Monday, March 9, 2020

Embrace The Suck

h/t WRSA
















Italy Lombardy region is on the brink. Retired doctors summoned, nursing students field promoted to graduation. Just under 10% of Lombardy's #COVID19 cases need ICU. 10% of doctors/nurses have already caught #coronavirus and in quarantine. Jesus.
 The head of the Lombardy's intensive care crisis unit says the health system is on the brink of collapse, intensive care being set up in hallways. By March 26 they predict ~18,000 #Covid19 cases in Lombardy, of which ~3,000 will need intensive care.
The U.S. will not  automagically do it better because "'Merica, f**k yeah!". In fact, more than likely, we'll do it worse. 50 states' licensing boards are not going to overnight drop their standards for getting a nursing license. Which license only confers on a shiny new grad the 80% likelihood than on any given day, they won't kill their patient outright. It takes six months of baby-steps precepted training to make a specialty nurse that can operate without training wheels, and 10-18 months' time practicing in that specialty to become a certified functional badass. You won't teach nurses how to function faster simply by pointing a blowtorch up their butts, and getting a license is a wee bit more involved than getting a diploma from the Wizard of Oz.

And we're not set up (and never have been), outside the 4 BL-IV level bio-hazard wards in the entire U.S., to deal with a highly infectious pandemic, nor surge capacity anywhere to 4000% of normal census.

Not. Going. To. Happen. Evah.

So what you'll get, is what I've described on these pages previously.

A FEMA Kung Flu Treatment Center in a sports auditorium, or convention center.
No isolation. lots of cots in an open-air open-grid coughatorium. Genius!
No licensed personnel (except some poor schlub or two, holding the bag and supervising an army of well-meaning amateurs).
No PPE equipment for staff, and certainly nowhere near enough of anything, but patients.

Were talking, on our best day, Crimean War-era levels of hospital care.
(Hint: Horrible hospital care put the "crime" into Crimean. 900,000 soldiers out of 1,650,000 soldiers on all sides died in it, most from disease, not combat or wounds from it.)
Care so bad Florence Nightingale had to invent modern nursing science to fix the death rate. How did America do at that? Google Civil War hospitals 6-10 years later, and Clara Barton. Same damned thing, even with years of a head start.

Because you can't pull hospital beds (just regular ones, let alone ICU beds) for millions of people out of your ass on the fly if you don't know what you're doing, and we won't do that either. By the time anyone realizes this and takes it to heart, it's going to be time for bulldozers and bonfires.

I repeat for emphasis:
Shit Mardi Gras.


This is why I keep telling you to do things so you don't get this virus. Maybe you'll be in the lucky 80%, for whom it's just a PITA. Millions of your friends, neighbors, and your family, FFS, may not be as lucky. Start working out how you and yours might start self-quarantining, before it becomes mandatory instead of an option. And if you can do so, do it.

And you should take a long, loving look at the healthcare system that was the envy of the world. Take some souvenir photos. If this goes Shit Mardi Gras, like it apparently has in Italy, it's probably going bye-bye for the duration. If not altogether and for good.

Pay close attention to those last two points at the bottom.
Math optional, but recommended. When 40% of your staff is
 symptomatic, in a viral outbreak with a 2-28 day latent
period, you're not crippled; you're DONE.

Start wrapping your heads around the increasing likelihood of those unpleasant realities.

It'll hurt less than waiting until you do a faceplant in the brick wall at 60MPH if you wait until five minutes after it's already too late.

Like the government - here, there, everywhere - is doing.



















I'd love - LOVE -  if I turn out to be all wrong on this (as would half a dozen armchair sceptics with low-level IQs and government-level critical thinking skills).
And I'm frankly scared shitless of being spot-on. It's not fun to contemplate.

But I've yet to see any promising news from anywhere, and I've been sciencing the shit out this since late January, when it hit radar.

And a curmudgeonly pessimist is rarely ever disappointed in how things turn out, but occasionally pleasantly surprised.



32 comments:

The Gray Man said...

Our COVID-19 patient is dead, but luckily at least one of our nurses that was quarantined for the virus turns out NOT to have it.

Now we wait for the others.

Tasties said...

Have you heard anything about how it affects young children? I have a 4 yr old and a 6 month old. If we have to do any “self-quarantining”, they’re gonna get it.

