Report from the trenches

[Maddy]

It was Trump himself who referred to the "Deep State Department," in relation to all this, to the obvious chagrin of Dr. Fauci who was standing right beside him. I suppose he'd know.

[dualstow]

It was Trump himself who referred to the "Deep State Department," in relation to all this, to the obvious chagrin of Dr. Fauci who was standing right beside him. I suppose he'd know.

Got it all cued up for you guys: viewtopic.php?f=9&t=2221&hilit=youtube+ ... 96#p189163
If the link doesn’t take you to the correct time, go to 54:50. It’s in the comments. (Link works on my desktop but not on my ipad)

[vnatale]

I'm also a licensed MD with a hospital accreditation in New York City, and I'm still sitting at home still waiting for The Call. In this AM's broadcast to staff, our hospital reiterated that no one would be asked to do something out of their skill set. And our dept chair made it clear that we are not even allowed to "volunteer" and that all re-deployments will go through him. If I get called I'll probably be asked to staff a testing clinic or something along those lines. Frankly, in an ICU I'd probably be less than useless.

I would guess that while our hospital has its act together and has been planning for weeks, not all have done this. I know that some hospitals only cancelled elective procedures a few days ago. This one must be poorly run. 20% of beds occupied by patients with respiratory illness from a virus - that is A NORMAL FLU SEASON!!!! If they're panicking already that's not a good sign. We haven't gone over the cliff yet...YET.

The good news is that the rate of new cases is beginning to slow, AND the acuity is less as a proportion of cases, because more testing means milder cases are being detected. Watch the numbers, reported daily in Cuomo's 10:30am broadcast.

It would have to get unimaginably worse before I'm told I have to become an ICU attending. And frankly, asking retired people to volunteer is sheer insanity. First, they are the vulnerable group who aren't going to do well if they get sick - and they are likely to get sick. Second, they have no clue how to navigate the ridiculously complex and time-sucking EHR systems that have been foisted on us. You want greater physician capacity? Shut down the damned EHRs and let us go back to paper charting and be damned to billing. Let some office busybody figure that out and scan in the paper documents after all is over.

Yes, EHR is crap and I hope something will be done about that.
I know Trump is not a big fan of red tape.

On the other hand I did all the accounting work for a pediatric practice starting in 2005 until, maybe, 2011 (I think). Their Managing Partner was an early, early adopter of electronic records -- way, way before it was mandated. They were an extremely profitable practice and his patients absolutely loved this Manager Partner / doctor.

Vinny

[Kriegsspiel]

To follow-up....I just talked to my sister who is an ER doc in Massachusetts. She was in a full-blown panic, because her hospital has done nothing to manage the situation and she's starting to see COVID cases in the ER. She said she had to intubate someone without an N95 mask because she's a small, and the hospital had run out of that size. She's been working every day (she's supposed to be part-time) because some of the ER docs are on quarantine. She asked me to send her the literature my hospital has been sending us (so I did) because she's been having to improvise protocols on the spot.

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[Maddy]

WiseOne, after hearing that your sister is an ER doc, I surmised that you must have come from a family with a strong role model in the form of a scientist or physician. It galvanized my image of you as something resembling the protagonist in the series Dr. Quinn, Medicine Woman. In Episode 1, we are introduced to Michaela Quinn (Jane Seymour), the outspoken daughter of an educated, well-to-do Boston physician in the mid-1800s who has battled her way through the Women's Medical College of Pennsylvania to achieve her dream of becoming a physician. Her father, staunchly supportive of her ambitions, has unfortunately died, leaving his daughter with virtually no hope of carrying on the practice given the era's prejudices against a "woman doctor." To the horror of her mother, who simply can't understand why her daughter can't be satisfied with marriage, Dr. Quinn embarks by train to the Colorado Territory, only to find that the people there would rather be doctored by a barber than submit themselves to the care of a woman. It's a wonderful story, one of my favorites. Of course, Sully (her eventual love interest) isn't hard to look at.

[WiseOne]

Vinny: Simple SAT test question. The computerized records system developed by a physician-run practice is to a
federally mandated, commercial EHR system as:

- Ecuador is to the Soviet bloc during the Cold War
- a game of checkers is to a murderous stampede at a World Cup soccer game
- Gerald Ford tripping while getting off an airplane to Bush proclaiming Mission Accomplished in front of an enormous banner in Iraq

I could do a bunch more of those, but hopefully you get the point. EHR systems and their ironclad enforcement of a long string of Obama-era mandates have practically destroyed our health care system. It's amazing that it functions at all.

Maddy: Hate to disappoint but my life isn't nearly that interesting! My father was an environmental engineer who did a ton of community & volunteer work on the side, so maybe that's something.

[Kriegsspiel]

Vinny: Simple SAT test question. The computerized records system developed by a physician-run practice is to a
federally mandated, commercial EHR system as:

- Ecuador is to the Soviet bloc during the Cold War
- a game of checkers is to a murderous stampede at a World Cup soccer game
- Gerald Ford tripping while getting off an airplane to Bush proclaiming Mission Accomplished in front of an enormous banner in Iraq

I could do a bunch more of those, but hopefully you get the point. EHR systems and their ironclad enforcement of a long string of Obama-era mandates have practically destroyed our health care system. It's amazing that it functions at all.

Maddy: Hate to disappoint but my life isn't nearly that interesting! My father was an environmental engineer who did a ton of community & volunteer work on the side, so maybe that's something.

