Introducing the Poopypants-bot 2022

h/t Weasel Zippers

You have to see this to believe it:

Watch The Whole Thing

Poopypants turns to shake hands with no one, then has a conversation with his Imaginary Friend and the Voices In His Head until, after multiple aborted tries to find the exit, blabbering to No One all the while, he wanders off the stage and into the sunset...

Ongoing showdown with Russia.

Nuclear launch codes.

"Leader of the Free World".

Fraudulently installed illegitimate occupant.

Full. Blown. Advanced. Alzheimer's.

What could POSSIBLY go wrong?!?

Sleep tight, kids.

Vaxxholes, And The Rise Of The Resistance.

 

So, it turns out the reason the ED was short-staffed the last two weeks, is that something over 50% of the ED staff, and including several of the docs - the ones who were "fully vaxxed" and boostered - all got Kung Flu. (We don't test for variants as such - and neither does anyone else, BTW, in case you wondered about that b.s. - so no one has any wild idea what strain got them).

Unvaxxed me: still negative for two solid years, and still forced to test twice a week at work.

Anonymous Idiots in the crowd: Keep telling me masks and handwashing don't work.

Similar stories in the rest of the hospital.

So now, HR and Infection Control have told them to return to work after just five days. (Because Kung Flu magically dissipates in health care workers after a few days, apparently.)

They're worried they're still contagious. I'm worried they are too.

The one bright light: After three bites at the apple, many of them have said "Fuck another booster. Fire me, or fuck off, but I'm not getting any more of those worthless jabs!"

So they're not jet-fueled geniuses, but they are teachable.

From such acorns, might oaks of resistance grow.

The Federalist Beclowns Itself

 

Masktardation is a thing, and it cuts both ways.
Don't be a masktard.

Some blogs, even ones which we visit and pass along content here, apparently either desperate for content, and/or overcome by pathological levels of confirmation bias, go dredging old news to come up with that content. (Kids with a blog, we beseech you earnestly, don't do this. It rarely goes well, and will nearly always  blow up in your face.) Kill your own meat, kids, and eat it fresh, not months-old. Case in point:

The Federalist has now breathlessly announced that Kung Flu is an "airborne" virus. Based on the pronouncements of "medical experts" (our emphasis, with appropriate derision) from the Communist News network, CNN.

Firstly, when you're listening to any of the usual gang of five-star gold-plated idiots at CNN, you deserve what you get, and even the fucktards at The Federalist who pointed at that bunch of @$$clowns should have known better than to go there, yet away they went.

Secondly, much like that term in a military context, the designation of a virus as "airborne" has actual criteria, which Kung Flu does not meet, and has never met thus far. It's a virus transmitted by droplet transmission and contact transmission. (And nota bene, gentle reader, that the @$$clowns at CDC and numerous sites have deliberately hazed and clusterfornicated up all those definitions in their ceaseless efforts to karenize Kung Flu into the Virus From Hell; I had to go all the way to that bastion of accuracy, Wikipedia, which was the seventh or eighth listed definition for "airborne" transmission, to get an accurate and correct definition that hadn't been completely and purposely fucked up to make Kung Flu fit that mold, which it does not meet to date.) 

For reference: "Airborne or aerosol transmission is transmission of an infectious disease through small particles suspended in the air." (Emphasis mine, for a reason.)

Briefly, something like TB is airborne. The bacteria wafts around and floats in air for prolonged periods of time (we're talking half an hour to hours) after mere exhalation, let alone coughs or sneezes. This is what makes TB or any airborne disease such a royal PITA, medically and epidemiologically. One person with TB can infect dozens in a restaurant or movie theater in a few minutes' time, and did before antibiotics, and still do. Which is why places where TB is endemic and widespread, like slam-packed Asian nations, are places where wearing a cloth surgical mask over the nose and mouth is a daily thing going back decades. (We'll return to tht point momentarily as well.)

But then, the dutiful Karens at Wikipedia, not content to leave the science alone, have gotten into the moving goalposts act, which is what happens when high school and college "experts" are left to edit any repository of knowledge, with all the experience of Gilligan playing with plastic explosive:

"Airborne transmission traditionally has been considered distinct from transmission by droplets, but this is incorrect." - same Wikitardia article 

With a footnote that links directly to some hogwash entitled "COVID-19 has redefined airborne  transmission".

By the numbers:

1) Airborne transmission is, is, IS distinct from transmission by droplets. If you have a plant mister, you get this. Blast a mist of aerosolized water into the air, and there's a mist cloud there, briefly. Unlike, e.g. tuberculosis bacteria, that vapor cloud isn't there very long. (For instant proof, try that on a hot day.)

2) COVID-19 didn't "re-define" airborne transmission, but jackholes trying to make COVID-19 do something which it manifestly does not do, have changed the definition of "airborne" to suit their purpose, by first ass-raping the English language and medical definitions.

QED

Language doesn't work like that, especially in science, versus in political advocacy.

Language, especially medical and scientific, is not
fungible, despite the earnest opposing desires of
crack-smoking Leftards.

For those with military training, it's the difference between getting hit with nerve gas, versus by a projectile. If you're standing in someone's cough- or sneeze-spew cone, you're being hit with a droplet. It's a projectile. If you walk into a cloud of VX, you're getting hit with something airborne. And minute sneeze particles hanging about for a few minutes is not the same as something that lingers for hours. Period.

But wait, there's more.

Then, our heroes, both the blog in question, and The Federalist, not content with that much fail, go far beyond stupid, to recockulous.

