Are you worried about the Coronavirus?

[TooPatient]

FYI

Who Gets a Ventilator? Rationing Aid in COVID-19 -- An Ethicist's View
Arthur L. Caplan, PhD
April 08, 2020

I feel so bad for the doctors and nurses who are having to work on these guidelines and all those who have to make the judgement calls between patients and those who have to carry out the directions. It can't be easy for people who have trained to save lives to take an active role in ending lives, however necessary those decisions and actions are.

 

[missy]

I feel so bad for the doctors and nurses who are having to work on these guidelines and all those who have to make the judgement calls between patients and those who have to carry out the directions. It can't be easy for people who have trained to save lives to take an active role in ending lives, however necessary those decisions and actions are.

Heartbreaking for all involved. Truly no words.

 

[missy]

@TooPatient how is your DH doing today? How are you doing?

 

[missy]

@missy oh no, they don't deliver to me I'm only a block from 11215. Would love some baguette, macarons, croissants, cakes, etc..I got desperate and bought a box of duncan hines brownie mix. Unfortunately it was all bubbly and spongy and sticky i don't know what i did wrong.

They just added more zip codes! Maybe this includes your area?

 

[missy]

Many Covid 19 patients are surprisingly young.

Many New York Coronavirus Patients Are Young, Surprising Doctors

"This is not just elderly patients. It’s anyone."

www.bloomberg.com

"
Younger adults in New York City are being hospitalized with Covid-19 infections at surprisingly high rates, said doctors and other health-care workers treating them, undermining earlier assumptions about who’s most at risk from the new coronavirus.



New York has more confirmed cases than anywhere else in the U.S., and about 1 in 5 hospitalizations are occurring in people under age 44, according to data released by the city’s health department. Globally, moderate-to-severe cases have occurred in 10% to 15% of adults under age 50, according to the World Health Organization.



On Friday at Manhattan's Mount Sinai Morningside Hospital, a previously healthy 32-year-old male patient turned to doctor Kaedrea Jackson and asked: “Am I going to die?”







The young man, who had no underlying medical conditions, was short of breath with a fever, and his oxygen levels were dropping rapidly. He’d come to the hospital’s emergency department four days earlier but was told to go home, drink water, take Tylenol and self-isolate. Now he was back and his condition was deteriorating. “The level of fear in his eyes stood out to me,” Jackson, an emergency medicine physician, recalled in an interview Tuesday. “He was extremely scared. And he was so young.”

People line up outside Elmhurst Hospital for testing in Queens, New York on March 24.
Photographer: Eduardo Munoz Alvarez/Getty Images
For months, the message from authorities had been that older people were at the highest risk. It was a belief so strongly held that health officials took to chastising people in their 20s and 30s to stay home—not to protect themselves, but to avoid transmitting the disease to older populations. That changed in mid-March, when a top White House health official warned that young people in Italy and France were falling ill. Now, the trend has shown up in the U.S.

“So many patients are not fitting the picture that we’ve been told from China or Italy. This is not just elderly patients; it’s anyone,” Jackson said. A confidential U.S. intelligence report has raised doubts about China’s reporting of the outbreak, including under-counting cases, Bloomberg News reported Wednesday.


As many as 20% of confirmed cases at the hospital have been under age 50, Jackson estimated. Many younger doctors in their 30s are watching healthy patients their age being admitted into the hospital and needing to be put on a ventilator.

“People are scared. These are patients where you’re thinking: ‘This just shouldn’t be happening to you. You’re so young. Why is this happening?”

New York Governor Andrew Cuomo said too many young people haven’t gotten the message that they can be infected.

“"You still see too many situations with too much density by young people,” Cuomo said at his daily press briefing Wednesday. “They can get it, and they're putting their lives at risk. This can kill young people, rare circumstances, but it can."

