cases, because more testing means milder cases are being detected. Watch the numbers, reported daily in Cuomo's 10:30am broadcast.

It would have to get unimaginably worse before I'm told I have to become an ICU attending. And frankly, asking retired people to volunteer is sheer insanity. First, they are the vulnerable group who aren't going to do well if they get sick - and they are likely to get sick. Second, they have no clue how to navigate the ridiculously complex and time-sucking EHR systems that have been foisted on us. You want greater physician capacity? Shut down the damned EHRs and let us go back to paper charting and be damned to billing. Let some office busybody figure that out and scan in the paper documents after all is over.
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Re: Report from the trenches

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Ok, WiseOne's post makes me feel better.

For what it's worth, the guy quoted by tech in the OP is less alarmist in his next post. It still implores us to stay home, but it begins:
To be fair, I am off this week. The last two I was in house. Next week I am on again. Normally I would be in the office but instead I am home, as the administrative work I am doing can be done remotely.
So it's not yet M*A*S*H triage territory.
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Re: Report from the trenches

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dualstow wrote: Wed Mar 25, 2020 12:54 pm Couldn't it (top part of your list) just be ascribed to incompetence?
As for Amazon, they're trying to discourage- shut down- price gouging.

But, setting aside the C-word, what is your theory, Maddy?
Honestly, I don't have a theory, but if I had to speculate, I'd say that the paradoxical response we're seeing might have something to do with the fact that there are political factions with tremendous money and power behind them that are very much invested in seeing the economy fail during Trump's watch and in bringing about as much chaos as possible. The timing in relation the failed impeachment effort and the upcoming 2020 election makes this idea compelling, even by Occam's standards.

I'd also observe that the CoVid-19 crisis provides a very convenient scapegoat for whatever bubble-popping might need to occur in the financial system. In fact, Trump would have been a real idiot not to take advantage of the situation in this regard.
Last edited by Maddy on Wed Mar 25, 2020 3:49 pm, edited 2 times in total.
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Re: Report from the trenches

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To follow-up....I just talked to my sister who is an ER doc in Massachusetts. She was in a full-blown panic, because her hospital has done nothing to manage the situation and she's starting to see COVID cases in the ER. She said she had to intubate someone without an N95 mask because she's a small, and the hospital had run out of that size. She's been working every day (she's supposed to be part-time) because some of the ER docs are on quarantine. She asked me to send her the literature my hospital has been sending us (so I did) because she's been having to improvise protocols on the spot.

However, she's NOT being totally inundated yet - this is all due to poor management from above. On her shift today she saw 5 people with suspected COVID, one of whom needed to be admitted, and no one needed intubating. This is a lot, yes, but it's not her biggest problem. This sounds like the guy who posted to bogleheads.
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Re: Report from the trenches

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I think i know what you’re getting at, Maddy.
Does it rhyme with “cheapskate?” or bleep slate?

EDIT: @WiseOne: it sure does.
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Re: Report from the trenches

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It was Trump himself who referred to the "Deep State Department," in relation to all this, to the obvious chagrin of Dr. Fauci who was standing right beside him. I suppose he'd know.
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Re: Report from the trenches

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Maddy wrote: Wed Mar 25, 2020 3:54 pm It was Trump himself who referred to the "Deep State Department," in relation to all this, to the obvious chagrin of Dr. Fauci who was standing right beside him. I suppose he'd know.
Got it all cued up for you guys: viewtopic.php?f=9&t=2221&hilit=youtube+ ... 96#p189163
If the link doesn’t take you to the correct time, go to 54:50. It’s in the comments. (Link works on my desktop but not on my ipad)
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Re: Report from the trenches

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Libertarian666 wrote: Wed Mar 25, 2020 4:03 pm
WiseOne wrote: Wed Mar 25, 2020 2:01 pm I'm also a licensed MD with a hospital accreditation in New York City, and I'm still sitting at home still waiting for The Call. In this AM's broadcast to staff, our hospital reiterated that no one would be asked to do something out of their skill set. And our dept chair made it clear that we are not even allowed to "volunteer" and that all re-deployments will go through him. If I get called I'll probably be asked to staff a testing clinic or something along those lines. Frankly, in an ICU I'd probably be less than useless.

I would guess that while our hospital has its act together and has been planning for weeks, not all have done this. I know that some hospitals only cancelled elective procedures a few days ago. This one must be poorly run. 20% of beds occupied by patients with respiratory illness from a virus - that is A NORMAL FLU SEASON!!!! If they're panicking already that's not a good sign. We haven't gone over the cliff yet...YET.

The good news is that the rate of new cases is beginning to slow, AND the acuity is less as a proportion of cases, because more testing means milder cases are being detected. Watch the numbers, reported daily in Cuomo's 10:30am broadcast.

It would have to get unimaginably worse before I'm told I have to become an ICU attending. And frankly, asking retired people to volunteer is sheer insanity. First, they are the vulnerable group who aren't going to do well if they get sick - and they are likely to get sick. Second, they have no clue how to navigate the ridiculously complex and time-sucking EHR systems that have been foisted on us. You want greater physician capacity? Shut down the damned EHRs and let us go back to paper charting and be damned to billing. Let some office busybody figure that out and scan in the paper documents after all is over.
Yes, EHR is crap and I hope something will be done about that.
I know Trump is not a big fan of red tape.
On the other hand I did all the accounting work for a pediatric practice starting in 2005 until, maybe, 2011 (I think). Their Managing Partner was an early, early adopter of electronic records -- way, way before it was mandated. They were an extremely profitable practice and his patients absolutely loved this Manager Partner / doctor.