"Joe Biden’s COVID-19 adviser Dr. Michael Osterholm similarly agreed that wearing masks is “largely” nonsense and that “trying to stop the flu [another respiratory virus] is like trying to stop the wind.”

Point of Order: So CNN "experts" weren't stupid enough, now you're going to reference Joe Biden's "science adviser"?!? Well-played, soopergeniusii.

And then point to a "meta-analysis". Which isn't a clinical study. It's a study of other clinical studies.

What could possibly go wrong with that?

If you do a meta-analysis of physics studies, published by Einstein, Fermi, Richard Feynman, and Sir Isaac Newton, you might have something worth reporting. If instead you do a meta-analysis of studies published by Gilligan, Goober from Mayberry, Inspector Clouseau, and Baldrick from Blackadder, well, not so much.

Because you lump all the studies in together, and assume that their methodology wasn't hugely suspect, and that their results are repeatable.

Put another way: Exactly how much straight horsehsit are you okay with being cooked into your meatloaf?

Now bear in mind that most of the "studies" are pure horseshit, and re-answer the question.

That the overwhelming bulk of such studies are results that are totally unreproduceable has been an open secret in research science for two decades. SiG revisits this topic frequently, and it's gotten worse than 70% bullshit, year after year. It's something like 90%+, when last I looked. "Meta-analysis" sweeps all that under the rug into a nice hidden shitball of fail.

That's just the overall problem. Next, there's methodology.

IOW, if you want to study something, you have to account for all variables. ALL variables. Ideally, you want to get down to studying just one. Hopefully, the exact one you're hypothesizing about.

For instance, if you want to know the exact temperature at which water freezes, you do at testing at 14.7 psi, I.e. atmospheric average pressure at sea level. Otherwise, when someone tries to replicate your data in Denver, it won't work. You standardize ambient humidity at, e.g., 50%. Or else someone in Panama, at 99% humidity, and someone in Anchorage in January, when humidity is 2%, are going to fail to get the same results, and thus doubt your "proof". And you use absolutely pure sterilized ionized water, with 0% salinity, otherwise, someone trying seawater, or sediment and bacteria-laden swamp water, are going to announce loudly and publicly that your research is horse cobblers. So then, with only the ambient water temperature a factor, at standard sea level pressure, and 0% salinity, you freeze water 100 times, and it keeps coming to 32° F. time after time after time, and you've got something you can publish.

And, for bonus points, if you get random other numbers, you've failed, but you've discovered a hidden variable, an Unknown Unknown, and your new job is to find that little bastard, and track down the Truth. This is why Edison tried and failed hundreds of times to invent a working lightbulb, until he'd weeded out all the variables, and it finally worked.

But grant-beholden scientists nowadays especially are too lazy for that. It's too hard; they know they're right, so they skip a few steps. And when someone checks their experiment, and it cannot be reproduced, it's so much crap. But the "scientist" who did the original experiment has "proved" that asbestos is harmless, and smoking causes no health problems, so the building material supplier or tobacco company who funded their "experiment' pays out, and they cash the check, and never look back. Have lab coat, will falsify data for cash.

Enter advocacy government.

Global warmism/climate change. Or gender dysphoria. And now, coronatardation and COVIDmania.

Suddenly, you're "testing" masks never designed to protect the wearer, and - mirabile dictu! - "masks don't work". (Somebody call Pasteur, Lister, and Semmelweiss, and tell them it's not germs, it's bad air floating in the phlogiston that cause diseases. I'll wait over here.)

There may be others in recent times, but I'm aware of precisely one proper study of the effectiveness of cloth and surgical face masks, used as intended, using documented infected persons, in a study that lasted years, and controlling for the only variable that matters: does the virus get out?

TL;DR: 

No mask - 100 to 1000 coronavirus viral particles land in a viral particle chamber in front of their face after 30 minutes.

Bog-average surgical mask - 1 viral particle escaped. IOW, a 99.9% to 99.99% prevention of viral load down to 5 microns or less was achieved over 30 minutes' exposure.

None of the studies referenced by The Federalist tested that. They tested whether the masks protect the wearer. [Pro-tip, fucktards: they are neither designed nor intended for that, since ever. You could look it up.] This is like testing parachutes to see how many people wearing them didn't land on the earth. Fucktard Science 101 level error there, geniuses.

They tested whether the masks stopped everything, for unknown long periods of time, e.g., during extended surgical procedures.

In one "study" cited, they found that wearing a double t-shirt mask increased the level of virus expelled above the level transmitted by wearing nothing. [Pro-tip: if you can't figure out why this is prima facie recockulously impossible, try putting a t-shirt over the gas nozzle at the local station, and see if that delivers more gasoline into your car's tank. IOW, you can't exceed the results of no mask, under any circumstances, unless you're having people blow through a fully colonized petri dish of germs grown for days beforehand.]

When a test succeeded exactly as expected, it was labelled as "apples and oranges".

We could go on and on, as these assclowns have, but their point is pointless.

When you keep pointing to retards, and bullshit studies, and then act like Little Jack Horner pulling a plum out of your ass, you're just an idiot.

When you can't account for a thousand other things, like people wearing their masks on their chin, or touching everything with gloves, and then taking those gloves off with their teeth to touch their cellphones, or don't wash their nasty hands after they crap and rub feces all over them and then finger-bang everything they touch afterwards with their poo, the problem isn't masking or not, it's societal retardation. And dozens of variables you forgot to control out of the experiment.

