Monday, March 30, 2020

More Local Color

I'll take Kung Flu over Arkansas Flu any day.

We can hear the footsteps.
Last week we had Kung Flu rule-out patients in the single digits.
This week, almost 20. Two confirmed are most worrisome: one from a local convalescent hospital; the other from the county jail. That's two future clusters we can look forward to seeing explode locally over the next month. The latter will ripple through the entire jail population, the sheriff's deputies, then the prisons, courts, and the local homeless bunch, followed by the local addicts/psych patients, etc.
The former through that hospital's patients, then staff, then the families of both.
Most of whom we'll get as well.

One of them was classic: Came in talking, but not feeling well. Within hours, full respiratory distress, then intubation. Cardiorespiratory arrest within 24 hours, got him back. Tried proning him while intubated to increase oxygenation. Couldn't tolerate it by the second day. Arrested multiple times throughout the next day, finally made a DNR, and managed to die before 72 hours in-hospital.

Two more nearby hospitals are getting hammered by respiratory distress patients. Most are either Kung Flu, or highly likely, pending test results.

We're spiders in a jar, and the jar is filling with water.

EMS is coming in with varied levels of protection. Keep telling them be safe, not sorry, but some of them just haven't got the PPE available. They're going to get this. Then they'll share it unknowingly, and take it home. Then get sick, go into quarantine, and we lose another medic crew, or a fire station full of guys.

Local PDs, same-same. They're practically rolling on nothing but violent crimes now; don't want the risk, jails won't take anyone else anyways. The homeless, the crooks, even the crazies are avoiding the ER now like we've got the plague. Which, actually, we kind of do.

Nursing staff registries are offering crazy stupid amounts of money to fill holes everywhere. Anybody near retirement is punching out early. Younger ones, or with families, staying home. They're just not feeling it. (I told you people would walk.) L.A. County is doing herculean work to get homeless out of their cardboard hovel towns, and into buildings, with full staff - PD, medical, shelter management, etc. regular temperature checks. Anyone suspicious for Kung Flu gets the boot. The homeless turn other residents in for coughs and sneezes. They don't want this thing either, and they're only as crazy as they have to be.

More pedestrians in the streets, and less airplanes in the sky. It's giving me post-9/11 flashbacks, where seeing airplanes was non-existent for weeks. For most of the people I work with, they have no recollection; they were in grade school then. But it feels a lot like it.

I see more couples walking. And they hold hands. That's more commitment than rings and wedding vows now. You're literally telling that partner "If you go, I go too; I'm with you, thick or thin."

Then there's the other side: had two domestic violence cases this weekend. Put people in the same house non-stop for days, and tempers flare. Weak and wobbly relationships aren't going to survive this thing, even if the people do.

More cars on the road than there should be, and more each day. People are trying to slide by the stay-home orders. That's going to get us the Notional Guard response at the on-ramps, sooner or later, just like R.I.

Oh, remember this? Wherein I told you .Gov was going to have to set up Kung Flu Centers in convention centers and sports arenas?
Called it.
Called it again.
And again.
And again.
And yet again.
This isn't hard. .Gov telegraphs its plays, it's just that most people a month ago couldn't conceive of them needing this much capacity. I could, because I know what the system can and can't handle.

Anybody in full-blown denial about this still, is having a psychotic breakdown, and can't deal with reality.

Nawlins ER Doc's laxative-substitute (because it'll make you sh*t yourself) field clinical report is pointing towards what I'm afraid will become standard protocol: no one's worried about 100,000 ventilators, or any such nonsense, because the survival rate once you're intubated (for the 3-5% of everyone who get that sick) is from 30-14%. From about 1 chance in 3, to 1 chance in 7. Which, I suspect, is going to lead to standard of care to become "If they need intubation, don't bother. Medicate for pain, and move to hospice tent." It's a futile intervention, and it generates more aerosol viral load, so it isn't worth the risk to practitioners to intubate, and we cannot justify the effort and expenditure of staff time and resources, for something that's 70-86% fatal anyways. In short, practice will be to let you die, because you're going to anyways. If possible, in a narcotic haze to ease the pain of the transition.320M of you will never have to worry about it, but for some number of the last 10M, you may get an unfortunate POV angle on this, either in person, or the patient in the cot next to you. That's not actual Hell, but the smell of brimstone from there will be annoyingly close.
We're getting more and more reports of younger patients, too. Not a lot, but it turns out that youth does not equal immortality. Bummer, children. Not so bitchin' when Kung Flu can whack you, too, is it? Maybe now you'll stop going to beach parties, and learn to wash your hands. Or not. Suture self.

That's most of things, but I've got to get some rest before going back in again. I'm not in the sh*t yet; but the day is coming likely as not, and one of these nights, I'm going to zip in to work, and walk into the Baghdad ER during The Surge. Then it's on like Donkey Kong.

Stay frosty, and if you're in an area where this is a distant tale, count your blessings. This will be over, sooner or later, and things afterwards aren't ever going to be like they were before it happened. Keep an eye peeled for the good and bad proceeding from that.

We're going to get a lot of both.

Sunday, March 29, 2020

Hopeium Futures Down 5000%

Hopeium: addictive and dangerous.
Stop shooting it up. Just say "No."

“We will be extending our guidelines to April 30th, to slow the spread,” said President Trump on Sunday.


Sunday Music: Little Too Late

(We repeat last week's note: I picked these out a year ago, I swear. I'm not making any commentary on current events. But we'll take the serendipitous happenstance.)
Rock and roll queen extraordinaire, at peak Benatar here, before she faded away doing sappy ballads. Packing seven octaves into about 5' worth of spandex leotard never hurt her appeal, and today's selection is quite the kick-ass song even without that.
{Pat and Neal: if you're ever short a drummer for the next tour, I've got this.}

Saturday, March 28, 2020


Especially if tomorrow it's 700.
Don't believe me, or even Baghdad Bob, though.

