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  • Im big on pushing for mask usage, but i agree not when you're in your own car, or outside not around anyone. But you still need one with you for when you go into a store, or a busy street in nyc for example. If you live and walk around no people, dont wear it. If you live and walk in crowded areas, then wear it. But we've seen what happens with the american public when given a choice- most that havent seen the bad covid numbers pile up yet wont wear it anywhere.

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    • I think this thread illustrates perfectly the level of confusion there is going around the US (and probably the world in general) about this pandemic. Here we have a bunch of doctors/healthcare professionals who can't quite agree on what type of PPE is best or if even wearing any at all is useful. Who's to blame? I don't know. But, it certainly doesn't help that we've somehow let this whole thing turn into a political fight. Everyone is basically just doing whatever they think is best for themselves. The problem is that very few are basing those decisions on sound scientific evidence. And I can't blame them. I find it difficult to navigate all of the information being thrown at me every day and I went to school for biology and grad school for medicine and I've been working in the healthcare industry for the last 12 years of my life. How can we expect people like my parents who didn't even go to college to make any sense of it? Answer is, they can't. They have to rely on elected officials should have their best interest at heart. They should be using all of their resources to discuss the best path forward based on advice from researchers and scientists. Is this what's actually happening? Clearly not at the federal level. I think there are some governors who are doing a decent job as best they can, but when the federal government is not really supporting them with a clear, united message, it makes the public distrustful and fed up with it all. It's difficult not to be frustrated with politics in general, but lately it's been crazy.

      Comment


      • Reading about these college professors and school teachers that are balking about the idea of going back to school in the fall. I don't see why no one is proposing just opening the schools and giving the teachers and professors the option of being furloughed if they decide that they do not want to come back to work. That's the problem with the school systems, they are making it seem like the choices are you can either go back to school and teach or continue to stay at home and collect your full salary and benefits while not teaching. If you are going to expect your 70 year old with diabetes to continue to work in the grocery store or walmart in order to collect their paycheck, I don't see why teachers should be on a different playing field. The same thing goes for disney workers protesting the amusement parks opening, I don't have a problem with disney not opening their parks, it's probably not a good idea, but I don't think that people should continue to expect to get paid when they are not working. The money has to come from somewhere.

        https://www.nytimes.com/2020/07/03/u...gtype=Homepage

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        • Interesting forecasts by good judgment project for total us deaths by March 2021 and probability of vaccine:
          https://goodjudgment.io/covid-recovery/#1390
          https://goodjudgment.com/covidrecovery/

          Superforecaster comments on the questions are also interesting.
          Last edited by Dont_know_mind; 07-03-2020, 08:21 AM.

          Comment


          • Originally posted by hightower View Post

            I believe the number one reason the EU and many other countries are doing better at the moment is because their governments let scientists do the talking when it came to the coronavirus. The government stepped aside, put people first (not big businesses), and told everyone what to really expect with this thing. I remember reading what the German Chancellor told the German people early on...something along the lines of, "this virus is coming, it will likely infect 2 out of every 3 people before it starts to subside, and this could take a couple of years or more to achieve" She was blunt and honest and used the best available scientific evidence to decide what to do. The U.S., as we all know, got quite a mixed bag of messages from the White House, and our leader frequently got on Twitter and made bogus claims about beating the virus by Easter or telling everyone we "have it under control." That sort of poor leadership really hurts people, because coming from a person in a place of authority, many Americans actually believe what he says.
            More recently when discussing "re-opening" the economy over there she again used clear scientific evidence to make the decision on how to proceed: https://www.vox.com/2020/4/17/212259...fting-lockdown

            We again, got a completely different message here. What we're seeing now (with cases absolutely exploding everywhere) is simply the result of poor leadership and greed in my opinion. It's really sad. And a lot of people are going to suffer and/or die because of it.
            The “Chancellors” of New York and California seemed to be in favor of keeping things open all the way through St. Patrick’s Day. “We are open, party hard” seemed to be the message. Their “EU” representatives call the travel halt from China “racist”. Rinse and repeat. Meanwhile, “do me a favor” and acknowledge that the “states” in EU have a tremendously different environment. A blanket lockdown would have resulted in cries of a dictatorship. No doubt.
            The doesn’t change the facts that politics were and are completely different and greatly limit the response. I didn’t see any demands for PPE and ICU’s from the EU. Maybe I missed that. How bad is it? We could get a unanimous vote for the sun to rise tomorrow.

