Medical Discussion of Coronavirus

[nephron]

https://youtu.be/xc63q49T46s

I appreciated the discussion with the RN today on the wci podcast about the care of covid patients. I think that most of us who have been taking care of covid patients have some degree of stress from the large amounts of death we have been seeing and the personal risks we had been taking pre-vaccine just entering patients rooms. I remember early in the pandemic when people around us were either afraid to be around us knowing we had been exposed to covid patients (my in-laws avoided me for about a year which was nice) or generally appreciative of us for going into work while they were staying home. I think that the lack of sympathy or appreciation of healthcare workers these days is the realization that healthcare workers were not subjected to a higher risk then much of the "essential" working population. I may have seen more documented covid people then the grocery store clerk or receptionist, but paradoxically, they were probably at a higher risk with their job because they were exposed when the patients more infective and did not have the luxury of knowing that they were covid positive before donning on more protective gear before entering a negative pressure room. I was highly compensated caring for a large proportion of covid patients while others who were expected to still go into work were not. I still think children, who were not even that susceptible or documented at risk from covid early in the pandemic, were asked to sacrifice the most. I know that mortality is not the only measure of morbidity in children but it seems hard to justify the degree of disruption in children's lives for disease that caused far less death then accidental drowning from January to September in 2021.
https://www.vox.com/22699019/covid-1...lization-death

[Shant]

Kids sacrificed a lot but they also gained from avoiding lingering illness and/or death in their parents or other caretakers as well.

[snowcanyon]

If I was having surgery and could only have the surgeon either wear gloves or wear a mask, I would take the gloves. Wouldn't you?

I haven't searched to see if a study has been done on the comparison, I doubt one exists, but it would be interesting.

In regards to mask wearing. You already noted that the virus is airborne. The biggest benefit of wearing a mask is to prevent droplet spread. With airborne transmission our paper masks are merely theater in that environment. We have the benefit of looking back at over two years of results of different states and countries mandating different levels of precaution regarding Covid. Recent charts show no identifiable difference in death rate and case rate between states that had strict mandates (NY) compared to those with minimal restrictions (FL). In fact, Florida has better numbers than NY and NJ as well as many other states with more strict mask mandates. I'm ready to go back to "normal".

Yes, for surgery, of course. But in clinic? The ER? With immunocompromised patients who literally go nowhere but to the doctor and home? These are not patients who are going to pick up Covid in the grocery store. They need caregivers who are masked- surgical masks are pretty good for source control. I agree since the virus is airborne hospitals need better ventilation standards.

Are you suggesting we get rid of masking in Covid units, too?

Florida has one of the highest death rates in the last six months of any state.

"Getting back to normal" doesn't help the immunocompromised who need medical care.

[StateOfMyHead]

Florida has one of the highest death rates in the last six months of any state.

I didn’t know this but it doesn’t surprise me. What does surprise me is the lack of protective measures in a state with a significant percentage of vulnerable citizens. Just my opinion but I believe lives would have been spared had Florida required indoor masks and encouraged to social distance particularly during surges.

[PWMDMD]

Absolutely. Two way masking is effective in preventing transmission of a disease (diseases) that have an extremely high mortality rate in the immunpcompromised, elderly, renal patients etc. I do agree that N-95s would be preferred over surgical masks, but the data for two way surgical masking are robust.

What are we preventing with routine hand washing that could potentially kill half a million patients a year? E. coli? VRE? MRSA? C. diff?These haven't killed anywhere near as many as Covid.

While it may not be the primary route of transmission for CV-19, you don't think touching fomites covered in droplets containing CV-19 and then picking your nose or touching your food or touching another fomite or touching someone else who could do the same is a possible route of transmission? It seems reasonable to me that the goal should be to in general reduce the bioburden of CV-19 virus that could be transmitted by all possible routes of transmission.

[K82]

Yes, for surgery, of course. But in clinic? The ER? With immunocompromised patients who literally go nowhere but to the doctor and home? These are not patients who are going to pick up Covid in the grocery store. They need caregivers who are masked- surgical masks are pretty good for source control. I agree since the virus is airborne hospitals need better ventilation standards.

Are you suggesting we get rid of masking in Covid units, too?

Florida has one of the highest death rates in the last six months of any state.

"Getting back to normal" doesn't help the immunocompromised who need medical care.

I understand your concern for the immunocompromised but forcing unhelpful measures on everyone doesn't help anyone. Here is a chart of the death rates by state up to this month for the pandemic:

https://www.statista.com/statistics/...s-us-by-state/

As you can see, FL is 18th from the top, below NY, NJ, Mass among others with much stricter mask mandates. TX is even lower on the list. Its becoming more and more apparent that the mask mandates did not prevent disease spread.