Follow it yourself at the Johns-Hopkins COVID-19 tracking page.
Ignore case numbers if you like; we've only been testing for a couple of weeks, really. And we expected those to blossom as soon as they started doing tests.

But AFAIK, we aren't blending Kung Flu deaths with deaths from heart attacks or flu.
So deaths are real. IOW, we lost more people in the last 2 days as we lost in the six weeks before that. Got your attention there, did we? Welcome to exponential growth.
That means in the next week, it's only going to keep going up every day.
NYFC is losing someone every 24 minutes now. I'm sure actually it's just fine there, though, and this is all just hype and hoax. I heard that on the Internet. Bummer if your relative was one of the 600 today though. That's the breaks, I guess.

How long will this keep climbing?
No one can say for sure. Possibly into mid-summer. Maybe longer.
We're at this point with only 115K confirmed cases.
That only leaves 329,900,000 other Americans yet to infect.
That's a paltry 1.6% CFR.
Seasonal flu, which everyone was clucking about being "much worse" until about 15 minutes ago, has a CFR of 0.1%.
So this is "only" 16 times worse than that.
And the actual case numbers could be double, making this "only" 8 times worse than flu.
I feel better already, don't you?

So depending on how many people get this, it might "only" kill 2.6M people before it fades out. Maybe even less.
Which is only how many people die in this country every year, from everything.
Buck up.
What's to worry about?
You didn't need 21st century medicine this year anyways, right?
For anything. Not yourself. Not your kids.
And hey, fuck Grannie anyways, she was old, and she had a good run, amirite?

Call me when the deaths peak, and start going down every day.
That won't be the beginning of the end of this.
But it'll be the end of the beginning.
We're still in the ramp-up phase, apparently.

UPDATE: One courtesy of Matt Bracken

This embiggens. Click it.

Between 11A and 4P, the JH website updated.
New U.S. numbers:
121,478 confirmed cases; 2026 deaths.
135 new deaths in 5 hours.
That works out to 27 deaths/hr in the intervening 5 hr period.
About one death in the U.S every 2 minutes.
27/hr = 648/day, if this keeps up.

Yet again: we told you so.
BTW, half of all U.S. cases, currently, are in New York. Just saying.

Stay home. Wash your Hands.

Breaking: NFY Quarantine; R.I. Calls Out NG Troops To Go House-To-House

h/t Irish

If only I had a nickel from every smart/stupid m*****f****r who told me in the last two weeks this would never happen. :

Rhode Island police began stopping cars with New York plates Friday. On Saturday, the National Guard will help them conduct house-to-house searches to find people who traveled from New York and demand 14 days of self-quarantine.
“Right now we have a pinpointed risk,” Governor Gina Raimondo said. “That risk is called New York City.”
New York is the epicenter of the coronavirus outbreak in the U.S., on Friday reporting a total of 44,000 cases.
“Yesterday I announced and today I reiterated: Anyone coming to Rhode Island in any way from New York must be quarantined,” the governor said. “By order. Will be enforced. Enforceable by law.” 
Gov. Raimondo signed an executive order Thursday that applies to anyone who has been in New York during the past two weeks and through at least April 25. It doesn’t apply to public health, public safety, or health-care workers.
National Guard members will be stationed at the T.F. Green airport, Amtrak train stations and at bus stops. The citizen-soldiers will be following up with people at local residences. The maximum penalty for not complying: a fine of $500 and 90 days in prison.
And in D.C.:
 White House Calls For 14-day Quarantine For All leaving New York 
The White House urged anyone who has been in New York to self-quarantine for 14 days to stop the spread of the coronavirus, which has become widespread in the city.
“You may have been exposed before you left New York,” Deborah Birx, the State Department doctor who is advising Vice President Mike Pence, said at a White House news conference on Tuesday. “Everybody who was in New York should be self-quarantining for the next 14 days to ensure that the virus doesn’t spread to others.”

I've been telling people that failure to comply with voluntary quarantines would get you mandatory ones, enforced by smiling Notional Guard troops at onramps, etc., with M-4s, and loaded magazines.

It's here, now.

Welcome to the New Normal.

Shit: Real.
It's now official.
And serious as a 5.56 coming your way at 3200fps.

ROE: Zero fucks will be given.

Comport yourselves accordingly.

Field Clinical Report: Nawlins ER

h/t Will in Comments


Another health care professional who didn't get the memo that telling the truth will panic the proles. On the front lines every day, rather than bullshitting through his teeth from a podium in DC, or sitting in a lounge chair on some FakeNews show.


"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this b***h has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.


worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."

My first expanded lost draft (thanks again MacBook Touch Bar) contained the appropriate hedging, disclaimers, and uncertainty the current understanding of this pandemic deserves. Some of the more concise, unproof-read, hastily rewritten original post (OP) presents itself as more definitive instead of "what I think I know". For this, my apologies. I am not performing clinical trials. I am not involved in cohorting and analyzing data. The academic physicians involved in ER, Infectious Disease and Pulmonary Critical Care are likely (hopefully) way beyond my understanding of Covid 19. Furthermore, I fail to appreciate any additional benefit I could provide to Hospital Administrators who have been preparing and communicating with each other for months; or for some already combating this daily.

Basically, several state medical licensing boards are temporarily loosening their independent practice regulations on NPs, PAs, and to a lesser extent Medical Students. I wrote the OP as much for me to collect and organize my thoughts, as it was to provide a jumping-off platform for providers who may find themselves in an ER-like setting and unknowingly be treating Covid 19 patients or will be treating them soon enough. If any of it helps some of my colleagues hit the ground running then that is something too.

The OP was a summary of thoughts from being immersed in Covid 19 for weeks, reading as much as I can, and following up on my own patients. It is not my intention for this to be taken as dogma. I do not have the answers or the algorithm everyone is searching for. I was merely looking to point the handful of people I thought would read it in a clinical direction best I could. What I think I know evolves every day with the presumption it may very well end up markedly different once this pandemic is better understood. I do not know when this crisis will ultimately be arrested, however, I maintain resolute that each one of us can help make that happen. Stay home. Be safe. Find a way not to have to visit grandma.