            Comment


            • There have been several posts condemning the response of the US to the pandemic and suggesting it wasn't taken seriously and should have been dealt with more severely. I disagree.

              The initial goal stated was to shut things down for a very short period in order not to overwhelm our healthcare system. Our healthcare system was never overwhelmed. Opening things back up was needed and overdue. We all knew that cases would increase as we opened back up. The trajectory of deaths in the US continues to trend down despite a huge increase in the number of cases.

              In my healthcare community I was one of a few Docs who was strongly pushing to open things back up. We had a ton of patients that weren't getting needed care due to being terrified to come to the hospital because of Covid as well as due to our facilities being afraid to open back up. Strokes went untreated, breast cancers and lung cancers were delayed in being diagnosed and treated.

              The other effects of being shut down for several months will take years to assess. There has been a massive cost financially to our country. Suicides and divorces have shot up. The deaths that have and will results from the worsening economic position of families will be real. As the data continues to come out, the actual death rate of Covid will likely be very close to that of the yearly flu, possibly even better. Was the cost of the "treatment" worth the benefit? At this point I don't think so.

              Common sense precautions like distancing, wearing a mask if in a confined public space, self quarantining for high risk individuals will and would have achieved the same results as the overboard shut downs.

              The news and reactions to this pandemic has been extremely political the likes of which I have never before seen. Very sad. Could things have been done better in hind sight? Of course. Do we need more severe lock downs going forward for everyone? No way. My group covers 10 hospitals in our state and we are not even close to being overwhelmed. Are any of you getting overwhelmed?

              Comment


              • Originally posted by K82 View Post
                There have been several posts condemning the response of the US to the pandemic and suggesting it wasn't taken seriously and should have been dealt with more severely. I disagree.

                The initial goal stated was to shut things down for a very short period in order not to overwhelm our healthcare system. Our healthcare system was never overwhelmed. Opening things back up was needed and overdue. We all knew that cases would increase as we opened back up. The trajectory of deaths in the US continues to trend down despite a huge increase in the number of cases.

                In my healthcare community I was one of a few Docs who was strongly pushing to open things back up. We had a ton of patients that weren't getting needed care due to being terrified to come to the hospital because of Covid as well as due to our facilities being afraid to open back up. Strokes went untreated, breast cancers and lung cancers were delayed in being diagnosed and treated.

                The other effects of being shut down for several months will take years to assess. There has been a massive cost financially to our country. Suicides and divorces have shot up. The deaths that have and will results from the worsening economic position of families will be real. As the data continues to come out, the actual death rate of Covid will likely be very close to that of the yearly flu, possibly even better. Was the cost of the "treatment" worth the benefit? At this point I don't think so.

                Common sense precautions like distancing, wearing a mask if in a confined public space, self quarantining for high risk individuals will and would have achieved the same results as the overboard shut downs.

                The news and reactions to this pandemic has been extremely political the likes of which I have never before seen. Very sad. Could things have been done better in hind sight? Of course. Do we need more severe lock downs going forward for everyone? No way. My group covers 10 hospitals in our state and we are not even close to being overwhelmed. Are any of you getting overwhelmed?
                It will be interesting to see actual data. While I will withhold opinion about your final conclusion, your entire statement above is based on just that--unsupported opinion. And that is the whole problem, isn't it?

                I hear the anecdotes about delayed diagnosis and the worse outcomes, but I didnt see a single case of that. In fact, during the lockdown, all I noticed was near 100% actionable CT scans (vs irradiating patients for their bogus symptoms) and 200% higher admission rates by volume (because the worried well decided to see what a night of rest might do as opposed to rushing into the hospital).

