Coronavirus

[gary17]

so back to stock market...

 

    quick rebound ?  don't know ?  prolonged recession...

[KCLarkin]

Also - on Fauci's point about the primary way a mask helps is so he doesn't infect others.

I think he is totally wrong.  Commonsense is that masks trap respiratory droplets coming in and out.  The First Lady is right!  Mask help reduce your chance of becoming infected.

Isn't that amazing - America's top doctor on that is probably completely wrong on what could be the most effective way to lower the R0.

 

Two points:

- Scientists and doctors rely on evidence. There is little evidence that masks protect the wearer in low-risk situations. There are two reasons why there is little evidence. One, they probably are less effective than you think (see below). But mostly, ethics boards tend not to approve research studies where you intentionally expose someone to an infectious disease.

 

- Common sense is that masks droplets coming in and out. So they should provide equal protection in either case. But if you think about it, you will see that Fauci is right.

 

Let's say a homemade mask reduces 50% of the droplets you inhale. But you can also get infected through the eyes, so let's say that reduces your protection by 1/3. You can also get infected by fiddling with an infected mask or improper washing. So maybe a mask is 25% effective. But respiratory droplets are probably not the primary transmission mechanism. Infection also occurs when you touch an infected person or item. Let's say that is 50% of transmissions. So a mask only reduces your odds of infection by 12.5%. (all numbers made up but roughly based on the limited research I have seen)

 

But what happens if you put that mask on the infected person? The mask basically eliminates the airborne virus. Any droplets are unlikely to be expelled with enough force to enter your eyes, mouth, or nose. It will also reduce the number of droplets on nearby items. So a mask on an infected person might be 75% effective.

 

Imagine you are in a crowded grocery store. There are 99 susceptible people and 1 infected person. If you put a mask only on the 99 susceptible people, the infected person will be walking around shedding virus on the shopping cart, breathing out droplets and aerosols, breathing on the veggies, touching the boxes, coughing on the checkout counter, touching the PIN pad.... So you can see why the Fauci and the CDC recommended masks for the infected people only! Now the problem was underestimating asymptomatic transmission and the lack of testing. The CDC advice is correct, but only if you can tell who is infected!

 

KCL using your numbers...

 

--masks worn by non-infected persons are 12.5% effective in preventing infection

 

--masks worn by infected persons are 75% effective in eliminating transmission

 

Have you not just made the case for everyone wearing a mask? And that is just to assist with lowering the spread of the corona virus let alone the impact on assisting with lowering the spread of other infections/ diseases.

 

I was #maskforall but that arstechnica article that Liberty posted is pretty strong evidence against masks. Especially homemade masks.

 

However, Austria and Czech are seeing a flattened curve. I wonder if the effect is social, not physical. If young people believe they are helping vulnerable people by wearing masks, maybe they are changing behaviour in other ways that are actually more effective.

 

 

[ERICOPOLY]

https://www.foxnews.com/media/mark-levin-jim-acosta-cnn-briefings

 

Fox News host Mark Levin was one of the many who blasted CNN chief White House correspondent Jim Acosta for interrupting Dr. Deborah Birx during a White House press briefing on the coronavirus last week.

 

 

“Jim Acosta’s not a news reporter. He’s a self-aggrandizing narcissist. Exactly what America doesn’t need during the pandemic. He should wear a mask and a dunce cap,” Levin posted in a tweet Sunday.

 

 

wait for it...

 

Spend the day and post some more of your "valuable links" - like your mental health experts at the NYT.

[Kaegi2011]

We appear to be at the top of the curve in NY and still have underwhelming trends in other states. Oregon is sending out ventilators, they are done. Looking at the data NY is the complete outlier. Again they are the exception, not the rule.

 

Interesting that Fauci sat on the sidelines during the presser yesterday. I wonder/have a feeling people within the administration are a little tired of his worst case scenario and dire predictions. Especially with signs that we are nearing/at the top and currently at 10kish deaths. This is the worst week coming up, Overall deaths in the US way down compared to the corona virus deaths. We are saving humanity indirectly.

 

The model used for all of this wildly wrong and NYC discharging way more pts then admitting. ICU need off by a factor of 10x per Cuomos previous comments. Holy shit.