Thank you to all the well-wishers and good luck to us all.




From Aesop:

If you aren't following the clinical aspects of his notes, I am, and it scares the shit out of me.

70-86% death rate, even with ventilator therapy?
14% of cases coming to the ER require hospitalization?
5% of cases coming to the ER require ICU/intubation?
And Plaquenil (which is hydroxychloroquine) doesn't seem to help?

Cancel Christmas, kids.
This is going to f**k sh*t up in every ER that gets hit with it!
Reality is too Doomy and Gloomy for ya?
Go back to bong hits and shooting up hopeium.

And if that guy's seen a hundred Kung Flu cases, and he's working his whole shift in a PAPR, treat that like him saying he flew 100 missions over Germany in a B-17; that's a certified badass.

Just spitballing, but I think you can forget about going out to play by Easter.
Unless you're a total moron.
At least Easter this year. 2021 is still in play, so far.


Today's Reality Check

This is cases. It's also a launch profile for a moonshot.
And deaths to date tracks this apace.

On January 21,2020, the US had 1 case of Kung Flu.
On February 1, we had 8 cases.
On March 1, we had 98.
Today, March 28, at 1:26AM EDT, we have 104,837.
Blame all of that on finally doing testing that you like, I don't care.

On about March 21st, we had 400 deaths from 1/21-3/21, total.
Today, we've had 410 deaths in the US in the last 17 hours.
I'm waiting to see how many more by 8AM today, but it's somewhere around 700 deaths/day now.
That's not because we just started testing. Deaths are deaths. Period.

Flat-lined at that rate, that's a 9/11 by the end of the month, at midnight Monday, in four more days.
That's the entire Iraq OIF War by Friday.
By the end of April, that's 21,000 additional deaths, which is more flu deaths than we get in an entire average year of influenza. So clearly, this isn't "just the flu, bro." And that's extrapolating them out on a flat line.

But the death rate doesn't flat-line. It grows, exponentially, just like the infection rate.
And the death rate, and tally, aren't even the problem with this bug (for the fiftieth time).
Because odds on, 97% or more of everyone lives through this just fine.
That's 320M out of 330M Americans who'll get through it with minimal muss and fuss.
And probably more than that.

But we still only have hospital beds for 0.28% of America.
2.8 per thousand of you.
And we still only have ICU beds for about 0.018% of you.
1.8 per 10,000 of you.
(Which last, BTW, isn't even enough for everyday problems, 6 days out of 10.)

But if either 1M of you need to be hospitalized, or 100,000 of you get really sick, because of Kung Flu, and need the ICU and a ventilator, health care goes bye-bye, until a month after this is all gone.

And people on vents with this are in ICU for 11-21 days.
We don't even have numbers yet on how many, even with that level of intervention, survive.
But it looks like "not many".

And if we get the numbers, and that comes back as less than 1%, we're probably going to tell you that "there will be no more ICU admits for Kung Flu pneumonia. If you get Kung Flu, and you have pneumonia, we'll be sending you back home to die. It's that, or cancel health care for everyone else. Sorry, but that's how it is."

The latest straw-clutching happy gas is to claim this will peak completely in 2 weeks, because of the assumption that "everybody's got it, so people will stop getting it."

Mathemagic FTW.

And if we just erase five or six zeroes from the Holocaust, it never happened either. That's the level of bullshit you're being spoonfed by the idiots and soothsayers.

So let's see how that fairytale works out, day by day.

You can claim anything you want with infection rate, because of the testing problems and shortcomings. Fair enough. I get that. It also bones us for ever getting accurate handles on the breadth and width of this pandemic.

But you can't gainsay the body count. We aren't suddenly counting car accidents and gang shootings as Kung Flu deaths, anywhere, AFAIK.

For the perennial shit-for-brains club, that's not panic.
It's just the actual ground reality.

Nota bene: No one told anyone to do the Headless Chicken Fandango.
Never. Not once, at any point this year.

But use the actual reality to counter the happygas b.s the idiots are pimping, harder and harder, the worse this gets.

UPDATE: Such happygas and mainlining hopeium includes the magical belief that things are going to be different in your AO, because your area is administered by [R]s instead of [D]s. FFS, this is a pandemic; the virus doesn't give a shit about your politics. And we've never met a politician yet that had our best interests at heart more often than not, from any party. This is not a D vs. R thing; it's an infected vs. not infected thing.
YMMV, but I sincerely doubt it. More enlightened administration may get you some extra time, and a few better interventions, but in the long run, this is already everywhere, and it won't stay out of town because your mayor or governor is less socialist. That's an entire barnyard of horseshit. You have lower population densities some places, which only slows the spread. If you haven't avoided it entirely, or stopped it cold (and so far, no one has), you're already doing it wrong, and that bill is going to come due, no matter where you live.
And say, how many major acute-care hospitals you got out there in Mayberry, Aunt Bea?
And how many pharmaceutical manufacturing lines? So it's already bitten you in the ass, hard, and you didn't even know it. Unless you prefer 1960s- or 1930s- (or 1830s)-era morbidity and mortality numbers for common conditions. Let me know when the penny drops for you. I'm guessing the first time you go to fill a monthly prescription, and the local pharmacist zeroes it out and says, "Sorry, don't have that anymore." Bummer. All my best to your relatives on monthly meds.
And FTR for the general assistance of the reading comprehension impaired, we've
1) never said this is the Zombie Apocalypse, nor even anything remotely close
2) consistently, early, and often told people not to panic
3) never told anyone, anywhere, anytime, to bug out and head for the hills.
This is a pandemic. We have advocated most circumspectly the appropriate response. Period.
You're not seeing it somewhere, yet? So it therefore isn't happening?
Best wishes with that plan.
We still counsel a firm lever, to break suction, and pull your heads out.
The issue for you is when, not whether.
If you cannot grasp those obvious facts, nor quote us or characterize our statements accurately, kindly don't mention us at all on your pages, unless desirous of the same back.
Trying to make points by telling outright lies only makes you look petty and/or stupid, which is seldom a good look for either your credibility, or your character. Let alone your blog.
We understand that Fucktards gonna Fucktard.
Best not to be one.

