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NOLA_BAR

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We are definitely seeing an increase in hospitalizations. Nowhere near the peak back in the spring or midsummer, but above the low we had on October 4th of 518. Now at 644.
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Also seeing a rise in positivity. The daily incidence of positive tests is erratic. With all the storms, displaced citizens, and out-of-state visitors and repair workers it's hard to figure out.
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The state is currently at Stage 3 which allows 75% occupancy in restaurants. There is also a state-wide mask mandate. Our governor is in a constant battle with a state legislature that wants to check the public health measures. Will see.
 

NateB

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The headline on this article is a little misleading: from the article half of the responding physicians report either making changes to their practice, retiring, or changing professions. Including retirement, about 20% of physicians look to be retiring, turning away from patient care, or changing careers entirely because of this pandemic.

Chuck, I know you said you were looking move away from your military career. Have you heard the same from other physicians? I haven't heard physicians talk about leaving who weren't already retiring, but I mostly only see the ER group who oversee us. We have had a few nurses and medics leave the field because of this.
 

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The Centre for Evidence-Based Medicine
Are you infectious if you have a positive PCR test result for COVID-19?

"...PCR results may lead to restrictions for large groups of people who do not present an infection risk."
"The results indicate that viral RNA load cut-offs should be used: to understand who is infectious, the extent of any outbreak and for controlling transmission."

What is your understanding of this study ?
It is all we have and we must try to protect the elderly.
 

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The headline on this article is a little misleading: from the article half of the responding physicians report either making changes to their practice, retiring, or changing professions. Including retirement, about 20% of physicians look to be retiring, turning away from patient care, or changing careers entirely because of this pandemic.

Chuck, I know you said you were looking move away from your military career. Have you heard the same from other physicians? I haven't heard physicians talk about leaving who weren't already retiring, but I mostly only see the ER group who oversee us. We have had a few nurses and medics leave the field because of this.
A lot of military physicians are retiring. It has little to do with COVID and lot to do with current climate in the military.
 

ksaves2

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I bailed out of primary care FP (mainly geriatrics) last July 1st from a multi-specialty group practice. The group was fine. The people/docs I worked with were great. The Obama mandated EHR and documentation is not. Covid was part of but not the primary reason to retire. What the government doesn't realize is docs can advise people what to do for good health but patients don't have to follow that advice one iota. Look at the diabetes and obesity problem this country has. Think primary care is to blame! Heck no! People go out the door and keep doing the same lousy health behaviors they did before they came to the office. When I went to med school, '78 - '82, I was told I could only advise patients what to do for good health. They didn't have to follow my recommendations! Now they have this "accountable" care and P4P (pay for performance) bullcrap and doctors can't get most people to change their habits, period and get dinged for it. I hit 64 years old, had medical insurance so it was bye-bye for me. I took my skills with me to lay dormant and I have zero regrets. Sorry for being OT but when folks bring up the topic of MD's leaving practice, it really jerks my chain. Practice was satisfying until they started blaming doctors for outcomes. Once the D@m^ed patient leaves the office or hospital, they do whatever they please. Kurt (back to the regularly scheduled Covid discussion. Cripes up to 837 cases and 4 deaths in my Illinois county. Most have survived but the last couple of weeks have ballooned. Shoot.)
 

NateB

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What the government doesn't realize is docs can advise people what to do for good health but patients don't have to follow that advice one iota.
I hate how reimbursement depends on the patient being compliant. Readmissions don't get paid the same or at all in some cases, and like you said, if the patient doesn't follow the doctor's advice they won't get better. I intubated the same patient 3 times in just over a year for COPD and he continued to smoke multiple packs a day. At some point the patient needs to accept responsibility for their actions.
 

Bill S

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"At some point the patient needs to accept responsibility for their actions."

That's the issue. Hardly anyone will accept responsibility for anything at all. After all, its always someone else's fault, and many people have a severe victim mentality, along with a case of entitlement and there you go. :(
 

mo2872

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Wish I knew how to fix that “personal responsibility“ problem. Think it’s bleeding heart juries that have spurred the issue?
 