 

Fauci now saying maybe 25-50% of people asymptomatic? No shit, didnt I say that a month ago?  Once more serologic testing comes out we will find that way, way, way more people have antibodies, millions of people. The death rate will plummet as I suggested back in one of my first posts and even though this "isnt the flu" we will find the death rate approaches it rapidly with serologic testing.

 

Based on the data there appears to be no question that warmer climates seem to limit the spread, look at CA, FL, TX, AZ, NM.

 

I have a feeling those who were at first forecasting the most dire predictions will become disingenuous and suggest we are not counting enough dead bodies!!!

 

Ill stick my neck out again and say country is opened by 4/30. Fauci losing favor with Trump and will slide into the background. Watch for more evidence on a daily basis that this was way more wide spread then thought. 

 

We will see in the next 7-10 days but I think there is a good chance that we will find that the lockdowns did nothing as evidenced by the death rate, number of deaths and miles traveled in the Dalal's ealier post. A lot of the areas that people traveled the most have the lowest death rates!!!! How do we explain that?

 

I hope you're right Orthopa, and thanks for chiming back in this thread.  In the spirit of trying to better understand the situation I have a few points / questions:

 

1) miles traveled is likely closely correlated to population density.  If you live in Montana on a ranch, your miles traveled is irrelevant vs. miles traveled in Chicago.  Not suggesting what you're saying could not be correct - for sure it could, especially in Southern / more rural regions, but I think it conflates a few factors.

 

2) I'm unclear how you're drawing the conclusion that the lockdown isn't doing anything.  I mean, if it was effectively would you not expect it to reduce the infection rate (and the whole reason to lockdown)?  This doesn't prove that the lockdown is as effective as everyone thinks, but it certainly does not prove it to be ineffective ("did nothing").

 

3) Miami metro area seems to have ~50% of the cases.  Does this not confirm density vs. weather may be more of a factor? 

 

4) For herd immunity with R0 of 2-3 I've seen numbers between 50-70% in terms of percentage of the population that need to be immune / recovered.  It seems like we're very far from that?  I don't know that anyone really even knows the % of the population that may have had it at this point - do you have some data sources that have cited this?

 

Lastly, how do you think we emerge from this?  Youv'e cited end of the month being a demarcation line - why?  Based on immunity, or that face masks are really effective and we can bring R0 down below 0 with them, or some other factor?  Just trying to understand your line of reasoning. 

 

[LC]

Thread on NYC morgue problem:

 

 

I posted about this a while back. I have some friends who are nurses/MDs at NYC facilities, they have replaced their morgue vans with trailers as the twitter thread mentions. I think I even posted the picture. This happened about...1.5 weeks ago?

 

Not sure where he is getting the rest of the information (burial trenches in city parks?) but it seems the most effective way to manage the bodies would be cremation,but I am no professional in this area.

[minten]

The model used for all of this wildly wrong and NYC discharging way more pts then admitting. ICU need off by a factor of 10x per Cuomos previous comments. Holy shit.

 

Orthopa:

 

Along the lines of "unintended consequences - what is your opinion on this article?  - which I find surprising:

 

https://www.dailywire.com/news/coronavirus-hospitals-across-nation-lay-off-tens-of-thousands-of-healthcare-workers

 

I keep getting urgent bulletins here in Illinois about the shortage of healthcare workers and a call for them to come out of retirement.

 

I dont practice in NYC, King County, LA etc but to just give some perspective whats happening here medically.

 

1. The urgent cares in our network have closed down centers within close proximity on weekends. 15% of centers now closed on weekends. Next step is closing at 6pm instead of 8pm. Volumes are down 80% across the board.

2. ER wait times online averaging 0-10 minutes. There are 5 hospitals in this IDN with these ERs. ~2400 beds total, not sure of bed count.

3. All elective surgery has been cancelled at local hospitals. Nurses are being told to take vacation time/furloughed as there are little no patients on the orthopedic/general surgery floors. OB/GYN still at normal volumes of course. No pre op/post op recovery being done.

4. Im still in contact with many in the orthopedic community and the largest non academic orthopedic group has asked all non provider staff to take 50% pay cuts going forward if salaried. Use vacation/sick time first. All PAs have been furloughed until further notice as its mainly a non trauma/orthopedic group. Ortho surgeons who do sports medicine better have a nice emergency fund saved up.

