Category: Coronaplague

“Health Care Workers Plead With Americans To Take Pandemic More Seriously” (NPR):

Health workers and hospitals already strained by the pandemic are increasingly making direct appeals to the public with open letters, asking people to mask up and stay at home this holiday season.

I was chatting this evening with our stealth author of Medical School 2020. He’s working 12-hour shifts at a hospital where roughly 8 percent of the beds are occupied by COVID-19 patients. “Remember that if someone comes in with appendicitis and happens to test positive, they become a ‘COVID-19 patient’ in our census,” he said.

How seriously do frontline health care workers take the pandemic? Our mole in the system described a doc and nurse couple electing to take a mid-November vacation in Aruba. They got on a flight that was 100-percent full, thus voluntarily spending hours sharing a narrow cylinder of air with 150+ other humans. When they got off the plane, they were subjected to screening questions by the Aruban authorities. Instead of admitting that they worked in a hospital every day, they said that they “worked in biochem.” On reaching the (packed) resort, they said “The majority of the other guests were health care workers” (i.e., there were additional hundreds of doctors, nurses, etc. who had chosen to take the risk of contracting COVID-19 at the jammed airports or on the full flights).

(Separately, should COVID-19 patients be in the hospital to begin with? It is not like having a heart attack or getting into a car accident where the doctors have effective treatments to offer. Why aren’t they at home with an oxygen bottle and a CPAP machine or high-flow nasal cannula? A med school professor friend:

Many things could be done from home cheaper and safer but we don’t have the infrastructure or culture. Home model kills the rationale for the hospital cash cow.

Our Medical School 2020 author:

I agree that outside of severe Covid, most of the interventions can be done at home — we send patients home with up to 5 L O2 for bad COPD. It somewhat reminds me of the slow transition from inpatient to outpatient management for other conditions, e.g., deep ventous thromobosis (“blood clots in the legs”) that now is managed with oral blood thinners at home instead of in the hospital. … There are really only a few interventions that we do for covid19 — low and high flow oxygen supplementation, noninvasive (think CPAP) or invasive mechanical ventilation, steroids (actually a good intervention for mechanically ventilated patients — 30 vs 40 percent 1-month mortality) and remdesivir (only benefit shown in low O2 patients with decrease in hospital stay of 10 vs 15 days in small study). … I agree that the only difference for non-severe covid infections between home versus inpatient is just getting telemetry monitoring and daily labs in the hope of catching worsening pulmonary function or prognostication of the weird complications of covid (e.g., heart attacks, blood clots). Unsure of our prognostic ability to guess who will worsen versus who will improve early on in the course (uptodate states the shortness of breath from covid19 occurs up to 8 days after symptom onset). Perhaps utilizing some Apple Watches and Fitbits over those 8 days might save some hospital beds.

See “A Covid-19 Lesson: Some Seriously Ill Patients Can Be Treated at Home” (NYT, July 18) for a story about a hospital that innovated.)

Is #StayHomeSaveLives the new #TakeTheBusSaveThePlanet? Classically, everyone agrees that it would be a good idea if other people took the bus or the subway, thus reducing traffic congestion and pollution.

From the official Aruba tourism site:

(I would love to go right now, but despite my reputation for skepticism regarding coronapanic, I would not voluntarily get on a commercial airline with all seats full.)

Related:

• “California lawmakers head to Maui with lobbyists despite pandemic, travel warnings” (Politico): Roughly 100 people from four states converged at the Fairmont Kea Lani for a four-day legislative conference organized by the Independent Voter Project, said the group’s chair and executive director, Dan Howle.

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Text message exchange with a couple of 24-year-olds:

• Me: We can come over now.
• Them: We are at the gym!
• Me: You’re always there. I am amazed you haven’t gotten coronaplague yet!
• Them: Hahaha I know! The gym we go to is super clean.

Surface contamination has been ruled out as a significant source of coronavirus infection, right? (see below, however, for how cleaning can cut flu risk by 2 percent) Everyone agrees that it is now mostly about aerosols and therefore a gym is a perfect environment for spreading, yes? (People breathing hard and relying on non-N95 masks and/or bandanas as PPE.)

Masks make people complacent and prone to ignoring instructions to keep a 6′ distance. I wonder if the sight of workers with spray bottles and paper towels has the same effect. These 24-year-olds feel that they are significantly less likely to get infected because they’ve seen every surface being wiped, despite the fact that wiped surfaces are irrelevant when faced with an aerosol enemy.

Related:

• “Transmission of Influenza A in a Student Office Based on Realistic Person-to-Person Contact and Surface Touch Behaviour” (2018): “Regular cleaning of high-touch surfaces, which can reduce the infection risk by 2.14%, is recommended and is much more efficient than hand-washing.”

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… does this mean coronapanic is over? Some items that haven’t been seen for 8+ months were simultaneously in stock on December 2:

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What happened?

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What about my May 2020 dream Plague-proof Florida and Texas with shaded outdoor classrooms?

“Classrooms Without Walls, and Hopefully Covid” (NYT) says that it is vaguely alive, but the examples are mostly in the frozen north. The efforts at physical infrastructure have been feeble. And, instead of simply teaching the regular curriculum, the schools are trying to reinvent teaching at the same time as reinventing the teaching environment.

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“Government Model Suggests U.S. COVID-19 Cases Could Be Approaching 100 Million” (NPR):

The actual number of coronavirus infections in the U.S. reached nearly 53 million at the end of September and could be approaching 100 million now, according to a model developed by government researchers.

Since [September], the CDC’s tally of confirmed infections has increased to 12.5 million. So if the model’s ratio still holds, the estimated total would now be greater than 95 million, leaving about 71% of the population uninfected.

The model, created by scientists at the Centers for Disease Control and Prevention, calculated that the true number of infections is about eight times the reported number, which includes only the cases confirmed by a laboratory test. … Some of these antibody studies have suggested that only about one in 10 coronavirus infections is reported.

Cases are currently “spiking” all over the U.S.:

We yearned for ventilators and, by the time they were available, realized that we didn’t need or want them (since they actually harm the typical COVID-19 patient). Currently we yearn for vaccines, but perhaps we won’t need or want them by the time they’re available in significant quantity. (Though perhaps a vaccine could be useful to boost the immunity of someone who’d had COVID-19 the natural way a year earlier.)

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We’re more than a year into coronaplague. Saliva-based tests were developed back in the spring of 2020. At least here in Maskachusetts, children need COVID-19 tests before they can return to school following the sniffles and/or a trip to the cousins’ house (nearly every state in the U.S. is considered hazardous, even those with lower coronavirus infection rates than Massachusetts itself). Why isn’t is possible for children and adults to go to the local strip mall, spit, and have Kary Mullis‘s magic PCR machine give a thumbs up or thumbs down answer a few hours later?

(Is it the same answer as why we can’t buy Bounty or Formula 409? The U.S. managed to ramp up production of sophisticated aircraft during World War II (partial list). Why can’t we ramp up production of the tests that our governors and school bureaucrats are demanding? (separate issue as to whether there is any medical value to these tests! Last I checked with an MGH doctor, hospital care for COVID-19 patients still consisted primarily of “monitoring” and the care would be the same regardless of test result))

From the CVS MyChart site (November 26):

• there were five FDA-approved saliva-based tests as of mid-August
• BBC report on an Oxford study: “Most people are infectious only for about a week, but could test positive weeks afterwards.” (not great news for American enthusiasts of testing, since it now takes about a week of phoning/surfing to get a test and then another few days to get a result!)

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