Friday, March 27, 2020

Baby Ducks & Hidden Rabbits

To A Baby Duck, everything is new. Every minute of every day.
I mention that because I've only said what I'm about to cover about 57 times in the last 6 weeks, but maybe one more time will bring it home.

"You are really upset about this virus. Apparently It's not the death toll, it cannot be the number that tests positive - they don't all need hospital bed space, it isn't your love of Leftist gov't employees, -- What the heck are you seeing in CA that we should worry about??? I'm just not seeing it. If they covered the Swine flu like they are covering this nothing burger - we would have been hiding under our beds..." - Anonymous
So, yet again:

The death rate per se (the CFR) is meaningless (except to the Guests of Honor, and their nexts-of-kin). The dead are dead; as Patrick McGoohan said in Braveheart, "they cost nothing".
[BTW, the number of Kung Flu deaths in the U.S. went up 280 between 7:57A and 3:19P , just today, per the Johns Hopkins Kung Flu tracker. That's one death every two minutes, kids. Forget that it's exponential, for a minute. If it flat-lines, and stays at just that rate, it's 700/day. That's another 2800 by end of the month. Another 21,000 on top of that by the end of April. Which is more than the number of flu deaths (20K) in the U.S., in an average year. In one month. Oh, and it's not flat. Minute's up: It's growing exponentially. But that's still not the biggest problem.]

But if the "requires hospitalization rate" for this virus is 1%, and "only" 100M people get it, that's 100K more beds than we have in the nation.
If the "requires ICU admission" rate is "only" 0.1%, that's 40K more ICU beds than we have available in the whole U.S.
(For those who noticed, the old number was 90K ICU beds. It's not. It's 60K. The other 30K are PICU beds, pediatric beds, etc., none of which can nor should be converted to adult ICU beds. So you have approx. 60K ICU beds, in 50 states. period. -A.)

That's 40K Kung Flu patients who'll die.
And another 60K other critical patients who'll die too, because there will be no available ICU beds for them either.

This is like an Indy crash, where the announcer is focusing on "this will only kill 1 driver, FFS; what's the fuss?", except the car is airborne and flying at 200MPH at 50 feet, headed right for the thicket of hundreds of fans in the grandstand, who have nowhere to move out of the way. They're going to die too, and no one is thinking about that.

Everybody's looking at the magician's hat, and I'm telling you where the rabbit is going to come from.

If you can do magic, pull a top hat out of a rabbit, and then come talk to me.


h/t Rollory

Coronatardation: (n) 1. the uncanny knack for zeroing in on the opposite of reality in every situation, right up until the Darwin Award moment

Failure Is Not An Option


I've told folks what was coming. Now it's here. What's next?

Here's a draft speech for POTUS. His communications staff can revise, amend (and censor) as necessary.

Ignore the idiots stuck on stupid, singing about how this is nothing, and whistling past the graveyard about how it's all going to go away magically. It's not. Ignore FakeNews, and leave the morons to play with themselves in the bathtub. The grownups have work to do.

Second: Fix the problems, not the blame.
What hosed us the hardest (besides a steadfast belief that something like this would never, ever happen ('cuz 'Merica!), was the CDC clusterf**king the test kits.
Get that sorted out, and get away from tests that require 24-72 hours to read. That's unacceptable horsesh*t.
And don't worry, there'll be plenty of time for firing squads, and flogging around the fleet, for all guilty parties after this is all over.
Anyone who can't get rapid-response Kung Flu tests done, yester-effing-day, can pack their shit for a one-way flight to a 10-year assignment studying skin diseases of the Emperor Penguin at McMurdo Sound in Antarctica.
We want 300M test kits, that can be read within half an hour, and we want them ASAP.
Get it done.

Third: Find a solution to the outbreak.
We've fast-tracked vaccine research. That will take 1-to-infinity years.
If we get one, great. Meantime, there are other options to explore.
The anecdotal evidence for chloroquine (CQ) and hydroxychloroquine (HCQ) coupled with azithromycin "Z-paks" (AZ) is promising. Crash-test it now, in every state, particularly those like GA and NFY, where the outbreak has reached critical mass, and is crushing healthcare. All results fast-tracked back to CDC, vetted in real time by Harvard, Stanford, USAMRIID, and every other Swinging Richard with the creds to offer an opinion, and come up with a verdict, in 30 days or less. If it works, I expect all pharmaceutical companies to have 100M dose courses ready to ship in days. Not weeks, days. The kind I could count on the fingers of one hand.

And BTW: Any state that wants to restrict doctors from being doctors is free, under federalism, to do that. So, we should let them.
And then, inform them that all federal funding, for EVERYTHING, will be withheld from any and every state electing to go that route. You want to be an individual in this crisis, say goodbye to FEMA funding. Disaster Relief. Medicare funds. Your federal budget will be zeroed, until further notice. Any governor presenting his or her own valid medical license, a diploma from a bona fide medical school, and board certification from the appropriate medical licensing authorities will be exempt from this restriction. Anyone else, knock off the bullshit, and get with the program. Or prepare to get very lonely. And broke.

Fourth: Mitigate the problems we now face.
Any company setting up assembly lines for PPE, to include masks, gowns, eye protection, etc., should be given a dedicated fast-track to git 'er done. If necessary, the land they sit on will be federalized, and leased back to the company for $1/yr., and all state restrictions and laws set aside thereon for the duration of this emergency, if the states can't get out of their own way.

The companies who make the current N95 masks in use also need to do emergency research to find out if, and under what conditions, that PPE could be used, extended-used, and/or sterilized for such extended use.

