Dire situation in New York State

[Ready-4-ER-at-14]

In Italy, some doctors are using off-the-shelf diving/snorkelling masks as makeshift ventilators.

https://www.dailymail.co.uk/news/article-8143099/The-ventilators-diving-masks-Italy.html

Wow that is super smart, wish I had thought of it!

 

[NameRedacted]

Thanks for the update. I don't know why I didn't check the news first thing in the morning like I always do but this is the first I heard of the expected timeline for the next 21 days.

I live in Brooklyn and don't drive but I have a good backpack with a hip belt that I put to good use with about 5 trips to the supermarket within a week, sometimes two a day. It wasn't until the last trip when the lines were crazy. I think I got more weeks worth of stuff than most people.

I have a washboard and ordered a tub. No more building laundry room for me, I think.

I'm considering a strategy like ordering one or two grocery items from Amazon every couple of days. I have to wait 1-1/2 months for my order of OJ and envelopes, both estimated to arrive on May 14, and I'm thinking the date is of the item it will take longest to ship. The fewer items you order at a time, maybe the better.

Yes, it must be really tricky avoiding people if you don't have a car and can't load up on a ton of supplies all at once - stay safe.

 

[NameRedacted]

It's much, much worse in New York than anywhere else. Check the numbers. 15x as many cases as CA and a smaller population.

 

[NameRedacted]

Yep we have friends that are wintering near St Augustine. They are staying put. Whoever was supposed to be staying next in their rental in FL canceled. So they can stay there as long as they need.

 

[Lawrencewendall]

New York will get through this. I don't know why they don't convert CPAP machines to ventilators.

How would one do that? I am on a CPAP and have my old discontinued one that DW could use, as she is high risk. It still works but insurance refused to resupply stuff for a discontinued model.

 

[NameRedacted]

Maybe they are waiting to see which areas need them?

New York says they "may" need them. So the Fed ships every single ventilator they have to New York. What happens when it turns out Seattle needs 1000 and New York still has 4500 spread out that are not being used yet?

You don't deplete a emergency reserve immediately, before they are even needed. You ration.

Yes the reason why they should be deployed now is explained in the video. The ventilators are re-usable and so can be redeployed after the peak has passed in NY to the next hotspot.



It takes a while to ship them and set them up. If they don't get deployed as soon as possible there is a good chance that people will die.

 

[NameRedacted]

Not making light of situation, but I seriously doubt this is true:

"The number of cases in NY State is doubling every 3 days."

What I believe is true is that the number testing positive is increasing at that rate due to massively increased number of tests of people who have had the virus for some time or suspect they have it. Where is the number of persons tested stated?

As numbers tested keep increasing, the number of newly known cases will continue to rise for a while but the percent infected will drop.

Great article today on subject in WSJ:

https://www.wsj.com/articles/is-the...as-they-say-11585088464?mod=opinion_lead_pos8

Perhaps we should rephrase that statement as:


"The number of known cases in NY State is doubling every 3 days."

 

[NameRedacted]

New York will get through this. I don't know why they don't convert CPAP machines to ventilators.

They are looking at hooking two patients up to each ventilator.

 

[NameRedacted]

"Edit: As I read this I realize it could be interpreted as an attack on posters here. Really, as I think about it the rant is probably aimed mostly at the politicians and idiots like Cuomo who want to hog all the resources and to see themselves on TV. Apologies to anyone who was offended"


Not sure how you can watch that video and conclude that Cuomo is an idiot. He comes across as a smart guy.

 

[NW-Bound]

We do not know the true number of the infected, because many have mild or even no symptoms as reported by the CDC.

But if you look at the number of deaths, well, dead bodies are easier to count, that number is also doubling every 3 days. It's still relatively small, but with that exponential increase, where will it end?

 

[FIREd]

To keep this thread open, let's focus more on the situation in NY and less on the politicians.

 

[unclemick]

"Edit: As I read this I realize it could be interpreted as an attack on posters here. Really, as I think about it the rant is probably aimed mostly at the politicians and idiots like Cuomo who want to hog all the resources and to see themselves on TV. Apologies to anyone who was offended"


Not sure how you can watch that video and conclude that Cuomo is an idiot. He comes across as a smart guy.

+1

72 year old cousin in NYC. Talked to her this morning. Tense.

heh heh heh - Those who are knee deep in it usually have a better idea of how deep the 'water' is.

 

[Midpack]

We do not know the true number of the infected, because many have mild or even no symptoms as reported by the CDC.

But if you look at the number of deaths, well, dead bodies are easier to count, that number is also doubling every 3 days. It's still relatively small, but with that exponential increase, where will it end?