‘This is not just elderly patients; it’s anyone’

A lack of widespread testing for the virus in the U.S. has made it difficult for health officials to know which groups are most at risk. But doctors and other health workers who spoke to Bloomberg described surprising numbers of younger patients who needed life-saving care.
“It’s young folks, previously healthy,” said Eric Wei, an emergency room doctor and chief quality officer at NYC Health + Hospitals, the city’s public hospital system. “They look like they have the flu. Within hours, they need oxygen. Within a few more hours they need a ventilator.”

Pedestrians look at an emergency field hospital under construction in Central Park in New York, on March 30.
Photographer: Gabby Jones/Bloomberg
At NYU Langone Health’s Medical Center overlooking the East River in Manhattan, dozens of patients in intensive care last week were under age 50, according to a worker who was providing direct medical care to them. A handful were in their 20s, and one was just 7 years old. The hospital declined to provide exact numbers of Covid-19 patients, details about their ages or whether they had underlying health conditions, citing patient privacy.

In China, which was hit first by the virus, just 4.3% of patients age 40 to 49 were hospitalized after developing Covid-19, according to a report published in the journal Lancet Infectious Diseases. It was even lower for younger people, with just 1% of those in their 20s and 3.4% of those age 30 to 39 requiring hospitalization, the report found.

Those gaps could be made up of differences in demographics, the share of people with pre-existing conditions or differing medical practices or resources. Italy, for example, has one of Europe’s oldest populations and people age 80 and up died at a rate of about 20%. In China, the fatality rate for the same age group was 15%.

“These cases in young and middle-aged people are striking,” said Paul Sax, clinical director of infectious diseases at Brigham and Women’s Hospital in Boston. “This isn’t how it was originally perceived from afar. There are definitely people who are surprised that this is a severe infection in this group, people who were previously totally healthy and exercising and doing just fine.”


In New York, 77% of the 914 patients who died had a medical condition such as diabetes, lung disease, heart disease or asthma, according to the city’s health department. Only 1.5% were otherwise healthy, with another 20% of the cases still under review. A broader analysis by the U.S. Centers for Disease Control and Prevention found a similar trend, that three-quarters of Americans who ended up in the ICU because of Covid-19 had one or more underlying health problems. Few people with such problems are able to recover without a hospital stay, the CDC said.

Risk Factors
Two-thirds of the U.S. is overweight or obese, factors shown to increase the risk of Covid-19. Nearly half of adults have high blood pressure. And 1 in 8 Americans haven’t visited a doctor in the past year, meaning that some may have health conditions and not know it.

Experts are seeing the same pattern emerging elsewhere in the U.S. as outbreaks grow. In Philadelphia, 56% of confirmed Covid-19 cases are under 40. A teenager lost their life in Los Angeles, a 12-year-old was intubated in Seattle, an infant was infected in Delaware and a 1-year-old baby died in Chicago.

For patients nursed through the infection with the help of a ventilator, there may be lasting health problems, said Ross McKinney Jr., chief scientific officer of the Association of American Medical Colleges. For even the youngest patients, doctors have to use ventilators set to high pressure, pumping in high levels of oxygen.

“Many will end up with damaged lungs and thereafter may be constrained in the future,’’ he said. “Any respiratory illness will make you sick, because you don’t have reserves, and things like running cross country or doing a 5K race may be out. You may not be able to be as active because your lungs don’t have the capacity anymore.”

The flood of young patients has been hard for doctors, said Jackson.

“It’s hard to lose anyone,” she said. But when physicians have to intubate patients in their 20s, 30s and 40s—that weighs heavy. “It’s the young, those with their full lives ahead of them who have no medical problems, they stand out. They are the ones that are hard to forget.”

