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Coronavirus: What questions do you have?

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afadeev

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Kids not bring in school is hurting them and it is more than just learning.
Contact tracing data locally has failed to show a single case of "supersprading". Meanwhile, schools around the world is mounting and places like India, Japan, Thailand, South Africa, and Vietnam are finding that opening schools did not contribute to “superspreader” events. In Sweden, there is zero mortality from the virus in the 1.8 million children who stayed in school in the spring. It makes you question our decisions.
Totally agree on schools contributing an essential social learning aspect to kids development.
Home-schoolers might dissent, but I send my kids to school and clubs to primarily help them develop social and communication skills.

But you are misinterpreting the circumstances around schools re-opening for in-person learning.

Data point #1: Three (3) towns around mine, as well as our own school district, had gone all-virtual for at least one day to conduct contract-tracing after someone at school had tested positive for cov-2. All nearby school districts have implemented 50-50 class split with mandatory masks worn by students and teachers, to allow for 6+" if distancing in the classrooms. As a result, all Cov-2 positives were traced to events outside of school, and in-class instructions resumed. That includes a dozen+ teenagers who held a Labor Day party in someone's garage (house of a school district employee), all of whom got infected.
Data point #2: One of the neighboring towns never opened for in-person schooling, as did many other school districts in NJ, because they could not get enough teachers to commit to show up. Enough teachers have threatened to call-in sick to make in-class education untenable. They have gone into 100% virtual (pun intended) learning mode.
Data point #3: Our school district can not secure enough substitute teachers, for the first time ever. Admins have publicly announced that fact, and at least once already my kids were left without instruction doing "online labs" when one of the teachers got sick and a qualified substitute could not be found.
Data point #4: Many of friends whose kids go to private schools report that enrollment this year fell 30-50% off from the prior year. A few private schools have not opened at all. Parents who are able to afford $35+55K/year/kid for private schools, have shifted those funds into hiring private tutors instead. Which further exacerbates points #2 and #3.
Data point #5: For the first time, EVER, my kids are actually looking forward to going to school, in-person.

Now that Cov-2 positives are spiking throughout the country, and hospitals are starting to fill up again (with the inevitable consequences that will follow, with some lag), I am NOT too optimistic that we will manage to stay safe and continue with in-person learning throughout the year.

In September, 242 out of ~600 NJ school districts were forced into all-remote opening mode due to teachers shortages and parents' concerns.
https://www.nj.com/education/2020/0...e-opening-all-remote-hybrid-or-in-person.html
Since then, many more shifted into online-only mode.
I'm holding my breath for when we will be next.

Pretty good with social distancing. In fact, social distancing may be a superior prophylactic.
Only if you wash your hands, right ?!
:cool:
 

cwbullet

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In the news:

This happens when you test too many asymptomatic people with screenings tests. Exposers need to incubate and unlikely exposures should not be tested. The world is trying to use the test as a rule-out test and it is not able to do that. It is a good rule in the test with your index for suspicion is high for COVID. If your index is low, DO NOT order the test. This being said, if properly ordered and performed, the false positive rate is low.
 

Peartree

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The world is trying to use the test as a rule-out test and it is not able to do that. It is a good rule in the test with your index for suspicion is high for COVID. If your index is low, DO NOT order the test. This being said, if properly ordered and performed, the false positive rate is low.
Yeah, but everyone is really hoping for a "rule out test" that will work. That would be a game changer. We could have church choir practices and Kiwanis meetings simply by testing everyone on the way in the door and things would feel a lot more "normal" than they have since March.
 

cwbullet

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Today, I found a pretty good research test. 98% specific and 97.5% sensitive. The problem is that is with symptomatic patients. It is a new antigen test. Binaxnow
 

mo2872

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Question: I find myself in a quandary this evening. Came home freezing, but the heat had been out in the office today, so didn’t think anything about it. Until I couldn’t warm up even under blankets. Great. Take temp with forehead scanner, normal. Underarm, one degree over normal. Great. Grab the ear probe....101! Great great.
Now the question is, which one do I trust????

I feel fine, other than the earlier chills......now what????
 

cwbullet

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Question: I find myself in a quandary this evening. Came home freezing, but the heat had been out in the office today, so didn’t think anything about it. Until I couldn’t warm up even under blankets. Great. Take temp with forehead scanner, normal. Underarm, one degree over normal. Great. Grab the ear probe....101! Great great.
Now the question is, which one do I trust????

