18 minutes ago, EagleVA said:

I'm sure you heard about the woman that ran into a tree and died because she passed out while driving due to a lack of oxygen caused by wearing a mask. 

I hate to say it but Americans are really stoopid........before the clowns reply, I know how to spell stupid.  

Yes I did. I had a similar incident at work I was moving stuff around and before I knew it I was gasping for air and it was such a crappy feeling to feel like you are suffocating. 

Those headaches I got are a direct result of the masks I've had them all day everyday since this started. Ranging from dull to the worse pain I've ever felt in my life. 

I'm not against the masks but, I'm definitely tired of it . Having other health issues to protect you from another isn't the answer either. 

3 hours ago, hey suess said:

Beaches are opened, with the social distancing measures in place. (If you lived within walking or bicycling of the beach you could always have went there, so it never really closed......just beach parking closed.) Restaurants opened at a 25% max capacity. Traffic is light with snowbirds back up north. 
Now, whether or not people adhere to the distancing standard or not, we shall find out. But for the most part, other than Miami-Dade, COVID diagnosis has been below predictions.

They are also supposedly flubbing numbers, so who knows. 

3 hours ago, hey suess said:

Beaches are opened, with the social distancing measures in place. (If you lived within walking or bicycling of the beach you could always have went there, so it never really closed......just beach parking closed.) Restaurants opened at a 25% max capacity. Traffic is light with snowbirds back up north. 
Now, whether or not people adhere to the distancing standard or not, we shall find out. But for the most part, other than Miami-Dade, COVID diagnosis has been below predictions.

Not sure where you are in Florida but in the ft myers area the roads are packed and nearly all of my snow bird neighbors are still here. Actually, i think all of them are still here. 

What's the word on PA opening up?

1 minute ago, What The F said:

Not sure where you are in Florida but in the ft myers area the roads are packed and nearly all of my snow bird neighbors are still here. Actually, i think all of them are still here. 

It’s 5:30pm and here the main highway and the Olive Garden parking lot in Melbourne. Dead.

 

I miss Olive Garden. Haven't been there in awhile(before the virus)

14 minutes ago, hey suess said:

It’s 5:30pm and here the main highway and the Olive Garden parking lot in Melbourne. Dead.

 

Lucky.   Our area def doesn't look like that. 

39 minutes ago, LeanMeanGM said:

They are also supposedly flubbing numbers, so who knows. 

They're definitely cooking the books, the directive from the CDC can be found on any alternative new outlet but that move is never mentioned on the mainstream news. 

And I see YouTube is at it again, any video that contradicts the WHO is/was removed, they don't want the truth known, I can think of several other topics where they did the same thing.

7 hours ago, mr_hunt said:

we have procedures in place...temp taken upon entering the building, social distancing, cleaning procedures, masks are mandatory,...although idk if folks will wear them in their own offices unless someone else is in there.  should be fun. 

Yeah I mean you don’t need to wear a mask if you’re sitting in an office by yourself.  It’s for when you’re in a position where you can’t maintain physical distance from others.  

5 hours ago, homerpat said:

yeah was drinking when i wrote and have since reread. Apologies. I definitely misinterpreted some of the themes of the article. 

Lol no worries.

So Taco Tuesday on Cinco De Mayo is ruined because of Corona.  

5 minutes ago, Mlodj said:

So Taco Tuesday on Cinco De Mayo is ruined because of Corona.  

My company had tacos catered in for us today. Wasn’t too bad. 

I ordered some TP off amazon a few weeks ago and wasn’t sure if it was legit. It was. 60 individually wrapped rolls of cottonelle. 

4 minutes ago, Tnt4philly said:

I ordered some TP off amazon a few weeks ago and wasn’t sure if it was legit. It was. 60 individually wrapped rolls of cottonelle. 

👍

When everyone was losing their minds over TP shortages at the supermarkets, I ordered a case of the same from a janitorial supply distributor...they had TONS available.

1 hour ago, Tnt4philly said:

I ordered some TP off amazon a few weeks ago and wasn’t sure if it was legit. It was. 60 individually wrapped rolls of cottonelle. 

 

Waiting for the meat panic buying to kick in; although, I think some stores are trying to head it off and are already restricting purchases.

