Tuesday, March 24, 2020

Some More Therapeutic Reality

h/t Herschel @ Captain's Journal















A report from 5 minutes into the future. More information to the low information chattering monkeys who think Death Rate is the big problem. (Hey, fucktards, the Dow dropped 10,000 points, but nobody died. So, nothing to worry about there either, I suppose...? Just checking. Idiots.)

Bear in mind this is in Louisiana, not Lombardy, Italy, from a Respiratory Therapist:
Since last week, he’s been running ventilators for the sickest COVID-19 patients. Many are relatively young, in their 40s and 50s, and have minimal, if any, preexisting conditions in their charts. He is overwhelmed, stunned by the manifestation of the infection, both its speed and intensity. The ICU where he works has essentially become a coronavirus unit. He estimates that his hospital has admitted dozens of confirmed or presumptive coronavirus patients. About a third have ended up on ventilators. 
His hospital had not prepared for this volume before the virus first appeared. One physician had tried to raise alarms, asking about negative pressure rooms and ventilators. Most staff concluded that he was overreacting. “They thought the media was overhyping it,” the respiratory therapist told me. “In retrospect, he was right to be concerned.” 
"I have patients in their early 40s and, yeah, I was kind of shocked. I’m seeing people who look relatively healthy with a minimal health history, and they are completely wiped out, like they’ve been hit by a truck. This is knocking out what should be perfectly fit, healthy people. Patients will be on minimal support, on a little bit of oxygen, and then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all.” 
"We have an observation unit in the hospital, and we have been admitting patients that had tested positive or are presumptive positive — these are patients that had been in contact with people who were positive. We go and check vitals on patients every four hours, and some are on a continuous cardiac monitor, so we see that their heart rate has a sudden increase or decrease, or someone goes in and sees that the patient is struggling to breathe or is unresponsive. That seems to be what happens to a lot of these patients: They suddenly become unresponsive or go into respiratory failure.” 
"It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth. The ventilator should have been doing the work of breathing but he was still gasping for air, moving his mouth, moving his body, struggling. We had to restrain him. With all the coronavirus patients, we’ve had to restrain them. They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning." 
"Before this, we were all joking. It’s grim humor. If you are exposed to the virus and test positive and go on quarantine, you get paid. We were all joking: I want to get the coronavirus because then I get a paid vacation from work. And once I saw these patients with it, I was like, Holy shit, I do not want to catch this and I don’t want anyone I know to catch this." 
“I worked a long stretch of days last week, and I watched it go from this novelty to a serious issue. We had one or two patients at our hospital, and then five to 10 patients, and then 20 patients. Every day, the intensity kept ratcheting up. More patients, and the patients themselves are starting to get sicker and sicker. When it first started, we all had tons of equipment, tons of supplies, and as we started getting more patients, we started to run out. They had to ration supplies. At first we were trying to use one mask per patient. Then it was just: You get one mask for positive patients, another mask for everyone else. And now it’s just: You get one mask."
“I work 12-hour shifts. Right now, we are running about four times the number of ventilators than we normally have going. We have such a large volume of patients, but it’s really hard to find enough people to fill all the shifts. The caregiver-to-patient ratio has gone down, and you can’t spend as much time with each patient, you can’t adjust the vent settings as aggressively because you’re not going into the room as often. And we’re also trying to avoid going into the room as much as possible to reduce infection risk of staff and to conserve personal protective equipment.” 
“There is a very real possibility that we might run out of ICU beds and at that point I don’t know what happens if patients get sick and need to be intubated and put on a ventilator. Is that person going to die because we don’t have the equipment to keep them alive? What if it goes on for months and dozens of people die because we don’t have the ventilators?" 
“Hopefully we don’t get there, but if you only have one ventilator, and you have two patients, you’re going to have to go with the one who has a higher likelihood of surviving. And I’m afraid we’ll get to that point.”
RTWT

Yet again:


 

41 comments:

Anonymous said...