5. Local surgical centers have shut down. ENT, plastics, ophthalmology, GI docs/PAs, nursing staff same as above.

 

The hospitals are all emptied, waiting, and ready to go.

 

Maybe cobfadec and others/relatives/family working in the hospitals can give some color on what they are seeing.

 

This is my post from 2 weeks ago I believe every bit of that article. I'm not in NYC but am in NY. At least in my area everything was modeled as worst case ie Italy, Spain. One local system has 650 free beds and had 80 corona virus patients as of a couple of days ago.  I got a call from NYS DOH 2 weeks ago regarding my skill set experience etc. Haven't heard back since and don't expect to either. I think people in NYC have come out of retirement and or working cross specialty. I dont think its makes much sense to pull anyone else state wide going forward

 

All that was occurring in my above post is still the same now. Hospital system still shut down outside of emergency surgery, ERs etc. Some of the local hospital employed specialty physicians have been asked to take a pay cut. Low census and no elective surgeries make for no money. Crazy to think hospitals are asking doctors to take a pay cut during a pandemic but what we are seeing in many areas is that the amount of covid patients are not superior to normal patient volume for every day community care. We certainly will see exceptions in "hot spots" but nationwide this is not the case it seems.

 

out of curiosity: don't you guys in the US move patients around?  seems so utterly weird some hospitals are "over-run" (at least that's what we're told in the media), while others in the same state have plenty of spare capacity.

[Liberty]

Liberty - you're a Trump hater of the highest order - so you can let it be.

 

There is a lot of good in this thread - and a lot that is terrible - much of it "not for debate".

 

So you guys can continue to try humiliate Orthopa, hammer Gregmal, make fun of Stanleyp and a few others that dissent from

your know-it-all orthodoxy.  It's not at all pretty. You guys have all the answers and just LOVE to stick it to those that don't agree with you.

 

Spend the day and post some more of your "valuable links" - like your mental health experts at the NYT.

 

I'm a hater of corruption, stupidity, incompetence, bullshit, meanness, authoritarianism, nepotism, tribalism, irrationality, anti-science, and a few other related things.

 

If that makes me a Trump hater, oh well ¯\_(ツ)_/¯

[Kaegi2011]

Relatively new user here.

 

Is there an "ignore user" feature on this forum?  95% of the people are trying to have a civilized conversation even if they disagree on the conclusion, just would like to cut out the 5%. 

 

Anyone?

[Liberty]

Relatively new user here.

 

Is there an "ignore user" feature on this forum?  95% of the people are trying to have a civilized conversation even if they disagree on the conclusion, just would like to cut out the 5%. 

 

Anyone?

 

[Liberty]

I was #maskforall but that arstechnica article that Liberty posted is pretty strong evidence against masks. Especially homemade masks.

 

However, Austria and Czech are seeing a flattened curve. I wonder if the effect is social, not physical. If young people believe they are helping vulnerable people by wearing masks, maybe they are changing behaviour in other ways that are actually more effective.

 

On the balance of the evidence that I've seen, I'm still masks4all too, as long as there's heavy education about their limitations and making sure they don't replace other measures or lead to more dangerous behaviour. And as long as home-made cloth masks are encouraged until supply of other masks catches up to demand from medical workers.

 

Seems like we won't have solid evidence quickly enough to decide, but the asymmetry of risks pushes in favor of going with masks.

 

I do think they're probably a good constant reminder of the situation (including visually for those not wearing them) and probably help maintain social distancing more than they hurt, on top of any effectiveness in catching some droplets that may otherwise infect others, but who knows. It's probably not one answer, but has a lot to do with education surrounding them and other measures, so it can be done well or badly.

[Liberty]

Thread on NYC morgue problem:

 

 

I posted about this a while back. I have some friends who are nurses/MDs at NYC facilities, they have replaced their morgue vans with trailers as the twitter thread mentions. I think I even posted the picture. This happened about...1.5 weeks ago?

 

Not sure where he is getting the rest of the information (burial trenches in city parks?) but it seems the most effective way to manage the bodies would be cremation,but I am no professional in this area.

