Medical Discussion of Coronavirus

[PedsCCM]

Well, we're getting killed. Midwest state with overlapping delta and now omicron over the last 4-8 weeks. Delta has crushed us with really sick patients and omicron has wiped out a big chunk of our staff. Thankfully we implemented mandatory vaccines at the beginning of Sept so no staffing changes from that recently. Peds is getting hit really hard (covid + all the other viruses) so we cannot help the adult ICU's this time around. Elective cases are canceled and PACU/cath lab nurses are helping us staff the PICU. Supply chain problems have made central lines and other supplies hard to come by. We haven't had to use expired lines yet (we've come really close...) but we are trimming 4Fr PICC's down to make central lines for the little patients. The frustration and disbelief from patients and families is just another drop in the already full bucket of ************************. There's a ton of skepticism regarding our care but they still come to us - just angrier and more convinced that FB and Twitter holds the Truth and we're incompetent or liars. I cannot imagine what it's like to round in the MICU at this point. Our EM residents tell us the giant academic ED has frequently doubled their capacity - one bed in the room with the other in the hall outside the room. Various state representatives loudly tell the news outlets that we're lying and not as full as we claim. They just never seem to have time to take us up on the offer to tour our hospitals...

[snowcanyon]

Okay, I think everyone would live to live a life free of Covid, but I'm still unclear which people you are accusing of infringing on your freedoms as an individual? People who are against lockdowns? Or the unvaccinated? People who oppose mandates? And what's an example of how these people, whoever they are, are preventing you from being free as an individual?

Well, I'm not free to get care in the hospital. I'm not free to get blood. I'm not free to get monoclonals or paxlovid, because they are only going to the unvaccinated. I'm not free to be free of further mutations of the coronavirus.

[Bellescamp]

Well, we're getting killed. Midwest state with overlapping delta and now omicron over the last 4-8 weeks. Delta has crushed us with really sick patients and omicron has wiped out a big chunk of our staff. Thankfully we implemented mandatory vaccines at the beginning of Sept so no staffing changes from that recently. Peds is getting hit really hard (covid + all the other viruses) so we cannot help the adult ICU's this time around. Elective cases are canceled and PACU/cath lab nurses are helping us staff the PICU. Supply chain problems have made central lines and other supplies hard to come by. We haven't had to use expired lines yet (we've come really close...) but we are trimming 4Fr PICC's down to make central lines for the little patients. The frustration and disbelief from patients and families is just another drop in the already full bucket of ************************. There's a ton of skepticism regarding our care but they still come to us - just angrier and more convinced that FB and Twitter holds the Truth and we're incompetent or liars. I cannot imagine what it's like to round in the MICU at this point. Our EM residents tell us the giant academic ED has frequently doubled their capacity - one bed in the room with the other in the hall outside the room. Various state representatives loudly tell the news outlets that we're lying and not as full as we claim. They just never seem to have time to take us up on the offer to tour our hospitals...

we are getting crushed as well
we have lots of docs out, in addition to nurses and support staff
maybe half the patients (at least) or their families are incredibly hard to deal with. job satisfaction is pretty poor
if i never have to talk about ivermectin or hydroxychloroquine or other bogus treatments again i would be happy
seeing an uptick in admission not related to pneumonia (PE, hyponatremia)
we have had to try antigen testing before PCR due to shortages. these tests are garbage. 3 covids in last 24 hours were negative antigen test

[StarTrekDoc]

Hang in there all -- sending some love from Cali.

I read that the guard are at my old community hospitals back in Michigan earlier because of staffing --- Hard to see all this; harder to hear you all trying and the open hostility that comes with some of these patients' families.

Hang tight.

[snowcanyon]

we are getting crushed as well
we have lots of docs out, in addition to nurses and support staff
maybe half the patients (at least) or their families are incredibly hard to deal with. job satisfaction is pretty poor
if i never have to talk about ivermectin or hydroxychloroquine or other bogus treatments again i would be happy
seeing an uptick in admission not related to pneumonia (PE, hyponatremia)
we have had to try antigen testing before PCR due to shortages. these tests are garbage. 3 covids in last 24 hours were negative antigen test

What part of the country are you in?

[Bellescamp]

What part of the country are you in?

Colorado

[Jaqen Haghar MD]

We generally run first in the waves, and fast…. A few days ago, we started to feel and see the beginning of a slight let up in COVID patients. Our numbers look like we have crested at this point. As of yesterday, 50% of our COVID inpatients are incidental, and admitted for other reasons. Our late summer Delta surge looks like it was worse than this one was, as far as admissions, % of ED visits, and severity of illness.

There appears to be a light at the end of the tunnel. We are restocked with the new monoclonal, so that is flowing freely through the ED again. Omicron is definitely less severe, though we are admitting some with respiratory failure, I still haven’t admitted one yet during this omicron wave, as opposed to the young admits every day during Delta.

Don’t get be wrong, it’s very busy, and I’ve been working almost every day. Staff is short, though everybody in the ED has returned from their mini-COVID vacation.

I now question the utility of massive community testing. It’s everywhere with Omicron. It’s causing more problems, than it is helping. There was an article today saying they predict 80% of the population of Florida will have had COVID by the end of this wave. I think people who are well with colds should just quarantine 5 days, mask up, and assume they have it. The community is now totally overrun with the COVID sniffles at this point.

The hospitals continue to get the beat down as the community goes relatively maskless and wide open. I wouldn’t say we are in crisis mode though, and there is evidence things are rounding the corner.

[burritos]

My wife last week had 1 covid patient on her inpatient team. This week, half of her team are COVIDs, a 46 year old passed last night in the ICU. Non vaxxed. I'll get an update on her day tonight. Seems like things are starting to percolate here in L.A. County.

