CORONA Main Coronavirus thread

From the local Fox station:

Boston 25 News has learned more than a hundred Boston hospital workers have tested positive for coronavirus.
More than 100 Boston hospital employees test positive for coronavirus
From CNN's Ellie Kaufman


Massachusetts General Hospital is pictured in Boston, on March 14.
Massachusetts General Hospital is pictured in Boston, on March 14. Michael Dwyer/AP
More than 100 employees at three Boston hospitals have tested positive for coronavirus
  • Boston Medical Center said 15 employees have tested positive for the virus.
  • Brigham and Women’s Hospital has 45 employees that have tested positive, Brigham Health Media Relations Associate Serena Bronda told CNN.
  • Massachusetts General Hospital has 41 employees who have tested positive, though Senior Public Affairs Officer Terri Ogan told CNN the hospital believes most contracted the virus somewhere other than the hospital.
===
Biogen conference.
Italian strain SARS COV-2.1
Honey Badger
View: https://www.youtube.com/watch?v=c36UNSoJenI

===
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.
 
Last edited:

Krayola

Veteran Member
Here's what I don't get about those cameras....the Chinese have such a tight lockdown on all social media/news type things-how are these broadcasting? You would think the Chinese would NOT want to rest of the world to continue seeing empty streets.
I've been wondering this too. How can we even trust that those images are real/live footage? The Chinese govt could put any footage they want up there to run.
 

Mixin

Veteran Member
There's a little county in the southern part of the state that I was kind of interested in. There was only 1 case and it was a death. Google Scott County Indiana HIV epidemic... Austin, IN

Scott County Reports First COVID-19 Death
By ADAM PINSKER
Posted March 23, 2020

Scott County Health Department officials say the county's first coronavirus victim was between 50 and 60 years old and had a pre-existing condition. They died on March 22.

Scott County Public Health Nurse Brittany Combs says the victim tested positive for COVID-19 on Friday. That’s when health officials last made contact with the patient.

“This person was doing fine at that time, and unfortunately took a turn for the worst, and passed away at their home, very early Sunday morning,” says Combs.

In 2015, Scott County was ground zero for an HIV outbreak, and there are concerns people living in this rural southern Indiana County may be especially vulnerable to the novel coronavirus.

“Social distancing is huge, it’s a major issue people aren’t listening to,” says Combs.

Comb says she’s concerned because there are only three intensive care beds available at Scott County Memorial Hospital, meaning the county could be quickly become overwhelmed by more cases of the virus.

“We do need to have more access to testing, because if we can get those test results back quickly, we can do contact tracing, and make sure those people are tested,” says Combs.

Though she could not specify how many days’ supply of personal protection equipment (PPE) is left, Combs says it is dangerously low. “We’re low on all of it, the face masks, the gloves, the goggles, the gowns,” she says.

Combs says all medical professionals and first responders throughout the county are required to report their inventory of PPE to the state each morning. That helps state and federal officials determine how to disperse a resupply of those materials.

***********************
Scott County Health Department
March 22 at 11:11 AM ·
SCOTT COUNTY CONFIRMS 1st DEATH DUE TO NOVEL CORONAVIRUS
There are conflicting reports of a second documented case of Coronavirus in Scott County. This case actually lives in a surrounding county. We are working closely with that county to ensure all protocols are followed. We are also working with the Indiana State Department of Health to update the information on their website to reflect our data. www.in.gov/coronavirus

**************************
Story about Austin, IN: 235 people in the southern Indiana community of Austin, Ind., diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.

5 Years After Indiana's Historic HIV Outbreak, Many Rural Places Remain At Risk
February 16, 20207:00 AM ET
 
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Blacknarwhal

Let's Go Brandon!
So...yeah...

Fair use cited so on and so forth.


China Just Sent 150,000 Test Kits To Prague And 80% Of Them Didn't Work

by Tyler Durden
Thu, 03/26/2020 - 05:35

As the real state of affairs in China, now months into its coronavirus outbreak, remains unknown, the country is trying to at least give the impression that things are fine and that it is genuinely interested in helping out the rest of the world.