NateB

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To be fair, most patients are compliant with their care and many injuries and illnesses are no true fault of their own and are either genetics or accidents. KSaves certainly has a different view in primary care than my experience in EMS. The problem that really hurts the finances of the healthcare industry are the small percentage of people who really ignore the help we give them start to amount for a larger amount of visits and expensive care.
 

NateB

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Wish I knew how to fix that “personal responsibility“ problem. Think it’s bleeding heart juries that have spurred the issue?
In my world, the juries are a small part, but the insurance companies and CMS are a bigger role. Our healthcare system is broken in many places from the board rooms and courts, to Wall Street and Capital Hill. That's probably as far off topic as we should get though before breaking rules and ruining the Q&A thread.
 
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boatgeek

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A lot of military physicians are retiring. It has little to do with COVID and lot to do with current climate in the military.
Can you give a short capsule of the problem with the current climate? I totally understand if you can't, but first hand knowledge is always better.
 

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Can you give a short capsule of the problem with the current climate? I totally understand if you can't, but first-hand knowledge is always better.
For me, It is a list of things.
  • I have been a geographical bachelor for 5 years and want to live in the same house with my wife. She no longer wants to move every 1-3 years.
  • The PC culture is destroying our military. We need to treat people with dignity and respect but we cannot be worried at every moment about hurting someone's feelings.
  • I am nearly 53 years old and the Army just changed their fitness test. I am just too old for the high impact lifestyle that is demanded.
  • 10 years ago, most of the commanders were doctors and nurses. Now they are administrators and I tire of explaining to them why they can just order me to do a test or procedure. I actually had one order me to give all the STD results for her until a few years ago. I contested and won the battle but it was a hassle.
 

cwbullet

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Myth: the PCR test is worthless. A recent article in the NY Times hinted that the PCR for Covid was next to worthless.


This is absolutely false. The test is not a great test unless the patient is symptomatic. If you order it after the symptoms are gone or too early, you can create a false positive or negative. It is vitally important that the test be used correctly.
 

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Think about it this way - NYT claims 90% are not contagious so there for 90% do not need to quarantine. How do you determine that 90%? The test and tightening results will not do it. That is an over-simplistic view.

I personally disagree with shutdowns right now. We need to find a way to live with this virus and that means masks in public and quarantine if you are ill. We cannot destroy our culture and country.

Testing should be reserved for contacts and symptomatic patients 3-5 days into the illness or 3-5 days after the exposure. From what I have seen, we are testing way too much and the wrong populations. You can be positive for up to 90 days after exposure. That is not common, but testing everyone will still bring up a bunch of those.

Do we need a mask mandate? Absolutely not. Why mandate the wearing of masks when you step outside your home to run or exercise? It should mask or social distance outdoors. Mask 100% of the time in public spaces indoors.
 

KC3KNM

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Do we need a mask mandate? Absolutely not. Why mandate the wearing of masks when you step outside your home to run or exercise? It should mask or social distance outdoors. Mask 100% of the time in public spaces indoors.
FWIW I went on a bike ride this weekend in northern MA. All the entrances to the path had signs requiring mask use. Didn't see any detractors, and people would bunch up on busy sections, so I can't see how it'd hurt. I smoke a pack a day and had no issues riding 20 miles with a mask on. What's the benefit to not requring masks for folks walking around town on the sidewalk or going for a walk or run? For how easy it is to put on a mask I really don't see the downside to requiring them in public spaces (indoor or out). Seems like the butt pain to wear a mask is minor vs. the difference it could make.
 

CalebJ

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For some of us, exercising generates too much sweat to wear a mask for long. I can run with one until it loads up in sweat, but at that point it doesn't allow enough air through to continue.
 

