Reports from the frontlines in NY

24,183 Views | 95 Replies | Last: 4 yr ago by Mordred
Windy City Ag
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AG
Loved his aquarium.
jeremy
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AG
Which one was the Lenin quote?
Fenrir
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If you read it, it will become quite apparent.
jeremy
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AG
We'll,crap. Now I'm going to have to read it again carefully. Thanks for nuttin...
Mordred
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AG
Reasonably positive update today:



Source
Beat40
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Mordred said:

Reasonably positive update today:



Source


God bless the fighting human spirit!
Fireman
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AG
You know, if you are running short on masks, you might consider working for hours with patients that have been diagnosed with COVID-19 and wearing the same mask, then working for hours with patients that do not have the disease and wear a second mask. I recognize that in normal times you get a new mask and a new pair of gloves with each new patient. Things stop being normal about 20 days ago, so you have to adapt, and doctors using 200+ masks in a single day, doesn't make much since when you seem so impassioned that masks are in short supply.
Builder93
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Regarding the freak out over the Lenin quote: Remember, a broken clock is still right twice a day.
BigN--00
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Fireman said:

You know, if you are running short on masks, you might consider working for hours with patients that have been diagnosed with COVID-19 and wearing the same mask, then working for hours with patients that do not have the disease and wear a second mask. I recognize that in normal times you get a new mask and a new pair of gloves with each new patient. Things stop being normal about 20 days ago, so you have to adapt, and doctors using 200+ masks in a single day, doesn't make much since when you seem so impassioned that masks are in short supply.


If you don't take the mask off for hours, you cannot eat or drink for hours. There are stories from Wuhan about nursed and doctors getting dehydrated for this very reason.
Not a Bot
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Fireman said:

You know, if you are running short on masks, you might consider working for hours with patients that have been diagnosed with COVID-19 and wearing the same mask, then working for hours with patients that do not have the disease and wear a second mask. I recognize that in normal times you get a new mask and a new pair of gloves with each new patient. Things stop being normal about 20 days ago, so you have to adapt, and doctors using 200+ masks in a single day, doesn't make much since when you seem so impassioned that masks are in short supply.


It's a bit more difficult to do that in some settings like ER where you still have people coming in for other stuff and don't want to cross contaminate. Not an easy decision to have a designated staff for rule outs in the ER as a lot of people coming in for similar symptoms don't have the virus. Definitely don't want to give it to them. Just have to leave your mask on and be very careful.

However, on the patient care floors you plan to cohort these patients and have a single group of staff taking care of them and no one else. They can wear the same PPE throughout the shift and conserve resources.
Mordred
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Fireman said:

You know, if you are running short on masks, you might consider working for hours with patients that have been diagnosed with COVID-19 and wearing the same mask, then working for hours with patients that do not have the disease and wear a second mask. I recognize that in normal times you get a new mask and a new pair of gloves with each new patient. Things stop being normal about 20 days ago, so you have to adapt, and doctors using 200+ masks in a single day, doesn't make much since when you seem so impassioned that masks are in short supply.
Just to be clear, I am not the doctor writing these up, just an Ag in Texas, looking on and pulling hard for our fellow Americans in NYC.
Nom de Plume
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Marcus Aurelius said:

I predict alot of NYers fleeing the state. Be careful around any of these people. They will likely head South.

Welcome to 2002.
IDAGG
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AG
That Dr. is showing some impressive leadership.
tamc91
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I was driving my daughter back to TX from school in North Carolina yesterday. I noticed a relatively high number of NY license plates heading west through Tennessee. Most were on nice cars and SUVs. I believe it has started with those with resources to leave.
expresswrittenconsent
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tamc91 said:

I was driving my daughter back to TX from school in North Carolina yesterday. I noticed a relatively high number of NY license plates heading west through Tennessee. Most were on nice cars and SUVs. I believe it has started with those with resources to leave.

Yeah, those are Duke students.
tamc91
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This was in TN and AR. West bound I40. New York license plates on luxury sedans and SUVS. Duke's Spring Break was 2 weeks ago. Not Duke students.
Mantis Toboggan MD
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For those without twitter here is a direct link to the Columbia Surgeon's website with the daily updates.
https://columbiasurgery.org/news/covid-19-update-32420
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
94chem
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Builder93 said:

Regarding the freak out over the Lenin quote: Remember, a broken clock is still right twice a day.
And wussies are still gonna wuss. Quote of Lenin =/= ode to Lenin.
Mordred
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Sorry for being late with today's update. Not the most fun read, and the 10% increase every day is definitely alarming.

96AustinAg
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Agree with the poster above, that doc is leading his ass off!
KR Training staff instructor - www.krtraining.com
Mordred
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96AustinAg said:

Agree with the poster above, that doc is leading his ass off!
No matter how dire his updates get, the last lines of every post always have me ****ing proud and wishing I could actually do something to help.
unmade bed
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Thanks for posting these. Read them every night before bed. Inspiring. God bless our health care workers. The fight is just starting for them. God bless them all.
KidDoc
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Mordred said:

Sorry for being late with today's update. Not the most fun read, and the 10% increase every day is definitely alarming.


Wow.

Don't have a heart attack in NYC any time soon.


Yikes.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Mordred
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Watching smart people react and adapt in the face of a crisis is awe inspiring.

