Are you worried about the Coronavirus?

[Karl_K]

Word is that the fda is giving wavers but only in a way a #@%@% bureaucracy can...
If they partner with a company that has fda clearance they can make medical goods under the partners supervision and license.
It looks like GM and Ford are partnering with 3M and GE.

https://media.ford.com/content/fordmedia/fna/us/en/news/2020/03/24/ford-3m-ge-uaw-respirators-ventilators.html

 

[Phoenix]

Husband just called. He was leaving work when he got a call. Some one there has tested positive. He's talking to HR now.
He says they guy hasn't been to work since Friday, works second shift and he (husband) hasn't had any direct contact with him.
But husband is director of manufacturing. He's all over that facility every day.
Ugh. Ughy, ughy,
UGG

HUGS! Prayers your hubby doesn't get it.

 

[LemonMoonLex]

I dont know if this has been posted or not but I love love this.




As one of the younger PSers on here I firmly cannot fathom how a lot of my fellow youth don't understand or don't care to understand how their poor choices can/will impact those around us; including those we love.

& While it's definetely not the attitude of every young person, it is still a very present one that I'm seeing. Hell, there's tons of footage online about spring breakers out and about giving slurred speeches over hookah coals and margaritas, about how they're so cool to be partying during the end of the world yet they only feel the weight of their words and portrayed attitude when their video blows up.

Although we also cannot soley be blamed for this attitude because everyone introduced it to us as the virus that is hurting the immune suppressed and the elderly- but not the young nor healthy. I believe that saying that and marking this virus as such was a huge mistake and honestly its not so true. The first person in my town to be confirmed was a healthy 20 year old male and hes not doing too well.

Idk...I digress.
In the words of someone out there.....

"This sh** be CRAY."

 

[missy]

That Discomfort You’re Feeling Is Grief

During the global pandemic, a palpable sense of collective grief has emerged. Grief expert David Kessler says that grief is actually multiple feelings that we must manage. In an interview with HBR, he explains how the classic five stages of grief (denial, anger, bargaining, sadness, acceptance)...

hbr.org

"
That Discomfort You’re Feeling Is Grief

• by
• Scott Berinato

March 23, 2020

HBR Staff/d3sign/Getty Images
We’ve made our coronavirus coverage free for all readers. To get it delivered to your inbox, sign up for the Daily Alert newsletter.
Some of the HBR edit staff met virtually the other day — a screen full of faces in a scene becoming more common everywhere. We talked about the content we’re commissioning in this harrowing time of a pandemic and how we can help people. But we also talked about how we were feeling. One colleague mentioned that what she felt was grief. Heads nodded in all the panes.
If we can name it, perhaps we can manage it. We turned to David Kessler for ideas on how to do that. Kessler is the world’s foremost expert on grief. He co-wrote with Elisabeth Kübler-Ross On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. His new book adds another stage to the process, Finding Meaning: The Sixth Stage of Grief. Kessler also has worked for a decade in a three-hospital system in Los Angeles. He served on their biohazard’s team. His volunteer work includes being an LAPD Specialist Reserve for traumatic events as well as having served on the Red Cross’s disaster services team. He is the founder of www.grief.com which has over 5 million visits yearly from 167 countries.
Kessler shared his thoughts on why it’s important to acknowledge the grief you may be feeling, how to manage it, and how he believes we will find meaning in it. The conversation is lightly edited for clarity.
HBR: People are feeling any number of things right now. Is it right to call some of what they’re feeling grief?
Kessler: Yes, and we’re feeling a number of different griefs. We feel the world has changed, and it has. We know this is temporary, but it doesn’t feel that way, and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we’re grieving. Collectively. We are not used to this kind of collective grief in the air.
You said we’re feeling more than one kind of grief?


Yes, we’re also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level.

Understanding the stages of grief is a start. But whenever I talk about the stages of grief, I have to remind people that the stages aren’t linear and may not happen in this order. It’s not a map but it provides some scaffolding for this unknown world. There’s denial, which we say a lot of early on: This virus won’t affect us. There’s anger: You’re making me stay home and taking away my activities. There’s bargaining: Okay, if I social distance for two weeks everything will be better, right?There’s sadness: I don’t know when this will end. And finally there’s acceptance. This is happening; I have to figure out how to proceed.
Acceptance, as you might imagine, is where the power lies. We find control in acceptance. I can wash my hands. I can keep a safe distance. I can learn how to work virtually.

