Corona Virus

[SpaceBus]

Right now the system is overloaded. Many small businesses are trying to log on and crashing the system. It's pretty dysfunctional at a time when the owners are faced with a make or break decision going forward. They don't have the luxury of waiting weeks for this to get sorted out.

My wife's employer is deemed necessary, but is a home nursing agency. She is unable to work right now, partly because of my immune system. Because she is deemed an essential employee, the FFCRA does not apply and she cannot get sick leave. They finally furloughed my wife, but she can't even get into the website to submit her unemployment claim. This is a real mess.

 

[PaulOinMA]

… There was an article today about why mortality rates can't be trusted right now …

The April 6 Daily Update in the following (scroll down) mentions that NY reported numbers are probably low by an estimated 180 - 195 daily deaths.

United States COVID - Coronavirus Statistics - Worldometer

United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.

www.worldometers.info

 

[Medic21]

An alternative POV in the method of treatment from the front line. Interesting. He is focusing on the methodology of the respirator use rather than rote pressure. It is interesting to note that in Europe, where they have changed the way they are using the ventilator they are not losing patients.

Possible Developments in the Treatment of Acute COVID-19

This appears potentially quite important. Since it has to do with technical clinical details and treatment protocols I'll try to be both as precise and general as possible. Yesterday I noticed this…

talkingpointsmemo.com

I may not be an MD but, we have extensive training on the use of Intubation and Ventilators. Over the last decade and a half we have become much more selective on when we take control of an airway. The number one reason ithe human body has its own defense and compensatory mechanisms to protect itself. When we take over the airway and use a ventilator we bypass that, sometimes to the detriment of pt outcomes.

15 years ago if you coughed or sneezed wrong the drugs came out and boom, you had a tube. Then along cane CPAP and BiPAP, send me a message if you want to know the difference, and we began to have great outcomes, shorter ICU stays and quicker turn arounds to discharge. We became very selective as to who we intubated.

This comes along and we in EMS have not changed our though processes. But, it seams like the hospital ERs forgot everything and started dropping tubes left and right. I have questioned that from the beginning. Scott Wiengart is an ICU/ER physician in NYC and he questioned this from the beginning. We know that once that tube goes in there is a much greater risk of a poor outcome for all pts. That was proven years ago.

I agree 100% that too many pts are going on ventilators. If you need drugs to intubate a pt it may not be the best choice right now. As long as they have a gag reflex they can protect their airways and the use of high flow O2 systems may be the best use. CPAP and BiPAP can add PEEP an inspiratory pressures needed to help breathing. I’m very interested to see more in this.

We ARE NOT using RSI to intubate these pts in the field.

 

[begreen]

That is an interesting insight. I hope Dr. Kyle-Sidell is listened to. What is PEEP?
Coincidently I’m reading the Escapist right now and he is describing the perils of the death zone on Everett and what happens as one's body runs out of oxygen. Interestingly some have started taking Viagra because it opens up the aveoli and helps them adapt better to the very thin air.

Regardless of our differences in demographics, economics, etc. I can't say thank you enough to the people on the front line. From EMTs to ICU docs to nurses and to the cleaners and janitors, you are all so important to this fragile thing called life.

EDIT:
This article discusses CPAP, BIPAP and PEEP with thoughts and concerns about CPAP use in a viral situation.

What's the difference between coronavirus ventilators, CPAP and BiPAP machines?

Coronavirus has sparked a new conversation about the difference between ventilators, CPAP and BiPAP machines.

www.foxbusiness.com

 

[Medic21]

That is an interesting insight. I hope Dr. Kyle-Sidell is listened to. What is PEEP?
Coincidently I’m reading the Escapist right now and he is describing the perils of the death zone on Everett and what happens as one's body runs out of oxygen. Interestingly some have started taking Viagra because it opens up the aveoli and helps them adapt better to the very thin air.

Regardless of our differences in demographics, economics, etc. I can't say thank you enough to the people on the front line. From EMTs to ICU docs to nurses and to the cleaners and janitors, you are all so important to this fragile thing called life.

EDIT:
This article discusses CPAP, BIPAP and PEEP with thoughts and concerns about CPAP use in a viral situation.

What's the difference between coronavirus ventilators, CPAP and BiPAP machines?

Coronavirus has sparked a new conversation about the difference between ventilators, CPAP and BiPAP machines.

www.foxbusiness.com

PEEP is holding pressure in the lungs after exhalation. It is used to keep the alveoli opened and makes use of the dead space in the lungs to allow for easier gas exchange. It also keeps the lungs from filling up with fluid.

CPAP can be used with a viral filter to keep from aerosolizing the virus. That is a concern with BiPAP and vents also. CPAP is constant PEEP though and makes work of breathing worse where BiPAP “assists” breathing kinda like a ventilator. BiPAP is relatively new to EMS and outside of critical care units there are very few of us that have it for 911. The Vents that do it were in the $30k range when we got ours. Much cheaper now.

