Coronavirus COVID-19 - Global Health Pandemic #44

[pocketaccent]

(Ahh...Now we know why. FEMA and hospitals...)

Hoarding not the only reason for toilet paper shortage
...

Rich Hebert is the CEO of Clean It Supply, a wholesaler for cleaning supplies. He told News 8 tissue manufactures have a priority hierarchy with Federal Emergency Management Agency and medical companies at the top with big box stores somewhere in the middle.

“Aside from consumers trying to stock up, the government and first responders are definitely taking far more than they were before,” Hebert said.
...
Herbert added that he thinks the strain on the supply will last at least another three months.

 

[MassGuy]

This is sobering, for sure. My 84 year-old mother had a heart attack and was put in a medically-induced coma and on a ventilator in August, and suffered a pretty steep and quick decline following that, eventually dying in December. The decisions and balancing of pros and cons and "least bad" outcomes was exactly as described above, but at least she had led a full life up until then. The fact that these same painful choices and difficult outcomes are happening to relatively young and previously healthy people is really something terrible to see...

Yeah, I had absolutely no idea how risky the process was. I figured they hooked you up to a ventilator, and that allowed your body to recover.

While that’s true for some, it’s not a magic bullet, and it can cause a whole new set of problems (lung and heart damage).

What sucks is that loved ones are forced to make choices that they never expected to make, especially considering the relatively young age of some of the victims.

They’ve got to do it over the phone in many cases, which makes it even worse.

Awful stuff.

 

[JRWoodwardMSW]

No wonder surgical masks have been called disposable masks. They should be carefully thrown away without touching the outside after each use.

But since the masks are more precious than gold these days, let's hang them in a remote corner of house for 7 days, then reuse. Frankly I'm tired of new studies after new studies giving us more bad news.

Took my 4yo granddaugter for a walk the other day. Got a call. I’m answering it. She picks up a discarded surgical mask from the gutter. “Grandpa, what’s this?” I’ve had two strokes so my braim-dun-workrite: I hadn’t brought sanitizer. I called my wife in a panic and asked her to come at once and bring all the rubbing alcohol she could reach.

 

[KALI]

I think that I'd like them to place me in a coma and let me die.
If it got to that.
Currently, I'm going to do my hardest to not get this virus.
Hubby is on the frontlines taking care of orders at our restaurant.
We are reporting from San Diego, California. So far 19 deaths (seriously, less then we would normally experience from traffic deaths).
So, there is that.
Very little testing.
Don't know what the next 3 weeks will bring us.
We have a population of nearly 4 million.
In my little area, from what I see, everyone is mostly staying home.

Here’s part of it. Eye opening for sure:

Doctors are left with impossible choices. Too much oxygen poisons the air sacs, worsening the lung damage, but too little damages the brain and kidneys. Too much air pressure damages the lung, but too little means the oxygen can’t get in. Doctors try to optimize, to tweak.

Nobody can tolerate being ventilated like this without sedation. Covid-19 patients are put into a medically induced coma before being placed on a ventilator. They do not suffer, but they cannot talk to us and they cannot tell us how much of this care they want.

Eventually, all the efforts of health care workers may not be enough, and the body begins to collapse. No matter how loved, how vital or how needed a person is, even the most modern technology isn’t always enough. Death, while typically painless, is no less final.

Even among the Covid-19 patients who are ventilated and then discharged from the intensive care unit, some have died within days from heart damage.

Even before Covid-19, for those lucky enough to leave the hospital alive after suffering acute respiratory distress syndrome, recovery can take months or years. The amount of sedation needed for Covid 19 patients can cause profound complications, damaging muscles and nerves, making it hard for those who survive to walk, move or even think as well as they did before they became ill. Many spend most of their recovery time in a rehabilitation center, and older patients often never go home. They live out their days bed bound, at higher risk of recurrent infections, bed sores and trips back to the hospital.

All this does not mean we shouldn’t use ventilators to try to save people. It just means we have to ask ourselves some serious questions: What do I value about my life? If I will die if I am not put in a medical coma and placed on a ventilator, do I want that life support? If I do choose to be placed on a ventilator, how far do I want to go? Do I want to continue on the machine if my kidneys shut down? Do I want tubes feeding me so I can stay on the ventilator for weeks?

Right now, all over the country, patients and their families are being asked to make these difficult decisions at a moment’s notice, while they are on the verge of dying, breathless and terrified.

 

[Jessthinkin]

Struggling to sleep tonight (well, this morning, as it’s nearly 3am)
Fell down the YouTube rabbit hole and found a new Chris Mann parody that made me smile and cry at the same time

Good night, all

That's a beautiful video. (I'm not crying, you're crying!) Ok, yeah, I'm crying...

