[BostonCard]

Haven't posted for a while but wanted to check in here. Looks like in typical Cardboard fashion you guys have been on the ball with this.

It's going to get worse, much worse before it gets better.

I think it's probably been emphasized before, but more people will die from other medical causes being unable to be properly handled, than from the virus itself. Will be like Katrina across our country's hospitals. Where I work we are already saving old masks in a bin for later in case we run out and have to sterilize these with lysol and reuse. We are trying to transition as much as possible to telephone and video visits, but not everyone wants tha t, and of course some things need to be seen. Friday however, I saw a young healthy person for a deviated septum, a whole coughing family for a long missed and delayed check on ear tubes, and an 85 year old who wanted earwax cleaned. This going forward I'm sure will be untenable. Will probably have to cancel some OR cases next week. Some can wait without major consequence, but for patients who might have cancer and need a biopsy to know and get treated, it must be horrible to have to wait. Hopefully I can still accommodate these patients, but in NYC and Seattle nonemergency cases are already being cancelled.

Right now our hospital in LA is rumored to have a couple cases. I think this is certainly the tip of the iceberg and the weeks ahead will be bad. Hopefully social distancing is happening quickly and by enough people to blunt the deluge.

I am looking in 20 people's throats a day. I really wish I had an n95 mask to wear, and I really wish our leadership didn't piss away the precious weeks China bought us.

Things I'd like in an ideal world-

1) Enough tests. Automated PCR machines to run them. The reagents to run them. Probably a ways away, but some private labs like quest are finally up and running. Kaiser has had a few drive in tents but still just trial runs. This will be weeks away still. Probably too late to make a big big difference.

2) Enough masks. For everyone to wear in public and especially for health care providers to protect themselves and limit spread of disease. A regular surgical mask may only trap what you're pushing out but everyone doing so, like in many parts of Asia, would help.

3) An antibody assay to assess for possible immunity. In the weeks and months ahead, knowing who has immunity will be really important in putting this all back together. Since many, particularly the young, may not have symptoms, we may not know this. Clarifying if people do develop immunity after exposure will of course be critical, but I think most people with a normal immune system would develop at least partial immunity to a second exposure.

4) Sometime to convince Elon to stop building Teslas in his tent factories and start churning out ventilators.

Stay safe everybody

Thanks for the report dabigv. My thoughts go out to all my colleagues on the front lines. I no longer practice, but I can’t imagine what this is going to be like for my former critical care colleagues. There are three confirmed cases in my local hospital and four others with tests pending. The number of hospital beds in the US has been going down for decades as hospitals squeeze out spare capacity in the name of efficiency.  Unfortunately, that system is not built for resilience, and while you can defer elective cases, run of the mill reasons for hospitalization, like myocardial infarctions or motor vehicle collisions don’t know to wait until after the pandemic passes. Italy has already been in the position of having to decide between two patients who need a ventilator and only one available.  And when healthcare providers start to get sick, it is easy to see how the healthcare system can very quickly become overwhelmed.

Testing is starting to come online, slowly.  A serology test has been developed as well, and that may be able to help, especially in figuring out who is already immune, though there are anecdotal reports of patients becoming re-infected.

Good luck out there.

BC

[BostonCard]

Haven't posted for a while but wanted to check in here. Looks like in typical Cardboard fashion you guys have been on the ball with this.

It's going to get worse, much worse before it gets better.

I think it's probably been emphasized before, but more people will die from other medical causes being unable to be properly handled, than from the virus itself. Will be like Katrina across our country's hospitals. Where I work we are already saving old masks in a bin for later in case we run out and have to sterilize these with lysol and reuse. We are trying to transition as much as possible to telephone and video visits, but not everyone wants tha t, and of course some things need to be seen. Friday however, I saw a young healthy person for a deviated septum, a whole coughing family for a long missed and delayed check on ear tubes, and an 85 year old who wanted earwax cleaned. This going forward I'm sure will be untenable. Will probably have to cancel some OR cases next week. Some can wait without major consequence, but for patients who might have cancer and need a biopsy to know and get treated, it must be horrible to have to wait. Hopefully I can still accommodate these patients, but in NYC and Seattle nonemergency cases are already being cancelled.

Right now our hospital in LA is rumored to have a couple cases. I think this is certainly the tip of the iceberg and the weeks ahead will be bad. Hopefully social distancing is happening quickly and by enough people to blunt the deluge.

I am looking in 20 people's throats a day. I really wish I had an n95 mask to wear, and I really wish our leadership didn't piss away the precious weeks China bought us.

Things I'd like in an ideal world-

1) Enough tests. Automated PCR machines to run them. The reagents to run them. Probably a ways away, but some private labs like quest are finally up and running. Kaiser has had a few drive in tents but still just trial runs. This will be weeks away still. Probably too late to make a big big difference.

2) Enough masks. For everyone to wear in public and especially for health care providers to protect themselves and limit spread of disease. A regular surgical mask may only trap what you're pushing out but everyone doing so, like in many parts of Asia, would help.

3) An antibody assay to assess for possible immunity. In the weeks and months ahead, knowing who has immunity will be really important in putting this all back together. Since many, particularly the young, may not have symptoms, we may not know this. Clarifying if people do develop immunity after exposure will of course be critical, but I think most people with a normal immune system would develop at least partial immunity to a second exposure.

4) Sometime to convince Elon to stop building Teslas in his tent factories and start churning out ventilators.

Stay safe everybody

Thanks for the report dabigv. My thoughts go out to all my colleagues on the front lines. I no longer practice, but I can’t imagine what this is going to be like for my former critical care colleagues. There are three confirmed cases in my local hospital and four others with tests pending. The number of hospital beds in the US has been going down for decades as hospitals squeeze out spare capacity in the name of efficiency.  Unfortunately, that system is not built for resilience, and while you can defer elective cases, run of the mill reasons for hospitalization, like myocardial infarctions or motor vehicle collisions don’t know to wait until after the pandemic passes. Italy has already been in the position of having to decide between two patients who need a ventilator and only one available.  And when healthcare providers start to get sick, it is easy to see how the healthcare system can very quickly become overwhelmed.

Testing is starting to come online, slowly.  A serology test has been developed as well, and that may be able to help, especially in figuring out who is already immune, though there are anecdotal reports of patients becoming re-infected.

Good luck out there.

BC