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Kern County ER Docs C-19

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Emergent has 25 years experience .

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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On 5/5/2020 at 5:56 PM, toomuchbaloney said:

In response to the notion that people who needed hospital care got hospital care I posted the article. People died in their homes without hospitalization from covid.  

Again, the article does not indicate that these people were refused care in a hospital due to lack of capacity.

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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On 5/5/2020 at 7:06 AM, hherrn said:

https://www.foxnews.com/health/nyc-hospitals-overwhelmed-by-coronavirus-patients-resident-warns

That avoids the inevitable objection to the source, rather than the content of information based on the idea that it was presented by the lamestream media, which is clearly the enemy of the people.

This article is from March 26.  I am talking about now.  Even New York is easing their lockdown at this point.

Even at the peak of the crisis in NYC, there were enough ventilators.  An emergency tent hospital was built, but hardly used.  The US Navy ship sent to NYC was also hardly used.

At the peak, were individual hospitals stressed?  Yes.  Were individual healthcare workers like doctors and nurses stressed to the breaking point?  Yes.  

However, no one has presented actual evidence that patients with serious COVID illness were unable to obtain care if they sought care.  

NYC imposed a strict lockdown.  Yet, Governor Cuomo just admitted that 66% of recent cases in New York are in people that have been obeying lockdown restrictions.  So that begs the question of how effective these lockdowns really are.  And before everyone gets all excited, my point is that perhaps we should also look at other factors driving COVID spread.  Why was NYC hit so hard compared to cities in California?  After all, both New York and California have high populations and lots of international travelers.  

What troubles me is that the point of the lockdowns was to flatten the curve.  It was not to prevent death - just to prevent the healthcare systems from being overwhelmed.  That has now been accomplished.  And in most of the country, the healthcare systems were never in danger of being overwhelmed.  Yet, the lockdowns continue and in the mind of many people, are now supposed to continue until there is a vaccine or cure, which we may never have.  Furthermore, less than 50% of Americans get the flu shot every year.  What makes anyone think that % will be higher if  COVID vaccine is available?

Yes, some people are going to die from COVID.  But does that justify continued strict lockdowns in all parts of the US?  No.  The world is always full of risks and we always perform cost-benefit analysis.  We don't ban cars because a lot of people die in MVA every year.

At this point, we know what the high-risk groups are.  Those individuals should continue to take precautions and self-isolate.  Lockdowns can continue or be re-instituted in hot spots, as needed.  

We are now in danger of falling into a Depression worse than the Great Depression, and that is going to result in long-term misery and serious health consequences, physically and mentally.  Economic disaster kills people, too, in a myriad of ways.  The US does not have national health insurance, so unemployed people may lose health benefits, making it difficult for them to obtain medical care.  In addition, the general population is so terrorized by hysteria that they are not seeking medical care even when they are having a heart attack or stroke!  Once this is all over, we may very well find that more people were harmed by these lockdowns than were saved.

" As the pandemic took hold, the number of patients showing up at hospitals with serious cardiovascular emergencies such as strokes and heart attacks has shrunk dramatically.  Across the country, ER volumes are down about 40% to 50%, says Dr. William Jaquis, president of the American College of Emergency Physicians."  The article discusses that people are dying or suffering permanent long-term damage by not seeking emergency care when necessary.

https://www.npr.org/sections/health-shots/2020/05/06/850454989/eerie-emptiness-of-ers-worries-doctors-where-are-the-heart-attacks-and-strokes

More and more doctors and public health experts are expressing concern that these lockdowns are going to do more harm than good.  I have previously cited some, but here is a new one:

"Three Hebrew University professors claim that Israel and other countries could have controlled Covid-19 without resorting to lockdowns.

Their data-based study, “Managing the Covid-19 Pandemic without Destructing the Economy,” argues that the “medieval” approach of quarantining the population for a prolonged period takes a catastrophic economic and social toll.

