Coronavirus: What questions do you have?

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cwbullet said:
Gary: It is always a risk. The highest risk is touching people or surfaces in public. You just must assume that everyone has it. If she used universal precaution plus everyone wears a mask, her is risk much less. Not a single patient has caught this working as a medical provider or nurse in my region (to this point). Nearly all patients that I have traced caught COVID through physical contact from a loved one or friend and not a coworker.

Personally, I wear a mask, wash diligently, remove my clothes before going home, and change clothing in my garage at home. I am very protecting of myself and my family but I still will go home. My family visits me and I am not worried about them catching it.

Suggestions reiterated:
  1. Wear a mask at all times - to protect others and hopefully this Is the standard in her worksite.
  2. Never touch your face, nose, mouth, or eyes without washing your hands first.
  3. Wash you hands after touching 2.
  4. Change clothes before coming home or before entering house.
  5. Wash your hands, wash your hands, washing your hands.
  6. If you can’t do 5, use Purell.
Click to expand...
Thanks much I will pass info on
Stay well
 
cwbullet said:
The Cow Pox or vaccinia is still used today. I have had it 3 times (lasts 8-10 years).

The CDC is a good reference site. Coronavirus is a common virus. They suspect two strains but there is not evidence that all of the strains are equally deadly. There are approximately 7 know human infecting varients.

References:
https://www.cdc.gov/coronavirus/types.html
https://www.newscientist.com/articl...are-there-two-strains-and-is-one-more-deadly/

I would hedge this by saying that the multiple virus theory comes from the WHO and is not universally accepted. The WHO helped suppress news on the Coronavirus infections in China and is one of the reasons were are where we are. It is either purposeful suppression or incompetence. I hope it was not intentional but it happened. They missed an opportunity to highlight the problem and they missed the opportunity.
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Not trolling here Chuck or trying to get political but there is a basis of Trump's criticism of the WHO then? Kurt
 
ksaves2 said:
Not trolling here Chuck or trying to get political but there is a basis of Trump's criticism of the WHO then? Kurt
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Concur. Nothing else need to be said. I was not referring to the Presidents criticism of the WHO. I am using the information of the most experienced infectious disease and public health physicians on my staff. Neither is a conservative so it is not political.

Then again, there is plenty of blame to go a round. We need to focus on taking care of our people and preventing or slowing infections.

Georgia just extended the shelter in place to 30 more day. 9901 infections and 368 deaths.
 
75Grandville said:
Well said!
Click to expand...

Thanks. I have gotten a little defense and I trying to avoid blaming, but some of these organization need to look their procedures when we do our after action report / review and learn form our mistakes. I have learned a lot from this pandemic.
 
cwbullet said:
Concur. Nothing else need to be said. I was not referring to the Presidents criticism of the WHO. I am using the information of the most experienced infectious disease and public health physicians on my staff. Neither is a conservative so it is not political.

Then again, there is plenty of blame to go a round. We need to focus on taking care of our people and preventing or slowing infections.

Georgia just extended the shelter in place to 30 more day. 9901 infections and 368 deaths.
Click to expand...

Thanks for the response. Kurt
 
Update today: Ventilators are definitely not the Panacea we think. Data out of the Bronx clearly indicates that avoiding a vent is recommended at all costs. The data shows two presentations in NY. 1. A patient shows up happy by breathing rapidly but looks ok. They have low oxygen but you would not guess it was so low based upon appearance. 2. A patient looks sick as stink and has oxygen to match. Patient 1, you should delay intubation but admit. Patient 1, get more improvement with hydroxychloroquine than 2. Patient 2 absolutely needs to be intubated. Both have a poor outcome if intubated.
 
That is interesting about vent use. In our normal practice, I would probably try to get ABG trends and try non-invasive methods before intubating pt 1 anyway. With our Covid guidlines, we are supposed try O2 by NC and NRB, but intubate if we can't keep SpO2 > 90%. Pt 2 would probably be an immediate intubation, maybe using BiPAP as a bridge while we prepare meds and equipment. Our pulmonologists are able to use hydroxychloroquine, but we won't be stocking it or administering it.

We have a great deal of autonomy, but still have to follow the guidelines of our medical director since it is his license that allows us to practice. He wishes us to consult with him, the attending at our ED, and the recieving pulmonologist if we have questions. He is always open to discussion and any good research we can present as well.