— With assistance by Jason Grotto, and John Tozzi

"

 

[missy]

I don't want to start a new thread so adding this here. Hope it's OK to do so.
From Bloomberg business.com

Our take on the latest developments

Two and a half months after it began on Jan. 23, the lockdown of China’s Wuhan is over, and those who were trapped in the quarantined city have taken to the roads, rails and skies to leave the scene of thousands of Covid-19 deaths. From abroad, the thought of an ending to the harsh measures that have closed schools, curtailed livelihoods and lifestyles, and cut off family members looks appealing. And in fact, other countries are already starting to discuss getting out from under. Austria, Denmark, Norway and Italy—Europe’s worst virus-hit country—are all discussing relaxing their stay-home orders. Even the U.S., which has never issued a blanket quarantine, is talking about a limited return to work in some cities and towns where the outbreak is less severe. But moving too fast is perilous. Able to spread from seemingly healthy people, the virus can lurk and return with a vengeance. Expect it to stick around for at least two years, according to Peter Collignon, a professor at Australian National University Medical School. “We have got to ensure that the public understands we’re moving to a new phase,” said Bruce Aylward, a top World Health Organization official who led missions to Spain and China. “It’s not lifting lockdowns and going back to normal. It’s a new normal.” As Bloomberg’s Enda Curran, Frank Connelly and Suzi Ring report, that’s going to have to be a normal where testing is fast, available, and accurate. Where infected people can be isolated, and their contacts traced and quarantined. It will probably be normal for more people to work at home, have less contact with others, and talk and joke through masks, while negotiating a juddering economic restart. It’s been 100 long days since the WHO’s first notification of a mysterious pneumonia. The weather’s getting warmer and sunnier in the U.S. and Europe. The gruesome death counts appear poised to level off. And people are suffering—physically, mentally and financially—from confinement. But the virus is still out there. And governments everywhere need to prepare their citizens for a long road ahead, perhaps longer than the one trod by Wuhan.—Thomas Mulier and John Lauerman

 

[SparklieBug]

Many Covid 19 patients are surprisingly young.

Many New York Coronavirus Patients Are Young, Surprising Doctors

"This is not just elderly patients. It’s anyone."

www.bloomberg.com

"Younger adults in New York City are being hospitalized with Covid-19 infections at surprisingly high rates, said doctors and other health-care workers treating them, undermining earlier assumptions about who’s most at risk from the new coronavirus.

New York has more confirmed cases than anywhere else in the U.S., and about 1 in 5 hospitalizations are occurring in people under age 44, according to data released by the city’s health department. Globally, moderate-to-severe cases have occurred in 10% to 15% of adults under age 50, according to the World Health Organization.

On Friday at Manhattan's Mount Sinai Morningside Hospital, a previously healthy 32-year-old male patient turned to doctor Kaedrea Jackson and asked: “Am I going to die?”

The young man, who had no underlying medical conditions, was short of breath with a fever, and his oxygen levels were dropping rapidly. He’d come to the hospital’s emergency department four days earlier but was told to go home, drink water, take Tylenol and self-isolate. Now he was back and his condition was deteriorating. “The level of fear in his eyes stood out to me,” Jackson, an emergency medicine physician, recalled in an interview Tuesday. “He was extremely scared. And he was so young.”

I wonder whether vaping factors into young people being more susceptible to COVID?

 

[whitewave]

Louisiana:

At DH’s hospital, things in the ICU are crazy but we aren’t overwhelmed and a “surge” hasn’t really happened in the way it could have (like NYC). They are scheduling surgeries starting May 4. Hopefully that will happen. The governor extended the stay at home order until April 30.

I hope we aren’t suddenly surprised with a giant surge, which in theory could happen at any given time.

The hospital, like many many others, has made a few different ICUs— those designated for Covid positive patients and then one for non COVID patients and one for non Covid post surgical patients.

 

[Matata]

As I predicted earlier in this thread, the virus came here later than the north part of the state. We have 49 confirmed cases in my county which, of course, means there are likely thousands who have the virus. Testing arrived here very very late. In my county the majority of those ill with covid-19 are aged 60 years and below with a few in their 70s and a very few older than that. No deaths yet. I hope our county health officials and hospitals are attempting to research why it's the younger portion of the population that seems more vulnerable at this point in time.

