Hopefully we will get at least some travel restrictions tomorrow from the Finnish government, but let’s see. Also seeing stupid behaviours in open non-covid regulated bars and nightclubs at the moment, so hoping these will be forced closed also.

 

Curious to hear more about this. Like I was saying in another post, BiPAP is the go-to a lot of the time for patients who present like what we are seeing in C19 types, but it's contraindicated in those cases. What are you doing to ensure good seals on the masks?

 

Btw, as of yesterday I saw that at least one of my admitted patients tested positive and was subsequently discharged on the hydroxychloroquine/Zithromax cocktail.

 

Is this part of the WHO study?

 

Oncologist in PA, I wouldn't place myself on the frontlines per se doing my best to keep myself and our patients behind them. I'm relatively young (40ish) and healthy, personal risk isn't a major concern but worried about bringing stuff back with me to my patients with every extra human contact I have. Also my partner is in his 70's and although healthy could potentially get very sick if he gets COVID.

Cases have just started to really hit the area in last week or so. I have a patient of mine who came in overnight waiting on test results, seems likely will be positive. Intubated in ICU, imaging looks horrible and consistent with COVID. Was very old and in not so great shape to begin with (although doing basically ok all things considered), it seems unlikely she will pull through.

We are doing whatever we can to limit our patient's risk/exposure. I'm no longer physically seeing most hospital patients, I just look at their chart and weigh in with advice best I can. We are offering telemedicine visits to outpatients (although most of my patients are elderly and/or poor making this an unrealistic option), cancelling as much "routine" (this is a relative term in oncology) stuff as possible (visits, scans, bloodwork). It's been a risks and benefits balancing act unlike anything I've ever encountered before, had to decide today whether to proceed with an "elective" (again, a relative term) curative breast cancer surgery on a patient or push it off a few months and try to treat her with just a bridging hormone treatment. We don't have much PPE, trying to limit its use as much as possible to people who really really need it.

Lots of conference calls and emails discussing how to best mitigate this situation. Fortunately office is pretty empty, volume down at least 50% so its been this odd situation where its almost dull but super stressful at the same time.

 

Not sure? This was recommended and prescribed by the Infectious Disease (ID) team, two days before it was to begin in NYS (which is today AFAIK).

Also saw a video circulating by a NY doc claiming 100% efficacy with no deaths in a decent cohort (350?) utilizing hydroxychloroquine and zinc. The latter is interesting because it is my understanding that zinc depletion can lead to loss/alterations of smell and/or taste, something I have begun to hear from patients.

 

Not me, but my wife, who is a NHS consultant forensic psychiatrist. She’d write this herself but she’s rather busy right now. Her day was spent planning, in an upsetting amount of detail, the end-of-life plan for one of her patients were they to contract the virus.

 

Today was the first day I feel like we really got hit. From the moment I got into work a majority of our calls were potential or confirmed Covid patients. Last week we had similarly dispatched calls, but most were just worrisome individuals. Today we started to see what it really looks like first hand. I’d be lying if I said I wasn’t starting to be scared.

 

I wish you and everyone else that have been hit hard, strength. I am hearing reports / rumours that the situation in our capitol is deteriorating fast.

Do your job to the best of your abilities. When you feel exhausted (mentally or physically) talk your colleagues and then loved ones after your shift. Most importantly, remember to protect yourself.

I got good advice from my senior surgeon during my residency:
"Help one patient at a time in their medical urgency (/triage) order and if they're equal in that, help the younger ones first"

 

As a board certified pediatrician but retired since 2007, due to chronic lung disease (i.e. fibrosis mediastinitis with total left pulmonary vein obstruction resulting in pulmonary hypertension, hypoxia, and hemoptysis), I have always had a small handful supply of N95 masks on hand to protect me.

You may not be aware of all of the circumstances behind someone wearing a mask in public, and I'd hope that you would not rush to be so judgmental of me when I had to wear one to drop off my broken MacBook at a repair center recently (called ahead to do a no-contact drop but you never know when someone else will screw that up). I've been holed up in my house for several weeks, terrified to catch this. If I get sick and medical services are overwhelmed, I have to hope my cpap at 14cm and 5L of O2 piped in from my concentrator will keep me from needing hospitalization, but with one functional lung and 90% sats on a good day I'm one of those most at risk. I've been on a ventilator in the ICU a few times, and is NOT fun, especially when your ET tube gets plugged and you pass out while they try to clear the blockage.

I made my wife wear one of my masks on an airplane when she traveled without me 4 weeks ago, so she would not bring something home to me. She wiped down her seat and everything nearby with Clorox. She recently quit seeing private pediatric occupational therapy patients at their home, and is doing telemedicine on the half of her patients that are willing to do so. As director of clinical services for a not for profit pediatric PT/OT and Speech therapy company, she has been instrumental in setting up telecommuting to work from home, and implementing their telemedicine program and getting approval for her people to be paid, so that she can keep her 200 employees working instead of looking for food stamps.

 

We really need to divide up resources and locations, so that non-CoVid-19 cases like these can be kept separate from places that are having case after case of contagious patients streaming through. That's what China did. Unfortunately, we still need to test everyone seeking medical care so that if one of the "non-infectious" patients turns out to be positive then we can do contact tracing, testing, and quarantining of any of their contacts.

