Mar 21, 2020

Hi there. Hope you’re staying in, staying well.

After evaluating several sites for case reports, I think this is the best–John Hopkins, It’s updated every 30 minutes and easy to dive into whatever part of the country or world you want to look at. Also reports the recovered cases, which is a key metric missing from many other sites. The true fatality rate is dependent on not only the number of cases, but the number of cases followed to recovery–which may be 2-4 weeks out. The fatality rate likely improves when we follow it out. Here’s the link:  https://coronavirus.jhu.edu/map.html

Below is crib sheet for hospitalists admitting COVID suspect patients. Pretty much everything we know, on one page. We’d like to know a lot more.

 

The good news back at work today–people are discovering they really don’t need to come to the ER for everything. Our ER census is often 120 – 140 any given afternoon. Today it’s 30.  The bad news–some people are probably not coming in who should. I have 3 patients out of 10 who are isolated for covid testing (our census is down too–we normally have 12-18 patients). These are my patients to care for at this time–we are not allowing residents to care for them until/ unless we get overwhelmed.

Those of us in direct medical care are not feeling tremendously supported with PPE (personal protective equipment) anywhere in our country. We were told in January we needed to be fitted for N95 masks (tight-fitting microfiltration masks). Now we’re being told by CDC that we can wear simple surgical masks into COVID rooms if the patient does not have aerosol risks (a ventilator, high flow oxygen, specialized breathing masks called bipap, or having ordinary nebulizer treatments). This is not because we have any evidence the standard surgical mask is as protective as the N95 from coronavirus (it filters out some smaller viral particles, but mostly filters large droplets), it’s because we don’t have enough N95 masks. A patient who coughs or sneezes coronavirus creates an aerosol every time they do that. The aerosol has been shown to last up to 3 hours in the air.

Of course current world leaders didn’t create this novel virus. But some countries were prepared for pandemic with technology and systems in place, and their infections more readily controlled as a result. It’s disheartening to feel that our lives are at risk, in part, because of poor leadership, planning, and continued overt denial. We need the National Defense Act invoked now to manufacture PPE’s and ventilators in the U.S. Not only should medical personnel have masks available, those being forced to work in group/ public exposure settings for infrastructure support should have masks available too, if they choose. That’s not even possible at this point. Not to mention, those Americans who occasionally have to go to the grocery store.

My current rescue from anxiety? Among other things, the Calm app. There are some free features, but I fell in-love-at-first-listen with the “Rules of Cricket, Explained”–a howling, ridiculously boring recitation, and “The Shipping Report,” spoken by a man whose voice I want to marry. No kidding, the rules of cricket! There’s also a man who calls himself, “the French whisperer,” who reads the theory of relativity (20 minutes) –Einstein would be impressed. I sprang for the 59.95$ version, and haven’t regretted it. There’s a buffet of relaxation choices, sounds, music, stories, and a wonderful meditation app (I used a beginner module with Jeff Warren–30 days, 10 minutes per day guided by him). I’ve never meditated before–that has really not been my thing–but it has helped me remain calmer in difficult situations. I’m sure everyone who knows me will agree. Yep. I’m sure. Sure. 🙂

Stay in, stay well.

 

 

 

 

 

 

 

 

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