So it has been a while since I have been on this website. When Covid started to hit back in March-April, going to work and then coming home and interacting/reading more about Covid just stressed me out even further. I had a few occasions where I would lash out and say rude things to other users for no reason, so I put myself in timeout for a few months.
That said, I did want to just share my own personal experience in the ED over the past few months.
So I am an ER doc in one of the major hospitals in Dallas. I work about 13-14 shifts a month and have logged probably 500 hours in the ER since all this started. I want to also preface this by saying, all of what I am going to say is based on my own personal experiences in Dallas. I have been following the numbers like all of you have, but my opinions are strictly anecdotal. I know for a fact some of my ER doc friends in Houston/SA have had different experiences. I guess I will start with what I am seeing now, start riffing, and see where this goes.
So as of the month of June, we are definitely seeing a higher volume of positive tests. The reason for seeing a higher volume of "positive tests" is twofold, #1-more people are sick aka the disease is spreading, and #2-we are pretty much testing everyone who walks through the door now. Now back in March/April, I was still seeing a ton of people who I thought had Covid, but we weren't testing any of them. I would shoot a chest xray of the patient, look at their vitals, and if they weren't toxic appearing, I would explain the disease process to the patient, would give azithro at the time, discharge them, and basically would tell the patient to come back to the ER when they were too short of breath to talk, or too weak to walk to the bathroom. For that reason, I believe we are definitely seeing a higher volume of covid + patients as the disease is now more prevalent, however I don't think the "positive cases" is a true accurate reflection of how bad it has gotten, because I was rarely testing those people back in March-Early May. I think it is getting bad, but not as bad as the numbers reflect.
Of note, there is also a handful of patients who have come to the ER for something unrelated to covid (broken arm, car accident, missed dialysis, kidney infection), who we automatically test for covid because they are being admitted to the hospital. I've seen a handful of these patients test positive, even though their reason for being in the hospital has nothing to do with the disease. To my knowledge, these patient's are still being counted as "covid admissions" even though they aren't there because of covid, they were asymptomatic carriers, but its now a positive patient and we move them to the covid area of the hospital.
Why are less people dying if the disease is spreading more? I have two theories. Probably the number one thing is our understanding of the disease and the treatment strategies. My hospital has learned a lot by what happened in Italy and NYC. The big thing has to do with intubating patients and putting them on vents.
So back in March/April, our agreed upon treatment method, was if a patient was requiring more than 6 liters of supplemental oxygen, we would just intubate them. The reason for this was the fear that giving higher flows of oxygen, including CPAP/BiPAP/Hi Flo O2, would aerosolize the oxygen through out the entire ER/ICU thus spreading it to more patients and staff...... We are now realizing that early intubation is a bad thing. Previously we were using O2 saturation (a vital sign) to determine when someone should be intubated. We are now using other assessments such as how hard someone is working to breath, their mental status, or acidosis in the blood. The reason for this is because Covid is causing something called silent hypoxemia. Meaning, when you take the patient's oxygen saturation, it could be 70% but the patient looks fine and is not having any shortness of breath (usually we get worried when its under 88%). You would think someone with an O2 sat of 70% would be turning blue and huffing/puffing, but they aren't with covid. We are now letting these patients basically just ride on supplemental O2 and not intubating them. I think this is saving lives. We also know hydroxy doesn't work, dexamethasone may help, and we have covalescent plasma.
2nd theory.- the virus is becoming less deadly. Now my microbio/infectious disease docs could probably correct me on a lot of this, (I am going off first year of med school here) but it seems like the virus is becoming less virulent. It seems like we are seeing a higher volume of patients, but they are less sick. I haven't intubated a patient since April. I've probably sent 10 total to the ICU since May. So one idea is that NYC got hit with a more deadly strain of Covid, and we got the less deadly version. Or we got the same version, but over long periods of time, as the virus enters thousands of people, it goes through millions of RNA replications within our cells. And every time the virus replicates in our body, there is a very small chance the virus mutates. And over four months, is the virus slowly mutating out of a less deadly version of itself until it is finally gone?
Kinda going back to hospitalization numbers. One thing we are seeing is a high number of "covid admissions". Yes this is true. But a majority of these patients are staying in the hospital 1-3 days and getting discharged home. We aren't having a prolonged stay in the hospital for most patients. Basically what is happening is we get a big batch of covid patients one day, while at the same time a big batch from a few days ago are being discharged. It is a revolving door. They aren't stacking up on each other and clogging our hospital up. We are definitely very busy but we aren't overflowing. To my knowledge my hospital has aprox 15-20% of our beds occupied by Covid.
So to summarize, I feel like I am definitely seeing a higher volume of patients with covid. They are less sick than they were in early March/April. This thing could turn on a dime at any moment. I feel our hospital is busy but we aren't drowning. I feel the numbers are increasing but the numbers given out to the public are not an accurate representation about what is actually going on. Would also like to say I am by no way trying to downplay the disease. We are still seeing the disease do amazing things. I am 100% still seeing young healthy people get sick to the point that they need to come in the hospital. Have had two 30 year olds in the past month who presented with covid symptoms and were in complete renal falure (Crt of 15-19 for each), had a 40 year old who was positive with a celiac artery thrombosis, a few elderly adults who presented with encephalitis, and a guy who had a massive heart attack. The disease still isn't to be taken at all lightly and it continues to surprise me everyday. Luckily myself and my fiance (ER nurse), have all been healthy. We have probably taken care of a combined 500 covid patients to this point and I have only had one coworker who has gotten covid, and she is doing great now., aka masks work. Sorry for the long article. Stay safe everyone. Gig'em
TLDR- wear a mask and wash your hands if you want Aggie football
-doug
That said, I did want to just share my own personal experience in the ED over the past few months.