                To continue the anecdotes, I have admitted at least one patient per shift the last 4 shifts for CV. (A disease that did not exist 12 mo ago!) The last 2 had RA sats in the 60s. They will be in the ICU probably for weeks (?) but because we have learned more, I didnt intubate them immediately (which I would have done 2 months ago) which saves a ton of resources. We think we have treatment that might work, which we didnt have 2 months ago. I also have masks and respirators and gowns which were in dangerously short supply 2 months ago.

                The shutdown also stopped the ongoing flu and RSV that were still causing problems in terms of missed work and hospital admissions, be sure you add that to your calculations.

                My final comment to you would be that I'm somewhat surprised you would point out the death rates are going down. I hope you are right, but did I miss the update that deaths are NOT occurring a couple weeks AFTER infection? Again, K82, hopefully in 2-3 weeks this is a lot of hot air, but I have a pretty dim outlook of that reality.

                Comment


                • K82 which state? and what specialty? I can say nyc/nj was very much overwhelmed in march/april, completely underwhelmed right now. So we're open for business. Agree different localities can be open at different times as do most on this thread, but disagree that it doesn't require data to assess when and how much to open up. Test more trace contacts wear masks and wash hands.
                  For the suicides is going up - do we have any hard data on that? data that lumps suicides with overdoses and cirrhosis (so not technically an acute cause) shows the rate has been going up for a decade. - Did it jump significantly more in the last 3 months? Psychiatrists please weigh in if you know.
                  At least in my area even during shutdown we were still doing urgent procedures (cancers, transplants, etc). My wife continued her chemo treatments. Did asymptomatic people get screening procedures ? no- but a few months delay shouldn't affect outcomes there.
                  Final thought- I do think the death rate will decrease, but it is still deadlier than the flu. I do not believe it will get to "just the flu" mortality rate unless the virus mutates significantly to a weaker form. As of now its ~50x the flu mortality worldwide and in the US (5% of cases dead so far, pretty much the same for Us and total world). Maybe numbers will change in a month or two if all the new florida/arizona/texas cases survive since we know more and supposedly its a majority of younger people infected.
                  How are the arizona florida and texas docs on this site seeing things? Overwhelmed, underwhelmed or just right in terms of hospital response to covid? curious to hear from you all.

                  Comment


                  • Has anyone seen other illnesses recently? I figured with all this distancing and other precautions that they would be driven to almost zero. However I have seen a handful of patients with fevers via telemed then car side swab come back negative and we just chalked it up to non covid viral infection. Now I am running a N of 1 study with myself as I have had a fever this past week. 2 negative tests so far. And the next person who tells me to get another test might get punched in the nose.

                    Comment


                    • Originally posted by Lordosis View Post
                      Has anyone seen other illnesses recently? I figured with all this distancing and other precautions that they would be driven to almost zero. However I have seen a handful of patients with fevers via telemed then car side swab come back negative and we just chalked it up to non covid viral infection. Now I am running a N of 1 study with myself as I have had a fever this past week. 2 negative tests so far. And the next person who tells me to get another test might get punched in the nose.
                      this week: flu b, strep, herpangina.

                      Comment


                      • Originally posted by G View Post

                        It will be interesting to see actual data. While I will withhold opinion about your final conclusion, your entire statement above is based on just that--unsupported opinion. And that is the whole problem, isn't it?

                        I hear the anecdotes about delayed diagnosis and the worse outcomes, but I didnt see a single case of that. In fact, during the lockdown, all I noticed was near 100% actionable CT scans (vs irradiating patients for their bogus symptoms) and 200% higher admission rates by volume (because the worried well decided to see what a night of rest might do as opposed to rushing into the hospital).