When we’re feeling grief there’s that physical pain. And the racing mind. Are there techniques to deal with that to make it less intense?

Let’s go back to anticipatory grief. Unhealthy anticipatory grief is really anxiety, and that’s the feeling you’re talking about. Our mind begins to show us images. My parents getting sick. We see the worst scenarios. That’s our minds being protective. Our goal is not to ignore those images or to try to make them go away — your mind won’t let you do that and it can be painful to try and force it. The goal is to find balance in the things you’re thinking. If you feel the worst image taking shape, make yourself think of the best image. We all get a little sick and the world continues. Not everyone I love dies. Maybe no one does because we’re all taking the right steps. Neither scenario should be ignored but neither should dominate either.

Anticipatory grief is the mind going to the future and imagining the worst. To calm yourself, you want to come into the present. This will be familiar advice to anyone who has meditated or practiced mindfulness but people are always surprised at how prosaic this can be. You can name five things in the room. There’s a computer, a chair, a picture of the dog, an old rug, and a coffee mug. It’s that simple. Breathe. Realize that in the present moment, nothing you’ve anticipated has happened. In this moment, you’re okay. You have food. You are not sick. Use your senses and think about what they feel. The desk is hard. The blanket is soft. I can feel the breath coming into my nose. This really will work to dampen some of that pain.

You can also think about how to let go of what you can’t control. What your neighbor is doing is out of your control. What is in your control is staying six feet away from them and washing your hands. Focus on that.

Finally, it’s a good time to stock up on compassion. Everyone will have different levels of fear and grief and it manifests in different ways. A coworker got very snippy with me the other day and I thought, That’s not like this person; that’s how they’re dealing with this. I’m seeing their fear and anxiety. So be patient. Think about who someone usually is and not who they seem to be in this moment.

One particularly troubling aspect of this pandemic is the open-endedness of it.
This is a temporary state. It helps to say it. I worked for 10 years in the hospital system. I’ve been trained for situations like this. I’ve also studied the Spanish Flu. The precautions we’re taking are the right ones. History tells us that. This is survivable. We will survive. This is a time to overprotect but not overreact.

And, I believe we will find meaning in it. I’ve been honored that Elisabeth Kübler-Ross’s family has given me permission to add a sixth stage to grief: Meaning. I had talked to Elisabeth quite a bit about what came after acceptance. I did not want to stop at acceptance when I experienced some personal grief. I wanted meaning in those darkest hours. And I do believe we find light in those times. Even now people are realizing they can connect through technology. They are not as remote as they thought. They are realizing they can use their phones for long conversations. They’re appreciating walks. I believe we will continue to find meaning now and when this is over.

What do you say to someone who’s read all this and is still feeling overwhelmed with grief?

Keep trying. There is something powerful about naming this as grief. It helps us feel what’s inside of us. So many have told me in the past week, “I’m telling my coworkers I’m having a hard time,” or “I cried last night.” When you name it, you feel it and it moves through you. Emotions need motion. It’s important we acknowledge what we go through. One unfortunate byproduct of the self-help movement is we’re the first generation to have feelings about our feelings. We tell ourselves things like, I feel sad, but I shouldn’t feel that; other people have it worse.We can — we should — stop at the first feeling. I feel sad. Let me go for five minutes to feel sad. Your work is to feel your sadness and fear and anger whether or not someone else is feeling something. Fighting it doesn’t help because your body is producing the feeling. If we allow the feelings to happen, they’ll happen in an orderly way, and it empowers us. Then we’re not victims.
In an orderly way?

Yes. Sometimes we try not to feel what we’re feeling because we have this image of a “gang of feelings.” If I feel sad and let that in, it’ll never go away. The gang of bad feelings will overrun me. The truth is a feeling moves through us. We feel it and it goes and then we go to the next feeling. There’s no gang out to get us. It’s absurd to think we shouldn’t feel grief right now. Let yourself feel the grief and keep going.



"

 

[TooPatient]

Test came back negative!

I don't know if that is because this wasn't COVID-19 or if it was but was already gone with just lingering symptoms or what. This has been absolutely miserable, so I hate to think there is worse!

Anyway, hopefully that means DH can see his regular Dr if he needs to.

