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Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away


InkaUtexas

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Had a long visit with our friends in Norway this morning via Facetime.  They're all fine, but all experiencing what we are -- stress, isolation, boredom.  But our friends (the adults) are both in the medical field, including being a regional director of their EMS service.  They shared some interesting facts:

All of their ambulance crews are wearing PPE to all calls - because people are failing to inform them that they have already tested positive.  It's a waste of gear, but people can be clueless idiots.

Norway has a LOT of cases.  BUT....only 7 deaths.  Hospitalization is increasing, but they still have it managed.  They ARE using chloroquine on hospitalized patients, and per my friend, it is reducing the amount of time patients have to be on the ventilator.  I know that's just anecdotal, and he's not a Dr. or clinician, but he's at least somewhat plugged into that world on a regular basis.

He's working from home, but working around the clock handling crises, staffing challenges (expose one of their crews, and they're sidelined for 14 days in quarantine, so staffing is a real challenge).  Our friends seemed concerned, and not happy about the situation, but they also weren't in despair.  They are managing, and Norway seems to be managing.

Oh, and per the teenagers in the group, teens are being clueless dickheads there, too.  Too many gatherings and the like.  The authorities are starting to really crack down.

But it was a great visit.  We talked about (hopeful) plans of seeing each other this summer.  And their steady presence, and hopeful outlook, was refreshing to hear.  We need some more hope these days, and less doom-and-gloom (although I damned well want the people in charge to hear the doom-and-gloom, because that can get them off their asses to fix shit).

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9 minutes ago, Hanrahan said:


Think your assumptions and math are both off here, Chief.

Of course it’s off. But 20 days from now when we don’t have a quarter million dead, he’ll just move out the date of the end or the world a couple weeks, again. It won’t be long before we hear “we got lucky with summer rolling in, just wait til fall though. Shut it all down now or we’re all dead by Christmas!”

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58 minutes ago, Zepol87 said:

So many loopholes for companies to try to say they fit in these "essential" businesses. Buddy works at a car dealership and they are telling everyone they aren't closing. No one will close

there's no laws in this place... anything goes....it's Thunderdome

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3M CEO said they were ramping up to produce 35 million respirators (N95 masks, not ventilators) per month in the US, with capacity for 100 million per month worldwide.  They are working to double their capacity worldwide within 12 months.

I think early on there was some person that said we had 30 million in reserve in the US and we needed 300 million.  So, with 3M cranking them out as fast as possible, we'll have what we need in maybe 7-8 months, assuming more production comes online during that time.

 

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This is pretty much my point- we need schematics but once you open source that and let people at it I can’t imagine this isn’t taken care of in short order. Give whoever has the schematics (sounds like meditronics) a royalty or licensing on every unit built by someone other than them and let’s roll. 

Im not saying it’s easy, I’m saying it’s not splitting the atom hard and I trust the industrial might, technical know how and general ingenuity of America. 

Raspberry Pi. Come up with the program and ten and thousands of them will be donated by the public. Likely thousands more in Amazon

warehouses.

 

 

Sent from my iPhone using Tapatalk

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53 minutes ago, Wulaw Horn said:

This is pretty much my point- we need schematics but once you open source that and let people at it I can’t imagine this isn’t taken care of in short order. Give whoever has the schematics (sounds like meditronics) a royalty or licensing on every unit built by someone other than them and let’s roll. 

Im not saying it’s easy, I’m saying it’s not splitting the atom hard and I trust the industrial might, technical know how and general ingenuity of America. 

You probably also need the controller software for the board, any display units, things like that.  You at least need the binary image that they are loading.

Plus factory lines to make the stuff, any calibration or other factory software they use to manufacture the boxes.  If they are using a flexible manufacturer now this might be easier to do, but if they are doing that, why not just tell the flexible manufacturer to just change all lines over to ventilators?

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Was definitely laughable.  But imo so is celebrating sending 100k masks.  Individual hospitals are ordering a million at a time.  
How often are you changing masks? If you have 1000 employees that requires masks in a hospital per day, that's 365k masks used in a year. Is one mask not good enough to last all shift? Or are you counting hanging them out to patients and their families as they come in?
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2 hours ago, XYZ said:

https://www.thelancet.com/action/showPdf?pii=S0140-6736(20)30566-3

Page 5, table 2.

