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Coronavirus (Stay on Topic)

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I couldn't find any major metropolitan area outside of China (who's data is wrong) that compares to New York City on a population density however Madrid looks to have come within 50%.

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Dr. Fauci states in today’s press conference that Trump instituted the shutdown/restrictions as soon as he and Dr. Birx recommended them. Is he telling the truth? Who knows, but it sounds like Dr. Fauci will be sticking around, which is good.
 
I couldn't find any major metropolitan area outside of China (who's data is wrong) that compares to New York City on a population density however Madrid looks to have come within 50%.

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A big part of New York's problem was the insane decision by NYC officials to allow the Feb. 9th Lunar New Year celebrations to proceed as normal. Absolute madness.

 
A big part of New York's problem was the insane decision by NYC officials to allow the Feb. 9th Lunar New Year celebrations to proceed as normal. Absolute madness.

Agreed. Honest question: has the media held the mayor accountable?
 
Updated for today for GA statewide: today not a good day at all but much of this could be due to “makeup” after the relatively quiet holiday weekend:

Here are some 24 hour changes (based on 7 PM) back to 3/28 for # of new cases/# of new deaths:

Sat 3/28: 168/4
Sun 3/29: 317/14
Mon 3/30: 349/4
Tue 3/31; 1,085/38
Wed 4/1: 631/29
Thu 4/2: 696/22
Fri 4/3: 523/22
Sat 4/4: 416/10
Sun 4/5: 359/11
Mon 4/6: 816/75
Tue 4/7: 1,598/54
Wed 4/8: 1/033/21
Thu 4/9: 696/43
Fri 4/10: 974/13
Sat 4/11: 402/7
Sun 4/12: 289/10
Mon 4/13: 1,076/38
 
I'm just warning you guys not to become extremely excited about the possible reopening, because it's likely we'll end up in a similar situation later this year or shortly after reopening. It's going to take a few cycles of closing and reopening to completely rid the virus, unless we want to just stay open until late summer. Not trying to be a bummer, but Pandemics often have many cycles and waves, just a warning.
 
I'm just warning you guys not to become extremely excited about the possible reopening, because it's likely we'll end up in a similar situation later this year or shortly after reopening. It's going to take a few cycles of closing and reopening to completely rid the virus, unless we want to just stay open until late summer. Not trying to be a bummer, but Pandemics often have many cycles and waves, just a warning.
Thanks for the heads up Debbie Downer
 
A little inconvenient fact for some folks, well face it, a huge inconvenient fact.

From the March 9th Whitehouse Briefing; these aren't gotta lock the country down immediately the sky is falling statements from Fauci and note that Trump declared a National Emergency on March 13th


Q You’re up, Tony. (Laughter.)

More and more organizations, charities, are canceling fundraising events, other events. Is that prudent? Is that an overreaction? Do you think the President should continue with campaign rallies? And do you believe that people, even if they’re healthy, should get onboard a cruise ship?

DR. FAUCI: Okay, so there’s multiple different questions, John.

So the idea about individual entities — governors, mayors, or whatever — canceling activities that are not coming from a direct recommendation from the federal government, I think that they have the — I don’t “think”; I know they have the authority to do that. But what they’re probably acting on is what they would consider, for their citizens, an abundance of caution.

Most of the time when that happens, it usually is in an area where there is already documented community spread. And Dr. Redfield mentioned the four areas right now that are having community spread that’s documented. But you know there may be — as we know, it’s a rea- — it’s a possibility that there’s community spread going on in areas in which we’re not detecting it yet. And I think that’s the response of the individuals, be they mayors or governors, who have you, who are doing that. So I wouldn’t criticize them for that. They’re using their own individual judgment. And to me, I think that that would be prudent.

Q Campaign rallies?

DR. FAUCI: You know, I can’t comment on campaign rallies. It really depends. We are having — as we’ve all said, this is something in motion. This is an evolving thing.

So, not sure what we’re going to be able to say at the time where you have a campaign rally. If you’re talking about a campaign rally tomorrow, in a place where there is no community spread, I think the judgment to have it might be a good judgment. If you want to talk about large gatherings in a place where you have community spread, I think that’s a judgment call. And if someone decides they want to cancel it, I wouldn’t publicly criticize them.

