Kern County ER Docs C-19

Cowboyardee · May 4, 2020

9 hours ago, FullGlass said:
Except for a few areas, like NYC, the healthcare system was not overwhelmed and there is no reason to think it will be now. And even in NYC, everyone that needed treatment got it.

This isn't true. It may seem to be the case from the outside, but I can assure you first hand that it's not. Many people who would have otherwise been admitted to hospitals were sent home for self-monitoring (my sibling with bilateral pna, dyspnea, and chest pain but maintaining a sat above 90 was one example). What you saw in nyc was a severe lack of adequately trained personell being wallpapered over by the very visible production of extra beds, as though space was the real problem.

Dig a little deeper and you'll find hundreds of very credible horror stories of traveler nurses with zero critical care experience being placed in charge of half a dozen vented patients they had no realistic ability to care for safely or competently.

Meanwhile, in my area, which isn't considered overrun as NYC was, our non-covid critical care patients are being managed almost entirely by staff with step down training at best, while the few ICU staff we have left are struggling with 3 or 4 patients that might have been 1:1 a month ago, proning, on neuromuscular blockade, juggling multiple pressors on short supply, and rotating CRRT treatments because we dont have enough staff or machines to run it continuously. All while responding to frequent codes from the floor as patients that once would have been in ICUs circle the drain in 6:1 assignments with nurses not trained for the care they need. People are most definitely suffering and dying for lack of resources or trained personnel. I watched an in-patient die of treatable hyperkalemia earlier this week.

But the tent we built outside the hospital isn't yet at full capacity, so from the outside, it seems like everything is under control...

Wuzzie · May 4, 2020

7 hours ago, FullGlass said:
They provided raw data from their practice. How is that inaccurate?

The data they used may have been accurate but they applied it incorrectly.

7 hours ago, FullGlass said:
Why are you okay with them making those types of statements which caused widespread fear and panic, but you are so upset with the Bakersfield docs?

Because at the time all we had was what we saw in China and Italy. Once we had our own data to look at we adjusted appropriately.

FullGlass, BSN, MSN, NP · May 4, 2020

15 hours ago, Cowboyardee said:
This isn't true. It may seem to be the case from the outside, but I can assure you first hand that it's not. Many people who would have otherwise been admitted to hospitals were sent home for self-monitoring (my sibling with bilateral pna, dyspnea, and chest pain but maintaining a sat above 90 was one example). What you saw in nyc was a severe lack of adequately trained personell being wallpapered over by the very visible production of extra beds, as though space was the real problem.
Dig a little deeper and you'll find hundreds of very credible horror stories of traveler nurses with zero critical care experience being placed in charge of half a dozen vented patients they had no realistic ability to care for safely or competently.
Meanwhile, in my area, which isn't considered overrun as NYC was, our non-covid critical care patients are being managed almost entirely by staff with step down training at best, while the few ICU staff we have left are struggling with 3 or 4 patients that might have been 1:1 a month ago, proning, on neuromuscular blockade, juggling multiple pressors on short supply, and rotating CRRT treatments because we dont have enough staff or machines to run it continuously. All while responding to frequent codes from the floor as patients that once would have been in ICUs circle the drain in 6:1 assignments with nurses not trained for the care they need. People are most definitely suffering and dying for lack of resources or trained personnel. I watched an in-patient die of treatable hyperkalemia earlier this week.
But the tent we built outside the hospital isn't yet at full capacity, so from the outside, it seems like everything is under control...

I can't speak to what is going on inside each individual hospital. My point is that in most parts of the country, the healthcare system was never overwhelmed. Even in NYC, it was clear that the system was not "overwhelmed" in the sense that everyone who needed treatment in the hospital got it and the overflow facilities got little use. While individual hospitals may have struggled to provide all the needed care, they were able to do so.