 

Can they cremate bodies against the wills of the deceased/families, if they had wanted to be buried? Probably wasn't an issue in China, but here the law may prevent it. I don't know.

[Gregmal]

Re: masks, is it really that hard of a decision?

 

Assuming the hospitals dont need them, why take a chance? Worst case it is no different than not wearing one and you look like a paranoid idiot(ego bruising but nothing else), best case it helps keep you safe...

 

We all wore masks on Halloween as kids...are we too grown up to do so again?

[Gregmal]

Thread on NYC morgue problem:

 

 

I posted about this a while back. I have some friends who are nurses/MDs at NYC facilities, they have replaced their morgue vans with trailers as the twitter thread mentions. I think I even posted the picture. This happened about...1.5 weeks ago?

 

Not sure where he is getting the rest of the information (burial trenches in city parks?) but it seems the most effective way to manage the bodies would be cremation,but I am no professional in this area.

 

Can they cremate bodies against the wills of the deceased/families, if they had wanted to be buried? Probably wasn't an issue in China, but here the law may prevent it. I don't know.

 

Probably not a popular stance, but(outside of religious reasons) who TF cares about the body after death? Organ donation? sure. But aesthetics of a funeral Ive never understod. Even with close family, Ive always maintained that I dont like wakes and all that shit. I'd rather my memories be of vibrance and liveliness than a stiff log with makeup on...My ability to "pay respects" has zero to do with the presence of a physical body.

[Liberty]

Re: masks, is it really that hard of a decision?

 

Assuming the hospitals dont need them, why take a chance? Worst case it is no different than not wearing one and you look like a paranoid idiot(ego bruising but nothing else), best case it helps keep you safe...

 

We all wore masks on Halloween as kids...are we too grown up to do so again?

 

The worst case isn't that it's no different. The worst case is that it's worse, potentially because it'll make people rush to get masks that hospitals need, and because people not used to wearing masks can do all kinds of wrong things that increase their risks (they constantly touch their faces to re-adjust the mask, they feel protected, so they get themselves in situations that they wouldn't have without the mask (going out more, getting closer to people, etc), and they may not understand that the mask can be contaminated, so it must be taken off carefully without touching the outside, washing hands before and after, not re-using the same masks, etc).

 

These are all real considerations.

 

I still am in favor of masks, but I think you need to educate people about them, just like how most people recently realized they didn't wash their hands properly and didn't understand surface contamination and such.

 

It can be done, but it has to be done well. Done badly, I think it could make things worse.

 

You certainly don't want to do what has just been done, with the CDC and many cities recommending cloth masks, and then having the president say right after "well, it's totally voluntary, you don't have to, I don't think I will, etc". You need a clear message, because masks work if enough people wear them (you need lots of asymptomatic people who don't even know that they're sick to wear them to bend R0), so if you do it half-assed, you won't get much out of them. It's like if you only vaccinate 10% of a population... Still too many potential vectors.

[Liberty]

Probably not a popular stance, but(outside of religious reasons) who TF cares about the body after death? Organ donation? sure. But aesthetics of a funeral Ive never understod. Even with close family, Ive always maintained that I dont like wakes and all that shit. I'd rather my memories be of vibrance and liveliness than a stiff log with makeup on...My ability to "pay respects" has zero to do with the presence of a physical body.

 

Personally I agree with you, but I suspect that a bunch of laws have been shaped by religious considerations. And I also think that respecting the wishes of the deceased/family needs to have weight in the equation, though it shouldn't be an absolute veto if there's a significant public health risk to trying to accomodate these wishes.

[Gregmal]

That is why I said, "assuming hospitals dont need them". This is why I think the WH and health organizations originally lied, to attempt to prevent that panic and hoarding...not that it helped. I am not aware of a retailer who's had masks in over a month.

[Liberty]

That is why I said, "assuming hospitals dont need them". This is why I think the WH and health organizations originally lied, to attempt to prevent that panic and hoarding...not that it helped. I am not aware of a retailer who's had masks in over a month.

 

Yeah, I also think that's probably why they did it (or partly why, they probably also interpreted too rigidly some studies without considering the asymmetry in risks -- too many people think you can't do anything without RCT studies, but sometimes you just don't have good data and need to make a decision with what you have).

