Coronavirus: What questions do you have?

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NateB

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The question is how many of them will decide to retire instead.
We are battling this within our department. 1 nurse and 1 mechanic are still working from day 1 of the program, 30 years ago. We have several more nurses and medics around 55-60 who are looking at other options for non-clinical work or retirement.

Our positions will be filled, we always operate at a minimum full time staff level. Time will tell if the hospital fills other positions after people will retire. The health network has not laid off anyone off, ever, but we have cut positions as people retired or moved to other departments.
 

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We are battling this within our department. 1 nurse and 1 mechanic are still working from day 1 of the program, 30 years ago. We have several more nurses and medics around 55-60 who are looking at other options for non-clinical work or retirement.

Our positions will be filled, we always operate at a minimum full time staff level. Time will tell if the hospital fills other positions after people will retire. The health network has not laid off anyone off, ever, but we have cut positions as people retired or moved to other departments.
I do think a lot of oldtimers that our my age and older will hang up their stethoscopes.
 

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Any questions for today?

I am on week two and we do nto have a huge number of positive AB tests. I would have guessed 10-20% and it is far lower than that.
 

Flyfalcons

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I purchased a pulse oximeter so we can check our levels if we get sick. At what percentage saturation would we need to consider going to hospital for treatment?
 

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I purchased a pulse oximeter so we can check our levels if we get sick. At what percentage saturation would we need to consider going to hospital for treatment?
Great question. It really has to be adjusted for your health condition and prior medical status. This is variable because some skin tints make the measurement more challenging. Remember the the measurements you read on the display is plus or minus 2-4%.

Because of the range, I use the level of 95% is normal in the average healthy person and less than 92% is concerning.
 

dhbarr

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Are there national / international numbers for ILI / flu-like-symptoms? That's a number reported in my state, and *shock* it dropped like a rock when safer-at-home started up. The c19 test numbers care still all over the place due to various constraints.
 

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Are there national / international numbers for ILI / flu-like-symptoms? That's a number reported in my state, and *shock* it dropped like a rock when safer-at-home started up. The c19 test numbers care still all over the place due to various constraints.
I am not sure if some areas are tracking this. They track confirmed cases only and required to report those numbers. I am not sure the same is true internationally but suspect it is. Tracking numbers of colds and flu-like illnesses would be impossible. They track medical coding but that would also be incomplete because that would only hit those on Medicaid, medicare, and accept insurance.
 

Peartree

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A bandana is better than no-dana. In all seriousness, I talked to my public health officer, infectious disease, and infection control experts and they struggled their shoulders. I would call and ask in a non-confrontational manner. They will either rethink the policy or explain it.
Mom has started getting her mail. I heard from one of our church folk, at the same facility, (who will celebrate her 104th birthday on Monday) that they are holding mail for 24 hours (seems longer) for "disinfection." I have no idea how they might disinfect mail nor why they wouldn't allow our daughter to drop anything off when she was there. But, now we know. Onward.
 

ksaves2

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I do think a lot of oldtimers that our my age and older will hang up their stethoscopes.
I’ve mentioned before I am bailing out July 1st at 63 and a half years of age. Too tired of doing a classical practice of office, hospital and taking call. Keep me up all night long on the phone and takes 2.5 days to recover. Got the opportunity for health care coverage so I’m gone. Too many changes in primary care medicine and burnout in younger docs is becoming a problem. I’m glad I was able to hang on this long. I’m in a county where there have only been 3 cases of Covid and even though testing is rationed, the local hospital is not jammed with people in respiratory failure and elective surgeries are back on. Covid testing can be had but request has to go through the pathologist. Except for pre-op testing which is becoming standard of care.

I also posted I lost my spouse January 25th, 2019 and am responsible for a 25 year old autistic spectrum son who, BTW, is doing great now. Won’t be employable and will always need help but no more violent meltdowns. Once he got through hormones and adolescence, the violent meltdowns went away. At least Sally got to see that.

So I have a lot on my plate and consider it a blessing to be able to hang it up completely. No part time medical work as I will consider myself a civilian after July 1st.

Will deep clean the house and two small workshops so I can get back to rockets. My son, Christopher, is doing so great he’ll be able to travel with me and go to launches without any problem whatsoever. Looking forward to it though I still will carry a little grief in my heart and will likely do so till I’m laid to rest. (Not that I want to “rush” my ending.) :)
Kurt
 

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I’ve mentioned before I am bailing out July 1st at 63 and a half years of age. Too tired of doing a classical practice of office, hospital and taking call. Keep me up all night long on the phone and takes 2.5 days to recover. Got the opportunity for health care coverage so I’m gone. Too many changes in primary care medicine and burnout in younger docs is becoming a problem. I’m glad I was able to hang on this long. I’m in a county where there have only been 3 cases of Covid and even though testing is rationed, the local hospital is not jammed with people in respiratory failure and elective surgeries are back on. Covid testing can be had but request has to go through the pathologist. Except for pre-op testing which is becoming standard of care.

