Tweet perspective on Coronavirius and health care

[shupat08]

well its going to happen

They are not going to close down schools, colleges, testing, etc for another 1.5 years interrupting 3 years of education... And that's just education. Not anything else.

That plan is for "suppression" not "mitigation". And these guys are scientists and they should certainly play a major role, but at some point policy & science have to work together to continue to fix this virus situation as well as the societal, economic, educational, political stuff as well in society.

I say we will return to relative normalcy with some restrictions by early to mid may (8-10) weeks after this all began last week.

 

[HALL85]

any link for the NJ state police/highway situation? im planning an escape from NYC soon and dont want to be stuck

No link; just a source in the NJSP that indicated it was being considered as a containment strategy.

Spoke to another hospital system today that said they are testing at a brisk level. Biggest challenge is turnaround time. State labs are 2 to 3 days and third-party are 5 to 6 days.

From my perspective there are three major issues with this virus.
1-We still don’t know a lot about it
2-Because of #1, we’re not sure how to prepare and ultimately what the impact is going to be on capacity and caregiver bandwidth
3-There is no vaccine so the only method to control is distancing and containment

The hotspots are a potential big problem because there are a number of factors that they have, other areas of the country don’t. It’s difficult to measure right now but the homeless population is entering the equation as a means for rapid transmission.

 

[PosterFormallyKnownAsShuathelete]

No link; just a source in the NJSP that indicated it was being considered as a containment strategy.

Spoke to another hospital system today that said they are testing at a brisk level. Biggest challenge is turnaround time. State labs are 2 to 3 days and third-party are 5 to 6 days.

From my perspective there are three major issues with this virus.
1-We still don’t know a lot about it
2-Because of #1, we’re not sure how to prepare and ultimately what the impact is going to be on capacity and caregiver bandwidth
3-There is no vaccine so the only method to control is distancing and containment

The hotspots are a potential big problem because there are a number of factors that they have, other areas of the country don’t. It’s difficult to measure right now but the homeless population is entering the equation as a means for rapid transmission.

Does your source know if it would happen before the weekend? It would help me alot haha. Dont wanna be stuck here

 

[HALL85]

Does your source know if it would happen before the weekend? It would help me alot haha. Dont wanna be stuck here

I think you’re good...

 

[HALL85]

https://www.wfmz.com/health/coronav...cle_68d9b5f6-6a24-11ea-9799-f7e712b56fc4.html

Expect NJ likely to follow suit. Good news is no testing delays now in PA.

Obviously, reported cases are going to spike now that more are being tested. The two numbers that we need to watch are fatalities and number of patients hospitalized and in ICU. My sense is that will be difficult to get regular aggregated numbers on that, but hopefully we will hear about that reporting locally.

 

[HALL85]

Just to update if anyone interested:
- Continue to poll a number of hospitals on activity and readiness (PA, NJ, MD, OH, FL). Most have cancelled elective but a few haven’t which surprised me. Patients self-selecting out. Didn’t think about this, but with bar/restaurants closed and curfews/traffic, fewer auto accidents, violent crime, ER visits way down. Now if this goes on too long, domestic violence will likely go up....
- Readiness varies. Better Supply Chain execs have enough PPE, some still sourcing but no one I spoke with in a panic. Some have not done a good job IMO.
- Overall very few COVID admissions and ICU patients in hospitals I spoke. Also, one hospital system has six clinics performing tests (no wait). To speed process they have non-physician case managers qualifying patients. They acknowledge some patients are not being truthful about their symptoms but since they can handle the volume they are approving.
- It’s unfortunate but ER and ICU docs/nurses are most exposed and ones that need PPE. All other areas aren’t at risk as much and not needing as much if any PPE.
- Hackensack/Meridian bearing most of brunt in NJ.
- Atlantic Health not much at all

 

[PosterFormallyKnownAsShuathelete]

Just to update if anyone interested:
- Continue to poll a number of hospitals on activity and readiness (PA, NJ, MD, OH, FL). Most have cancelled elective but a few haven’t which surprised me. Patients self-selecting out. Didn’t think about this, but with bar/restaurants closed and curfews/traffic, fewer auto accidents, violent crime, ER visits way down. Now if this goes on too long, domestic violence will likely go up....
- Readiness varies. Better Supply Chain execs have enough PPE, some still sourcing but no one I spoke with in a panic. Some have not done a good job IMO.
- Overall very few COVID admissions and ICU patients in hospitals I spoke. Also, one hospital system has six clinics performing tests (no wait). To speed process they have non-physician case managers qualifying patients. They acknowledge some patients are not being truthful about their symptoms but since they can handle the volume they are approving.
- It’s unfortunate but ER and ICU docs/nurses are most exposed and ones that need PPE. All other areas aren’t at risk as much and not needing as much if any PPE.
- Hackensack/Meridian bearing most of brunt in NJ.
- Atlantic Health not much at all

Thanks for the info. Always good to take in as many persepectives as possible

 

[Merge]

- Readiness varies. Better Supply Chain execs have enough PPE, some still sourcing but no one I spoke with in a panic. Some have not done a good job IMO.
- Overall very few COVID admissions and ICU patients in hospitals I spoke.

