Report from the trenches

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Libertarian666
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Report from the trenches

Post by Libertarian666 » Wed Mar 25, 2020 12:20 am

(from bogleheads)

I’ve read several posts in this thread with the them of “this is no big deal” or that we are overreacting.

I’m a doctor in New York. I work at a large tertiary care hospital. In the last 4 days the COVID census is up to about 20% of our beds. 2/3 these are ICU patients. Staff are being pulled from totally unrelated specialties to care for these patients. All other clinical programs are mothballed. Unless you are dying, you probably cannot get care from a specialist. Non Intensivists are taking crash courses on ventilator management. If you come down with this virus you may very well be cared for by a gynecologist.

This is unprecedented. We have never seen anything remotely like this. We have been at this for about a week and we are at capacity. Despite what you may read, young people get very ill too. They may not be dying at the same rate as older folk, but a week on the ventilator will scar you for life and take 6 months to recover from.

This is just the beginning. We anticipate this to worsen over the next 2-4 weeks. Doctors and nurses are getting sick.

Every doctor I know with half a brain is scared out of their whits.

Listen to me.
This is not the flu.

Please stay home no matter what the president says.
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Kriegsspiel
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Re: Report from the trenches

Post by Kriegsspiel » Wed Mar 25, 2020 7:44 am

That would be a legit argument against my idea of letting medical people opt out of being generalists. Having some slack in the line for emergencies.

On the other hand, the gal who only knows how to do rhinoplasties would have a pretty good excuse for staying out of the trenches >:D
You there, Ephialtes. May you live forever.
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Re: Report from the trenches

Post by dualstow » Wed Mar 25, 2020 8:04 am

Reading this gives me the shivers all over again. I’ve only been going out about once a week. I was going to sneak out to get some food items I missed, but forget it.
We have joggers coming by and breathing on anyone who’s otherwise careful, just to make sure we all have a chance to get infected. Screw it.
RIP Marcello Gandini
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Re: Report from the trenches

Post by Cortopassi » Wed Mar 25, 2020 8:17 am

It is going to be real interesting to see how this develops over the next couple weeks.

Part of me certainly wants to agree with Trump's optimism. The other part is sitting here swallowing 10x more than normal wondering if I have a sore throat. It is quite a constant low-medium level of stress.

I rode my bike to work today. At least there are very few cars on the road. We are considered an essential business, we do some military work. About 35 people in the office normally, this week about 6-7. So distancing is not an issue. At least it allows me to mentally seem like everything is normal for 8 hours a day.
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Re: Report from the trenches

Post by dualstow » Wed Mar 25, 2020 8:20 am

p.s. Did they delete it on bh? I can’t find it there.
Found it.
RIP Marcello Gandini
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Re: Report from the trenches

Post by ochotona » 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.

On the other hand... I am an essential worker! Energy & IT vital infrastructure. Working from home.

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Libertarian666
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Re: Report from the trenches

Post by Libertarian666 » Wed Mar 25, 2020 8:57 am

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.

On the other hand... I am an essential worker! Energy & IT vital infrastructure. Working from home.


essential_employee.jpg
My wife is a retired RN.
She would be willing to help out but figured I would object.
I said "You're not doing it until there is a reliable treatment."
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Re: Report from the trenches

Post by Xan » Wed Mar 25, 2020 9:04 am

I have a friend who's an ER doc in Boston, whose wife is a doctor up there too. They've had to send their kids away to go live with their grandparents, because childcare (with schools closed) was an amalgamation of 8 different babysitters, plus the docs' high chance of exposure.

I commented that sending the kids away sounded like WWII.

Reply:
It feels like WWII for sure. We aren't swamped yet, but feels imminent. It's weird going to work everyday knowing that the majority of your patients will be coming in with concerns of having this virus that could possibly kill us if we get it. Just a strange feeling that your life is at risk constantly at work.
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Re: Report from the trenches

Post by vnatale » Wed Mar 25, 2020 9:35 am

Cortopassi wrote:
Wed Mar 25, 2020 8:17 am
It is going to be real interesting to see how this develops over the next couple weeks.

