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Covid 19 virus inpacts sports, NHL,Season Tix other impacts

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On 3/31/2020 at 9:26 PM, LakeLivin said:

The first covid-19 case reported in the US was Jan 19th.... 

So unless someone was exposed to a "high risk" situation, wouldn't the odds be really high that someone experiencing covid-like symptoms but without severe respiratory distress in Feb was a likely a victim of the common flu rather than covid?  

Good points....BUT, I'm convinced I had it in late February. All the symptoms, but very mild for two days. I still have the dry cough...but it's MUCH better today. I'm a police detective so I see/am exposed to a ot of people. Considering for most people the symptoms are mild or non-existent it seems possible.    

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1 minute ago, Altaholic said:

Good points....BUT, I'm convinced I had it in late February. All the symptoms, but very mild for two days. I still have the dry cough...but it's MUCH better today. I'm a police detective so I see/am exposed to a ot of people. Considering for most people the symptoms are mild or non-existent it seems possible.    

You are high risk for contact.  I believe you.

 

I think once the antibody test gets out there, we're going to be surprised at the exposure population.

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I also had mild symptoms and a dry cough that lasted for well over a month (until two or three weeks ago).  And I'm a substitute teacher, so if I've got PE or the library at a school I could be exposed to over 100 kids in just one day.  But I had something similar last year, before Covid-19 was even out there.  And it seems like it's so contagious that if I contracted it in January or February I'd have passed it on to enough people that some would have likely developed severe enough symptoms that they'd have been diagnosed by now.

 

Given when the virus was first identified in the US, when I think of "high risk" in February I'm thinking exposure to someone recently in China, or someone visiting NYC or Seattle, places where the virus first hit in the US. 

 

I'm certainly not saying it's not possible.  And I do understand the desire to be tested.  I also hope that wxray is right, that we find out a lot more people have already been exposed than we're currently aware of.  You know, because of that Herd it Through the Grapevine immunity thing.  (is there a groan emoji?)

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On 4/2/2020 at 3:07 PM, LakeLivin said:

 

Rem, how are you guys with respect to projected respirator needs?  Do you see potential help by modding those respirators that could allow multiple ptns per machine?  What about BiPAP apnea machines modded for intubation for less severe cases?  And  PPE projections for your hospital?  Just curious as to your feel for equipment given local projections..   

We have had 5 confirmed Covid cases, so in terms of ventilators, we're ok at the moment. Our problem is PPE, especially gowns and masks. The N95 masks are being held back by administration for fear of running out, and even regular surgical masks are being rationed to one per provider per week, which is nuts, but that's where we are. 

 

BiPAP is feared because it is thought to spew virus around the room. 

 

I've been off a few days, but my last shift we were still mostly in the calm before the storm. But as I watch updates from ED docs in New York and California, it's pretty crazy. 

 

Academic docs tend to let the residents to the procedures so they end up intubating a lot less. One attending said he'd intubated more patients in the past 2 weeks than he had in the past 3 years. Intubations are considered by far the most risky procedure for the provider. 

 

We get pretty good at intubations in the ED, especially "crash" emergency ones. But these are special. In addition to doing it with all of the PPE on, and trying not to contaminate yourself or teammates, and doing things in a different room, and a different way, these patients are already severely low on oxygen, and the methods to try to boost that up, like using a bag and mask or the CPAP or BiPAP are virus spewing, so not a great idea. In normal times if a doctor had trouble intubating patients an the patient's oxygen levels start dropping, most patients 02 levels can be brought back up by using the ambu bag and mask hooked up to oxygen, but again, not a great idea here due to virus spewing. Further, these very sick Covid patients drop FAST. So you've got a very short window to get the tube in. Then, as if all of that isn't enough, many of these patients have a peculiar swelling of the tissues of the upper airway, making intubation harder. 

 

The last update I saw the ED doc in NJ just outside of NYC said that basically 100% of their sick patients were Covid positive. 

 

We now see every single patient with mask, gloves and goggles. Even someone with a sprained ankle. Because if we don't, and they turn positive then hospital policy takes every person who contacted them out of work for 14 days. When it ramps up, we'd be out of staff in no time.

 

Running out of PPE and Vents though? That is the whole thing in this pandemic. Everything else we could deal with. 

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On 4/2/2020 at 5:13 PM, remkin said:

We have had 5 confirmed Covid cases, so in terms of ventilators, we're ok at the moment. Our problem is PPE, especially gowns and masks. The N95 masks are being held back by administration for fear of running out, and even regular surgical masks are being rationed to one per provider per week, which is nuts, but that's where we are. 

 

BiPAP is feared because it is thought to spew virus around the room. 

 

I've been off a few days, but my last shift we were still mostly in the calm before the storm. But as I watch updates from ED docs in New York and California, it's pretty crazy. 

 

Academic docs tend to let the residents to the procedures so they end up intubating a lot less. One attending said he'd intubated more patients in the past 2 weeks than he had in the past 3 years. Intubations are considered by far the most risky procedure for the provider. 

 

We get pretty good at intubations in the ED, especially "crash" emergency ones. But these are special. In addition to doing it with all of the PPE on, and trying not to contaminate yourself or teammates, and doing things in a different room, and a different way, these patients are already severely low on oxygen, and the methods to try to boost that up, like using a bag and mask or the CPAP or BiPAP are virus spewing, so not a great idea. If a doctor has trouble intubating patients, their oxygen levels will start dropping. Typically most patients can be brought back up by using the ambu bag and mask, but again, not a great idea here. Further, these very sick Covid patients drop FAST. So you've got a very short window to get the tube in. Then, as if all of that isn't enough, many of these patients have a peculiar swelling of the tissues of the upper airway, making intubation harder. 

 

The last update I saw the ED doc in NJ just outside of NYC said that basically 100% of their sick patients were Covid positive. 

 

We now see every single patient with mask, gloves and goggles. Even someone with a sprained ankle. Because if we don't, and they turn positive then hospital policy takes every person who contacted them out of work for 14 days. 

 

Running out of PPE and Vents though? That is the whole thing in this pandemic. Everything else we could deal with. 

 

Thanks for the update rem.  In a sense many of our medical personnel have become similar to our soldiers in times of conflict; putting themselves at risk for the sake of others.  I hope that most of our "civilian population" realizes and appreciates that.  I was going to say stay as safe as possible, but of course you're already doing that.  I guess the best I can do is wish you luck as this thing works it's way through.

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Current projections have our hospital with 60 ventilated Covid patients on June 1. Our ICU has 18 beds. We have contingency plans for this, but part of our ability to do that is that we have more lead time than say Italy or New York City. The only we will be able to handle that by stopping elective surgery and converting that apparatus to Covid Care, including using anesthesiologists for critical care. (Our hospital has 2 critical care doctors and one is out with quarantine for a covid exposure). 

 

That is why flattening the curve. 

 

On the other hand, apparently the hospitalization models have been way off to the high side. So that's what I'm hoping.

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