We were advised earlier this week that the ED docs have seen Covid cases rapidly drop their BP after intubation and have been requiring pressor support. Chuck, have your providers seen the same? We were also warned to be careful with Ketamine use with a foreseen shortage coming.

My partner and I usually prep a push dose of Epi when we RSI someone so this wouldn't be a change in our practice.
 
NateB said:
That is interesting about vent use. In our normal practice, I would probably try to get ABG trends and try non-invasive methods before intubating pt 1 anyway. With our Covid guidlines, we are supposed try O2 by NC and NRB, but intubate if we can't keep SpO2 > 90%. Pt 2 would probably be an immediate intubation, maybe using BiPAP as a bridge while we prepare meds and equipment. Our pulmonologists are able to use hydroxychloroquine, but we won't be stocking it or administering it.

We have a great deal of autonomy, but still have to follow the guidelines of our medical director since it is his license that allows us to practice. He wishes us to consult with him, the attending at our ED, and the recieving pulmonologist if we have questions. He is always open to discussion and any good research we can present as well.

We were advised earlier this week that the ED docs have seen Covid cases rapidly drop their BP after intubation and have been requiring pressor support. Chuck, have your providers seen the same? We were also warned to be careful with Ketamine use with a foreseen shortage coming.

My partner and I usually prep a push dose of Epi when we RSI someone so this wouldn't be a change in our practice.
Click to expand...

Have you been successful at removing patients from the Vent? Ou facility is not a good example, our population is a little younger. I do expect that we will see come difficulty extubating some patients.
 
cwbullet said:
Have you been successful at removing patients from the Vent? Ou facility is not a good example, our population is a little younger. I do expect that we will see come difficulty extubating some patients.
Click to expand...

I can't speak for the full hospital, they don't pass those statistics on to everyone right away and I haven't had many conversations with the RTs lately. I don't dare read charts for patients I didn't treat or for runs I am doing QA or rounding reports on. The folks that compile all those statistics usually have monthly meetings and inform the rest of us during normal inservice or through our educator.

The patients moved by our department are not doing well. For everyone else reading this, I cannot stress enough that by the time someone needs a helicopter or mobile ICU ambulance, their outcome is probably not the best to begin with. Covid or something else, we only get involved for the most severe cases.
 
NateB said:
I can't speak for the full hospital, they don't pass those statistics on to everyone right away and I haven't had many conversations with the RTs lately. I don't dare read charts for patients I didn't treat or for runs I am doing QA or rounding reports on. The folks that compile all those statistics usually have monthly meetings and inform the rest of us during normal inservice or through our educator.

The patients moved by our department are not doing well. For everyone else reading this, I cannot stress enough that by the time someone needs a helicopter or mobile ICU ambulance, their outcome is probably not the best to begin with. Covid or something else, we only get involved for the most severe cases.
Click to expand...


Just in general, that is what I am hearing. A few sister hospitals have 24-30 patients intubated. That is Huge.
 
Chuck, are you forming thoughts on hydroxychloroquinone / chloroquine yet? I've read studies that range from "wonder drug, best thing since sliced bread" to "no improvement in clearing virus as measured by PCR and no clinical benefit."

I'm a "wait for the data" guy. I would think that if it was even reasonably effective, it would have been deployed in hotspots in Europe and maybe things wouldn't be so bad over there. Or, maybe it is being deployed but the impact isn't enough to tamp things down.

A few doctors I know suggest "marginal benefit in some cases" but none of them have dealt with large numbers of cases.
 
Marc_G said:
Chuck, are you forming thoughts on hydroxychloroquinone / chloroquine yet? I've read studies that range from "wonder drug, best thing since sliced bread" to "no improvement in clearing virus as measured by PCR and no clinical benefit."

I'm a "wait for the data" guy. I would think that if it was even reasonably effective, it would have been deployed in hotspots in Europe and maybe things wouldn't be so bad over there. Or, maybe it is being deployed but the impact isn't enough to tamp things down.

A few doctors I know suggest "marginal benefit in some cases" but none of them have dealt with large numbers of cases.
Click to expand...

I have not seen data to convince me. Then again, if there is a storm, I am looking for shelter and Hydroquinone may be the only shelter available at this time. I would not take it as an outpatient and I would not dissuade a patient who is deaths bed. I give them their options and allow them to choose.
 
cwbullet said:
Just in general, that is what I am hearing. A few sister hospitals have 24-30 patients intubated. That is Huge.
Click to expand...

On Friday, I had heard somewhere between 40-45 patients were intubated with several more on the fence. They are still planning for a surge in cases this week.