Non-invasive mechanical ventilation: 26 patients, 24 died

Invasive mechanical ventilation: 32 patients, 31 died

Paper with larger sample size, 70,000+ not that drastic

https://jamanetwork.com/journals/jama/fullarticle/2762130

 

other papers as well with larger sizes not stating 90%. its high, but not that high looking at the bigger samples

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2 hours ago, ChiTownDoc said:

I know of a group of 50-60 people out St. Pats.  All around 30-40 yo.  All have felt a little shitty and self quarantined the last few days.  But they all were out and about for several days.  The first of that group got a test and was, not shockingly, positive.  I got a 'you're lucky you didn't go out'.  I just let it slide.  As if it was luck I wasn't out with the unwashed masses just a week ago.  JFC

yeah, i posted on here about going out on the 7th, but that was the last time i was at a bar/dining at a restaurant. Saw tons of people out on the 14th in bar crawls and a few on the 17th. I wanted to go out real bad but there was no way in hell. I shouldn't have gone out on the 7th either but too late now.

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8 hours ago, BrazilHorn said:

What all this means is that a shit ton of New Yorkers and CA folks are going to move to Austin in fucking droves (more than there have already been) once dust settles.

You're assuming that Austin/Texas is going to handle this in a manner that doesn’t make them rethink that choice.  

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12 minutes ago, Texaus said:

I thought the masks didn’t prevent infection of the healthy? Seem to remember they were only useful for preventing spread of virus when worn by someone who was sneezing/coughing?

 

Yeah, I’m not a doctor, but that’s complete bullshit.

Someone wearing an n95 mask plus eye protection is significantly less likely to catch it than someone who isn’t.

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I'm not sure why anyone would read that tweet as anything other than N95 masks. 3M N95 masks are very good. It's nothing to sneeze at that they are shipping 500K. I don't care about rumors of a hospital ordering them by the milion. The VA I mentioned earlier is Top 10 in number of staffed beds, and on the floor screening for Covid-19 patients, didn't have propers masks for a while. So clearly there is a need.

Shitty vents might be easier to crank out, but not all vents are equal. Managing ARDS is a little more than just intubating a post-op patient. Throw prone positioning to mix and the complexity adds up. Expectations of how many vents can be produced quickly should be tempered down. Tens of thousands, not hundreds of thousands or a million.

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4 minutes ago, atomheartbevo said:

You're assuming that Austin/Texas is going to handle this in a manner that doesn’t make them rethink that choice.  

good point.  I say we artifically inflate our cases/deaths later to keep them away.

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16 minutes ago, Texaus said:

I thought the masks didn’t prevent infection of the healthy? Seem to remember they were only useful for preventing spread of virus when worn by someone who was sneezing/coughing?

 

If your ppe is only a mask that is true. If worn properly with other ppe then it can prevent infection

 

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45 minutes ago, ShaggyBevo RIP said:

Raspberry Pi. Come up with the program and ten and thousands of them will be donated by the public. Likely thousands more in Amazon

warehouses.

 

 

Sent from my iPhone using Tapatalk

if only if were that simple.  it's not a "program" we need, it's a manufacturing plant and assembly line.

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19 minutes ago, Texaus said:

I thought the masks didn’t prevent infection of the healthy? Seem to remember they were only useful for preventing spread of virus when worn by someone who was sneezing/coughing?

 

They prevent infection. The problem is that other countries as using them mostly for workers that are not conducting highly risky things on these patients (intubation, swabbing, nebulizer treatments). Those things get you PAPR wear in the Asian countries and Germany.... those are very hard to find here, so we are having people doing those things wearing just N95 masks.. if they can find them

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21 minutes ago, Texaus said:

I thought the masks didn’t prevent infection of the healthy? Seem to remember they were only useful for preventing spread of virus when worn by someone who was sneezing/coughing?

 

this was debated in the first couple hundred pages and i came to the same conclusion.  i would hope there are such masks that protect both the host and parasite.

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35 minutes ago, Modessit said:
2 hours ago, ChiTownDoc said:
Was definitely laughable.  But imo so is celebrating sending 100k masks.  Individual hospitals are ordering a million at a time.  

How often are you changing masks? If you have 1000 employees that requires masks in a hospital per day, that's 365k masks used in a year. Is one mask not good enough to last all shift? Or are you counting hanging them out to patients and their families as they come in?

If it's an N95 all day is really not a problem...if it loses shape or whatever grab another...but you don't need to change it after every 1-2 patients for sure.  Right now a lot of docs/nurses are using the same N95 several days in a row.  That's definitely not safe. 

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3 hours ago, ChiTownDoc said:

Oh yeah, too many forget where we came from.  It's still imbedded deep down in there somewhere.  Agree 100%. 

If the jagoffs in D.C., and I mean all of them, get out of the way Americans will do the right thing.

I didn’t see anyone mention that New York is starting the drug combo Tuesday. Mylan in Morgantown is ramping up production as well.

