Medical Discussion of Coronavirus

[Jaqen Haghar MD]

On covid news:

we hit highest positives since last year -- surpassing Delta surge.
starting to see ED visits bumping up as expected and level of severity creeping up.
hospitalizations so far stable -- still too early -- check back in 1-2 weeks

Bad news:
MAB capacity overrun - triage to highest risks now
oral therapeutics just starting deliveries to county and will take another few days with extreme limits
requests for ivermectin increasing

Yeah, we’ve given thousands of doses on monoclonals through the ED this year, but for this round, we can’t get much. Supply is spotty and intermittent, we might get 100 doses and burn through that in a day or so. Then none. Everywhere in the country is eating it up now.

As far as don’t ask - don’t tell….. are you guys testing asymptomatic workers, you mean? Blatant exposures have been daily and continuous for almost 2 years now. Everyone is walking around with COVID everywhere out there and in here. COVID patients cough forcefully into my face all day, and want to have 20 minute theoretical musings and casual discussions in a closed room.

[StarTrekDoc]

Yeah, we began stocking sotrovimab late Nov/Early Dec but it's been hard to come by with everyone hitting the pot now. It's the nice thing being University and diverse sourcing that allows more access than most other systems.

We're using N501Y mutation to guide MAB therapy. Still tapped out though - fast and furious

For testing - we haven't gone back to weekly screening yet. It's only with confirmed in clinic close contact tracing do we test days 2 and 5 per conventional exposure risks.

[StateOfMyHead]

As far as don’t ask - don’t tell….. are you guys testing asymptomatic workers, you mean? Blatant exposures have been daily and continuous for almost 2 years now. Everyone is walking around with COVID everywhere out there and in here. COVID patients cough forcefully into my face all day, and want to have 20 minute theoretical musings and casual discussions in a closed room.

Most of it is likely coming from community those with family, kids who have it. The email read to me like they are discouraging testing and reporting unless the person is so ill they are not coming in. IDK that was just my impression.

[StateOfMyHead]

Nope. If there are "crisis" standards, infected caregivers are advised to work. Pretty easy for hospitals to invoke "crisis" to avoid sick time.
.

Ding, ding, ding a local hospital has instituted Crisis Protocol.

[zlandar]

I was watching the local news and saw a CDC chart showing the prevalence of Delta vs Omicron. Delta is orange and Omicron is purple:

https://covid.cdc.gov/covid-data-tra...nt-proportions

Pretty amazing Omicron has crowded out Delta in most of the US and especially the SE. Yet I have not noticed any significant uptake in moderate to severe covid cases on CT chest exams from the ED here in GA. When Delta was ticking up earlier this year I was seeing those cases every time I worked an evening/weekend shift.

My anecdotal experience is omicron is significantly less virulent then Delta or the initial covid.

[StarTrekDoc]

Delta absolute counts are slowing down but still quite active so can't simply ignore it. There's been an explosion of Omicron. I do wonder if Omicron will overpower Delta completely or have two circulating variants like Influenza A+B.

[shady]

I'm glad to report there are still non-COVID respiratory pathogens that can make you feel rather miserable. I've been sick since Monday - progressively worsening. Have COVID tested 3 times - Monday, Wednesday, Friday. All negative. Flu A/B negative on Saturday as well. I was under the impression that if you were sick it was almost sure to be COVID or Influenza, but I'm outside of primary care so not sure how many people with respiratory symptoms have COVID or Flu vs more benign viruses. Messed up Christmas plans but thankful to not have to miss a bunch of work.

[StarTrekDoc]

Rsv very much active

[Lordosis]

Oh yeah I forgot to circle back. We are all covid neg. No rush or flu either. Just daycare crud. And everyone is better now!

professionally I have been seeing a lot of random viral illness. Lots of negative tests. Unfortunately lots of positive tests as well. Much more illness this winter compared to last.

[Jaqen Haghar MD]

Well, today most of the people with malaise or headache, and all of the people with URI symptoms were COVID Positive (triple vaccinated, double vaccinated mostly. 1-2 unvaccinated). Some abdominal pains positive. Zero admits for any of these for me though. Just a couple COVID admits in a COVID tidal wave in the ED today overall.

