masks without valves or masks with valves still reduce the probability of transmission and if EVERYONE is wearing a mask then an exhaust valve matters even less, because if everyone is wearing a mask, then you cannot receive the exhaust gasses from someone else.
https://youtu.be/aNjpH5lBZ8w
https://youtu.be/ieI7HITRm3c
For those with skills:
https://youtu.be/zz0YpY6VqVU
Not really the forum to have a transphobic rant.
Fence at top of cliff,
OR no fence and a sign saying ‘no danger here’ and ambulance at the bottom of the cliff.
hmmmm
My Wife who I have said is a Manager of Ortho-Neuro and Oncology but runs her full unit on Ortho-Neuro as a dedicated 36 bed unit for the Honey Badger Virus. Well, 7 members of her staff are now sick. Their swabbed a we await the results, hopefully today. Barb’s boss has tested positive and was probably infected outside the hospital. So, our brave front, my brave front has took a severe blow. I cannot live without my Lady, she doesn’t have to do this, money and retirement are preserved. Barb does it because it is one of mankind’s worst virus outbreak ever, one for the ages and she is compelled to do her part. I call bullshit to that! Why! The hospital has been late to the party and are still woefully out of touch. Since early January I have badgered my wife about “what is the hospital doing” to get prepared? I seen all of this coming as I stayed focused on what was happening in China and I just felt masks would be the simplest and easiest way to combat this way back in early January and I’m a house painter. A knucklehead who isn’t suppose to even be interested in this. Well, I can say with all honesty, I have been ahead of this virus way before the truly stupid and many of them are Doctors at the hospital. If Barb, my wife were to walk and she may be forced to by me, she would walk out with many of her nurses in tow. Hospitals by nature are a conflicting bunch. They do such honorable work but they are greedy son’s of a bitches. It is their greed and bullying that has me fighting mad. I want mask’s, I want masks handed out to every citizen, I want fines applied to anyone not wearing a mask severe enough to wake these people the fuck up. When Barb’s boss tested positive was the last straw. No I don’t admire the medical field when doctors brow beat the nurses who give 90 percent of care to not wear masks because the real reason is he didn’t see this coming (NOT a good excuse) and didn’t order enough supplies. My God, it’s an easy call the it be required to maintained so many reduntant supply’s in some wearhouse where hospitals order from. In the case of a serious blow they would have more than enough supplies to handle any emergency. Instead we play this “just in time” bullshit ordering system. I just don’t understand. No, I understand, I just think those in charge are stupid, stupid, stupid because the most valuable resourse is our nurses and their treated professionally like shit. It isn’t about money but I wish one really gifted nurse who commanded attention would fight for better working conditions, have an insurance policy to pay one and a half times salary for whatever time is lost to sickness of a virus or anything while at work, and an immediate 20% pay raise for the duration of this virus, retroactive and immediate!. That would be a cheap costs too. Imagine a nurse strike?! They wouldn’t, I’m only asking they threat to do so and all would be given to them. That’s their true value and I am certain they would be treated more intelligently, with more professionalism. Do you know that nurses are the ones who catch the most med errors that doctors prescribe and this is done by trying to read the worst handwriting on the planet. Not even a thank you is given to these high character nurses. I do not hold doctors in high esteem. Too many are drug pushers looking to make whatever they can. Shit man, the opioids pandemic is all on them and the governments push to treat pain at all costs and they have the balls to point a finger at their patience who now have a dependency!? Paaalease! I want to confront the Doctor myself who is giving the no mask argument. I would have him on his knees in tears just using simple logic. He was probably on his high school debating team take both sides of an argument. He’s ridiculous, I knew and I’m a knucklehead that masks were the most important tool to fight this virus from early January on. He simply messed up and now a brilliant nurse is at home, with her 5 year old who has breathing issues anyways and now they deal with what they must, just trying to stay alive. I had a long talk with Barb and gave her my ultimatum, yes Lady’s, an ultimatum: If the hospital do not pull it together and protect her, and Barb’s staff better, then she’s coming home. If I have to drag her from the back of her hair, she is coming home. We’ll pack up everything and head for the woods, get our garden ready and all other chores done and wait this out. No martyrs in my family, especially when I have to hear of story’s from a Doctor saying masks are unnecessary. I cannot believe we are still talking about this or not giving at least Chloroquine hydroxide to all positive patients who just tested positive. They get an immediate dosing. I am very disappointed. Chris, you never stop with your message until we get a vaccine, you have been a gift to the human race and need to keep doing what you have. Included in your praise is the outstanding work Adam does to get your message out. I think the both of you should be cited an “American Hero” for doing what you are doing. Peace
PC costs lives…
Facts don’t care about your feelings.
