Medical Discussion of Coronavirus

[gap55u]

Frankly COVID in the president’s inner circle or himself personally was all but inevitable even with the 100% daily testing he and staffers get. If you don’t socially distance, don’t mask, and go to crowded events you are asking for it. As for the move to Walter Reed, we don’t have details. But I can’t imagine being his doc and saying “yeah, it’s fine to stay at the White House “ pretty major egg on face when your obese septuagenarian with HTN and high cholesterol crumps. Regardless of politics we all should hope for recovery and an end to his anti-science stance against masks.

[Tim]

Not throwing stones at any individual.
The narratives are typically based in support or opposition to individuals, not the intent of the healthcare actions.
•CDC requiring confirmation of tests at the beginning was a problem. I don’t think it was intentional, best available.
•Remember the plastic sheets taped to ceilings?
I specifically referenced the plexiglass hood for use in intubation. Seem far out reach for a solution. Guess what is in every grocery store, Home Depot and restaurants? Plexiglass!
•Masks, the narrative shifts based on opinion not science. N-95’s protect the wearer or others? Public masks protect spreading or the wearer?
Can masks lower the curve or is this going to reduce spread or eliminate it? Is the a standard for masks for the public? The point isn’t the debate, but the narratives are about discussing what is effective and when. It is always directed at individuals.
Hindsight is great, maybe the president should have worn N-95’s. Screw the testing(sarcastic).
Narratives evolve based on the person being attacked, and it changes to fit the desired outcome.
Not one person suggested modifications of existing technology: The Bubble Helmet!

https://airandspace.si.edu/collection-objects/bubble-helmet/nasm_A20150191000

Shoulder harness and an air tube to the waist!
I appreciate that we actually have no solution and I doubt very few are actually trying to cause harm.

[billy]

Not throwing stones at any individual.
The narratives are typically based in support or opposition to individuals, not the intent of the healthcare actions.
•CDC requiring confirmation of tests at the beginning was a problem. I don’t think it was intentional, best available.
•Remember the plastic sheets taped to ceilings?
I specifically referenced the plexiglass hood for use in intubation. Seem far out reach for a solution. Guess what is in every grocery store, Home Depot and restaurants? Plexiglass!
•Masks, the narrative shifts based on opinion not science. N-95’s protect the wearer or others? Public masks protect spreading or the wearer?
Can masks lower the curve or is this going to reduce spread or eliminate it? Is the a standard for masks for the public? The point isn’t the debate, but the narratives are about discussing what is effective and when. It is always directed at individuals.
Hindsight is great, maybe the president should have worn N-95’s. Screw the testing(sarcastic).
Narratives evolve based on the person being attacked, and it changes to fit the desired outcome.
Not one person suggested modifications of existing technology: The Bubble Helmet!

https://airandspace.si.edu/collection-objects/bubble-helmet/nasm_A20150191000

Shoulder harness and an air tube to the waist!
I appreciate that we actually have no solution and I doubt very few are actually trying to cause harm.

I beg to differ about the masks- while nothing will 100% eliminate this disease so far, masks are proven to reduce spread. The people who refuse to wear masks in public, crowded spaces tend to follow one political party, but that doesn't make the science behind wearing masks political.

[Rando]

The press is making a big deal about the recent Rose Garden ceremony, but it seems to me the risk was much greater in the White House offices themselves especially as it appears there was not consistent masking or social distancing. I would also add any other confined spaces such as trips to and from the rallies, "green rooms" prior to going on stage, etc.

[Tim]

The narrative was a Person was infected by not wearing a mask.
You are welcome to state your political narrative as well. I don’t wish this thread to be shut down.
Your plexiglass solution at the beginning was creative. And thank you for your best efforts in your work.

[billy]

trying not to make it political Tim. I respect your opinions. But had the person and everyone around him wore masks more consistently, I doubt we'd be having this part of the conversation. One may have still caught it, but I don't think as many around him would've. I too do not want this thread closed. If i am coming close to having it shut down, can a moderator please warn me.

[Hatton]

Just keep clear of politics and the thread will remain alive.

[G]

The press is making a big deal about the recent Rose Garden ceremony, but it seems to me the risk was much greater in the White House offices themselves especially as it appears there was not consistent masking or social distancing. I would also add any other confined spaces such as trips to and from the rallies, "green rooms" prior to going on stage, etc.

No doubt. But: When was the last time you sat shoulder to shoulder to shoulder at a meeting/conference? I can tell you mine, it was March 4th. Or when was the last time you walked around giving hugs in greeting? Heck, I don't even shake hands anymore.

Dunno. I've said it before, these folks are employees of the American people. I demand better.

And back to the medical discussion, I'm not stoked that my employee is getting experimental treatment or off protocol therapy. Clearly the narrative we have been provided does not fit with the natural history of the disease. Hard not to be dubious.

Perhaps now my patients will stop asking for hydroxychloroquine and azithromycin.

Of course, now they will be asking for the medicines the president is getting.

What a mess.

[StarTrekDoc]

Contact tracing is very important to mitigate and cap the exposure to limit the spread. The hard part trying to find Patient 0 and work from there to track all the exposure arms. It does appear to originate from the ceremony where most likely an outsider brought it in. There were sub-party celebrations and subsequent days on contact of the known positives and those islands really need to be quarantined and watched.

