Medical Discussion of Coronavirus

[PedsCCM]

My best guess is that because he's a VIP he's going to pretty much get everything regardless if he met the criteria or not. This is the part of medicine I hate the most. VIPs routinely get worse care because of stuff like this.

I understand the risk of doing that but I honestly don't think that's what has gone on. From what we can gather I would say the president has gotten the best possible care and the care that I would want. Remdesivir and Regeneron during early symptoms and close to diagnosis to fight viral replication and further direct injury. Dex as soon as he is hypoxemic and requiring supplemental oxygen to blunt the SIRS . My point was that dex seems to be potentially harmful and not helpful in norm-oxic patients but fantastic for patients requiring oxygen - especially good if they have not yet needed intubation. My suggestion was that because of this, we don't need to fight about press conference nuance - if he's on dex, he's hypoxemic QED

[PedsCCM]

So you agree it's a terrible decision? then why would you put someone in that position in the first place, seems very irresponsible.

I believe an exposure is defined by unmasked contact for 15 minutes so the people driving him are not considered exposed.

Kinda looks like your position flips based on who the principal is

[StarTrekDoc]

Close direct contact definition does not delineate mask or no mask. It never was part of the guidance. Only time and distance are the measures.

The two secret service folk are considered positive direct exposures if they were in the vehicle for.more than fifteen minutes.

Now it's up to the physician caring for the two to determine if isolation and quarantine is indicated.

They are by definition essential workers IMHO and if asymptomatic can work while fully masked and asymptomatic with twice a day checks on negative symptoms for forteen days

The issue is again optics and necessity. He's not doing a necessary function of returning to the WH. the prudent thing would be PCR swab negative of pres and confirmed N95 fit test of agents then consider the optics of the photo op.

[fatlittlepig]

He should have wore a n95, not doing so was kind of sketchy.
I do not fault him for wanting to get out of the hospital. I kind of want the president (whomever that may be) to be in a good frame of mind mentally, and if that means he gets to take a 5 minute ride to see some cheering people, so be it.

[StarTrekDoc]

So your Covid patients on dexa and remdesivir are allowed to leave the hospital grounds just because they want to from your medical standpoint. That's okay?.

[CordMcNally]

So your Covid patients on dexa and remdesivir are allowed to leave the hospital grounds just because they want to from your medical standpoint. That's okay?.

Pretending this is a normal patient situation does nothing.

[StarTrekDoc]

Pretending this is a normal patient situation does nothing.

I'm not. I've always said optics matter for our Pres. There's a right way of doing things with the medical condition and a wrong way of doing things. His team did not do it the right way from the medical standpoint in protecting everyone.

Letting a patient go while on dexa and remdesivir and presumed viral pneumonia because of that cocktail is pretty ballsy medical call -especially with the Pres.

Even if the medical unit was 'okay' -
1. Fit test the secret service agents
2. N95 on the pres.

[CordMcNally]

I'm not. I've always said optics matter for our Pres. There's a right way of doing things with the medical condition and a wrong way of doing things. His team did not do it the right way from the medical standpoint in protecting everyone.

Letting a patient go while on dexa and remdesivir and presumed viral pneumonia because of that cocktail is pretty ballsy medical call -especially with the Pres.

Even if the medical unit was 'okay' -
1. Fit test the secret service agents
2. N95 on the pres.

You're still treating it like a normal patient situation. In this situation, the doctors (all military) get their orders from the patient (President).

[FIREshrink]

I understand the risk of doing that but I honestly don't think that's what has gone on. From what we can gather I would say the president has gotten the best possible care and the care that I would want. Remdesivir and Regeneron during early symptoms and close to diagnosis to fight viral replication and further direct injury. Dex as soon as he is hypoxemic and requiring supplemental oxygen to blunt the SIRS . My point was that dex seems to be potentially harmful and not helpful in norm-oxic patients but fantastic for patients requiring oxygen - especially good if they have not yet needed intubation. My suggestion was that because of this, we don't need to fight about press conference nuance - if he's on dex, he's hypoxemic QED

What does SIRS stand for?

[MoneyMoth]

What does SIRS stand for?

Systemic Inflammatory Response Syndrome (SIRS)

[Hatton]

I wonder if the secret service members have had COVID or been vaccinated. All kinds of stuff that we do not know.

[Tim]

I wonder if the secret service members have had COVID or been vaccinated. All kinds of stuff that we do not know.

The question is does anyone actually know what they don't know?
I wish that perfect person would simply speak up.

[StarTrekDoc]

You're still treating it like a normal patient situation. In this situation, the doctors (all military) get their orders from the patient (President).

Dr Girabaldi is not military - He's the lung expert borrowed from Hopkins to drive appropriate medical care.

I don't see in ANY medical rationale where this ride should have been appropriate. It's certainly was not a national security issue.

One can justify this only simply as our President wanted to do it. Which is fine, he's the President -- a spade is a spade. Call it that.

[CordMcNally]

Dr Girabaldi is not military - He's the lung expert borrowed from Hopkins to drive appropriate medical care.

I don't see in ANY medical rationale where this ride should have been appropriate. It's certainly was not a national security issue.

One can justify this only simply as our President wanted to do it. Which is fine, he's the President -- a spade is a spade. Call it that.

The good news is that you don't have to see any medical rationale in the decision because I doubt they're going to ask you. Girabaldi also doesn't get the last say. I don't believe I have made any statements of support of the action (I personally thought it was stupid/pointless but every patient in the hospital wants to go outside all the time), just trying to explain how something like this happens since some people are flabbergasted how something like this could happen.

[hightower]

Media is now hyperventilating about the excursion to greet supporters. Here’s a quote

“Every single person in the vehicle during that completely unnecessary Presidential 'drive-by' just now has to be quarantined for 14 days. They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity," Dr. James Phillips tweeted.

How does Dr Phillips think trump will get back to the White House? Presumably he will eventually leave the hospital and presumably he will not be walking back to the White House. This is just hyperbole. I believe an exposure is defined by unmasked contact for 15 minutes so the people driving him are not considered exposed.

People are justifiably upset that our president would do something that selfish. Although they shouldn’t be surprised that the world’s worst narcissist would put others lives in danger for no apparent reason other than to stroke his own fragile ego. Nothing he does or says shocks me anymore for this reason.

Driving in a car with a known covid pt who is only wearing a piece of cloth on his face is definitely an exposure. Cant tell if the SS have true N95’s on or not but even so, in that closed space it’s still a risk to them. 5% of particles can still pass through and it is probably safe to assume that the air in that car was totally full of virus after that trip.

And I dont care where that 15 minute BS came from. Just ask yourself if you would be cool sitting in there for 11 mins? 5 mins? 14 mins 30 secs? Doubt anyone here would do it for even 10 seconds and not feel anxious afterwards.