The Governor of NY wants 30,000 ventilators. I hope his Top Men have compiled a list of the extra available techs to run them. As Aesop has pointed out and this story demonstrates, you cannot just pull these people out of thin air.

nick flandrey said...

Nor can you pull the vents out of thin air. He can stomp his feet and demand all he wants to, but there are only so many available. He wants them ALL, even though they won't be enough ever, and he wants everyone else to get FUCK ALL.

Maybe triage NYFC and send all the extra vents to places where it will actually matter?

Nope. Can't do that. Gotta spread them around so that no one benefits.

nick

Anonymous said...

A voice of reason

http://coyoteblog.com/coyote_blog/2020/03/covid-19-and-some-thoughts-on-data-analysis.html

Anonymous said...

Do you think we will have a mask shortage? NY Presbyterian uses 40,000 masks per day, and may use up to 70,000 per day. That is 1.2-2.1 Million Masks per month. TWO MILLION MASKS FOR ONE HOSPITAL.

https://www.usatoday.com/story/news/nation/2020/03/22/coronavirus-n-95-mask-shortage-us-fema-donald-trump/2895344001/

Last I heard 3M was making 35 million masks per month at their Dakota Plant.

The math doesn't work.

Anonymous said...

Governor Cuomo didn't want to buy 16,000 ventilators back in 2015. He decided then that he was going to triage patients and let them try to live without any help. Maybe they should blue tag Cuomo and his entire administration.

https://www.realclearpolitics.com/articles/2020/03/18/new_yorks_ventilator_rationing_plan_142685.html

Anonymous said...

Anecdotal Hydroxychloraquine success in NY,

https://www.citizenfreepress.com/breaking/ny-doctor-has-remarkable-results-with-hcq-500-patients-zero-hospitalizations/

There is also an oncology doctor that said his NYC hospital and others are using it as a standard treatment now.

Anonymous said...

Coronavirus is now in the NYC Homeless population.

https://nypost.com/2020/03/24/coronavirus-in-ny-30-people-in-homeless-shelters-test-positive/

The hospital sent patient zero back to the shelter. Five of the thirty positives left and they don't know where they are?

Anonymous said...

More anecdotes about Chloriquine,

https://threadreaderapp.com/thread/1241653925171720193.html

The interview with the doctor from Lenox-Hill is also interesting.

These aren't just isolated cranks pushing snake oil. Hopefully we get more results from NYC by rhe end of this week

Anonymous said...

I am hearing that your descriptions in this post are dead on accurate, primary sources. Bad juju is here. Thanks again for posting.

McChuck said...

There are two rules of war.
Rule number one is that young men die.
Rule number two is that doctors can't change rule number one.
--M*A*S*H: TV show

You cannot save everyone in an epidemic. Save those you can, preferably the younger, healthier (beforehand) people. (civilizational triage)

You're going to have to let people die. And nurses get the "privilege" to hold their hands while they die, so that in their last moments they knew somebody cared.

Anonymous said...

Trump says we are back to work April 1, a beautiful day.

Barb said...

FWIW to medical: Ive posted this before. It's just a thought and experimental research report.https://doi.org/10.1016/j.resuscitation.2007.10.016

Barb said...

Perhaps those that are specialists might consider..I dont have any expertise here..just an old retired RN concerned for my own ass and others too.
lnow

Barb said...

FWIW and this
https://emcrit.org/pulmcrit/split-ventilators/

Anonymous said...

You're going to have to let people die. And nurses get the "privilege" to hold their hands while they die, so that in their last moments they knew somebody cared.

God bless the people who give comfort to the dying...
_revjen45

Barb said...

Imo testing medical personnel could be a tool to discern asymptomatic carriers among hospital personnel..nosocomial viral load already.Since actual cause of death probably under reported and written off to covid 19 from reports of Italys death rates and ? early stats..think S.Korea did do testing of personnel but were able to do so...

Anonymous said...