This DOES mean the vast majority of the press corps(three tested positive) and white house should probably ALL be in quarantine: definition: 15minutes of sustained contact (defined as <6') with KNOWN positive. This is regardless of masking or not by definition.

The WH was contemplating of using Essential worker status like medical staff that even with known exposure, okay to work if ASX with daily attestation and masking compliance. If they do, they need to announce this and give the protocol for all the staff to follow adequately.

[Rando]

No doubt. But: When was the last time you sat shoulder to shoulder to shoulder at a meeting/conference? I can tell you mine, it was March 4th. Or when was the last time you walked around giving hugs in greeting? Heck, I don't even shake hands anymore.

Dunno. I've said it before, these folks are employees of the American people. I demand better.

And back to the medical discussion, I'm not stoked that my employee is getting experimental treatment or off protocol therapy. Clearly the narrative we have been provided does not fit with the natural history of the disease. Hard not to be dubious.

Perhaps now my patients will stop asking for hydroxychloroquine and azithromycin.

Of course, now they will be asking for the medicines the president is getting.

What a mess.

Yeah I agree. We are basically talking about degrees of irresponsibility. My previous post was triggered by a CNN TV doctor this AM saying if they were going to design a super spreader event the Rose Garden was how they would do it. Well no, obviously if you wanted a super spreader event you would put it indoors.

Your comments on the president’s treatment brings to mind that celebrities often receive inferior treatment than the average patient. He seems to have been treated based on very shaky evidence.

[Tim]

@G
”Dunno. I've said it before, these folks are employees of the American people. I demand better.

And back to the medical discussion, I'm not stoked that my employee is getting experimental treatment or off protocol therapy. ”

Purely a personal opinion. When an employee has a medical issue, the employer has virtually not right to demand anything. Not a political statement, just a reminder of confidentiality in the workplace. Privacy extends to employees as well as patients.
Small example, health insurance employee surveys for rate determination. It’s not unheard of for targeting an employee group that have individual or family members with preexisting conditions.
May least that is the principle followed based on the 4th amendment.
Not political, one can debate need to know all day.

[StarTrekDoc]

The Rose Garden is approximately 125 feet long and 60 feet wide. Press there said about 150 persons were there - shoulder-to-shoulder; most unmasked and for sustained duration and mingling afterwards -- only thing missing was an indoor contained area. Rose Garden does get quite close to that unfortunately.

Regardless, the recent medical press conference is a perfect example of not to do as a physician. Conley should have walked away way before the steroid question (which indicates president got without answering the question itself given the abrupt ending of the presser --- not that was a wrong choice; but again should be within protocols).

I am glad that Conley did state no HCQ 'at the moment' - doesn't mean he didn't get it Wednesday night on AirForce One.

[Jaqen Haghar MD]

Mostly in march april- since then been doing very well in jersey. combo of: not knowing what to do at the time (intubate early, throwing everything and the kitchen sink at pts), populations not masking or social distancing (commuter areas/workers packed in trains going to PENN or port authority) in the beginning. Since mid may when we started opening back up, numbers reflect a very different story. Anectodally, went from intubating or coding someone daily in march april to not intubating anyone for covid from late may-->2 weeks ago. Take away the time when we were the 2nd earliest area hit, and it tells a different narrative.

quick google search- deaths peaked april 30th in nj (>400 reported that day). Daily deaths in recent months hover around 10 or less

For some reason, the northeast US faired particularly bad in the first couple months. Other areas had cases that started earlier and were initially just as numerous. The Pacific Northwest, Western, Southern states didn’t get the spread though, or the fatality rates.

I’ve thought the spread issue was likely due to population density plus the modes of travel in the northeast urban areas. The fatality rates... I don’t know why they are so high. Other areas didn’t seem to have those high rates, though I can’t find the exact numbers. I imagine it might be obesity/age related, combined with the aggressive treatments used early on, as opposed to the more hands-off treatments now.

NYC’s healthcare system had a particularly difficult time coping with Covid. Despite a 60% decrease in ED volumes, they had lines around the block to get in, and patients hanging from the rafters, and bad mortality rates. I’ve always imagined it was because of an already normally overburdened healthcare system there.

[CordMcNally]

Regardless, the recent medical press conference is a perfect example of not to do as a physician. Conley should have walked away way before the steroid question (which indicates president got without answering the question itself given the abrupt ending of the presser --- not that was a wrong choice; but again should be within protocols).

I am glad that Conley did state no HCQ 'at the moment' - doesn't mean he didn't get it Wednesday night on AirForce One.

I'm not quite sure why they really have those press conferences. They typically give non-answers or don't ever answer the question directly (basically like every other facet of politics) but I also wonder how HIPAA is applied here.

[Tim]

I'm not quite sure why they really have those press conferences. They typically give non-answers or don't ever answer the question directly (basically like every other facet of politics) but I also wonder how HIPAA is applied here.

My guess is patient authorized.
We, the public seem to think we have the “right” to a whole host of answers, when in reality privacy has existed in the past. New “rights” are invented everyday. Mostly curiously and self serving.
John Kennedy was the “picture” of youth and vigor. Photo ops of family football games. Pretty sketchy.

https://www.bostonmagazine.com/health/2017/07/11/jfk-health-problems/

Politics and business are bloodsport.