 

[KaeKae]

HUGS! Prayers your hubby doesn't get it.

Thank you! I was a $%^$ false alarm.
The fool texted that he had covid 19, but hasn't actually been tested!
Way to create a panic in your workplace.

He's not high risk and he hasn't been exposed that he knows of. Why would you do that? How about call and say you don't feel well and take a couple days to see what's going on/see a doctor?

On a happier note, my brother wasn't feeling well, was tested and came back negative.

 

[Calliecake]

GREAT NEWS @TooPatient And @KaeKae . It feels wonderful to feel happy. Thank you for sharing.

 

[Arcadian]

Coronavirus: Iceland’s mass testing finds half of carriers show no symptoms

As the coronavirus pandemic surges worldwide, each piece of data counts in the fight against the deadly pathogen.But significant findings about the

english.alarabiya.net

this here

40 mutations of the virus
Iceland's high-volume testing also involves genetic sequencing of the different samples of the virus, which helps researchers to investigate the various mutations of the virus.

Icelandic scientists say testing has already revealed that there are at least 40 mutations of coronavirus in Iceland, and the virus might develop to become more contagious, but less dangerous. These variants can also act as the fingerprints of the virus to trace its origin. Seven of the infected people were traced to an undisclosed football match in England, the team said.

 

[AdaBeta27]

The latest positive test in my region was a school age kid, middle school, perhaps. There is all kinds of anecdotal evidence that, at least in USA, it's not just elderly affected by this virus. And news from Cleveland area says that the virus often manifests gastric symptoms and other "milder" symptoms, not immediately fever and difficulty breathing. That has a lot of people here worried, because those symptoms don't get you permission to either self-quarantine or get tested for COVID-19. And people can be walking around infecting others with the virus.

 

[Niffler75]

@AdaBeta27 I think our understanding of this virus is an evolving situation. Here scientists and health advisors in the UK working on their current understanding but are processing new data all the time and learning as they go along.
I think this virus has flown under the radar for a while being diagnosed as flu, other winter viruses and pneumonia.

 

[Begonia]

The ferry company I work for has gone to level 4 of a 5 level pandemic response plan. Jeez.

Living on an island, the govt has mandated ferries an essential service. Now normally at this time, we run at an A license and take many passengers, and a large amount of crew to safely evacuate the vessel in the event of an emergency. Should we reach stage 5, we would have a maximum of 100 aboard (our #1 vessel can take 2200 pax, and does so usually during spring break, summers, heck most weekends), and would be a D license. Essential meaning only trucks and drivers bringing goods, and essential personnel needing to travel back or forth from our island to the mainland.
Crew would all be wearing PPE. Full on PPE.

The ferries are relatively quiet currently, and our #2 vessel isn't running, which normally it would be. People are wisely choosing not to travel, but are not required to not travel.

Thanks for listening. It's
huge for us islanders. Our
ferry system is considered a hwy, and only the govt can do the extreme restrictions above. To be this close to level 5 (essential service only) is very big indeed. I never thought I'd experience this, another surreal moment.

 

[Lilith112]

Crew would all be wearing PPE. Full on PPE.

The ferries are relatively quiet currently, and our #2 vessel isn't running, which normally it would be. People are wisely choosing not to travel, but are not required to not travel.

It's great to hear that everyone is protected though! It's horrifying how under-protected a lot of healthcare workers across the U.S. and Europe are. I've also heard horror stories about hospitals rejecting PPE sold at a loss...because it wasn't free. And then forbidding employees to buy their own personal PPE. DOH.

 

[MakingTheGrade]

I read this account from a young doc in training in NYC and cried. I wish there was a boot camp to retrain me for icu and vent care. If things get really bad, there might end up being one..
I really hope that doesn’t happen though. As much as I’m itching to be frontline and helping, drafting in sub specialists will have meant the US lost a huge amount of physician workforce.

Link:
3 days in nyc

 

[Begonia]

It's great to hear that everyone is protected though! It's horrifying how under-protected a lot of healthcare workers across the U.S. and Europe are. I've also heard horror stories about hospitals rejecting PPE sold at a loss...because it wasn't free. And then forbidding employees to buy their own personal PPE. DOH.

Well currently at level 4. This just happened. People keeping social distance and crew have gloves, but not full PPE. If someone is identified with covid 19, then full on PPE (suit, face shield, mask and gloves).