China has claimed to have made donations of ventilators and testing kits to countries like Iran and Italy over the last week, seemingly trying to now play "good cop" with the neighboring countries it is likely at fault for infecting. Meanwhile, we have been pointing out obvious inconsistencies with the information coming out of Beijing as it has been happening.



And in terms of faking the notion of helping the rest of the world, China can't even do that right.



Czech newspaper Irozhlas reports that China sent 150,000 testing kits to Prague which have returned false results up to 80% of the time. In other words, they simply don't work. PJ Media provided a translation to the article:

"We checked them on Saturday at the University Hospital Ostrava, but unfortunately the error rate was quite high, so now we are waiting for the results of further testing across the country, they have never been tested positively because it works with antibodies," said Svrčinová.
"We tested those who searched for a sampling site. Fortunately, we were so far-sighted that samples were immediately taken for the classic examination and that just proved the error rate of the tests," Svrčinová continued.


1,392 people are talking about this



Meanwhile, the reality on the ground in China paints a far different picture than both the attitude out of Beijing and the daily coronavirus numbers suggest.




For example, for the first time since the virus outbreak began, China’s national health commission claimed on March 19 that there were no new infections in the entire country. But Chinese citizens described a different reality.


In Wuhan, ground zero of the epidemic, residents witnessed long lines at hospitals while more facilities were reportedly being set up to accommodate ill patients.

In a video posted to social media on March 19, a Chinese citizen shows the Wuhan Union Hospital, one of 46 designated facilities to treat COVID-19, and the queue in front of it. “Look, Look! People are lining up in front of the fever clinic at Wuhan Union Hospital,” the person says. The Epoch Times confirmed the footage was filmed at the hospital.

Also on March 19, a construction worker shared a video of a new makeshift hospital set up within a stadium in suburban Wuhan. “After another night, our mission is almost complete,” the man said. “A new makeshift hospital will be in operation soon.”

So China, if you're seeking to virtue signal, lie and change the narrative, perhaps a couple of lessons on how to do so are in order.
 

psychgirl

Has No Life - Lives on TB
There's a little county in the southern part of the state that I was kind of interested in. There was only 1 case and it was a death. Google Scott County Indiana HIV epidemic... Austin, IN

Scott County Reports First COVID-19 Death
By ADAM PINSKER
Posted March 23, 2020

Scott County Health Department officials say the county's first coronavirus victim was between 50 and 60 years old and had a pre-existing condition. They died on March 22.

Scott County Public Health Nurse Brittany Combs says the victim tested positive for COVID-19 on Friday. That’s when health officials last made contact with the patient.

“This person was doing fine at that time, and unfortunately took a turn for the worst, and passed away at their home, very early Sunday morning,” says Combs.

In 2015, Scott County was ground zero for an HIV outbreak, and there are concerns people living in this rural southern Indiana County may be especially vulnerable to the novel coronavirus.

“Social distancing is huge, it’s a major issue people aren’t listening to,” says Combs.

Comb says she’s concerned because there are only three intensive care beds available at Scott County Memorial Hospital, meaning the county could be quickly become overwhelmed by more cases of the virus.

“We do need to have more access to testing, because if we can get those test results back quickly, we can do contact tracing, and make sure those people are tested,” says Combs.

Though she could not specify how many days’ supply of personal protection equipment (PPE) is left, Combs says it is dangerously low. “We’re low on all of it, the face masks, the gloves, the goggles, the gowns,” she says.

Combs says all medical professionals and first responders throughout the county are required to report their inventory of PPE to the state each morning. That helps state and federal officials determine how to disperse a resupply of those materials.

***********************
Scott County Health Department
March 22 at 11:11 AM ·
SCOTT COUNTY CONFIRMS 1st DEATH DUE TO NOVEL CORONAVIRUS
There are conflicting reports of a second documented case of Coronavirus in Scott County. This case actually lives in a surrounding county. We are working closely with that county to ensure all protocols are followed. We are also working with the Indiana State Department of Health to update the information on their website to reflect our data. www.in.gov/coronavirus

**************************
Story about Austin, IN: 235 people in the southern Indiana community of Austin, Ind., diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.

