Medical Discussion of Coronavirus

[fatlittlepig]

Per current protocols - current guidelines for both dexa and remdesivir is mod/severe respiratory covid. Either the patient qualifies for those parameters or not.
If the pt qualifies, then the patient is deemed pretty severe and warrants intensive monitoring on stabilization through the course of this EUA protocol. Early discharge can be a bit cavalier -- even as it is the WHMedical staff -- do they have 24/7 anesthesia onsite? Allowing for an off-campus photo op -- can certainly meet the cavalier criteria.

If the pt does NOT qualify -- then using these EUA medications off protocol - can certainly be deemed cavalier.

So which is it?

I think you are criticizing his care because you don't like the patient. that's your prerogative, but I think his care was reasonable and appropriate.
I think early treatment with a medication that inhibits the viral polymerase and viral replication (RDV) is wise especially in someone in his age group (He would have gotten RDV at my facility), and I think early treatment with a monoclonal antibody against the S protein is reasonable. In terms of discharge, if a patient is ambulating without dyspnea, and maintaining a normal room air sat, and is afebrile >24 hours, and wants to go home, and has adequate supervision (which obviously he does), AND most importantly "Looks Good", as a hospitalist that's an easy call...

[StarTrekDoc]

Edited -- removing personal political opinion and declarations.

Yet, I check all that at the door medically. I'm there to do the right medical thing for my patient.

Clearly we simply differ on our medical risk tolerances.

[Tyche]

I don't have a bone to throw in this fight but he hates hospitals and I'm guessing is pushing for release as early as possible, even at his own risk.

[Hatton]

This has been a great long running thread. Several of you are getting way too political. Warning you all to keep your politics to yourself.

[xraygoggles]

I don't have a bone to throw in this fight but he hates hospitals and I'm guessing is pushing for release as early as possible, even at his own risk.

I doubt he is leaving just because "he hates hospitals". This is basically his only option if he wants any chance to regain any polling numbers. He can't stay in the hospital for more than a few days - it looks weak and completely goes against the whole alpha-male vibe he tries to desperately project to his supporters.

It is a big gamble though - if he needs to be re-hospitalized due to worsening condition, not only is his health going down the drain, but so will any hope of re-election.

[xraygoggles]

This has been a great long running thread. Several of you are getting way too political. Warning you all to keep your politics to yourself.

I was writing my post while you posted this, but point taken.

[StarTrekDoc]

This has been a great long running thread. Several of you are getting way too political. Warning you all to keep your politics to yourself.

Noted and edited my prior message - my apologies to this. Will try to restrain harder on this thread.

Truthfully trying to keep this medical and seeing what really is standard care outside our institution as patients will be asking and seeking advice on this.

Our center runs quite conservative. Unless you're on a protocol or approved clinical trial, you're not getting anything. I know early on in April people where throwing anything and everything at this before more regimented protocols where adopted and best practices from lessons learned.

So looking for current practices out there - are current protocols for steroid indication too restrictive? Remdesivir will continue to lacking in general given the short supply remains, but is it safe to give partially and dc home on this? I know our system would never do that on an EUA protocol medication, but again we run quite a tight ship that will not deviate from established protocols either --- eg no N95 unless active aerosolizing procedures.

[Kamban]

This has been a great long running thread. Several of you are getting way too political. Warning you all to keep your politics to yourself.

Agree. From my long presence here one clearly knows which side of the aisle one stands and unfortunately that has started to color this thread. More importantly, the back and forth arguing on a point after a certain length gets tiring.

[fatlittlepig]

I doubt he is leaving just because "he hates hospitals". This is basically his only option if he wants any chance to regain any polling numbers. He can't stay in the hospital for more than a few days - it looks weak and completely goes against the whole alpha-male vibe he tries to desperately project to his supporters.

It is a big gamble though - if he needs to be re-hospitalized due to worsening condition, not only is his health going down the drain, but so will any hope of re-election.

I guess that’s one interpretation, or perhaps he feels that he no longer needs to be hospitalized and feels well enough to be discharged.

[fatlittlepig]

I’m not a Trump supporter or a voter, however there has been an enormous amount of schadenfreude with regards to his developing covid and his recovery from covid. I’ve heard numerous people state (not here on this forum) they wish he doesn’t do well, gets sicker etc. Perhaps on a certain base level this is understandable given his actions, however this does not seem to be compatible with the values of a physician. In addition this sentiment has skewed the media and media/medical coverage of his disease and treatment. That’s all. My perspective has always been from the perspective of a physician and not through an emotional or political lens.

[oysterblues]

This trump guy is walking around without a mask after getting discharged from the hospital. The only way to get rid of this virus is to get out the vote.

[gap55u]

I had been hopeful that Trump getting Covid might result in Trump recommending masks and social distancing. Silly me. This is not political, but practical for the safe care of our patients. I also am shocked but not surprised at the White House response to multiple Covid cases among inner circle and the president: no specific direction to staffers until Sunday night; unclear contact tracing; referral of staffers to personal physicians for testing (not White House medical);!no instructions for self monitoring.

The press secretary found out from media that she was a close exposure to hicks, and was of course neither distancing nor masking.

All of this is waaaaay more lax than what would have happened at my hospital system or yours I’m sure. I’m frustrated, regardless of political persuasion - at how lax and irresponsible this response has been.

[SouthernSwanSong]

Lots of politics showing up on this thread. I have enjoyed the conversation. I do not enjoy the politics and do not want this thread shutdown.

[FIREshrink]

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.

I always thought secret service had final say. Historically it was widely reported when the Secret Service refused to allow a president to visit certain locations, typically overseas: visiting the troops, dictating motorcade routes, etc. Was that not true then, is it not true now, or did the secret service in fact approve the performance?

[Tim]

Someone needs to come up with a new dashboard, government imposed restrictions and lockdowns. With the government actions occurring in UK, Israel, France and every different continent and state, there is no way to gather the actions and compare to the covid-19 statistics.
The tradeoff between “lowering the curve” and government mandates requires actual data.
Drilldown to county and school district would be helpful.
It could be “protecting the vulnerable” is the most effective. Just a guess.