Coronavirus: What questions do you have?

[rocketsaway]

Question: PA's 7 day positive rate is trending up. The 7 day death rate is slightly kicking up.
However, the 7 day case fatality rate is going down.

What do you make of the case fatality rate ?

btw- Got kicked out of HS football stadium because my mask was down. Less than 50 people in an outside large stadium.
I was eating a piece of licorice. No one within 20ft.
Meanwhile half the football team standing on sidelines wore no masks. And my bus was full of non-masked players and coaches.
Wonder where the positivity rate is coming from<sic> ?

 

[cwbullet]

Question: PA's 7 day positive rate is trending up. The 7 day death rate is slightly kicking up.
However, the 7 day case fatality rate is going down.

What do you make of the case fatality rate ?

btw- Got kicked out of HS football stadium because my mask was down. Less than 50 people in an outside large stadium.
I was eating a piece of licorice. No one within 20ft.
Meanwhile half the football team standing on sidelines wore no masks. And my bus was full of non-masked players and coaches.
Wonder where the positivity rate is coming from<sic> ?

Fatality rates are delayed. I am not sure at this time if this is due to better treatments or just the standard lag. I will tell you that we are using several outpatient and inpatient experimental protocols. One of which will be on 60 minutes soon. The inpatient treatment we are using is revolutionary and can reduce fatalities by up to 80% in the right patient if implemented in a timely manner. It was developed by DARPA. The outpatient protocols are still being developed but I think they might be just as good.

I am sorry you got thrown out of the game. I understand their concerns. The largest risk for superspreader events is removing the mask and eating or conversing. Every superspreader event that I have seen involves a portion or all participants removing their masks. Our local events have all come from eating, singing, having coffee, working out at a gym, or parties in which masks were removed to consume food, talks, sing, or drink in close proximity with a COVID positive individual.

This is not a political rant. I understand the want to mandate masking in public. Masks make sense to protect others and appear to even provide some protection for the wearer. I know that mandating a mask on private land is unenforceable and may be unconstitutional. Businesses can require you to wear them on their premises. I am not sure about a public mandate but I think we are gonna find out soon enough.

20 Feet? If you are within 3 feet of a positive COVID individual, your risk is about 12-13% to catch COVID. That goes up high if you spend 15 minutes together and reduced if you wear a mask (up to 80% reduction) and/or face shield (up to 66% reduction). Six feet of distancing Every 6 feet outside of 6 feet reduced viral exposure by 1/2. At 6 feet, your risk is 2.8%. Every 6 feet from that point reduced it by about 50%. I am no mathematician but at 20 feet, your risk would essentially be zero. In fact, you risk high to catch it from the bleacher than aerosolized from the dude 20 feet away.

 

[cwbullet]

On a prior topic, it is not just military physicians that are planning to change:

https://www.mdlinx.com/article/near... Morning Alert&utm_source=iPost&?show_order=1
If even a fraction of them hang up their stethoscopes, our medical system will collapse. If health care is truly a right, you might need to see a witch doctor to get medical care, because with will not be enough physicians to see the patients even if they have free insurance.

 

[modeltrains]

If health care is truly a right, you might need to see a witch doctor to get medical care, because with will not be enough physicians to see the patients even if they have free insurance.

Are already shortages of lab techs, and nurses, and other places I've brought that in to the health care topic through a couple decades it has been mostly ignored.

Have a reference, which also discusses the VA, appropriate here on Veterans Day.
From, The American Society for Clinical Laboratory Science | 1861 International Drive, Suite 200 | McLean, VA 22102

In addition to this projected demand for additional laboratory professionals, laboratory managers continue to report high vacancy rates. The average vacancy rate is 7.2% for the 17 laboratory departments identified in the 2016-2017 ASCP vacancy survey. These vacancies are felt across the nation, with the Northeast region reporting the highest overall vacancy rate (9.4%) compared with the other regions; the South-Central Atlantic had the lowest vacancy rate (6.3%).5

The VA Office of Inspector General (OIG) conducted its fourth determination of Veterans Health Administration (VHA) occupations with the largest staffing shortages, and once again the Medical Technologist job code ranked as one of the largest critical needs occupations. Many VHA facilities are no longer hiring Medical Technicians due to the challenges of hiring under the current position description and compensation. The VHA has not been able to increase the net onboarding of Medical Technologists in the past year, although the absolute numbers of staff in the other four critical need occupations has increased. 6

With the projected increases in the need for medical laboratory professionals, and the current high vacancy rates, the profession is suffering from a workforce shortage that is approaching crisis levels for medical laboratory technicians, medical laboratory scientists, histotechnicians and histotechnologists.

Reasons for the Shortage

Several factors impact the clinical laboratory workforce shortage. These factors include, but are not limited to:

• The retirement of the aging workforce
• An increase in demand for laboratory services
• Changes in the practice of clinical laboratory science due to technology advances; and
• Vacancy rates that exceed the number of MLS and MLT graduates

https://www.ascls.org/position-pape...ng-the-clinical-laboratory-workforce-shortage

 

[modeltrains]

If health care is truly a right, you might need to see a witch doctor to get medical care, because with will not be enough physicians to see the patients even if they have free insurance.