So ferry Corp encouraging people to stay in their cars, or better yet, not travel at all. In some ways I believe our crews want level 5 so that all nonessential travel stops, and lowers their risk of being exposed. Still level 5 represents...that things have gotten worse. Of course we knew it would, but the reality of it is...unsettling.

 

[TooPatient]

I read this account from a young doc in training in NYC and cried. I wish there was a boot camp to retrain me for icu and vent care. If things get really bad, there might end up being one..
I really hope that doesn’t happen though. As much as I’m itching to be frontline and helping, drafting in sub specialists will have meant the US lost a huge amount of physician workforce.

Link:
3 days in nyc

That was horrible to read, but so well done. More people need to read accounts like this and understand what this looks like from inside a hospital.

I hope things don't get so bad that you end up in the midst of the ICU. Thinking of you often as the cases keep climbing. Take care of yourself!

 

[lissyflo]

This virus is really contagious - at least half of my son’s class now seems to have had it over the space of less than two weeks. A few very mild symptoms (cold type intensity), but lots of very high temperatures and flu-type aches/chills and lots left with very bad coughs. And these are children, who supposedly get more mild illness from it in general. There’s no way the UK figures on number of cases are anywhere near accurate or reliable - they’re only testing those who reach hospital, but it’s raging through the general public it seems.

 

[beatricecrummles]

We are all worried. It has become a global crisis already. This should end as soon as possible.

 

[Phoenix]

This virus is really contagious - at least half of my son’s class now seems to have had it over the space of less than two weeks. A few very mild symptoms (cold type intensity), but lots of very high temperatures and flu-type aches/chills and lots left with very bad coughs. And these are children, who supposedly get more mild illness from it in general. There’s no way the UK figures on number of cases are anywhere near accurate or reliable - they’re only testing those who reach hospital, but it’s raging through the general public it seems.

This.

I fear for the UK. I fear for everyone. Cases in SG are rising too, with the highest number of cases per day recorded yesterday.

 

[jaaron]

My H is on day 9 and I think is finally on an upward trajectory, college-aged kid on day 5. Both have been mild cases, but even a mild case is pretty brutal. H is fit and healthy, but it's kicked him hard. We're just thankful that it hasn't hit a point where it's been scary. College-aged kid's started with a fairly terrifying fever - almost 105, but it came right down with Tylenol. Other than one night of bad coughing, and the occasional cough subsequently, she's been tired and achey and has lost sense of smell/taste, but otherwise ok. Our doctor has been reassuring and available throughout by phone and zoom, which has been nice.

Other college-aged kid and I have not (yet) succumbed. Really looking forward to the antibody test, which they are saying will soon be widely available here. There are so many people needing help right now- I hate the fact that I can't get involved until I know I'm safe for them.

Hope everyone is staying safe.

 

[icy_jade]

This virus is really contagious - at least half of my son’s class now seems to have had it over the space of less than two weeks. A few very mild symptoms (cold type intensity), but lots of very high temperatures and flu-type aches/chills and lots left with very bad coughs. And these are children, who supposedly get more mild illness from it in general. There’s no way the UK figures on number of cases are anywhere near accurate or reliable - they’re only testing those who reach hospital, but it’s raging through the general public it seems.

This sounds really scary

That Discomfort You’re Feeling Is Grief

During the global pandemic, a palpable sense of collective grief has emerged. Grief expert David Kessler says that grief is actually multiple feelings that we must manage. In an interview with HBR, he explains how the classic five stages of grief (denial, anger, bargaining, sadness, acceptance)...