I’ve been wondering all along, since we’ve had totally inadequate testing resources (until recently?), have some seniors died without anyone able to connect to Covid-19? How many deaths from pneumonia, lung infection caused by viruses, bacteria or fungal infections or ARDS (acute respiratory distress syndrome) brought on or worsened by Covid-19 without being identified as such? I suspect some countries, states, or local reports are better than others since testing has been so slow to ramp up some places.

 

[sengsational]

I have a specific question about ventilators. I understand that fda approval for ventilator requires a complex and sophisticated system. I have some medical, biological, and engineering background so I hope my question is not so bad that it totally embarrasses me

I always try to look outside of the box a bit and I have a basic engineering question.
If the reason for the ventilator is simply to get oxygenated air into diseased lungs and any increase leads to more people living, why couldn't the government use some makeshift heart lung device similar to old iron lungs at least for the non critical people?

I envision a bulky chest plate type thing with both an exhaust and a blower port. This could be molded plastic with airtightness around neck and waist area. They are then hooked up to a compressor vacuum system with some sort of cam regulator opening and closing the ports (pressure and suction) to simulate and assist breathing. Yes we would have to breathe with the cycle of the machine. Some sort of nasal oxygen tube and a source of moisture in the oxygen supply.

New York will get through this. I don't know why they don't convert CPAP machines to ventilators.

If indicated, I'd prefer a CPAP machine over being ventilated. That's just my feeling.

Once you understand how a mechanical ventilator works for ARDS patients, you'll realize that snorkel masks and CPAP machines ain't gonna cut it. They might make it more comfortable to breath for a while, but when breathing gets critical in a patient, those alternative devices are probably not going to save lives. This is my VERY uninformed opinion, but I HAVE watched a youtube video about how the real ventilators work, and it's not just simply pushing oxygen or air into a person's lungs.

When treating ARDS, the patient is usually "out cold", otherwise the patient would "freak out" because the urge to breath by one's self is hampered by the machine.

If you want to learn about mechanical ventilation, here's a youtube link. I've got it queued-up at 2:18, which is the start of the intro to mechanical ventilation:

https://youtu.be/mnIpD1VwyMo?t=138

This is from another of this doctor's videos:

I just watched a "MedCram" on youtube from by pulmonologist Dr. Seheult and he lays out three papers that offer ideas to improve the survivability of ARDS: 1) Lower Tidal Volume (a setting on the ventilator), 2) Paralysis (so the patient can't change how the ventilator is set), and 3) Prone position (flipping the patient over for most of the day).

I wonder how many ICU's follow these processes.

 

[atmsmshr]

[rant]There is an implicit myth that drives the public discourse in times like this: That the relief organizations are well-oiled and experienced machines and, thus, any problems are due to incompetence.

In reality, the organizations are being built on the fly and all disasters are unique. So being in the middle of one is like changing all four tires while you're blasting down the road to an uncertain destination.

BTDT on a small scale flying search & rescue. I have also had most of the national Incident Command System training, which is basically to teach standard language and standard org charts for people who are coming together to deal with a problem.

Overlay this with a political situation where every elected official considers themselves to be in charge; sheriff, mayor, governor, cabinet secretary, president, etc. and one of their most important goals is to push everyone aside and get on TV. All of this prevents the people who actually know what they're doing from doing it efficiently.

Logistics is also a nightmare. Space has to be identified and procured. The staff has to be housed and fed beginning at time zero. Then the inbound and outbound freight capacity has to be acquired and organized. Radios, telephones, computers, ... all have to be pulled from emergency warehouses and distributed. Special things like gowns and masks, respirators, etc. must also be acquired or identified and moved. All of this requires a triage function that serves to prioritize, making almost no one happy.

Really, it's a miracle that anything at all gets accomplished. Think about it and be grateful, folks.[/rant]

The majority of our population does not realize how true this is - and probably a lot of politician to boot. The news media makes this false impression worse when talking heads yak about FEMA this and FEMA that.

As an ex- Recovery Manager for Emergency Preparedness at a Nuclear Plant, I personally know that the federal and state 'help' is/can be more of a hinderance at the outset of a disaster. Disaster preparedness starts at the individual level, neighborhood, corporation, local government then state. Feds drop helicopter money, leave a news footprint, call up the army corps of engineers and then pass a raft of new regulations. If the state has not done their part at the outset of any disaster it is a sad situation. (Like strict quarantine and contact tracing of New Rochelle.) I do agree with Cumo that the fed response could have been faster, but then again New York City and State response was just as slow.

We as a country are now starting to get into the finger pointing phase of the pandemic.

 

[gerntz]

Not making light of situation, but I seriously doubt this is true:

"The number of cases in NY State is doubling every 3 days."

What I believe is true is that the number testing positive is increasing at that rate due to massively increased number of tests of people who have had the virus for some time or suspect they have it. Where is the number of persons tested stated?