5 Years After Indiana's Historic HIV Outbreak, Many Rural Places Remain At Risk
February 16, 20207:00 AM ET


View: https://www.facebook.com/scottcountyhealthdepartment/photos/a.1385712581751794/2596854550637585/?type=3&eid=ARDY97cv2DmVsjz2pBH124ZmLyxWnvLG6DQgX9H-43nP8RxYmNxnrUkZvSX0z9NEkHbpUY8J9cFBQjjG&__xts__%5B0%5D=68.ARDTb78AlAnxzrir5WbI8x1N5JnqYa1l6qpwuhLxHI_2D5D3KZjMOF9T6pXp1wxWtaKt0ALY1yQxBEYUfgeHymH9b-QwKuY_Onn6w29am06N0ctIPxLXYPj11Py_uhPZq2i9rRAI4Rlw8vVniq2sD4owHh5eArfVWjinIgOtYhdAOHdG7Hez3mRyr6Q1zN5CfDbDrCPk-aR8rFEEQR8DcVWv-Fit3Zak9oNagLuXmPS8c0Ay7g0H-paClNaWr-x4_xyT-kh50pK-D5uPLEqraAISY30NnId_KAMa0RUM86ikVt4B6E1qFRaAhtRNjmavNTDmf5__kjnMmcxU8_JQOICwHEOu&__tn__=EEHH-R


Hmmm....Interesting . Good detective work Mixin!

I absolutely had no idea about that little place, especially the HIV information.
 

library lady

Veteran Member
From the local Fox station:

Boston 25 News has learned more than a hundred Boston hospital workers have tested positive for coronavirus.
Today's Boston hospital worker cases may stem from a biotech company meeting-- Biogen-- held weeks ago. When Biogen workers were told that several people who had attended an executives meeting had been infected with coronavirus, a mob literally stormed the emergency room at Mass General Hospital to demand immediate testing and treatment.

Hospital security/police were called to make them leave. Shortly thereafter, some 60 ambulances transported Biogen employees from a Marriott to Brigham and Women's hospital and Mass General where an emergency test center had been hastily set up outside. Police had to shut off traffic down Shattuck St., a major route.

The Biogen cluster was reportedly associated with coronavirus spread across the US and several other countries.

 

DragonBurrow

Contributing Member
Completely wrong-headed! "Price gouging" is nothing more or less than free market economics at work. Highly desired items go up in price. No one is forced to buy the products at gun point. The so-called black market - which is really the free market - generally makes products available (at a price) that people can't get anywhere else.

Best
Doc
The one that got me was Limes, really there isa question why limes get more expensive in winter under travel restrictions?
 

SmithJ

Veteran Member
So...yeah...

Fair use cited so on and so forth.


China Just Sent 150,000 Test Kits To Prague And 80% Of Them Didn't Work

by Tyler Durden
Thu, 03/26/2020 - 05:35

As the real state of affairs in China, now months into its coronavirus outbreak, remains unknown, the country is trying to at least give the impression that things are fine and that it is genuinely interested in helping out the rest of the world.

China has claimed to have made donations of ventilators and testing kits to countries like Iran and Italy over the last week, seemingly trying to now play "good cop" with the neighboring countries it is likely at fault for infecting. Meanwhile, we have been pointing out obvious inconsistencies with the information coming out of Beijing as it has been happening.



And in terms of faking the notion of helping the rest of the world, China can't even do that right.



Czech newspaper Irozhlas reports that China sent 150,000 testing kits to Prague which have returned false results up to 80% of the time. In other words, they simply don't work. PJ Media provided a translation to the article:


"We tested those who searched for a sampling site. Fortunately, we were so far-sighted that samples were immediately taken for the classic examination and that just proved the error rate of the tests," Svrčinová continued.


1,392 people are talking about this


Meanwhile, the reality on the ground in China paints a far different picture than both the attitude out of Beijing and the daily coronavirus numbers suggest.