I feel fine, other than the earlier chills......now what????
The most accurate temperature is a core temperature such as a rectal temperature. A rectal temperature can be taken on individuals of all ages, but it may be uncomfortable. I do not recommend doing these on yourself. A rectal temperature is an internal measurement taken in the rectum and is slightly higher at 99.6 °F or 37.6 °C.

The next best is oral but must be done without recent cold or hot drinks. An oral temperature is measured with a thermometer placed under the tongue, is the most convenient and comfortable type of temperature measurement for adults. A normal oral temperature is 98.6°F or 37.0 °C. This is the accepted standard temperature for the normal body temperature.

External measures of the body’s temperature such as an axillary, tympanic membrane, or skin temperatures are the least accurate and may take hours to reflect true changes in the body’s core temperature. They are very susceptible to changes in the environment and extremes in temperatures.

I recommend oral temperatures but make sure you are using an oral thermometer.
 

mo2872

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Thanks Chuck. Went and purchased a new oral thermometer, and getting 97.1*F. Will monitor through the day, I suppose.
 

boatgeek

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FWIW, there's a pretty wide range of "normal" temperatures, at least on the low side. I (and my kids) normally run around 96.5-97 on an oral thermometer, and I start feeling really crappy if I get over 99. Of course, the standard for a fever is 100... Sometimes it helps to explain that to medical professionals, and sometimes is hasn't. I don't know if there's a similar range of normal on the high side, but Chuck surely does.
 

mo2872

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FWIW, there's a pretty wide range of "normal" temperatures, at least on the low side. I (and my kids) normally run around 96.5-97 on an oral thermometer, and I start feeling really crappy if I get over 99. Of course, the standard for a fever is 100... Sometimes it helps to explain that to medical professionals, and sometimes is hasn't. I don't know if there's a similar range of normal on the high side, but Chuck surely does.
Yes, my “normal” range since we’ve been monitoring daily at work is 97.1-98.0 via forehead scanner.
 

SecondRow

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FWIW, there's a pretty wide range of "normal" temperatures, at least on the low side. I (and my kids) normally run around 96.5-97 on an oral thermometer, and I start feeling really crappy if I get over 99. Of course, the standard for a fever is 100... Sometimes it helps to explain that to medical professionals, and sometimes is hasn't. I don't know if there's a similar range of normal on the high side, but Chuck surely does.
My wife runs low as well. To the point where she feels terrible at 98.6. Once, back when we were dating and visiting my family, she started experiencing stomach pain. The day started off as mild discomfort, but got worse. It turned to vomiting. So I took her to the ER, where the triage nurse just stonewalled us because her temp was “normal”. We tried explaining, but she just assumed pregnant.

Finally, we get a bed and every nurse there has now already assumed she’s either pregnant or has a blockage because her temp isn’t high. Meanwhile, my wife is about to pass out. They take her blood to run tests. Then, the doctor comes in, touches her stomach once and says “She’s got appendicitis. She needs surgery immediately.” The head nurse objects because they don’t have the results from the blood test. I’ll never forget what he said. In a thick Jersey accent, he says “I don’t need a test. She’s got the look.” He turns to my wife and explains “Every case of appendicitis, when I touch the patient right here, they make the same look on their face. You got the look. Let’s go.”

Sure enough, he was right. I try not to think about what would’ve happened if the nurses had their way. You have to explain over and over again that some people normally run lower than 98.6.

“You got the look” has been a running inside joke between me and my wife for 20 years now.
 

boatgeek

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My wife runs low as well. To the point where she feels terrible at 98.6. Once, back when we were dating and visiting my family, she started experiencing stomach pain. The day started off as mild discomfort, but got worse. It turned to vomiting. So I took her to the ER, where the triage nurse just stonewalled us because her temp was “normal”. We tried explaining, but she just assumed pregnant.

Finally, we get a bed and every nurse there has now already assumed she’s either pregnant or has a blockage because her temp isn’t high. Meanwhile, my wife is about to pass out. They take her blood to run tests. Then, the doctor comes in, touches her stomach once and says “She’s got appendicitis. She needs surgery immediately.” The head nurse objects because they don’t have the results from the blood test. I’ll never forget what he said. In a thick Jersey accent, he says “I don’t need a test. She’s got the look.” He turns to my wife and explains “Every case of appendicitis, when I touch the patient right here, they make the same look on their face. You got the look. Let’s go.”

Sure enough, he was right. I try not to think about what would’ve happened if the nurses had their way. You have to explain over and over again that some people normally run lower than 98.6.