[burritos]

My wife last week had 1 covid patient on her inpatient team. This week, half of her team are COVIDs, a 46 year old passed last night in the ICU. Non vaxxed. I'll get an update on her day tonight. Seems like things are starting to percolate here in L.A. County.

Tonight, she has more on her team. I asked for details and she didn't want to talk about it. Somehow the freedom seeking covid non vaxxed has put me in the doghouse.

[nephron]

I have a few 40 some year old unvaxxed patients on my service. I don't know about all this data coming out reporting that omicron is that much benign then delta. I don't recall seeing the same percentage of 40-60 year olds as the prior covid waves pre-vaccine. I imagine that is probably due to the higher uptake of vaccine in the 70 plus range though. My icu service is either unvaxxed or transplant, with an occasional elderly 2 shots (missing the "booster"). They really need to stop calling it a booster and rename it a 3/4 shot regimen. "Booster" makes it sound optional.

[HikingDO]

Tonight, she has more on her team. I asked for details and she didn't want to talk about it. Somehow the freedom seeking covid non vaxxed has put me in the doghouse.

So you’re in the doghouse for something that has nothing to do with you? Are we married to the same woman?

[StarTrekDoc]

SD still rocking and rolling : 10-18k daily this past weekend. I thought we had peaked and going down --- nope ~6x delta peak

Hospitalizations steady. 2x delta peak and splitting 60/33/7 unvac/vac/boosted

vent/ecmo - all unvaccinated.

So Omicron by sheer volume is packing up the ED and admissions. Luckily most vaccinated and nearly all boosted do okay with the expected hi-risk ones fighting the good fight. While unvaccinated all over the map and inhouse/intubated/dying.

[Jaqen Haghar MD]

I have a few 40 some year old unvaxxed patients on my service. I don't know about all this data coming out reporting that omicron is that much benign then delta. I don't recall seeing the same percentage of 40-60 year olds as the prior covid waves pre-vaccine. I imagine that is probably due to the higher uptake of vaccine in the 70 plus range though. My icu service is either unvaxxed or transplant, with an occasional elderly 2 shots (missing the "booster"). They really need to stop calling it a booster and rename it a 3/4 shot regimen. "Booster" makes it sound optional.

Not sure where you are geographically, but I thought early on that areas like the Northeast and other areas are clearly having mixed infections of omicron and delta based on what people were reporting anecdotally. They didn’t have the early, massive Delta surge like the south over late summer, and were gloating about it, but they normally surge last.

Their delta surge was still happening at the same time as omicron started hitting, it was just delayed a few months. Now they appear to have the hospitalization of delta with the sniffle volume of omicron.

Today I started seeing mainstream articles reporting that this is likely the case.

I still think places like here, that had massive summer delta are getting off easier right now. Places that didn’t have hospital records day after day in August seem to be getting a double whammy right now.

My theory is also that places that were focused on “slowing the spread” were successful in doing so. But they couldn’t stop the spread. They seemed to have slowed it into the next wave with restrictions, and that next wave happed to be super contagious and impossible to slow, though vaccines are also lessening severity.

It looks like locally we have started on the downslope of this wave, and the hospitalization burden has been less than in August with many more cases. We shall see if it holds.

[White.Beard.Doc]

Not sure where you are geographically, but I thought early on that areas like the Northeast and other areas are clearly having mixed infections of omicron and delta based on what people were reporting anecdotally. They didn’t have the early, massive Delta surge like the south over late summer, and were gloating about it, but they normally surge last.

Their delta surge was still happening at the same time as omicron started hitting, it was just delayed a few months. Now they appear to have the hospitalization of delta with the sniffle volume of omicron.

Today I started seeing mainstream articles reporting that this is likely the case.

I still think places like here, that had massive summer delta are getting off easier right now. Places that didn’t have hospital records day after day in August seem to be getting a double whammy right now.

My theory is also that places that were focused on “slowing the spread” were successful in doing so. But they couldn’t stop the spread. They seemed to have slowed it into the next wave with restrictions, and that next wave happed to be super contagious and impossible to slow, though vaccines are also lessening severity.

It looks like locally we have started on the downslope of this wave, and the hospitalization burden has been less than in August with many more cases. We shall see if it holds.

I would have assumed the same, that Omicron was causing more minor illness, and that Delta might be the sicker ones. But the data doesn’t support that. CDC genomic sequencing surveillance demonstrates that 99.3% of Covid in my region is Omicron 1/2/22 through 1/8/22. So my conclusion is that Omicron causes less severe illness, but not that much less severe.

https://covid.cdc.gov/covid-data-tra...latingVariants

I currently have many Covid patients in hospital. In the first wave, we saw severe pneumonia with profound hypoxemia so frequently. 25% of our admissions were on mechanical ventilation in the first surge in 2021. Now we have 5% on the vent, but not the vaccinated ones, more like 10% of the unvaccinated folks. But these are likely Omicron. Yes, less severe, but still causes bad pneumonia in some.

[White.Beard.Doc]

The situation in our country concerns me. We are all at each other’s throats. We are fighting about everything. What to do with vaccinations, what to do with masks? What to do with quarantines? What to do with school opening? What medicine to give when people get Covid? Who gets scarce monoclonals? Who is stomping on whose rights?

And the media gets everyone all riled up to fight for one opinion over another. Where does all this anger, frustration, and battling with one other lead us? In the lunch room at the hospital, the docs are getting so upset with one another over the politics. It is the same here on this forum. It is the same in Congress. Yes, I am concerned for our future.