[beholder3]

The numbers in Italy are scary (not only there). Today it is already x2.5 as bad in Italy alone as the world trade center plane crashing thing some 20 odd years ago and as far as I remember, the locals in NY did not consider that a triviality.

I wish all Italians the best.


They report a ratio of 10% deaths versus identified infected. If the real fatality rate was 1% that would mean Italy already has 700,000 infected...

[PDL]

The issue with testing those individuals who are showing signs is:

1. The incubation period for this virus to have a individual show symptoms is long.
2. While the individual is infected but not showing symptoms, they can be shedding - read spreading - the virus.
3. Once infected and showing symptoms the damage done by spreading the virus is like shutting the barn dorr after the horses have left.
4. The real issue with the virus is that the hospitals do not have enough capacity to handle the really sick poeople.
5. The really sick people tend to all show up at the same time due to the long time that it takes the virus to show itself.
6. Regardless of where you are, medical supplies are running short, for example each test requires a new mask, and gloves to keep contamination to a minimum.
7. To be blunt - there are not enough masks, gloves and other material to support testing of millions of people, even if we had the ability to test all the people or if we had enough tests - read we do not.
8. Testing people who are symptomatic is too late.

[beholder3]

1. To be blunt - there are not enough masks, gloves and other material to support testing of millions of people, even if we had the ability to test all the people or if we had enough tests - read we do not.

If you provide the things contact free to people (e.g. drive through; people stick the swab into their own throat) and they drop them in a box the need for protective gear for testing can be absolutely minimized.

[aslyfox]

If you provide the things contact free to people (e.g. drive through; people stick the swab into their own throat) and they drop them in a box the need for protective gear for testing can be absolutely minimized.

I am not a doctor, nurse nor a lab technician nor have I ever played one on stage or screen large or small

and I did not stay at a Holiday Inn Express last night


but as I understand it, the way samples are taken for the covid 19 test is hard for someone to do themselves:

How are the tests conducted?
A.B.: The CDC recently updated its recommendations for sampling and is now prioritizing a sample from the upper respiratory tract, specifically a nasopharyngeal swab (a swab taken through the nose that collects a sample from the back of the nose and the throat). If oral swabs are taken, they should be combined with the nasal swab. The goal of these samples is to detect the virus in the upper respiratory tract.

The Ins and Outs of COVID-19 Testing. Who is being tested? What are tests looking for? When might we have a vaccine? < Yale School of Medicine

[Parallax]

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Can you say "slippery slope"?
"You didn't use any resources to save my .........." can be couched several ways.

The slippery slope part comes in later; after this crisis is over.
A patient with x% chance of survival form [insert disease] won't get treated because it takes resources (read: costs more money) than treating a patient with x+1% chance of survival.

[BigMackCam]

I'm more than a little concerned by a couple of news articles I've just read.

The first describes how the UK's COVID-19 death rate has only increased by half the expected number in the last 24 hours, despite a significant jump in confirmed infections. The second describes Cuomo's statement that NY's rate of hospitalizations is slowing, suggesting that measures are working.

Why am I concerned? This is good news, right? Well, yes... of course... but I seriously doubt that social distancing and self-isolation measures have been sufficiently adopted by the public thus far to have had such a marked effect at this relatively early stage. Furthermore, such good news might ease tensions a little and, therefore, the self-discipline of many. Unless folks continue to take this seriously - ideally, ever more seriously than before - then I fear we might see a bounce.

Obviously I'm delighted that infection and death numbers are lower than the projections for a day... and I'd love to believe that this is a first ray of hope in our respective countries. But it's way too early to be popping champagne corks, IMHO

[aslyfox]

Can you say "slippery slope"?
"You didn't use any resources to save my .........." can be couched several ways.

[ can you say slightly out of order this post is out of order because of my error ]

Hospitals consider universal do-not-resuscitate orders for coronavirus patients
Worries that ‘all hands’ responses may expose doctors and nurses to infection prompts debate about prioritizing the needs of the many over the one
Doctors across the U.S. sound the alarm as coronavirus cases rise
By
Ariana Eunjung Cha March 25, 2020 at 1:58 p.m. CDT

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the virus’s contagion.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a universal do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators have asked Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

Several large hospital systems — Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks — are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment. . . .

Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, . . . “We are now on crisis footing,” he said. “What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff.”

The new protocols are part of a larger rationing of lifesaving procedures and equipment — including ventilators — that is quickly become a reality here as in other parts of the world battling the virus. The concerns are not just about health-care workers getting sick but also about them potentially carrying the virus to other patients in the hospital.

Alta Charo, a University of Wisconsin-Madison bioethicist, said that while the idea of withholding treatments may be unsettling, especially in a country as wealthy as ours, it is pragmatic. “It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,” she said. “The code process is one that puts them at an enhanced risk.” . . .