 

[Jessthinkin]

Yeah, I had absolutely no idea how risky the process was. I figured they hooked you up to a ventilator, and that allowed your body to recover.

While that’s true for some, it’s not a magic bullet, and it can cause a whole new set of problems (lung and heart damage).

What sucks is that loved ones are forced to make choices that they never expected to make, especially considering the relatively young age of some of the victims.

They’ve got to do it over the phone in many cases, which makes it even worse.

Awful stuff.

Agreed, this is just awful all the way around... One of my friends is married to an ER doc who's working at an "impacted" ER, as well as at a facility set up for homeless, COVID-positive patients. I've known and loved them both for 30 years, and held them both in my prayers especially these last few weeks, but this morning when she posted on FB a special plea for prayers for him as he ventured out today, I felt truly scared as I prayed for both of them. I can't imagine the fortitude it takes to put yourself directly in harm's way, day after day. Incredible.

 

[JRWoodwardMSW]

I just figured out that “Handvana” is the main outfit I was referencing in my earlier post - they sell something like Bactine and imply it keeps you safe from coronavirus, but the active ingredients in products for minor wounds are anti-bacterial, NOT anti-viral. “Handvana” does not list ANY of the ingredients in their products on the web ads I have seen. I’m going to see if the Florida Dept of Agriculture and Consumer Services can do anything. They build cases against fraudulent products sold anywhere in Florida, even on the web.
Also, I think they have at least one more brand name. Workin’ on it.

 

[MajorHoople]

US Politicians Call For Resignation Of WHO Head, Tedros Adhanom Ghebreyesus

World Health Organization Boss Partly Blamed For China's Lack Of Transparency

Senator Martha Mcsally Said Tedros Should Resign Over The 'Chinese Cover-Up'

Activists Claimed 42,000 Or More Could Have Died In Wuhan, Where Virus Began

"The director-general of the World Health Organization is facing calls to resign over criticisms of the way China's response to the coronavirus crisis was managed.

Tedros Adhanom Ghebreyesus is facing growing calls to step down from US politicians for trusting the communist regime's official reporting about the extent of the spread of the disease."

WHO director faces calls from US politicians to resign over handling of China's coronavirus response | Daily Mail Online

 

[Sillybilly]

As COVID-19 depletes stockpiles, 3M reaches deal to supply Canada with face masks despite U.S. restrictions

 

[Curious Me]

...snipped to reply...
We are reporting from San Diego, California. So far 19 deaths (seriously, less then we would normally experience from traffic deaths)….

Let's celebrate neighbor because the good news is there were No Covid-19 deaths in San Diego today.

You're right about the number of traffic deaths usually. It seems lots of innocent people trying to cross the street lost their lives around town earlier this year and cars kept driving into buildings.

 

[Snoods]

Burglaries are up 20% in Houston since the city issued stay-at-home orders last month, according to the Houston police chief.

”Right now, burglaries have spiked 20%,” Police Chief Art Acevedo told Brietbart. “Some people are seeing the shutdown of businesses as a target-rich opportunity. Habitual burglars should not be released.”

Hmm...what to do, what to do. I know! Release more career burglars with no money, no job, no place to stay and possibly infected with Coronavirus into the streets!

Harris County Judge Lina Hidalgo signed an order this week to release up to 1,000 nonviolent criminals from the county’s jail because of coronavirus fears.

Police chief: Houston burglaries up 20% since city's stay-at-home orders

 

[Curious Me]

Toilet paper I got.

I need a decent thermometer for just in case. I have the old mercury ones, but can't read the darn numbers. Can't tell where the shiny mercury stops on the glare of the glass!

So, I bought a new kind online, but it was way off so I returned it. Then, out of desperation I got one at the Dollar Tree and it gives me fake temperatures.

They took my temp at the hospital pharmacy today without me even knowing it. Wow, I want that thermometer.

 

[neesaki]

Couple things I've been wanting to mention, but between the fast-moving threads and fairly significant personal struggles, I haven't had a chance before now. I'm referencing items from previous posts, but they're buried, so I do apologize in advance for not being able to assign proper credit.