I have heard conflicting information. Some reports are “kids don’t even show symptoms”. Some are “kids are like the elderly”. Or you hear nothing.

EasyCompany said...

So, what should someone like me do?

I have endocarditis and take warfrin and need to get tested for it regularly.

I get check at the hospital because the clinic is filled with people/kids that, at least a third, are hacking & coughing.

If I tell my cardiologist that I'm not going because of C-19, can they declare me as "non-compliant" and drop me?

I live in rural northern Michigan and finding doctors isn't easy and there is only one healthcare system (Munson) in this area.

Anonymous said...

Beds - no. Hammocks - maybe. Takes up less space and entire assembly can be boiled for killing virus (I think - no idea if that would kill COVID strain). Tying poles to sides can convert to stretcher if required.

EasyCompany - my condolences. I am in much same predicament (replaced mechanical heart valve some years back requires blood thinners) and I have only a 90 day warfrin supply. I intend to call my GP today and see if I can get more. Good luck finding a solution !!

Anonymous said...

I just want to thank you, Aesop.

I've been trying to get some family members on board with preparing the last month and a bit and was blown off mostly. They are good people and not stupid but cognitive biases, you know. I pointed them to your site last week and it looks like the penny dropped for two of them. No panic. Just, shit, we better start taking stock and getting organized. Your lists were very useful.

Thanks again.

Deacon

nick flandrey said...

TPTB are still selling off medical equipment in surplus auctions. That shit should have stopped last week at the latest.

publicsurplus.com
slapsale.com

look at the medical category for examples.

It MAY be less than last month, but it naturally ebbs and flows so it's hard to be sure.

n

Anonymous said...

While it might be gratifying to be validated it's frequently " cold comfort".
Again, THANK YOU for all you have done and continue to do. Hope your break-contact plans are available if/when the time comes.
Boat Guy

nick flandrey said...

Hey guys,

has anyone seen anything about the early patient that was sent to Nebraska and admitted to the BL-4 ward?

Or heard anything out of USAMRIID or Nebraska?



I'm still curious about the jewish lawyer in NY and why nothing mentions where he might have picked up his case. That multipage article with his wife's apology and more background only mentions Miami in passing at the very end. It's odd, because every single article about a case lists or speculates about where the case might have originated, but not this guy.

nick

Anonymous said...

I think we are prepared. But keep looking for opportunities missed. Luckily as of last weekend here in S New England most of the sheeple are still enjoying the CDC hopium and thinking, 'its just the flu'. Good. Keep em calm and from buying up everything until I'm sure I've got all we need. Plan is when they are freaking I'll be at home chilling but prepared to man the defenses if needed.

I too was hoping I was 'wasting money' starting back in Jan. Oh well. Another case of no way out but through.

Anonymous said...

There is stupid and then there is MO stupid. Our first case identified this weekend in St. Louis county. Family said they would self-quarantine. Evidently, their version of self-quarantine was for the father to take his other daughter to the school dance that night...no shit. Now public health officials in St. Louis country are telling the family if they don't self quarantine, they will forced quarantine them. Oh, BTW, the infected family member just got back from Italy and took AMTRAK from Chicago to St. Louis on their return trip.

GruntPa

Badger said...

As Trump gets chastised for holding rallies I wonder if the Commies still intend on conducting their Giant Petri dish event in June at the major indoor venue in downtown Milwaukee. Arena size - 2 legged organisms from all over. What could go wrong?

Anonymous said...

Aesop,

This is from an ICU Dr. in Italy

https://threadreaderapp.com/thread/1236933818654896129.html

Irish

Anonymous said...

@EasyCompany and Anon 4:29

You've got 21st century medical issues requiring 21st century drugs so you're pretty much screwed when supply chains falter. BUT rather than *totally* give in to that fact you might look to 19th century medicines for the heart but realize that you'll most likely get the lower mortality rates of that same century. Before aspirin we had white willow bark that contains Salicin. Apparently, Beethoven died from an overdose! (kidney damage)

Natural blood thinners are turmeric, ginger (also contains salicylic acid), cinnamon, cayenne and Vitamin E. There's lots of scientific research on cayenne (boosts circulation and lowers blood pressure)so out of the list cayenne would be #1 with turmeric coming in 2nd. Cayenne is good (mixed with hot water) for heart attack and stroke victims. Do your own research! Also in my medicine cabinet is bentonite clay. It can be taken internally for food poisoning and applied externally on wounds and spider bites. Again, lots of research on how it works with staph infections, MRSA, etc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413170/


Note to Aesop: When it's down to field medicine with limited supplies I'd prefer a wee bit of plant hopium before throwing in the towel completely. I'm an old school herbalist and you're a modern drug guy but we're most likely gonna be peddling back in time when Native American mud was really amazing stuff.