 

[mcdougy]

Canada Emergency Response Benefit (CERB) - Canada.ca

Learn who was eligible for the Canada Emergency Response Benefit (CERB), if you need to repay, and about CERB debt reduction for students.

www.canada.ca

Being self employed this is what I was able to sign up for today. It will help for sure. Employees are being subsided 75% of their regular pay via the government. Business has to have a 15% drop in revenues from last year to qualify for the employee subsidy.
My business is completely shut down given the situation.

Archived - The Canada Emergency Wage Subsidy - Canada.ca

To help businesses keep and return workers to their payroll through the challenges posed by the COVID-19 pandemic, the Prime Minister, Justin Trudeau, proposed the new Canada Emergency Wage Subsidy. This would provide a 75-per-cent wage subsidy to eligible employers for up to 12 weeks...

www.canada.ca

This is the employee benefit

Ottawa, banks near deal on coronavirus small business loans

Federal government wants five day window to verify borrowers’ details; banks push for same-day funding

www.theglobeandmail.com

This has also been rolled out....if you pay back your loan before end of this year, up to 25% of principal is forgiven.

 

[johneh]

If you have been laid off in Canada
in order not to overload the CRA web site
your birthday indicates the day you can apply
My youngest son was laid off the first week of march
applied for EI or at least his boss did for him
he received his first 2000 dollar direct deposit today
That's pretty fast for the Canadian Gov.

 

[thewoodlands]

All the info below was taken off our county webpage.

As of 4/8/2020, there are 78 Confirmed Cases of COVID-19

There are 5 Hospitalizations and with sadness, the first COVID-19 death has been reported today as well. We mourn the loss of one of our own St. Lawrence County residents and offer our sincere condolences.

There have been 23 have been released from Mandatory Isolation and are recovering at home.

 

[begreen]

Canada Emergency Response Benefit (CERB) - Canada.ca

Learn who was eligible for the Canada Emergency Response Benefit (CERB), if you need to repay, and about CERB debt reduction for students.

www.canada.ca

Being self employed this is what I was able to sign up for today. It will help for sure. Employees are being subsided 75% of their regular pay via the government. Business has to have a 15% drop in revenues from last year to qualify for the employee subsidy.
My business is completely shut down given the situation.

Archived - The Canada Emergency Wage Subsidy - Canada.ca

To help businesses keep and return workers to their payroll through the challenges posed by the COVID-19 pandemic, the Prime Minister, Justin Trudeau, proposed the new Canada Emergency Wage Subsidy. This would provide a 75-per-cent wage subsidy to eligible employers for up to 12 weeks...

www.canada.ca

This is the employee benefit

Ottawa, banks near deal on coronavirus small business loans

Federal government wants five day window to verify borrowers’ details; banks push for same-day funding

www.theglobeandmail.com

This has also been rolled out....if you pay back your loan before end of this year, up to 25% of principal is forgiven.

Hats off to Canada for caring for its workers.

 

[begreen]

Germany's early and comprehensive testing has helped it keep notably ahead of the virus compared to its neighbors.

Pass the salt: The minute details that helped Germany build virus defences

One January lunchtime in a car parts company, a worker turned to a colleague and asked to borrow the salt.

www.reuters.com

 

[Ashful]

Yes, but in fairness, they had the advantage of foresight, as it ramped up two weeks earlier in Italy. Without the benefit of having seen that, I doubt Germany could have done as well as they did.

 

[begreen]

Yes, but in fairness, they had the advantage of foresight, as it ramped up two weeks earlier in Italy. WI thought the benefit of having seen that, I doubt Germany could have done as well as they did.

Read the article. First case was in January. They had the advantage of early detection and acting on it. Good medical forensics, record keeping, extensive testing and early action are what has kept their numbers low. As the report points out, it is the detailed follow up to cases #0 and #1 that led to quick action. Like S. Korea, they are testing 500,000 people a week.

 

[Ashful]

One thing I’m interested in, but haven’t seen any discussion of in the media, is any anticipated spike in new cases as various state forced closures and self-quarantine orders are lifted, and employers expect their employees to return to work. If they lift those orders in two weeks, should we not expect a corresponding spike in new cases?

 

[SpaceBus]

One thing I’m interested in, but haven’t seen any discussion of in the media, is any anticipated spike in new cases as various state forced closures and self-quarantine orders are lifted, and employers expect their employees to return to work. If they lift those orders in two weeks, should we not expect a corresponding spike in new cases?

If you chart the Maine cases you can clearly see that the stay at home measures have been effective.

