in North Dakota

[OutsiderFan]

I would be very interested in who provides that service . . . and others here might as well.   Can you post, or PM me that info?  

I work in a high-importance setting where full-time WFH is not particularly feasible. We also have some at-risk higher ups that need to be protected at all costs. As a result, our workplace provides free at-home tests delivered to our doorstep whenever we like. Tests arrive a day after we request them, self-administering it takes 30 seconds, we can drop it in the Fed Ex box, and we get the results back by (usually) the end of the following business day. It's a very efficient process and one that, costs aside, should be rolled out as far and wide as possible.

WellConnectPlus is the gateway but best as I can tell, it's all operated by LabCorp. You log in, order a test, they ship it, you take it, you return it, they give you the rests. Notably, I'm still waiting on the lab result from the test I shipped on Thursday - typically I get an result by the end of the business day after I ship it. So it's possible LabCorp is starting to experience delays too. And it's too bad, because the longer the wait, the less useful the testing becomes. Still, I'm grateful: our system is about as easy and seamless as I've heard possible.

Is this a PCR test or antigen test?

[2006alum]

Is this a PCR test or antigen test?

PCR. Goal in my org is to squash any COVID before it starts, so immunity is not as important as actively monitoring anyone for signs of infection. In theory, we're all getting tested weekly, regardless of symptoms, and there's also various protocols (that vary to some degree) among the sub-units in terms of social distancing, rotating who's in the office, plexiglass barriers between desks, etc. Fortunately we also have private outdoor space which greatly facilitates the capacity for meetings and (small, abbreviated) social mixers/lunches. But everyone here is assuming a fully vaccinated and therefore relatively "back to normal" workplace is a year out, so the goal is sustainable mitigation in the interim. 

And I think it's largely been a success: while occasionally annoying, our protocols are neither overly disturbing to maintaining an efficient workflow nor dampening our org's morale in any non-necessary ways. The only question is how easy it is to maintain this in the heart of winter, where meeting outside is just not comfortable, but we're now investigating outdoor heating options to make short meetings viable over the next 3-4 months.

[dabigv13]

https://www.usatoday.com/story/news/heal...237635002/

ND, the worst place in the world in terms of covid prevalence, finally gives in and orders a mask mandate. I guess once it gets bad enough, everyone eventually gives in when the healthcare system is buckling. Since we know how the pandemic works, its the height of ignorance and stupidity to wait for that to happen. 

On the topic of frequent, routine testing, I have yet to get a covid test, and I look inside people's throats, while they often cough, about 50 times a week. Of course I am wearing a (6 month old) n95 and faceshield. My nurses wear n95 masks generally, but some just use surgical masks. Everybody in the hospital wears a mask. Most departments it's just surgical masks. No outbreaks in our facility, and the staff covid prevalence is half that of the community. There is no regular staff testing, just if symptomatic.

IMHO, if masks are used at all times and social distancing measures are followed, regularly testing in an organization or for individuals is not necessary, but maybe a nice peace of mind thing. If testing isn't daily, and not coming back within a day, probably just theater in terms of stopping an outbreak in a setting that is lax with masks or distancing. And if you aren't lax, then an outbreak is unlikely anyway.

Now, streamlined and quick testing if symptomatic is critical and if an organization can offer that, then great. My skepticism is more with a weekly or monthly sort of screening setup.

[Goose]

IMHO, if masks are used at all times and social distancing measures are followed, regularly testing in an organization or for individuals is not necessary, but maybe a nice piece of mind thing. If testing isn't daily, and not coming back within a day, probably just theater in terms of stopping an outbreak in a setting that is lax with masks or distancing. And if you aren't lax, then an outbreak is unlikely anyway.


Now, streamlined and quick testing if symptomatic is critical and if an organization can offer that, then great. My skepticism is more with a weekly or monthly sort of screening setup.

For what little it's worth, I totally agree with your thinking here. This virus has the very unfortunate attribute of rending you contagious before you feel sick. Periodic testing helps this situation only by random chance, and generally not at all if the test results take two or more days to arrive. All the exposed people still must quarantine. The precautions taken by your facility provide the best defense possible. People who have symptoms should assume it is COVID-19 until proven otherwise. That is really all that can be done.

[OutsiderFan]

I saw Dr. Vin Gupta last week saying masks are no longer enough when there is exponential spread. They are better than nothing, but the curve isn't gonna be flattened by them when we have so much infection in the population.

Positive test rates over last 7 days according to Johns Hopkins:

South Dakota: 62.6%
Iowa: 58.5%
North Dakota: 12.8%

That North Dakota percentage is really hard for me to believe given that state has the most infections per capita in the world, greater than any other individual country.

[Goose]

I saw Dr. Vin Gupta last week saying masks are no longer enough when there is exponential spread. They are better than nothing, but the curve isn't gonna be flattened by them when we have so much infection in the population.