MTHead said...

What bothers me is the CDC, Canada, and god knows who else have had samples of this virus for years and done exactly what? These morons cost billions of dollars a year and their not even developing vaccines? Partnering with FEMA for better outbreak response? Maybe just stockpiling enough PPE to handle this sort of thing?
To me it's as ignorant as an army planners not ordering bullets!

George True said...

One thing that struck me from the nursing home status update is the ratio of patients (120) to staff (180). That is 1.5 staff members per patient. I never realized just how many people it takes to care for elderly people in long term care facilities. If (when) this hits LTC facilities everywhere, probably at least a third of the staff is going to get it too. Another third of the staff might very well leave and never come back. There will be essentially skeleton crews trying unsuccessfully to adequately care for the elderly and infirm residents. The death rate in these facilities is likely to be quite high. These folks already have one foot in the grave and the other foot on a banana peel.

nick flandrey said...

WRT mask use, in just this one article from Italy, the ordinary people are 7 for 7 wearing good respirators incorrectly. I can see in the pix that they don't have the straps positioned properly, or have not formed the nose wire to fit their faces.

https://www.dailymail.co.uk/news/article-8090779/Italian-PM-makes-impassioned-plea-16-million-obey-quarantine.html

Most of the masks are just surgical masks, serving only to keep chunks out of your mouth and to keep your chunks in, and even then, as simple as those masks are, there are at least two people wearing them incorrectly.

Among the uniforms and medical "auxiliary" people, the ones with actual respirators have only about 2/3 are worn correctly, and many have just the surgical mask for protection.

No wonder it's spreading.

nick

and no, I don't think their use of masks should be restricted, but we'd be much better served by having them shown the correct way to wear them, so that good respirators with exhaust valves even, aren't completely wasted.

Anonymous said...

@Tasties
I've read from a couple of (questionable) sources that KungFlu contains TB as a third component which is why children ages 5-12 fare better. However, in this early report from "The Lancet" they studied a familial cluster and asymptomatic children had ground-glass lungs according to the CT scan. A one year old recovered and was released from hospital.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext

With ordinary influenza-bro we expect to fully recover and carry on as before. With this virus we don't know what "recovery" looks like. We don't know if the lungs healed or if the kids got reinfected and succumbed. We've got enough cases in the US, like the first patient in Washington state that recovered, to use as lab rats. Maybe some super-spreaders from cruise ships and throw in a couple of autopsies from the Kirkland nursing home for good measure.

In the meantime, we don't know just how deadly (or not) this bug really is and our Top Men at the CDC and scientific institutions are looking like blatant criminals with each passing day.

Anonymous said...

Italian doctor at ground zero.

He is living what Aesop foretold.

https://mobile.twitter.com/silviast9/status/1236933818654896129

MTHead said...

Thatwouldbetelling, Maybe at least be able to inform the public of the virus parameters? Spread times? How long can it live on different surfaces? You know, the normal things a public truly needs to know in order to protect themselves?
Kind of like, you live in an earthquake zone. Put some more rebar in your foundation. Type info.
Seems to me every time one of these situations comes along. The guy that's been extorting money to cover it all along is the most flatfooted/surprised that something happened of the crew.
And as for testing vaccines. I knew a guy in Vacaville state prison/hospital that use to get paid for doing medical trials.

chewbacca said...

Very few kids have gotten sick and or diagnosed. Mild symptoms. From the data so far.

chewbacca said...

Get a very respirator, goggles, and go in to the clinic like that. To hell with people making faces. It's your health.

Unknown said...

rural nothern Michigan??? you hit the lottery pal.. im in a big noththeast city with new cases every day. You'll be fine if you just stay local

Anonymous said...

My wife an RN, just called me from the hospital. There are no Kung Flu cases yet, but we live in a fairly remote part of the eastern Sierras. The surge tent was set up last week.