 

While my current role within the hospital has taken me away from the front line I have remained heavily involve in the disaster relief efforts. I was an ER RN for the last 15 years and in Jan I transitioned into a managerial role over Cath lab, special procedures, interventional radiology, GI lab and PICC team. Several of my current departments have essentially shut down as all elective procedures have been cancelled. This has left me with a lot of employees not getting their full hours and starting to struggle. The ED (while not in my current job description) has been utilizing my knowledge of that area in terms of setting up disaster tents and triage areas to route suspicious patients for triage to areas outside the hospital, get tested and if minor symptoms they are sent home. One of my roles in the ED was the Ebola disaster trainer/planner so those skills from the 2014 Ebola crisis have become useful. Many positive results, however many were sent home to self monitor and treat symptoms due to the fact that symptoms were mild. The critical arrivals are placed in a dedicated Telemetry or ICU unit depending upon severity. The severely sick patients I have seen are extremely critical. Business has not been as normal for any hospital and all leaders/caregivers have shifted focus to handle this current crisis. Are PPE supply is tight but available and is rationed for those patients who are highly suspicious for covid19. My immediate concern is for caregiver burn out as many of the ICU/ED frontline caregivers have been working tirelessly to combat this virus. To all the front line providers hang in there, this too shall pass.

 

Retired internist, 69 years old with some personal health risks. Can't stay on the sidelines during this. Though risky to me, I'm back in practice again. Fortunately in our rural area, it is just coming in. We have had the benefit of watching other areas. We have separated acutely ill from non acute to give some safety to the non infected. This will likely delay it a bit longer for most, but not entirely. That will take more. Vaccine, drug tools. Hopeful in the short run to see what plays out in the NY trials.

 

Little more hectic today. Had to tube a few emergently as they were decompensating. Both were obese with underlying medical problems. I had one patient today that was 80+ male, positive and absolutely fine (and there quite a while waiting for a bed). Really is a wacky virus to say the least.

Not looking forward to tomorrow's shift. Also, if I have to tell another resident again that we can't BiPAP patients who aren't in negative pressure rooms, I'm going to lose my shit.

 

Yesterday I dropped off a patient in a NYC hospital and scene was unfathomable. I need to collect myself but I'll try to share more later. These next few days in New York are going to be very very Rocky.

 

I agree with this sentiment. I have two N95 masks, one for use when I go out, and the second as a backup for when the other wears out. I am 61, have severe persistent asthma, a long history of recurrent bronchitis and pneumonia, and am medication dependent to breathe. I wear the mask when I go out on the advice of my physician as contracting Covid-19 would likely land me in the ICU or worse. I have a friend who also wears a mask when out because she receives chemotherapy and her immune system is compromised. It seems to me that the anger of medical providers over the shortage of masks and other PPE - which I completely understand - is more properly directed at those who are really responsible for the shortage - the federal government, FEMA, and any other government agencies that failed to plan for a pandemic despite the warnings that one would eventually occur. That being said, I want to thank all of the medical providers on this forum who are putting their lives on the line every day in order to care for the rest of us. You are appreciated more than you know and we are grateful for all that you do.

 

I'll say that I feel differently about citizen use of n95. Thank you @larryganz for sharing your perspective. Use one if you can, but don't buy dozens. Get one or two and reuse them carefully (assume the fronts are contaminated). Please don't continue to compete with hospitals for PPE.

My mom found old n95s from when my dad did construction around the house and I told her and my dad to wear while in public. She is mailing to all my siblings. Otherworldly.

I was at the supermarket an hour ago and a guy was coughing. Like more than once. Please don't go out if you are not feeling well - even if you think it's "just allergies acting up."

 

A question: orthopedic physical therapist in private practice, getting multiple calls from patients who are in significant pain and want to be seen.

I'm deferring to the dentists, who, like me, practice for many hours in close proximity to their patients. Most of them are closed until at least April 7th, and will re-assess after that.

So, what would you all recommend as a good screening thermometer when I decide to again see patients? Forehead swipe; sub-lingual with disposable sleeve? I hear the "gun" style is often inaccurate. Many thanks.

 

Meta-Analysis published in JAMA a couple years back indicated that peripheral thermometers (temporal membrane, oral, etc.) had poor reliability for detecting low-grade fevers. However, I am not sure how happy your clients would be if you required a rectal temp from them before being seen. Source: doi: 10.7326/M15-1150.

Having said that, another very recent study notes that only 88.7% of COVID+ patients had a fever. Not sure what your tolerance for risk is but just noting that fever is not a foolproof way of screening. Source: doi: 10.1016/j.tmaid.2020.101623

 

Unfortunately there are no good screening measures. People are contagious for up to several days before they exhibit any symptoms at all. In addition there are some that don’t have any symptoms and can have active Covid infection.

If you’re going to see patients like I am doing you can wear a mask for all patients. While surgical masks afford some protection they are not as effective As an N 95 mask which has been correctly fitted. You can decrease your risk somewhat by not seeing sick patients who are coughing with a fever but it will not lower your risk to zero. You have to be able to except some risk when any patient or person is within 6 feet for any significant period of time. That is our only tool now, to reduce the number of people you see, sick or not. Stay safe.