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Re: Covid 19
Nothing in that article i posted said anything about an over reaction. And a poll out today says 60% of Americans still say it’s too soon.
Tell me I’m wrong...the same dumb asses protesting a pandemic were the same ones telling Kaepernick to stfu.
Reading comprehension STILL not your strong point. Read what I said, not what you imagined I said, then get back to me.
The same ones telling the protesters to stop now were the same ones protesting when Trump won. Any time you pick a side in the political game, it can get flipped on you in a second because (as I've said a gazillion times) both sides do the same things.
Re: Covid 19
Buzz, one thing we do know NOW is hospitals in outbreak areas are overwhelmed right now. To stop other areas going the same way, we have lockdown.
We have a virus circulating that we still don't know a whole lot about, what we do know is it is similiar to SARS and MERS, since it comes from the same family of viruses as they do and causes similiar symptoms, but with a higher infectivity rate and lower fatality rate. Given that, the measures taken so far seem prudent. Better safe than sorry.
Folk need to remember that the people dying face down on hospital beds suffocating as their lungs decay aren't just numbers. They meant something to some people. And for a lot of people they don't want themselves or those they care about to die that way.
You keep arguing that these measures are extreme because we don't know enough. If we wait until we know enough it's potentially catastrophically late.
Where? Hospitals in the US are laying off staff. A nurse went to NYC to help and had her contract cancelled. It's just not actually happening that way...not here.
By your logic, a criminal kills someone with a butter knife and we ban all butter knives because that person meant something to someone. Ridiculous. This is about the many, not the one or the few. By your logic any time a new virus comes out, we just shut down the whole world because we don't know enough. Equally ridiculous.
You have to take emotion out of decisions unless you want to keep making bad ones.
Re: Covid 19
Interesting article:
https://www.nytimes.com/2020/04/20/opin … 5b1rKduG3k
The Infection That’s Silently Killing Coronavirus Patients
This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital.
By Richard Levitan
Dr. Levitan is an emergency doctor.
April 20, 2020
I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.
So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.
On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”
He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.
During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.
Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.
And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?
We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.
Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.
To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.
In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.
A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.
We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps keep the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.
Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until their oxygen levels plummet. In effect, the patient is injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.
By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.
Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)
A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.
Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they don’t buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.
There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.
Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.
Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.
Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.
People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.
All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.
There are other things we can do as well to avoid immediately resorting to intubation and a ventilator. Patient positioning maneuvers (having patients lie on their stomach and sides) opens up the lower and posterior lungs most affected in Covid pneumonia. Oxygenation and positioning helped patients breathe easier and seemed to prevent progression of the disease in many cases. In a preliminary study by Dr. Caputo, this strategy helped keep three out of four patients with advanced Covid pneumonia from needing a ventilator in the first 24 hours.
To date, Covid-19 has killed more than 40,600 people nationwide — more than 10,000 in New York State alone. Oximeters are not 100 percent accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We don’t fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.
But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.
It’s time to get ahead of this virus instead of chasing it.
Re: Covid 19
“Interesting article”? I found it terrifying. Interestingly terrifying maybe.
I find things that a) people weren't expecting; and b) can help people going forward interesting. The whole thing is somewhat fascinating and things like this help explain some of what we're seeing.
I've seen reports that states are manipulating the Covid deaths because they get some sort of financial benefit from doing so. I was out playing golf today (respecting social distancing rules), so I haven't had time to read up on that yet. I know a lot of people think I'm on some crazy conspiracy thing here, but I am a lefty compared to some things I've seen people post...
Re: Covid 19
You're about as Left as Mitch is a Trump supporter.
j/k what kinda things do they post. Like conspiracy stuff or just like anti-Dems & 'I dont care about no virus' type stuff
Honestly? I don't know because I can't read that crazy shit. I mean my point on Covid is that we could have handled this better had we not destroyed the economy; I see people posting everything from they should be able to do whatever they want to it's a government conspiracy to the stuff someone posted earlier about this being done on purpose by China. Now all that stuff *could* be true on some levels, but the % possibilities are ridiculously low.
I have someone I went to school with that is an anti-vaxxer and is convinced Bill Gates is trying to take over the world through vaccines. That's all she posts about. Contrary to popular belief, I'm not enough of a dick to tell her she's nuts, so I just skip anything she posts because...well, she makes me look like a lefty!
Re: Covid 19
bigbri wrote:“Interesting article”? I found it terrifying. Interestingly terrifying maybe.
I find things that a) people weren't expecting; and b) can help people going forward interesting. The whole thing is somewhat fascinating and things like this help explain some of what we're seeing.
.
No your right, it was interesting. The hypochondriac in me about had a panic attack though.
What I got from it (i read it all), if you go to the hospital because you’re having trouble breathing, you might already be too late. And that is scary.
Re: Covid 19
buzzsaw wrote:bigbri wrote:“Interesting article”? I found it terrifying. Interestingly terrifying maybe.
I find things that a) people weren't expecting; and b) can help people going forward interesting. The whole thing is somewhat fascinating and things like this help explain some of what we're seeing.
.No your right, it was interesting. The hypochondriac in me about had a panic attack though.
What I got from it (i read it all), if you go to the hospital because you’re having trouble breathing, you might already be too late. And that is scary.
Well, that's one way of looking at it. I look at it as here's the first thing to look at when you get there and treat it immediately instead of figuring it out later. I am going to pick up one of those pulse/ox things assuming they are fairly affordable. It seems (like most things) the sooner you realize you have a problem, the better the odds of them being able to fix it.
On another note, California moved the timeline for their first Covid death to mid February...several weeks before the WA nursing home. I'm telling you this has been around much longer and is much more widespread than people think/know.