Masks Work - As Designed

A surgical or cotton mask isn't something you wear to protect yourself. Write that on your hand with a Sharpie in case you're too stupid to remember that. You wear one to protect other people from you. For the same reason you put a diaper on a baby's ass. It's not there to protect the baby from shitting himself. If this needs further explanation, you're not smart enough to be let out in public without the chaperone from the short bus field trip, and you can probably tell the class what the glass on its windows tastes like.

If your aim is self-protection, you need to be wearing a properly fitted and fit-tested N95, or better. Got facial hair that prevents a proper seal? You're f**ked. Haven't been fit-tested? You might be f**ked. Don't know how to put it on right and seal it properly? You're f**ked. That's why the surgeon general correctly told you not to bother with an N95, unless you're going to do the homework necessary. Only afterwards did CNN and Fauci retardedly conflate that down to "masks don't work".

Anybody who was ever in a military or police tear gas training chamber exercise knows what I'm talking about here.

People too stupid to understand that were very entertaining to those of us in those chambers who watched them spaz out and lose their shit, choke, and puke, because they didn't pay attention. Don't be That Guy.

What Masks Won't Do

An N95 won't protect you from anyone if you wear it wrong, or it doesn't fit and seal.

A surgical or cotton mask isn't there to protect you from anyone else.

Any mask is pointless if you aren't in close proximity to the infected, and you aren't infected yourself.

In your car, by yourself, wearing a mask? You're a fucktard. Walking outside, or exercising, by yourself, with a mask on? You're a fucktard. In a population that isn't infected with COVID, flu, or anything else, and wearing a mask? You're a fucktard.

The problem comes with that last part: knowing whether you, or anyone else, is infected. Want to go mask-free? ROWYBS. And so will everyone else around you. Which works fine (just like with VD and AIDS, and merrily sport-f**king people.) Until it doesn't. Play stupid games, win stupid prizes.

I've been wearing masks of all levels, and putting them on people, professionally, for decades. They piss me off mightily. But if you cough or sneeze or spit, fuck your comfort. And if I have to be around you, and you could give me something nasty, or lethal, fuck my comfort too. Harden the fuck up.

When enough people play stupid games, the professional jackasses in politics feel honor-bound to nanny them.

When they have a spring-loaded fuck-with-everyone-and-control-their-every-waking-activity setting, then it becomes the shitshow we've lived for the last two years and counting.

And when intelligence is a constant, but the population is increasing, the mean IQ is dropping like CNN's ratings.

Bloggers and the usual gang of science-impaired idiots at The Federalist should probably stop hitching their wagons to the fucktards at CDC and ABCNNBCBS. Unless you don't want people to be able to tell the difference.

Related: GMTA. RTWT.

Sixth Circus Reasserts The Rule Of Decree By Fiat

h/t WRSA

It's not hard to find a couple of stupid people in Appalachia,
if you look in the right place.

Who needs the law when you've got an agenda? Certainly not the Sixth Circus.

For the most masterful deconstructionist rant of the recockulous overturn of the unconstitutional vaxx mandates I've seen, I direct you to bad cattitude, before whose efforts I stand awestruck, and deliver a richly deserved Slow Clap.

This is masterclass on fisking judicial activism, kids.

RTWT

Possible silver lining? Other than the two braindead black-robed assclowns who overturned the stay on OSHA's mandate, the rest of the Sixth Circus has apparently voted to hear the case en banc, with a view to overturning it, and reinstating the original nationwide stay, by majority vote.

If that happens, Emperor Poopypants' judicial record will drop to 1-3, and he won't make the playoffs even as a wild card.

Phil's Luck

If any of you are regular visitor's to Phil's Busted Knuckles blog (and if you're not, fix that), you know what I'm talking about here.

So there I was, ranting away t'other night on the keyboard, when suddenly there was a loud BANG! downstairs, and the sound of a firehose. I could hear the water rushing through the pipes, and thought it must be a neighboring suite, but being seated near the duct for the bathroom, I could also detect the sound was apparently coming from my bathroom. As I wasn't using any appliances in the bathroom downstairs at the time, I was a tad concerned.

Descending tout de fucking suite, I arrived at what could only be described as the screaming nightmare of every current or former submariner: water blasting into the space at ludicrous pressure, uncontrolled by anything whatsoever.

From the supply line somewhere underneath the porcelain throne. 

Quick as a flash, I flipped the cut-off closed. No dice. Standing ankle deep in cold water, I couldn't see that the reason the water continued was because the supply tank was also draining back out through the supply line, which was why shutting off the stopcock alone wasn't making the flow stop.

But having been here some years, I also made a point of knowing where the master water cut-off was outside, so out I dashed, and flipped that as well. When I returned, blissful silence, but again, only because in my absence, the supply tank had finally emptied itself. Inside the room.

I also remembered that the management company's two hired plumbing flunkies, Goofus and Doofus, had done exactly one thing right in their just-before-COVID replumbing of the building I was occupying: they'd installed a whole-house cutoff upstairs. So I went up, accessed that, and threw it for good measure.

Then went out to turn the rest of the building's water back on, and ponder my next move(s).

Elapsed time: maybe three minutes. Now I returned to the scene of the catastrophe, and started bailing and bucketing water into the john, before it soaked through walls, etc. It was about a bathtub's worth, and the rest I set upon with all the spare linens I could locate.

Now with time to think, I explored the source of the problem.

About two-plus years ago, Goofus and Doofus had come through, and re-piped (so to speak) each unit. Why, the management company and God alone knows. The new supply pipeline they'd installed hangs two feet lower, robbing that much useable space, and creating another attic headache in what was once almost all useful storage space.