 

[begreen]

What has repeatedly worked is quick action backed by a robust pandemic response. What doesn't work is denial. This is the stark difference between S. Korea, Germany, Taiwan, etc. and Italy, the US, Spain, etc.. The same thing is playing out in the states. The states that have kept the curve flat and have good testing will be able to get people back to work quicker. The states in denial are going to have a harder time at containment and returning people to the workplace. The speed with which this will happen depends on how quickly we can ramp up testing. So far we are still woefully behind on this key objective.

(broken link removed)

Locally, yesterday at one of our largest hospitals, a doc we know has a patient they refuse to test because she didn't fit the profile. He is convinced she has Covid-19, but without the full list of symptoms, they are still denying testing due to a continued shortage. Until we get enough testing that we can return people to the workplace with full knowledge of when they were testing negative, we will not be up to speed. To date we can not give accurate numbers of how many people have been tested or by when we will have the testing capacity to test the whole population. Now we are competing for medical supplies necessary to complete the tests like swabs, so speculating when is just a guess.

 

[Medic21]

One thing I’m interested in, but haven’t seen any discussion of in the media, is any anticipated spike in new cases as various state forced closures and self-quarantine orders are lifted, and employers expect their employees to return to work. If they lift those orders in two weeks, should we not expect a corresponding spike in new cases?

This is exactly what will happen. Since it takes upwards of 2 weeks to show symptoms the next time it spikes it will be outrageous. Look at the second wave of the Spanish flu.

 

[begreen]

This is exactly what will happen. Since it takes upwards of 2 weeks to show symptoms the next time it spikes it will be outrageous. Look at the second wave of the Spanish flu.

Yes, that hit with several spikes over almost 3 yrs. The second spike in the fall of 1918 was very deadly.

 

[NickW]

And unfortunately we won't be smart enough as a whole to continue isolating until the ability to test EVERYONE is available... Restrictions will get lifted, people will have big parties, one contagious person will infect 10 people who will infect 5 more each before they show symptoms and on and on...

 

[begreen]

The manual worker will be hit the hardest due to lack of testing. This BBC reporter's opener states the issues with Covid-19 and the working class in refreshingly straight-forward language.

Maitlis praised for 'extraordinary' opening to Newsnight

Coronavirus: the symptoms

www.standard.co.uk

 

[Ashful]

Yes, that hit with several spikes over almost 3 yrs. The second spike in the fall of 1918 was very deadly.

... as every Philadelphian knows: https://www.cnn.com/2020/03/15/us/philadelphia-1918-spanish-flu-trnd/index.html

If I recall from history class, unless I'm cross-pollinating the stories in my head, the first wave to hit the US was in the ramp up to WW1, in 1914.

 

[begreen]

... as every Philadelphian knows: https://www.cnn.com/2020/03/15/us/philadelphia-1918-spanish-flu-trnd/index.html

If I recall from history class, unless I'm cross-pollinating the stories in my head, the first wave to hit the US was in the ramp up to WW1, in 1914.

1918-1919
(broken link removed to https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/pandemic-timeline-1918.htm)

In contrast to Philly, St. Louis's health commissioner shut down the town and they had notably less cases as a result.

 

[Woody Stover]

An alternative POV in the method of treatment from the front line. Interesting. He is focusing on the methodology of the respirator use rather than rote pressure. It is interesting to note that in Europe, where they have changed the way they are using the ventilator they are not losing patients.

Maybe it's time to ramp up cardio workouts, especially us old goats, to increase our ability to uptake oxygen..

 

[begreen]

Maybe it's time to ramp up cardio workouts, especially us old goats, to increase our ability to uptake oxygen..

I'd go up to the summit at Rainier for a month to acclimatize to lower oxygen levels, but the park is closed.

 

[begreen]

Here is a Hong Kong epidemiologist's perspective on getting people back to work.

Opinion | Lockdown Can’t Last Forever. Here’s How to Lift It. (Published 2020)

We need to hit and release the brakes on physical distancing, again and again, until we safely get to immunity.

www.nytimes.com

Meanwhile

Federal Support Ends For Coronavirus Testing Sites As Pandemic Peak Nears

As the coronavirus pandemic peak approaches, local officials say the federal government is ending support for COVID-19 community-based testing sites.

www.npr.org

Looks like HHS got a lot of flack about this and just reversed the decision. This policy shifting is like riding down a country road with a drunken uncle at the wheel.

In Reversal, Federal Support For Coronavirus Testing Sites Continues

The Trump administration had planned to end federal support for 41 COVID-19 testing sites around the country. But after complaints from local officials, the government will continue funding.

www.npr.org

 

[Medic21]

Yes, that hit with several spikes over almost 3 yrs. The second spike in the fall of 1918 was very deadly.

This is why our current quarantine procedures need adjustment. We need healthy people to gain an immunity to this to protect the at risk from that second deadly wave.