They still intend to move the intubated Covid patients into our hospital from our community hospitals. People that have DNR or DNI orders and those expected to remain stable on supplemental O2 or HFNC will stay in the community hospitals. On the other end, we are moving non-covid cases to the community hospital ICUs and floors for admission.
 
NateB said:
On Friday, I had heard somewhere between 40-45 patients were intubated with several more on the fence. They are still planning for a surge in cases this week.

They still intend to move the intubated Covid patients into our hospital from our community hospitals. People that have DNR or DNI orders and those expected to remain stable on supplemental O2 or HFNC will stay in the community hospitals. On the other end, we are moving non-covid cases to the community hospital ICUs and floors for admission.
Click to expand...

Wow, That is a lot of work. 45 is impressive. My thoughts and prayers are with your [roviders and nurses to give the strength to get through the heavy emotional burden caused by the toll created bu this virus. I hope we don't get there.

Out burden is under 200 per day in our screening tent. We topped out. Everyone thinks they have COVID, but the folks that really have it (sort of).
 
How do you have so much time to post during a pandemic?
Click to expand...

I am an administrator and medical planner. Sure I am a physician, but I am responsible for the whole operation. I plan the response and monitor for success. Most fo day is spent waiting for data points and adapting the response. I have a lot of downtimes to post.
 
My nurse’s son is a pharmacist in a Milwaukee hospital and he called to tell his mom what the most common denominator he observed for deaths on a ventilator........ Obesity. My county has been spared the scourge so far.
If one thinks about it, obesity can be associated with diabetes, heart disease, hypertension, sleep apnea and if they smoke, COPD. I’ve seen all those maladies printed but perhaps they are being politically correct? I think I’ve seen one askance mention of obesity written. You guys? Are you seeing prone ventilation? Guidelines I’ve seen said to avoid non-invasive ventilation (CPAP bipap) and opt for early intubation. Thing that scares me the most is its been mentioned that flaming ARDS can develop quickly and my past experience with that was with rapid onset, they die. Other thing written is folks can look not so bad and have lousy O2 sats. I wonder if that is more prevalent with people who have pre-existing lung disease.

Oh there was a blurb of ivermectin had an effect in tissue culture but it probably will take iron cajones to get the research done to go to clinical trial on that one. Kurt
 
ksaves2 said:
My nurse’s son is a pharmacist in a Milwaukee hospital and he called to tell his mom what the most common denominator he observed for deaths on a ventilator........ Obesity. My county has been spared the scourge so far.
If one thinks about it, obesity can be associated with diabetes, heart disease, hypertension, sleep apnea and if they smoke, COPD. I’ve seen all those maladies printed but perhaps they are being politically correct? I think I’ve seen one askance mention of obesity written. You guys? Are you seeing prone ventilation? Guidelines I’ve seen said to avoid non-invasive ventilation (CPAP bipap) and opt for early intubation. Thing that scares me the most is its been mentioned that flaming ARDS can develop quickly and my past experience with that was with rapid onset, they die. Other thing written is folks can look not so bad and have lousy O2 sats. I wonder if that is more prevalent with people who have pre-existing lung disease.

Oh there was a blurb of ivermectin had an effect in tissue culture but it probably will take iron cajones to get the research done to go to clinical trial on that one. Kurt
Click to expand...

Obesity is a factor. What I am seeing locally is Obesity, Immunocompromised, Age, Smoking, and Vaping.

In particular, it is obesity with type two diabetes.
 
I've read in a few places that said ivermectin appears to stop the virus.
Quite odd but one can hope it does work since it is a commonly available drug....
 
djmartins said:
I've read in a few places that said ivermectin appears to stop the virus.
Quite odd but one can hope it does work since it is a commonly available drug....
Click to expand...

It was tested artificially in tissue culture. Ideally would move to an animal model but I don't know. The investigator said they needed money and they'll probably get it. (Rightfully so) Now whether or not anyone will dive in and do now I don't know. Some word came out from China that an IL-6 inhibitor, sarilumab, showed promise. Me suspects that whatever is found to work, timing it will be most important. If one is on death's door a med that might be effective early on might fail because the person is too far gone.

In the old days, Levophed used to be known as "Leave 'em dead" as it was used as a the very last thing in shock. Lo' and beholden, it's used as one of the very first agents in shock now (along with other stuff) and by golly it works! That was supported by the appropriate studies too.
Kurt
 
ksaves2 said:
In the old days, Levophed used to be known as "Leave 'em dead" as it was used as a the very last thing in shock. Lo' and beholden, it's used as one of the very first agents in shock now (along with other stuff) and by golly it works!
Click to expand...