One of the surgical techs my wife works with just received a call from a friend who is in Italy and has been on vacation there. There 14 friends from the US touring together in Italy. All 14 have come down with Kung Flu. I suspect they were using public transportation. One of the group is a 30 year old male in good shape. He was placed on a ventilator and taken away to a place unknown.

Perhaps there is something to the suggestion that Italy and Iran have a more virulent strain of the Kung Fly that can infect younger people as well as old.

Anonymous said...

But...but... muh dance...

https://www.kmov.com/news/st-louis-county-coronavirus-family-attends-villa-duchesne-dance/article_41ec34a4-6179-11ea-b3e3-6fbf809e7778.html

Thanks, dick. You’ve killed us all. Hyperbole, but how fucking stupid do you have to be?

KGH

Aesop said...

"Perhaps there is something to the suggestion that Italy and Iran have a more virulent strain of the Kung Fly that can infect younger people as well as old."

Or...China has been lying about it all along.
Which could it be?
Which could it be...?

Video from Iran had adolescent children dropping and flopping in the street.

Marty said...

So, I took my 86 y/o mom to the oral surgeon to consult on a procedure, was in the room when he came in, I stood to be polite he reached out to shake my hand I just raised them and shook my head, and said no offence he seemed annoyed at that and said the "well media has a lot of folks scared lately" O wanted to say check please but it was not my call, we have a follow up April 6, I wonder what the odds are his office will be closed by them.

Marty said...

@Aesop the Red Chinese lying, what ARE the odds?

"I am shocked, shocked to find that is Gambling going on in here."
"Y"our winnings sir"
"O thank you very much."
Casablanca

Anonymous said...

Aesop,

Between you and CA at WRSA, I would like to hear any thoughts on a post WuFlu reckoning.

From our Administration, thru the CDC, down to local health officials, school administrators, etc. etc. Will the people demand accountability?

An under-informed buddy asked (via text) if I was going to car show this Friday. Big event, indoor venue, sponsored by O’Reilly Auto Parts. I said no and that O’Reilly should rethink having the event. In my mind, O’reilly is assuming the risk by having the event. They have an identifiable Board...

Now transpose that to the college where my daughter works. No closure until profs get lesson plans online. So instead of telling profs get your shit in one sock, 40,000 student continue to mingle. I see the Chancellor around town...

I would think that our state and county politicians, bureaucrats, and emergency managers would be lucky if all they took away from a pandemic was a lifelong limp or needed to be spoon fed for 6 months. Do cruise line COO’s have PSDs?

Probably the most that people will due is stage a protest, cause those work so well.

foot in the forest said...

Hello all. A word to the wise. I have seen reports of wu-flu being detected in the air ducts of hospital rooms that have been used for isolating patients. I have installed commercial HVAC systems for going on 30 years. Every hospital I have worked on and there have been dozens have return air systems that recirculate the air in the hospital after conditioning and freshening. There is generally no cleansing of virus or bacteria in the air stream. If you need to take someone to a hospital be prepared to where an n-95 mask when in any hospital for any reason.

Anton Hackl said...

Here's the "Brutal Truth" per Covid-19...hat tip to WRSA...enjoy!!!


https://capitalisteric.wordpress.com/2020/03/08/coronavirus-blunt-truth/

soapweed said...

A foot in the forest: Sir, As a former owner/slave/peon of a heavy commercial/industrial mechanical service contracting firm for 30 years, we have had multi year service contracts in 7 major hospitals in Colo, Wyo, and SD. and additional work on a short term basis with others. You are correct that the return air systems are one of the many Achilles heels in the healthcare facilities. The neg pressure treatment areas are few and quite small in treatment net square footage.
Doctors keeping up with treatment protocols and supplemental/alternative education is zip, unless it involves a convention in Vegas or Aspen
We are sooooo pleased with retirement, we feel for the political ass sucking involved with plant maintenance honchos and hack directors you now must endure for a paycheck......

Unknown said...

I am not as prepared as I'd like but will isolate and feelingmake do. I too am thinking of the 'after' more and more that this can only end in a fight. Not sure how or what but this event is going to be used for every excuse ad to why the financial system collapses to gun control. Want to bet the organizers of the 2A march and their families are already on the quarantine list? That Trump will get sick? The options for the controllers are unlimited... (evil laughter)