COVID* STANDFORD MASK STUDY---Elsevier journal to retract widely debunked masks study whose author claimed a Stanford affiliation p345

How about a little trip trip through your local hospital ER's,(the more the merrier) preferably without a mask?

And its "their" not "there", which is a pretty good indication of your I.Q.

Y’all need to watch this.

[link to www.nytimes.com (secure)]

From big thread

ood morning! Got some much needed sleep last night and am enjoying my day off before returning to the ER tomorrow.

I'm a member of several nurse groups and thought y'all would enjoy reading this that was written by an ER doc in New Orleans. Very interesting read:

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."

[link to monotreme1000.wordpress.com (secure)]

Gestalt #16 – SARS-2 Pandemic

[link to www.cnn.com (secure)]

Florida reports more than 2,000 coronavirus cases


The Florida Department of Health has recorded 2,229 positive cases of novel coronavirus and 27 deaths as of Thursday.

That is a significant increase from Wednesday's report of 1,921 cases and 22 deaths.

Broward, Dade and Palm Beach counties make up the vast majority of cases in the state.

[link to www.cnn.com (secure)]


4 min ago
More than 1,000 people in the US have died from coronavirus


At least 1,046 people have died due to coronavirus in the United States, according to CNN’s tally.

[link to www.cnn.com (secure)]


280 US service members have tested positive for coronavirus

As of Thursday morning, there are 280 US service members who have tested positive for Covid-19. This is an increase of 53 from 227 on Wednesday.

There is now nearly 600 positive cases across the US Department of Defense.

[link to www.cnn.com (secure)]

City of Miami imposes a curfew

The Miami City passed a curfew during a virtual commission meeting. The curfew starts Friday and will be in effect from 10 p.m. to 5 a.m. local time.

The exceptions to the curfew are going or coming from work, a medical emergency and walking a dog within 250 feet of your home.

The curfew motion passed unanimously 5 – 0.

[link to www.cnn.com (secure)]


More than 37,000 people have tested positive for coronavirus in New York

So far, at least 37,258 people have tested positive for coronavirus across the state of New York, Gov. Andrew Cuomo said.

Additionally:

5,327 people are currently hospitalized
1,290 patients are in intensive care
1,517 patients have been discharged after being hospitalized

[link to www.cnn.com (secure)]


Michigan is "a few weeks out from the apex" of coronavirus cases, official says

Dr. Joneigh Khaldun, chief deputy director for Health for the Michigan Department of Health and Human Services, said that as they are able to test more Michiganders, their target date for the apex of cases will improve, but right now they are “a few weeks out from the apex.”

Khaldun said they can flatten the curve if people listen to the stay-at-home order and practice social distancing.

How’s your dad NB?

Last couple of day's, pretty good. Thanks for asking. We are trying one last predinisone blast, and we have a referral for home hospice.

What is their typical death rate? That puts things into perspective.

So I sent the Louisiana info to an EMT is Penn

Her reply

Holy freaking shit. With the exception of his labs which we draw but obviously can’t run and don’t interpret they’ve learned a shit ton of predictors prior to multisystem organ failure.
We too are undressing and showering at work tossing uniforms in a dryer for 30 minutes, bagging them and taking them directly to laundry at home. I’ve stayed away from my husband and sister at least 10 feet and if I cough for whatever reason I go outside. I have my own bedroom. We’re wearing masks every patient every time no matter dispatch. We have a large community of New York New Jersey employees living in our bucolic Upper Bucks county.
They were all sent “home” two weeks ago. In the past 24 hours I’ve seen three families with one suspected household member. We’ve seen two today call us for well checks cause they’re terrified.
Only one of us goes inside so as to hopefully not expose the crew.

We believe in this area we are five to seven days from numbers similar to New York/New Jersey.

My daughters an ER nurse in a large facility just 5 miles north of Philadelphia. They are overwhelmed. They’re nearly out of PPE and we are all running dangerously low and reusing masks days at a time. We are building a uv-c light box to do what we can to kill viruses in/on our masks. We are low on gowns. Eye protection is reused as we’re using commercial safety glasses. We’re spraying our uniforms with Lysol.
My daughter says they’ve been able to predict next stage disease process as well but I’m not certain how aggressive they’re being with prophylaxis intubation and vents.

I haven’t seen my grandchildren in three weeks.