@anonymous 5:56AM

April 12th, not April 1st. Easter Sunday. When the country will rise again with our Lord and Savior Jesus Christ. Pray that it happens because that's about what we've got right now, given the state of the medical supply chain.

Nemo

Aesop said...

@McChuck

1) This ain't a war, so that's irrelevant.
2) The people I'm going to "let" die will be the stupid, who didn't self-isolate when they had the opportunity. Those with no choices get a pass.
3) That will be the younger ones, overwhelmingly. The stupider their choices, the slower I'll move. I'm getting up there in years, y'know.
4) Avg. vent pt. in the story? 40 year olds. Welcome to "old" age, Gen X!

Aesop said...

@Nemo
If Trump goes through with this, he's an idiot. Pandemics don't march to a calendar, and he'll likely be lifting the restrictions, or recommending same, at the height of things.
I'm hoping someone tackles him before he gets his head that far up his own ass.

It takes a world-class fucktard to make Govs. Gabbin' Nuisance and Mario Cuomo sound like the calm, rational ones in any discussion, but he's just done that.

I'd tell him that to his face. After opening with, "Mr. President..."

Anonymous said...

I suspect this Apr 12th date is more rope-dope from the President. Probably trying to pressure someone do to something w/o having to use full force of .gov.

At least I really hope this is what he is doing.

nick flandrey said...

All trump has to do is finally agree to maintain restrictions when the time comes. In the mean time, the harder his haters push for restrictions the more they own it. (and the more likely people will DO it.)

He must have been told about the true length of time needed. He also knows people will do the opposite of what he says out of spite, and if it turns out to be a nothingburger, he doesn't want to be left holding the bag.

LOTS of people out there still think it's all massive overreaction/power grab/just the flu/nothingburger. Many of them are HERE despite Aesop's efforts. If so many are here, think about out in the general public.

He's got lots of time to 'nuance' his position, or 'consider new information' or any of the other things public figures do when they change their minds.

In the mean time, there's a sorting function happening. We'll see how it ends up, and which people come thru this when it runs its course.

nick

Avalanche said...

Dear Aesop; prayers for your health-and-safety!
Have you looked at the Ginn article? https://www.zerohedge.com/health/covid-19-evidence-over-hysteria

There's some conflict between the 40-million+-views Pueyo article and the Aaron Ginn article. Apparently Medium took Ginn down; but Zerohedge reposted it. I found Pueyo's work to SEEM sound if quite alarmist. However, the barking over which one was more likely soundly reasoned made me go read Ginn. (My view? Ginn's article seems reasonable... MATHS do NOT require experience in epidemiology!)

{commenters here: http://coyoteblog.com/coyote_blog/2020/03/covid-19-and-some-thoughts-on-data-analysis.html}
==================
Just an FYI Tomas Pueyo's background is more or less as a social media marketer and his current position is the VP of growth for Course Hero (an online learning platform that will certainly benefit from everyone transitioning to online learning). His original piece was so alarmist and so widely spread I would wager it is one of the biggest influences on a lot of the policy decisions over the past 2 weeks. 40+ million views in a short amount of time and shared by politicians, celebrities, and academics non-stop.
I don't know the science well enough to know how far on or off he was, but I do know that very educated people talked about it as though it was a research article and not just a bunch of CDC, WHO, etc. charts that he pulled to support his opinion. On the opposite side, a similar article using CDC, WHO, etc. charts by Aaron Ginn to support a less alarmist opinion was quickly shouted down and censored from lots of places.
=====================
Aaron Ginn has a bachelors in economics with zero experience working in epidemiology or medicine. Instead of replying to legit criticism from a biologist, he just went ahead and focused on reposting his article. He even lied about having responded to the biologist's criticism. Aaron doesn't care about debate. He cares about his ideology.
I don't agree with Medium taking down his post, but let's not forget Aaron doesn't have the background to say anything worth listening to.
====================

Can you take a minute (or ten) to take a look at Ginn?

Warren said...