LINK

One of the most critical things we do in medicine day in and day out is to discuss risks with patients. A good doctor has these talks a dozen or more times a day. Why? Because both medical care and life has risks. So as the data is published on how lethal COVID-19 really is or isn’t, it’s time to level with the Average American patient about the risk of dying from this disease. New German data again shows that the risks to the average person are generally being overexaggerated by most in the media. Let’s dig in.

What We Know from Other Sources About COVID-19 Risks

The single biggest number that everyone is concerned about with the novel coronavirus is the IFR or Infection Fatality Rate. Why? It’s a great way to convey to the average person how much risk there is of dying if they get infected. That simple statement of odds can then provide them with some sense of their personal risk.

Last week and the week before, two data points were shared about the coronavirus infection fatality rate. One was out of Stanford which pegged your odds of dying at about 1 in 500 and another out of New York that pegged it at about 1 in 200 (1-4). While these numbers were different, they were more similar than the prior crude mortality rate of 3-4% that was reported in the media. Where did they get that number? Through a misreading of a March document published by the World Health Organization (5). Here’s what that document actually said:  "While the true mortality of COVID-19 will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%, the infection mortality rate (the number of reported deaths divided by the number of infections) will be lower.”  Hence, even the WHO has been reporting that the real risk of dying from COVID-19 if infected with the SARS-CoV-2 virus would be lower than the crude mortality rates once the dust settles.

The German Data

Germany has been arguably one of the world’s coronavirus testing superstars. Early on when the U.S. had tested barely a few thousand people per million citizens, it had already tested 20,000 per million. Last month, researchers at the University of Bonn had begun to release information about the IFR in Germany that was just updated (6). Basically, after testing almost a thousand people in a German town where a festival took place with both RT-PCR nasal swabs and ELISA serum assays and then estimating the IFR for the whole country, the Germans had it pegged at 0.37%. That also comes with the realization that about 10 times the number of people they thought were infected were actually infected, with 14% showing immunity.

But Wait! Excess Deaths or Dishonest Hospitals?

This week the media has been all abuzz about a Yale study that many have interpreted as showing that in the early part of the U.S. Pandemic there were almost 40,000 extra deaths that weren’t listed as COVID-19 on death certificates but may have been due to COVID-19 (7). They calculated these deaths by looking at the number of deaths that usually occurred during this time and then reviewing the number that actually happened. However, these researchers didn’t review any hospital or medical charts, so this is their "guess” that these are deaths due to COVID-19. The deaths also could have also been due to the fact that the medical care system in many of these places was all but shut down outside of COVID-19 care and many people were terrified to go to the hospital to seek any medical care for anything unrelated to the coronavirus.

There was another interesting article this past week on the phenomenon of dishonest hospital reporting of COVID-19 deaths. An article put out by the Foundation for Economic Education quoted many different physicians and experts who believed that hospital administrators were pressuring physicians to add COVID-19 on death certificates even when there was little credible information that the patient had died of this disease (8). This was thought to stem from the fact that the CARES act added a 20% COVID-19 kicker to hospital payments (9). In addition, it guaranteed hospitals that amped up reimbursement for uninsured patients in the way of direct government reimbursement. The act also included unusual things like advance payments.

Hence, as a physician, my opinion is that we likely have far more hospital administrators trying to keep their facilities afloat and people dying because they are terrified to go into hospitals than we do uncounted COVID-19 deaths. If anything, the incentive right now if you’re unsure about the cause of death is to code it as COVID. Any physician or administrator who has been in medicine for more than a few years will understand how medicine bends itself to whatever insurance reimbursement schema is devised.

Leveling with the American and Worldwide Public

The real risk of dying from COVID-19 is coming in consistently at 0.015-0.5%.  If we take the median number, that’s the German data with a risk of dying from COVID-19 of about 1 in 300. Hence, it’s time to begin getting the word out.

Would you accept a 1 in 300 risk of dying? Put in terms of a surgical procedure, if I told you that a new procedure would help you keep walking after an accident and had a 90% chance of success with a 1 in 300 chance of mortality, would you allow that procedure to happen? Let’s say the benefit wasn’t as great or you weren’t as disabled, would you still take the risk? Those are the kind of questions we all should be asking ourselves.

The upshot? This is a bad bug that has caused lots of deaths and overwhelmed selected health systems like Italy and New York. As I have said before, we need to have a heavy heart and a clear mind. However, now that our health systems are ready and testing is ramped up here, it’s time to level with the world that the real fatality rate per infection is not nearly as high as previously reported.