And even if some areas and hospitals struggled, it does not justify a mass lockdown of every single area at this point. As I said, this is becoming a moot point as over half of states are lifting lockdowns and more and more local areas and individual businesses are disregarding lockdown orders

FullGlass, BSN, MSN, NP · May 4, 2020

9 hours ago, Wuzzie said:
The data they used may have been accurate but they applied it incorrectly.
Because at the time all we had was what we saw in China and Italy. Once we had our own data to look at we adjusted appropriately.

OK, so now you qualify your statements. You are OK with the raw data, but don't like how they applied it. OK. But I am OK with what they said. Here in California, we have been fortunate. More than half of cases and deaths have been in Los Angeles. So the doctors were correct when speaking about Bakersfield. Their key point is don't treat every location the same and I totally agree with that. I live in Sacramento and this city has the LOWEST number of cases/fatalities of any major metro area in the US. I don't believe in a one-size-fits-all approach to this issue.

And as you conclude, we have to adjust our approach based on new data. That also involves discussion and debate. We can't have that if we stop and/or condemn doctors from presenting their perspectives and opinions

When this started, there was panic over lack of ventilators. Fortunately, we had enough. But then some doctors reported the ventilators may make things worse. Then other doctors found that turning patients on their stomachs was helpful. These doctors didn't wait around for controlled, double blind studies because we were in an emergency situation. They were absolutely right to express different opinions and try different approaches based on what they were seeing in their practice.

Medicine has a long, sad history of trying to squash new ideas: Semmelweise, Dr. John Snow, etc

The "experts" in this country said Sweden was wrong. Now WHO says Sweden is a model.

Wuzzie · May 4, 2020

57 minutes ago, FullGlass said:
OK, so now you qualify your statements. You are OK with the raw data, but don't like how they applied it.

I am not qualifying anything! I have always said their calculations were wrong which is why I linked the article from an epidemiological expert supporting my position. Anyone with half a brain can count to a thousand. But mashing numbers together in incorrect formulas does not provide reliable, or truthful for that matter, statistics and presenting them as factual and themselves as experts is what I have a beef with. Had they limited themselves to simply saying “we don’t have as many cases as we thought we would so maybe it will be okay to open things up” that would have been fine but that isn’t what they did. They threw around made up statistics to make themselves look more trustworthy to an unsuspecting public with the purpose of riling them up. Otherwise why didn’t they just talk to their local officials instead of posting on social media?

And please, don’t conflate these two with frontline physicians and nurses who were thinking outside of the box and coming up with novel approaches to care. They aren’t even close.

Susie2310 · May 4, 2020

56 minutes ago, FullGlass said:

Saying that an entire state (any state) is justified in relaxing the lockdowns because there are some counties/cities within the state that are not as badly affected, makes no sense in my opinion. Once the lockdowns are relaxed people significantly decrease or stop the social isolation/social distancing and continue to behave as before. With more people driving/traveling, out in public, mingling, given the current Covid-19 situation in the US, it seems logical that the case numbers/numbers of deaths are only going to increase, both in the lesser affected areas and throughout the state and country.

Cowboyardee · May 5, 2020

4 hours ago, FullGlass said:
I can't speak to what is going on inside each individual hospital. My point is that in most parts of the country, the healthcare system was never overwhelmed. Even in NYC, it was clear that the system was not "overwhelmed" in the sense that everyone who needed treatment in the hospital got it and the overflow facilities got little use. While individual hospitals may have struggled to provide all the needed care, they were able to do so.

For whatever it's worth, I'm not particularly arguing about whether the country should open back up. There are far too many considerations to that kind of decision for me to pretend I know what's best.

But on the subject of NYC or any other hot spot...

Nope.

You're just plain wrong. Why are you just reiterating the same incorrect talking points I responded to in your last post? You clearly aren't on the front lines and clearly don't understand the challenges we face. You clearly have little idea of what's gone on in NYC or any other hot spot. Please have a little humility. Read my post again if you need to. The problem wasn't and isn't the number of beds. It's the need for trained personnel. Critical care has been overwhelmed in many areas and still is, and many patients are dying not only of the disease but of inadequate medical care for that reason. You may not read about it in political op-ed pieces, but that doesn't make it any less true. If you want to learn whats going on with critically ill patients, talk to people who work in the field rather than searching out whichever talking heads most closely agree with the conclusions you've already made.