We also learned how to best use it along with aggressive fluid resuscitation and other pressors. Covid treatment could involve the same with timing and other supportive treatments.
 
ksaves2 said:
It was tested artificially in tissue culture. Ideally would move to an animal model but I don't know. The investigator said they needed money and they'll probably get it. (Rightfully so) Now whether or not anyone will dive in and do now I don't know. Some word came out from China that an IL-6 inhibitor, sarilumab, showed promise. Me suspects that whatever is found to work, timing it will be most important. If one is on death's door a med that might be effective early on might fail because the person is too far gone.

In the old days, Levophed used to be known as "Leave 'em dead" as it was used as a the very last thing in shock. Lo' and beholden, it's used as one of the very first agents in shock now (along with other stuff) and by golly it works! That was supported by the appropriate studies too.
Kurt
Click to expand...
We make a drug called Actemra that is in 2 different trials right now related to COVID-19. Its also an IL-6 inhibitor but I believe its in trial to prevent a cytokinestorm that happens in some people.

Any safe harbor in a storm is kinda where we are right now. Throw everything including the kitchen sink at it and see what sticks.
 
cwbullet said:
Gary: It is always a risk. The highest risk is touching people or surfaces in public. You just must assume that everyone has it. If she used universal precaution plus everyone wears a mask, her is risk much less. Not a single patient has caught this working as a medical provider or nurse in my region (to this point). Nearly all patients that I have traced caught COVID through physical contact from a loved one or friend and not a coworker.

Personally, I wear a mask, wash diligently, remove my clothes before going home, and change clothing in my garage at home. I am very protecting of myself and my family but I still will go home. My family visits me and I am not worried about them catching it.

Suggestions reiterated:
  1. Wear a mask at all times - to protect others and hopefully this Is the standard in her worksite.
  2. Never touch your face, nose, mouth, or eyes without washing your hands first.
  3. Wash you hands after touching 2.
  4. Change clothes before coming home or before entering house.
  5. Wash your hands, wash your hands, washing your hands.
  6. If you can’t do 5, use Purell.
Click to expand...
Chuck, I have been putting in backup energy systems in several health care facilities. (my primary career before COVID19 was intallation of solar energy sytems, but a lot of the controllers I used are now on backorder thanks to our country's dependance of China, but that is another topic). My wife is a PharmD at a Walmart. So we both put each other in harms way.
What I have done, in addition to your excellent control protocols, is that when we get home, we have a designated room apart from our regular living quarters, that I have installed UVC lights with remote controls. Before we see each other or anyone else, we expose our selves (with eye protection) to UV rays for 5 minutes. The set up cost me around 300 bucks total, but its well worth that and more for piece of mind.
Pat G
 
Pat Gordzelik said:
Chuck, I have been putting in backup energy systems in several health care facilities. (my primary career before COVID19 was intallation of solar energy sytems, but a lot of the controllers I used are now on backorder thanks to our country's dependance of China, but that is another topic). My wife is a PharmD at a Walmart. So we both put each other in harms way.
What I have done, in addition to your excellent control protocols, is that when we get home, we have a designated room apart from our regular living quarters, that I have installed UVC lights with remote controls. Before we see each other or anyone else, we expose our selves (with eye protection) to UV rays for 5 minutes. The set up cost me around 300 bucks total, but its well worth that and more for piece of mind.
Pat G
Click to expand...
Nice! Any pictures and/or a build parts list?
 
Pat Gordzelik said:
Chuck, I have been putting in backup energy systems in several health care facilities. (my primary career before COVID19 was intallation of solar energy sytems, but a lot of the controllers I used are now on backorder thanks to our country's dependance of China, but that is another topic). My wife is a PharmD at a Walmart. So we both put each other in harms way.
What I have done, in addition to your excellent control protocols, is that when we get home, we have a designated room apart from our regular living quarters, that I have installed UVC lights with remote controls. Before we see each other or anyone else, we expose our selves (with eye protection) to UV rays for 5 minutes. The set up cost me around 300 bucks total, but its well worth that and more for piece of mind.
Pat G
Click to expand...

Pat,
Because soap is recognized as an excellent disinfectant for viruses, my wife and I just shower together. No eye protection required.
Steve
 
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