To clarify, I believe that Julio is the best openly known (but still in the closet) gay wide receiver that has difficulty catching touchdowns in the history of the league. Of note, Jimmy Graham is the best still in the closet gay tight end (well, probably not anymore...pun intended) in the league. NTTIAWWT.
Now back to the good stuff...COVID info...
Locally (meaning gulf coast that is between NOLA and Mobile):
Our numbers had sharply spiked on my last update and quick update. These are improved in the last 2.5-3 weeks. We have transitioned down from a high of 41 patients (18 days ago) hospitalized in our COVID units to currently 15 patients. Although 10 of these are in ICU (and at least 5-6 of these expected to die “from” COVID-I will address this in a bit). All of these that are critical are over 60 with comorbid conditions (as per @Jeffrey Lee request to clarify my numbers).
As mentioned in a previous thread, our local six county area did begin mask mandates 4 weeks ago when our numbers began to spike. We have seen a 25-30% decrease in total positives. However, our percent positive is still hovering around 20% of those tested (down from 24% at peak). Community spread is a significant issue here.
With that said, 5 out of the bottom 6 “coastal counties” of MS are planned to start school in the next week. My 5 year old started today. The Mississippi State Medical Association had recommended a delay in start (Sep 1). Per my sources, part of the decision to start now had to do with federal funding for non e-learning school.
I know that not many of you live in my area, but this is just a microcosm of what is going on in each small area across America.
We are still using Remdesivir, dexamethasone, lovenox, vitamin C, vitamin D, and zinc in our protocol. As stated previously, once patients reach the ventilator, mortality continues to be 90-95%.
Other issues to cover:
Nationally, not a ton to report. It seems we are going through a phase in which somewhat less populated areas (but still significant) than large cities are having significant community spread but this is expected as a pandemic rolls along.
Not many updates regarding medications except to update a previous blurb in one of my updates regarding Ivermectin. It appears that this will not be as hopeful as that the concentration to inhibit the virus intracellularly will not be obtainable without toxicity. Studies ongoing, but significant concerns exists.
As much as physicians hoped that hydroxychloroquine would treat or assist in treating COVID (based on it being inexpensive, plentiful supply, and previous effectiveness against other corona viruses), it does not appear that this will be part of protocols going forward. The gold standard in medicine/science is the randomized clinical trials and subsequent meta analysis of said trials to determine best practices. As of now, we have a few RCTs showing little to no benefit and only a handful of anecdotal reports/retrospective studies showing benefit. There may be an RCT that does show benefit for HCQ but the overall consensus will not be favorable. It has become quite political which is not ideal and I have made my thoughts quite clear in other posts regarding this. That being said, even if it is somewhat minimally effective (which is the best we can hope for), it would still have to show superiority over other medications and treatments which would be quite the hurdle to overcome. Of note, initially we had some minimal success with it anecdotally but have seen better with current protocols.
Camp spread: There was a significant spread in a camp in June in Georgia with relative lax measures undertaken. This was somewhat surprising given the relatively small amount of superspreading events in children. However, it appears that this camp almost took every safety protocol to the opposite extreme (closed windows, indoors, screaming and singing in close quarters, no masks, etc). This will serve as a warning signal to schools opening. There have been some signals and concerns about the initial thoughts of children not being superspreaders being underestimated. This is not just from this event either. My personal concern for schools starting has been elevated significantly over the last couple of weeks.
One more thing quickly, dying “with COVID” or “from COVID”. There have been a handful of anecdotal reports of people having COVID listed on their death certificates that clearly died of other causes (ie motorcycle wrecks, overdose, etc). These should absolutely not be listed as a death caused by COVID. However, if a patient with stage IV breast cancer that would’ve lived for 3 more months except for catching the ‘Rona or a patient with chronic kidney disease that catches COVID and ends up on dialysis and dies from a cardiac arrest while being treated for sepsis caused by COVID should absolutely be listed as deaths “from COVID”. SARS-CoV-19 has far reaching effects that affects multiple organ systems and coding deaths is far more complicated than it seems. All of these will even out in the end. Doctors are not compensated to fraudulently claim COVID on death certificates and I really don’t know any/hardly any that would jeopardize their career/reputation to do so for a measly few dollars from CMS (that we likely wouldn’t receive anyway).
I had more to discuss but will try to put another one out soon. Stay safe and please wear masks. As a 50/50 split profession politically, over 85% of us believe masks are at least somewhat effective.
I will try to correct any errors in the morning, I’m on my 3rd OWA. Also, I usually try to answer a lot or most of the questions that I get on these. If I don’t get to yours, don’t be offended. Ask again on another thread or tag me. Most times I don’t make it all the way through the threads. Please try to avoid making this thread political as well. I don’t want this to end up on the Dear Diary/PoRe board.