I also posted I lost my spouse January 25th, 2019 and am responsible for a 25 year old autistic spectrum son who, BTW, is doing great now. Won’t be employable and will always need help but no more violent meltdowns. Once he got through hormones and adolescence, the violent meltdowns went away. At least Sally got to see that.

So I have a lot on my plate and consider it a blessing to be able to hang it up completely. No part time medical work as I will consider myself a civilian after July 1st.

Will deep clean the house and two small workshops so I can get back to rockets. My son, Christopher, is doing so great he’ll be able to travel with me and go to launches without any problem whatsoever. Looking forward to it though I still will carry a little grief in my heart and will likely do so till I’m laid to rest. (Not that I want to “rush” my ending.) :)
Kurt
Here is to retirement. I will find another job that does not involve pulling call or being told I am moving every 2 years. That is not to name all the experts that feel they now medicine better than the subject matter expert. I am all for patients being involved in their care, but I am tired of commanders and other leaders trying to tell my clinicians which tests and medications to order. I am ready to only having to deal with the my boss (single boss) and patient or parents.
 

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Any more questions or did I miss any?
 

Marc_G

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I've got one: do you see any benefit in school and college aged kids having a test to detect infectious covid-19 prior to return to school in the fall?

I'm on the fence myself. I think it would be a positive step to avoid a sudden compressed spike of cases in each school district, but of course a clean bill of health on day one doesn't keep a kid from becoming infectious on day 2.

Presuming tests are widely available in the fall, I'd like to see the kids tested frequently and infectious ones pulled out of the school population to minimize spread. Hopefully saliva tests instead of annoying nasal swabs.

While far from perfect, do you think this would contribute towards getting R<1?
 

ksaves2

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Here is to retirement. I will find another job that does not involve pulling call or being told I am moving every 2 years. That is not to name all the experts that feel they now medicine better than the subject matter expert. I am all for patients being involved in their care, but I am tired of commanders and other leaders trying to tell my clinicians which tests and medications to order. I am ready to only having to deal with the my boss (single boss) and patient or parents.
One big problem Chuck is in a rural area with the less academically inclined patients, more often than not, patients ignore what we tell them to do and then the doc gets dinged for poor outcomes and metrics. Patients aren't held responsible for their lousy health behaviors and docs are expected to be nursemaids, guardian angels, secretaries and health policemen. We're not paid enough to do the first three and there is no way we can be health policemen.

When I started out 32 years ago, if a COPD'er kept smoking and was hospitalized every two weeks, I did my best and tried to get them to quit and avoid re-hospitalizations. Now primary care docs are screening patients and trying to avoid the most difficult non-compliant people. That's not including the mentally ill, feeble or demented folks. In those situations one does the best they can with them. It's the people who should know better but still ignore recommendations who docs are trying to avoid. Druggies included.

We are seeing a class of patients that no doc wants to deal with and they end up wandering the earth getting little or no care. (Undoubtedly clogging the E.R.)
In the old days, at least we were more than willing to try to "change them" even though
we knew the chances were little to none. Now with "accountable care" docs are being choosey. (Ooooops, sorry about the OT rant.)

Kurt
 

Reinhard

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... and there is no way we can be health policemen.
While we can't have real health policeman, I think we should at least have cheesy action movies about them. "Dr. Dredd", "Eat your Veggies or Die Hard", "The Proctolator". Ok, maybe we shouldn't have the last one...

Reinhard
 

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I've got one: do you see any benefit in school and college aged kids having a test to detect infectious covid-19 prior to return to school in the fall?

I'm on the fence myself. I think it would be a positive step to avoid a sudden compressed spike of cases in each school district, but of course a clean bill of health on day one doesn't keep a kid from becoming infectious on day 2.

Presuming tests are widely available in the fall, I'd like to see the kids tested frequently and infectious ones pulled out of the school population to minimize spread. Hopefully saliva tests instead of annoying nasal swabs.

While far from perfect, do you think this would contribute towards getting R<1?
Great question. We are trying to answer that question right now. They are mass testing some groups of DOD trainees that function in similar groups fo college kids. We may get an answer soon. I think we will test with a test of some type. Antibody testing might be the answer. It indicated some of exposure or not and can be used to put students in cohorts to lower risk.
 

