Coronavirus General Discussion (no politics, no flamewars!)

Hi Dave,
Like you, my first reaction was 'There are a lot of medical professional who are not routinely exposed to infected patients, yet who do need (non-N95) masks".
I was merely inquiring if Renata had experienced the need to address the issue of meeting healthcare standards that are in place. I saw a TV news segment about a group of women in SF Bay area, and the interviewee mentioned orders from a number of hospitals by name. Then days later there was a discussion on TV in which a hospital official mentioned to the interviewer the inability to use homemade masks in the hospital. So I was seeking more insight, as well as not wanting Renata to have wasted her time unaware of the underlying requirements.

Wilt wrote in post #19038241
Interesting read. One governor had the wisdom and insight and budget available for the effort to have emergency mobile hospitals. Then the next governor had the misfortune to have the drop in income tax revenue due to the Great Recession, accompanied with the need to balance the budget by reducing 'unnecessary expenses'. Leading to our current shortage of supplies and beds.

From the story it says the savings from cutting the program was 5.8 million dollars per year, the way money is wasted in government that number is a mere pittance.

Certainly there are differences in needs and care at the state to even county level. The sense I've gotten from most clinicians is that they need all forms of PPE. Unfortunately, NY is in such desperation, that even being around infected patients, some clinicians are mostly relying on face shields and just ordinary face masks. It's compounded by the scare and hoarding from the public seeing that n95 masks are most effective for airborne viruses. There are some news segments trying to tell people about how odds are still good with just normal face masks (for blocking aerosols), and that self isolation and hand sensitization are even greater safeguards. I feel those treating COVID-19 patients should be the ones with all the necessary PPE they need (for both theirs and patients safety)...and there are other, more effective safeguards for the general public that can try avoiding exposure.

If by chance their are *cough political* *cough* reasons for saying one facility is not accepting a certain PPE, doctors and nurses are uniting for trying to mobilize PPE equipment. If by chance they're under order that they can't use a certain PPE...I'm sure most would help with finding the professionals who can use it. In my local area, the most recent local PPE manufacturing I've been seeing is a neighbor 3D printing face shields. For those who are interested in steps for volunteering, resources like givemeppe.org provides contact info of the facilities asking for PPE (so you can get current info from the requester).

davesrose wrote in post #19038261
Certainly there are differences in needs and care at the state to even county level. The sense I've gotten from most clinicians is that they need all forms of PPE. Unfortunately, NY is in such desperation, that even being around infected patients, some clinicians are mostly relying on face shields and just ordinary face masks. It's compounded by the scare and hoarding from the public seeing that n95 masks are most effective for airborne viruses. There are some news segments trying to tell people about how odds are still good with just normal face masks (for blocking aerosols), and that self isolation and hand sensitization are even greater safeguards. I feel those treating COVID-19 patients should be the ones with all the necessary PPE they need (for both theirs and patients safety)...and there are other, more effective safeguards for the general public that can try avoiding exposure.

If by chance their are *cough political* *cough* reasons for saying one facility is not accepting a certain PPE, doctors and nurses are uniting for trying to mobilize PPE equipment. If by chance they're under order that they can't use a certain PPE...I'm sure most would help with finding the professionals who can use it. In my local area, the most recent local PPE manufacturing I've been seeing is a neighbor 3D printing face shields. For those who are interested in steps for volunteering, resources like givemeppe.org provides contact info of the facilities asking for PPE (so you can get current info from the requester).

Trouble is that no doctor knows who is carries Covid 19. Routine exams of asymptomatic patients by any specialist could potentially turn into a nightmare unless they test every non-covid 19 related patient before they see whatever specialist just to be on a safe side. I don't think it's possible.

Just to clarify: COVID-19 is the disease manifested by SARS-CoV-2 coronavirus. One of the issues for not knowing how many people have this coronavirus is that most the population will present mild symptoms. It's bad for people who are at risk, but in the long term, there will be some herd immunity (note, after the spike and if a vaccine is out). What's making things worry some for areas like the US, hospitals have already gotten quite a few cases of younger people (20-50) requiring respiratory care (and then not having future capacity for those at high risk). One of the main reasons medical professionals have been screaming for self isolation is to slow the spread of the virus so that hospitals have the capacity to take care of the highest risk patients.

I also have an uncle in Austria who developed heart problems right at the start of confirmed cases. The hospital discharged him early and locked down for COVID. They've started triaging for other cases now, so he was able to have treatment done this week. Other hospitals in other areas are all going to be different (based on healthcare system and number of cases in that area).

davesrose wrote in post #19038275
Just to clarify: COVID-19 is the disease manifested by SARS-CoV-2 coronavirus. One of the issues for not knowing how many people have this coronavirus is that most the population will present mild symptoms. It's bad for people who are at risk, but in the long term, there will be some herd immunity (note, after the spike and if a vaccine is out). What's making things worry some for areas like the US, hospitals have already gotten quite a few cases of younger people (20-50) requiring respiratory care (and then not having future capacity for those at high risk). One of the main reasons medical professionals have been screaming for self isolation is to slow the spread of the virus so that hospitals have the capacity to take care of the highest risk patients.

