Latest Coronavirus - Yikes

I've done the Moorings sail cats for the last six trips. We're diving a bunch of wrecks and need to get from a to b a little quicker, plus I'm taking four teenagers and the Marinemax boat has a water maker.

This time we put the hammer down and use the iron main.
Is this you?
 
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At least we are getting press conferences. More than we have had in a long time.
 
It means she's got experience in a lot of high acuity areas of nursing and was able to manage to get there without a bachelor's, which is what most places want now a days.

The old diploma courses for RNs - 3-4 year nursing schools at real hospitals with lots of real hands on experience always seemed to make more sense than a BSN with more limited patient care at a university. Now we have degree creep and more care by non RNs. Most of those programs still worked with a university for subjects like chemistry, etc.
 
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The top level one trauma and Magnet status hospitals (like UTMC), require that extra education and won't even hire anything else. They encourage all their nurses to become Nurse Practitioners, educators, or to move into Administration, thus the cycle continues
We have NP's that can't find positions in this area. This hospital I work at has magnet ambitions right now. They are hemorrhaging nurses at this point, they attempt to go the magnet route now they will continue to leave. They want an open heart program in 3 years they are 7 years away by my estimate.
The money is definitely there in open heart.
 
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Coronavirus crisis underlines eight of Trump's failings as a leader (opinion) - CNN
8 problems:
First, Trump doesn't do any homework.
Related to Trump's first failing is his second: He always believes he knows more than the experts about any given subject.
Third, Trump trusts his own gut.
Fourth, Trump has increasingly surrounded himself with a team of acolytes who will not challenge him.
Fifth, it's hard for the public to believe a President who has made more than 16,000 false or misleading claims in his first 3 years
Sixth, Trump always blames the messenger for news he doesn't like,
Seventh, Trump is the reverse of President Harry Truman. The buck never stops at Trump's desk.
Eighth, Trump almost always plays the divider-in-chief, not the uniter-in chief.
9th. Trump will be right. Again.
 
They ( hospitals ) are turning the nurses into educated robots . I have nothing against higher education, but my problem is when the compassion nurses have for people turn into taking care of “ clients” and they start worrying and the numbers and percentages. bachelors isn’t enough anymore they are pushing masters . That leads to less floor nurses and more administrative nurses .

You and my wife would have a good time discussing that. She was a diploma nurse - then got her BSN, MSN, and DNP, and still believes that the fundamental thing is actual patient care ... including sitting down and talking with them, learning who they are and where the come from, and then with that suggesting to them how best to manage after they leave the hospital. Her plans to teach never seem to work that well because she sees what nurses should do differently from what educators think ... it just turns into a constant struggle that she hates.
 
At least we are getting press conferences. More than we have had in a long time.
I honestly don’t see how you could listen to the press conference going on right now and conclude anything other than we have taken proper precautions for whichever direction this thing is heading and we are taking proper steps to handle current cases as well. Trump has done well with this issue and Pence basically seems to have gotten the experts pulled in and is properly getting out of their way. I know many on here didn’t like Trump’s messaging of downplaying the virus but he has clearly taken action as needed.
 
It'll either be Flor de Caña or Havana Club.

You get what you get and you don't have a fit.

Got some bottles of Havana Club in Havana, and now it's sold everywhere. At least the cigars were still on the novel list.
 
Won't say his full name but his last name was Bunch. He was quickly nicknamed Blue Flame Bunch. He would regularly light them up. Never thought you could get singed through denim. Must have been especially rough food in the dining hall that night.

We also had an audio of a segment called The Dump. I had some Bose 301's hooked up to a Denon receiver and could broadcast half way across campus. We'd load that cassette tape up and crank the volume. Never failed to leave my sides aching. That audio was classic, from the footsteps running down the hall to the final flush. It was fun to be young and easily entertained.

I remember (and not admitting or saying who) broadcasting over the Hess Hall intercom system from an undisclosed location.
 
AKA the "zoo"

I actually got kicked out of the place ... they had to let me go someplace, that's how I would up in a private room in Melrose as a sophomore. This was before the presidential complex and stuff ... Hess was the edge of campus. I'm thinking I made a huge mistake though - I asked the Hess manager if he thought I might get a private room in Melrose ... walked into the housing office and they said "Would you like a private room in Melrose?" I should have asked about a room in a female dorm.
 