As numbers tested keep increasing, the number of newly known cases will continue to rise for a while but the percent infected will drop.

Great article today on subject in WSJ:

https://www.wsj.com/articles/is-the...as-they-say-11585088464?mod=opinion_lead_pos8

As I thought here,

"Dr. Deborah Birx noted on Thursday that the number of positive COVID-19 cases, commonly known as the Wuhan coronavirus, are dramatically increasing, but that's largely because the number of tests is becoming more widely available."

Net, not a reason to panic.

 

[NameRedacted]

As I thought here,

"Dr. Deborah Birx noted on Thursday that the number of positive COVID-19 cases, commonly known as the Wuhan coronavirus, are dramatically increasing, but that's largely because the number of tests is becoming more widely available."

Net, not a reason to panic.

Actually I think that's quite worrying. What it means is that there are a lot more people with the disease than we thought and those people didn't know they have it.



Surely, the ideal situation would be if we did a lot more tests and found little increase in the number of cases.

 

[ivinsfan]

Actually I think that's quite worrying. What it means is that there are a lot more people with the disease than we thought and those people didn't know they have it.



Surely, the ideal situation would be if we did a lot more tests and found little increase in the number of cases.

Well I don't think any random healthy people are getting tested. Is anybody aware of any places that you can walk up and get a test, just because you want one?

 

[ivinsfan]

Well I don't think any random healthy people are getting tested. Is anybody aware of any places that you can walk up and get a test, just because you want one?

In our state testing is limited but even with increased testing the % or people with actual high risk testing positive is hanging steady at under or around 5%.

During flu season the percent of positive flu tests is around 35%.

 

[Ready-4-ER-at-14]

Once you understand how a mechanical ventilator works for ARDS patients, you'll realize that snorkel masks and CPAP machines ain't gonna cut it. They might make it more comfortable to breath for a while, but when breathing gets critical in a patient, those alternative devices are probably not going to save lives. This is my VERY uninformed opinion, but I HAVE watched a youtube video about how the real ventilators work, and it's not just simply pushing oxygen or air into a person's lungs.

When treating ARDS, the patient is usually "out cold", otherwise the patient would "freak out" because the urge to breath by one's self is hampered by the machine.

If you want to learn about mechanical ventilation, here's a youtube link. I've got it queued-up at 2:18, which is the start of the intro to mechanical ventilation:

https://youtu.be/mnIpD1VwyMo?t=138

This is from another of this doctor's videos:

Thanks for the information. The idea of compliance of the lung tissue was something I was not really considering although I have read about lungs tissue having an imagining display being glass like with bands.. I was thinking more along the lines of secretions limiting alveoli diffusion and helping the chest expand more fully.

 

[Freedom56]

They are looking at hooking two patients up to each ventilator.

CPAP machines can be converted to BIPAP machines which can help those who can't breath in/out on their own. The parts used in these machines are also similar to ventilators.

 

[CRLLS]

For those who do not believe that the CPAP is of no use, please read the FDA's notice that I referenced. Of course, in the more dire cases the Ventilators are required. I would suggest that there may be cases in-between being able to get enough oxygen on their own and needing the full effects of a respirator. The FDA addressed the alternatives to ventilators when respirators were not available. This includes, among other things, a CPAP.

I would go as far as suggesting that when ventilators are not available, they be assigned based on triage. Use, or at least try other devices when there are more needs than ventilators available rather than give everyone ventilators on an as available basis. I have not seen any reports that this is being planned, nor that there is currently a shortage, only projected shortages.

 

[Aerides]

CPAP machines can be converted to BIPAP machines which can help those who can't breath in/out on their own. The parts used in these machines are also similar to ventilators.

Just to be clear, a BIPAP is a way to pump oxygen into lungs, but a Ventilator is far more invasive and complex.

So they are "similar" only in that they are ways to help get oxygen in, but a ventilator requires intubation and directly places a device into the patient's windpipe, to basically directly assist with actual breathing.

 

[Lawrencewendall]

For those who do not believe that the CPAP is of no use, please read the FDA's notice that I referenced. Of course, in the more dire cases the Ventilators are required. I would suggest that there may be cases in-between being able to get enough oxygen on their own and needing the full effects of a respirator. The FDA addressed the alternatives to ventilators when respirators were not available. This includes, among other things, a CPAP.

I would go as far as suggesting that when ventilators are not available, they be assigned based on triage. Use, or at least try other devices when there are more needs than ventilators available rather than give everyone ventilators on an as available basis. I have not seen any reports that this is being planned, nor that there is currently a shortage, only projected shortages.

CPAP machines can be converted to BIPAP machines which can help those who can't breath in/out on their own. The parts used in these machines are also similar to ventilators.

Sources please.

 

[CRLLS]

Sources please.

I posted the link and text in post#24 earlier. Look there.