Then installed the afore-mentioned drop line with individual cutoffs, connected to not new copper plumbing, but out of sheer cheapness and laziness, PEX lines. To which they'd attached new through-wall supply lines for toilet, sink, and such, but which, unlike the '70s-era original plumbing, now had shiny new individual point source cut-offs, enabling plumbing changes at whim by tenants or management.

So looking at the now empty toilet tank, I noted that the supply line from wall to flush valve was hanging as limp as Grandpa's johnson, completely detached from the wall cut-off.

After unscrewing it from the tank valve, I was looking at a virtually pristine stainless-reinforced supply line, without anything wrong.

Oh, except for the wall coupling end having become completely effing detached from it, after the joint blew apart.

I found the nut still attached to the supply valve at the wall, and unscrewed that. And found that the brass intake valve was sheared off completely at the nut, hence the sudden blast of water into a small room.

The (ostensibly brass) part was thinner, in actual fact, than gum wrappers I've unwrapped from Wrigley's gum. The shiny still-new label identified the supply hose as - wait for it - made in fucking China.

Aiyeee! Backstabbed by goddamned Chineseium bullshit pot metal masquerading as solid brass. My grandmother's ass. The aluminum on my military dogtags was thicker than was the wall thickness of whatever cheap copper- or brass-plated bullshit this was made, which is how it failed in under two years.

And a glance at the clock let me know the time was conveniently a couple of minutes after even the late-night hours of WallyWorlds had shuttered them for the night, so I had to wait all night until the next morning to secure a replacement hose, and a back-up spare.

See if you can guess how many times that night I needed the necessary plumbing the minute it was no longer an option.

And, come the dawn, only to find that the exact replacement was made of the exact same chineseium bullshit. Same story at Lowe's. Same story at Ace. And two local builder's supply outlets.

Chineseium? EVERYWHERE???Oh, F - - - !!!!!

Mind you, the spiral galvanized steel crapola that was here when I moved in pissed me off royally, but even that sorry old crap had lasted twenty years without a dribble, while this brand-f**king new supply line had full-on failed spectacularly in less than two years' time. Apparently, just for the helluvit.

So after no choice but swapping in a new version of the SOS, and a new toilet tank valve, because removing the old one revealed it sorely needed replacing, I can now only wonder when the next submarine damage control drill will occur, and whether it'll be the supply line, the stop-cocks, the PEX tubing, or some as-yet-undiscovered secret flaw in Goofus' and Doofus' ass-crack apprentice plumbing work.

(And yes, the sales receipt, the five-year warranty, and all associated materials are now zip-locked safely above the mean highwater mark, and any future damages will be handled by attorneys.) I'm seriously considering re-doing the bathroom floor to a height of six inches, including the lower door sill, in swimming pool gunite, covered by new tile, and with a porthole-style nautical door with knee-knocker surround. Yes, I'm serious.

The only happy accident - definitely not Phil's luck here - was that this happened while I was literally sitting right on top of the disaster when it happened, rather than freshly asleep, to find myself floating in a new lake the next morning, nor at work for a twelve-hour shift, and arriving to find the front door had been fire-axed open, after the neighbor's sheetrock was carried away in a wall of torrential flooding, or even worse: out of town for a few days, only to watch my disaster featured on the local news from somewhere else. 

This one is a cloud still floating somewhere off Catalina Island.

And the plumbers were hired by the same management company for the property who hired Julio, Hose-A, and Hose-B Roofers, whose ass-tastic work required removal of three sheets of roofing plywood from my roof, and a complete reroofing of the entire complex, within a year of when they reroofed it all, and about fifteen years after diligent efforts with roofing patch on my part after move-in had completely sealed my roof completely leak-proof, only to fail in multpile places within months of the new job, by the new assholes. (Did I mention the management company is a bunch of dumbass chicks who couldn't change a light bulb, and probably couldn't even manage a decent fake orgasm, let alone coordinating basic property maintenance or competent contractors for any property in the entire state, including a trailer park in Slab City? Anyone looking for a job that's about to be vacant, PM me for a hot lead.)

I cannot wait to build my own place from scratch, and never again depend upon the competency of the notably incompetent. But in the meantime, a sump pump and a flood alarm with cellular text notification are in my things-to-do queue.

And fuck anything made in China, sideways, with a rusty chainsaw, and Michelle Obama's dick.

COVID Vaxx Not Mandated For CDC

 h/t Phil

Laws For Thee, But Not For Me

And why would they mandate that?

The shot doesn't work to prevent COVID transmission;

The vaccinated are just as contagious as the unvaccinated;

Vaccine passports based on the jab are pointless, worthless, and stupid;

And even getting the shot doesn't eliminate the need for masks in public venues.

But they're still thinking of going for a third dose of the pointless vaxx!!

Don't believe me. Listen to the head of the CDC >spit!< tell you herself:

YouTube

Oh, wait, you can't do that because the CNN interview on YouTube was already pulled, in less than 24 hours after it escaped into the wild. Bravo, Comrade Partyline! Motherland Is Proud!

Too bad it was uploaded to Rumble already.

Watch it here.

Stick a fork in the cover stories. They're done.

As for the population Control Freaks (for all values of that phrase):

Oak stake through the heart, or bayonet through the liver.

Dealer's choice. Either one robustly recommended.

Welcome To The Green New Deal

 h/t John Wilder

Some people don't learn a lesson from Nature. Oh well.

Natural Selection generally refers to them as "lunch".