[link to www.cnn.com (secure)]

Louisiana sees a spike of more than 500 cases in one day

Louisiana has reported an additional 510 positive cases of Covid-19 and an additional 18 deaths since Wednesday.

Currently, there are at least 2,305 cases of coronavirus and 83 deaths in the state.

According to the state Department of Health, 676 patients are in hospitals and 239 are on ventilators.

Gov. John Bel Edwards on Wednesday said the state could run out of ventilators by early April in Orleans Parish, one of the hardest hit areas.

thnks for posting these

[link to www.cnn.com (secure)]

Italy records increase in new coronavirus cases

Italy reported an increase of 4,492 cases of coronavirus in the past day, bringing the total of active cases to at least 62,013.

There were at least 662 fatalities in the past 24 hours, raising the total to at least 8,165 deaths.



Crude fatality rate of ~13%


ugh

NB what do you think of this article my sister sent me.
[link to www.dailywire.com (secure)]

Hello Everyone ... Hope everything with your Dad goes well NB !!

So Cal report:
1. Clients and Job-sites seem to be dropping daily (I am in structural steel construction primarily hospitals and hotels)

2. Surprisingly our hospital projects are the ones that are still pushing for job completion but I guess that is expected and essential but we as a company are struggling with putting our people in a dangerous environment.

3. There seems to be a huge political power play between LA County and the Sheriff's Department and I see this as the beginning of the breakdown of the government structures.

4. Shelves are still mostly empty and as soon as they are filled the supplies don't last long at least for essentials. It seems junk food like potato chips are in abundance.

5. All of the hospitals and medical centers in my area are pre-screening with tents outside before admittance into the building itself. I haven't noticed any refrigerated trucks like NY yet.

7. People seem to be breaking the "stay at home" order more and more every day. I don't expect that to last much longer and it seems the officials are starting to consider implementing tougher standards and there is even talk of them shutting down water and power to non-essentials.

I personally can't help but feel that we are all in for the ride of our lives and life will never be the same and I am struggling with all of those around me thinking this will just blow over pretty soon. I guess until their loved ones start getting sick or their friends on social media start posting about family and friends dying they will all ride the denial train. Hard for me to concentrate on the day to day knowing what we all as a nation and a world are actually up against !!

Good Luck Everyone !!!!

I just went back and skimmed first 20 pages of this thread. We are screwed

i'm back. shill threw me in the hole for 3 days. i miss anything big?

I saw the article. The headline is very deceiving. This is what I posted to someone who posted it on FB.


Read the articles, and follow the links. What he said: "He said that expected increases in National Health Service capacity and ongoing restrictions to people’s movements make him “reasonably confident” the health service can cope when the predicted peak of the epidemic arrives in two or three weeks. UK deaths from the disease are now unlikely to exceed 20,000, he said, and could be much lower. " So, now that the UK has instituted lockdowns, they should be able to flatten the curve. He does not retract the paper, nor does he revise the paper. Impressive headline on the article, but hardly accurate. The model hasn't been revised. But, it doesn;t really matter, it will happen shortly or it won't. In the next 2-3 weeks things will be great again, or they will be whatever is diametrically opposed to great. Paying attention to what's actually happening will be the best indicator. New York is less than a week away from hospital overload. Los Angeles will be next, with New Orleans and Seattle close behind. If you don't think what is happening in the "big cities" can't happen across the country, you are sadly mistaken. Hope for the best, prepare for the worst.

Thank you!

Nope. All is well.





3 days in GLP Jail. You must have very bad.


I think we are losing NY. LA will folllow soon. I think the midwest is about 10 days behind NY.

20+ States have STFH orders, last time I checked....early this AM.

Trump thinks things will be open by Easter. The Joint Chief of Staff thinks 60-90 days before we can even condsider opening.

We are still on a severe upward trend as cases that were infected on the last 2 weeks are getting sick.

It's still near impossible to get a test, regardless of what the talking heads say.

But, all is well.

CUOMO,NY governor,did order all state hospitals to increase capacity by minimum 50%. he says he will send COVID patients to hospitals outside NYC for overflow.he claims we won't see max for 3 weeks. he has also asked other states for supplies and vents. i doubt anyone sent anything.

news as of yesterday.

i was trying to lighten the mood and tell jokes. of how wacky the world has gone. if i post intelligence,the shills still kick ya. can't win

what do u call a shill with the virus?
woke

New Hampshire STFH

a stay-at-home order starting at midnight Friday. The order will last until the end of May.