 

Big mistake, but the biggest mistake was to not have been ready for an epidemic with a huge stockpile and good plans for what to do, testing capability and all that, and to lose weeks to this disorganized response.

[orthopa]

We appear to be at the top of the curve in NY and still have underwhelming trends in other states. Oregon is sending out ventilators, they are done. Looking at the data NY is the complete outlier. Again they are the exception, not the rule.

 

Interesting that Fauci sat on the sidelines during the presser yesterday. I wonder/have a feeling people within the administration are a little tired of his worst case scenario and dire predictions. Especially with signs that we are nearing/at the top and currently at 10kish deaths. This is the worst week coming up, Overall deaths in the US way down compared to the corona virus deaths. We are saving humanity indirectly.

 

The model used for all of this wildly wrong and NYC discharging way more pts then admitting. ICU need off by a factor of 10x per Cuomos previous comments. Holy shit.

 

Fauci now saying maybe 25-50% of people asymptomatic? No shit, didnt I say that a month ago?  Once more serologic testing comes out we will find that way, way, way more people have antibodies, millions of people. The death rate will plummet as I suggested back in one of my first posts and even though this "isnt the flu" we will find the death rate approaches it rapidly with serologic testing.

 

Based on the data there appears to be no question that warmer climates seem to limit the spread, look at CA, FL, TX, AZ, NM.

 

I have a feeling those who were at first forecasting the most dire predictions will become disingenuous and suggest we are not counting enough dead bodies!!!

 

Ill stick my neck out again and say country is opened by 4/30. Fauci losing favor with Trump and will slide into the background. Watch for more evidence on a daily basis that this was way more wide spread then thought. 

 

We will see in the next 7-10 days but I think there is a good chance that we will find that the lockdowns did nothing as evidenced by the death rate, number of deaths and miles traveled in the Dalal's ealier post. A lot of the areas that people traveled the most have the lowest death rates!!!! How do we explain that?

 

I hope you're right Orthopa, and thanks for chiming back in this thread.  In the spirit of trying to better understand the situation I have a few points / questions:

 

1) miles traveled is likely closely correlated to population density.  If you live in Montana on a ranch, your miles traveled is irrelevant vs. miles traveled in Chicago.  Not suggesting what you're saying could not be correct - for sure it could, especially in Southern / more rural regions, but I think it conflates a few factors.

 

2) I'm unclear how you're drawing the conclusion that the lockdown isn't doing anything.  I mean, if it was effectively would you not expect it to reduce the infection rate (and the whole reason to lockdown)?  This doesn't prove that the lockdown is as effective as everyone thinks, but it certainly does not prove it to be ineffective ("did nothing").

 

3) Miami metro area seems to have ~50% of the cases.  Does this not confirm density vs. weather may be more of a factor? 

 

4) For herd immunity with R0 of 2-3 I've seen numbers between 50-70% in terms of percentage of the population that need to be immune / recovered.  It seems like we're very far from that?  I don't know that anyone really even knows the % of the population that may have had it at this point - do you have some data sources that have cited this?

 

Lastly, how do you think we emerge from this?  Youv'e cited end of the month being a demarcation line - why?  Based on immunity, or that face masks are really effective and we can bring R0 down below 0 with them, or some other factor?  Just trying to understand your line of reasoning.

 

I think population density does matter no question, NYC the best example of this. My main referencing was that the NYT picture Dalal posted a while back. The areas with the highest amount of travel, ie not staying at home have a lesser number of infections. FL just instituted a stay at home order (remember the beaches?) and Texas still does not have one!. Granted TX, FL, GA are spread out in rural areas but you there is still some significant density in Houston, Dallas, Orlando, Atlanta etc.  How much more interaction is there in large Texas cities with no stay at home order then in a locked down state? Main difference for NYC outlier maybe ultimately high reliance of subway travel in NYC compared to other cities.

 

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

 

 

I think what will answer a lot of our questions is serologic testing regarding herd immunity, need for masks etc. Whats a reasonable conclusion if 20-40-60% of the population has been exposed? The R value will be different for different locations and has been in multiple studies but something doesn't in vibe with a virus that is severely contagious but has only infected a small % of the population. A very small Italian study has shown that 70% of blood donors had antibodies. There is the Stanford paper and oxford paper suggesting the same. Again as I thought was possible a while back I think we are much further up the curve then we think.