As far as masking in Covid units, I think we need to go back to what we have done for decades in dealing with specific contagious diseases in pts in the hospital. I don't think we need to make permanent the science lacking methods that have been forced on all of us. It needs to stop.

[Tim]

Many opinions , very few science based conclusions. Certainly there was misrepresentation and withholding of data for purposes other than reaching scientific conclusions. I have yet to see anyone stand up and simply say, “I changed my mind, I was mistaken.”

[Tim]

https://www.jointcommission.org/-/me...ome-w-faqs.pdf
Masks are still an issue, for patients and healthcare and other places.
Just N95’s, surgical, cloth have morphed into the “source “.
Now it is guidelines or recommendations for minimum (surgical mask) are being used as maximum depending on source. These policies are not based on science, they are opinions.
Could you pre-COVID see anyone telling someone to take off an N95 mask as being dangerous?
Just an example of opinions, not science.

[East coast]

I understand your concern for the immunocompromised but forcing unhelpful measures on everyone doesn't help anyone. Here is a chart of the death rates by state up to this month for the pandemic:

https://www.statista.com/statistics/...s-us-by-state/

As you can see, FL is 18th from the top, below NY, NJ, Mass among others with much stricter mask mandates. TX is even lower on the list. Its becoming more and more apparent that the mask mandates did not prevent disease spread.

As far as masking in Covid units, I think we need to go back to what we have done for decades in dealing with specific contagious diseases in pts in the hospital. I don't think we need to make permanent the science lacking methods that have been forced on all of us. It needs to stop.

genuinely curious, since you are using death rate as a proxy for mask effectiveness - do you not think it different to compare NY, NJ, Mass which were quite clearly the first places significantly hit in the US before masking/lockdowns happened, to FL, which had time to react? Does the data show that same case (FL better than NY/NJ/MA) once you remove that irrelevant (in the context of Mask effectiveness) time period?

[K82]

genuinely curious, since you are using death rate as a proxy for mask effectiveness - do you not think it different to compare NY, NJ, Mass which were quite clearly the first places significantly hit in the US before masking/lockdowns happened, to FL, which had time to react? Does the data show that same case (FL better than NY/NJ/MA) once you remove that irrelevant (in the context of Mask effectiveness) time period?

You can slice and dice the data to mean anything you want. FL also has a much older population, wouldn't they be harder hit just due to that? As I look at all the charts from different states and countries, if all this lock down, mask mandate stuff made any real difference, wouldn't we be seeing marked differences in different locations? And yet, its not there. We have two years of data to look at it. We need to come to grips with the fact that it just didn't make any statistical difference.

[snowcanyon]

While it may not be the primary route of transmission for CV-19, you don't think touching fomites covered in droplets containing CV-19 and then picking your nose or touching your food or touching another fomite or touching someone else who could do the same is a possible route of transmission? It seems reasonable to me that the goal should be to in general reduce the bioburden of CV-19 virus that could be transmitted by all possible routes of transmission.

Not compared to aerosol transmission, no. And I can't find any evidence or cases series or anything showing any amount of fomite transmission. If anyone has any, I'd be interested. It's nearly all aerosol.

[Jaqen Haghar MD]

genuinely curious, since you are using death rate as a proxy for mask effectiveness - do you not think it different to compare NY, NJ, Mass which were quite clearly the first places significantly hit in the US before masking/lockdowns happened, to FL, which had time to react? Does the data show that same case (FL better than NY/NJ/MA) once you remove that irrelevant (in the context of Mask effectiveness) time period?

I remember our first couple COVID cases that came in on my shift the first week of March 2020. They had flown in from Italy. Back then, I think it took us many days (7?) to get results. It turns out the virus is confirmed to have been circulating already in January 2020 in Florida.

https://www.usatoday.com/story/news/...ry/3083949001/

Florida reported it’s first official case March 1st 2020.

I think the earliest confirmed case now in Florida, in retrospect, was December 31st 2019. February 2020 was a bad time for the Super Bowl to be in Florida.

Back in Feb 2020 we didn’t test most people with symptoms. Only travel risk at first. Boy did things change over the next few months.

Florida’s waves preceded the northeast every time once we started looking in earnest.

NY’s first confirmed case was March 1st 2020, though I’m sure it was circulating before that there also.
MA’s first COVID case directly from China was confirmed Feb 1st 2020, and their 2nd on March 2nd 2020.
NJ ‘s first Case was March 4th 2020.