Now back to the good stuff...COVID info...
Locally (meaning gulf coast that is between NOLA and Mobile):
Our numbers had sharply spiked on my last update and quick update. These are improved in the last 2.5-3 weeks. We have transitioned down from a high of 41 patients (18 days ago) hospitalized in our COVID units to currently 15 patients. Although 10 of these are in ICU (and at least 5-6 of these expected to die “from” COVID-I will address this in a bit). All of these that are critical are over 60 with comorbid conditions (as per @Jeffrey Lee request to clarify my numbers).
As mentioned in a previous thread, our local six county area did begin mask mandates 4 weeks ago when our numbers began to spike. We have seen a 25-30% decrease in total positives. However, our percent positive is still hovering around 20% of those tested (down from 24% at peak). Community spread is a significant issue here.
With that said, 5 out of the bottom 6 “coastal counties” of MS are planned to start school in the next week. My 5 year old started today. The Mississippi State Medical Association had recommended a delay in start (Sep 1). Per my sources, part of the decision to start now had to do with federal funding for non e-learning school.
I know that not many of you live in my area, but this is just a microcosm of what is going on in each small area across America.
We are still using Remdesivir, dexamethasone, lovenox, vitamin C, vitamin D, and zinc in our protocol. As stated previously, once patients reach the ventilator, mortality continues to be 90-95%.
Other issues to cover:
Nationally, not a ton to report. It seems we are going through a phase in which somewhat less populated areas (but still significant) than large cities are having significant community spread but this is expected as a pandemic rolls along.
Not many updates regarding medications except to update a previous blurb in one of my updates regarding Ivermectin. It appears that this will not be as hopeful as that the concentration to inhibit the virus intracellularly will not be obtainable without toxicity. Studies ongoing, but significant concerns exists.
As much as physicians hoped that hydroxychloroquine would treat or assist in treating COVID (based on it being inexpensive, plentiful supply, and previous effectiveness against other corona viruses), it does not appear that this will be part of protocols going forward. The gold standard in medicine/science is the randomized clinical trials and subsequent meta analysis of said trials to determine best practices. As of now, we have a few RCTs showing little to no benefit and only a handful of anecdotal reports/retrospective studies showing benefit. There may be an RCT that does show benefit for HCQ but the overall consensus will not be favorable. It has become quite political which is not ideal and I have made my thoughts quite clear in other posts regarding this. That being said, even if it is somewhat minimally effective (which is the best we can hope for), it would still have to show superiority over other medications and treatments which would be quite the hurdle to overcome. Of note, initially we had some minimal success with it anecdotally but have seen better with current protocols.
Camp spread: There was a significant spread in a camp in June in Georgia with relative lax measures undertaken. This was somewhat surprising given the relatively small amount of superspreading events in children. However, it appears that this camp almost took every safety protocol to the opposite extreme (closed windows, indoors, screaming and singing in close quarters, no masks, etc). This will serve as a warning signal to schools opening. There have been some signals and concerns about the initial thoughts of children not being superspreaders being underestimated. This is not just from this event either. My personal concern for schools starting has been elevated significantly over the last couple of weeks.
One more thing quickly, dying “with COVID” or “from COVID”. There have been a handful of anecdotal reports of people having COVID listed on their death certificates that clearly died of other causes (ie motorcycle wrecks, overdose, etc). These should absolutely not be listed as a death caused by COVID. However, if a patient with stage IV breast cancer that would’ve lived for 3 more months except for catching the ‘Rona or a patient with chronic kidney disease that catches COVID and ends up on dialysis and dies from a cardiac arrest while being treated for sepsis caused by COVID should absolutely be listed as deaths “from COVID”. SARS-CoV-19 has far reaching effects that affects multiple organ systems and coding deaths is far more complicated than it seems. All of these will even out in the end. Doctors are not compensated to fraudulently claim COVID on death certificates and I really don’t know any/hardly any that would jeopardize their career/reputation to do so for a measly few dollars from CMS (that we likely wouldn’t receive anyway).
I had more to discuss but will try to put another one out soon. Stay safe and please wear masks. As a 50/50 split profession politically, over 85% of us believe masks are at least somewhat effective.
I will try to correct any errors in the morning, I’m on my 3rd OWA. Also, I usually try to answer a lot or most of the questions that I get on these. If I don’t get to yours, don’t be offended. Ask again on another thread or tag me. Most times I don’t make it all the way through the threads. Please try to avoid making this thread political as well. I don’t want this to end up on the Dear Diary/PoRe board.
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