FullGlass, BSN, MSN, NP · May 5, 2020

3 hours ago, Susie2310 said:
Saying that an entire state (any state) is justified in relaxing the lockdowns because there are some counties/cities within the state that are not as badly affected, makes no sense in my opinion. Once the lockdowns are relaxed people significantly decrease or stop the social isolation/social distancing and continue to behave as before. With more people driving/traveling, out in public, mingling, given the current Covid-19 situation in the US, it seems logical that the case numbers/numbers of deaths are only going to increase, both in the lesser affected areas and throughout the state and country.

You misunderstood me. My stance is that lockdowns should be at the local level, not the state level. Anyway, that ship is sailing. Over 1/2 of states are starting to lift lockdowns. And more and more local governments are just outright defying state lockdowns.

We must be realistic. People were very cooperative with lockdowns initially. It has now been 6 to 7 weeks, the economy is tanking, and people are getting increasingly frustrated and angry. Food shortages are looming. I provided evidence that people are increasingly ignoring lockdowns.

I don't care if the case numbers increase. I care about serious illness and death. And we now know who are high risk indivduals so we can adjust safety guidelines accordingly.

We have now reached the point where the medical, financial, and emotions costs of the lockdowns exceed the benefits. The curve has been flattened. Time to build up herd immunity.

FullGlass, BSN, MSN, NP · May 5, 2020

10 minutes ago, Cowboyardee said:
For whatever it's worth, I'm not particularly arguing about whether the country should open back up. There are far too many considerations to that kind of decision for me to pretend I know what's best.
But on the subject of NYC or any other hot spot...
Nope.
You're just plain wrong. Why are you just reiterating the same incorrect talking points I responded to in your last post? You clearly aren't on the front lines and clearly don't understand the challenges we face. You clearly have little idea of what's gone on in NYC or any other hot spot. Please have a little humility. Read my post again if you need to. The problem wasn't and isn't the number of beds. It's the need for trained personnel. Critical care has been overwhelmed in many areas and still is, and many patients are dying not only of the disease but of inadequate medical care for that reason. You may not read about it in political op-ed pieces, but that doesn't make it any less true. If you want to learn whats going on with critically ill patients, talk to people who work in the field rather than searching out whichever talking heads most closely agree with the conclusions you've already made.

What is your point? It is irrelevant to this discussion. I am not talking about trained personnel or what your personal experience is. I am talking about policy decisions.

1. You have NO evidence that patients are dying for lack of critical care.

2. How many times do I have to say that NYC is not the whole country? I have repeatedly said these decisions need to be made at the LOCAL level. If NYC wants to continue their lockdown, that's understandable. That doesn't mean the rest of the country does.

3. The curve has been flattened.

4. Many hospitals are now half empty or more. Doctors and nurses being furloughed. Elective surgeries are now becoming emergencies. Some patients may have died from "elective" surgeries being postponed. Rural hospitals are always financially hurting and now some of them will have to close. You think that's OK?

5. I work in primary care and psych. People are not getting needed medical care, many people are psychologically imploding, and people with mental health issues are getting worse.

6. I have had multiple patients crying over whether they can put food on the table. I have given my own food to some patients.

7. The death rate from COVID is quite low. We also now know who high risk individuals are and those individuals can take extra precautions.

So don't extrapolate your own experience to the whole country. That's very poor reasoning. COVID isn't the only health problem we have to deal with, and other patients are suffering due to the lock down. And most people don't want to go into a depression and lose all their money, possible their house and car, and so forth.

Over half the states are lifting restrictions and more and more local governments, as well as individuals and businesses, are ignoring them.

14 hours ago, Wuzzie said:
The data they used may have been accurate but they applied it incorrectly.
Because at the time all we had was what we saw in China and Italy. Once we had our own data to look at we adjusted appropriately.

That is your opinion and you are entitled to it. My point is that it is plain wrong to censor and condemn doctors who have a different opinion and interpretation.