We don't want to wonder if you can use, or dry out, or sterilize a used N95 for further use, or alternate multiple masks on different days, nor wonder if they still work. We want to know, yesterf**kingday, and we want it researched, signed off, and over the signatures of your chief scientists and CEOs at the speed of light. Do it right, and we'll write off the costs of such work directly off your tax bill for next year. Get it wrong, lie, halfa$$ it, or skip doing it entirely, and we'll add two zeroes to that cost, and that will be your federal fine for negligence and malfeasance. We'll also add immunity from liability prosecution for your product(s), provided all work meets standards of due diligence and good faith.

It's Friday.
Any head of any federal agency, or any CEO of involved companies, can either send their letter of intent to comply, or their notice of resignation, to the White House, Washington DC, NLT Monday, 8AM, EDT. Anyone who can't get around to it by then can expect a visit from me, in person, in short order, to explain it.

Fifth: Everybody Else
1) You're going to be dealing with this longer than we'd hoped. Suck it up and deal with this.
2) You may be doing that longer than you'd anticipated too. Tough shit.
3) You're already going to be doing this longer than you'd like. Get over it.
Nobody promised you a rose garden. Life isn't fair. Don't lose your minds, and stop buying toilet paper and water like they were gold bullion. The stores are open, like always. The trucks are running, like always. And at the moment, with gasoline going for a pittance. So settle down, buy what you need each week, for a week, and you'll notice things getting back to normal in short order. If your job is on hiatus, look into the twenty businesses hiring instead. If you can't sling coffee, or sell shirts, you can damned sure get a job spraying down shopping carts and counters, and sweeping aisles at the grocery and big box stores. You can join the crews of people restocking the shelves every night, so there's goods there every day. And when your job comes back, they won't need you for the other one anyways.

If you can't do that, be a neighbor.
Help out people in your area who need to stay in, or have to stay in, because they're old, sick, weak, frail, or immunocompromised. Help get them what they need when they can't.

Sixth: The Douchebags and Vultures.
Local authorities have relaxed law enforcement response during this crisis. So be it.
Those who seek to take advantage of this situation can get three meals a day, including a green bologna sandwich every lunch, and free striped clothes to wear, by victimizing people during a national emergency. Your new job will be digging the foundation ditches from Brownsville to San Ysidro along the southern border with picks and shovels. We'll be saving the diesel fuel for our interstate trucker friends. Instead, you'll be working in chain gangs, shackled in groups, under the supervision of federal corrections officers from sunrise to sunset, six days a week, with hand tools, and no air conditioning, digging the works for the border wall. If you can't do that, you'll be picking up trash, by hand, in those same areas. If you can't do that, you'll be sweeping roads with a corn broom in Alaska, Montana, North Dakota, Minnesota, Michigan, Vermont, New Hampshire, and Maine, until springtime, at which time you'll be doing the same thing in California, Arizona, New Mexico, and Texas until late fall. And then back again. If that doesn't appeal to you, don't break the law, and don't be a problem during this emergency.

We can work our way out of this, and we can think our way out of this.
We cannot run around with our hair on fire out of this, and we can't panic our way out of this.
We're Americans.
We won our own freedom, we beat the Nazis, and we landed on the moon.
Dealing with this should be small potatoes, but only if we settle down, and get on with it.

Let's get to work and do just that.

Good night, and God Bless America.

Local Anecdotal

So, it having been a solid week since the Califrutopia lockdown order, and other than my work commutes, upon my first venture out and about, the following report:

Bank: Open. Reduced hours. No withdrawal limits. 6' tape marks on floor, lobby stripped to bare tile to make space. Traffic: light.

Gas station: Prices amazingly low. Under $3/gal., which hasn't been seen here since probably before 9/11. States with less confiscatory taxes added are at under $1/gal. in some places.

Sub shop: empty. Tables stacked up to make a 6' barricade between sandwich maker and customer line. I was the only one there, so I did my part to keep them open.

Supermarket: Welcome to the Soviet Union.
Chain store (not WalMart, Sam's, Costco, etc. - going there would be cray-cray.) and the staff is doing a herculean effort to maintain normalcy. BZ, shelf stockers and such.
Paper goods: stripped.
Milk: no problems.
Butter: raped.
Eggs: There, but raped, and limited to 1 carton/customer.
 (A man with some laying chickens now is a future millionaire.)
Bread: No disruption.
Canned meat, tuna, soup: What canned meat, tuna, or soup??
Canned fruit: sparse. Big holes on every shelf.
Produce: thinned, but fresh, clean, and still plentiful.
Pasta: What?
Fresh meat: Abundant.
Packaged lunch meats: Gooooone.
Paper goods: We have no idea what you're talking about.
Frozen foods: Moderate amounts, with some notable bare spots.
Cleaning products: raped.
Crackers: gang raped. Got the last box of saltines.
Bottled water: available. Limited to one flat@.
Couldn't get the carbonated colored caffeine-free diet soda I drink (mainly from habit), but had no problems finding any of 300 other varieties. Grabbed a couple of cans of lemonade powder instead, and some straight 100% fruit juice jugs, both in plentiful supply.
Also grabbed two whole bags of potato chips, which I haven't had in months, and was my sole activity that might pass for "hoarding". Otherwise, just did my normal week's shopping. Which means another week I won't have to dip into the emergency reserve of canned goods.

In short, in the last week, people lost their minds, and tried to make up in one trip what they should have been doing every week, ever.
If/when they settle down, and realize this is going to be okay, the stores will fill up again.
And we'll finally have half or more of the population at least half-ass prepared for the next Big Earthquake.

The mall parking lot was a ghost town after the zombie apocalypse. Except for in front of the supermarket. It was like Charlton Heston driving his convertible Mustang through L.A. in Omega Man.

But there are still one helluva lot of swinging Richards out there at midday who seem to think whatever they're doing is essential. It was like Charlton Heston trying to get around town in L.A. in Soylent Green.