And then about nursing, it's not just nurses, it is nursing educators too;

Achieving health system reform goals will turn on investing in the education of a 21st-century health care workforce. However, as the United States tackles the workforce shortage that exacerbates the stress in the health care system, nursing programs across the country are rejecting qualified candidates because there is not enough faculty to teach them. In 2011-2012, 64 percent of all nursing programs turned away qualified applicants. Pre-licensure nursing programs – which serve as the gateway into the nursing workforce – rejected 72 percent of qualified applicants due to limited space.

https://www.nln.org/advocacy-public-policy/issues/faculty-shortage
and

How the Nurse Educator Shortage Is Holding Back Healthcare

Interest in nursing careers has never been higher. But a lack of qualified nursing faculty is squeezing the pipeline of the future nursing workforce. This is a troubling long-term trend in the face of rapidly growing demand for healthcare.
March 5, 2020
Several indicators point to a shortage in nurse educators, with dire consequences for the future healthcare workforce. Despite a growing interest in the nursing profession, the American Association of Colleges of Nursing (AACN) argues that a lack of qualified nursing faculty across U.S. nursing programs will limit the industry’s ability to meet the growing demand for healthcare.

The U.S. Department of Labor’s Bureau of Labor Statistics (BLS) projects a 10% increase in jobs in the healthcare sector from 2018 to 2028, amounting to 1.9 million new jobs over 10 years. The BLS lists registered nursing (RN) to be among the top healthcare occupations with the most significant job growth and projects that the RN workforce will grow by as much as 12% by 2028.

In order to meet this demand, there is currently a need for more than 200,000 new RNs to enter the workforce each year.

Not Enough Seats for Qualified Student Nurses

In 2019, the AACN reported that U.S. nursing schools rejected more than 75,000 applicants in 2018, not because they weren’t qualified, but because there weren’t enough seats in the programs. Potential entrants into the nursing workforce are prevented from earning undergraduate and graduate degrees due to the lack of faculty.

https://www.snhu.edu/about-us/newsr...-educator-shortage-is-holding-back-healthcare

 

[NateB]

Medics and firefighters are in short supply too. Many, especially firefighters, are volunteers and most departments are struggling to find people who can volunteer their time or the funds to pay for a full time staff. Even those of us who do these jobs for a career are in short supply. A lot of people are leaving the field and not coming back. You can only take so much abuse from people before you have enough. The day when you call 911 and there is nobody to come for you isn't too far away.

 

[cwbullet]

Nurses are making a killing in the market. I have an ICU Nurse that moonlights for $300 an hour during COVID. It is a worker's market in some fields.

 

[NateB]

Nurses are making a killing in the market. I have an ICU Nurse that moonlights for $300 an hour during COVID. It is a worker's market in some fields.

Nurses are, medics aren't. My partner probably makes twice what I make. A brand new RN starts higher than my pay is capped, more if they have a BSN. We have a different approach to medicine, but similar skills and similar amount of schooling. In our role, we are each hired for the complimentary background, but have the same protocols and expectations from our medical director.

 

[boatgeek]

Nurses are making a killing in the market. I have an ICU Nurse that moonlights for $300 an hour during COVID. It is a worker's market in some fields.

Does that rate include overtime if they go over 40 hours, or are they a contractor? Also, is that just because of COVID, or was that kind of moonlighting rate possible before too?

 

[NateB]

Does that rate include overtime if they go over 40 hours, or are they a contractor? Also, is that just because of COVID, or was that kind of moonlighting rate possible before too?

Our facility often offers 1.5x + $10 even before covid. Double time isn't unheard of at other facilities. Some smart nurses went with travel agencies and get assigned to the unit they just left.

 

[modeltrains]

I had been in a fire and rescue Explorer post in early 1980s and started LPN school in late 1980s but as it went on to do so many times since my defective body jumped up and said, no, not this career.
So instead of becoming a nurse then perhaps working toward EMT, I have lots and lots of times been the customer of nurses and several times of EMTs.
Err.
But I have kept that,

 

[cbrarick]

Have you been out on popular walking/bike paths since covid started? At least up here in VT they’ve been much busier and people don’t feel the need to wear masks because they’re outside, despite bunching up and chatting on the trail. I’ve had someone stop me to ask directions and wouldn’t put a mask on because “we’re outside and you don’t need masks outside”, despite being two feet away from me.

People seem very eager to run with the outside is totally safe narrative. Not sure where the 100ft argument or your farm come into play, seems like a bit of a straw man.

I think having mask required zones on paths like I saw in MA would alleviate some of these issues. The county I visited has less cases than my county here in Vermont despite us being lauded for our handling of the virus. We also have a significantly lower population density here, so I’d imagine they’re taking it much more seriously down there. People are apathetic in general, and I get that, but I’m sick of hearing stories about people not realizing how bad it can be until a close family member dies and asking people to take it seriously. It’s obvious this can do some bad things to elderly people, not sure why something so insignificant as wearing a mask in the interest of protecting other’s health is a controversial issue.

all trails app is your friend. Choose "lightly traveled" and you probably won't see anyone. That's been my experience pretty much all summer - I've probably run into 12 people on the 200+ miles this summer.