Got some bottles of Havana Club in Havana, and now it's sold everywhere. At least the cigars were still on the novel list.

I love Havana Club. I used to pour it into old bottles and put cheap rum in the Havana Club bottles so my buddies wouldn't clean me out when they came over. I'd bring back a few bottles everytime I flew general aviation to the Bahamas.
 
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I believe this was an engineered virus. It doesn't seem to behave like viruses that we've seen in the past. I still don't believe we, the scientist have a handle on how this virus behaves. Anyone have a similar mindset?
I think that this would be highly unlikely. If I were were bothering to spend the money to engineer something, it certainly wouldn't have the characteristics of this virus. Not nearly deadly enough to make a difference if you are deploying it against an enemy. Kills the wrong people if you wanted to destabilize via panic - try killing young adults or children for maximal effect here. The biggest reason, though, is that most bioweapons have a really crappy track record. If virulent enough to achieve your goals, most viruses will just keep going right past your intended target to circle back and bite you in the butt. Most bacteria haven't panned out. Anthrax is interesting given the extremely difficult-to-achieve aerosolized spore delivery option, but relatively easily countered with antibiotics. Most US interest dried up years and years ago due to the inherent limitations of biological agents as weapons. Nerve agents were a much more sure thing.

Our knowledge of viruses only extends as far as our modern experience. The degree of human expansion into previously uninhabited areas, abnormal environmental conditions or the search for food or animals for research have periodically put humans into contact with reservoir species, leading to Ebola, Marburg, Machupo, Hantavirus, SARS, MERS. I'd put my money on this being a similar zoonotic exposure.

The long incubation period and extremely variable severity (though apparently with the ability to achieve asymptomatic transmission) does make this virus a lot harder to spot, as many won't even seek care. That, and the initial sweeping under the rug of severe cases by local authorities as far back as late November or early December, is likely what allowed this to spread so widely. I'm not yet convinced by the scattered reports of reinfection. Definitely possible given some chance of incomplete immunity, but as a mainly lower respiratory virus, it may simply be a case of nasal swabs being transiently negative when a BAL would have picked up virus particles.

At the moment, from my perspective as an ED doc, the most difficult thing about controlling the spread of this virus here is that it is clinically indistinguishable from flu or other respiratory viruses and we still don't have short-turnaround molecular testing available to identify it while the patient is still in the ED. As of friday night, I was still shut down by the health department on doing a swab of a university student with an unexplained fever and negative PCR respiratory viral panel (for the standard pediatric respiratory viruses, but doesn't include COVID) but suggestive symptoms, and we have already had (since the end of January) 3 positives as of last friday and one case of community transmission IN MY MEDIUM-SIZED COMMUNITY HOSPITAL. That's not even considering the cases with suggestive symptoms that CDC didn't authorize testing on due to geographic limits of testing or lack of sufficient severity of illness. Being told to self-quarantine because you maybe have something is one thing. Being told to self-quarantine because you definitely have the virus and might kill your grandparents if you don't is another entirely. I'm not sold on the efficacy of the no-test self-quarantine model.

As a result, I think that due to clinically silent or insignificant cases combined with rigorous requirements for testing (probably due to lack of availability of test kits for the last month) we have accidentally recapitulated the Chinese model of failing to achieve local control when we had the chance. I'm not looking forward to the next couple of months in the ED. We've already had about 20 staff quarantined, and that's only going to increase until we get real-time diagnostics in our hospital lab, which is still probably a few weeks in the future, if it happens at all.

By the way, I had a conversation about SARS with colleagues in late January and found this article. Really interesting. One lucky thing about this outbreak is that it doesn't seem that super spreading is as prevalent.

SARS article
 
I actually got kicked out of the place ... they had to let me go someplace, that's how I would up in a private room in Melrose as a sophomore. This was before the presidential complex and stuff ... Hess was the edge of campus. I'm thinking I made a huge mistake though - I asked the Hess manager if he thought I might get a private room in Melrose ... walked into the housing office and they said "Would you like a private room in Melrose?" I should have asked about a room in a female dorm.
I was in Clement hall on the other side of Cumberland. I had a buddy that had a room in Hess, it was a pos, no air conditioning.
 