This is what happens when the MSM spends years lying about BS things like Russian Collusion Hillary is wonderful years of if it bleeds it leads about every stoopid incident of a car crash ten states over so when there really is a crises stout door no one believes them because they lie about everyone and everything in order to promote some agenda and so when the sky really is falling things that could be done we're not done and now we are phucked

Aesop said...

It foolishly pours gasoline on the flames of the jackholes who think this was and is a non-event. Raising expectations you don't intend to fulfill, especially at this point, is simply a dick move.

Jabbering fond wishes that don't jibe with common sense or best scientific advice is a moron move.

His Easter guesstimate was both.

And if he later has to walk it back, he gets to lick his own ass, and look like a bigger dope.

Hat Trick of Fail.

ThatWouldBeTelling said...

"Trust the Plan" is getting beyond tiresome to hear.

Meanwhile, no one in Nevada is going to be dispensed chloroquine or hydroxychloroquine for COVID-19 without violating a order by the governor:

The governor signed the emergency regulation Tuesday on the recommendation of the state Board of Pharmacy.

[ Their normal uses. ]

In a letter to the governor, the Pharmacy Board noted that the safety and the efficacy of the drugs “have not been established” in the treatment of COVID-19 and that “an emergency exists due to the hoarding and stockpiling” of the drugs.

The governor’s order prohibits the prescribing and dispensing chloroquine and hydroxychloroquine for a COVID-19 diagnosis, requires the appropriate prescription coding for their “legitimate medical purposes,” and limits prescriptions to a 30-day supply.

“At this point in time, there is no known cure for COVID-19 and we must not withhold these drugs from those who need them,” the governor said in a statement. “The best way to prevent the spread of COVID-19 is to stay home for Nevada, not to stockpile these drugs.”

In a companion statement, Dr. Ishan Azzam, chief medical officer for the state Division of Public and Behavioral Health, said the regulation would protect patients with COVID-19 as well.

Anonymous said...

How bout summa those PP Docs and nurses get their asses to the local ED and pitch in? Maybe save a life instead of ending one
Boat Guy

Anonymous said...

My nephew s girlfriend works at NY Presby, 8 weeks ago I told my sister that they needed to prep she was too busy hating on Trump to listen I would FB her about the CV she would say I was fear mongering because I voted for DJT, a total non sequitor. Now her future daughter in law has no masks and she is sewing her own for her and my mom is saying I should send her the 20 I have, I told her I was not going to go to the USPS wait in line and possibly get the virus to send her masks she could have picked up at CVS in January or Feb. And since I bought mine several years ago after the h1 scare I do not consider myself a hoarder,

George True said...

"Hey Doc, with all this Covid-19 stuff going on, I am going to go into isolation outside of Nairobi, Kenya with a friend who has invited me to stay with him for the duration. As you know, malaria is rampant there, so would you please write me a prescription for Chloroquine? Thank-you."

nick flandrey said...

@aesop, I don't actually disagree with you about Trump, it's just that he may see his role differently. He may think that cheerleading is the best use of his voice. He doesn't seem to have much emotional sense, almost to the point of being somewhere on the spectrum, so I really don't think he knows how what he's saying will be received.

He may be playing chess, he may be an idiot, or he may simply be extraordinarily lucky. I don't know. Maybe he's seen the projections and knows that the whole world burns and thinks that nothing will change that anyway.

After seeing what the Dems jammed into the stimulus, I frankly don't know how he gets out of bed in the morning, knowing he'll have to face people that selfish and evil before breakfast. Only a monstrous ego will let you function in that environment.

----------------

Things I believe I do know--
-this is bad. Really bad. lot's of people are gonna die or be life-changing ill.
-I don't want to get it
-I did my 'last run' and am now set for twice as long in isolation
-most people will come thru this in good shape health-wise, but terrible shape money-wise.
-career politicians are NEVER smart, cunning yes, smart no
-the biggest factor in getting thru this is ME, (outside of some scientist with a treatment or cure)
-we ain't seen nothing yet

nick

nick flandrey said...