For example, for the first time since the virus outbreak began, China’s national health commission claimed on March 19 that there were no new infections in the entire country. But Chinese citizens described a different reality.


In Wuhan, ground zero of the epidemic, residents witnessed long lines at hospitals while more facilities were reportedly being set up to accommodate ill patients.

In a video posted to social media on March 19, a Chinese citizen shows the Wuhan Union Hospital, one of 46 designated facilities to treat COVID-19, and the queue in front of it. “Look, Look! People are lining up in front of the fever clinic at Wuhan Union Hospital,” the person says. The Epoch Times confirmed the footage was filmed at the hospital.

Also on March 19, a construction worker shared a video of a new makeshift hospital set up within a stadium in suburban Wuhan. “After another night, our mission is almost complete,” the man said. “A new makeshift hospital will be in operation soon.”

So China, if you're seeking to virtue signal, lie and change the narrative, perhaps a couple of lessons on how to do so are in order.
It's not that they don't work. It's just that they are preset to "negative"
 
More than 100 Boston hospital employees test positive for coronavirus
From CNN's Ellie Kaufman


Massachusetts General Hospital is pictured in Boston, on March 14.
Massachusetts General Hospital is pictured in Boston, on March 14. Michael Dwyer/AP
More than 100 employees at three Boston hospitals have tested positive for coronavirus
  • Boston Medical Center said 15 employees have tested positive for the virus.
  • Brigham and Women’s Hospital has 45 employees that have tested positive, Brigham Health Media Relations Associate Serena Bronda told CNN.
  • Massachusetts General Hospital has 41 employees who have tested positive, though Senior Public Affairs Officer Terri Ogan told CNN the hospital believes most contracted the virus somewhere other than the hospital.
===
Biogen conference.
Italian strain SARS COV-2.1
Honey Badger
View: https://www.youtube.com/watch?v=c36UNSoJenI

===
.

.
  • Massachusetts General Hospital has 41 employees who have tested positive, though Senior Public Affairs Officer Terri Ogan told CNN the hospital believes most contracted the virus somewhere other than the hospital.

LIARS

SNIPS From:
How the Biogen leadership conference in Boston spread the coronavirus
By Saturday night, signs of trouble were emerging. One Biogen executive reported feeling sick, and planned to seek treatment at Massachusetts General Hospital in the morning, according to a person familiar with the company. That executive was told on Sunday that a coronavirus test was not warranted under existing criteria, the executive told colleagues on Sunday.


By Tuesday morning, March 3, more executives who had been at the Boston conference were not feeling well, according to the person with knowledge of the company, who asked not to be identified because of the sensitivity of the situation. Some of them had gone to MGH or to their doctors to request coronavirus testing, only to be rebuffed because they did not meet the federal government criteria for a test, which at the time was a set of symptoms in addition to recent travel to a breakout area or contact with someone known to have the virus.

That same day, a “significant number" of people from Biogen — though still fewer than 10 — came to the Emergency Department at MGH asking for coronavirus tests, said Dr. Paul Biddinger, chief of the division of emergency preparedness at the hospital.

MGH had not been informed previously of the Biogen meeting or that people had been exposed to the virus.
“There was concern that there may be many more coming,” Biddinger said. Too many Biogen walk-ins, the hospital feared, could disrupt care for other patients.

All the Biogen people got a medical evaluation but many did not have symptoms that would rise to an emergency; they just wanted testing, Biddinger said.

Some of the Biogen walk-ins became “very frustrated” that they couldn’t get a test. “There were some challenging discussions,” Biddinger said.

Two people familiar with the company said a number of employees got up and left after reading the e-mail, with many of them heading straight to MGH to request a test.

In an e-mail from the company Thursday evening, Biogen officials asked employees to refrain from going to MGH to be tested for the coronavirus. The e-mail said their efforts “are overwhelming the emergency room” and that hospital police may have to bar Biogen employees from entering the area.

Biogen acknowledged for the first time on Thursday night that the coronavirus had been spread at its meeting the week before. By Friday, MGH and Brigham and Women’s set up temporary testing facilities in their ambulance bays to handle an influx of potential patients.