 

[Dancing Fire]

A confidential U.S. intelligence report has raised doubts about China’s reporting of the outbreak, including under-counting cases, Bloomberg News reported Wednesday.

I have been saying it for weeks now. If you believe the Chinese #s then I have a Golden Gate bridge to sell you for $100 bucks. Take the #s that China are reporting and then multiply it by at least 10X. My guess China's death total is well over 50K people.

 

[TooPatient]

@TooPatient how is your DH doing today? How are you doing?

Mixed bag. I was feeling awful last night then sort of okay this morning. DH seemed a bit better this morning then went to get a few hours of extra sleep and I had to pull him out of bed because his oxygen hit 82% when I checked on him.

I got his inhaler picked up. Hoping that helps. It hasn't so far, but that was a single use. I'm thinking I may try to have him use my CPAP tonight. Either way, I will have to keep a close eye on him when he sleeps. Scrambling to get our oxygen tanks filled. Also trying to find out how HR wants to do things because he has used nearly 3 weeks of vacation time (after running out of sick time) already and I don't know how to go about short term disability or if that would even be approved.

 

[whitewave]

Mixed bag. I was feeling awful last night then sort of okay this morning. DH seemed a bit better this morning then went to get a few hours of extra sleep and I had to pull him out of bed because his oxygen hit 82% when I checked on him.

I got his inhaler picked up. Hoping that helps. It hasn't so far, but that was a single use. I'm thinking I may try to have him use my CPAP tonight. Either way, I will have to keep a close eye on him when he sleeps. Scrambling to get our oxygen tanks filled. Also trying to find out how HR wants to do things because he has used nearly 3 weeks of vacation time (after running out of sick time) already and I don't know how to go about short term disability or if that would even be approved.

If his pulse ox is 82% then he needs to be in the hospital. That is flat out life threatening

 

[Dancing Fire]

Is it possible that Dr. Li died because as a doctor who spent a lot of time around severely ill Covid-19 patients, he was infected with such a high dose?

He was arrested then executed by the CCP for whistleblowing. I think she's dead too.

Whistleblowing coronavirus doctor at Wuhan hospital mysteriously vanishes

A Chinese doctor who claimed her bosses tried to silence her early warnings about coronavirus appears to have disappeared — stirring fears that she was detained, according to new reports. Ai …

nypost.com

 

[AGBF]

The virus is not going where the experts predict (although I do hope that the prediction that the drop in new hospitalizations in New York is a good sign).

I am leery about the area where I live. If one looks at a map, Connecticut looks untouched by Covid-19. That cannot be the case. Many people from my county commute into New York City to work. My father did all his life and before we moved to Virginia, my husband did. Even I did for a while, and what I was paid did not make commuting very smart! People here have to be infected.

Stay safe and healthy, Matata.

As I predicted earlier in this thread, the virus came here later than the north part of the state. We have 49 confirmed cases in my county which, of course, means there are likely thousands who have the virus. Testing arrived here very very late. In my county the majority of those ill with covid-19 are aged 60 years and below with a few in their 70s and a very few older than that. No deaths yet. I hope our county health officials and hospitals are attempting to research why it's the younger portion of the population that seems more vulnerable at this point in time.

 

[AGBF]

If his pulse ox is 82% then he needs to be in the hospital. That is flat out life threatening

This sounds very frightening.

 

[arkieb1]

As we reach a recorded 1.5+ million people that have or have had the virus worldwide the most sobering statistics is that scientists and statisticians claim the "real" number of infected could be many many times that amount.

Testing is grossly inadequate everywhere, many early tests come back negative, many younger people that recover do not get tested.

In Spain people that died at home were not even recorded as Covid - 19 deaths and in China I think we will NEVER know the "real" numbers....