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I love Havana Club. I used to pour it into old bottles and put cheap rum in the Havana Club bottles so my buddies wouldn't clean me out when they came over. I'd bring back a few bottles everytime I flew general aviation to the Bahamas.

I remember being in the place at Redstone that serves as mini mart, gas station, and liqueur store, saw Havana Club on the shelf, and thought WTH.
 
I love Havana Club. I used to pour it into old bottles and put cheap rum in the Havana Club bottles so my buddies wouldn't clean me out when they came over. I'd bring back a few bottles everytime I flew general aviation to the Bahamas.
I knew you were a capitalist!
 
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I think that this would be highly unlikely. If I were were bothering to spend the money to engineer something, it certainly wouldn't have the characteristics of this virus. Not nearly deadly enough to make a difference if you are deploying it against an enemy. Kills the wrong people if you wanted to destabilize via panic - try killing young adults or children for maximal effect here. The biggest reason, though, is that most bioweapons have a really crappy track record. If virulent enough to achieve your goals, most viruses will just keep going right past your intended target to circle back and bite you in the butt. Most bacteria haven't panned out. Anthrax is interesting given the extremely difficult-to-achieve aerosolized spore delivery option, but relatively easily countered with antibiotics. Most US interest dried up years and years ago due to the inherent limitations of biological agents as weapons. Nerve agents were a much more sure thing.

Our knowledge of viruses only extends as far as our modern experience. The degree of human expansion into previously uninhabited areas, abnormal environmental conditions or the search for food or animals for research have periodically put humans into contact with reservoir species, leading to Ebola, Marburg, Machupo, Hantavirus, SARS, MERS. I'd put my money on this being a similar zoonotic exposure.

The long incubation period and extremely variable severity (though apparently with the ability to achieve asymptomatic transmission) does make this virus a lot harder to spot, as many won't even seek care. That, and the initial sweeping under the rug of severe cases by local authorities as far back as late November or early December, is likely what allowed this to spread so widely. I'm not yet convinced by the scattered reports of reinfection. Definitely possible given some chance of incomplete immunity, but as a mainly lower respiratory virus, it may simply be a case of nasal swabs being transiently negative when a BAL would have picked up virus particles.

At the moment, from my perspective as an ED doc, the most difficult thing about controlling the spread of this virus here is that it is clinically indistinguishable from flu or other respiratory viruses and we still don't have short-turnaround molecular testing available to identify it while the patient is still in the ED. As of friday night, I was still shut down by the health department on doing a swab of a university student with an unexplained fever and negative PCR respiratory viral panel (for the standard pediatric respiratory viruses, but doesn't include COVID) but suggestive symptoms, and we have already had (since the end of January) 3 positives as of last friday and one case of community transmission IN MY MEDIUM-SIZED COMMUNITY HOSPITAL. That's not even considering the cases with suggestive symptoms that CDC didn't authorize testing on due to geographic limits of testing or lack of sufficient severity of illness. Being told to self-quarantine because you maybe have something is one thing. Being told to self-quarantine because you definitely have the virus and might kill your grandparents if you don't is another entirely. I'm not sold on the efficacy of the no-test self-quarantine model.

As a result, I think that due to clinically silent or insignificant cases combined with rigorous requirements for testing (probably due to lack of availability of test kits for the last month) we have accidentally recapitulated the Chinese model of failing to achieve local control when we had the chance. I'm not looking forward to the next couple of months in the ED. We've already had about 20 staff quarantined, and that's only going to increase until we get real-time diagnostics in our hospital lab, which is still probably a few weeks in the future, if it happens at all.

By the way, I had a conversation about SARS with colleagues in late January and found this article. Really interesting. One lucky thing about this outbreak is that it doesn't seem that super spreading is as prevalent.

SARS article

There are many things the Chinese don't do well - like build jet engines. This could have simply been an unintended release from a tinker toy lab wile they were working up to something better. They apparently have a researcher in prison for selling infected test animals to food vendors ... apparently he made over a $1M doing it before they caught up to him.
 
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