===

.
 

Doomer Doug

TB Fanatic
Watch what happens when Corona Chan infects a person already infected with AIDS
I also saw where one entire nursing home patients was infected. The virus is out of control at this point. My step brother emailed me about his drug plant in Hillsboro, Oregon, he works for Roche of Switzerland is ramping up to make key chemicals needed, so that is good news at least.:eleph:
 

Doomer Doug

TB Fanatic
Limes are usually imported from Mexico now
They can be grown in Florida like a lot of other citrus fruit
Like much else we now also get our orange juice from Brazil too.
 
Italy records increase in new coronavirus cases
From Nicola Ruotolo in Rome


Doctors tend to Covid-19 patients in the intensive care unit of San Matteo Hospital, in Pavia, Italy, on March 26.

Doctors tend to Covid-19 patients in the intensive care unit of San Matteo Hospital, in Pavia, Italy, on March 26. Claudio Furlan/LaPresse via AP

Italy reported an increase of 4,492 cases of coronavirus in the past day, bringing the total of active cases to at least 62,013.

There were at least 662 fatalities in the past 24 hours, raising the total to at least 8,165 deaths.


===
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Mixin

Veteran Member
  • Massachusetts General Hospital has 41 employees who have tested positive, though Senior Public Affairs Officer Terri Ogan told CNN the hospital believes most contracted the virus somewhere other than the hospital.

LIARS

SNIPS From:
How the Biogen leadership conference in Boston spread the coronavirus
By Saturday night, signs of trouble were emerging. One Biogen executive reported feeling sick, and planned to seek treatment at Massachusetts General Hospital in the morning, according to a person familiar with the company. That executive was told on Sunday that a coronavirus test was not warranted under existing criteria, the executive told colleagues on Sunday.


By Tuesday morning, March 3, more executives who had been at the Boston conference were not feeling well, according to the person with knowledge of the company, who asked not to be identified because of the sensitivity of the situation. Some of them had gone to MGH or to their doctors to request coronavirus testing, only to be rebuffed because they did not meet the federal government criteria for a test, which at the time was a set of symptoms in addition to recent travel to a breakout area or contact with someone known to have the virus.

That same day, a “significant number" of people from Biogen — though still fewer than 10 — came to the Emergency Department at MGH asking for coronavirus tests, said Dr. Paul Biddinger, chief of the division of emergency preparedness at the hospital.

MGH had not been informed previously of the Biogen meeting or that people had been exposed to the virus.
“There was concern that there may be many more coming,” Biddinger said. Too many Biogen walk-ins, the hospital feared, could disrupt care for other patients.

All the Biogen people got a medical evaluation but many did not have symptoms that would rise to an emergency; they just wanted testing, Biddinger said.

Some of the Biogen walk-ins became “very frustrated” that they couldn’t get a test. “There were some challenging discussions,” Biddinger said.

Two people familiar with the company said a number of employees got up and left after reading the e-mail, with many of them heading straight to MGH to request a test.

In an e-mail from the company Thursday evening, Biogen officials asked employees to refrain from going to MGH to be tested for the coronavirus. The e-mail said their efforts “are overwhelming the emergency room” and that hospital police may have to bar Biogen employees from entering the area.

Biogen acknowledged for the first time on Thursday night that the coronavirus had been spread at its meeting the week before. By Friday, MGH and Brigham and Women’s set up temporary testing facilities in their ambulance bays to handle an influx of potential patients.

===

.
That's such a sore spot with me. One of those Biogen fellas brought it to my county; we now have 21 cases here. He either missed the warning email or chose to ignore it. He worked in Wake Co, NC for the following week while showing symptoms.
 

library lady

Veteran Member
That's such a sore spot with me. One of those Biogen fellas brought it to my county; we now have 21 cases here. He either missed the warning email or chose to ignore it. He worked in Wake Co, NC for the following week while showing symptoms.
I don't believe they all got it outside of the hospital. Not with Brigham and Women's at almost the same number of worker cases.
 

library lady

Veteran Member
  • Massachusetts General Hospital has 41 employees who have tested positive, though Senior Public Affairs Officer Terri Ogan told CNN the hospital believes most contracted the virus somewhere other than the hospital.