 

[itsmeGriff]

Some of these mask directives are as insane as " Having a peeing section in your swimming pool". Tell me how effective that is! LOL

 

[cwbullet]

Some of these mask directives are as insane as " Having a peeing section in your swimming pool". Tell me how effective that is! LOL

I think the same can be said for sneeze guards. They are proven to work, but the concept breeds doubt.

 

[cwbullet]

I am going home for Thanksgiving. I have not seen my father since February. I am worried I bring something home. I found this article:

https://www.mdlinx.com/news/how-to-... Morning Alert&utm_source=iPost&?show_order=1

 

[BABAR]

Nurses are making a killing in the market.

Not the best choice of words. You can forget the second career as a political speech writer.

 

[cwbullet]

Not the best choice of words. You can forget the second career as a political speech writer.

Crap that is funny, but you are right.

 

[Exactimator]

Chuck, is there any chatter in your professional arena about the skyrocketing cases? Is there any sort of plan? Or has everyone just giving up on containing it and hoping the vaccine arrives soon?

 

[kuririn]

I was wondering if there is a national plan for vaccination, or are individual states going to take the lead?
Are we going to be relying totally on the Pfizer vaccine or are we going to use several different vaccines as they become available?
Reason I ask is that I just read that the Pfizer product needs to be kept at -100 deg. F (!!!!) and must be administered in two doses 21 days apart. That might make it difficult distributing it to remote rural areas of the country.
Once again, thank you for your good work.

 

[rharshberger]

WA state just went into a slightly modified version of Lock Down 1.0...again...

 

[NOLA_BAR]

Chuck, is there any chatter in your professional arena about the skyrocketing cases? Is there any sort of plan? Or has everyone just giving up on containing it and hoping the vaccine arrives soon?

Looks like we are going into the upward swing of our third wave/peak. COVID fatigue, denial, “can’t happen again”?? Football parties? Hope it is not as bad as being forecasted.

 

[BABAR]

We haven’t even renewed our local mask mandate here.

Sigh......

 

[NateB]

We have record admission for covid and no signs of slowing. Our governor is talking about locking down again, and schools are shutting down one by one.

With cases getting worse, people becoming more resistant to wearing masks and staying at home, what do we do to bridge the gap before vaccine availability? Moderna has amazing results as well as Pfizer, but manufacture, distribution, and administration all pose major challenges. On top of those challenges, how do we get the people who won't wear a mask to get a vaccine?

 

[Marc_G]

From the Indiana dept of health Coronavirus dashboard, here is our ICU usage chart. More COVID-19 usage than at any other time since pandemic start. Governor not showing much leadership. I firmly believe he is waiting for formal transition to new administration to start before he fully acknowledges the threat and takes more action. However, it's already too late...

 

[NOLA_BAR]

I get COVID reports for individuals that test positive in my work building. There was a noticeable lull from the mid-summer spike, but I have had 4 notifications in the last 3 days. If that has any correlation to the general population then it is gonna get bad. Luckily nobody in my office has tested positive.

 

[NateB]

Judging from our hospitalizations recently, I would expect to see a rise in deaths soon. We are getting better at treating this, but the cases requiring admission are growing fast.

Edit to add:

Almost half of Indiana's total cases have been diagnosed in the past 30 days

 

[Cl(VII)]

As I am sure most people have heard, the Moderna vaccine has come in with positive data today, but they had a second press release that doesn't appear to be getting as much attention (yet), but is very important: https://investors.modernatx.com/new...ounces-longer-shelf-life-its-covid-19-vaccine

Relavent part:
"...COVID-19 vaccine candidate, remains stable at 2° to 8°C (36° to 46°F), the temperature of a standard home or medical refrigerator, for 30 days...The ability to store our vaccine for up to 6 months at -20° C including up to 30 days at normal refrigerator conditions after thawing is an important development and would enable simpler distribution and more flexibility to facilitate wider-scale vaccination in the United States and other parts of the world.”

This fits into the standard pharmacy supply chain, which is obviously a really big deal for wide spread administration.

 

[NateB]

That is good news about the Moderna vaccine as well. I am glad their trials are addressing the storage concerns of the Pfizer one. Using standard refrigeration for 30 days will be very helpful in rural areas where hospital pharmacies are not as well equipped as the larger ones and for areas with no hospitals or doctors nearby .

 

[cwbullet]

That is good news about the Moderna vaccine as well. I am glad their trials are addressing the storage concerns of the Pfizer one. Using standard refrigeration for 30 days will be very helpful in rural areas where hospital pharmacies are not as well equipped as the larger ones and for areas with no hospitals or doctors nearby .

Very true. I am beginning to get some hope as we get hammered locally. The hospital is not full but we are feeling the heat.

Two local counties have doubled in 7 days. Our hospital has tripled. Not this crap agains!

 

[cwbullet]

Ok, we started another trial of medication for outpatients. Data from the lev3l 2 investigation looks promising. More to come.