In the first wave, patients in the Northeast seemed to do particularly poorly. NYC had a difficult time. This seemed to be related to problems with their overburdened healthcare system in the setting of population density more than anything else.

[snowcanyon]

I remember our first couple COVID cases that came in on my shift the first week of March 2020. They had flown in from Italy. Back then, I think it took us many days (7?) to get results. It turns out the virus is confirmed to have been circulating already in January 2020 in Florida.

https://www.usatoday.com/story/news/...ry/3083949001/

Florida reported it’s first official case March 1st 2020.

I think the earliest confirmed case now in Florida, in retrospect, was December 31st 2019. February 2020 was a bad time for the Super Bowl to be in Florida.

Back in Feb 2020 we didn’t test most people with symptoms. Only travel risk at first. Boy did things change over the next few months.

Florida’s waves preceded the northeast every time once we started looking in earnest.

NY’s first confirmed case was March 1st 2020, though I’m sure it was circulating before that there also.
MA’s first COVID case directly from China was confirmed Feb 1st 2020, and their 2nd on March 2nd 2020.
NJ ‘s first Case was March 4th 2020.

In the first wave, patients in the Northeast seemed to do particularly poorly. NYC had a difficult time. This seemed to be related to problems with their overburdened healthcare system in the setting of population density more than anything else.

New York has a terrible health care system for all but the wealthiest- not that FL's is great, but New York's is in a class of its own in terms of dysfunction. I agree this was part of the problem, along with crowded housing, transit, and Cuomo's corruption.

[East coast]

You can slice and dice the data to mean anything you want. FL also has a much older population, wouldn't they be harder hit just due to that? As I look at all the charts from different states and countries, if all this lock down, mask mandate stuff made any real difference, wouldn't we be seeing marked differences in different locations? And yet, its not there. We have two years of data to look at it. We need to come to grips with the fact that it just didn't make any statistical difference.

I'm not debating whether or not mask mandates/lockdowns were effective; that's obviously a much longer discussion and one i suspect we agree on.

But I am keenly curious if you had data in the specific context you mentioned (FL death rate being better than NY/NJ/MA as a proxy for "mask mandates werent effective"). One would presume given the spike in the NE pre mask mandate/lockdown that the death rate going back to the start wouldn't be a great data set, so was curious what it looks like if you remove, say the first 2 months, for example. maybe it changes the assertion (FL has a better rate than NY/NJ/MA), maybe it doesn't.

BTW - i was kinda surprised that FL isn't all that much older (definitely older and with more 65+), though NJ is 4x denser, MA 2+x denser, and NY as dense (state, not accounting for NYC well outsize relative to other metro areas in FL) - point is there are a ton of other variables, but I'm just focused on the data you presented.

[K82]

I'm not debating whether or not mask mandates/lockdowns were effective; that's obviously a much longer discussion and one i suspect we agree on.

But I am keenly curious if you had data in the specific context you mentioned (FL death rate being better than NY/NJ/MA as a proxy for "mask mandates werent effective"). One would presume given the spike in the NE pre mask mandate/lockdown that the death rate going back to the start wouldn't be a great data set, so was curious what it looks like if you remove, say the first 2 months, for example. maybe it changes the assertion (FL has a better rate than NY/NJ/MA), maybe it doesn't.

BTW - i was kinda surprised that FL isn't all that much older (definitely older and with more 65+), though NJ is 4x denser, MA 2+x denser, and NY as dense (state, not accounting for NYC well outsize relative to other metro areas in FL) - point is there are a ton of other variables, but I'm just focused on the data you presented.

I don't know how it would affect the results. Like I said earlier, there are a ton of variables in all of this. If you have an interest in slicing up the data for NY depending on when their mask mandate went into effect compared to FL, go for it and get back to us.

I still hold to the fact that when you compare the charts from all the states we see that each state has gone through peaks and valleys related to each variant that are pretty universal. The masks did not make a statistical difference to that outcome. If mask mandates were so effective wouldn't we see definite differences in each state depending on how strict the mandate was? I would sure think so, yet its not there.

Another insanity that is driving me crazy is making all US citizens test negative for Covid to get back into our country when flying home. This is insane. Its not for the safety of the other passengers on the plane because I can get on the plane in the US without a negative test to fly out of the country. Its not to protect our countries border from bringing Covid into the US because I can drive into the US in a car without a negative Covid test. Can anyone explain to me the logic behind this?