Part of me certainly wants to agree with Trump's optimism. The other part is sitting here swallowing 10x more than normal wondering if I have a sore throat. It is quite a constant low-medium level of stress.

I rode my bike to work today. At least there are very few cars on the road. We are considered an essential business, we do some military work. About 35 people in the office normally, this week about 6-7. So distancing is not an issue. At least it allows me to mentally seem like everything is normal for 8 hours a day.
My organization is also considered an essential business because we are both in the financial industry (provide financing to small businesses) and we are part of the food production chain (having a food processing center). For the office side of the business we are coordinating all our schedules so that (in theory) only one person is in them at a time. I'm not going there at all! Nowhere as much out of concern for me as much just do not want to be any part of a chain that exponentially affects others.

Vinny
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
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Re: Report from the trenches

Post by vnatale » Wed Mar 25, 2020 9:38 am

Xan wrote:
Wed Mar 25, 2020 9:04 am
I have a friend who's an ER doc in Boston, whose wife is a doctor up there too. They've had to send their kids away to go live with their grandparents, because childcare (with schools closed) was an amalgamation of 8 different babysitters, plus the docs' high chance of exposure.

I commented that sending the kids away sounded like WWII.

Reply:
It feels like WWII for sure. We aren't swamped yet, but feels imminent. It's weird going to work everyday knowing that the majority of your patients will be coming in with concerns of having this virus that could possibly kill us if we get it. Just a strange feeling that your life is at risk constantly at work.
Several weeks ago I started making the comment that we've not had anything like this that has directly affected the lives of so many people since World War II. Now in some aspects this has surpassed all in our history, including all the wars. I do not remember ever reading wherein almost all schools were closed and so many workers were ordered not to work. Conversely during World War II we pulled the women out of the home and into the work force.

Vinny
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
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Re: Report from the trenches

Post by Maddy » Wed Mar 25, 2020 10:06 am

I posted a couple of weeks ago about a friend with an obvious surgical emergency. She was literally turned away from the ER, then sat in the ER of another city for nearly 6 hours while surrounded (immune compromised due to chemo) by people hacking like crazy. She eventually received surgery, in another town, although the post-surgical care was so astoundingly negligent that additional issues promptly surfaced. She is now out of the country and is finally receiving a reasonable amount of care. Getting here there was no small feat.

Here in this town, where there are no known cases of CV-19, just try to get seen by a doctor for something non-CoVid-related. Doctors are literally sitting at home, as their practices have been ordered closed. One guy with a backbone is seeing patients on the sly.

I'm sorry, but nothing here is adding up.
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Re: Report from the trenches

Post by CT-Scott » Wed Mar 25, 2020 10:58 am

Maddy wrote:
Wed Mar 25, 2020 10:06 am
I'm sorry, but nothing here is adding up.
Please elaborate (conspiracy-theory?)

Also, just curious...is your avatar photo an actual photo of a house/cabin that you own?
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Re: Report from the trenches

Post by Tortoise » Wed Mar 25, 2020 11:15 am

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

Post by dualstow » 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.
RIP Marcello Gandini
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Re: Report from the trenches

Post by Kriegsspiel » 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.
You there, Ephialtes. May you live forever.
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Re: Report from the trenches

Post by dualstow » Wed Mar 25, 2020 12:06 pm

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

Post by Maddy » Wed Mar 25, 2020 12:35 pm

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

Post by dualstow » 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?
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Re: Report from the trenches

Post by vnatale » Wed Mar 25, 2020 12:57 pm

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
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
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Re: Report from the trenches

Post by CT-Scott » Wed Mar 25, 2020 1:35 pm

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

Post by WiseOne » 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.
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Re: Report from the trenches

Post by dualstow » Wed Mar 25, 2020 3:10 pm

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

Post by Maddy » Wed Mar 25, 2020 3:31 pm

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

Post by WiseOne » 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.

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

Post by dualstow » Wed Mar 25, 2020 3:36 pm

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

EDIT: @WiseOne: it sure does.
RIP Marcello Gandini
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