Re: High-dose vitamin C as treatment for Covid19:
This is actually a treatment, developed several years ago by an MD here in VA, as a last resort treatment for sepsis/septic shock/MSOF (multi-systems organ failure) due to sepsis. It still continues to be highly controversial, with results varying from study to study. People (general public) mistakenly believe that these patients are being given OTC vit C tabs. But--that isn't the case at all. First, they're being given high doses of ascorbic acid (aka vit C) IV (intra-venously). Second, vit C is being given in conjunction with 2 other medications, and the theory is that one enables the other to work. Just to give a visual on the complexity, this is the protocol from 2017:
https://www.evms.edu/uploads/magazine/9-4/downloads/Dosing_strategy.pdf


And some other reference articles:
Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. - PubMed - NCBI
A cure for sepsis? | EVMS Magazine 9.4
EVMS Pulse Newsroom | Eastern Virginia Medical School | Media | Press

https://www.facebook.com/video.php?v=10156743855497095

As far as this protocol being beneficial in the setting of Covid19, I have absolutely no clue, as I don't believe there's anything more than anecdotal or theoretical evidence at this point, although I don't think it should be totally discounted, as I believe CV19 can lead to sepsis/MSOF (MOO)

Hand Sanitizer:
I don't understand the public's infatuation with this. It's harsh on your hands, has who-knows-what chemicals in it that aren't listed, and it doesn't even kill some particularly nasty bugs. Not to mention it does nothing for visible dirt. I was ridiculed years ago by med school friends of mine when I adamantly stated that hand sanitizer was inferior to hand-washing (I'm a lowly non-doctor). This isn't to say there's no use for hand sanitizer. There is good evidence to show its utility in certain circumstances (e.g. when soap/water isn't available). It's the over-reliance on this stuff that bugs me to no end.

You have naturally occurring oils on your skin, which trap dirt and microbes. Soap and water work by breaking up the oils on the surface of your skin and surrounding them. Then the running water washes it off. PS, don't forget that you have beneficial flora that lives on your skin too!
https://chem.ku.edu/sites/chem.ku.edu/files/docs/CHEM190/soap.pdf (how soap/water work)

I used to scrub in for sterile procedures at my old job, and there was a certain way and order to scrub our hands/forearms in order to reduce the bio-burden as much as possible. I still do the mechanics of it out of habit, but also because it's beneficial. If you're interested in an aseptic way of washing your hands, check out this training video on scrubbing in:

Obviously, no need to be this militaristic, as you're most likely not performing surgery , but applying the basic idea/principles are useful.

Ventilators:
Someone posted this interesting podcast: REBEL Cast Ep79: COVID-19 - Trying Not to Intubate Early & Why ARDSnet may be the Wrong Ventilator Paradigm - REBEL EM - Emergency Medicine Blog
Some of its topics are whether the ARDSnet protocol is doing more harm than good, whether intubation/ventilation is leading to poorer outcomes in some cases, and questioning the pathophysiology of Covid19. I had actually had the thought that perhaps using a device that increases positive end-expiratory pressure (PEEP) might not be the best thing in these cases. I've treated lots of patients with fluid in their lungs, mostly from CHF, certain types of MIs (heart attacks), and skipping dialysis treatments. PEEP in the form of CPAP, BiPAP, manual or mechanical ventilation can be a great way to get that fluid back where it belongs. Generally, the fluid is plasma that has leaked into the lungs from the vasculature that surrounds the alveoli. But in a pneumonia, if I understand it correctly, you've also got pus and other products of the immune response. So a) does that "gook" transition back into the vasculature with positive pressure ventilation (i.e. is it too thick/viscous), and b) if it could be absorbed back into the vasculature, aren't you just sending some nasty gunk straight into the circulatory system, and could that be a pathway for sepsis? I'm not entirely sure I'm making sense here, and I could very well be completely wrong, but I'm curious what others with medical expertise might think.
Pulmonary Edema - Cardiovascular Disorders - Merck Manuals Professional Edition

They also mention proning the patient, which I remember seeing in videos at the Italian hospitals. This is quite interesting to me, and I'll have to dig into this more to figure out why/how it works.

One thing I found odd, is why they don't mention EtCO2 (end-title carbon dioxide) monitoring--at all. That's become the gold standard in the EMS system I used to work in. Odder still, I was visiting a friend in the ICU a couple months ago at a major university hospital here, and they said they didn't use it outside of resuscitation. So who knows if they know something I don't know? Anyway, in short, it's very useful as a confirmatory and diagnostic tool, including telling you how well your tissues are being perfused. There are many limitations to the pulse ox/O2 sat monitoring. On the podcast, they talk a lot about being baffled regarding the seemingly high tolerance of very low O2 sats in some patients, but I'd like to know how their EtCO2 compares. Maybe nothing, but still curious.
A Systematic Approach to Capnography Waveforms - JEMS

Re: NY EMS changing protocols of when they take a cardiac arrest (aka a code) to the hospital:
This doesn't seem too weird, although I may have worked in a more progressive EMS system. Our medical director allowed us to call TOD in the field, at which point the scene was turned over to PD. The circumstances were outlined in our protocols, but one option was to work the patient at the scene. If we didn't get a pulse back (ROSC) after a certain amount of time, we could call the attending at the local hospital to obtain orders to cease resuscitation in the field. If we got ROSC, or felt they were viable (very case-by-case), we took them to the ED. I'm not intimately familiar with the NY EMS system, but from what I read about what they were being asked to do, it didn't seem like a big deal, but they also might not be used to it.

