"I may be repeating myself, but I want to fight this sense of security that I see outside of the epicenters, as if nothing was going to happen "here". The media in Europe are reassuring, politicians are reassuring, while there's little to be reassured of. This is the English translation of a post of another ICU physician in Bergamo. Read until the end."
(Bergamo, Italy) "After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible. I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder. I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly "emptied", elective activitieswere interrupted, intensive care were freed up to create as many beds as possible. All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity. I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I've seen what's happening. Well, the situation now is dramatic to say the least. The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace. The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia. Now, explain to me which flu virus causes such a rapid drama. And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is"temporarily" put in crisis, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us. Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing. Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized. Someone already to be intubated and go to intensive care. For others it's too late... Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before. The staff is exhausted. I saw the tiredness on faces that didn't know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?" Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can't save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny. There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols. Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can't go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate. We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy." - Dr. Daniele Macchini.
"I finish by saying that I really don't understand this war on panic. The only reason I see is mask shortages, but there's no mask on sale anymore. We don't have a lot of studies, but is it panic really worse than neglect and carelessness during an epidemic of this sort?"
If you need another nickname for the virus, I might suggest “Who goes there” Title name of the book that John Carpenters “The Thing” actually tracks better to the book. Long no symptom infection kind of builds the tension of whom actually is the thing.
Wow, I recently watched a documentary called The Polio Crusade, and it was such a scary time. It was so eerie how everything they did back then is being repeated now: the fear and panic and social distancing, the daily illness and death counts the spraying the streets down, the quarantining at home. It was de ja vu, to what we are seeing now.
I’m glad you survived. I hope your PPS symptoms are not too bad.
It was so interesting to0, to watch the search for answers, it seemed to be the first real modern attack on a disease, coordinated by President Roosevelt’s foundation for infantile paralysis: the enlisting the public with small donations of a dime for the March of Dimes the race for the vaccine, and the competition between Salk and Sabin. I admire the persistence and talent of those who finally found a vaccine.
No, not talking about CDC or WHO.
On my final town trip today, I got started later than I wanted, dang DST. First stop was post office to send items. Clerk said no mail in or out of the area today because police action on Hwy. 20, main rout from the west. Grocery store was fairly unremarkable, more sale items than usual including paper towels. Picked up a big box( 12 bags) of ginger snap (my favorite) cookies pre ordered on line at Dollar Tree. Got gas. Went to hardware store. Bought $40 of nails and screws for my summer projects. I don’t know what the builders will do this summer if production in China doesn’t pick up. In between all stops, trying to don and remove disposable gloves and protect my credit card, license and store card. Wiping down, put in ziploc. All packages into back of pick up, immediately sprayed down with lysol, so have contact time on trip home. If you shop, plan extra time, no noted virus in area, yet, so everything is still a work in progress for contamination.
I decided to keep one set of clothes for outside trips. They do not come into the house. Waterproof boots, hat, socks, sweat pants, Tshirt, jacket. Then I cover with light plastic rain gear. Change in carport. Will have H2O2 spray bottles and clothes lines. Don’t have it all worked out, yet. It is time consuming, I plan to stay home for 1-2 months at a time. Will use respirator if the worst happens, here.
Given the exponential spread pattern AND the poor reaction so far from the US government AND the fact that health care facilities are already running out of supplies, anyone want to guess at the date and time before we see a regional quarantine ordered like Italy has done?
(I’m watching today’s video and feeling like someone in the good seats down near first base in a ball field…)
Less than 60 miles from Seattle and now at least one case in adjacent county - Pierce. Lots of people in my agency commute from Seattle, Tacoma and southwards so I pulled the plug today and asked the boss last week if I could telecommute this week (and who knows beyond that). Ok so doing that.
Chris, your ideas and everyone else’s about decontaminating are spot on. It is ALL in the details and my one trip out today convinced me that it is better to stay home, period. It’s a LOT more complicated than you might think to go to a public place (store, library, airport, etc.) and genuinely stay un-exposed. Since I asked to telecommute, I also need to be super careful in my personal life too. If you are really drawing a bright red line, probably good to practice before going (as I discovered today!) Did not see one person today on library trip (gotta keep entertained!) I didn’t see one person with a mask on. I didn’t have one bc by the time I figured out that I might need them, they were all gone.