Interesting perspective from a friend:
WELL PLAYED CHINA…
China becomes ill, enters a “crisis” and paralyzes its trade. The curtain closes.
The Chinese currency is devalued. They do not do anything. The curtain closes.
Due to the lack of trade of companies from Europe and the USA that are based in China, their shares fall 40% of their value.
The world is ill, China buys 30% of the shares of companies in Europe and the US at a very low price. The curtain closes.
China has controlled the disease and owns companies in Europe and the US. And he decides that these companies stay in China and earn $ 20,000Billions. The curtain closes. How is the play called?
Checkmate!
ReAmazing but true
Two videos have passed that convinced me of something I suspected, but had no basis. It was just my speculation. Now I am convinced that the coronavirus was purposely propagated by the Chinese themselves.
At first they were too prepared. Three weeks after the start of the roll, 14 days and a 12,000-bed hospitals were already under construction. And they really built them in two weeks.
Awesome.
China announced that they had stopped the epidemic. They appear in videos celebrating, they announce that they even have a vaccine. How could they create it so quickly without having all the genetic information? Well if you are the owner of the formula it is not difficult at all.
And today I just saw a video that explains how Den Xiao Ping gave the west a half stick. Due to the coronavirus, the actions of Western companies in China fell dramatically. China I just hope, when they went down enough they bought them. Now the companies, Created by the USA and Europe in China with all the technology put in by these exchanges and their capital they passed into the hands of China, which is now rising with all that technological potential and will be able to set prices at will to sell everything they need to the West. How are you?
None of this could have happened by chance. China who cared that a few old men died? Fewer old-age pensions to pay, but the loot has been huge. And right now the West is financially defeated, in crisis and stunned by the disease. And without knowing what to do.
Masterfully diabolic. It had to be the communists.
Adding to this, they are now the single largest owners of US treasury with 1.18 trillion holding surpassing Japan.
An instrument that has seen the most rally
One 
prospective & Analogy
How come Russia & North Korea have Low or Zero incidence of Covid- 19 ?
Is it because they are staunch allies of China
On the other hand USA / South Korea / United Kingdom / France / Italy / Spain and Asia are severely hit
How come Wuhan is suddenly free from the deadly virus?
China says that the drastic initial measures that they took were very stern and Wuhan was locked down to contain the spread to other areas
Why Beijing was not hit ? Why only Wuhan?
It is interesting to ponder upon… right ?
Well …Wuhan is open for business now
Covid - 19 needs to be seen in the backdrop of the arm twisting of China by USA in the trade war
America and all the above mentioned countries are devastated financially
Soon American economy will collapse as planned by China.
China knows it CANNOT defeat America militarily as USA is at present THE MOST POWERFUL country in the world.
So use the virus…to cripple the economy and paralyse the nation and its Defense
Wuhan’s epidemic was a showcase.
At the peak of the virus epidemic…China’s President Xi Jinping…just wore a simple RM1 facemask to visit those effected areas.
As President he should have been covered from head to toe…but that was not the case.
He was already injected to resist any harm from the virus…that means a cure was already in place before the virus was released
China’s vision is to control the World ECONOMY by buying up stocks now from countries facing the brink of severe ECONOMIC COLLAPSE…Later China will announce that their Medical Researchers have found a cure to destroy the virus
Now China shall OWN the stocks of All Western Alliances and these countries will soon be slave to their NEW MASTER… CHINA:
Robert
Mar 28, 2020 at 8:32 pm
This from an E.R. doctor in the front line trenches in Louisiana (highly technical, but note, especially for those advocating massive industrial diversion to crank out ventilators his observation that 80% of those going on ventilators die):
“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
It’s not often that PP gives bad advice. Or perhaps its intentional prepper-talk to drum up more business. if there were 10 billion masks in the world and the sustainability of producing them wasnt in question, I might overlook the rhetoric. However it is irresponsible to suggest we all need to wear masks when there are barely enough to go round, even for medicsl staff on the growing front lines. We should all try focussing on the science of risk and be practical about dealing with it. Otherwise we run the risk of destroying our credibility and losing the ear of the people we really need to reach.You can get right the heck out of here with your horrible, terrible, nonsensical "counter advice." This post of yours is already stale. The entire world woke up yesterday to the idea that everyone needs to wear a mask. It's scientific, backed up by data, logical, and responsible. To suggest ('charge'?) that I am promoting #masksforeveryone to "drum up business" is deeply offensive. Because your entire post is not at all grounded in logic, or data, or defensible in any way and lacking in any generosity of interpretation towards myself or this site, I am going to chalk it up to an awkward adjustment reaction. But let me be clear - I have zero tolerance these days for anti-scientific political talking points that come from the WHO or CDC. Ain't nobody got time for that.