 

Why end of April? I think as the month goes on deaths, new infections, admissions<discharges and there will be societal pressure to start to get back to normal. States may do what they want but I can envision many things opening up, especially for those who have antibodies. I envision serologic testing becoming much more available and that as a gateway in some function to return to a work place with others who have been exposed. Maybe restaurants limited to 1/2 capacity? Theaters limited seating etc? I would hope we would avoid an Orwellian tracking system but some may call for that.

 

I thought I read some governors discussion some return to work protocol. Certainly none of what I am postulating is scientific but honestly what data have we had that has been indisputable from a CFR, R0, chinese data, iceland data, etc etc. Its all been a mishmash learn on the go but I think things are looking up for the first time in a while.

 

 

[cwericb]

I agree 100% with Gregmal's last 3 posts.

 

Wearing a mask may not that all that effective in protecting you from from catching the virus, but it may help some. However it would obviously help stop those who have the virus, weather they know it or not, from spreading it.

 

So if it is even only 10-20% effective, doesn't it make sense that everyone wear a mask when in contact with others? What's the downside as long as it doesn't deplete masks available to health care workers.

 

[Liberty]

Houston:https://www.nbcnews.com/news/us-news/houston-hasn-t-reported-surge-coronavirus-cases-its-hospitals-tell-n1175291

 

So far, Houston, the nation’s fourth largest city, has not recorded a swell of confirmed coronavirus cases similar to those straining health care systems in New York and Detroit, giving some residents hope that stay-at-home orders issued by local officials came early enough to stop the virus from spreading too widely here. But interviews with Houston ICU doctors and nurses — as well as the daily rise in the number of critically ill patients now showing up in their hospitals — paint a more sobering picture of what’s happening in southeast Texas.

 

While limited testing has prevented officials here and across the state from getting a complete accounting of how many people have been infected with the coronavirus, hospitals in greater Houston have seen a steep increase — 40 percent over four days — in the number of patients believed to be suffering from the virus, according to a daily census of hospital admissions collected by the SouthEast Texas Regional Advisory Council, which helps coordinate emergency response efforts.

 

That's one thing we're likely to see with the uneven testing around the country... Some places may stay under the radar for a bit and then seem to come out of nowhere because suddenly they start testing more.

[Liberty]

Two people's experience of the "mild" case of the virus, still pretty brutal:

 

[LC]

Thread on NYC morgue problem:

 

 

I posted about this a while back. I have some friends who are nurses/MDs at NYC facilities, they have replaced their morgue vans with trailers as the twitter thread mentions. I think I even posted the picture. This happened about...1.5 weeks ago?

 

Not sure where he is getting the rest of the information (burial trenches in city parks?) but it seems the most effective way to manage the bodies would be cremation,but I am no professional in this area.

 

Can they cremate bodies against the wills of the deceased/families, if they had wanted to be buried? Probably wasn't an issue in China, but here the law may prevent it. I don't know.

 

It's very touchy here particularly NY which is pretty diverse religiously. I am not sure about those laws, whether the governor can suspend them in times of crisis, and if so whether there will be fallout in the future if families decide to sue the city/state.

 

I would think in crisis situation the governor would be able to order cremations but I am guessing the logic now is, "let's spend some short-term cash, do whatever we can today to build body preservation capacity, rather than risk a slew of multi-million dollar lawsuits in the future".

[orthopa]

The model used for all of this wildly wrong and NYC discharging way more pts then admitting. ICU need off by a factor of 10x per Cuomos previous comments. Holy shit.

 

Orthopa:

 

Along the lines of "unintended consequences - what is your opinion on this article?  - which I find surprising:

 

https://www.dailywire.com/news/coronavirus-hospitals-across-nation-lay-off-tens-of-thousands-of-healthcare-workers

 

I keep getting urgent bulletins here in Illinois about the shortage of healthcare workers and a call for them to come out of retirement.

 

I dont practice in NYC, King County, LA etc but to just give some perspective whats happening here medically.

 

1. The urgent cares in our network have closed down centers within close proximity on weekends. 15% of centers now closed on weekends. Next step is closing at 6pm instead of 8pm. Volumes are down 80% across the board.