 

https://www.nothingbutthetruthmd.com/2020/05/5520-covid-19-update.html

Good evening,

 

What hath coronavirus wrought?

 

Coronavirus and Healthcare's New Normal

JAMA learning network 5/4/20

Interview with Donald Berwick, MD

 

Dr. Berwick is one of the most insightful individuals I have ever had the pleasure to learn from, be it  by lecture or reading.  He is the past director of CMS and was the President and CEO of the Institute for Healthcare Improvement.

 

Dr. Berwick outlines the choices for the new normal, and they involve all of us, thus are worth briefly presenting. As a society we should have a voice in how this unfolds

 

1.  The speed of learning;

The tempo that has been forced upon us by the virus to learn, has been incredible, as has the cooperation and sharing of information.  The speed at which literature is being disseminated and research being initiated has never been seen before.  There has also been the tendency to make assumptions that we know more than we really do, or to speak loosely about the "facts".To be sure there is a tremendous desire to find traction in some treatment.

 

2.  The value of standard;  

The American culture generates and tolerates a large variation in the utilization of tests and treatments, often without complete informed consent.  The physicians value autonomy and why should they differ from any other citizen who desires the choice of whether or not to wear a mask, and to hell with society.  But we need to approach treatment systematically, we need to ask and learn together.  We need to be able to learn through standardization not just in medicine.  We need to tie ourselves to controlled learning through disciplined method.  Thousands of convalescent plasma treatments at enormous cost, and we know little more than the day we started. Thousands of qualitative antibody tests at enormous cost and no benefit in the improvement of health. These costs will be paid for, they are not free.

 

3.  Protecting the workforce:

It was scary at first but at least many of us knew the possibilities, especially if you trained through HIV,  But what of the policeman, the fireman, the mass transit worker, and the meat packer, just as vital, but they were really thrown into the pit.  You can't tell me a bus driver signed up for this!  We should have done better.

 

4.  Inequity

Madonna had it wrong, she claimed this virus was the great equalizer.  The homeless, the Native American, and the incarcerated were dealt with harshly by this virus, right up there with workers who were left unprotected.  The next time, with better preparation, we need to do better.

 

5. Preparedness for threats

 

We were not prepared, responded sluggishly and did not learn from the responses of countries that had prior experience and were prepared.  Even as this virus spread across our country, states sat paralyzed, as they watched the carnage beginning in California and Washington.  They waited to be informed instead of performing.  Years ago, as a volunteer fireman, our company had fire school every Thursday night, we would prepare for the worst by pretending to fight fires at our tallest , biggest or most complex structures in the little town.   As a member of our County Medical Reserve we train for potential disasters, have stockpiled equipment and supplies,  not if, but when they occur.  What happened at the macro level?

 

Performance of our leadership has not been stellar, they waited for consensus instead of molding it. The CDC and the WHO have disappointed, but can't be abandoned, they must be strengthened, hoping for a better performance the next time.

 

I marvel at the creativity, flexibility and leadership in our Hospital (and many, many others) as they very quickly responded to a crisis not of their own making.  Budgets went to hell, profits out the window, but they served their communities.  Hopefully, the next time, they will not be forced to be so resourceful, preparation will save the day.

 

6. Virtual Care

 

For those of you who dislike visiting a doctor, this must be like a dream come true.  Telemedicine offers efficiency, convenience and is here to stay.  It has substituted social proximity for physical proximity.  Maybe some of you have already experienced this new normal.  Socrates must be rolling in his grave over the absence of touching and examining the patient.  I watched in awe as Dr. Sol Sherry (oral antihyperglycemic fame)  would gently touch the hands, examine the nails, and  scrutinize the sclera, as if reading a book, the words only he could see.  Office visits will no longer be automatic, probably should have happened sometime ago.  Thursday we are sending our Vet a picture of our dogs healing incision.  Wonder what that will cost?

 

Uncovering choices

 

The virus is still here, everytime I hear Covid-19, I think covert.  Hiding in the healthy appearing public.  Who would get up close and personal with someone who looks like they are barely alive?  Every time an individual with no mask, chooses to get close to others with no masks, they are choosing to take a chance at catching the covert virus known as Covid-19.  It won't be everyone, so far only 1,176, 000 have been adversely affected and only 69,000 have died, and it is their choice.

 

Frontline celebration

 

Tonight, if all continues to go well, a 16 year old athlete will be sent home to be with her family, after six grueling days of struggling to breath, a victim of Covid-19.  I am sure she will remember these nightmarish six days of loneliness and fear, the rest of her life.  