UTExan
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tamc91 said:

I was driving my daughter back to TX from school in North Carolina yesterday. I noticed a relatively high number of NY license plates heading west through Tennessee. Most were on nice cars and SUVs. I believe it has started with those with resources to leave.


I hope they're not headed to Utah. Park City just shut down.
It is better to light a flamethrower than to curse the darkness- Sir Terence Pratchett
“ III stooges si viveret et nos omnes ad quos etiam probabile est mittent custard pies”
Aggie1946
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Can someone explain what "Jaws of doomsurfing" is? No reference to this anywhere online except an obscure game.
Mordred
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AG
Aggie1946 said:

Can someone explain what "Jaws of doomsurfing" is? No reference to this anywhere online except an obscure game.
In the movie Jaws, Brodie knew there was a shark in the water, but the Mayor wouldn't close the beach.

I took it as all the negativity he's reporting would make him the guy that the alarmists would be shouting about, i.e. "we have to shut things down, look what Craig Smith is saying!"

Not a perfect analogy since Brodie wasn't someone surfing in the movie, but cut the guy some slack he's probably completely burnt out trying to lead his people.
Aggie1946
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I wasn't trying to be hard on him. Thanks for the insight. I figured it had something to do with the movie since he capitalized Jaws, but couldn't figure it out through searching.
Mordred
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Interesting update today. Sounds like the N95 PPE situation might be getting better in NYC. Also, Smith isn't buying into the Hydrochloroquine hype, and he does make a very interesting point.

Proposition Joe
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Mordred said:

Aggie1946 said:

Can someone explain what "Jaws of doomsurfing" is? No reference to this anywhere online except an obscure game.
In the movie Jaws, Brodie knew there was a shark in the water, but the Mayor wouldn't close the beach.

I took it as all the negativity he's reporting would make him the guy that the alarmists would be shouting about, i.e. "we have to shut things down, look what Craig Smith is saying!"

Not a perfect analogy since Brodie wasn't someone surfing in the movie, but cut the guy some slack he's probably completely burnt out trying to lead his people.

And worth mentioning again.

The Mayor in Jaws is still the Mayor in Jaws 2 despite keeping the beach open.
Rossticus
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Builder93 said:

Regarding the freak out over the Lenin quote: Remember, a broken clock is still right twice a day.


?t=8C4316
KT_Ag08
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Thanks again for sharing. My guess is the Doc would want the HCQ if he tested positive. I get what he is saying but until we come up with something better or prove that it isn't making any difference then it seems irresponsible to not continue treating with that cocktail.
Dr. Not Yet Dr. Ag
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KT_Ag08 said:

Thanks again for sharing. My guess is the Doc would want the HCQ if he tested positive. I get what he is saying but until we come up with something better or prove that it isn't making any difference then it seems irresponsible to not continue treating with that cocktail.
I'm sure many have seen my opinions on this already and disagree, but I do think it is important to remain skeptical, especially in times like these. I can't speak for Dr. Smith, but unless I am intubated and can't say otherwise, I would not want the HCQ+Zpack combo therapy unless they can get me enrolled in an RCT. Giving two QT prolonging agents together in a disease that increases incidence of Vtach/V-fib is a bad idea if there is no proven benefit. Couple that with HCQ's history of failing to demonstrate clinical efficacy in countless viruses it had shown promise in based on in vitro studies (HIV, HepC, Dengue, Chikungunya, Zika), and you can see why there are many docs right now that are a bit hesitant about its use. You have a known severe, but rare complication of the drug combo, and a low pre-test probability of efficacy. That combination should give pause to anyone considering this therapy. This is also ignoring countless people who are being treated with it for their connective tissue disorders now being unable to fill their prescriptions. Smith's comments on this are not irresponsible, they are prudent.
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VKint
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Well said. Very frustrating trying to explain this to patients and explain how flawed that French study was.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Mordred
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Dr. Not Yet Dr. Ag said:

KT_Ag08 said:

Thanks again for sharing. My guess is the Doc would want the HCQ if he tested positive. I get what he is saying but until we come up with something better or prove that it isn't making any difference then it seems irresponsible to not continue treating with that cocktail.
I'm sure many have seen my opinions on this already and disagree, but I do think it is important to remain skeptical, especially in times like these. I can't speak for Dr. Smith, but unless I am intubated and can't say otherwise, I would not want the HCQ+Zpack combo therapy unless they can get me enrolled in an RCT. Giving two QT prolonging agents together in a disease that increases incidence of Vtach/V-fib is a bad idea if there is no proven benefit. Couple that with HCQ's history of failing to demonstrate clinical efficacy in countless viruses it had shown promise in based on in vitro studies (HIV, HepC, Dengue, Chikungunya, Zika), and you can see why there are many docs right now that are a bit hesitant about its use. You have a known severe, but rare complication of the drug combo, and a low pre-test probability of efficacy. That combination should give pause to anyone considering this therapy. This is also ignoring countless people who are being treated with it for their connective tissue disorders now being unable to fill their prescriptions. Smith's comments on this are not irresponsible, they are prudent.
Nice to hear a 2nd opinion on this.

His point about 98% of patients recovering so we shouldn't be shocked when our patients recover, reframed the discussion for me and was definitely an eye-opener.
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