Full Disclosure

 

I don't want to write this post, but I don't think I can duck the issue.

I was unofficially informed that apparently it will be the policy of my employer to require all employees, presumably including myself (they think), who have not received any COVID vaccinations, to submit to twice-weekly testing for COVID. This would involve shoving a swab up both nostrils two times a week, indefinitely.

Um...no.

If they try that, and make it official, my opening answer will be to invite the person who puts that suggestion into action to tell me exactly how far up their ass they'd like to stick that policy, and would they like my assistance in that endeavor?

Followed by the following blizzard of queries:

1) Who told you I did or did not get vaccinated?

2) Do you have a copy of my signed authorization to release that personal health information to any third party?

3) Lacking any such authorization, how would you possibly know my actual vaccination status?

4) Lacking that knowledge, how do you know which employees to even approach with this suggestion?

5) "Have I been vaccinated against COVID?" That's none of your fucking business.

6) Now you're asking me if I'm vaccinated against COVID? Again, that's none of your fucking business.

7) Submitting to receiving experimental therapies and becoming an unpaid medical guinea pig with respect to their effectiveness and potential complications was not and is not a condition of my employment. If it were otherwise, you'd have noted that from the outset. Trying to bluster and bootstrap it in now as if it were anything less than that is egregiously intrusive, entirely recockulous, and wholly unwelcome.

8) None of the vaccines for COVID are authorized for anything but emergency use. The makers have no liability for what happens to those who receive them. To date, the VAERS reports over 11,000 deaths from those COVID vaccines in just the U.S., and a quarter of a million adverse events. More of both deaths and adverse reactions than the total for every vaccine ever invented in human history, combined, for as long as we've kept records. Those COVID vaccines are therefore unsafe at any speed. And you have no more right as an employer to compel me, either directly, nor by onerous policies for non-compliance, to receive such an experimental therapy, any more than you could demand I submit to gender reassignment therapy, get an abortion, or have a limb amputated.

9) It's my body, and my choice. Shall we call in the company's legal counsel, and see how they'd like to sell the case against that legal position in court?

10) Ask counsel how they'll feel when the next three words I bring into the conversation are "hostile workplace environment". Then go over words like "mental stress and cruelty", "back pay", and "treble damages, plus all legal costs".

11) There are literally hundreds of other communicable diseases I (or any other employee) might or might not bring to work, many of which have no available vaccine. Are you going to test me for those bi-weekly as well? Why, or why not?

12) Are you going to be testing every other employee of the company for those dozens to hundreds of other communicable diseases? Why, or why not?

13) If I'm being singled out and categorized, isn't that the definition of "arbitrary and capricious"? How does corporate counsel like his odds in court defending that plan?

14) Why would you think you need to test me now, 18 months into a pandemic, for a disease for which I've shown no symptoms whatsoever, ever, to date, despite being a front-line caregiver with the sickest of the sick non-stop since the outset?

15) Are you aware the CDC reports that 75% of those fully vaccinated are the overwhelming bulk of those with the newest COVID variant? Will you be testing everyone twice a week, given that that's a far more sensible policy than proposing to test unvaccinated persons (bearing in mind you have no valid idea to which of those categories I belong)?

16) Are you aware that the CDC also reports that vaccinated persons carry the same amount of communicable virus in their bodies as unvaccinated persons? What's your plan to deal with that, and how do you intend to protect the unvaccinated from those vaccinated super-spreaders?

17) Are you aware that according to the CDC, despite being fully vaccinated, a person could suffer a more serious infection than an unvaccinated person? Knowing that to be the official position of the US government agency responsible for propagating communicable disease policy and procedure, why in hell would you suggest anyone get vaccinated, since it confers no immunity to the disease, no inability to spread the disease, and promises no diminution of symptoms if infected, despite getting the vaccinations?

18) In light of the above official CDC reported information, isn't promoting further vaccinations just about the most gobsmackingly dumbass thing you possibly could do, short of suggesting that people lick toilet bowls?

19) Given everything in #1-18, above, would you like to continue this discussion with lawyers, a judge, and a jury, in open court, or would you rather just quietly shitcan this silly-assed scheme, and allow all parties to pretend it never happened?

I'm old, ornery, and smart, and I won't be taking any shit, but I'll happily give it out by the metric fuckton if they try to push this sort of nonsense. I like my odds.

If my employer wants to test my resolve to go all "No, fuck YOU!", and become the poster child for why employment is not indentured servitude, they've grabbed the wrong tiger's tail. If they want to be the poster child on what not to do, I can only warn them that the stove is hot. But as Mark Twain said about the man who picked up the cat by the tail, they're about to learn something which they can learn in no other way.

I'll keep you posted, as appropriate.

If I'm betting, I'd give good odds this jackassery will be quietly strangled to death in a basement broom closet in about 5 minutes' time. Time will tell.

Anecdotally: Keeping It Real, Yo

 

About that pandemic you might think we're not having:

Nameless SoCal Hospital is full, bottom to top, wall to wall.

Because elective surgeries are cancelled, those nurses normally doing anesthesia recovery are now caring for overflow patients.

Nurses on floors normally holding stable telemetry patients are caring instead for ICU patients, because the ICU is full, wall-to-wall, and has been for days, so when someone gets worse, they can't be moved to higher care, and the floors are stuck with them.

ER is holding ICU patients, now for multiple days. Entire ER is now set up for COVID isolation, which is running 75-90% of patients seen, 24/7. And those are only the ones too sick to send home.