If otherwise-idiot L.A. Mayor Garcetti turns trash scoops loose to scoop up some of the idiots out and about during the misnamed "lockdown", I might move back to the town just long enough to vote for his re-election. And then scamper back to safety behind the Orange Curtain.

If things go sideways up there, that whole city is beyond f****d.

Wake-Up Call

"America, I need you dig in now. It wasn't a nightmare, and there really is a Kung Flu pandemic..."

What's Happened To All The Flu Hoaxers And Pollyanas???

Keep clutching at straws. Don't take this as heart-attack serious.

Keep insisting that the people who analyzed this, and predicted exactly what you're getting now, are panic-mongers and doomsayers.

THAT will help.

It's not like anyone warned you this was a Shit Mardi Gras three weeks ago, or suggested it was going to go there a lot sooner than the soopergeniuses and soothsayers said it would.
And told you that when this exploded, you were going to lose all health care for everyone for the duration, anywhere it blew out society's safety seals.

O, waitaminute...

And, hey, LOOK!:
Show of hands: Anybody out there still think China's number of cases and deaths reported to the West was anything close to reality? Or was the sudden disappearance of 20M Chinese cellphone users after a month or two of crematoriums there running 24/7 perhaps a wee bit closer to the truth?

So, does this mean that just maaaaaaaaaaaybe it's not
"Just the flu, bro" anymore?

Even among the sh*t-for-brains and cementhead demographic?
{Nope. They'll be repeating that the Titanic is unsinkable, and ride it right to bottom of the ocean, with one helluva surprised look on their faces. Pretty much like everything else in their lives.}

Those of you who didn't f**k around then, or even earlier, well done. Hope you ride out the pandemic, and the 57 layers of follow-on effect madness, which is the far bigger problem, and make it safely to the other side. This is going to be a much longer thing, and a lot harder, than most people have planned for, or even imagined. Steel yourselves for that reality, and the reaction of the Village Idiots when they realize you're okay, and they're screwed. And if the opportunity arises to redouble your efforts on anything needful, make the most of it.

The rest of you, well, Play Stupid Games, Win Stupid Prizes.

Thursday, March 26, 2020

Pull Pin. Fall On Grenade.

(WRSA) The ‘cure’ – of bankrupting entire industries through the loathsomely-termed “lockdown” – is worse than the threat.
And it increasingly appears that “curve flattening”, as advocated, has failed, with major hospitals continuing to fill to capacity and beyond.

Pandemic suppression may indeed fail.

 Probably because too little, too late, and kabuki theater screening at airports, when we should have shunted everyone into mandatory quarantine for 30 days before entry was allowed, starting in early- or mid-January.

If only the CDC hadn’t pooch-screwed the test kits so hard that the dog will never walk right again.

So if the answer is to throw caution to the winds, and open all the things, Kung Flu cases, and deaths – even if just a fraction of the whole – will skyrocket, and most importantly, the much higher percent than deaths, people requiring hospitalization, has a very good shot at destroying health care in this country for any area that’s swamped, meaning anything life-threatening after that point will be fatal.

And doctors and nurses, being older than most people entering professions, will die at a higher rate too. If you thought there was a doctor and nurse shortage before, just wait until you lose 10% of them for months, and some permanently. Which also makes salaries for the survivors higher. Adam Smith’s Invisible Hand is going to bitchslap that part of the economy. The only saving grace will be all those people dying might cut the cost of Medicare, and keep Social Security solvent for another few years before it teeters and falls over.

And opening the floodgates again will guarantee that this comes back, in waves, which will knock a given percentage of the country on its ass, over, and over, and over again, just without killing most of them. Let’s sign up for that, please.

With no recognizable healthcare where that happens, probably through next spring, at least.
Riches for me, even 7-day-a-week employment if I want it;
plague, financial ruin, and death for you/us all.
No medical care, as such, for anyone, for perhaps the rest of 2020.

(And if we have back-and-forth quarantines, and then not, and then another wave of outbreak, serially, take a wild guess how many front-line people in health care will say “F**k it; I’m out. Call me back when you’re serious.”? My guess is 25-50%. We’re not draftees, we can walk when we want. And will.)

What’s not to like?

Unless TPTB triage all Kung Flu actual and suspected cases out of the hospitals' normal system, and open up government ghetto Kung Flu Treatment Centers.

And of course, seeing how the Deep State was weaponized to go after Trump, no one can possibly think that such a pandemic gulag would ever be subsequently weaponized to weed out the Deplorables, can they?

 Sheer coincidence, no doubt.

Wednesday, March 25, 2020


This is 1/3rd of Peter, Paul, and Mary, from 1977. The middle name should give you a clue. Some of you need this about now. Even if you think you don't, it won't kill you. Think of it as a stress break for 3 minutes. And it should have a lot more than a paltry 4K hits on YouTube.

Sauce For The Goose

News Bulletin From the Dept. Of Epicaricacy:
(RINO News) The National Commission on Military, National and Public Service, formed by Congress to assess various military issues, will recommend making women eligible for the U.S. military draft, Politico reported on Tuesday.
“This is a necessary and fair step, making it possible to draw on the talent of a unified Nation in a time of national emergency,” the commission wrote in a report to be released on Wednesday.
Splendid. Competence Be Damned. Yay, Wimmin Trying To Be Butch. This will end well.

There is a silver lining: if they're required to register (as they should be) for a draft and don't, they are ineligible for college loans. Which failure will finally start the tectonic shift of colleges from Screaming Feminazi Indoctrination Centers, and hopefully tip it back to parity with equal numbers of Toxic Masculine types. Women will have to get menial jobs, or stay home and try having babies and running households with a lifelong partner again. Maybe it'll catch on, instead of being the aberration it is now.

We should test this out though. One year, draft the entire year group of women who would normally enlist, just to make sure it works. Require a two-year term of active duty.
In fact, let's be really fair: let's do that every year, for all women serving, for the next 245 years, as reparations to all the men who were sexistly drafted alone, for all the years since the Revolution. Fair is fair, after all.