Which means that 2 to 5 times (statisticians are saying it could be as high as 10) the amount of people being recorded globally could actually be infected....

 

[TooPatient]

If his pulse ox is 82% then he needs to be in the hospital. That is flat out life threatening

Yep! The good news and bad news is that it comes up as soon as he wakes up and moves some. The ER didn't record anything under 96% and they don't want that in the hospital. I'm going to have him try my CPAP tonight as I monitor closely and make sure he stays in safe levels.

His GP just repeats the instructions to get evaluated by ER if under 90%. No guidance beyond that. Then the ER didn't do anything but prescribe an inhaler.

 

[Karl_K]

Yep! The good news and bad news is that it comes up as soon as he wakes up and moves some. The ER didn't record anything under 96% and they don't want that in the hospital. I'm going to have him try my CPAP tonight as I monitor closely and make sure he stays in safe levels.

His GP just repeats the instructions to get evaluated by ER if under 90%. No guidance beyond that. Then the ER didn't do anything but prescribe an inhaler.

I deal with lung issues all the time myself.
If at all possible get a nebulizer and some "ipratropium bromide and albuterol" sulfate solution for it.
It has saved my life many times.
Today's albuterol inhalers are very close to useless.

Also have him sleep sleep sitting up or at least propped up.
Sleeping flat on his back is a no no with lung issues.

edit: use the nebulizer every 4 hours, use an alarm and wake him up and have him use it if he is sleeping.

 

[Karl_K]

This is what scares me I see lots of kids to 30ish out and running around no masks and in large groups.
This is the numbers for my area by age group.

 

[TooPatient]

I deal with lung issues all the time myself.
If at all possible get a nebulizer and some "ipratropium bromide and albuterol" sulfate solution for it.
It has saved my life many times.
Today's albuterol inhalers are very close to useless.

Also have him sleep sleep sitting up or at least propped up.
Sleeping flat on his back is a no no with lung issues.

edit: use the nebulizer every 4 hours, use an alarm and wake him up and have him use it if he is sleeping.

Great information! Thank you! I'll see if I can get his GP to prescribe one tomorrow. Or is it something I can get without a prescription?

 

[Karl_K]

Great information! Thank you! I'll see if I can get his GP to prescribe one tomorrow. Or is it something I can get without a prescription?

The nebulizer itself used to be no script but I heard that has changed because druggies found a use for them.
Not all pharmacies stock them.
Walgreens carries them

Walgreens Nebulizer Services | Walgreens

Find nebulizers, aerosol masks, filters and support to optimize your nebulizer treatment for asthma or other conditions at your neighborhood Walgreens.

www.walgreens.com

The solution is prescription and I believe the machine is also now.
You want the compressor type preferably for home use and get some replacement cups.
Cups are what they show on the webpage.
Multiple people can share a compressor type nebulizer but never share cups.

 

[whitewave]

I deal with lung issues all the time myself.
If at all possible get a nebulizer and some "ipratropium bromide and albuterol" sulfate solution for it.
It has saved my life many times.
Today's albuterol inhalers are very close to useless.

Also have him sleep sleep sitting up or at least propped up.
Sleeping flat on his back is a no no with lung issues.

edit: use the nebulizer every 4 hours, use an alarm and wake him up and have him use it if he is sleeping.

Maybe sleep prone on stomach

 

[Karl_K]

Maybe sleep prone on stomach

Thank you for mentioning that.
I can't because I have acid reflux so I forgot to mention it.

 

[TooPatient]

Maybe sleep prone on stomach

I can't breathe if I sleep that way so I hadn't thought about that. Will see if he can try that too.

 

[Karl_K]

I can't breathe if I sleep that way so I hadn't thought about that. Will see if he can try that too.

yea a lot of people can't do it but it is one of the recommended things to try.

 

[TooPatient]

yea a lot of people can't do it but it is one of the recommended things to try.