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A new report from NEJM:

Transmission between cats: SARS-CoV-2 can be transmitted between domestic cats, according to an NEJMreport. Researchers inoculated three domestic cats with the virus, and a cat with no history of SARS-CoV-2 infection was cohoused with each of the inoculated cats 1 day later. Two days later, one of the cohoused cats tested positive for the virus, and by 5 days, all three cohoused cats had tested positive. All of the cats studied were asymptomatic. The researchers note, "Cats may be a silent intermediate host of SARS-CoV-2, because infected cats may not show any appreciable symptoms that might be recognized by their owners."
Interesting. I am not recommending you kick your cats out of the house or going to the pound and dropping them off. If is a sign that maybe our cats should house or outdoor cats but not both.
 

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Also on Herd Immunity from the New England Journal of Medicine:

Infection rate in France: Researchers estimate that in France, just 4.4% of the population has been infected with SARS-CoV-2. Their modeling study, reported in Science, also suggests that 65% of the world would need to be immune to establish herd immunity. The results therefore strongly suggest that, without a vaccine, herd immunity on its own will be insufficient to avoid a second wave at the end of the lockdown.
 

Peartree

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A new report from NEJM:



Interesting. I am not recommending you kick your cats out of the house or going to the pound and dropping them off. If is a sign that maybe our cats should house or outdoor cats but not both.
They've been talking about this for a while since they diagnosed the big cats at the Bronx zoo. Since our cats don't normally go to church, restaurants, or rock concerts, they aren't likely to bring a virus home to us. *We* are the ones who are endangering them, not they, us.
 

Stefan2k4

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There are actually a couple of other corona virus that can affect cats. There's the relatively benign FECoV which might cause mild symptoms or no symptoms at all. Then there is the dreaded FIPV, which is devastating and fatal. The interesting part is cats don't catch FIP virus. Somehow and for some reason in a small percentage of cats, FECoV mutates into FIPV, and prior exposure and antibodies are believe to somehow make this more likely. Recently, there seems to be a drug known as GS-441524, which is quite similar to Remdesivir that has shown some promise in treating FIP. Perhaps it could be useful against SARS-CoV-2 as well?


Cats can also get H1N1 as well. Last summer, I had a kitty that came down with what intitally appeared to be an upper respiratory infection that didn't respond to antibiotics. One of the tests the vets performed on her was a swab test that tested for several viruses, one of them being H1N1. Unfortunately, in her case it turned out not to be an infection at all but nasal B cell lymphoma. Anyway, it's been documented that cats can indeed catch some strains of flu from their owners.
 

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They've been talking about this for a while since they diagnosed the big cats at the Bronx zoo. Since our cats don't normally go to church, restaurants, or rock concerts, they aren't likely to bring a virus home to us. *We* are the ones who are endangering them, not they, us.
That is probably 100% correct. Still no reported deaths in house cats from COVID-19. They are reportedly "asymptomatic spreaders".
 

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There are actually a couple of other corona virus that can affect cats. There's the relatively benign FECoV which might cause mild symptoms or no symptoms at all. Then there is the dreaded FIPV, which is devastating and fatal. The interesting part is cats don't catch FIP virus. Somehow and for some reason in a small percentage of cats, FECoV mutates into FIPV, and prior exposure and antibodies are believe to somehow make this more likely. Recently, there seems to be a drug known as GS-441524, which is quite similar to Remdesivir that has shown some promise in treating FIP. Perhaps it could be useful against SARS-CoV-2 as well?


Cats can also get H1N1 as well. Last summer, I had a kitty that came down with what intitally appeared to be an upper respiratory infection that didn't respond to antibiotics. One of the tests the vets performed on her was a swab test that tested for several viruses, one of them being H1N1. Unfortunately, in her case it turned out not to be an infection at all but nasal B cell lymphoma. Anyway, it's been documented that cats can indeed catch some strains of flu from their owners.
Remdesivir is a good drug. Expensive but seems to work.
 

NateB

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Remdesivir is a good drug. Expensive but seems to work.
Now that it is public information, our docs and patients have been part of the trial for Remdesivir for Covid with good results. The first ICU patient we had was treated with it. He has since been discharged from the hospital, but still in inpatient therapy.

Another patient was treated with hydroxychloroquine and azthromycin but ended up on ECMO for 2 weeks before recovering. 2 cases made public are hardly enough to base more decisions on, but are certainly helpful for researchers.
 

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Now that it is public information, our docs and patients have been part of the trial for Remdesivir for Covid with good results. The first ICU patient we had was treated with it. He has since been discharged from the hospital, but still in inpatient therapy.

Another patient was treated with hydroxychloroquine and azthromycin but ended up on ECMO for 2 weeks before recovering. 2 cases made public are hardly enough to base more decisions on, but are certainly helpful for researchers.
I have a much large pool of data but I am not at liberty to release the specifics. Remdesivir vs several other treatments and drugs: It is not even close. Remdesivir by a mile. Other positive treatments: Pruning and Nitric Oxide.
 

Angie

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Do you know if pet Bunny rabbits that stay inside are in the same classification of house cats? I've had someone ask me if bunnies can catch C-19
 
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