The fact that the screaming Mimis in Congress will sound off like scalded cats if we did that is just a side-benefit, despite them shrieking since the 1970s that even equality for women in the military meant that "drafting women will NEVER happen!" Listen to liars, win stupid prizes.

Later in the article, they note that (after slipping in booster steps for the physical training, lowering standards to ensure graduation, and finally issuing command guidance that "Wimmin WILL Graduate!"), the Army has had 30 women actually graduate Ranger School since 2015.

So I couldn't resist.


For Concerned American, via LTGEN Russel Honoré:

Regarding CA's comment at WRSA:
"Do you see anybody thinking about the impact on med staff (MDs to newest hire nurses and techs) of this first wave?
Last time I checked, it takes more than a season to grow a credentialed med pro of any label, let alone make one that is truly competent."
Only tangentally.

The Good :

All students, interns, volunteers, etc. were told to Eff Off and stay home. No clinicals, etc.
That's cost some of them some valuable pre-graduation clinical bedside experience, but it spares them from in-hospital exposure risk.
It's also the right thing to do.
They're students, and unpaid, not hired and licensed professionals (Yet, kids. Patience.).
Their job is to pass school, and their boards, not be casualties for zero pay in a battle they haven't been vetted for, at this point. Don't worry, their day will come.

I told my department leadership waaaaaaay back in early February about getting alternate sourcing for the 40+% of our everyday supplies (including some pretty important sh*t) that only comes from China.
Surprising the hell out of me, they kicked it up the chain, and gave me credit. So the important thing is that we did get alternate sources of a lot of things, and the China problem for our supplies is less of a factor going forward.
The minor factor is that my management (and I) are now certified jet-fuel geniuses compared to TPTB that run the joint, because none of them were even paying attention to this until my memo popped up on their radar. Still no pay raise, but I'll settle for the street cred. Less than a year in this gig, and they asked me about joining managemanglement. Pass. I like doing my job, for now. Not waving my arms and telling other people how to do theirs all day, and flying a desk. And I'm not interested in the pay cut. Besides, when this is over, and things return to normal, the first cuts are always desk jobs, not bedside. Color me employed and making six figures right where I am, thanks very much.

Some docs have been epic at telling b.s patient visits to "Get Out of My E.R!" (which is where the backstage medical term GOMER came from). They have literally chased dumbasses out of the lobby the minute they signed in for silly-ass stuff that should have gone to Urgent Care, PMDs, or been treated at home using the patients' own common sense, generally in short supply. The dropped jaws when this happens are worth the admission price to see the show.

And we've told visitors, point blank, to stay home. Except with newborns, and those visiting expectant patients and DNRs. Yay, 500 fewer Kung Flu reservoirs trooping in and out every day, and using up all the other masks and gloves. Brilliant.

Cops, criminals, and homeless are even afraid to come in and get Kung Flu, so daily census is low, until stupidity breaks out. So far. Meanwhile, what does come in is really sick, and we've lost a few spots creating Kung Flu dedicated beds on all wards, so we have less than a dozen available beds in the whole hospital, most nights.

Still, we've had enough PPE (mostly). So far. But this has barely begun. Which brings me to

The Bad :

Our entire first batch of N95s, for the entire hospital, grew legs and walked away by the 15th of February. (Staff pilfering, patients and their gypsy families helping themselves, etc.) February, BTW, was our month to do Annual Mask Fit Testing. Being a good boy, I trotted right down by the 2nd or 3rd, and got checked off. Then had to do it again on the 16th, because the first brand (everyone's favorite 3M Item #) had walked away, and we had a new brand of N95s. We have burned through all of those, and are now on our third version of N95 masks. Which are running low. Because, never having had 4 to 20 rule-outs for Kung Flu, and 10-20 admits under surveillance (or active confirmed cases, we have a couple of those) before, the planning for how much stuff we'd go through daily, weekly, monthly - masks, gloves, gowns, face shields - was, to put it gently, rather exuberantly optimistic.

[Hospital Manglement/Purchasing/Supply Dweebs EVERYWHERE! - Word to your mothers: If you haven't planned for every nurse on every shift to go through twenty complete uses of PPE, for every patient in the hospital, at 200% of normal peak visit capacity, for 6 months non-stop, you're fucking this up by the numbers. You should have 40' conex boxes of this sh*t (FFS, they're paper, etc., and they don't go "bad" in the cartons) stored in the hospital parking lot, and every 90 days, the oldest month's stock should be rotated into use, so you're using up old stock and replenishing it with fresh stock, always, forever. This is Disaster Prep 101-level common sense, you cheap lazy bastards.]

No one AFAIK anywhere is doing this like they should. Consequently, things are running out. Masks are rationed through supervisory staff, and it still runs out.
My take on this, is that in this sort of pandemic/disaster, three things will run out.
1) First will be beds.
2) Second will be PPE.
3) Third will be staff - out the back door, when asked or voluntold to "suck it up" and walk into a bonafide hazmat room with faulty, inadequate, or no PPE.
We get to that point, and that's the day I file for a personal leave of absence. I've seen me do it.
(I will work for you. I will not get sick or die for you. Especially because you were cheap, stupid, short-sighted, or all three. I can't spend my paycheck from Forest Lawn Memorial Park. You wanna threaten to replace me with fuckheads who will, suture self. My starting rate after they die will be 200% of what I make now, minimum, after this all blows over. Suck it, or learn a lesson. Florence Nightingale and Dr. Schweitzer are dead. If loyalty only goes one way, the only love you show me is in my paycheck. I will live to spend it, or seek other employment, with someone less f**kheaded. I'm not a dewy-eyed 20-year-old nitwit. You're paying me for my common sense, clinical experience, and mature judgment. Don't be surprised or butthurt when I and my brighter co-workers exercise it. Period.)

Which brings me to

The Ugly :

The "guidelines" for this are worse than the Pirates Code. Which really are guidelines, per Capt. Barbossa.