GODDAMMIT WiseOne! Does the fart defense work against the Wuhan or what!?!?!

[WiseOne]

Kriegspiel I wouldn't count on it.

[dualstow]

Is anyone else besides me enjoying Kriegs' drunken posts in real time?

[Kriegsspiel]

Kriegspiel I wouldn't count on it.

If you were performing life saving maneuvers on a Wuhan-infected, one a scale of 1-10, what level of protection does the fart defense afford?

[Mountaineer]

Is anyone else besides me enjoying Kriegs' drunken posts in real time?

I had the same exact thought!

Love you Kreigs, hope the hangover isn't too bad.

[Maddy]

In today's news, Kaiser Permanente is threatening to fire any nurse who wears a mask while treating patients.
https://www.naturalnews.com/2020-03-25- ... virus.html

Via The Intercept:

The California Nurses Association and National Nurses United sent a flyer to members noting that Kaiser had threatened nurses with firing if they wear their own N95 masks, which offer a high level of protection from airborne contaminants, to work. “Kaiser has told nurses that if they’re seen wearing their personal N95 masks, they could be fired ‘on the spot’ for insubordination,” the flyer read.

Close to 100 nurses and family members gathered outside Kaiser’s Oakland Medical Center on Monday night to protest the new guidelines, saying that they put both patients and critical staff at risk. Staff at the center have been caring for patients from the Grand Princess cruise ship, which had at least 21 passengers test positive for Covid-19, the disease caused by the coronavirus.
* * *
What this means is that health authorities in California are trying to spread the coronavirus. This has become increasingly obvious with LA County previously announcing they would no longer even attempt to contain the virus. They ordered doctors to stop nearly all coronavirus testing, which also means halting all isolation attempts to stop the spread from accelerating.

Not long before that, Sacramento County ended all quarantine attempts and announced that high-risk people would simply be released from quarantine directives and allowed to spread the coronavirus without limit.

Does this sound like incompetence, or like a concerted attempt to spread the virus?

[Kriegsspiel]

Honestly, that sounds like fake news.

[Libertarian666]

Honestly, that sounds like fake news.

It does but these days it's hard to tell.

[Kriegsspiel]

Ain't that the truth.

[Maddy]

I found it hard to believe, also, but the California Nurses' Association website tends to corroborate this report:

The California Nurses Association/National Nurses United today called on California Gov. Gavin Newsom and other state officials to sharply escalate steps to get immediately personal protective equipment to nurses and other health care workers.
* * *
“We hear from scores of nurses every day, across the U.S., and many of them in California. They still do not have access to proper protective masks, such as N95 respirators, and full head-to-toe protective clothing,” said Castillo.
* * *
To make matters worse, the California Department of Public Health, which has been underfunding public health budgets for a decade, yesterday informed California hospitals that it is waiving the state's current strong requirements on hospital safety.

This waiver will allow hospitals to sharply lower practices on a wide variety of standards, including personal protective equipment (PPEs) and even safe nurse staffing for patients (nursing ratios).

On PPEs, CDPH cites the much lower, non-mandatory, guidelines suggested by the Centers for Disease Control and Prevention that is allowing hospitals to use vastly inferior materials, such as bandanas, that provide almost no effective protection when patients are highly contagious.

“At a time when nurses are already being told to use makeshift, inferior coverings, see N95 respirators locked up, and even being disciplined when they bring in their own N95s, this is the worst message we can send to hospital employers,” Castillo noted.

https://www.nationalnursesunited.org/pr ... ctive-gear

[dualstow]

I’m not defending Kaiser, but even the union’s charge is not that they’re “firing any nurse who wears a mask.” They’re trying to get nurses to not bring in any old mask. Clearly, though, if nurses are taking that step then they’re not getting what they need from Kaiser.

[FarmerD]

I found it hard to believe, also, but the California Nurses' Association website tends to corroborate this report:

The California Nurses Association/National Nurses United today called on California Gov. Gavin Newsom and other state officials to sharply escalate steps to get immediately personal protective equipment to nurses and other health care workers.
* * *
“We hear from scores of nurses every day, across the U.S., and many of them in California. They still do not have access to proper protective masks, such as N95 respirators, and full head-to-toe protective clothing,” said Castillo.
* * *
To make matters worse, the California Department of Public Health, which has been underfunding public health budgets for a decade, yesterday informed California hospitals that it is waiving the state's current strong requirements on hospital safety.

This waiver will allow hospitals to sharply lower practices on a wide variety of standards, including personal protective equipment (PPEs) and even safe nurse staffing for patients (nursing ratios).

On PPEs, CDPH cites the much lower, non-mandatory, guidelines suggested by the Centers for Disease Control and Prevention that is allowing hospitals to use vastly inferior materials, such as bandanas, that provide almost no effective protection when patients are highly contagious.

“At a time when nurses are already being told to use makeshift, inferior coverings, see N95 respirators locked up, and even being disciplined when they bring in their own N95s, this is the worst message we can send to hospital employers,” Castillo noted.

https://www.nationalnursesunited.org/pr ... ctive-gear

The military has literally millions of Chem warfare masks sitting in storage. The masks form a tight face seal and the filters on these masks are much more efficient than the N95 filters. Over the years in the military, I argued with several infection control doctors that they need to toss their leaky N95 masks and use real HEPA filters to protect themselves. The Chem warfare masks can be cleaned and re-used.

[Tortoise]

The Chem warfare masks can be cleaned and re-used.

(Kriegs has entered the chat.)