Q I asked one last one about cruise ships because a lot of people are planning cruises over the spring break.

THE VICE PRESIDENT: Oh, that’s — yeah.

Q Would you recommend that anybody, even a healthy person, get onboard a cruise ship?

DR. FAUCI: Yeah. Yeah. Yeah. I think if you’re a healthy, young person, that there is no reason, if you want to go on a cruise ship, to go on a cruise ship. Personally, I would never go on a cruise ship because I don’t like cruises — (laughter) — but that’s another story.

But the fact — the fact is that if you have — if you have the conditions that I’ve been speaking about over and over again to this group, namely an individual who has an underlying condition, particularly an elderly person that has an underlying condition, I would recommend strongly that they do not go on a cruise ship.
 
I had a meeting with an ED director of one of Atlanta's large hospitals yesterday and their daily census is so small now that they are not using a large portion of their department. We know the peak keeps getting pushed back for Georgia but their case load is getting smaller by the day.
 
Updated for today for GA statewide: today not a good day at all but much of this could be due to “makeup” after the relatively quiet holiday weekend:

Here are some 24 hour changes (based on 7 PM) back to 3/28 for # of new cases/# of new deaths:

Sat 3/28: 168/4
Sun 3/29: 317/14
Mon 3/30: 349/4
Tue 3/31; 1,085/38
Wed 4/1: 631/29
Thu 4/2: 696/22
Fri 4/3: 523/22
Sat 4/4: 416/10
Sun 4/5: 359/11
Mon 4/6: 816/75
Tue 4/7: 1,598/54
Wed 4/8: 1/033/21
Thu 4/9: 696/43
Fri 4/10: 974/13
Sat 4/11: 402/7
Sun 4/12: 289/10
Mon 4/13: 1,076/38

As of noon today vs 7PM yesterday, GA has risen by 602 cases and 21 deaths. These aren’t good numbers. Let’s see where GA is as of 7PM today. Tuesday has been a tough day relative to surrounding days the last 2 weeks.
 
New York with a 14% increase in deaths since yesterday. 40% of people being tested are positive for Covid-19.

13.9% of pregnant patients were found to have Covid-19 at NYC hospitals between March 22 and April 4. None of them had symptoms. 1% had symptoms before entering the prenatal unit. That's nuts.

I'm not buying into this whole idea that hitting a peak with confirmed cases or deaths somehow means that the threat is on the decline, especially in the highly urbanized, populated, and mass transitory City of New York. I would keep that area quarantined as long as possible.
 
New York with a 14% increase in deaths since yesterday. 40% of people being tested are positive for Covid-19.

13.9% of pregnant patients were found to have Covid-19 at NYC hospitals between March 22 and April 4. None of them had symptoms. 1% had symptoms before entering the prenatal unit. That's nuts.

I'm not buying into this whole idea that hitting a peak with confirmed cases or deaths somehow means that the threat is on the decline, especially in the highly urbanized, populated, and mass transitory City of New York. I would keep that area quarantined as long as possible.

I saw about the pregnant woman this morning. It brings the question, are we really just getting a very small percentage of the total cases where only a very small percentage has severe symptoms or does asymptomatic carriers infect other people with Covid that is asymptomatic.
 
I'm just warning you guys not to become extremely excited about the possible reopening, because it's likely we'll end up in a similar situation later this year or shortly after reopening. It's going to take a few cycles of closing and reopening to completely rid the virus, unless we want to just stay open until late summer. Not trying to be a bummer, but Pandemics often have many cycles and waves, just a warning.

Don't let other's bring you down on this thread. I agree with everything you said. I don't understand how people can just completely turn a blind eye to a pandemic. Whether people like it or not, most places will not be opening in May and the states that decide to do so will end up regretting it. Politics play a huge role in this as well, all politicians want is to get reelected. So, they will give in to whatever the majority of voters in their state want. And despite what many say, this isn't an attempt to control us. It's trying to save us from making epic mistakes. Things are never going to go back to normal. Even if we do end up reopening sooner than later. This all sucks. No other way to say it. But I can tell you that's as bad this is for us, I can promise you that it's hell for people in epicenters who are having to bury their loved ones in mass graves in AMERICA.
 
If you guys need masks, this is a legit company and they’re offering KN95 masks. Decent price for 5. I get nothing from the company for sharing this info; just wanted to help. I’d rather use this than a fabric mask.