hbr.org

"
That Discomfort You’re Feeling Is Grief

• by
• Scott Berinato

March 23, 2020

HBR Staff/d3sign/Getty Images
We’ve made our coronavirus coverage free for all readers. To get it delivered to your inbox, sign up for the Daily Alert newsletter.
Some of the HBR edit staff met virtually the other day — a screen full of faces in a scene becoming more common everywhere. We talked about the content we’re commissioning in this harrowing time of a pandemic and how we can help people. But we also talked about how we were feeling. One colleague mentioned that what she felt was grief. Heads nodded in all the panes.
If we can name it, perhaps we can manage it. We turned to David Kessler for ideas on how to do that. Kessler is the world’s foremost expert on grief. He co-wrote with Elisabeth Kübler-Ross On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. His new book adds another stage to the process, Finding Meaning: The Sixth Stage of Grief. Kessler also has worked for a decade in a three-hospital system in Los Angeles. He served on their biohazard’s team. His volunteer work includes being an LAPD Specialist Reserve for traumatic events as well as having served on the Red Cross’s disaster services team. He is the founder of www.grief.com which has over 5 million visits yearly from 167 countries.
Kessler shared his thoughts on why it’s important to acknowledge the grief you may be feeling, how to manage it, and how he believes we will find meaning in it. The conversation is lightly edited for clarity.
HBR: People are feeling any number of things right now. Is it right to call some of what they’re feeling grief?
Kessler: Yes, and we’re feeling a number of different griefs. We feel the world has changed, and it has. We know this is temporary, but it doesn’t feel that way, and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we’re grieving. Collectively. We are not used to this kind of collective grief in the air.
You said we’re feeling more than one kind of grief?


Yes, we’re also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level.

Understanding the stages of grief is a start. But whenever I talk about the stages of grief, I have to remind people that the stages aren’t linear and may not happen in this order. It’s not a map but it provides some scaffolding for this unknown world. There’s denial, which we say a lot of early on: This virus won’t affect us. There’s anger: You’re making me stay home and taking away my activities. There’s bargaining: Okay, if I social distance for two weeks everything will be better, right?There’s sadness: I don’t know when this will end. And finally there’s acceptance. This is happening; I have to figure out how to proceed.
Acceptance, as you might imagine, is where the power lies. We find control in acceptance. I can wash my hands. I can keep a safe distance. I can learn how to work virtually.

When we’re feeling grief there’s that physical pain. And the racing mind. Are there techniques to deal with that to make it less intense?

Let’s go back to anticipatory grief. Unhealthy anticipatory grief is really anxiety, and that’s the feeling you’re talking about. Our mind begins to show us images. My parents getting sick. We see the worst scenarios. That’s our minds being protective. Our goal is not to ignore those images or to try to make them go away — your mind won’t let you do that and it can be painful to try and force it. The goal is to find balance in the things you’re thinking. If you feel the worst image taking shape, make yourself think of the best image. We all get a little sick and the world continues. Not everyone I love dies. Maybe no one does because we’re all taking the right steps. Neither scenario should be ignored but neither should dominate either.

Anticipatory grief is the mind going to the future and imagining the worst. To calm yourself, you want to come into the present. This will be familiar advice to anyone who has meditated or practiced mindfulness but people are always surprised at how prosaic this can be. You can name five things in the room. There’s a computer, a chair, a picture of the dog, an old rug, and a coffee mug. It’s that simple. Breathe. Realize that in the present moment, nothing you’ve anticipated has happened. In this moment, you’re okay. You have food. You are not sick. Use your senses and think about what they feel. The desk is hard. The blanket is soft. I can feel the breath coming into my nose. This really will work to dampen some of that pain.

You can also think about how to let go of what you can’t control. What your neighbor is doing is out of your control. What is in your control is staying six feet away from them and washing your hands. Focus on that.

Finally, it’s a good time to stock up on compassion. Everyone will have different levels of fear and grief and it manifests in different ways. A coworker got very snippy with me the other day and I thought, That’s not like this person; that’s how they’re dealing with this. I’m seeing their fear and anxiety. So be patient. Think about who someone usually is and not who they seem to be in this moment.

One particularly troubling aspect of this pandemic is the open-endedness of it.
This is a temporary state. It helps to say it. I worked for 10 years in the hospital system. I’ve been trained for situations like this. I’ve also studied the Spanish Flu. The precautions we’re taking are the right ones. History tells us that. This is survivable. We will survive. This is a time to overprotect but not overreact.

And, I believe we will find meaning in it. I’ve been honored that Elisabeth Kübler-Ross’s family has given me permission to add a sixth stage to grief: Meaning. I had talked to Elisabeth quite a bit about what came after acceptance. I did not want to stop at acceptance when I experienced some personal grief. I wanted meaning in those darkest hours. And I do believe we find light in those times. Even now people are realizing they can connect through technology. They are not as remote as they thought. They are realizing they can use their phones for long conversations. They’re appreciating walks. I believe we will continue to find meaning now and when this is over.

What do you say to someone who’s read all this and is still feeling overwhelmed with grief?