First, they change daily. Or more normally, multiple times per day. That'll work well.

Second, they get finger-banged, re-interpreted, and outright ignored, depending on the IQ of the nurse/doctor/charge nurse/house supervisor/infection control person/CNO/CEO/County Health Office flunkie in question. And every one of them, in the last two weeks especially, has proved the truth of the contention that 50% of everyone graduated in the bottom half of their class. Patients are being run through "isolation" rooms with no filtration or negative pressure. Patients who meet all criteria for a Kung Flu rule-out, and full precautions, are being waved into regular patient care areas, with minimal PPE in use, because there aren't enough isolation rooms and PPE supply carts to do that. This exposes all staff, and other patients, to potential infection who didn't have it previously.
Staff members ignore this and basic precautions, due to stupidity, apathy, resignation at substandard practice becoming the norm, or laziness. All of this is a recipe for disaster. Ask the entire uniformed military services, or Cunard Lines, or Boeing, or Airbus, or NASCAR, or NASA, how that works out in field tested situations.

Safety Rules Are written in blood.
Don't make it yours.

I would have it otherwise, could but wishing make it so. But stupidity reigns, more often than not. We're going to pay for that, and by extension, so are you.
I'm not looking forward to writing Solzhenitsyn's "how we burned later" Lament for the medical field, in a year or two, but it will be written by someone over this, mark my words.

The only thing I'm sure of now is that I didn't have Kung Flu 14 days ago. Until I do.

Third, because in the immortal words of Gen. Honoré,  "you didn't plan for a disaster, you only planned for an inconvenience", none of the shit - pardon me, I meant to say SHIT - we have pulled out of storage to use for this has ever been field-tested for fifteen minutes.
What they seem to know about basic tent usage wouldn't impress a boot camp private on his first attempt to set up a shelter half with a buddy. Recent rains collapsed - COLLAPSED - the tents in which we were going to house patients outside the building. Electrical cords and generators were/are snaked through sudden deep puddles of water in driving rainstorms, because they only ever do disaster drills briefly, on sunny, warm, non-windy days. God help them when we get a good Santa Ana wind day. Temperature-sensitive equipment includes thermometers, FFS, which we kind of need to check for fever, but they become unreliable or fail in normal outdoor temperatures that aren't 68-72º. And no one thought to have actual no-shit mercury bulb glass thermometer backups, that have worked since 1800 and earlier, because it gives the EPA a case of the vapors.

Radios fail. People - and I'm talking educated folks with science degrees, not just Joe Average - don't understand simple concepts about how they work. (Oh, and not one swinging Richard in the whole house, top to bottom understands basic radio use or protocol. I had mine beaten into me both as a member of Uncle Sam's Misguided Children, and again as a Red Cross Volunteer by a Navy LDO Lt. Cmdr. who did truly legendary meltdowns on the clueless, via landline, at wee events of 1-2M people, which all of you have seen on TV in your lifetime. O, to get him to come out and teach that class where I work now, for but an hour...). When you have hundreds of people making mistakes that a simple hour of training could cure, it's because the planners don't know what they don't know, and never asked anyone who does what they need to know.

The concept that generators run out of gas has been an amazing discovery.
In tomorrow's news, water is wet, and the sun comes up in the morning.
I can hardly wait until they discover that gasoline fumes and vapors are flammable and explosive. Maybe they can get the FD or Burn Center to hold a powerpoint or something.
Ideally, before the FOOM!

And it's cold now. Wait until this stretches into May, and they've made no provision for when it's hot outside instead. Nothing like heatstroke for staff and patients to get your attention to what you're fucking up, daily, by the numbers. Stuff any decent assistant director in Hollywood could have told people, because TV and the movies work outside 24/7/365, but the hospital is a bunch of wilting orchids once they exit the building.

What I really don't want to point out, but will have to in another week or two, is to ask WTH their plan is for when, quite literally, the natives get restless, and storm the bastion. Who's going to provide more than kabuki token security the day we have 40 scared people in the outside tents, or the community decides we have food, medicine, etc., which they want and don't have?

Does anybody really think that Joe Rent-A-Cop and glass doors will avail when the Free Shit Army comes calling? Well, I mean does anybody besides the idiots running the joint who haven't thought that far ahead...

Somebody's hospital, mark my words, is going to be the bellwether for when it's time to deploy the Notional Guard, with fucking bayonets and loaded mags, and tell them to repel boarders with extreme prejudice. I don't want it to be mine. But the day may well come when I'm carrying at work, and sporting a discreet kevlar undershirt, and it'll be NDBBM*, with something larger and louder in the vehicle rack. Or, I'll simply self-deploy home, for the duration.

That's before I get to lack of thought for any provision whatsoever for anything but the everyday JIT supply of normal materials, let alone water, sanitation, food, power, and all the other necessities that make a functioning hospital possible.

The lessons of hospitals and disaster relief from the Northridge Quake, Rodney King free tennis shoes and TVs Riots, or hospitals in Nawlins during Katrina, are like stories about trench warfare, Greek myths, and the Jurassic period: ancient history. People who should be able to quote how to do this from memory don't have the first fucking clue what they're doing, or going to do, if anything seriously untoward happens, or one person out there so much as says "Boo!"

They've planned for a grade school fire drill, not for the Paradise Fire sweeping through the city.

It's going to be an expensive OJT lesson, for a lot of people.

So no, in sum, they've given the safety and well-being of the medical (and all other) staff, and patients, and by extension the entire community we serve, far too little thought (and I use that word loosely) to suit me. And that's not just the hospital, it's ALL the entities, private and public, and agencies involved, from the city council to FedGov, and everyone in between the two, at every level.

I've been through two major earthquakes, and two region-wide riots, and what I'm seeing is what happens when jackholes with zero experience in either try to run something they've never even imagined.

If anything, I'm sugarcoating this.

And yet again, the safety rules are going to be re-written, in blood.
Hopefully, not mine, nor yours.

*(Nobody's Damned Business But Mine)