Morgue overflow conex cold storage is now full of corpses. Who died from COVID, not just with COVID. We ran out of body bags day before yesterday, so until we got more, deceased patients had to stay in occupied rooms. Even with getting decedents out, new dead are piling up faster than we're getting old ones off to coroner or mortuaries.

In the only state out of 50 with mandatory safe nursing:patient staffing ratios, those ratios have been thrown out indefinitely because of the current emergency. Because apparently an international emergency means we can use magic to do what we can't do when we're not redlined, at 110% of capacity and ability. (Roll two D6 to cast Spell Of Magical Healing.) I haven't asked, but I'm pretty sure the Official Answer to overcrowded hospitals will be: Bunk beds! No, really.

Nearby hospitals have gotten so bad, some nurses have walked off the job. No small part of that is the ongoing insufficient supplies of PPE necessary to do the job without getting sick. We're not there yet here, but morale is low, and the troops are pissed. And if someone calls in and says "I have a fever", there's not much anyone can say. It's coming, in 3, 2,...

Between staff shortages and actual sick staff, we're starting the day with 50% staffing in some units, and it's virtually impossible to get hired guns to come in. Everyone is over this, and all they get by picking up registry work or extra shifts where they work, is more sh*t sandwich, every day, into infinity. And you can't spend bonuses if you're dead.

And in L.A. County, everything I just wrote? Worse. Squared.

Oh, and we're still weeks away from the peak of the current surge, which is simply the sum total of people who decided Halloween and Thanksgiving get-togethers were more important than silly COVID restrictions, with predictable results.

We're all dreading what happens when we get the Christmas/New Year's Stupidity Surge, 3-5 weeks from now, but it's definitely coming.

Things are spiffy where you are? Outstanding. Goody for you. No, really. Hope your luck holds.

Meanwhile, I'm hearing from nurses who blog in other states, e.g. Texas, that they're getting, now, what we had here in Apr-July, and hospital manglement (not a typo. -A.) there learned nothing from what happened in NYFS, NJ, Atlanta, Nawlins, or CA, and accordingly planned for no such thing.

No points for guessing how that's paying dividends for them now. (Two of the reasons I'm lifetime-banned from hospital administration is because I tested with an IQ over 80, and my parents were married, to each other.)

The next phase beyond this is when the healthcare system starts to collapse. That is already nibbling around the edges of things now. When we get to full collapse, we'll be Italy: we're going to have to start to decide who we see, and save, and who we move over to the "It was a good life, and best wishes" area for no further treatment. No one has broached the topic openly, so the docs haven't decided whether they'll sort out the oldest, the sickest, or just throw darts at the Big Board when they're forced to actually decide who lives, and who dies. Mainly, they're just hoping real hard we don't get to that phase, ever. If we do, the word "unprecedented" is hardly going to cover our New Normal.

Of course, all this is just like we've done in every seasonal flu season for the last 90 years. (/sarc) NOT.

Keep pushing horsesh*t theories and crackpot stayed-in-a-Holiday-Inn-Express-once medical mail-order diploma explanations of what's REALLY happening. We need the comedy relief.

Those of us holding the shitty end of the stick with gloved hands are too busy to give a wet fart for such prognostications, but to a person, everyone of them has expressed that the Internet jet-fuel geniuses who think this is a scam should STFU, and pull a shift here, any day of the week, with their eyes and ears open, and their pieholes shut.

Most of you would last about half an hour before you left skidmarks out the back door.

We don't want thanks, or Starbucks gift cards, or hazard pay raises (though we wouldn't turn any of those down). We knew the job was tough when we took it. We just wish the Gilligans driving this day in, day out, would stop being such overachieving jackholes, and use some common goddam sense, just for the novelty, if for no other reason. It stopped being cute to be blisteringly stupid about nine months ago.

And if you think there isn't going to be a reckoning down the road that grabs you by the short curlies for the jackassery we're seeing and dealing with now, once this is over with, I'm here to tell you, you've got another think coming.Think long and hard about that. TPTB in the medical field have memories like elephants, and you aren't going to like what you get, nor get what you like. And health insurers will once again be driving the No Sense Of Humor bus, regarding future lifestyle choices. Mark my words.

The brighter lights among you, which has thankfully been a majority, had best make plans accordingly.

You will see this material again, and probably sooner rather than later, but even if not, being prepared for anything even roughly similar means you don't have nearly as much to worry about, no matter what rolls down the pipe at you the next time Fate pulls the chain on the Flush Bowl of Life.

UPDATE: For those who aren't trolls or retards, and able to read and comprehend, here's a link to a yuuuuge amount of collected data on COVID 19 from L.A. County.

A couple of points to note from that pdf, (beyond the fact that hospital capacity for 10M people is going down the shitter at warp speed just now): 

Page 6: ethnicity of hospitalizations in the LA County public hospitals, 3/1/20-present: 

72% Hispanic. 2% white.

Go back and read that again. Yes, it said what you thought it said.

Pg 7: 

Age of hospitalized in county DHS hospitals. Highest percentage, every week since this started.

Generally 50% or more Age 18-49

Next highest Age 50-64.

65+ is almost always in third place, until very recently.

So if you think 18 is elderly, keep thinking this only kicks old peoples' @$$#$. 

Suture self.

Our profound apologies if facts and Reality have yet again left hoofprints on your ass.

Why Science Is An Annoying Bitch

From Comments:

"Aesop,
Would it be fair to suggest that, as lay persons, we do not know shit about the CV-19? Would it be further advisable, considering the lack of consensus among the researchers, to err on the side of caution? Is there definitive, rock solid information upon which we can make informed decisions other than the suggested cautious approach?