LIARS

SNIPS From:
How the Biogen leadership conference in Boston spread the coronavirus
By Saturday night, signs of trouble were emerging. One Biogen executive reported feeling sick, and planned to seek treatment at Massachusetts General Hospital in the morning, according to a person familiar with the company. That executive was told on Sunday that a coronavirus test was not warranted under existing criteria, the executive told colleagues on Sunday.


By Tuesday morning, March 3, more executives who had been at the Boston conference were not feeling well, according to the person with knowledge of the company, who asked not to be identified because of the sensitivity of the situation. Some of them had gone to MGH or to their doctors to request coronavirus testing, only to be rebuffed because they did not meet the federal government criteria for a test, which at the time was a set of symptoms in addition to recent travel to a breakout area or contact with someone known to have the virus.

That same day, a “significant number" of people from Biogen — though still fewer than 10 — came to the Emergency Department at MGH asking for coronavirus tests, said Dr. Paul Biddinger, chief of the division of emergency preparedness at the hospital.

MGH had not been informed previously of the Biogen meeting or that people had been exposed to the virus.
“There was concern that there may be many more coming,” Biddinger said. Too many Biogen walk-ins, the hospital feared, could disrupt care for other patients.

All the Biogen people got a medical evaluation but many did not have symptoms that would rise to an emergency; they just wanted testing, Biddinger said.

Some of the Biogen walk-ins became “very frustrated” that they couldn’t get a test. “There were some challenging discussions,” Biddinger said.

Two people familiar with the company said a number of employees got up and left after reading the e-mail, with many of them heading straight to MGH to request a test.

In an e-mail from the company Thursday evening, Biogen officials asked employees to refrain from going to MGH to be tested for the coronavirus. The e-mail said their efforts “are overwhelming the emergency room” and that hospital police may have to bar Biogen employees from entering the area.

Biogen acknowledged for the first time on Thursday night that the coronavirus had been spread at its meeting the week before. By Friday, MGH and Brigham and Women’s set up temporary testing facilities in their ambulance bays to handle an influx of potential patients..
I don't believe the Mass General healthcare workers all got it outside of the hospital. Not with Brigham and Women's workers at almost the same number of employee cases as MGH.

Tom, they are lying.
 

Tristan

Has No Life - Lives on TB
I posted that article because I knew that India was banning exports of the drug. I decided to search online to see if India was the only source and found the article (in my post that you quoted) stating that these other companies (none based in India) are ramping up production, so I think that is good news.


Good news indeed.
 

Macgyver

Has No Life - Lives on TB
Heard this from a nurse on FOX NEWS:

How bad is it? "STAY AT HOME unless you want to intubated by a Gynecologist (I took that to mean ...Medical people drafted into this fight who are NOT the best at what they are being called to do. In other words it will be more than normally painful and difficult to help you survive)


UNDERSTAND NOW? Is that enough "incentive" to remember to STAY AT HOME and wash your hands and stay away from other people?
Sounds like they would still be good about sticking things in a hole.
I'd be more worried about a podiatrist, there all creepy mf's.
 
China will ban most foreigners from entering country
From CNN's Steven Jiang in Beijing

China will close its borders to most foreigners starting Saturday, the government announced Thursday, amid continued concerns over rising imported cases of novel coronavirus.

Foreign nationals currently holding Chinese visas or residency permits will be temporarily banned from entering the country until further notice, according to a statement from the foreign ministry and the national immigration authority.

The government is also suspending all visa-free transit and visa-on-landing programs. People holding diplomatic passports are exempted from the new rule.

Foreign nationals who must visit China out of necessity need to apply for new visas, and holders of Chinese visas issued after Thursday will be allowed into the country, the statement added.


===

%!@###*

I sincerely hope there's payback plan in place.

===
.
 

Hfcomms

EN66iq
From a redit;


Good morning! Got some much needed sleep last night and am enjoying my day off before returning to the ER tomorrow.