The mathematical model developed by the authors – finance and banking experts David Gershon and Alexander Lipton of the Jerusalem Business School and epidemiologist Dr. Hagai Levine of the School of Public Health – confirmed that lockdown was not necessary for the stated purpose of “flattening the curve” of infection to avoid overwhelming the healthcare system.

One of the study’s conclusions is that lockdown is not necessary in countries that have more than 60 ICU beds per million available for Covid-19 patients.

Supporting the study’s conclusions is the fact that countries such as Sweden, Singapore, Taiwan and South Korea – each with fewer ICU beds per population than in Israel — never imposed a general lockdown and yet their healthcare systems did not reach full capacity.

Another piece of evidence the authors point to comes from a Gertner Institute study showing that on March 9, when the disease just started spreading in Israel, the infection rate was very high but decreased significantly by March 22 — before the start of the lockdown period–presumably due to hygienic precautionary measures.

What about Italy, Spain and the United States, where despite the lockdown thousands of people died?

The researchers suggest two possible explanations: First, these countries have a high percentage of citizens over age 60. Second, because of a lack of preventative hygienic measures the number of infected people was already high when the lockdown was enforced.

“By now, all the high-risk population is aware of the danger and the need to overprotect itself in general more than the low-risk population,” the authors stated.

According to the model, if a country adopts a policy of social distancing as much as possible, including at work; 14 days self-quarantine of every person with symptoms such as fever or cough; testing all individuals with symptoms; and hygiene measures including facemasks in public places, then in most cases there is no need for a lockdown.

Gershon, Levine and Lipton are calling for a systematic investigation of deaths that may have been or may still be caused by the lockdown itself in the short and long term.

They said the effects of long-term quarantine include high unemployment and social problems such as isolation and loneliness, limited access to healthcare, drug abuse, domestic violence, hunger and social unrest.

Given all those negative consequences, the researchers believe that the number of deaths related to lockdown will prove higher than the deaths related directly to Covid-19 infection.

They conclude that widespread lockdowns during the coronavirus pandemic may have a similar effect to “iatrogenesis,” a phenomenon where the treatment is more detrimental than the disease."

https://www.israel21c.org/lockdown-only-made-corona-crisis-worse-claim-experts/

https://arxiv.org/abs/2004.10324

Are these opinions correct?  I don't know, but we need to all calm down and start considering other opinions and approaches as new data is available.  And we are going to have to make trade-offs.  I am truly sorry, but some people are going to die from COVID.  We can't let that fear hold our entire health care system hostage, nor can we continue to let irrational fear govern our population, preventing them from seeking needed medical care for other issues.  In addition, the economy is important.  People need money in order to survive and live healthy lives.  Not only are we now facing unprecedented unemployment, we are also facing possible food shortages.  Don't forget that the US is an exporter of food, so issues in our agriculture have international implications.  It is now projected that millions of people worldwide will die from starvation due to COVID-induced food shortages.

"[David Beasley, Exec Dire of the World Food Programme] cited conflict, an economic recession, a decline in aid and a collapse in oil prices as factors likely to lead to vast food shortages, and urged swift action to avert disaster.

"While dealing with a Covid-19 pandemic, we are also on the brink of a hunger pandemic," David Beasley told the UN's security council. "There is also a real danger that more people could potentially die from the economic impact of Covid-19 than from the virus itself."

The WFP had already warned that 2020 would be a devastating year for numerous countries ravaged by poverty or war, with 135 million people facing crisis levels of hunger or worse. Their updated projections nearly double that number.  When added to the 821 million people already chronically hungry, that scenario would push more than 1 billion people into dire situations."

https://www.cnn.com/2020/04/22/africa/coronavirus-famine-un-warning-intl/index.html

 

Other references cited above:

https://www.marketwatch.com/story/majority-of-new-covid-19-hospitalizations-in-new-york-are-people-who-stayed-at-home-2020-05-06

https://www.wusa9.com/article/news/verify/majority-of-americans-dont-get-flu-shot/65-473ff1af-2fb7-4709-b4d7-9ffdf3a0916d

https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/

Edited by FullGlass

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30 minutes ago, FullGlass said:

Again, the article does not indicate that these people were refused care in a hospital due to lack of capacity.

