Latest Coronavirus - Yikes

[volfanhill]

View attachment 268611

Don’t blame me I voted for Kronos

 

[Franklin Pierce]

Chinese Companies Reap Huge Profits Making Medical Masks

Radio Television Hong Kong (RTHK) reported on Friday that mainland Chinese companies are reaping huge profits selling face masks to combat the virus unleashed upon the world by the Chinese Communist Party (CCP).

One Chinese manufacturer literally described its operation as a license to print money.

According to Chinese data cited by RTHK, some 8,950 manufacturers began producing face masks this year, some of them converting from garment production and other industries that were already working with fabric. They are very pleased with their profits, according to the report:

​

Some new manufacturers were able to spin up mask production in as little as ten days. Fabric prices surged by thousand-percent margins as demand skyrocketed in Dongguan, whose businessmen now regard it as the world’s factory for medical mask production. Skilled experts who can help in fabricating and testing masks are reportedly fetching ten times their previous salaries. Factory managers in Dongguan said their profits remain high despite these soaring costs.

Chinese Companies Reap Huge Profits Making Medical Masks

 

[Electric Orange]

What exactly did you interpret my post to be saying?

I dont remember now. Something along the lines of some dumb bull**** that sounded deliberately provocative for the sake of being provacative. Was I mistaken?

 

[Mick]

The link you posted about multiple people on ventilators had a headline that made it seem like it was needed, when very clearly it isn’t right now. It was preparation for worst case scenarios.

I have no issue with anticipating needs. But anticipation does not equal emergency.

It was by coincidence the link exemplified your thoughts on the media.

 

[Coug]

That guy was the ultimate slurper. "I salute you!"

Funny, said we can't afford to lose a day. This idiot President has lost us WEEKS!!! A month plus!

He had a 2 month head start on preparations and absolutely squandered it. Now you have nurses literally wearing trash bags for PPE in hard hit hospitals. It's pathetic and sad the governments response to this.

 

[UT_VOLS13]

It was by coincidence the link exemplified your thoughts on the media.

What are your thoughts on the media?

 

[allvol123]

It's a joke. With these quarantines, something like this had to be done imo. I wish more money was allocated to folks and less to corporations, and that there was no means test.

Go to thinking how badly we are going to screw this up.

Like why would you give a public school teacher a check? They are still getting paid.

 

[Devo182]

Chinese Companies Reap Huge Profits Making Medical Masks

Radio Television Hong Kong (RTHK) reported on Friday that mainland Chinese companies are reaping huge profits selling face masks to combat the virus unleashed upon the world by the Chinese Communist Party (CCP).

One Chinese manufacturer literally described its operation as a license to print money.

According to Chinese data cited by RTHK, some 8,950 manufacturers began producing face masks this year, some of them converting from garment production and other industries that were already working with fabric. They are very pleased with their profits, according to the report:

​

Some new manufacturers were able to spin up mask production in as little as ten days. Fabric prices surged by thousand-percent margins as demand skyrocketed in Dongguan, whose businessmen now regard it as the world’s factory for medical mask production. Skilled experts who can help in fabricating and testing masks are reportedly fetching ten times their previous salaries. Factory managers in Dongguan said their profits remain high despite these soaring costs.

Chinese Companies Reap Huge Profits Making Medical Masks

Entrepeneurship and private sector at its finest. I am glad evereyone is ramping up to meet the demand for all these items. Lots of US companies and entrepeneurs doing so as well. Glad everyone is. All hands on deck.

 

[volinbham]

He had a 2 month head start on preparations and absolutely squandered it. Now you have nurses literally wearing trash bags for PPE in hard hit hospitals. It's pathetic and sad the governments response to this.

LOL

 

[C-south]

He had a 2 month head start on preparations and absolutely squandered it. Now you have nurses literally wearing trash bags for PPE in hard hit hospitals. It's pathetic and sad the governments response to this.

So did the hospitals....which aren’t ran by the government btw. There’s plenty of blame to pass around and the one that deserves the most is China.

 

[InVOLuntary]

This is making its way around social media. Thought it was interesting. From an ER doctor in New Orleans, I believe.

There are not my words but are very informative from an ER physician in New Orleans. One of my ENT friends graduated with him from Medical school. A lot of this information is counterintuitive on how we usually treat respiratory failure and pneumonia. Thought you guys might enjoy it.

(Copy and pasted from a private group)this is a really interesting read and breakdown of covid for this U.S. facility.

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.

 

[joevol33]

The irony is you'll still vote for him

How much you wanna bet? Post the $amount, you're welcome to come up and walk in with me. #bringyourcheckbook!

Don't mean I'm voting democrat though ftr, didn't last time

 

[Stew Cook]

Trump's tone seems to have changed considerably, I'm curious if it will be contagious here on the PF.

Haven't heard from Dr Birks, yet though, which should be another indicator.

 

[hog88]

The irony is you'll still vote for him

And here’s the “libertarian” shaming.

 

[hog88]

That guy was the ultimate slurper. "I salute you!"

Funny, said we can't afford to lose a day. This idiot President has lost us WEEKS!!! A month plus!

How drunk are you?

 

[evillawyer]

 

[hog88]

He had a 2 month head start on preparations and absolutely squandered it. Now you have nurses literally wearing trash bags for PPE in hard hit hospitals. It's pathetic and sad the governments response to this.

You’re a gullible little one aren’t you?

 

[UT_VOLS13]

Try again!

 

[1972 Grad]

And here’s the “libertarian” shaming.

No candidate is pure enough for PJ.

 

[1972 Grad]

.....and?

 

[luthervol]

I dont remember now. Something along the lines of some dumb bull**** that sounded deliberately provocative for the sake of being provacative. Was I mistaken?

As usual.

 

[utvolpj]

And here’s the “libertarian” shaming.

Had nothing to do with that. It's all those online conservative celebrating free govt cheese. Same thing happened with the checks from Bush

 

[hog88]

This is making its way around social media. Thought it was interesting. From an ER doctor in New Orleans, I believe.

I’m sure it would have been a good read if written in English.

 

[UT_VOLS13]

As usual.

Hey, Bo, how are things this evening?

 

[UT_VOLS13]

Had nothing to do with that. It's all those online conservative celebrating free govt cheese. Same thing happened with the checks from Bush

Hey, Bo, you can send your free money to me!