I'm a member of several nurse groups and thought y'all would enjoy reading this that was written by an ER doc in New Orleans. Very interesting read:

"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 ***** 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."
 

Bps1691

Veteran Member
In most of my AO, the schools are providing lunch
They obviously mean percentage/per capita here...

Coronavirus spreading faster in Detroit than nearly anywhere in United States

DETROIT — The coronavirus pandemic is ravaging the poorest big city in the nation, prompting concerns about whether a municipality still recovering from bankruptcy can provide services to its most vulnerable residents.

Michigan’s surging infection rates are propelled by a startling number of cases in Detroit, which has a per capita infection rate that is among the nation’s highest, exceeded only by New York and its surrounding counties and New Orleans.

Detroit’s challenges are particularly acute because 1 in 3 residents are impoverished and have high rates of diabetes and other ailments that increase the severity of the virus.

As of Wednesday, 12 of the state’s 43 deaths were Detroit residents, while the pandemic has quarantined nearly 300 city police officers and firefighters and led to a one-day stoppage of a public transit system.

The city is the “epicenter” of Michigan infection because of its vulnerable populations, and it’s “scary” how fast it is spreading, said Dr. Teena Chopra, an infectious disease expert at Detroit Medical Center.

Nearly a third of Michigan’s cases, 705 of 2,295 as of Wednesday, are from Detroit, even though the city has less than 10 percent of the state’s population.

“It’s been real scary,” said Tammara Howard, a resident of the city’s east side who is CEO and founder of a nonprofit known as What About Us, Inc.

The group is a hub for neighborhood gatherings, and Howard said many still underestimate the seriousness of the virus, despite Gov. Gretchen Whitmer’s order that residents stay at home until at least April 13.

“They knock on the door, and you don't want to be rude, but the virus is out there,” said Howard, who has high blood pressure and diabetes.

On Wednesday, Mayor Mike Duggan announced the city is ramping up testing and hopes to provide them to 400 people a day, six days a week for the next six weeks.

“We haven’t hit the peak,” said Duggan, who added that “four people connected to me have died in the past 48 hours.”

“The idea that you would just go on with life and survival of the fittest, that is not what this country is about,” he said.

‘Rapid acceleration’
Detroit’s coronavirus rate, 83 cases per 100,000 residents as of earlier this week, is nearly five times the statewide rate and more than double the next highest rate, Oakland County. Nationwide, Wayne County, including Detroit, has the 13th highest per capita rate. Oakland County is 25th.

“We’re on the rapid acceleration of the growth curve,” Dr. Betty Chu, associate chief clinical officer at Henry Ford Health System, said on Wednesday.

Dr. Marcus Zervos, a specialist in infectious diseases at Henry Ford, is working with Detroit health officials and said Michigan “has done a better job of testing than other states.”

“It’s good that we have higher numbers,” Zervos said. “It’s important. If we know who’s positive, we can implement control measures.”

Chopra, the Detroit Medical Center doctor, sad Detroiters are vulnerable because so many have underlying health conditions. Cases that in other areas are mild may instead hospitalize Detroiters or worse, she said.

Dr. Abdul El-Sayed, the city’s former health director, said city and state officials have “done their best given the circumstances.”

“The city is full of people who are poor and marginalized. It’s the densest part of Michigan, and Detroiters in general are less healthy,” said El-Sayed, who ran against Whitmer for governor in 2018.

When Duggan appointed him to run the health department in 2015, it had five staffers. Today, there are 110, but about a third of them focus on animal control, according to the city’s budget.

Overall, Michigan ranks near the bottom of the nation, 43rd, on public health funding, according to America’s Health Rankings, an annual report by United Health Foundation, a Minnesota-based nonprofit.“This is what happens when you create a system built on austerity,” El-Sayed said.

“Folks are working really hard now. But they’re working from their back foot. Catching up amid a pandemic is not how you want to do it.”

Help is ‘not enough’
Amid the crisis, Detroit is ramping up efforts to provide essentials. Three of Detroit’s 11 recreation centers, which are otherwise closed until at least April 13, are repurposed to provide breakfast and lunch for children on weekdays.