KC3KNM

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For some of us, exercising generates too much sweat to wear a mask for long. I can run with one until it loads up in sweat, but at that point it doesn't allow enough air through to continue.

They gave us a few of these at work, they're great for wearing while working out.
 

CalebJ

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Interesting. I'd be curious to look at one up close but not terribly optimistic. OR makes great products, but I haven't found a fabric yet that breathes well enough to keep up as a base layer or anything else. It's all eventually drenched. I frequently wring my shirt out mid run if I stop for any reason.
 

SecondRow

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Myth: the PCR test is worthless. A recent article in the NY Times hinted that the PCR for Covid was next to worthless.
The original NYT article is over two months old and, in my view, doesn’t say what the Daily Wire blog you linked to purports. It doesn’t even hint that the test is worthless or that 90% of people who test positive shouldn’t quarantine.

It is vitally important that the test be used correctly.
Yes, that’s what the NYT article hinted at.

https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html
 

kuririn

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The original NYT article is over two months old and, in my view, doesn’t say what the Daily Wire blog you linked to purports. It doesn’t even hint that the test is worthless or that 90% of people who test positive shouldn’t quarantine.
Yes, The Daily Wire takes selective parts of the NYT article and spins them into "this test is practically worthless".
The original article says something quite different.
Same thing happened on this thread:
I think the main point that Chuck is trying to say is that the Daily Wire's spin is a myth.
 

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NateB

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Why mandate the wearing of masks when you step outside your home to run or exercise? It should mask or social distance outdoors. Mask 100% of the time in public spaces indoors.
I have done most of the activities I normally would do during the Summer. I haven't worn a mask when hiking or mountain biking. I've only hiked alone or with my son and other people were few and far between. When mountain biking on singletrack trails, if you get within 6ft of someone you are doing something wrong. The crash would most likely be worse than the chance of catching Covid.

I have been to the zoo and an amusement park that I used to work at several times. Masks were required at both places and social distancing measures were taken as much as possible. I felt plenty safe and haven't heard of either place being linked to covid outbreaks.

There was interesting research out of Germany with indoor concerts. They had 1000 people in a club, but I think that was still partial capacity. Everyone was masked and remained in their seats, so it wasn't a true concert experience. They found the ventilation in the club played the biggest role in limiting any spread of droplets. The study still needs peer review, but the conclusion that mask wearing and lots of airflow indoors makes for a much lower risk of spreading disease. If the results are reproduced, this should make outdoor events easy to call low risk and indoor events manageable.
 

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Thought I’d give a little status update. I’m on Day 12 since I had a fever, and Day 10 since my positive result. I have had no other recognizable symptoms since the fever, or before. I can totally see how and why this bug is spreading like wildfire, even amongst a mask user(me).

I count myself fortunate with this outcome, as it could have been way worse. I’m not the healthiest guy in the world, and could certainly stand to lose a few. I am reasonably fit overall, as far as no other real comorbidities. I don’t have high BP, cholesterol was slightly high last year, but have been on Crestor since, no diabetes or other issues.

Hoping to get clearance to return to work soon. 🤞
 

Cl(VII)

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With Pfizer/BioNTech announcing their vaccine efficacy data today I got curious about how the work toward their cold distribution chain was going. The WSJ has a very good article on that here: https://www.wsj.com/articles/pfizer...vaccination-distribution-campaign-11603272614

My read is that they really have it together on this, and spent a bunch of Pfizer money (they didn't take Operation Warp Speed cash) to build and work out a robust cold supply chain. I am very encouraged by the detail of their custom shipping box that will allow for 1000-5000 doses per box, and hold temp for 10 days...it sounds like a small detail, but it will make a big difference versus stock cold shipping containers. Also, that they will be relying on existing couriers across many flights per day. I was afraid they would be relying on a relatively dedicated supply chain, which is easier to manage, but leaves you open to catastrophic loss if something goes wrong. With the system they have chosen they will certainly experience some loss level, but it will be inherently limited in scale, i.e. no losing a 250,000 doses to a single warehouse fire/power outage/plane crash/truck wreck/blizzard/bad truck refrigeration unit/dock workers strike/etc.