My brother was denied care in a hospital due to lack of capacity. They specifically sent him home with an acknowledgement that they would rather admit him but couldn't. The hospital I work at is sending people home on O2 and waiting for them to get worse and bounce back, hopefully still with a pulse. Meanwhile I'm responding to STAT teams inside the hospital, finding patients that once would have been admitted to critical care and telling the med surg nurses how to manage these patients from the floor because we don't have capacity. Not in the least coincidentally, I'm also responding to a surge in code blues on the floor. It's ludicrous if you think these conditions don't hurt or kill patients. 

I'm also baffled at your apparent mindset that journalists who have no medical training and have never worked in medicine are more reliable sources of information than professionals telling you their working conditions directly. I don't know what you do for a living (aside from that it's obviously not hospital-based acute care), but imagine how much more you know about your field of expertise than a newbie in the field, and then consider how much more that trained newbie STILL knows about the field than some journalism major who's been covering a story for a few weeks, and maybe you'll get an idea of why your "but... but... the article says..." silliness is not merely misinformed but downright offensive. 

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Gingerpup has 36 years experience and specializes in Hospital Employee Health.

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These guys are dangerous.  

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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36 minutes ago, Cowboyardee said:

My brother was denied care in a hospital due to lack of capacity. They specifically sent him home with an acknowledgement that they would rather admit him but couldn't. The hospital I work at is sending people home on O2 and waiting for them to get worse and bounce back, hopefully still with a pulse. Meanwhile I'm responding to STAT teams inside the hospital, finding patients that once would have been admitted to critical care and telling the med surg nurses how to manage these patients from the floor because we don't have capacity. Not in the least coincidentally, I'm also responding to a surge in code blues on the floor. It's ludicrous if you think these conditions don't hurt or kill patients. 

I'm also baffled at your apparent mindset that journalists who have no medical training and have never worked in medicine are more reliable sources of information than professionals telling you their working conditions directly. I don't know what you do for a living (aside from that it's obviously not hospital-based acute care), but imagine how much more you know about your field of expertise than a newbie in the field, and then consider how much more that trained newbie STILL knows about the field than some journalism major who's been covering a story for a few weeks, and maybe you'll get an idea of why your "but... but... the article says..." silliness is not merely misinformed but downright offensive. 

I am very sorry about your brother and hope he will be OK.  I cannot speak to conditions at your hospital or in your area.  You are clearly working very hard and are frustrated.  Your responses are based on your personal experience.  Your experiences are real; I've never questioned that.  Have you considered that perhaps your hospital and/or city hasn't reacted optimally?  Do they have a good disaster preparedness plan?  If there is such an overflow of cases, then why not construct a temporary tent hospital or make arrangements to transfer patients to other hospitals?  If there is a lack of trained personnel, then why not make emergency training plans to train people in skills like ventilator use and implement those?  How about having healthcare personnel come in from areas that aren't impacted?  Since elective surgeries have been postponed, how about reconfiguring other, unused areas of the hospital to handle COVID patients?  

Also, most cities have more than one hospital.  Sick patients can be transported to another hospital if necessary.  I just moved from a very rural area with a very small hospital and they routinely transported patients to Redding, Chico, Sacramento, and even San Francisco if needed.  Why is this not happening in your area?

What would you have us do?  Do you want the entire US on a lockdown until a vaccine or cure is found, which may never happen?  

Are we not allowed to have discussions, debates, or evaluate evidence because it might offend you?

I'll accept your perspective that some people with COVID in your area have been turned away from hospitals.  What about the people who need emergency care for issues other than COVID who are so frightened they are not seeking care for heart attacks and strokes and then dying or suffering permanent disability?  What about people who were scheduled for elective surgeries like heart valve replacements who are dying because those surgeries have been postponed?  What about the increase in alcohol and opioid abuse and ODs due to the lockdown, job loss, etc?  What about cancer patients that have been unable to receive needed surgeries and treatments?