It probably also helps if you don't have a couple of DD's in the way

 

[missy]

United States COVID - Coronavirus Statistics - Worldometer

United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.

www.worldometers.info

 

[missy]

@TooPatient how is your DH doing and how are you doing today?

 

[lissyflo]

I read in the paper this morning that New York State reported more new cases yesterday than any entire country (outside of the US). I did a double take when I read it and assumed it was a typo. I’ve only just realised looking at your figures @missy that it wasn’t a mistake at all. My brain is actually in melt down trying to comprehend that. Has the state recently ramped up testing relative to other areas/countries, or is it just truly, staggeringly bad there?

I thought you hit full lock-down at a similar time to us in the UK and we’re being told that our rates might be starting to slow (although testing here is appalling low). Are people not complying with lockdown or do you think it spread like wildfire before lockdown and those cases are still unwinding in the figures?

 

[missy]

I read in the paper this morning that New York State reported more new cases yesterday than any entire country (outside of the US). I did a double take when I read it and assumed it was a typo. I’ve only just realised looking at your figures @missy that it wasn’t a mistake at all. My brain is actually in melt down trying to comprehend that. Has the state recently ramped up testing relative to other areas/countries, or is it just truly, staggeringly bad there?

I thought you hit full lock-down at a similar time to us in the UK and we’re being told that our rates might be starting to slow (although testing here is appalling low). Are people not complying with lockdown or do you think it spread like wildfire before lockdown and those cases are still unwinding in the figures?

@lissyflo forgive my rambling thoughts. Just thinking aloud and free flowing it so it might be a bit disorganized.


I think more people are following social distancing and staying at home than in weeks previous. The death toll is going up because people who were hospitalized a few weeks ago are now dying. Tragic. Painful. The good news is that the peaking of new cases is (hopefully) plateauing.

When will the death tolls start going down? No one really knows.

As for are we testing more? I don't think nearly enough no. I think we have many more cases than is being currently reported.

Antibody testing, rapid testing, plasma treatment. All new challenges and we haven't yet done it and they are working on this. How well will government respond and get this up and running? That is critical and their response will change lives for the worse or better depending on how fast they can get their act together concerning this.

Global experts are just making projections and no one can predict. This is all a function of what people are doing and directly related to our behavior. People need to continue to stay at home and stay 6 plus feet apart when out. The numbers are a consequence of our daily actions. Cause and effect. I hope people get it here.

Staying at home does save lives.

We have to keep staying at home and staying safe and if we keep doing that the death tolls should come down.

A second wave is worrisome and that is a real and scary potential but one day at a time and look to the past to learn what might happen and do the best we can to prevent that from happening.

Will we continue to meet the demand for beds and ventilators over the coming weeks? IDK. I don't think anybody knows. Projections are scary but what is the reality? Time will tell.

My friend lost her mother to Covid 19 a few days ago. Because she was 80 they wouldn't intubate her. Would it have saved her? No one can say for sure but they didn't give her a chance IMO because they couldn't spare the ventilator.

In NYC I will say it is scary and anyone who says differently who lives here is deluding themselves. And anyone who isn't living here cannot fully grasp what is happening I think. We are the epicenter and will remain the epicenter for a long time to come.

And even more scary is I think people will die from non Covid related deaths at a higher number due to hospitals being full and also having rampant Covid 19. I am worried for my dh and his large kidney stones that have been acting up. His urologist said he has to go to the ER if it gets worse as that is the only way he will get admitted to the hospital. And as we all know the ER is not where one wants to go.

The loss of life now greatly overwhelms the loss from 9/11. Much worse in terms of death. We are paying a very high price for misjudging and not acting fast enough. Let's hope we can learn from this and never let something like this happen again to this degree.

I want to take this time to say thank you to all the countries and states who have reached out and helped NY. Thank you thank you thank you and I know in my heart without a doubt that we will return the favor as soon as we can.