I need someone to tell me what I need to know. I need the certainty. I need succor.... "

Everyone is a layperson at something, in fact, at most things.

The bigger problem is that most people stopped doing science somewhere around high school.
So they forget (if they ever learned) that there's no such thing as "settled science". Nor "scientific consensus".

As Michael Crichton famously said in a lecture I refer to and quote from frequently:

"In science, consensus is irrelevant. What is relevant is reproducible results. The greatest scientists in history are great precisely because they broke with the consensus. There's no such thing as consensus science. If it's consensus, it isn't science. If it's science, it isn't consensus."

It's fair to say that the experts don't know shit about COVID-19. If anyone looked at the JAMA Online website on a recent post where I linked to it, one of the papers published was a list of all the things that were known and unknown about Kung Flu, specifically with the purpose of jerking people's chains in the research biz about things that they should be trying to nail down, to the extent possible.

At this point, most of the map of Kung Flu is marked "Here be dragons." Most of what we know is extrapolated or interpolated from other versions of coronavirus, and prior pandemics. Science is a tool for exploring the unknown. It provides clues, and a framework for learning. What it isn't designed to do is provide philosophic certainty and ontological comfort.

Actual honest science is but a framework, just as certainly as a latticework of 2x4s begins a house.

Science is not, nor was ever intended to be, a paneled living room with nice paint and wallpaper, cozy décor, and a comfortable chair next to the fireplace.

This is why people who do science are generally lousy at building houses, and people who actually build houses are lousy at doing science.

And the people who cannot cope with things they don't like, because they don't like them, are usually lousy at both things. Rich people have choices in that, and can order life to conform to their wishes in many instances. Those less financially fortunate have no such options, and end up living in cardboard boxes, because life refuses to bend over and kiss their ass. Those of us between the two extremes pick our battles, and try to ignore the things we cannot change and cannot stand to deal with, if we don't have to do so.

What's kicking most peoples' asses now is that they cannot ignore Kung Flu, and don't want to deal with it, nor will it conform to how they wish the world was. Hence the massive amount of hitherto sensible people who are serially and collectively losing their shit.

They just can't cope, and they're not resilient enough to deal with uncertainty and chaos that seemingly never ends.

The rest of this year, and this crisis, will not go well for them, and their responses thus far bode poorly for their eventual status.

Darwin snickers in the wings.

 

Little Victories

I had no idea when I went to see it how much

this movie would direct the forces in my life.

Longtime readers may recall that Fat Cat, having used up all nine lives, shuffled off her feline coil last Thanksgiving. So, as sure as God makes little green apples, a couple of weeks afterwards, the landlord decided to upgrade plumbing hereabouts.

Goofus #1 and Goofus #2 employed to do the job were earnest, if not very bright, plumbers, and they managed to get the digs' piping upgraded, and with only three tries, finally sweated the final fitting right, and stopped the leak they created.

Buuuuuut...they left gaping holes in the sheetrock where they dropped new lines to replace the old copper tubing. Way up in the attic space, but still...

Consequently, there lately was newly heard a rustling and bustling up thataways, where normally only old boxes sit, and the only residents are dust bunnies and ghost turds.

Until last month.

I know this, because old potato chip bags that fall behind the trash bin do not, as a rule, chew themselves to small ribbons.

Then there was a regular rustling behind piles of piles around the manor.

Rodents in the wire! Set off the claymores!

Knowing that I have, when there's a local heatwave, propped open the front door to capture a breeze now and again, I was afraid that, like one brief incident decades hence, I might have inadvertently invited Mssr. Rat in to set up residence.

That was bad enough.  Having no desire to share space and have to deal with Kung Flu and plague-carrying rabid sewer rats, I began removing possible hiding places from among the piles of grown-up toys, ammunition for same, books, and other research material in the various corners of the lair. But a couple of weeks later, as I whittled down the available hiding spaces, imagine my shocked surprise when, instead of some monstrous Norwegian Brown Sewer Rat, my late night visit to the loo revealed a couple of field mice, in flagrante delicto.
The brazen rodentious bastards.

And, in what quickly became apparent, they had obviously brought their relatives and relations.
Such that
1) containment measures that would suffice for Mssr. Rat would not work on an animal that can get through a dime-sized knothole, and
2) They had already escaped containment, and decamped to the four corners of my fiefdom.
3) Which, thanks to the gorram Kung Flu, is now awash in potential mouse food, much of it so new I haven't had time to decant it into mouseproof sealed metal cans and food-grade buckets yet. And which, if they get into it, will beget a never-ending sh*tstorm of well-fed mice.

F**k that very much, thanks.

They sure as hell aren't getting any of my chow, no effing way.
Having some wee experience with the little rodentious bastards, and the campaign awards to prove it, I hie myself to Orange Box, and grab a package of Mk. I Traps, Mouse, (4)@. And, Callooh! Callay! Sam's Club gifted me a few months back with a free tasty retort packet of honey-peanut butter.

I bait my trap line, and set the ambush.

I have thus been greeted by a steadily increasing bodycount this week, until this morning, on arising, the last rodentious p.o.s. was found dispatched.
O frabjous day! 
I have since patched the holes in the sheetrock, on my side and the neighbor's side of the wall, so they won't be getting in again. Other than animals I've brought home, the biggest problem I've had were ants and the occasional spider.