                        To continue the anecdotes, I have admitted at least one patient per shift the last 4 shifts for CV. (A disease that did not exist 12 mo ago!) The last 2 had RA sats in the 60s. They will be in the ICU probably for weeks (?) but because we have learned more, I didnt intubate them immediately (which I would have done 2 months ago) which saves a ton of resources. We think we have treatment that might work, which we didnt have 2 months ago. I also have masks and respirators and gowns which were in dangerously short supply 2 months ago.

                        The shutdown also stopped the ongoing flu and RSV that were still causing problems in terms of missed work and hospital admissions, be sure you add that to your calculations.

                        My final comment to you would be that I'm somewhat surprised you would point out the death rates are going down. I hope you are right, but did I miss the update that deaths are NOT occurring a couple weeks AFTER infection? Again, K82, hopefully in 2-3 weeks this is a lot of hot air, but I have a pretty dim outlook of that reality.
                        I just did a breast bx on a woman in her early 40's who has a mass occupying most of her breast. Her diagnosis was delayed due to Covid, according to her. A neurologist at one of our hospitals told us that his inpatient stroke volume had gone down by 30% after Covid fears started in March. These strokes were still occurring, the patients were not coming in due to fears of Covid.

                        The data that I looked at regarding deaths from the CDC still shows an overall downward trend, albeit with some aberrant days with a spike. I believe the marked increase in cases is due to increased testing.

                        I'm not saying that all is clear and the disease is past. I'm saying that at least in our area our healthcare facilities are not stressed and we should be seeing patients and opening back up. Also, I'm saying we as a country can not shut down due to something like this, the fallout from a lot of other areas that I described far outweighs any benefit.

                        Comment


                        • Originally posted by billy View Post
                          K82 which state? and what specialty? I can say nyc/nj was very much overwhelmed in march/april, completely underwhelmed right now. So we're open for business. Agree different localities can be open at different times as do most on this thread, but disagree that it doesn't require data to assess when and how much to open up. Test more trace contacts wear masks and wash hands.
                          For the suicides is going up - do we have any hard data on that? data that lumps suicides with overdoses and cirrhosis (so not technically an acute cause) shows the rate has been going up for a decade. - Did it jump significantly more in the last 3 months? Psychiatrists please weigh in if you know.
                          At least in my area even during shutdown we were still doing urgent procedures (cancers, transplants, etc). My wife continued her chemo treatments. Did asymptomatic people get screening procedures ? no- but a few months delay shouldn't affect outcomes there.
                          Final thought- I do think the death rate will decrease, but it is still deadlier than the flu. I do not believe it will get to "just the flu" mortality rate unless the virus mutates significantly to a weaker form. As of now its ~50x the flu mortality worldwide and in the US (5% of cases dead so far, pretty much the same for Us and total world). Maybe numbers will change in a month or two if all the new florida/arizona/texas cases survive since we know more and supposedly its a majority of younger people infected.
                          How are the arizona florida and texas docs on this site seeing things? Overwhelmed, underwhelmed or just right in terms of hospital response to covid? curious to hear from you all.
                          I'm in WI. Radiology.

                          A situation we observed early on with this made me wonder about how virulent the disease really is. We had a group of locals go on a Nile River cruise in Egypt and someone on the ship had Covid. 12 people in one of our local communites came down with it early on. They came home and were going about their usual daily activities until they became symptomatic. We thought we were going to see a huge surge related to this since there weren't many cases in WI at that time and these people were going about their usual daily activities. What surprised us was that no one in these folks families came down with it even though they lived with them for days. I know there are incidents out there with a large number of people in a bar getting it from someone, but this early unfolding made me wonder whether shutting everything down over this was the right thing to do.

                          Comment


                          • Originally posted by K82 View Post
                            There have been several posts condemning the response of the US to the pandemic and suggesting it wasn't taken seriously and should have been dealt with more severely. I disagree.

                            The initial goal stated was to shut things down for a very short period in order not to overwhelm our healthcare system. Our healthcare system was never overwhelmed. Opening things back up was needed and overdue. We all knew that cases would increase as we opened back up. The trajectory of deaths in the US continues to trend down despite a huge increase in the number of cases.