Omicron seems very contagious. Nurses and residents are out in big numbers now, with the sniffles/ COVID+. Staffing is becoming an issue. Seems to be very, very clustery in home/work contacts.

A bunch of patients had negative homes tests with cold symptoms and gathered for the holidays and parties, but were PCR positive in the ED today, so I expect it will get worse after the holiday.

This Omicron wave has its own pattern, different from the young, unvaccinated COVID admits of delta. Predominantly sniffly, well folk. Fair amount of bad headaches.

[doctorbone]

Why are these patients coming to the ER? To get a Covid test or are they worried about getting sicker at home?

I wouldn’t go to the ER just for a headache or URI symptoms. It seems like very few people who come to the ER are getting admitted. Do they just want reassurance?

[CordMcNally]

Why are these patients coming to the ER? To get a Covid test or are they worried about getting sicker at home?

I wouldn’t go to the ER just for a headache or URI symptoms. It seems like very few people who come to the ER are getting admitted. Do they just want reassurance?

It depends. Everything has been so sensationalized to the nth degree that they think they’re dying because they think COVID is a death sentence. I’ve had several that were too scared to be alone. Granted, one was 80 but in otherwise good health. Given education, reassurance, pulse ox on her first visit with instructions on how to use it, etc. yet still had 5 visits within 48 hours. She would leave one ER and immediately go to the next. Many come in because they need a COVID test to return to work. Even if you think the healthcare literacy in this country is low, it’s lower than that.

[Tim]

Why are these patients coming to the ER? To get a Covid test or are they worried about getting sicker at home?

I wouldn’t go to the ER just for a headache or URI symptoms. It seems like very few people who come to the ER are getting admitted. Do they just want reassurance?

“Much more illness this winter compared to last.”

Just an observation that “fear of Covid” seems to have mutated as well and society mobility has ramped back up.
Phase 1A- those that wanted vaccines and couldn’t get it, are still altering plans and behaviors. Fear of the unknown.
Everyone below in the priorities, were in groups that mobility and gatherings were restricted. The unrestricted gatherings were still taking place.
Under 65 and healthy? Every normal activity possible is now being used as back to normal.
Businesses, entertainment, sports and life are no longer fearful of Covid. No one cares to restrict mobility to prevent spread. The attitude is “stay home” only if I test positive.
Businesses are now balancing restrictions based on operating (profit, not health).
Radio City Music Hall, Cirque du Soleil, NFL, NBA, bowl games, restaurants, theaters, gatherings, cruise lines and hospitals are basing decisions on “Can we pull it off?”.
“Fear of Covid” is dead for much of society. Moving on, for better or worse.

Visits to ER for non emergencies is back!
They only wear masks because the ER makes them. Not because of any other reason. They never cared before and they don’t care now. You got Covid is much better news than you need an operation.
Fear of Covid is dead. It is what it is.

[FIREshrink]

My anecdotal experience is omicron is significantly less virulent then Delta or the initial covid.

Do we, you, have enough cases of omicron in COVID naive patients to compare? What percent of patients with omicron today never contracted any Covid variant and have never been vaccinated?

How much less virulent is it?

We all want this to be true!

[Jaqen Haghar MD]

Why are these patients coming to the ER? To get a Covid test or are they worried about getting sicker at home?

I wouldn’t go to the ER just for a headache or URI symptoms. It seems like very few people who come to the ER are getting admitted. Do they just want reassurance?

1) For someone to confirm it’s COVID.
2) To be 100% cured, absolutely and immediately.
3) To relieve any and all discomfort.
4) To be admitted so no one at home catches it.
5) For a work note.
6) For an explanation of why they are so tired.
7) Because their family member was just here, and told they had COVID.
8) for IV Monoclonal treatment (We’re out )
I could go on….

Dont get me wrong though. We welcome any and all patients, no matter how minor. Swab n’ homes are very quick visits for the walking well.

If there’s one thing we learned in the first original wave, and our one and only area shutdown, (while cutting everyone’s shifts to 1/3rd time) it’s that we will happily see anyone for anything. We don’t ever want to see the Spring 2020 lack of volume again.

COVID patients, even those in respiratory failure, are pretty straightforward. It’s not normally a huge diagnostic or treatment dilemma downstairs.