I also have an uncle in Austria who developed heart problems right at the start of confirmed cases. The hospital discharged him early and locked down for COVID. They've started triaging for other cases now, so he was able to have treatment done this week. Other hospitals in other areas are all going to be different (based on healthcare system and number of cases in that area).

The situation will indeed be different for different regions, but will more or less tend towards being overloaded if people continue to be careless and treat this casually. The PPE shortage that's being talked here and is also starting to affect just about every jurisdiction will only add to the general stress on the system.

I see patients every day. We screen when they call in for the appt., we screen again at the door but patients will sometimes lie about their symptoms and sometimes they are truly asymptomatic.

gjl711 wrote in post #19038075
Also, how poorly prepared some state governments are.

I worked for the Illinois state legislature for 25 years. In terms of being financially prepared it's an almost impossible task to accomplish. 2000 to 2015 when I last saw numbers the states obligations to cover healthcare programs (state Medicare match) was growing at a rare of 10% per year. This was through a recession and the impact of the tea party movement where the emphasis was on cutting budgets not increasing state revenues. States were struggling to pay for the healthcare needs for the poor an indigent on a daily basis, let alone set aside reserves for public health emergencies. The states have done a reasonable job of planning for such an event but the resources are not necessarily there to stockpile necessary supplies.

It's easy to say that a pandemic response plan should have been funded fully when you are in the middle of a pandemic but try being a legislator asking to divert funds from urgent projects to fund something that might never happen. It's like asking a family struggling to childcare an healthcare to focus on their 401k. Everyone knows its needed but it gets pushed back in favor of scoping with day to day life.

This may sound like I'm making excuses, and those who have never studied state government finance will probably scoff at my explanation. But this is how government works, not how they think it does. Pardon me if this seems overtly political but I've stuck to the facts as much as possible.

duckster wrote in post #19038315
I see patients every day. We screen when they call in for the appt., we screen again at the door but patients will sometimes lie about their symptoms and sometimes they are truly asymptomatic.

Am I interpreting correctly?...
patients call for an appointment and they are 'screened' per a list of questions that are asked.
If they answer the right questions to trigger an appointment for a visit,

• some may have 'lied about symptons' over the phone in order to get an appointment, while
  
• others truly are symptomless...
  

We really can't expect each state to have their own versions of everything from CDC to FEMA, Homeland Security, or Army corp of Engineers. etc.

This also is not a statewide emergency, it is a national one.

itsallart wrote in post #19038229
I am also going to make these https://www.youtube.co​m/watch?v=W6d3twpHwis

Thank you sir!

A mask made from a HEPA vacuum cleaner bag...Genius!

Apricane wrote in post #19038287
The situation will indeed be different for different regions, but will more or less tend towards being overloaded if people continue to be careless and treat this casually.

Just maybe a sliver of hope from over the pond. If everybody pulls together and actually care about taking this serious then it can get better. The doubling time (in brackets) of cases can go down as a consequence of tough measures: Italy (14 d), Germany (7.8 d), Spain (7), Switzerland (12), Austria (9.4), Netherlands (7.1) all decreased their doubling time of new cases (despite more and more testing) substantially and continuously. This provides crucial and precious time to ramp up the emergency system, create new ICU beds, produce safety gear and keep health worker sane and healthy. Just a few days delay can make a substantial difference on the capacity to handle the outbreak. Tough measures are worthwhile and does safe lives.

Wilt wrote in post #19038348
A mask made from a HEPA vacuum cleaner bag...Genius!

It is!
Making some right now!
I had a hard time finding the right size because the one in the video yields 4 filters. Searched all over the place and finally found some and just got them.

Wilt wrote in post #19038337
Am I interpreting correctly?...
patients call for an appointment and they are 'screened' per a list of questions that are asked.
If they answer the right questions to trigger an appointment for a visit,

• some may have 'lied about symptons' over the phone in order to get an appointment, while
  
• others truly are symptomless...
  

...but after coming to your door for an appointment, they are 'screened' again at the front door via questions. Is there also temperture check in order to prevent potential spread of infection to those in the office by someone with symptoms?

But what if a patient genuinely doesn't know that he/she is infected but shows up for ankle pain or whatever and yet he/she's spreading the bug like crazy?

Here are some good news from TX.
https://www.nbcdfw.com …tor-alternatives/2342307/