Dire situation in New York State

[Chuckanut]

Problem is, some covid patients can go from bad to terrible in a matter of a few hours. Rushing from a ward over to the ICU is difficult enough - moving from another non-ICU location means you might not make it to the ICU when you need it.

I have several family members on the front-line in hospitals. What I am hearing is that CV-19 has complicated everything. One nurse reported waiting over an hour today just to get into work - every person had to be tested for CV-19. Everyday. She advised me to lead my life as though the nearest hospital was 300 miles away and I have at least a 24 hour trip to get there.

Even if you walk into the ER with a simple broken arm, they have to treat you like you have CV19. That requires protective gear, testing, all sorts of extra cleanup, etc. No more exam, x-ray, set the bones in the cast, take 2 aspirin and send me $5. Of course, if you are not infected already, you may walk out of the ER with CV-19.

IOW, don't do anything stupid that will get you sent to the hospital.

 

[REWahoo]

IOW, don't do anything stupid that will get you sent to the hospital.

That was good advice before CV-19 and it is even better advice now. Avoid any medical facility like the plague!

 

[NW-Bound]

Some quick thoughts:

At this point, “stats” are possibly more anecdotal than anything as the numbers reported in various case series are very varying and likely to change as a better understanding of COVID disease progression and management evolves.

As of writing right now, non-invasive positive pressure ventilation (i.e. CPAP and BiPAP) is NOT preferred b/c of the risk of aerosolization. It may have utility in the setting of an OSA pt, at his home, with COVID19. In the hospital setting, even in a private negative pressure room, the recommendation would be not to.

Don’t think we’re quite at the point where jimmy-ing devices designed for one function, into another... is acceptable. Liability issues not withstanding...

Case series are clearly showing earlier intubation is associated with better outcomes than waiting ‘til acute respiratory distress or acute failure (respiratory or cardiac). Check NEJM, JAMA, BMJ et. for case series (free during outbreak).

My hospital system (since Jan) and I assume plenty, if not most, have been working on ventilator triage protocols. This best involves lots of different parties and time to get all views: hospital admin, physicians, nursing, ethics committees, legal, etc. This is best coordinated at the state or regional level, as one can imagine differing protocols can be disastrous at a societal level.

Thanks for posting. I like to hear from people who are at the front line. And I like to know the facts. No sugar coating needed. I am adult enough to hear the truth.

Please keep us informed. Thank you again.


PS. My nephew is the director of the pharmacy department of a NYC hospital. He surely knows a lot, but I know better than to bother him at the moment.

 

[Amethyst]

https://www.washingtonpost.com/outl...re-gone-my-new-york-hospital-is-melting-down/

This article mentions the "protocol" hospitals will use if they run out of ventilators. Patients who do not improve within a few days will be taken off.

 

[garyt]

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

There is a local dr. who was on the local news who was showing how to hook up 4 people to a ventilator. It was easy and she said it worked fine but I haven't heard anymore about it.

 

[Just_Steve]

One other issue with hospitalization, especially ventilators is that once a person is sick enough to require either one, the stay in the hospital must be long.
Out of our over 68,000 confirmed cases, only about 400 have recovered.
It seems it takes weeks to recover.

I think once the hospitals are full, there will be a need to get beds free and move "getting better folks not on ventilator" to a recovery location (not hospital) where they can get less intensive care for a couple of weeks until discharge.

Already being set up in NYC.
https://www.businessinsider.com/coronavirus-nyu-removes-students-dorms-hospital-beds-2020-3

"NYU is removing thousands of students from dorms and says it wants to be 'in a position to help' if there's a hospital bed shortage"

Also in my local area if needed.
https://www.dutchessny.gov/Departments/DBCH/DCC-to-serve-as-Additional-COVID19-Care-Site.htm

"Dutchess Community College Will Serve as Additional Care Capacity As Needed
DCC identified as an additional care recovery facility"

 

[NameRedacted]

Looking at the latest numbers - within 2-3 days the US will have the most confirmed cases of any country in the world.

Well that took a lot less time than I expected:


https://www.worldometers.info/coronavirus/#countries

 

[audreyh1]

China - a much, much larger population, has fewer cases, but a much higher death rate for those same number of cases. Of course there is a delay between detection and death, so we'll see in a couple of weeks? Ugh - of course our case count will be much higher.

 

[NW-Bound]

The death curve always runs behind the confirmed case curve. Always.

Most of the people who end up dying do not get confirmed to have the disease, then drop dead on the same day. Some linger on with the ventilator for many days.

 

[ivinsfan]

China - a much, much larger population, has fewer cases, but a much higher death rate for those same number of cases. Of course there is a delay between detection and death, so we'll see in a couple of weeks? Ugh - of course our case count will be much higher.

I believe we started reporting and tracking here much sooner then China. I am not sure China's numbers are legit.

 

[Sunset]

I believe we started reporting and tracking here much sooner then China. I am not sure China's numbers are legit.