Keep trying. There is something powerful about naming this as grief. It helps us feel what’s inside of us. So many have told me in the past week, “I’m telling my coworkers I’m having a hard time,” or “I cried last night.” When you name it, you feel it and it moves through you. Emotions need motion. It’s important we acknowledge what we go through. One unfortunate byproduct of the self-help movement is we’re the first generation to have feelings about our feelings. We tell ourselves things like, I feel sad, but I shouldn’t feel that; other people have it worse.We can — we should — stop at the first feeling. I feel sad. Let me go for five minutes to feel sad. Your work is to feel your sadness and fear and anger whether or not someone else is feeling something. Fighting it doesn’t help because your body is producing the feeling. If we allow the feelings to happen, they’ll happen in an orderly way, and it empowers us. Then we’re not victims.
In an orderly way?

Yes. Sometimes we try not to feel what we’re feeling because we have this image of a “gang of feelings.” If I feel sad and let that in, it’ll never go away. The gang of bad feelings will overrun me. The truth is a feeling moves through us. We feel it and it goes and then we go to the next feeling. There’s no gang out to get us. It’s absurd to think we shouldn’t feel grief right now. Let yourself feel the grief and keep going.



"

This really resonated with me - thanks for sharing!

Grief for loss of normalcy, grief for the millions who will die, grief for the economic impact on people... and all the unknowns regarding how my loved ones and I will get through this.

 

[AGBF]

My H is on day 9 and I think is finally on an upward trajectory, college-aged kid on day 5. Both have been mild cases, but even a mild case is pretty brutal. H is fit and healthy, but it's kicked him hard. We're just thankful that it hasn't hit a point where it's been scary. College-aged kid's started with a fairly terrifying fever - almost 105, but it came right down with Tylenol. Other than one night of bad coughing, and the occasional cough subsequently, she's been tired and achey and has lost sense of smell/taste, but otherwise ok. Our doctor has been reassuring and available throughout by phone and zoom, which has been nice.

Other college-aged kid and I have not (yet) succumbed. Really looking forward to the antibody test, which they are saying will soon be widely available here. There are so many people needing help right now- I hate the fact that I can't get involved until I know I'm safe for them.

Hope everyone is staying safe.

I hope everyone who is ill recovers soon and and those of you who are well do not get ill! Thank you for your good wishes to the rest of us.

Deb

 

[junebug17]

My H is on day 9 and I think is finally on an upward trajectory, college-aged kid on day 5. Both have been mild cases, but even a mild case is pretty brutal. H is fit and healthy, but it's kicked him hard. We're just thankful that it hasn't hit a point where it's been scary. College-aged kid's started with a fairly terrifying fever - almost 105, but it came right down with Tylenol. Other than one night of bad coughing, and the occasional cough subsequently, she's been tired and achey and has lost sense of smell/taste, but otherwise ok. Our doctor has been reassuring and available throughout by phone and zoom, which has been nice.

Other college-aged kid and I have not (yet) succumbed. Really looking forward to the antibody test, which they are saying will soon be widely available here. There are so many people needing help right now- I hate the fact that I can't get involved until I know I'm safe for them.

Hope everyone is staying safe.

@jaaron, I'm so sorry you're dealing with this and I hope everyone is better soon. Please protect yourself as much as you can and take care. <3

 

[MamaBee]

Yeah my spouse may go quarantine with his mom so that I can self quarantine with the cat.

We don’t have enough information yet but maybe if I end up getting it and recovering I wouldn’t need to self quarantine as much since in theory I wouldn’t be a risk to him (or anyone) anymore. Maybe wishful thinking.

@MakingTheGrade My husband is living by himself in our house in Pa. I’m isolating in Maryland with my son, David, my mom and Bailey, my dog. I don’t plan on seeing him unless he comes to the back yard here and keeps his distance. It’s over two hours...one way..so thinking he will have to pee in the bushes instead of coming in the house here to use the bathroom...no joke...He’s seeing minimal people but still working. His job is in the essential job list...I don’t want him coming in here...but I’m so worried about him...
If you hear anything I should know about Pa please let me know. He’s not up to date on the news and I get minimal news here in Maryland on Pa..
I hope you stay healthy..as well as your husband. I worry about you...I can’t help it..I worry about all the doctors...including my primary doctor.