Vinny
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Re: Report from the trenches

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WiseOne wrote: Wed Mar 25, 2020 3:36 pm To follow-up....I just talked to my sister who is an ER doc in Massachusetts. She was in a full-blown panic, because her hospital has done nothing to manage the situation and she's starting to see COVID cases in the ER. She said she had to intubate someone without an N95 mask because she's a small, and the hospital had run out of that size. She's been working every day (she's supposed to be part-time) because some of the ER docs are on quarantine. She asked me to send her the literature my hospital has been sending us (so I did) because she's been having to improvise protocols on the spot.
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Re: Report from the trenches

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WiseOne, after hearing that your sister is an ER doc, I surmised that you must have come from a family with a strong role model in the form of a scientist or physician. It galvanized my image of you as something resembling the protagonist in the series Dr. Quinn, Medicine Woman. In Episode 1, we are introduced to Michaela Quinn (Jane Seymour), the outspoken daughter of an educated, well-to-do Boston physician in the mid-1800s who has battled her way through the Women's Medical College of Pennsylvania to achieve her dream of becoming a physician. Her father, staunchly supportive of her ambitions, has unfortunately died, leaving his daughter with virtually no hope of carrying on the practice given the era's prejudices against a "woman doctor." To the horror of her mother, who simply can't understand why her daughter can't be satisfied with marriage, Dr. Quinn embarks by train to the Colorado Territory, only to find that the people there would rather be doctored by a barber than submit themselves to the care of a woman. It's a wonderful story, one of my favorites. Of course, Sully (her eventual love interest) isn't hard to look at.
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Re: Report from the trenches

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Vinny: Simple SAT test question. The computerized records system developed by a physician-run practice is to a
federally mandated, commercial EHR system as:

- Ecuador is to the Soviet bloc during the Cold War
- a game of checkers is to a murderous stampede at a World Cup soccer game
- Gerald Ford tripping while getting off an airplane to Bush proclaiming Mission Accomplished in front of an enormous banner in Iraq

I could do a bunch more of those, but hopefully you get the point. EHR systems and their ironclad enforcement of a long string of Obama-era mandates have practically destroyed our health care system. It's amazing that it functions at all.

Maddy: Hate to disappoint but my life isn't nearly that interesting! My father was an environmental engineer who did a ton of community & volunteer work on the side, so maybe that's something.
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Re: Report from the trenches

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WiseOne wrote: Wed Mar 25, 2020 9:09 pm Vinny: Simple SAT test question. The computerized records system developed by a physician-run practice is to a
federally mandated, commercial EHR system as:

- Ecuador is to the Soviet bloc during the Cold War
- a game of checkers is to a murderous stampede at a World Cup soccer game
- Gerald Ford tripping while getting off an airplane to Bush proclaiming Mission Accomplished in front of an enormous banner in Iraq

I could do a bunch more of those, but hopefully you get the point. EHR systems and their ironclad enforcement of a long string of Obama-era mandates have practically destroyed our health care system. It's amazing that it functions at all.

Maddy: Hate to disappoint but my life isn't nearly that interesting! My father was an environmental engineer who did a ton of community & volunteer work on the side, so maybe that's something.
GODDAMMIT WiseOne! Does the fart defense work against the Wuhan or what!?!?!
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Re: Report from the trenches

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Kriegspiel I wouldn't count on it.
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Re: Report from the trenches

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Is anyone else besides me enjoying Kriegs' drunken posts in real time?
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Re: Report from the trenches

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WiseOne wrote: Wed Mar 25, 2020 9:14 pm Kriegspiel I wouldn't count on it.
If you were performing life saving maneuvers on a Wuhan-infected, one a scale of 1-10, what level of protection does the fart defense afford?
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Re: Report from the trenches

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dualstow wrote: Wed Mar 25, 2020 9:14 pm Is anyone else besides me enjoying Kriegs' drunken posts in real time?
I had the same exact thought!

Love you Kreigs, hope the hangover isn't too bad. ;D
DNA has its own language (code), and language requires intelligence. There is no known mechanism by which matter can give birth to information, let alone language. It is unreasonable to believe the world could have happened by chance.
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Re: Report from the trenches

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In today's news, Kaiser Permanente is threatening to fire any nurse who wears a mask while treating patients.
https://www.naturalnews.com/2020-03-25- ... virus.html
Via The Intercept:

The California Nurses Association and National Nurses United sent a flyer to members noting that Kaiser had threatened nurses with firing if they wear their own N95 masks, which offer a high level of protection from airborne contaminants, to work. “Kaiser has told nurses that if they’re seen wearing their personal N95 masks, they could be fired ‘on the spot’ for insubordination,” the flyer read.

Close to 100 nurses and family members gathered outside Kaiser’s Oakland Medical Center on Monday night to protest the new guidelines, saying that they put both patients and critical staff at risk. Staff at the center have been caring for patients from the Grand Princess cruise ship, which had at least 21 passengers test positive for Covid-19, the disease caused by the coronavirus.
* * *
What this means is that health authorities in California are trying to spread the coronavirus. This has become increasingly obvious with LA County previously announcing they would no longer even attempt to contain the virus. They ordered doctors to stop nearly all coronavirus testing, which also means halting all isolation attempts to stop the spread from accelerating.

Not long before that, Sacramento County ended all quarantine attempts and announced that high-risk people would simply be released from quarantine directives and allowed to spread the coronavirus without limit.
Does this sound like incompetence, or like a concerted attempt to spread the virus?
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