But seriously, them getting in just after the lifelong unemployed cat, who would have made sport of them, had permanently departed, and just at the beginning of a pandemic where stored food could be kind of a big thing? WTAF?!? What are the odds of that?
I was looking for the hidden camera, I swear.

"Nine godless communist thieving mice dispatched, all weapons functional,  local patrols report no enemy within the AO. All enemy buried at sea via indoor plumbing. Area all secured."

And a moral to the story:
The little things and minor details, no matter how implausible, can always make any disaster go from bad to worse, just when you least expect it.
Like I needed reminding that Murphy is a right bastard.

Asepsis 101

From Comments:

"I follow pretty strict aseptic procedure - what I learned in microbiology class 42 years ago... but *very* few others do that. If everybody wears a mask, there's no reason for lockdown or quarantine, because the mask can prevent you from passing on the virus to others, something that people just don't seem to get, and the other thing is that it stops you from touching your mouth and nose... and there are simple instructions for making masks from common household materials online."

Yes, but.

You learned this in a higher-level class when Reagan or Carter was president.
That was a different world then.

Dipshits from later generations, by actual firsthand observation:

Wearing mask and gloves, touching everything with said gloves, transmits virus to everything he touches (his car, cell phone, wallet, everything else).
Then, can't get cell phone screen to work with gloves on, so
a) pulls mask down
b) pulls infected contaminated glove off with mouth
c) touches infected contaminated cell phone screen with bare finger
d) puts glove back on and pulls up mask when finished.

Assume afterwards:
e) Can't figure out how he got Kung Flu, and asymptomatically carried and spread it to his entire office group, apartment complex, or dorm.



Fine for everyday use.
Not so bright with nitrile gloves and surgical
 masks, during a pandemic. Sorry if this is news
to you, Common Core grads.
"Virus on my fingers? Wait, whut?"

If you therefore want to require an IQ test and mandatory sterile procedure class, with 100% as benchmark for pass/fail, for being let out of quarantine, I will march in your parade and subscribe to your newsletter.

Otherwise, most people are too stupid to let loose without a keeper, or at minimum, a class on how to do this right run by Dominican nuns with 3' sections of rebar in lieu of rulers.

Hints For Morons:
Do whatever you want. We'll be on lockdown forever. Fuck everybody else, amirite?
Suture self.

Hints For Non-Morons:

After you put it on, the outside of the mask is contaminated.
After you wear them once, the gloves are contaminated.
PERIOD.

You can remove the mask after wearing it for prolonged periods, and put it inside a bag, if you're going to decontaminate/sterilize it, using heat or disinfectants. If you don't do that, don't bother wearing the mask at all, and revert to the instructions for Morons.

The gloves are single use. You may put them on, but once you touch things (doorhandles, products in stores, counter tops, etc.) out in the Big Wide Nasty Infectious World, you cannot touch or handle anything else from the Clean World (like your cell phone, car door handles, steering wheel, wallet, glasses, keys, money, debit card, etc.) You can take the gloves off*, discard them, and then and only then touch your personal items.
You must re-glove with a fresh pair of gloves before touching new contaminated things in the Big Wide Nasty Infectious World, and the same rules for putting them on and taking them off apply, EVERY TIME, WITHOUT FAIL.

Period.

Some of us had personal decon beaten into us by wearing MOPP-4 and going through a gas chamber a time or five, and some of us learned it in well-run microbio classes, like a our commenter. And a subset got it both ways. Those who didn't get it either way ought to pay serious attention.

Don't have a BOX (or BOXES) of gloves? Every day? For every trip outside your personal bubble? Until the lockdowns end?
You can't play this game.

We tried to tell you that long, long ago. Most of you don't have enough supplies for this.
Like the honey badger, a viral pandemic doesn't give a shit.
Do it right, or stay your ass home.

Or else you're going to infect people, and possibly kill some of them with your needless, thoughtless, callous stupidity.

This is why you can't have nice things, and why we're all, most of us (okay, most of you), locked down until further notice. Because Joe Average can't handle the truth, nor follow simple directions. This is what happens when stupid people breed, and there are no saber-toothed tigers handy 24/7 to winnow out the less-than-bright. Kung Flu is standing in for the tigers this year. Mind the pathogen, folks.

The problem is the Gilligans don't have signs on their heads, or we could simply throw them into the volcano right off, and be done with it. Instead, they'll kill us all without realizing it, and have that stupid look on their face after they realize they've done it, but too late to save the non-Gilligans.

And the very worst of them will blame the non-Gilligans for being susceptible.
Like they do.

But if you can master asepsis, and follow it, your chances of having a problem with Kung Flu approach 0% very rapidly.
Now, see if you can see both a way out of quarantine, and spot the Not-So-Hidden Flaw in this approach.







*(Approved glove removal method: Put your dominant hand in your non-dominant hand. Curl it slightly. Peel the dominant-hand glove near - but not under - the cuff, stripping it off that hand and rolling it with the non-dominant hand into a little ball. Take the ungloved hand, slip a finger under the cuff, and strip it off the other hand, turning it inside out, so the sweaty, but clean, inside is now the outside of the whole ball. You now have a dirty glove bundle you can touch with bare hands. Discard it appropriately in the trash. Which does not mean "wherever you feel like throwing it down". In the trash means in the trash, please. No one else wants to handle your nasty contaminated glove ball either.)

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

TL;DR?

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.

RTWT:

"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.

Diagnostic
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.

Disposition
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.


Treatment
Supportive

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.


Sincerely,

NawlinsAg"

https://texags.com/forums/84/topics/3102444

----------

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?
Fuuuuuuuuck.

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.