“That’s helping to alleviate some of the stress of being able to have the children inside your homes fed,” said Jeremy Thomas, communications and marketing manager for the city’s parks and recreation division.

Posted hours are 8:30 a.m. to 1:30 p.m., but Farwell Recreation Center on the east side usually runs out of its 1,200 meals by 11 a.m., said staffer Terence Mercer.

“It’s not enough,” said a staffer outside the Adams Butzel Recreation Center on the west side who wasn’t able to share his name. Food at Butzel was gone by noon on a Tuesday, but “people are still coming.”

In one case, a woman said she had a household with 20 children, which was “hard to believe,” Mercer said. But when staffers drove the food over to her place, the house indeed looked full of kids.

More recreation centers will be deployed for food assistance next week, the city said, picking up from the Detroit public school system as it pares down its food delivery system from 58 to 17 locations.

In my AO, almost all the small town schools are providing breakfast and lunch sack meals for all of their students who are on the government programs (and to other students if they register). To get them, someone drives/walks to the school and they are distributed outside of the building each school day. One Fridays they also get sack lunches for Sat & Sunday as well as Fridays. No touching each other and it is done at a distance.

The fast food (and several of the now closed set down restaurants) are offering their menus as drive ups or delivery through the services (large town on north western side of AO only). There weren't that many restaurants in the smaller towns in my AO, but many are offering their lunch menus as a call in and pick up outside.

In the smaller towns in my AO, there are several programs where the elderly are still getting food, supplies and meals being run by the churches and other organizations. Again, they have to register and at delivery there is separation and no touching.

The Walmart's (always have had order online pickup) and other large grocery stores on the far north west part of my AO have continued their online order and pickup but all have limited their hours and are first come first serve on pickup times. Once the limit is reached for a time slot it closes. Once all the time slots are taken, the day closes. Almost all of them have also offering early morning times for elderly only to go to the store and pick up what they need. Walmart and two others of the larger grocery stores to my NW of AO are also offering a delivery service for called in orders, on a FCFS basis for limited time slots.

Supplies of fresh vegetables, fruits are well stocked. Canned goods have had times where they are close to out (and actually out of certain brands), but overall there are goods to buy. Fresh meat the same, many cuts out but they have less normal cuts available at times. TP, disinfectants, Clorox, rubbing alcohol, etc- gone-gone-gone.

The food pantries are still open and running on their normal schedule, but don't have a clue what they are supplying or how they are handling the personal contact rules.

It has gotten better as people settled down into the self-quarantine.

Overall the vast majority of people have been respecting the distancing thing and aren't being stupid about getting together. Oh, there are some younger ones that still weren't getting it, but once the data started coming about even younger people getting it most of them are finally accepting the rules.

I have no doubt that Detroit is having the troubles that it has. Large parts of that city have major problems even during normal times, an epidemic like this would quickly overwhelm their already broken to bits systems.
 

Hfcomms

EN66iq
Coronavirus-stricken aircraft carrier USS Theodore Roosevelt diverted to Guam

3_182020_ring8202_c115-0-3270-1840_s885x516.jpg

After three more sailors aboard the USS Theodore Roosevelt aircraft carrier tested positive for the coronavirus pandemic — bringing the total number to eight — commanders ordered the ship to Guam so the entire 5,000 person crew could be tested.


The ship, based in San Diego, will remain at the dock in Guam until the testing is complete. The crew won’t be allowed to leave the pier.


“We are already starting the process of testing 100 percent of the crew to ensure that we’ve got it contained,” acting Secretary of the Navy Thomas Modly told reporters at the Pentagon.

 




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Justin Trudeau confirms report that the Unites States is considering stationing troops near the Canadian border. PM says Canada is speaking to American officials, says Canada's view is that the border should remain unmilitarized.



Trudeau pushing back as U.S. looks to place troops near Canadian border | CBC News
Prime Minister Justin Trudeau said Canada is in talks with the United States over reports that the Trump administration is thinking of stationing troops near the Canadian border.

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