I can't imagine why anyone would ever think that by themselves masks were "enough". We don't have any evidence that was the case. The study BC posted that attempted to measure the impact of a mask mandate in Canada came up with a 25% reduction in Reff. That is a help. but it doesn't drive it to zero. If the value without masks is 1.5, the value with masks would be 1.275 (if the study is correct), still > 1. FWIW, we always have "exponential" spread. If the exponent (Reff) is < 1, the result is a net decrease over time, but it is still exponential.

[teejers1]

I saw Dr. Vin Gupta last week saying masks are no longer enough when there is exponential spread. They are better than nothing, but the curve isn't gonna be flattened by them when we have so much infection in the population.

Positive test rates over last 7 days according to Johns Hopkins:

South Dakota: 62.6%
Iowa: 58.5%
North Dakota: 12.8%

That North Dakota percentage is really hard for me to believe given that state has the most infections per capita in the world, greater than any other individual country.

With so few residents, ND stats can vary wildly in a short period of time.  Most infections per capita doesn't mean a lot, imo, for a sparsely populated state.  And if a bunch of them got it more than 7 days ago, the positivity rate in last week could be pretty low w/o affecting "the honor" of most infections/capita.

[BostonCard]

Here’s a dispatch from South Dakota.

BC

[dabigv13]

Conservative media, along with our fearless leader of course, has blood on its hands for misleading these folks.

[BostonCard]

El Paso has been flashing warning signs for a while.

But large parts of the country are headed in this direction, sadly.

BC

[82 Card]

Conservative media, along with our fearless leader of course, has blood on its hands for misleading these folks.

However this mental illness was induced, is there any way to break the spell?

---

Video from nurse who worked NYC in March and is in El Paso now. It's pretty raw. You probably want to advance the video beyond the initial setup.

Out of all the COVID assignments I’ve been on, this is the one that’s really left me emotionally scarred. The facility I’m at has surpassed the one I was at in New York.

[M T]

I have yet to get a covid test, and I look inside people's throats, while they often cough, about 50 times a week. Of course I am wearing a (6 month old) n95 and faceshield. My nurses wear n95 masks generally, but some just use surgical masks. Everybody in the hospital wears a mask. Most departments it's just surgical masks. No outbreaks in our facility, and the staff covid prevalence is half that of the community. There is no regular staff testing, just if symptomatic.

IMHO, if masks are used at all times and social distancing measures are followed, regularly testing in an organization or for individuals is not necessary, but maybe a nice peace of mind thing. If testing isn't daily, and not coming back within a day, probably just theater in terms of stopping an outbreak in a setting that is lax with masks or distancing. And if you aren't lax, then an outbreak is unlikely anyway.

Now, streamlined and quick testing if symptomatic is critical and if an organization can offer that, then great. My skepticism is more with a weekly or monthly sort of screening setup.

I know I speak for all of us when I say we all DO appreciate the care you and the other health caregivers give, and (to some level) appreciate the personal risks each of you take.

Your personal story of exposure and no apparent illness is one of the more encouraging things I've heard.  However, since you've had no testing (which I presume means no antibody testing), I don't think you can know whether you had an asymptomatic case (or a very mild one) and are staying well now due to immunity from that.  (I also don't know whether immunity can be gained from constant but very low exposure, without ever having an infection.)

Regarding the weekly or monthly testing of people at risk of exposure, I'd think of it as doing sampling of an at-risk population to understand infection levels (and thus, the level of risk), rather than an abatement measure designed to prevent spread.

If 100 MDs that are being exposed like you were being tested once a month, it would catch about 1/3 of the cases (10 days/30 days).  If zero of them are testing positive, then I'd think the likelihood is that your PPE & Procedures are doing a great job at preventing you from getting infected.  If 1/3 of those without antibodies are testing PCR positive, then I'd say it wasn't helping much.

[dabigv13]

A couple of my partners and my wife have had antibody tests, and have all been negative. It wouldn't change my behavior, so I haven't gotten one, but I could if I wanted to. Asymptomatic infections do happen (truly asymptomatic I think are the definite minority), but if I caught it, odds are good my family would too, and they'd have to all be asymptomatic as well then.

In any case, the lack of outbreaks is the critical thing. Anybody can get it in their personal life if they aren't careful but as long as it doesn't transmit at the workplace, that is what matters. And up to this point in the pandemic, not something we have seen.

Knocking on wood here, and hopefully the vaccine cavalry comes soon, but I think enforced universal masking goes a very long way to reducing transmission. And wear an n95 if another person in the room doesn't have a mask on.

[BostonCard]

Another dispatch from the warzone.

Some skepticism is always warranted on anecdotal claims like this, but still.

BC

[BostonCard]

Hospitalizations in the Dakotas are above 500 per million peopel.  North Dakota has 2003 staffed beds in the entire state (a state with 760,000 people).  By my math, one out of every four beds in ND are occupied by a patient with COVID.  SD (population 884,000) has 2741 staffed beds, or 3100 beds per million people, so about one in six beds in the state are occupied with COVID patients.