2. ER wait times online averaging 0-10 minutes. There are 5 hospitals in this IDN with these ERs. ~2400 beds total, not sure of bed count.

3. All elective surgery has been cancelled at local hospitals. Nurses are being told to take vacation time/furloughed as there are little no patients on the orthopedic/general surgery floors. OB/GYN still at normal volumes of course. No pre op/post op recovery being done.

4. Im still in contact with many in the orthopedic community and the largest non academic orthopedic group has asked all non provider staff to take 50% pay cuts going forward if salaried. Use vacation/sick time first. All PAs have been furloughed until further notice as its mainly a non trauma/orthopedic group. Ortho surgeons who do sports medicine better have a nice emergency fund saved up.

5. Local surgical centers have shut down. ENT, plastics, ophthalmology, GI docs/PAs, nursing staff same as above.

 

The hospitals are all emptied, waiting, and ready to go.

 

Maybe cobfadec and others/relatives/family working in the hospitals can give some color on what they are seeing.

 

This is my post from 2 weeks ago I believe every bit of that article. I'm not in NYC but am in NY. At least in my area everything was modeled as worst case ie Italy, Spain. One local system has 650 free beds and had 80 corona virus patients as of a couple of days ago.  I got a call from NYS DOH 2 weeks ago regarding my skill set experience etc. Haven't heard back since and don't expect to either. I think people in NYC have come out of retirement and or working cross specialty. I dont think its makes much sense to pull anyone else state wide going forward

 

All that was occurring in my above post is still the same now. Hospital system still shut down outside of emergency surgery, ERs etc. Some of the local hospital employed specialty physicians have been asked to take a pay cut. Low census and no elective surgeries make for no money. Crazy to think hospitals are asking doctors to take a pay cut during a pandemic but what we are seeing in many areas is that the amount of covid patients are not superior to normal patient volume for every day community care. We certainly will see exceptions in "hot spots" but nationwide this is not the case it seems.

 

out of curiosity: don't you guys in the US move patients around?  seems so utterly weird some hospitals are "over-run" (at least that's what we're told in the media), while others in the same state have plenty of spare capacity.

 

Problem with moving pts around is a couple

 

1. Transporting a critically care patient one at a time would be terribly expensive, dangerous and very time consuming to do 1 at a time.

 

2. Since the areas affected are nearly pin point relative to availability it allows for one area to get hammered and another 50-100 miles away dead.

 

So far in this country this really has been a NYC ground zero problem with very, very manageable covid patient population in the rest of the country. 

[orthopa]

I have been following this model all along. Yesterday predicted 94k deaths in US, now 81k.

 

This model has come under a lot of criticism. I only mention this as this was the model Dr. Birx had cited before.

 

https://covid19.healthdata.org/projections

[orthopa]

Houston:https://www.nbcnews.com/news/us-news/houston-hasn-t-reported-surge-coronavirus-cases-its-hospitals-tell-n1175291

 

So far, Houston, the nation’s fourth largest city, has not recorded a swell of confirmed coronavirus cases similar to those straining health care systems in New York and Detroit, giving some residents hope that stay-at-home orders issued by local officials came early enough to stop the virus from spreading too widely here. But interviews with Houston ICU doctors and nurses — as well as the daily rise in the number of critically ill patients now showing up in their hospitals — paint a more sobering picture of what’s happening in southeast Texas.

 

While limited testing has prevented officials here and across the state from getting a complete accounting of how many people have been infected with the coronavirus, hospitals in greater Houston have seen a steep increase — 40 percent over four days — in the number of patients believed to be suffering from the virus, according to a daily census of hospital admissions collected by the SouthEast Texas Regional Advisory Council, which helps coordinate emergency response efforts.

 

That's one thing we're likely to see with the uneven testing around the country... Some places may stay under the radar for a bit and then seem to come out of nowhere because suddenly they start testing more.

 

True and you will get "hotspots" but even the in the most overexagerated model Texas does not come close to available medical services.

 

All beds needed 3,682beds

 

All beds available 28,633beds

 

Bed shortage 0beds

 

ICU beds needed 712beds

 

ICU beds available 2,259beds

 

ICU bed shortage 0beds

 

Invasive ventilators needed 605 ventilators

 

https://covid19.healthdata.org/projections