 
Don't let other's bring you down on this thread. I agree with everything you said. I don't understand how people can just completely turn a blind eye to a pandemic. Whether people like it or not, most places will not be opening in May and the states that decide to do so will end up regretting it. Politics play a huge role in this as well, all politicians want is to get reelected. So, they will give in to whatever the majority of voters in their state want. And despite what many say, this isn't an attempt to control us. It's trying to save us from making epic mistakes. Things are never going to go back to normal. Even if we do end up reopening sooner than later. This all sucks. No other way to say it. But I can tell you that's as bad this is for us, I can promise you that it's hell for people in epicenters who are having to bury their loved ones in mass graves in AMERICA.
You are not telling the whole story.
 
You are not telling the whole story.

Okay... so it that supposed to take away from the fact that hundreds and hundreds are dying in NYC from Covid-19? This isn't going to change my opinion, at all.
 
Okay... so it that supposed to take away from the fact that hundreds and hundreds are dying in NYC from Covid-19. This isn't going to change my opinion, at all.
I agree that it is very sad that hundreds are dying from the virus in NYC but you stated people are having to bury their loved ones in mass graves. As NPR points out, the people being buried in the mass graves are "unclaimed" buy anyone. That's a big difference in how you stated the mass grave situation.
 
This says having patients to lie on their bellies saves lives. Any opinions about this? @Jon @Tornadocane @tramadoc or any other medical folks or non medical? What about if the patient is morbidly obese?

 
Right now places of business have no chance of surviving. I have a couple of friends that own there own business, they won’t survive if this gets extended until June. They may not catch Corona, but they will be broke, can’t pay bills, no health insurance for there families. They will be looking for a job during a period of record unemployment.

I want to hear people’s thoughts that have lost there jobs, savings dwindling, losing/lost health insurance on whether we should continue the lockdown. It’s easy for those that aren’t affected financially to say keep it locked down.

For the record, I’m not standing on my soapbox shouting reopen NC. I don’t know what the answer is either.
 
This says having patients to lie on their bellies saves lives. Any opinions about this? @Jon @Tornadocane @tramadoc or any other medical folks or non medical? What about if the patient is morbidly obese?


I don't remember where I saw this, Maybe Dr. Campbell video, but it moves the heart a little and makes it easier for the lungs to expand.
 
But if it was FOX or Breitbart would you trust it more?

Why so serious?

Do you think it's a good idea to lie on your stomach while you're having breathing problem. Go ahead and try it out. You are literally compressing your chest and heart. When people get older, sleeping on your left side (heart) puts a strain on it. The best breathing position is the tripod position in which a person leans forward while sitting or sitting. Yes breathing while your chest is down is optimal, but not when your diaphram and chest is being pushed against a solid surface.
 
Why so serious?

Do you think it's a good idea to lie on your stomach while you're having breathing problem. Go ahead and try it out. You are literally compressing your chest and heart. When people get older, sleeping on your left side (heart) puts a strain on it. The best breathing position is the tripod position in which a person leans forward while sitting or sitting. Yes breathing while your chest is down is optimal, but not when your diaphram and chest is being pushed against a solid surface.

Critical care specialists say being on the belly seems help because it allows oxygen to more easily get to the lungs. While on the back, the weight of the body in effect squishes some sections of the lungs.

From a Fox affiliate

(shhh... Lets see if he notices it's the same article)
 
From a Fox affiliate

(shhh... Lets see if he notices it's the same article)

What about sitting up?
But this isn’t a politically based article. And it cites this New England Journal of Medicine study:


This is acceptable. I still disagree with laying on your stomach cause it restricts the diaphragm. You could provide desired effects by allowing a patient lay in a sitting position that can be adjusted forward when the patient isn't sleeping.
 
What about sitting up?


This is acceptable. I still disagree with laying on your stomach cause it restricts the diaphragm. You could provide desired effects by allowing a patient lay in a sitting position that can be adjusted forward when the patient isn't sleeping.

Thanks. What about for obese patients? What position is best for them?
 