BC

[old spanish trail]

Hospitalizations in the Dakotas are above 500 per million peopel.  North Dakota has 2003 staffed beds in the entire state (a state with 760,000 people).  By my math, one out of every four beds in ND are occupied by a patient with COVID.  SD (population 884,000) has 2741 staffed beds, or 3100 beds per million people, so about one in six beds in the state are occupied with COVID patients.

BC

Jeeezus.

[magnus]

It's already too late to prevent the currently infected from getting proportionately hospitalized,  let's hope people are paying attention so that the next "batch" is drastically smaller.

[BostonCard]

Another dispatch from the warzone.

Some skepticism is always warranted on anecdotal claims like this, but still.

BC

It turns out maybe a lot of skepticism is warranted:

https://www.wired.com/story/are-covid-pa...-they-die/

I called a number of hospitals in the same part of South Dakota to ask emergency room nurses if they’d noticed the same, disturbing phenomenon. At Avera Weskota Memorial Hospital, about 20 minutes from Doering’s hometown of Woonsocket, an ER nurse told me, “I have not had that experience here.” At my request, Kim Rieger, the VP for communications and marketing at Huron Regional Medical Center, one of the four medical facilities where Doering works, spoke with several nurses at Huron to get their reactions to the CNN interview. None said they’d interacted with Covid patients who denied having the disease. “Most patients are grateful, and thankful for our help,” one told her. “I have not experienced this, nor have I been told of this experience, ever,” another said.

This in no way means that Doering’s account is untrue. But it provides, at minimum, some important context that was completely absent from the CNN interview and from all the media amplification that followed. Little or no effort was made to assess the scope of the problem that Doering so memorably described. How many Covid-19 patients in South Dakota are really so blinkered by disinformation that they're enraged at their caregivers and, in their final moments on earth, still dispute what’s happening? No one bothered to find out.

I regret posting the tweet.  Stopping to think about this, and based on my own experience, I think it is likely that the majority of patients (generally, haven't treated COVID-19 patients in South Dakota) are, as Huron notes "Most patients are grateful, and thankful for our help." That's not to say that Doering's experience couldn't have happened; there are always exceptions, but that it likely isn't representative.

BC

[dabigv13]

I have yet to get a covid test, and I look inside people's throats, while they often cough, about 50 times a week. Of course I am wearing a (6 month old) n95 and faceshield. My nurses wear n95 masks generally, but some just use surgical masks. Everybody in the hospital wears a mask. Most departments it's just surgical masks. No outbreaks in our facility, and the staff covid prevalence is half that of the community. There is no regular staff testing, just if symptomatic.

IMHO, if masks are used at all times and social distancing measures are followed, regularly testing in an organization or for individuals is not necessary, but maybe a nice peace of mind thing. If testing isn't daily, and not coming back within a day, probably just theater in terms of stopping an outbreak in a setting that is lax with masks or distancing. And if you aren't lax, then an outbreak is unlikely anyway.

Now, streamlined and quick testing if symptomatic is critical and if an organization can offer that, then great. My skepticism is more with a weekly or monthly sort of screening setup.

I know I speak for all of us when I say we all DO appreciate the care you and the other health caregivers give, and (to some level) appreciate the personal risks each of you take.

Your personal story of exposure and no apparent illness is one of the more encouraging things I've heard.  However, since you've had no testing (which I presume means no antibody testing), I don't think you can know whether you had an asymptomatic case (or a very mild one) and are staying well now due to immunity from that.  (I also don't know whether immunity can be gained from constant but very low exposure, without ever having an infection.)

Regarding the weekly or monthly testing of people at risk of exposure, I'd think of it as doing sampling of an at-risk population to understand infection levels (and thus, the level of risk), rather than an abatement measure designed to prevent spread.

If 100 MDs that are being exposed like you were being tested once a month, it would catch about 1/3 of the cases (10 days/30 days).  If zero of them are testing positive, then I'd think the likelihood is that your PPE & Procedures are doing a great job at preventing you from getting infected.  If 1/3 of those without antibodies are testing PCR positive, then I'd say it wasn't helping much.

Wanted to add another anecdote in support of the value of universal masking. A friend who works as a hospitalist in a west coast academic center caught covid from his family. Worked for two days before having a slight cough and his sister and her family started to have symptoms as well. He tested positive, his hospital contact traced over a hundred nurses, residents, patients, other staff he was in contact with and tested them at 1 day and 5 days after exposure. All negative. Just regular surgical masks and as much social distancing that's feasible in a hospital setting. 

Luckily he's mostly fine, just with some persistent smell and taste disturbances.

[BostonCard]

When I was a resident, I had a patient who was profoundly immunocompromised because of treatment for lupus.  Turns out, she got TB, and her outside physicians kept bombing her with steroids thinking it was her lupus flaring, which of course made her TB worse.

She came to our hospital, where she stayed for almost three months until her TB cleared.  During that time, she never developed any hospital acquired infections, because, of course, anyone who went into her room was gowned and gloved (and wore an N95 mask, since TB is airborne spread).

She cleared her TB after two months of treatment and was deemed non-contagious, so contact precautions were taken down.  Within a week, she developed VRE, likely transmitted to her via a nurse, doctor, or tech.

BC