Code blue
Health-care providers are bound by oath — and in some states, by law — to do everything they can within the bounds of modern technology to save a patient’s life, absent an order, such as a DNR, to do otherwise. But as cases mount amid a national shortage of personal protective equipment, or PPE, hospitals are beginning to implement emergency measures that will either minimize, modify or completely stop the use of certain procedures on patients with covid-19. . . .

Doctors consider universal do-not-resuscitate orders for coronavirus patients - The Washington Post

---

Last edited by aslyfox; 03-25-2020 at 03:31 PM.

[Parallax]

can you say slightly out of order

I don't think so, councelor, but I'll gladly drink the 5th and throw myself on the mercy of the court.

(I had edited my post to explain my reasoning, but I believe you posted prior to having had a chance to see the edit.)

[beholder3]

Can you say "slippery slope"?
"You didn't use any resources to save my .........." can be couched several ways.

The slippery slope part comes in later; after this crisis is over.
A patient with x% chance of survival form [insert disease] won't get treated because it takes resources (read: costs more money) than treating a patient with x+1% chance of survival.

Well which one would you want to let die following the rules:
a) the 20 year old fit, sporty party girl who catched covid19 on her own coronovirus barbecue with 50 friends and generally is an egomaniac ******* or
b) the 85 year old wise man helping out all weekends in social activities in the neoghborhood

The doctors will just see age and fitness.

Selecting humans for death is bad. Bad. Bad.

[timb64]

I'm more than a little concerned by a couple of news articles I've just read.

The first describes how the UK's COVID-19 death rate has only increased by half the expected number in the last 24 hours, despite a significant jump in confirmed infections. The second describes Cuomo's statement that NY's rate of hospitalizations is slowing, suggesting that measures are working.

Why am I concerned? This is good news, right? Well, yes... of course... but I seriously doubt that social distancing and self-isolation measures have been sufficiently adopted by the public thus far to have had such a marked effect at this relatively early stage. Furthermore, such good news might ease tensions a little and, therefore, the self-discipline of many. Unless folks continue to take this seriously - ideally, ever more seriously than before - then I fear we might see a bounce.

Obviously I'm delighted that infection and death numbers are lower than the projections for a day... and I'd love to believe that this is a first ray of hope in our respective countries. But it's way too early to be popping champagne corks, IMHO

Just watching the BBC 10-00 News,Mike and it is clearly pushing the point that everyone should be worried,no talk of the figures you mention and features about patients,young and old,fit and without preexisting conditions who have been struck by the virus.

[aslyfox]

I don't think so, councelor, but I'll gladly drink the 5th and throw myself on the mercy of the court.

(I had edited my post to explain my reasoning, but I believe you posted prior to having had a chance to see the edit.)

I just meant that my post to which you responded had been deleted by me in error and thus it is out of order with your post

that is all

nothing wrong with your post

[BigMackCam]

Well which one would you want to let die following the rules:
a) the 20 year old fit, sporty party girl who catched covid19 on her own coronovirus barbecue with 50 friends and generally is an egomaniac ******* or
b) the 85 year old wise man helping out all weekends in social activities in the neoghborhood

The doctors will just see age and fitness.

Selecting humans for death is bad. Bad. Bad.

Would it were so simple as an (a) and (b) choice. Health services work with what they have available in terms of beds, equipment, drugs, information, medical assessment etc. Usually, they don't have to make too many judgement calls on who gets to live and who doesn't. Rarely, they do. We'd be naive to think that never happens. It's terribly sad for those who get the raw deal, but sadly - in (thankfully) rare circumstances - a practical necessity.

[Parallax]

Well which one would you want to let die following the rules:
a) the 20 year old fit, sporty party girl who catched covid19 on her own coronovirus barbecue with 50 friends and generally is an egomaniac ******* or
b) the 85 year old wise man helping out all weekends in social activities in the neoghborhood

The doctors will just see age and fitness.

Selecting humans for death is bad. Bad. Bad.

It is bad. Its other name is triage. I realize that it has to be done. I spent 14 years in the Air Force. I was a medic. I understand that choices need to be made in a crisis.
My concern is that with our healthcare system, once a precedent has been established, it will become the norm absent a crisis.

[BigMackCam]

Just watching the BBC 10-00 News,Mike and it is clearly pushing the point that everyone should be worried,no talk of the figures you mention and features about patients,young and old,fit and without preexisting conditions who have been struck by the virus.

Thanks for that, Tim.

Here are the articles I was referring to:

Is it working? UK records 43 coronavirus deaths in past 24 hours compared to 87 yesterday

'It's working': Gov. Andrew Cuomo says the rate of coronavirus hospitalizations is SLOWING

Frankly, despite its reduction in standards in the past decade or so, I'm still more likely to trust the BBC's coverage... But one has to take all sources into account (even the DM )...

[Parallax]

I just meant that my post to which you responded had been deleted by me in error and thus it is out of order with your post

that is all

nothing wrong with your post

Got it.