“You got the look” has been a running inside joke between me and my wife for 20 years now.
Years ago when my older kid was about 9, they complained one night about stomach pain. We said we'd look at it in the morning. In the morning, they said they were pretty sure it was appendicitis. This kid had spent the entire time since learning to read going over the books we had about childhood ailments, so we kind of blew it off. Suuuure, appendicitis, we said. But OK, we'll go to the drop-in clinic at the pediatrician's office. My wife and the kid were sitting on the steps 10 minutes before the office opened when the pediatrician unlocks the door. The doc took one look at the kid and ushered us inside. About 15 minutes later, there was an appendicitis diagnosis and an order to report to Children's Hospital across town. Unfortunately, it took a while to get the official tests done and get in line for an OR, so they couldn't get to surgery before about 10pm. By that time, the appendix had perforated a bit, so it meant more time on high test antibiotics.

To this day, we don't doubt self-diagnoses anymore.
 

BABAR

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Today, I found a pretty good research test. 98% specific and 97.5% sensitive. The problem is that is with symptomatic patients. It is a new antigen test. Binaxnow
Great test. Still won’t work for what @Peartree wants to do.
Say you have 50 people in your choir. They all test negative. There is a reasonable chance that you missed one (ultimately depends on disease protest probability, but reasonable to expect you will miss one in 50.)

If no masks and no social distancing, you started with one case. You finish with 42 more, depending on how exuberant the singing is, and one or two deaths.

 

BABAR

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My wife runs low as well. To the point where she feels terrible at 98.6. Once, back when we were dating and visiting my family, she started experiencing stomach pain. The day started off as mild discomfort, but got worse. It turned to vomiting. So I took her to the ER, where the triage nurse just stonewalled us because her temp was “normal”. We tried explaining, but she just assumed pregnant.

Finally, we get a bed and every nurse there has now already assumed she’s either pregnant or has a blockage because her temp isn’t high. Meanwhile, my wife is about to pass out. They take her blood to run tests. Then, the doctor comes in, touches her stomach once and says “She’s got appendicitis. She needs surgery immediately.” The head nurse objects because they don’t have the results from the blood test. I’ll never forget what he said. In a thick Jersey accent, he says “I don’t need a test. She’s got the look.” He turns to my wife and explains “Every case of appendicitis, when I touch the patient right here, they make the same look on their face. You got the look. Let’s go.”

Sure enough, he was right. I try not to think about what would’ve happened if the nurses had their way. You have to explain over and over again that some people normally run lower than 98.6.

“You got the look” has been a running inside joke between me and my wife for 20 years now.
Today we call the look, “CT.”
 

NateB

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Our local news just published a press release stating that the first doses of a covid vaccine from Pfizer are expected in Indiana mid-november with one from Moderna expected to be available in December.

Is there any place where one can easily compare vaccine options and make an informed decision without being able to digest published tests or journal articles?
 

NateB

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“I’m in V-fib again! I’m in V-fib again!” (Okay, non-medical people may not think this is funny.)
We did have one pt with runs of v-tach that he could feel coming on. He told us it was happening again in the elevator, his eyes rolled in the back of his head and he went pulseless. We learned that day that the ICU gets really quiet, really quick when the elevator doors open and the staff all hear the defib charging.
 

cwbullet

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I have had patients like this before. I think V-Tach also.

I made a decision in my career that has been spawned by COVID. I am rotating out of leadership this summer by my choice and returning to clinical care to prepare for military retirement. It has been a fun and entertaining first career, but it is time. I will have 24 years when I finally hand up the uniform. I am tired of the OP tempo and want to focus on my family.
 

PatD

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Congratulations. Going into medical practice once you are out? Kind of a built in retirement profession, if you still like the clinical side. :) One thing I think you will miss is the military family, I know I do.
 

BABAR

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I have had patients like this before. I think V-Tach also.

I made a decision in my career that has been spawned by COVID. I am rotating out of leadership this summer by my choice and returning to clinical care to prepare for military retirement. It has been a fun and entertaining first career, but it is time. I will have 24 years when I finally hand up the uniform. I am tired of the OP tempo and want to focus on my family.
Looks like you have done more than your share.

You sound like someone extremely dedicated to your patients, which is good. Be careful in choosing a clinical practice, it is very easy for physicians with your degree of devotion to set themselves up for burnout (in your case sounds like you did this already in your military career.)