So I am an ER doc in one of the major hospitals in Dallas. I work about 13-14 shifts a month and have logged probably 500 hours in the ER since all this started. I want to also preface this by saying, all of what I am going to say is based on my own personal experiences in Dallas. I have been following the numbers like all of you have, but my opinions are strictly anecdotal. I know for a fact some of my ER doc friends in Houston/SA have had different experiences. I guess I will start with what I am seeing now, start riffing, and see where this goes.
So as of the month of June, we are definitely seeing a higher volume of positive tests. The reason for seeing a higher volume of "positive tests" is twofold, #1-more people are sick aka the disease is spreading, and #2-we are pretty much testing everyone who walks through the door now. Now back in March/April, I was still seeing a ton of people who I thought had Covid, but we weren't testing any of them. I would shoot a chest xray of the patient, look at their vitals, and if they weren't toxic appearing, I would explain the disease process to the patient, would give azithro at the time, discharge them, and basically would tell the patient to come back to the ER when they were too short of breath to talk, or too weak to walk to the bathroom. For that reason, I believe we are definitely seeing a higher volume of covid + patients as the disease is now more prevalent, however I don't think the "positive cases" is a true accurate reflection of how bad it has gotten, because I was rarely testing those people back in March-Early May. I think it is getting bad, but not as bad as the numbers reflect.
Of note, there is also a handful of patients who have come to the ER for something unrelated to covid (broken arm, car accident, missed dialysis, kidney infection), who we automatically test for covid because they are being admitted to the hospital. I've seen a handful of these patients test positive, even though their reason for being in the hospital has nothing to do with the disease. To my knowledge, these patient's are still being counted as "covid admissions" even though they aren't there because of covid, they were asymptomatic carriers, but its now a positive patient and we move them to the covid area of the hospital.
Why are less people dying if the disease is spreading more? I have two theories. Probably the number one thing is our understanding of the disease and the treatment strategies. My hospital has learned a lot by what happened in Italy and NYC. The big thing has to do with intubating patients and putting them on vents.
So back in March/April, our agreed upon treatment method, was if a patient was requiring more than 6 liters of supplemental oxygen, we would just intubate them. The reason for this was the fear that giving higher flows of oxygen, including CPAP/BiPAP/Hi Flo O2, would aerosolize the oxygen through out the entire ER/ICU thus spreading it to more patients and staff...... We are now realizing that early intubation is a bad thing. Previously we were using O2 saturation (a vital sign) to determine when someone should be intubated. We are now using other assessments such as how hard someone is working to breath, their mental status, or acidosis in the blood. The reason for this is because Covid is causing something called silent hypoxemia. Meaning, when you take the patient's oxygen saturation, it could be 70% but the patient looks fine and is not having any shortness of breath (usually we get worried when its under 88%). You would think someone with an O2 sat of 70% would be turning blue and huffing/puffing, but they aren't with covid. We are now letting these patients basically just ride on supplemental O2 and not intubating them. I think this is saving lives. We also know hydroxy doesn't work, dexamethasone may help, and we have covalescent plasma.
2nd theory.- the virus is becoming less deadly. Now my microbio/infectious disease docs could probably correct me on a lot of this, (I am going off first year of med school here) but it seems like the virus is becoming less virulent. It seems like we are seeing a higher volume of patients, but they are less sick. I haven't intubated a patient since April. I've probably sent 10 total to the ICU since May. So one idea is that NYC got hit with a more deadly strain of Covid, and we got the less deadly version. Or we got the same version, but over long periods of time, as the virus enters thousands of people, it goes through millions of RNA replications within our cells. And every time the virus replicates in our body, there is a very small chance the virus mutates. And over four months, is the virus slowly mutating out of a less deadly version of itself until it is finally gone?
Kinda going back to hospitalization numbers. One thing we are seeing is a high number of "covid admissions". Yes this is true. But a majority of these patients are staying in the hospital 1-3 days and getting discharged home. We aren't having a prolonged stay in the hospital for most patients. Basically what is happening is we get a big batch of covid patients one day, while at the same time a big batch from a few days ago are being discharged. It is a revolving door. They aren't stacking up on each other and clogging our hospital up. We are definitely very busy but we aren't overflowing. To my knowledge my hospital has aprox 15-20% of our beds occupied by Covid.
So to summarize, I feel like I am definitely seeing a higher volume of patients with covid. They are less sick than they were in early March/April. This thing could turn on a dime at any moment. I feel our hospital is busy but we aren't drowning. I feel the numbers are increasing but the numbers given out to the public are not an accurate representation about what is actually going on. Would also like to say I am by no way trying to downplay the disease. We are still seeing the disease do amazing things. I am 100% still seeing young healthy people get sick to the point that they need to come in the hospital. Have had two 30 year olds in the past month who presented with covid symptoms and were in complete renal falure (Crt of 15-19 for each), had a 40 year old who was positive with a celiac artery thrombosis, a few elderly adults who presented with encephalitis, and a guy who had a massive heart attack. The disease still isn't to be taken at all lightly and it continues to surprise me everyday. Luckily myself and my fiance (ER nurse), have all been healthy. We have probably taken care of a combined 500 covid patients to this point and I have only had one coworker who has gotten covid, and she is doing great now., aka masks work. Sorry for the long article. Stay safe everyone. Gig'em
TLDR- wear a mask and wash your hands if you want Aggie football
-doug
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