This vaccine is not the end, but it does indicate we CAN reach an end that doesn't involve all of us getting there the hard way.

- Sorry if there is a better thread to post this in the COVID subforum, I blocked that thing long ago as it was nasty and unproductive (at least at that point).
 

NateB

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I am excited about the Pfizer results. 90% efficacy is huge. I am pretty sure my employer is set to be a distributor for my region, we already have the storage capability. Hopefully we start getting information about vaccine availability soon.
 

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With Pfizer/BioNTech announcing their vaccine efficacy data today I got curious about how the work toward their cold distribution chain was going. The WSJ has a very good article on that here: https://www.wsj.com/articles/pfizer...vaccination-distribution-campaign-11603272614

My read is that they really have it together on this, and spent a bunch of Pfizer money (they didn't take Operation Warp Speed cash) to build and work out a robust cold supply chain. I am very encouraged by the detail of their custom shipping box that will allow for 1000-5000 doses per box, and hold temp for 10 days...it sounds like a small detail, but it will make a big difference versus stock cold shipping containers. Also, that they will be relying on existing couriers across many flights per day. I was afraid they would be relying on a relatively dedicated supply chain, which is easier to manage, but leaves you open to catastrophic loss if something goes wrong. With the system they have chosen they will certainly experience some loss level, but it will be inherently limited in scale, i.e. no losing a 250,000 doses to a single warehouse fire/power outage/plane crash/truck wreck/blizzard/bad truck refrigeration unit/dock workers strike/etc.

This vaccine is not the end, but it does indicate we CAN reach an end that doesn't involve all of us getting there the hard way.

- Sorry if there is a better thread to post this in the COVID subforum, I blocked that thing long ago as it was nasty and unproductive (at least at that point).
Operation Warp Speed is a huge success and I say that, not only because I am a part of it, but because it developed more than one successful vaccine in record time. The process has purchased mobile testing and treating site to give the vaccines and do all that is need to ensure patients get their care. I have 5 of the trailers and 2 drive throughs at my disposal. They are well made and have all of the needed referigeration and freezer space to test and vaccinate.
 

cwbullet

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I am excited about the Pfizer results. 90% efficacy is huge. I am pretty sure my employer is set to be a distributor for my region, we already have the storage capability. Hopefully we start getting information about vaccine availability soon.
Ditto. I planned to post on this tonight, but you guys beat me to it. This is a huge kudo for our current administration. I wonder if any credit will be given. Operation Warp Speed is nearly 100% driven by executive order with emergency funding.
 

Cl(VII)

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Operation Warp Speed is a huge success and I say that, not only because I am a part of it, but because it developed more than one successful vaccine in record time. The process has purchased mobile testing and treating site to give the vaccines and do all that is need to ensure patients get their care. I have 5 of the trailers and 2 drive throughs at my disposal. They are well made and have all of the needed referigeration and freezer space to test and vaccinate.
Please don't read anything into my statement other than that it is a fact that Pfizer did not take OWS money for development (I don't know if their first contract for delivery was part of that program or a separate governmental contract)...I called that out to say that Pfizer had some skin in the game here as they put big $ at risk (yes, they have the big $ to risk, and there are multiple reasonings for why this may have been the route they chose, and I am intentionally not calling them out as I don't know why). I am personally a fan of the OWS concept and program, I believe it was the right thing to do, particularly because some of the players like Moderna are small, and just didn't have the experience/horsepower/cash to ramp up for the type of mega trial that was needed. Having site infrastructure in place is also obviously vital to the overall testing and distribution effort. We will almost certainly get more vaccines quicker as a result of the program.

I will have to take your word for the multiple vaccines (though I don't doubt it), as I am not privy to any of the other data. I have to operate under the "In God We Trust, all others, bring data" mantra.
 
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