 

Frontline

 

393 patients with Covid-19 were admitted to two New York City Hospitals between 3/3/20 and 3/27/20.  60.6% were males, 35.8% were obese and 90% had a decreased lymphocyte count ( a type of white blood cell)

 

Between 3/3/20 and 4/10/20, 130 were intubated, as of 4/10/20 only 43 (31% were extubated), 40 (10.2 % died) 260 (66.2% were discharged, 93 remain in the hospital.

 

 

Numbers:  1800 From the Hopkins website

 

Testing - 7,544,328 (259,150 tests in the last 24 hours)

 

USA - 1,199,238 (up 1.89%, down from 1.95% the day before, 232 fewer new cases than the day before)

 

New York - 321,192 (up 1.5%, up from 0.80% the day before)

 

New Jersey - 130,593 ( up 1.81%, up from 1.20% the day before)

 

Pennsylvania - 53,434 (up 1.117%, down from 3.10%,973 fewer new cases than the day before)

 

Maryland - 27,117 (up 5.58%, up from 2.98% the day before)

 

California - 56,706 (up 2.97%, up from 2.28% the day before)

 

South Carolina -6751 (up 1.8% for the preceding 2 days)

 

Texas - 33,410 - (up2.54%, down from 3.14% the day before, 165 fewer new cases than the day before)

 

World - 3,646,206 (up 2.08%down from 2.20% the day before, 2043 fewer cases than the day before)

 

The projection curves have been reconfigured , at this time they don't have much meaning.  The down slopes are flatter and extend out longer.

 

Thank you for continuing to send this message to new readers.

 

Live Safely

Be Well

44 minutes ago, Mlodj said:

Waiting for the meat panic buying to kick in; although, I think some stores are trying to head it off and are already restricting purchases.

They've had restrictions for quite some time here. Limit 2 chicken, 2 beef, 2 pork. So I've been buying 2 of each  and freezing the extras. We are also doing 2 vegetarian dinners a week to make it last longer. 

 

3 hours ago, Mike030270 said:

What's the word on PA opening up?

It's a slow crawl. This week they opened up public golf courses, some camp sites and any restaurant that can safely keep people seperated like ice cream shops and Rita's. 

4 hours ago, EagleVA said:

Right, here in Virginia we haven't been mandated to wear a masks and thus far I've never worn one and won't wear on unless my job is threatened.

Ladies and gentlemen, I give you exhibit A of we are in our current position, and why places like South Korea, Hong Kong, Taiwan, and Japan are in their current position.  

4 minutes ago, Phillyterp85 said:

Ladies and gentlemen, I give you exhibit A of we are in our current position, and why places like South Korea, Hong Kong, Taiwan, and Japan are in their current position.  

Not really. The cdc changed there stance based on perception, not physical data. Masks still don’t prevent one from getting the infection they prevent one from spreading it. Those countries did not improve infections based on mask wearing. They improved infection based on broad testing and forceful quarantine and tracking. 

20 minutes ago, Lorddevn said:

Not really. The cdc changed there stance based on perception, not physical data. Masks still don’t prevent one from getting the infection they prevent one from spreading it. Those countries did not improve infections based on mask wearing. They improved infection based on broad testing and forceful quarantine and tracking. 

I could be wrong here, but I thought he was making a reference to the general compliance level of the population rather than the masks specifically.  ie the relatively large part of the US population whose natural response to any government guidelines is "F you I won't do what you tell me" regardless.

Seriously... why wear the glasses but not the mask???  Honest question. 

Also, 😂

I’ll stare into the eclipse without eye protection.

I’ll bang prostitutes bareback.

I won’t wear a mask to prevent the spreading of disease.

I’ll eat crap food, like hamberders, all day.

I’ll stay up late tweeting angrily into cyberspace.

Seriously. Who voted for the 13 year old who was allowed to move out on their own?

22 minutes ago, hey suess said:

I’ll stare into the eclipse without eye protection.

I’ll bang prostitutes bareback.

I won’t wear a mask to prevent the spreading of disease.

I’ll eat crap food, like hamberders, all day.

I’ll stay up late tweeting angrily into cyberspace.

Seriously. Who voted for the 13 year old who was allowed to move out on their own?

He called George Conway a moonface last night.  If you told me that the President after Obama left office would be tweeting out racial slurs I never would have believed it.