I'm just warning you guys not to become extremely excited about the possible reopening, because it's likely we'll end up in a similar situation later this year or shortly after reopening. It's going to take a few cycles of closing and reopening to completely rid the virus, unless we want to just stay open until late summer. Not trying to be a bummer, but Pandemics often have many cycles and waves, just a warning.
Unfortunately I agree with this. Look for a re-opening no sooner than May 15th
 
It's a CNN article. Enough said.

How About Mass General's Internal Covid-19 Treatment guideline? Link to PDF.

Exert From Page 8
Prone Ventilation: Prone ventilation for ARDS is strongly recommended in current clinical practice 9 guidelines and should be implemented early in COVID-19 patients. Current indications for prone ventilation are a persistent hypoxemia defined as P:F < 150 for 12 hours (some clinicians favor < 200 and sooner initiation of prone positioning) after optimal PEEP titration as noted above. Prone ventilation results in a host of improvements to lung mechanics and should be instituted via the MGH prone positioning guideline posted on Apollo. Prone ventilation can be carried out in the patient’s current bed and requires minimal additional equipment. Absolute contraindications to prone ventilation include an inability to turn neck (e.g. fixed or unstable c-spine) and sternal instability. Vascular access lines, chest tubes, and CVVH lines are not contraindications to prone ventilation. Extreme hemodynamic instability is a relative contraindication although consideration should also be given to the possibility that hemodynamics may improve with resolution of hypoxemia. The proning procedure itself should be carried out with staff adhering to current infection control guidance on PPE as outlined in the separate infection control protocols. A bolus of paralytic agent should be given prior to proning (similar consideration apply to the return to supine position). There is no need for ongoing neuromuscular blockade after the proning procedure itself, except as necessitated by vent asynchrony. The patient should be maintained in the prone position until at least the morning after proning. Thereafter, that patient may be assessed for suitability to return to supine position once each morning (qAM). PEEP requirements frequently decrease in the prone position and consideration should be given to decreasing PEEP after proning and increasing PEEP prior to return to the supine position in order to prevent de-recruitment. In particular, ½ of the difference in PEEP between the supine and prone position may be added back prior to return to the supine position (for example, if PEEP is 8 in the prone position , but was 12 in the supine position, then consider increasing PEEP to 10 prior to return to supine condition). If P:F remains greater than 150 (some clinicians prefer 200) and driving pressure is less than 15 at the end of the 2 hour period of supine ventilation on PEEP of 10 cmH2O or less, prone ventilation may be discontinued.
 
Right now places of business have no chance of surviving. I have a couple of friends that own there own business, they won’t survive if this gets extended until June. They may not catch Corona, but they will be broke, can’t pay bills, no health insurance for there families. They will be looking for a job during a period of record unemployment.

I want to hear people’s thoughts that have lost there jobs, savings dwindling, losing/lost health insurance on whether we should continue the lockdown. It’s easy for those that aren’t affected financially to say keep it locked down.

For the record, I’m not standing on my soapbox shouting reopen NC. I don’t know what the answer is either.

That's a pretty complicated question. There is one thing I'll side with the naysayers on though (at least ones elsewhere), and it's that if we were to reopen and need to shut again due to this virus, that'd be very devastating.

But then if you stay shut for a long time, you are most certainly going to open yourself to a hoist of other issues along with viruses.

I think the work needs to continue on the Abbott same day tests, antibody tests, and treatments and you're going to need to at least try to slowly reopen, with some changes, and with a plan of targeted quarantines for the at risk first if you see "rolling spikes" afterward (for 2020 purposes because a vaccine isn't coming until next year).

I just don't think staying shut down until there's an approved vaccine is anywhere in the ballpark of feasible. I would rather give re-opening a shot even if it's "doomed to fail" like some (not necessarily on here) have said.
 
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Thanks. What about for obese patients? What position is best for them?

Sitting up almost at as close to a 90 degree position as you can with your neck propped forward so your airway isn't being blocked by your tongue. Obese people have more fat at the base of the tongue, so leaning the head backwards causes an obstruction. That's as much as I know from my EMT days.
 
This is political and virus related. Unfortunately the scale is tipping to the other side which is what I was saying could happen if economies stay shut down. Within 2 weeks 50% of nation is broke. Also I’m sure most on here have seen they believe possibly a new strain of the virus might be emerging since recovered patients are getting it again. Also a dead body has passed it on to the medical examiner. Interesting times no doubt.
 
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