However it is irresponsible to suggest we all need to wear masks when there are barely enough to go round, even for medicsl staff on the growing front lines.Obviously you missed the video showing the Chezk Republic going 100% masks. Granted there are not enough to go around right now, but how many people in the US have sewing machines? How many people have material laying around, or even old clothing that they can make into masks? We need to stop waiting for someone else to save us, roll up our sleeves and get to work saving ourselves and helping others. That's the only way we come out of this with something positive to look back on.
Everyone wear masks is now proven to work (Czech Republic) and very achievable.
Start with a bandana or any covering…50% effective
Upgrade to a homemade sewn mask…more effective
Put a sleeve in a homemade mask with vacuum cleaner filter media…more effective
Buy N95 masks when they become available…soon…most effective.
I am in rural Texas where we have few reported cases. I was one of 4 people wearing a mask at the grocery store. I have some 3m N95’s purchased in January cause Chris alerted me. I wore a bandana over it so that I would look cool.
Right you are Chris. I trust nothing that doesn’t pass the logic test. You mention and I have in ever argument I have with people that talk down mask: your mask wearing protects me and my mask wearing protects me. Then I ask, do I think this simple mask wearing idea a good idea? My brain immediately screams: WELL!, HELL YEAH IT DOES!!! DAH! Chris, don’t even bother with stupid, we need you doing what you do and you said yourself and I agree: every second matters. This bullshit is an easy "stupid’ so pass them by. Great work Brother, Adam, you too. Chris is the headline by nature but your work is equally important. Plus, I sense you are a truly good guy and a walk the walk type. Peace
Still quite a bit of cog dis/normalcy bias in that rant.
Check your six.
DTrammel you will appreciate this I think…I am continuing to try and raise awareness where ever and however I can:
It dawned on me today: If you can call someone with two testicles, a penis, and a prostate a woman, and compel others to treat them medically as such, then you can pick and choose any facts you like about Covid19 based on political or ideological leanings.Aman AKGranny
Dutch family physician/doctor Walter Schrader from Leiden has written an Open Letter to the governement of the Netherlands stating that he has a plan to arrange face masks for every dutch citizen in just a few days. He tries to gets his message through which does not seem so easy yet. Here is his Open Letter (in dutch, but google translate will probably be willen to help): www.pdfarchief.com/openbrief.pdf
First total tests. We’re up to 0.8% of the entire population:
Now positives. Now at 0.3% of the population. The tail in the exponential rate is hopefully good news but is likely be related to testing which also tails off recently:
Hospitalizations keeping in mind pre-pandemic bed numbers were 53000 with 3000 ventilators - growing more or less exponentially:
Deaths - also growing exponentially:
Now a look at positive test rate. How much does this represent the underlying rate in the population and how much is selection bias?
The early days with few tests are excluded. Positive rate seems to be approaching 50%.
And finally positive rate by region:
New York City and most suburban counties are around 0.35%. Westchester is 0.81%. Upstate is at 0.05%. True infection rates are probably 1-6% downstate. At a doubling time of let’s say 5 days, that’s herd immunity in under a month, but the next few weeks will likely be tragic. Unfortunately, the next week or two of deaths is already in the pipeline with incubating cases. But the majority of the tragedy is at least 2 weeks out - not too late to get masks for all and truly flatten the curve.
Call to action for everyone in New York (and elsewhere): Let’s flood social media and the governor’s office with requests for Andrew Cuomo and his staff to wear hand-sewn masks at the next press conference!