I was seeing stuff out of Italy last night saying that people presenting at the ITU over 65 weren't put on ventilators because there were no ventilators to put them on. Italy is at triage. The Atlantic has a wildly speculative piece suggesting Iran has somewhere between 600,000 and 2 million cases. Iran has one advantage over the rest of the world: everyone of fighting age was wiped out in the Iran/Iraq war so their average age is like 30.
A lady in Fremont, Nebraska tested positive for COVID-19 after attending the Special fucking Olympics and a VFW dinner, showing all the symptoms you'd expect, and thinking "Yeah, it's totally fine for me to go hang out with these vulnerable citizens!" Nebraskans have a placid attitude about this whole infection, trusting our biocontainment unit to contain, and assuming that this is just a "coastal" problem. As far as I'm concerned, though, it's not a question of whether this lady infected anyone outside her family, it's how many, and we won't know that until it's too late. Her family is sick now, too. We're not fucking prepared for this.
Yeah my wife asked if I was going to yoga today. (1) no, my ear feels like it has an aquarium in it downward facing dog is not my idea of a good time (2) there's like 10 people in there in their 70s and I sweat profusely at the best of times so fuck no I feel bad enough maybe exposing them to whatever two weeks ago. I'm told that we can get chlorox wipes for our medical clinic if we order online from the grocery store the night before because the store opens at 6am and between the sprinters waiting at the door every morning and the online shoppers, it's all gone by 6:15am. Thing is? Eventually everyone who needs fuckin' Chlorox wipes will have fuckin' Chlorox wipes. They're hella easier to manufacture than blood oxygenators.
I'd appreciate updates on how things look on the ground in Seattle over the next few days. Kentucky is up to four cases now, one in Louisville that we know of. I'm thinking we're about twenty days behind Seattle, and given that I'm on the front lines, I'd like to know what I'll be up against. My immediate hunch is that our hospital is woefully unprepared for the next two months. Getting a little anxious.
If I had greater insight into the hospitals I'd give it to you. What I can tell you is that everyone has clamped down on the number of acquaintances you can bring into labor and delivery. I can also tell you that this has caused an uptick in calls to us from women who want to transfer their care from hospitals to our birth center. On the one hand, I'm conflicted: we've got carpet FFS and have to buy our disinfection products retail. On the other hand, I see the thinking: sick people aren't coming to birth centers to find out how sick they are. Our naturopaths, who see patients for reasons other than "checking on your pregnancy", have been masked up for two weeks now and wipe down all surfaces in the exam room between patients. We're doing what we can but one of our employees went home today with a sore throat. She's been through some shit lately so I'm more inclined to believe she caught it somewhere else. Whatever I got? I got from a flight from Seattle to Alaska on February 16th. One of my colleges shut down for a few days and then until the 20th because their nursing program was in and out of Life Care Center on the reg - they had like 60 exposures. The other one shut down for a day for deep cleaning and then reopened. They have, however, closed their food bank. I've heard it suggested that Seattle Public Schools has not closed yet because 13,000 of their 55,000 students are on SNAP and they're worried that those 13,000 students won't get any food if they don't come to school. I've heard it further suggested that NYC public schools aren't closing because fully 113,000 of their students are legit homeless so the whole "your college food bank is unavailable because of pestilence" is just the tip of the Dickensian spear here. Amusingly enough, North Seattle keeps saying "no Seattle Colleges campus has yet shut down because of Coronavirus" because despite the fact that LWTech is a college in Seattle, it's not a "Seattle Colleges" college. Fuckin' ridiculous. UW has gone remote, and has drive-through testing for their own medical employees. We haven't tried rounding up a CV19 test since we looked into it Wednesday. My understanding is they're easier to get ahold of now for a number of reasons but we haven't tested that hypothesis. There are no issues buying food whatsoever. Fred Meyer is limiting cold- and flu-related purchases to 5 per customer. I've heard from a Costco employee and a Fred Meyer employee that things like bleach and hand sanitizer and disinfecting wipes are available every morning or every other morning at 6am but there are always people lined up and waiting who purchase to the limit. What's left is taken by online shoppers. Italy is totally shut down but life goes on, which seems kinda like where this thing is gonna go. I got an email this morning from an Italian manufacturer of machine tools saying From this morning the Italian Government has declared the whole Italian territory as a "Red Zone", that means at risk of infection, thus limiting the movement of people throughout the territory, but with the same provision the Italian Government has kept the possibility for people to go to work, and the goods to move freely, in order not to block production activities. HSD has also taken extraordinary measures to deal with this situation and minimize the risks for its employees and consequently to give continuity to the supplies for its customers, consequently from today until 3 April 2020 included, the whole company will observe a timetable continued from 07:00 AM until 07:00 PM by dividing the coverage of this schedule with two groups of employees, the first in the morning (07:00 AM - 01:00 PM) and the second in the afternoon (01:00 PM - 07:00 PM). These two groups of employees will alternate weekly, in order to give continuity to the company activity and to the service to its customers. We also confirm that our 4 branches HSD Deutschland, HSD Mechatronics Shanghai, HSD USA and HSD Korea are fully operational at regular times, to support and possibly support our customers also in other areas of the world. Thanks to these actions, HSD has kept constant production levels and order management continues with normality: supplies and shipments of goods are regular. HSD continues to monitor the development of the situation while the HSD staff remains available for any request.Considering the most recent instructions concerning the spread of Coronavirus COVID-19, HSD Group has enacted a series of measures to guarantee the safety of employees, customers and anyone who interacts with the company, both at the Headquarters and at the Subsidiaries around the world.