Since China started dealing with this in Dec, and reported it to the WHO Dec 8. We didn't have any cases on Dec 8th so I can't see how we started tracking it first.

Frankly nobody's numbers are legit, if by legit you mean accurate.

For many weeks, CDC would not authorize any test unless the person came back from China, or had met with a confirmed case patient. They have now loosened those rules, but the lack of actual testing makes it a tiny improvement.

Here in IL we have many reports of non-testing of people because there are no test kits available. Some areas only test within the hospital, hospital staff and first responders, due to a shortage.

So until you are sick enough to be admitted into the hospital, they don't test you.
Should you show up at IL hospitals, seriously sick, they will test you for the flu and other things, and when those are negative, they will test you for covid-19 and tell you to go home for 3 days to wait for the results.

Reports are in the UK, their numbers are low because they are only doing limited testing, not trying to find infected people, just testing who shows up really sick.

 

[Dtail]

Just goes back to the concept of limiting tests, so the true number count is kept artificially low, in order to possibly stave off stock market disaster.

 

[48Fire]

Just goes back to the concept of limiting tests, so the true number count is kept artificially low, in order to possibly stave off stock market disaster.

Hmmm, interesting for sure. Few of us want to believe bad news, and some of us never do, even in the face of accurate data produced by experts.

A couple weeks ago my wife had a dry cough, a fever, and headache. She finally found a video chat with a medical person, who took all of her information, and was very nice. However, she said there were no test kits available, and just to self-medicate at home. If she had trouble breathing, call us back, but don't go to the hospital. Fortunately, her symptoms went away, but who knows whether she had the COVID-19 virus? What if she passed it along?

The bottom line is that the U.S. buried their heads in the sand, while the virus spread around the country. No testing, no tracing, and no preparation for the treatment of the sick, dying, and dead. Sad, but true.

The people that think we did better or even similar to South Korea are sadly mistaken. Their ignorance will cost others their lives, or their family and friends.

We are waiting for grandbaby number 2 any day, and it's a big worry. Our daughter's doctor told her that her husband may not be able to come in the hospital during delivery. Our daughter, between crying and sobbing, told her doctor that then she will just have the baby at home. Too bad, people are making real choices now like this.

 

[eytonxav]

I think Cuomo is basing his numbers on a worst case scenario. It appears based on the oxford model that is unlikely to happen. The task force yesterday indicated he had a sufficient supply of ventilators and would work with him as more may or may not be needed.

I am very curious to see what happens with malaria/z-pack trial that is going on in NYC which started on Tuesday. It appears there is some evidence from around the country and world that it is a game changer.

 

[Gumby]

Just goes back to the concept of limiting tests, so the true number count is kept artificially low, in order to possibly stave off stock market disaster.

One could posit just as easily that discovering there are far more infections than we currently know, but they did not require medical attention, would be helpful. The case mortality rate would be shown to be very low and maybe some of the panic would subside. That would be good for the market.

Why attribute to malice that which can be explained by incompetence? We have not tested more widely in this country because we were woefully unprepared, not due to some nefarious conspiracy to manipulate the case numbers.

 

[ivinsfan]

Since China started dealing with this in Dec, and reported it to the WHO Dec 8. We didn't have any cases on Dec 8th so I can't see how we started tracking it first.

Frankly nobody's numbers are legit, if by legit you mean accurate.

For many weeks, CDC would not authorize any test unless the person came back from China, or had met with a confirmed case patient. They have now loosened those rules, but the lack of actual testing makes it a tiny improvement.

Here in IL we have many reports of non-testing of people because there are no test kits available. Some areas only test within the hospital, hospital staff and first responders, due to a shortage.

So until you are sick enough to be admitted into the hospital, they don't test you.
Should you show up at IL hospitals, seriously sick, they will test you for the flu and other things, and when those are negative, they will test you for covid-19 and tell you to go home for 3 days to wait for the results.

Reports are in the UK, their numbers are low because they are only doing limited testing, not trying to find infected people, just testing who shows up really sick.

I didn't say first, I said sooner , meaning the US was watching for it sooner in our outbreak ... and I agree with your other comments. Even with stricter guidelines for testing our state is running 3-5% positive meaning at least 95% negative tests.

 

[ivinsfan]

Just goes back to the concept of limiting tests, so the true number count is kept artificially low, in order to possibly stave off stock market disaster.

In our state between 3 and 5% of the "limited" tests are still screening negative .

If "they" planned this way to keep the market from crashing, it was an epic fail.

 

[NameRedacted]

One could posit just as easily that discovering there are far more infections than we currently know, but they did not require medical attention, would be helpful. The case mortality rate would be shown to be very low and maybe some of the panic would subside. That would be good for the market.

Why attribute to malice that which can be explained by incompetence? We have not tested more widely in this country because we were woefully unprepared, not due to some nefarious conspiracy to manipulate the case numbers.