Wuzzie · May 5, 2020

3 minutes ago, FullGlass said:
That is your opinion and you are entitled to it. My point is that it is plain wrong to censor and condemn doctors who have a different opinion and interpretation.

Oh for god’s sake I have repeatedly expressed that having an opinion is fine. Presenting it as fact is not. And “condemn”? That’s a bit over the top. Nobody here is arguing to continue with the lockdown yet you seem to be deliberately obfuscating that fact while trying to school us on things we already know. We get your point. You just can’t seem to comprehend ours. You think your primary care patients have it rough? Try being an acute care patient right now. Or a cancer patient. And spare us the sainthood. Most of us have gone above and beyond for a patient a time or two in our careers. We just don’t feel the need to advertise it because it’s crass.

I don’t even know what you’re kvetching about anymore. The lockdowns are being lifted.

Cowboyardee · May 5, 2020

1 hour ago, FullGlass said:
What is your point? It is irrelevant to this discussion. I am not talking about trained personnel or what your personal experience is. I am talking about policy decisions.
1. You have NO evidence that patients are dying for lack of critical care.
2. How many times do I have to say that NYC is not the whole country? I have repeatedly said these decisions need to be made at the LOCAL level. If NYC wants to continue their lockdown, that's understandable. That doesn't mean the rest of the country does.
3. The curve has been flattened.
4. Many hospitals are now half empty or more. Doctors and nurses being furloughed. Elective surgeries are now becoming emergencies. Some patients may have died from "elective" surgeries being postponed. Rural hospitals are always financially hurting and now some of them will have to close. You think that's OK?
5. I work in primary care and psych. People are not getting needed medical care, many people are psychologically imploding, and people with mental health issues are getting worse.
6. I have had multiple patients crying over whether they can put food on the table. I have given my own food to some patients.
7. The death rate from COVID is quite low. We also now know who high risk individuals are and those individuals can take extra precautions.
So don't extrapolate your own experience to the whole country. That's very poor reasoning. COVID isn't the only health problem we have to deal with, and other patients are suffering due to the lock down. And most people don't want to go into a depression and lose all their money, possible their house and car, and so forth.
Over half the states are lifting restrictions and more and more local governments, as well as individuals and businesses, are ignoring them.
That is your opinion and you are entitled to it. My point is that it is plain wrong to censor and condemn doctors who have a different opinion and interpretation.

1. Wait, what? I only got involved in this conversation when you claimed (entirely without evidence) that healthcare is not overwhelmed in NYC or anywhere in particular, implying that hospitals are fine and handling the crisis well. I then presented you with a first-hand account of what "not overwhelmed" and "fine" actually mean to those trying to fight this disease... You then have the nerve to tell me I have no evidence as though seeing patients suffer and/or die of inadequate care first-hand and talking friends and relatives suffering from inadequate medical resources in NYC through their ordeal couldn't possibly compete with 'facts' you pulled out of thin air, about a real life crisis and tragedy you haven't seen or taken part in, to make blustery, tone-deaf arguments on the internet.

Seriously, check yourself. This is real life, not some keyboard warrior pissing contest.

As for numbers 2-7: Completely, 100% irrelevent to anything I actually said. If the rest of your argument hinges on your fantasyland head-in-the-sand nonsense about hospitals coping perfectly well with the crisis and patients not suffering at all for the chaos, then you should definitely reconsider your entire case. But I haven't particularly taken a side on economic shutdowns and mass quarantines and I don't know why you're wasting most of your post lecturing me about it.

It's still early on. The peer reviewed meta-analyses will come later. For now, best you can do is actually listen to accounts from the front lines rather than pretending you know what's going on when you clearly don't at all.

toomuchbaloney · May 5, 2020

https://www.reuters.com/article/us-health-coronavirus-fdny/at-home-covid-19-deaths-may-be-significantly-undercounted-in-new-york-city-idUSKBN21P3KF

This reporting suggests that people did, indeed die, without adequate hospital care.