When I think about it, this waaay more sad than funny? But gaddamn if I didn't laugh out loud. Which I've found myself doing at all the least appropriate moments in the last two weeks. Like all that's left for us is to dance in front of the fire. I'm not worried about supply shortages or the logistics of tele-educating. The JCPS system is such a shitshow that my kids' school could burn down tomorrow and we wouldn't see a blip in either direction in their MAP scoring. Might go up, seems like they learn more on the weekends anyway. I am absolutely worried about the fact that three weeks ago, our hospitals had no tele beds available, no ICU/CCU beds available, and we were boarding septic shock patients in ER overflow. That was BEFORE all this tomfuckery. I'm worried about the fact that our ER's plan for how to deal with COVID19 patients is to slap a mask on them and move them into one of our negative pressure rooms. Of which we have two. I'm worried that respiratory therapy's best estimate on how many vents our hospital has approaches 80, which is a far cry from, you know, building an entirely new hospital for COVID19 patients in a matter of a few days. I'm worried about the reports from medical staff in Italy which amount to "hey guys, so woah, we are way over our heads here and it's just spooling up for us, so y'all best pucker your butts." Meanwhile, Louisville is essentially a straight split between newlyweds and nearly-deads. We got old people for days. And I'm wondering what'll happen to all the really, really sick people we see NOW when our cup overfloweth with ARDS patients.I've heard it further suggested that NYC public schools aren't closing because fully 113,000 of their students are legit homeless so the whole "your college food bank is unavailable because of pestilence" is just the tip of the Dickensian spear here.
The new measures, announced by Prime Minister Giuseppe Conte, amount to an unprecedented commercial shutdown. They come in response to pressure from politicians in northern Italy, the center of the coronavirus outbreak, who had said more dramatic measures were needed to slow the virus’s spread. This story will be updated. ...well that lasted about 36 hours.BREAKING: Italy announces it will stop almost all commercial activity aside from supermarkets and pharmacies, ramping up national lockdown
All the smooth transitions hospitals are advocating any maternity patient not comfortable birthing alone "reach out to the community" to investigate the possibility of out-of-hospital birth. Effectively, everyone but Swedish is saying "we think our 94% marketshare belongs in a 6% place." We've heard Prov Everett isn't necessarily locking down to the "separate COVID-19 moms from their babies for 14 days" CDC recommendation but they haven't ruled it out. We've gone from "holy shit we had six client interviews this week woo hoo" to "holy shit we had six client interviews today..." and I've started discussions with the landlord about renting additional office space upstairs so we can separate our peds from our maternity. We're about to buy a Butterfly IQ and get someone to locum for us so that we don't have to bump our moms out anywhere for basic ultrasound. We've got six boxes of masks. On the plus side, Frontline came to visit and it looks like Seattle is doing substantially better than NY, but you never know: Trump took our hospital ship because someone reminded him that Jay Inslee criticized him on Twitter.
This is exactly what my wife heard from her old work cohort. This feels like a waking nightmare. We're not yet out of surgical masks or respirators, but with conservative use we'll still be out by next week, just before the shit is really projected to hit the fan. The president of our ED physician's group has told us not to bother soliciting the community to sew masks, as there's essentially no evidence to suggest that they're at all effective. CDC, as I'm sure you know, is recommending bandanas. It's like if we sent our soldiers to war without body armor. And then recommended that when they ran out of bullets they should just point their finger at the enemy and make a shooty sound. The first cases are trickling into our hospital. Had one guy last week in a serious way and his chest CT was sobering. He's now on a vent and people are saying critical but stable, but given that average stay in ICU before death was something like 19-21 days in China, I'm betting his ticket comes pre-punched. Then two days ago we had two more like him. I'm off until Tuesday, and I have no idea what I'll go back to. I'm a hundred percent gonna get it at some point in the following months. 35 is not young enough to feel like I'm gonna glide through. And I'm relatively healthy? But I've also had a chronic cough since I was about 15 and I'm betting my cilia are beaten all to hell. I've had at least one major panic attack per day, but I'm back on my anxiety meds so I got that going for me. But until they kick into full effect, I feel like I'm constantly progressing through finer and finer striations of dread. The dread of what work will be like when I go back. Dread of whether I'll be the one assigned to the COVID-heavy pod. Dread of what my PPE will be like. The dread of waiting for symptoms to kick in. When they inevitably do, eight to twelve days of dread waiting for my breath to get shorter and shorter until I can't talk in full sentences.
It's irresponsible of your ED's group to suggest that community produced masks are ineffective. Providence isn't going that way. We've even seen equivalency tests of like t-shirts and viral load up on Pub Med and NIH. Mine currently has inserts carved out of an MERV13 furnace filter which looks to be about an n65 equivalent. The odds are it won't hit you hard. The odds are if it does hit you hard, it won't hit you hard enough to need a ventilator. They are not odds I like but they beat the shit out of Ebola. Stay safe. And ask mk about baicalin powder. I think it made a difference for me.