I think the problem in the US is that we have a weak central government that basically left it all up to the states. There has been no coordinated response and this is now biting us in the butt. And I agree it's not malice but incompetence.



This crisis has been compared to a war but in a real war the federal government is in complete control and directs were and when the troops are deployed. Each individual state doesn't decide which battle its troops are going to fight or whether it should even bother to raise an army.


I still don't understand why discovering that the mortality rate is lower because there are many more cases than we thought is a good thing. What that means is that there are infected people walking around who don't know they are infected and spreading the virus. This has led to complacency rather than panic. Even now you still have governers that look at the numbers and say well we only have 200 cases and that's easy to control.



Finally, I don't give a damn about the stock market and I don't think others should either. Those that invested just before the crisis will lose money. Those that invest during the crisis or as it ends will make money. Those that have been investing for years will be OK more or less. Just like all previous market crashes - that's the thing about stocks they can go down as well as up. Once the crisis is over it will recover to a level commensurate with the strength of the economy - but the people that die from this disease are never coming back.

 

[audreyh1]

I didn't say first, I said sooner , meaning the US was watching for it sooner in our outbreak ... and I agree with your other comments. Even with stricter guidelines for testing our state is running 3-5% positive meaning at least 95% negative tests.

GA is running 18% positive on their testing! Their testing is still limited to elderly, very sick and medical workers.

 

[ivinsfan]

Hmmm, interesting for sure. Few of us want to believe bad news, and some of us never do, even in the face of accurate data produced by experts.

A couple weeks ago my wife had a dry cough, a fever, and headache. She finally found a video chat with a medical person, who took all of her information, and was very nice. However, she said there were no test kits available, and just to self-medicate at home. If she had trouble breathing, call us back, but don't go to the hospital. Fortunately, her symptoms went away, but who knows whether she had the COVID-19 virus? What if she passed it along?

The bottom line is that the U.S. buried their heads in the sand, while the virus spread around the country. No testing, no tracing, and no preparation for the treatment of the sick, dying, and dead. Sad, but true.

The people that think we did better or even similar to South Korea are sadly mistaken. Their ignorance will cost others their lives, or their family and friends.

We are waiting for grandbaby number 2 any day, and it's a big worry. Our daughter's doctor told her that her husband may not be able to come in the hospital during delivery. Our daughter, between crying and sobbing, told her doctor that then she will just have the baby at home. Too bad, people are making real choices now like this.

Did your wife stay home the minute she started feeling badly? Did you stay home and quarantine the minute your wife felt ill? If the answer to those questions is yes, then who would you have spread it to? I don't know where you live but our state government has been extremely responsive.

Give your daughter a couple days to process. Dads in delivery is only around a 40 year concept.

 

[NW-Bound]

Here in AZ, state officials discourage doctors from asking for tests, due to limited availability. Instead, doctors are advised to treat patients as if they already have the virus.

A bit more than 7,000 Arizonans have been tested.

Lack of widespread testing does not keep the confirmed case count from jumping up to 508 on yesterday, 3/26/2020. It was 234 3 days earlier, on 3/23/2020. Going back another 3 days, on 3/20/2020, the count was 78.

Moving right along the "doubling every 3 days" line to keep up with elsewhere in the country.

 

[Dtail]

One could posit just as easily that discovering there are far more infections than we currently know, but they did not require medical attention, would be helpful. The case mortality rate would be shown to be very low and maybe some of the panic would subside. That would be good for the market.

Why attribute to malice that which can be explained by incompetence? We have not tested more widely in this country because we were woefully unprepared, not due to some nefarious conspiracy to manipulate the case numbers.

We will have to agree to disagree then.
However, I do agree that the original decision not to test was due to error of judgment/incompetence, but concern for the stock market appears (to me) to be a major part of many of the current decisions made including effectively the Fed.

 

[ExFlyBoy5]

GA is running 18% positive on their testing! Their testing is still limited to elderly, very sick and medical workers.

Which to me brings about more questions. If they are currently only testing folks that are showing the symptoms and/or likely to have it, then I would think the positive rate would be much, MUCH higher than 1 in 5.

 

[Dtail]

In our state between 3 and 5% of the "limited" tests are still screening negative .

If "they" planned this way to keep the market from crashing, it was an epic fail.

If there were enough tests for the majority of those who get sick, but just have a mild case, vs. no tests for them and they get better, but are not in the official count, then the numbers are very skewed understated.

 

[NW-Bound]

I mentioned elsewhere earlier that the number of confirmed cases is not as important as the number of hospitalizations, and the morbid number of deaths.

It is true that many of the infected have symptoms so mild that they just stay home and tough it out, and are not counted. But if the number of people needing hospitalization exceeds the number of hospital beds, we have a real problem here.

And if we run out of space to store the dead, as hospitals in Queens NYC are having, I don't know how anybody can say that it is not a big deal.