No, I don't work in acute care.  I also don't live in a COVID hot spot.  So I am seeing more suffering and possibly death caused by the lockdown than it is preventing.  That is why my argument is to make lockdown and similar decisions at the local level based on local conditions.  And we also need to rethink the whole lockdown approach, as it may not be necessary or effective at this point, in addition to possible causing more harm than good.

In addition, I have volunteered to go to New York and other hot spots, as well as signed up for the California Health Corps.  Here's my experience with that:

1  California hasn't needed the Health Corps

2  Got a notice that New York wanted NPs to work as RNs.  Okay, I would do that.  But then there was a long list of requirements and no training.  Now, let's think about this:  most of the country was not hit hard by COVID.  So, perhaps training could be provided in areas that were not impacted and then trained providers could be sent from there to hot spots?  Hmmmm.  That seems to me more like a lack of people thinking this through and developing good plans.

3  Got multiple notices from New York of needs for NPs to care for non-critical COVID patients and screen for COVID.  I responded to multiple such notices and never got a response.

 

Edited by FullGlass

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2 hours ago, FullGlass said:

 Have you considered that perhaps your hospital and/or city hasn't reacted optimally?  Do they have a good disaster preparedness plan?  If there is such an overflow of cases, then why not construct a temporary tent hospital or make arrangements to transfer patients to other hospitals?  If there is a lack of trained personnel, then why not make emergency training plans to train people in skills like ventilator use and implement those?  How about having healthcare personnel come in from areas that aren't impacted?  Since elective surgeries have been postponed, how about reconfiguring other, unused areas of the hospital to handle COVID patients?  

 

 

🤣

WOW!, we havent thought of any of those. We'll get on implementing your suggestions right away. Also, do you have the number to any good pizza delivery spots in the mid-Atlantic region? We are very hungry.

More seriously, I consider all the time whether my hospital's response is optimal. I try to improve our response where I can. But yes, we know how to divert patients. Yes, we have a big pretty tent, hidden comfortably away from the truck refrigerating the remains of our neighbors. Yes, we've brought staff from other regions in. And yes we've retrained staff to critical care (which usually takes a year and a half or so to merely become competent) in a matter of days. Heck, I personally wrote the condensed training manual we're passing around.

It's not just my hospital. It's not like I don't know anyone working elsewhere in the area. Critical care can be a small world, and ex coworkers get around. You're so invested in the notion that this just can't possibly be as bad as people say that you're discounting all evidence to the contrary and arguing with professionals in a field you know nothing about.  

Your suggestions come off like interrupting a firefighter's story about an out of control blaze over hundreds of acres and asking if they bothered to try using water. 

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

9 Followers; 2 Articles; 1,135 Posts; 10,651 Profile Views

11 minutes ago, Cowboyardee said:

 

Your suggestions come off like interrupting a firefighter's story about an out of control blaze over hundreds of acres and asking if they bothered to try using water. 

I joined this thread to discuss the larger issue of lockdowns - when and how to lift them.  It was not my intention to debate how individual hospitals are faring.  Prior to becoming an NP, I was a business executive and from what I've seen, most healthcare organizations are actually very poorly managed.  This has nothing to do with clinicians - most doctors and nurses are very dedicated and work their butts off.  I can't say the same for most of the managers and administrators in healthcare, who also often completely ignore clinicians.  And given the general poor disaster planning in this country, at all levels, my skepticism is reasonable

Thank you for your hard work and dedication during this difficult time.  My best wishes to you, your family, and your hospital and area.

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TriciaJ has 39 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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On 4/28/2020 at 11:59 AM, lifelearningrn said:

These doctors have a financial interest in getting everyone out and about again.   

Don't we all?

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39 minutes ago, TriciaJ said:

Don't we all?

There's not really any evidence that hurrying workers into unsafe environments during a pandemic is in the financial best interests of most people. There is evidence that this may be an unwise and hurried process from a public health perspective. 

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Kern County is very corrupt in my opinion 

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