WOW am I glad I started following PP on this in late January. Now that things are (beyond) getting real, I am actually prepared to stay home. Would be sooooo stressful if I was trying to do all that now. Big thanks to all!
This sounds like a good way to get false negatives, although it is great PR for him. My understanding is that it needs a long swab and has to be swabbed deep in back of throat, although hopefully a MD here might see this and chime in ? But I have read that that is one of the issues with testing in terms of exposure to medical workers that this is not just a inside nose or cheek type swab. That is because this is not a runny nose type virus where you would have the virus in the nose, not usually.
Hi folks, Pro Tip: Put a spare toilet roll in your car. (Keep it hidden from thieves though.)
Put it inside your bag of portable PPE (sanitizer, wipes, masks, gloves etc.) You do have one of those bags don’t you?
Why TP?
There may come a day when your employer will not be able to stock the toilets with paper. I assure you that such a day, if it comes, will be a surprisingly memorable event for you.
Theft of masks, sanitizer, rubber gloves etc from places where health care workers operate is already endemic.
So… don’t be surprised if toilet paper goes missing from offices, factories, pubs, gas stations etc.
Heads Up people! Your world is changing.
Cheers
Grayman
I have not seen info on this anywhere, so if you have, please post it here.
Here is my question, What if you are over 50 or 60, PLUS you have high blood pressure, diabetes, asthma & are overweight? Do you add all the percentages, for each risk factor, together? If not, how do you factor that in? Many people in the US, are in this exact position. I have been pondering this question, for weeks, but have not seen anyone, anywhere, address it. I’d love to hear your feedback, especially if this is in your specialty. Thanks.
I guess people are just plain ignorant about the differences between SARS-CoV-2, and the common Flu.
30,000 deaths from flu for the entire USA equals a .01% fatality rate. So, if you wish to know how many the SARS-CoV-2 pathogen will kill, with its much higher fatality rate, simply take its LOWEST estimated fatality rate and multiply it by 336,000,000. This would be 6,720,000 dead Americans.
But, let us be real. It is expected only 70% of Americans will become infected, so we are only talking about 235,200,00 infected, of which 15% will become critically ill, or merely 35,280,000 seriously ill people. Now only 2% of these critically ill people are conservatively estimated to die from COVID-19, and this would only be 705,600 killed.
Only ignorant people, or those deliberately lying, would ever think to equate 705,600 deaths, caused by SARS-CoV-2, as being less serious than the estimated 30,000 deaths, related to the common flu…MOST OF WHICH are caused by secondary infections…and NOT the flu itself.
IN ADDITION, you can get OVER the common FLU…whereas…COVID-19 permanently damages the lungs and heart, and secondary infections have a much greater rate of death.
Oh, and unlike the common Flu…WE DO NOT HAVE A VACCINE to prevent COVID-19, and probably NEVER WILL. We are STILL waiting for a SARS 2008 vaccine…and it has been over eight years!
ONLY FOOLS COMPARE THIS PATHOGEN TO THE COMMON FLU…
Mtnhousepermi, I have had the same question. There’s nasal swabs (I believe the home kits are nasal), there’s throat swabs like when you are looking for Strep throat, and there’s nasopharyngeal swabs which are thin swabs that you push down the nose all the way into the back of the throat. There’s also testing down in the lungs that requires a bronchoscopy.
These must have different rates of false negatives. It also depends of course if you are symptomatic or not, and shedding or not.
Another important concept to understand is the positive predictive value, and negative predictive value. It is a combination of how common the disease is in the population (prior probability of disease) and the result of the test. This may be one reason why it can be a problem to test a ton of people. The positive predictive value of the test drops a lot if you are testing for something rare.
In the end as a doctor, it’s the positive and negative predictive value of a test that you want to know about.