 

[Babyblue033]

I read this account from a young doc in training in NYC and cried. I wish there was a boot camp to retrain me for icu and vent care. If things get really bad, there might end up being one..
I really hope that doesn’t happen though. As much as I’m itching to be frontline and helping, drafting in sub specialists will have meant the US lost a huge amount of physician workforce.

Link:
3 days in nyc

This was... haunting is the word that pops in my head. The terrible situation these doctors and nurses are in, worrying about their patients as well as their own safety, is truly sad and terrifying.

My good friend is a head nurse in ER and I worry about him and his family. I wonder when we will go back to "normal"...

 

[MamaBee]

I read this account from a young doc in training in NYC and cried. I wish there was a boot camp to retrain me for icu and vent care. If things get really bad, there might end up being one..
I really hope that doesn’t happen though. As much as I’m itching to be frontline and helping, drafting in sub specialists will have meant the US lost a huge amount of physician workforce.

Link:
3 days in nyc

Heartbreaking.....

 

[missy]

I’m not sure I should share this. Supposedly it’s from an ER doc in Louisiana. Warning. Don’t read if you don’t want to get upset. My DH told me he doesn’t want to hear any more horrible Covid 19 stories and Jess probably right because what good does this do us. As long as everyone is doing the best they can do and self isolating there’s nothing to be gained from these stories. But for those who are interested.


“ I'm going to share this write up from an ER doctor. I'll warn you that it's kind of scary to read through but for those that want some more details of what's actually happening right now in the field, this has some good information. This appears to be a credible report as very best I can tell.

"I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.

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"

 

[missy]

@jaaron sending bucketloads of healing dust to your family. Please take care of yourself. (((Hugs))).

 

[MakingTheGrade]

Thanks for sharing Missy. Ugh. The keeping them dry part in balance to wanting to up intravascular volume to support sepsis is such a bad place to be.uuuuggghhhh. I want to hug all my icu colleagues but I can’t.

 

[MamaBee]

I’m not sure I should share this. Supposedly it’s from an ER doc in Louisiana. Warning. Don’t read if you don’t want to get upset. My DH told me he doesn’t want to hear any more horrible Covid 19 stories and Jess probably right because what good does this do us. As long as everyone is doing the best they can do and self isolating there’s nothing to be gained from these stories. But for those who are interested.


“ I'm going to share this write up from an ER doctor. I'll warn you that it's kind of scary to read through but for those that want some more details of what's actually happening right now in the field, this has some good information. This appears to be a credible report as very best I can tell.

"I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.

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"

I am scared but doing okay now because we are in the house with no plans to leave... I will be here with the crew..minus my hubby.. until a vaccine or a miracle happens and it goes away....My mom is a worry because she is 94 with an abdominal aneurysm that hasn’t grown in three years..I‘m praying she remains stable...Her age by itself is a worry...
The doctors are heroes in my eyes....We are in the throes of war...

 

[voce]

Really anxiety inducing to read the reddit/notes posted by @MakingTheGrade and @missy. The stats coming out are scary. As of March 25 the death rate in Italy is 44.5% in closed cases.

I really believe that the big difference in China is they've figured out the treatment quickly, and they can mobilize resources quickly to roll out PPE. Like I've posted before, the experts in China say the most effective treatment was to administer a dose of antivirals and immune system suppressing hormones, over something like the course of a week. Really doubt that doctors in the US or Italy are going with that. Just intubating people does not seem to be effective. You've got to get them the hormones to prevent sepsis. But, since there's probably more red tape/requirements before certain treatments are approved, and I don't know how available those immune system suppressing hormones are, I fear the worst.

Really hope @Mamabean is able to stay COVID-free, and that @jaaron's family recovers without incident.

Honestly, I personally think I'm at the "bargaining" stage of the "grief" process.

*Edit* at least my family in China seems to be safe and sound from the virus. My uncle and cousin just returned to their homes in Wuhan where they were volunteering as medical support staff. My uncle was berating us for not taking the proper precautions (i.e. not dare to openly wear masks for fear of discrimination and reprisals). My mom is doing delivery, and plenty of people pay with cash, unfortunately. It's rather difficult to disinfect cash; my uncle was telling her to buy alcohol disinfectant spray and spray the dollar bills, and we were trying to tell him we can't buy the stuff because all the stores are out of stock; he didn't believe us and concluded that we're not taking the virus seriously enough.