Find a job that gives you balance, enjoy your family and your job. Maybe find a civilian lifestyle mentor who you meet with regularly to keep you from letting your medical practice eat you alive.

Good dedicated civilian providers are desperately needed, but “the system” often destroys rather than rewards them. I wish you the best!
 

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Looks like you have done more than your share.

You sound like someone extremely dedicated to your patients, which is good. Be careful in choosing a clinical practice, it is very easy for physicians with your degree of devotion to set themselves up for burnout (in your case sounds like you did this already in your military career.)

Find a job that gives you balance, enjoy your family and your job. Maybe find a civilian lifestyle mentor who you meet with regularly to keep you from letting your medical practice eat you alive.

Good dedicated civilian providers are desperately needed, but “the system” often destroys rather than rewards them. I wish you the best!
Thank you. I will find a mentor. I appreciate the advice. Part of my problem is work and living in separate homes from my spouse (our choice but cause my Army duty location) has limited my ability to participate in rocketry. That is the vent that reduced burnout.

I entered Army Medicine 22 years ago. I found out today that I am one of two left from my year group my specialty group. All of my internship group have left. I could stay for 30 years (8 more years). It would add retirement value, but so would a civilian or non-military government job.
 

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If it won't prevent all infections, why are we funding the vaccine
The goal of a vaccine is to reduce the impact of the disease both financially and medically. The small multibillion-dollar investment will turn much more dividends by reducing absenteeism at work, medical visits to emergency rooms, hospitalizations, and the possibility of a pandemic. This paltry investment will save us money in the future even if the vaccine is not 100% effective.
 

BABAR

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80% of Covid hospitalizations have VIT D deficiencies. Is that a cause, effect, or unrelated common variable?
Okay I am up because I work nights, this is a rare night I have time to breath. What’s your excuse?

Nearly all the ICU films and CTs on the Covid patients are on marked to morbidly obese patients. Suspect it is the obesity that is causing both the vitamin D deficiency


As well as the high admission and mortality rate. IOW, the D deficiency is a red herring.

We have GOT to get the message across to our teens and kids (probably too late for the adults) that obesity is a severe and potentially fatal state, condition, disease, whatever you want to call it. Particularly the vast majority of Covid deaths in young patients are probably related to obesity. Americans are literally eating themselves to death. It is becoming the leading cause of kidney and liver failure, in addition to the obvious heart disease and cerebrovascular disease. It is also a leading cause of spine and extremity arthritis . God did not design our skeletons to drag around this much mass.
 

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Okay I am up because I work nights, this is a rare night I have time to breath. What’s your excuse?

Nearly all the ICU films and CTs on the Covid patients are on marked to morbidly obese patients. Suspect it is the obesity that is causing both the vitamin D deficiency


As well as the high admission and mortality rate. IOW, the D deficiency is a red herring.

We have GOT to get the message across to our teens and kids (probably too late for the adults) that obesity is a severe and potentially fatal state, condition, disease, whatever you want to call it. Particularly the vast majority of Covid deaths in young patients are probably related to obesity. Americans are literally eating themselves to death. It is becoming the leading cause of kidney and liver failure, in addition to the obvious heart disease and cerebrovascular disease. It is also a leading cause of spine and extremity arthritis . God did not design our skeletons to drag around this much mass.
I would recommend 30 minutes of outdoor walking and a healthy diet every day. It will fix both issues.
 

cwbullet

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I am working on an observation data review. I have looked at data from 18 large to medium medical centers and community hospitals. The focus in on COVID numbers in staff. Nearly 80% of the infections were in Emergency Department staff and almost two-thirds spend more than 20 minutes in a break room per shift. All of the facilities had mask mandates with provisions to remove them when eating.

Think about the results when you dine in a restaurant.
 

NateB

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I am working on an observation data review. I have looked at data from 18 large to medium medical centers and community hospitals. The focus in on COVID numbers in staff. Nearly 80% of the infections were in Emergency Department staff and almost two-thirds spend more than 20 minutes in a break room per shift. All of the facilities had mask mandates with provisions to remove them when eating.

Think about the results when you dine in a restaurant.
I know it would be hard, but were any cases identified where Covid was thought to have been spread from patient to provider?

I have noticed some other hospitals and other departments have been wearing cloth or surgical masks rather than N95s when working with low risk or patients where Covid-19 was ruled out. Our staff is pretty good about wearing PPE, but our manager and infection control office are pretty serious about enforcing policy. As best as we were told, there isn't though to be widespread outbreaks from patients, just spread in temhe community or break areas.
 
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