My COVID-19 $0.02

[aap1966]

Graduated Med School 1990.

Few years of residency crap, then the last 26 years Intensive Care; cardiothoracic, general, cardiac.
Seen lots of stuff, lived and worked through lots of hype.

I thought COVID-19 was going to be just another bug accompanied by hysteria.
Until last week, really last 72 hours.
This is already ugly in places, it has a very high chance to get real ugly in lots of places.

I hope we dodge a bullet with this, but I'm worried we won't.
What's being happening the last few days is genuinely scary.

Take care guys.

[aigel]

Tell us, what have you seen to change your mind?

[786]

Ya, a little more insight please

[aap1966]

Originally Posted by aigel

Tell us, what have you seen to change your mind?

Italy; ventilating a lot of the patients prone (face down). This is the last gasp before you give up or start ECMO (extra-corporal membrane oxygenation..artificial lung). Having one or two patients being ventilated prone is a bad day in ICU, have all your patients prone is unheard of. Over 60? not even considered for ICU.

UK and parts of USA; you hear things from (Australian) colleagues working overseas.. We thought it'd be just the oldies (60 plus) who'd get into trouble. It's not. There's 40s and even 30s in the ICUs, and not doing well.

China; the only thing we trust about the information coming out of China is not to trust it. Sometimes statistics are just too accurate to be true. No noise in your stats? None? Not real stats.

The Disease itself; Not just respiratory failure.

ICU Staffing; About 24% of our ICU nurses have school age kids. What happens if / when the schools close? They stay at home to look after their kids. Ward nurses are great, but they're not ICU nurses and you can't train an ICU nurse overnight.

(And other chatter I'm not going to talk about. Feel free to dismiss that if you want, I can understand that.)

In the words of my daughter; "**** mum, I've never seen Dad scared before".

Some perspective; Mortality rate is probably going to be 2%.
Some more perspective; Monaco Formula 1 crowd size, about, say, 200,000.
Would you go if you thought a bomb was going to go off that would cause 20,000 minor injuries and 4000 deaths. Or would that worry you?
2% seems a small number, until you apply that to a very large number; those who are going to get this thing.

[tdw28210]

Thanks for posting.

[Ryan_Cunningham]

Originally Posted by aap1966

There's 40s and even 30s in the ICUs, and not doing well.

The people in their 30s and 40s you speak of, any idea if they have underlying health issues? Obese, smokers, etc...?

[aap1966]

Originally Posted by Ryan_Cunningham

The people in their 30s and 40s you speak of, any idea if they have underlying health issues? Obese, smokers, etc...?

Previously well.

You're right, smoking, obesity, diabetes, corticosteroids, all are significant co-morbities that contribute to bad outcomes.
But we're seeing previously well kids in their 30s go down, kids from University towns.

[speeder]

Well, there is some harsh reality for you. Thanks so much and please keep posting when you have time.

[aigel]

I thought you had seen things come through your department already.

There are stats from Italy, much more trustworthy than China and the mortality statistics by age hold - practically nil under 50. It was posted by JYL on the large CV thread we have going. Of course the anecdotes you hear from colleagues will emphasize the outliers and I am not saying we should down play those. I tell everyone "YOU DO NOT WANT TO GET THIS". You don't know how it is going to affect you, 1:100 chance to get put on a ventilator is not good odds.

Stay home and healthy everyone!

G

[pmax]

Originally Posted by aigel

I thought you had seen things come through your department already.

Same here. Here's an encouraging story admist the doom and gloom https://nypost.com/2020/03/12/woman-who-survived-coronavirus-shares-her-early-symptoms

Anyway, to the OP and all on the frontlines, I salute you for your service.

[93nav]

Yes, some of the stories coming out of Italy are quite sobering. Hopefully it will not get near that bad here in the USA. We have had more time to prepare, but.......

I figure things will get bad first in the northwest, CA, and NYC. Then where I am at in the middle of the country about a week (if we are lucky) later.

Thanks for your perspective. Stay safe and good luck.

Originally Posted by aap1966

Italy; ventilating a lot of the patients prone (face down). This is the last gasp before you give up or start ECMO (extra-corporal membrane oxygenation..artificial lung). Having one or two patients being ventilated prone is a bad day in ICU, have all your patients prone is unheard of. Over 60? not even considered for ICU.

UK and parts of USA; you hear things from (Australian) colleagues working overseas.. We thought it'd be just the oldies (60 plus) who'd get into trouble. It's not. There's 40s and even 30s in the ICUs, and not doing well.

China; the only thing we trust about the information coming out of China is not to trust it. Sometimes statistics are just too accurate to be true. No noise in your stats? None? Not real stats.

The Disease itself; Not just respiratory failure.

ICU Staffing; About 24% of our ICU nurses have school age kids. What happens if / when the schools close? They stay at home to look after their kids. Ward nurses are great, but they're not ICU nurses and you can't train an ICU nurse overnight.

(And other chatter I'm not going to talk about. Feel free to dismiss that if you want, I can understand that.)

In the words of my daughter; "**** mum, I've never seen Dad scared before".

Some perspective; Mortality rate is probably going to be 2%.
Some more perspective; Monaco Formula 1 crowd size, about, say, 200,000.
Would you go if you thought a bomb was going to go off that would cause 20,000 minor injuries and 4000 deaths. Or would that worry you?
2% seems a small number, until you apply that to a very large number; those who are going to get this thing.

[Cajundaddy]

Thank you for your insight. We have a SoCal pulmonary specialist doing useful daily updates without media spin and he is also reasonably concerned. This is not "just a bad flu".

https://www.youtube.com/watch?v=vww1nIIoqmw

[GG Allin]

Odd mix of reports. Everyone here in Illinois that I've heard of (40 or so cases) has been sent home to self quarantine, no one in serious shape or dead yet.

[Mahler9th]

THX.

It seems to me that many folks were just making blanket comparisons to conventional flu viruses and related mortality rates-- to some extent that is to be expected from laypeople.

I think more are beginning to understand that with conventional flu viruses, some amount of the population is protected via herd immunity and/or vaccines that may match. Here we are apparently fully exposed.

Folks are beginning to understand things like early/asymptomatic and heavy viral shredding and how those characteristics affect contagiousness. And how this novel virus may be different from conventional flu viruses in this regard.

And I think one big thing is that more folks are beginning to think not just about mortality, but of morbidity-- especially morbidity that requires facility-based care (like hospital and ICU care) and HCP's.

And of course how our global healthcare systems have historically not been resourced to handle situations like this (for various reasons).

One way to think of it... it seems the Martians have finally developed a space ship that can and has penetrated our outer defenses, and is already working on our mid-level defenses which can be overwhelmed.

We will not allow that.

Global cooperation on mitigation/suppression, diagnosis, and RX (treatment regimens and tools for those requiring care beyond typical flu care) and eventually and hopefully quickly vaccine are keys, and it seems that the experts are well motivated, and additional resources are being appropriately mustered.

Before we are finished, I think more folks will better understand things like Dx sensitivity and specificity and Rx safety and efficacy as well.

[RWebb]

Originally Posted by GG Allin

Odd mix of reports. Everyone here in Illinois that I've heard of (40 or so cases) has been sent home to self quarantine, no one in serious shape or dead yet.

there are (at least) 2 strains of this bug; plus there are a variety of risk factors for different people