Coronavirus Tidbits #37 4/22/20
First, there is now a Resources Page here for the most commonly asked questions I'm getting.
Tidbits will likely be a bit shorter and a little less frequent for the next little bit. I have been immersed in it and I need to spend a little more time on self-care, which for me means seeing the spring flowers emerge and digging in the dirt. Pesach is always a bit rough anyway, so I will turn to more nature.
Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.
Patients may have severe pneumonia with minimal symptoms
Picking up hypoxemia (low blood oxygen with a finger oximeter moniter) early and positioning patients to lie on their stomach or sides could avoid intubation (need for mechanical ventilation)
We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.
~ ~ ~
Ventilators may be overused in COVID-19. Changing recommendations
This is because patients with COVID tolerate remarkably low blood oxygen levels and their problems are different that typical pneumonias, and ventilators might cause more lung damage.
Interesting: Rather than a ventilator, “We use CPAP a lot, and it works well, especially in combination with having patients lie prone.”
~ ~ ~
While we're focusing on COVID, guinea worm, Ebola, and polio are quietly increasing.
~ ~ ~
Obscene, racist move.
1.2 Million U.S. citizens won’t get coronavirus stimulus checks — because their spouses are immigrants who don't have social security numbers.
~ ~ ~
Immigrants are on the frontlines fighting coronavirus
6.3 million immigrants hold jobs that are key to fighting coronavirus
according to the Migration Policy Institute, immigrants make up
38% of home health aides
22% of workers in the US food industry
35% of agricultural/crop production workers
69% of California's agricultural workers are immigrants
16% of grocery workers
34% of metro, bus and taxi drivers
Retaliation or not?
Dr. Rick Bright, who had led BARDA, the Biomedical Advanced Research and Development Authority, since 2016 until Tuesday, was reassigned to a narrower position. He was in charge of vaccine procurement.
He says is is retaliation for disagreeing with Trump over chloroquine and is filing a whistleblower suit.
~ ~ ~
So stupid and unethical, Las Vegas Mayor offers city as "control group"...
"we offer to be a control group" to see how many people die without social distancing, since she wants to open up the casinos and hotels. - CNN
For those who don't get to watch the @andersoncooper interview with Las Vegas Mayor, Carolyn Goodman. It’s 15 minutes long. This describes the entire thing. pic.twitter.com/LU28pC8lOb— Daniel Lewis (@snackbardan) April 22, 2020
still an incredible, negligent lack of testing.
High-power university labs that are approved to test for #COVID19 are getting turned away by hospitals.
At a time when the US desperately needs to test, administrative & logistical bottlenecks are deadly. --incl lack of integration w EMR. by Amy Maxman nature.com/articles/d4158
What will antibody tests mean?
We still don't know how protective they are, or how long protection will last.
Everything we know about coronavirus immunity and antibodies — and plenty we still don’t
Good explainer: https://www.statnews.com/2020/04/20/everything-we-know-about-coronavirus-immunity-and-antibodies-and-plenty-we-still-dont/
NIH Panel Recommends Against Drug Combination Promoted By Trump For COVID-19
As doctors have noted, the combination of hydroxychloroquine and azithromycin increases the risk of cardiac arrhythmias and death and has no proven benefit.
Texas nurse Tommye Austin creates face masks that protect against COVID-19 better than N-95 model
using AC material from Home Depot.
Coronavirus Death in California Came Weeks Before First Known U.S. Death in early Feb...
but you weren't allowed to test people then...or now.
Too bad. Think how many fewer deaths there might have been if Trump had accepted the WHO tests like other countries did. American exceptionalism and hubris bites us in the ass again.
~ ~ ~
CDC To Fund 650 Health Experts To Help States Trace, Stop COVID-19
Director Robert Redfield actually has some reasonable comments:
"I am very concerned about the magnitude of functional public health capacity we're going to need next November, December, January and February. We can't let the public health system get overwhelmed. I think the different states will open up again in a measured, stepwise fashion. It's not like we turn a light switch and everybody's back to full non-mitigation.