@george, doesn't matter if you've got the 'scrip... there's none on the shelf. That boat sailed.

A bunch of it comes from India, and they've locked the doors...nothing is coming from there for a while, and nothing at all of an effective medical treatment will be coming as long as they've got sick people. They've banned the export of masks and vents already.

n

Anonymous said...

If we're going to criticize decisions made in the past, the ratio of bad decisions between Trump and Cuomo is probably at least 100:1 (and that's being VERY charitable to Trump). How about we focus on decisions being made right now instead of playing tribal politics with EVERYTHING?

Anonymous said...

I'm one of the "at risk" guys. Old w/ COPD. Went to the old woman yesterday after reading this guys article on Zero Hedge the day before. I told her what a hideous death this was and that I would not die such a death if other options were available. And they are. I say this without bravado and with total humility. I won't die "that" death.

Anonymous said...

@aesop 7:16 I was correcting what anonymous above said as the date Trump wants the country to go back to work. April 12th is what Trump said, when asked, yesterday, at the daily dog and pony show. I added the reference to Easter Sunday as April 12th is Easter Sunday and the need for prayer as I think that's what it's going to take to get activity going by that date. That was my subtle way of saying that April 12th is a long shot.

Nemo

Anonymous said...

New Orleans EMS is at half staff due the quarantining of personal. How long before EMS stops picking up possible Covid19 patients due to staffing. they gonna hire new EMT Basics at 15 per hour to walk into a Covid19 mine field, ha! do not think so....now hiring, now quarantining. interesting fact, my spouse is in the business insurance game, employer liabilities, new clause is excluding Covid19. ex: my boss made me work and I got Covid19. employers are not protected.

Marina said...

Some of the possible influences on Trump to relax policies: Two letters sent to Trump and also check the people copied at the bottom.
March 19: https://www.armstrongeconomics.com/armstrongeconomics101/opinion/asking-for-your-help-forward-this-letter-to-whoever-you-may-think-will-help/ ---
March 23: https://www.armstrongeconomics.com/international-news/politics/did-trump-take-the-letter/ ---
March 24: https://www.armstrongeconomics.com/armstrongeconomics101/opinion/here-is-the-2nd-letter-to-trump-send-it-everywhere-you-can/

Anonymous said...

I wonder if the reason things are so bad in Louisiana is due to Mardi Gras? Aesop was very prescient with his "Mardi Gras Shit Show" article in a recent post....

Aesop said...

"Shit Mardi Gras" is simply an S3 shit show (i.e. worse than an ordinary Shit Show, or Shit Circus, but not as bad as a Shit Riot, Shit Tsunami, or Shit Apocalypse).
https://raconteurreport.blogspot.com/2020/03/sht-mardi-gras.html

IIRC, Nawlins cancelled Mardi Gras for this year, ahead of time, didn't they?

Anonymous said...

@nick 0819: While most of, if not all, HCQ is from India and/or China it could be made in US. It is a very simple molecule and a relatively easy synthesis. A report was published in Bilstein (2018 if I recall) of a way to make this on a continuous, not batch, basis.

There are enough skilled people and facilities in the US that this compound could be being produced by the ton. My semi-informed estimate would be 4-8 weeks depending upon the status of raw materials. Could be as little as 2 weeks if pharma companies were to bust their humps and if raw materials are in good supply.

Anonymous said...

Ref Mardi Gras:

Naw, they held it in February this year.

Termite said...

Aesop said: "Nawlins cancelled Mardi Gras for this year, ahead of time, didn't they?"

No, it happened as usual.

And it's probably the reason Louisiana's infection rate is far above the national average. About 1 million folks came to N.O in addition to the local population, and if you have never been to a Mardi Gras parade, just know that it's people standing shoulder-to-shoulder, multiple rows deep.

nick flandrey said...

"shoulder-to-shoulder, multiple rows deep."

--in and around so much bodily fluid you wouldn't believe it.

n