Getting a successful outcome (meaning, they achieve ROSC and go on to walk out of the hospital neurologically intact) in an out-of-hospital cardiac arrest is something crazy low, like 1-2%. If you aren't getting any ROSC in a certain amount of time, and don't suspect it's because of something you can't fix in the field, then there is almost no chance of meaningful survival, if at all.

I sure hope I've been making sense--my brain turned off for the night about an hour ago. I'll try to come back with some better facts tomorrow when I'm not as delirious from exhaustion

Obligatory disclaimer: If I haven't supported it with science or data, then it's MOO MOO MOO

Re: bolded, I recall reading a week or so ago that ventilator patients with viruses like Covid19 not only pushes oxygen into the blood stream, but also has the adverse affect of pushing the virus throughout the blood stream, thus causing sepsis. Now I can’t recall where I read this. If I find it again I’ll post the link.

 

[KALI]

Wow Mickey. Keep that man home and isolated!
Just my opinion

@Curious Me I called the Hospice center here a few weeks ago. If my husband gets sick, he isn't going to get a test, or go to the hospital. He is over age 80, and not in the best health.

The pallative care nurse told me that they would give him morphine if he was struggling to breathe. He doesn't have to go to the hospital or anything.

So, we know what the plan is for him. Hopefully not needed. But I already filled out the paperwork needed with them. All I have to do is call.

 

[Curious Me]

Struggling to sleep tonight (well, this morning, as it’s nearly 3am)
Fell down the YouTube rabbit hole and found a new Chris Mann parody that made me smile and cry at the same time

Good night, all

One more person to thank...You for turning us on to this video.
Good Night Dear CeeCeeCat.

 

[Tigerlily75]

So, no drive thru or food takeaways. If your water heater explodes, your oven or your computer go on the blitz, that's just too bad?g
they have 4.4 million people in New Zealand.
Only 100 cases? Statistically, of which 60% will not have symptoms?
Personally, I'm glad she is not my leader. I also do not applaud her for not including Scientists on her panel.
* My comments are based upon this article. If the reporters are not telling the whole truth. Then my comments will not stand.

This is very old, they have been doing this for two weeks now, have 1100+ cases , and yes, you can get your hot water service fixed.

NZ’s population is 4.7 million, why wait until it gets bad? Squash it now. Those 1100 could have infected another 2,750 who infect a further 6,875 etc etc if not locked down. Assuming a transmission rate of about 2.5 (not sure where that stands now).

Borders are closed, only returning residents can enter the country and of course must isolate. Jacinda is generally well regarded for being both decisive and compassionate.

You can click on “list of essential services” if you want to know more about things like getting an oven fixed:

Staying at home and self-isolation

 

[KALI]

Please watch this video everyone.
Really.
Chris Mann is my new hero.
Share with your family and children.
Really, watch.

That's a beautiful video. (I'm not crying, you're crying!) Ok, yeah, I'm crying...

 

[KALI]

Wonderful. Please watch and share....

One more person to thank...You for turning us on to this video.
Good Night Dear CeeCeeCat.

 

[katydid23]

(A lot of good information here)

The coronavirus can live on a surgical mask for 7 days, cloth for 2 days, and paper for 3 hours. Here's how to disinfect surfaces properly.
...
A study published April 2 in the journal The Lancet shows that the virus lasts longest — up to seven days — on stainless steel, plastic, and surgical masks.
...
Strikingly, the authors wrote, of all the materials they tested, the coronavirus lasted longest on the outer layer of a surgical mask. On day seven of their investigation, the virus was still present on the outward facing side of the mask.
...

I wonder where they put the mask for those 7 days? Was it in the sun, or in a very hot place?

I thought my surgical masks would be OK after 4 days in the sun, on my dashboard, where the car gets very hot during the day.

 

[KALI]

Sorry if I upset you.
I really was clear about saying if this information was not correct, that I would discard my comments.
The news media. Really?
Have they 0 shame?
I guess not.
Anything for clicks for their advertiser's and the money they make from them.
I find it all... disgusting.

This is very old, they have been doing this for two weeks now, have 1100+ cases , and yes, you can get your hot water service fixed.

NZ’s population is 4.7 million, why wait until it gets bad? Squash it now. Those 1100 could have infected another 2,750 who infect a further 6,875 etc etc if not locked down. Assuming a transmission rate of about 2.5 (not sure where that stands now).

Borders are closed, only returning residents can enter the country and of course must isolate. Jacinda is generally well regarded for being both decisive and compassionate.

You can click on “list of essential services” if you want to know more about things like getting an oven fixed:

Staying at home and self-isolation