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35 minutes ago, atomheartbevo said:

Is this one of those “hey kids, connect the dots to draw I-35!”

I'd imagine a lot of towns along interstate corridors are going to see cases. Imagine a trucker who didn't know he had it going through a small town that's running business as usual. 

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1 minute ago, ChiTownDoc said:

If it's an N95 all day is really not a problem...if it loses shape or whatever grab another...but you don't need to change it after every 1-2 patients for sure.  Right now a lot of docs/nurses are using the same N95 several days in a row.  That's definitely not safe. 

You are not supposed to use it for multiple patients. Doing so is merely playing a percentage gain of risk. You should not carry anything from an isolation room into another room. By definition all suspected cases should be isolation rooms. We are making due with what we have, but let's not start saying things are okay when they are not.

There is not one hospital policy on using PPE--before this broke out--where you would see it said that not changing your mask for different patients was ideal. Right now we are in the Extended Use and Reuse policies for using masks, but these are clearly outside the standard norm.

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2 minutes ago, naija said:

You are not supposed to use it for multiple patients. Doing so is merely playing a percentage gain of risk. You should not carry anything from an isolation room into another room. By definition all suspected cases should be isolation rooms. We are making due with what we have, but let's not start saying things are okay when they are not.

There is not one hospital policy on using PPE--before this broke out--where you would see it said that not changing your mask for different patients was ideal. Right now we are in the Extended Use and Reuse policies for using masks, but these are clearly outside the standard norm.

The CDC says it is ok to use scarves as PPE now. No bullshit. Fucking incredible

 

all rules are out the window at this point

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7 minutes ago, mdmost said:

I'd imagine a lot of towns along interstate corridors are going to see cases. Imagine a trucker who didn't know he had it going through a small town that's running business as usual. 

Think of the Lot Lizards.

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I’m a layman in the med field, but it stands to reaso that if you are around an infected person, every bit of ppe needs to be discarded. It’s contaminated after one cough, no? I’d bath myself in the emergency shower after every visit. Much respect to the med professionals having to do it.

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5 minutes ago, GreenspointTexas said:

The CDC says it is ok to use scarves as PPE now. No bullshit. Fucking incredible

 

all rules are out the window at this point

...which has led to alot of people on Facebook sharing stories of sewing/quilting masks to send to hospitals... when these masks are not going to do anything.

Edited by naija
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5 minutes ago, naija said:

You are not supposed to use it for multiple patients. Doing so is merely playing a percentage gain of risk. You should not carry anything from an isolation room into another room. By definition all suspected cases should be isolation rooms. We are making due with what we have, but let's not start saying things are okay when they are not.

There is not one hospital policy on using PPE--before this broke out--where you would see it said that not changing your mask for different patients was ideal. Right now we are in the Extended Use and Reuse policies for using masks, but these are clearly outside the standard norm.

Let me be clear - not talking about isolation rooms.  Those you discard everything the minute you leave but for a regular isolation patient you do not need an N95 mask.  
Im talking about rounding in general.  Or an ER where you have no idea who has what as you triage.  

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Just now, naija said:

...which has lead to alot of people on Facebook sharing stories of sewing/quilting masks to send to hospitals... when these masks are not going to do anything.

Oh I think they could come up with some just wonderful Covid19 inspired crocheted designs.

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You are not supposed to use it for multiple patients. Doing so is merely playing a percentage gain of risk. You should not carry anything from an isolation room into another room. By definition all suspected cases should be isolation rooms. We are making due with what we have, but let's not start saying things are okay when they are not.

There is not one hospital policy on using PPE--before this broke out--where you would see it said that not changing your mask for different patients was ideal. Right now we are in the Extended Use and Reuse policies for using masks, but these are clearly outside the standard norm.

Same here. What was ok 3 weeks ago and what is supposedly ok now are two different things. We ran through a lot of PPE in the first week or two discarding everything between patients.

 

Gowns and gloves are still thrown away between patients. Face shields are bleach wiped and used repeatedly. Masks you can’t bleach. You just reuse. I’m on the same mask and face shield for the last 3 days. It’s not ideal.

 

And I’m talking about known positive patients.

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Just now, naija said:

...which has lead to alot of people on Facebook sharing stories of sewing/quilting masks to send to hospitals... when these masks are not going to do anything.

The evidence in countries throughout the far east  does not support your conclusion.  The use and reuse of masks, which are often substandard to begin with,  are almost certainly a big reason why the virus spread has been slowed.

This is certainly not recommended in a hospital setting, but wearing nothing is far worse.

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  • hayden_horn changed the title to Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away


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