A lot of the stuff that we're doing now — social distancing, limited human gatherings — a number of these things are going to continue. But the centerpiece of our response needs to be the tried-and-true, proven-to-work public health response of early case recognition, diagnosis, isolation and contact tracing."
~ ~ ~
More evidence of asymptomatic/presymptomatic spread => reinforces the importance of social distancing, including the avoidance of congregate settings: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm
Tips, general reading for public:
Wash your hands.
Rinse and repeat.
If ill, don't lay flat on your back: lay prone (on stomach) or sides to help oxygenation.
~ ~ ~
Consider getting an oximeter (measures blood oxygen) if you can afford it. See the NYTimes story at the top.
Are increasingly being recommended. This article is a reasonable summary and is worth a read.
While binge-watching Netflix or whatever, it may be worth practicing these to become comfortable with them. Some are similar to those given to patients with COPD or pneumonia pts, given an incentive spirometer.
Focusing on the breath is an anchor in meditation and some forms of yoga. You might find these helpful in reducing your anxiety as well.
Groups opposing stay-at-home order protest outside the Ohio Statehouse in Columbus with a man holding an antisemitic sign.
Nauseating...especially right before Yom HaShoah.
~ ~ ~
Is anyone surprised? Maryland Gov. Larry Hogan tells @TheView that Pres. Trump's support for protesters went against his own policy recommendations from a day earlier.
Trump, in turn, disses Hogan for ordering testing kits from S. Korea since he couldn't get kits from the Feds.
~ ~ ~
The Education Department will ban colleges from giving DACA students emergency aid.
What would a day without cruelty from this regime be?
~ ~ ~
Quick drawing today...— Jon Lion Fine Art (@jonlionfineart2) April 20, 2020
I’m sure you all so the amazing batch of photos from the #lockdown protests
Here is my take...
Title: “Can’t Believe I Had To Draw This”
Charcoal/pastels drawing #COVID19 #COVIDIOT #supportdoctors #SupportNurses pic.twitter.com/e5Es6diS5W
~ ~ ~
You can't make this stuff up...
A @Reuters special report: HHS chief Alex Azar tapped ex-professional Labradoodle breeder to coordinate the coronavirus response reut.rs/2VTLqwU
~ ~ ~
I love this thread about docs/residents being exploited: Colleen Farrell, MD
"I know that silence erodes my soul and betrays my commitment to love and justice in medicine. I’ve been silent on this issue for longer than I am comfortable with."
Feel good du jour:
Obviously heartbreaking circumstances, but beautiful thread by Colleen Farrell and the support amongst them.
⏬"THE LIAR TWEETS TONIGHT"⏬ pic.twitter.com/pUAVuGAYOR— NANCY PELOSI IS RIGHT PT2! (@45rapedkatie7) April 21, 2020
"The measure of a human life is not how useful they were to capitalism." Rabbi Danya Ruttenberg
~ ~ ~
Calling Me a Hero Only Makes You Feel Better
Cashiers and shelf-stockers and delivery-truck drivers aren’t heroes. They’re victims. To call them heroes is to justify their exploitation. By praising the blue-collar worker’s public service, the progressive consumer is assuaged of her cognitive dissonance. When the world isn’t falling apart, we know the view of us is usually as faceless, throwaway citizens. The wealthy CEO telling his thousands of employees that they are vital, brave, and noble is a manipulative strategy to keep them churning out profits.
I have immense gratitude for my job. I love my co-workers like family. I respect the company that has employed me and given me excellent health-insurance benefits for more than 16 years. The anger I have is not toward my boss, or my boss’s boss, or even that guy’s boss. It’s toward an unfair system that will never change if we workers don’t question the motivations behind such mythmaking.
Bits of beauty:
These apple blossoms (Macintosh, I think) have the most heavenly scent... and delicate blush. I look forward to them every spring.