                            In my healthcare community I was one of a few Docs who was strongly pushing to open things back up. We had a ton of patients that weren't getting needed care due to being terrified to come to the hospital because of Covid as well as due to our facilities being afraid to open back up. Strokes went untreated, breast cancers and lung cancers were delayed in being diagnosed and treated.

                            The other effects of being shut down for several months will take years to assess. There has been a massive cost financially to our country. Suicides and divorces have shot up. The deaths that have and will results from the worsening economic position of families will be real. As the data continues to come out, the actual death rate of Covid will likely be very close to that of the yearly flu, possibly even better. Was the cost of the "treatment" worth the benefit? At this point I don't think so.

                            Common sense precautions like distancing, wearing a mask if in a confined public space, self quarantining for high risk individuals will and would have achieved the same results as the overboard shut downs.

                            The news and reactions to this pandemic has been extremely political the likes of which I have never before seen. Very sad. Could things have been done better in hind sight? Of course. Do we need more severe lock downs going forward for everyone? No way. My group covers 10 hospitals in our state and we are not even close to being overwhelmed. Are any of you getting overwhelmed?
                            Agree about the purpose of the initial lockdowns - was to prevent potential bed shortages in hospitals.

                            However, it does seem like this second part of the 1st wave is akin to having many NYC outbreaks throughout the US, mainly in the South and West. That may lead to multiple states with hospital shortages, but I guess we will find out in a few weeks or so, when all the young asymptomatic people start infecting their parents and colleagues, leading to increasing hospitalizations and eventual deaths. Hopefully not.

                            But if I had to guess, I don't think the US will be able to maintain control over the virus until there is strong leadership from the federal govt or a vaccine. (although with the rampant anti-vaxxers in social media, even that may not turn out favorably).

                            Comment


                            • Originally posted by K82 View Post

                              I'm in WI. Radiology.

                              A situation we observed early on with this made me wonder about how virulent the disease really is. We had a group of locals go on a Nile River cruise in Egypt and someone on the ship had Covid. 12 people in one of our local communites came down with it early on. They came home and were going about their usual daily activities until they became symptomatic. We thought we were going to see a huge surge related to this since there weren't many cases in WI at that time and these people were going about their usual daily activities. What surprised us was that no one in these folks families came down with it even though they lived with them for days. I know there are incidents out there with a large number of people in a bar getting it from someone, but this early unfolding made me wonder whether shutting everything down over this was the right thing to do.
                              Now that we know more I'm for local data driven opening/closing. In march it was a different story so felt a national response was required so we couldve been like europe now. I hope WI is staying ok with cases (admittedly havent followed WI cases), so I'm not saying your area should be treated the same as florida right now. Hopefully you guys never have to experience the wave, but I distinctly remember friends in florida and texas dismissing covid b/c "it wont survive or spread easily in heat" and well, now they unfortunately have to experience it. Good luck, stay safe, I expect most parts of WI are more sparsely populated than NYC, Houston, etc so that may help too.

                              Comment


                              • Originally posted by K82 View Post

                                I just did a breast bx on a woman in her early 40's who has a mass occupying most of her breast. Her diagnosis was delayed due to Covid, according to her. A neurologist at one of our hospitals told us that his inpatient stroke volume had gone down by 30% after Covid fears started in March. These strokes were still occurring, the patients were not coming in due to fears of Covid.

                                The data that I looked at regarding deaths from the CDC still shows an overall downward trend, albeit with some aberrant days with a spike. I believe the marked increase in cases is due to increased testing.

                                I'm not saying that all is clear and the disease is past. I'm saying that at least in our area our healthcare facilities are not stressed and we should be seeing patients and opening back up. Also, I'm saying we as a country can not shut down due to something like this, the fallout from a lot of other areas that I described far outweighs any benefit.
                                I'm not agreeing or disagreeing with your opinion about reopening. But for every one of the anecdotes you have above, I have a counter anecdote.

                                But your belief that "the marked increase in cases is due to increased testing" is demonstrably false.

                                Comment

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