I guess the question is, how long can we continue on the current trajectory before it becomes a problem for these systems? Still relatively few tests performed in NJ and PA but cases are growing around 30-40% per day. Last data I saw showed about 10% getting admitted and 3% needing ICU.

Will these hospitals be ok if those numbers are relatively close to accurate and we see an additional 20-25k cases and 2,500 hospitalizations and 6-700 needing an ICU bed within a week?

I don't mean to imply they won't be, I am just genuinely asking what happens if the trajectory holds true and we are still 1-2 weeks away from the peak in our region.

 

[HALL85]

I guess the question is, how long can we continue on the current trajectory before it becomes a problem for these systems? Still relatively few tests performed in NJ and PA but cases are growing around 30-40% per day. Last data I saw showed about 10% getting admitted and 3% needing ICU.

Will these hospitals be ok if those numbers are relatively close to accurate and we see an additional 20-25k cases and 2,500 hospitalizations and 6-700 needing an ICU bed within a week?

I don't mean to imply they won't be, I am just genuinely asking what happens if the trajectory holds true and we are still 1-2 weeks away from the peak in our region.

What I see happening is that hospitals/systems are clearing the deck and putting contingency plans in place. One of the larger systems in Eastern PA (LVHN) has diagnosed/confirmed 61 total cases of COVID 19 and only a handful have been hospitalized. They have also performed over 4,300 tests (no waiting) but still have a backlog waiting for results (2-7 days). The community has been very compliant as well in general.

I'll defer to people I have spoken, but the feeling is that by taking the containment steps we have and continue to do, many areas will not see the trajectory that we have seen in NYC and other population centers. I hate to say it, but NYC is a perfect storm for COVID-19. Large population in a tiny geography, high degree of international travel, multiple transportation systems with common surfaces, large homeless population and a population less compliant on restrictions. And while NYC has some of the most advanced healthcare in the country, their hospital supply chain is not as sophisticated as many other areas of the country. I do worry this disease will have a devastating impact on the homeless as the hot spots in the country have the highest homeless population with close living conditions and poor hygiene likely to rapidly accelerate the spread.

Quite frankly, if I was the Governor of a state with little impact thus far, I would shut interstate borders for two weeks with the exception of trucks and healthcare critical workers.

 

[Merge]

I hate to say it, but NYC is a perfect storm for COVID-19. Large population in a tiny geography, high degree of international travel, multiple transportation systems with common surfaces, large homeless population and a population less compliant on restrictions.

All true, but then you look at growth in Westchester which is not that dissimilar from many areas of NJ and PA and sure part of that will be from NYC commuters but so will areas of NJ and if how long was the virus in Philly.

From the first day with 100 confirmed cases to 6 days later
NY - 524
Pa - 644
NJ - 1,327

There are lots of variables within those numbers so not quite an apples to apples comparison.

I think it ultimately extends to a greater percentage of the population in NY than other states, but it's hard to see less than 20k cases in NJ and around 10k in PA within a week.

 

[HALL85]

Westchester, particularly, New Rochelle, was a hot spot early on because one of the early patients had multiple interactions and this was before any time of containment measures were put in place. The spread of this virus will vary by how states and communities adhere to the containment, distancing and hygiene. No different from the flu. I do expect significant variations across the country when all is said and done.

 

[Merge]

Westchester, particularly, New Rochelle, was a hot spot early on because one of the early patients had multiple interactions and this was before any time of containment measures were put in place. The spread of this virus will vary by how states and communities adhere to the containment, distancing and hygiene. No different from the flu.

Appears to be kinda different than the flu though, no?
If you get the flu, most feel symptoms within 2 days and are contagious for a week. Very few people are walking around spreading the flu once they start to feel symptoms but you can have Covid for weeks without knowing.
For each person that gets the flu, they give it to 1.3 people. For each person that gets Covid, they have it to 2.2.
Doesn't seem that significant until you start to extend that out 10-15 times.

I know tone is hard to convey through text, but I'm really not trying to argue or get political with it, I'm just honestly concerned about what could happen, that we were too late to act and people don't take it seriously enough until it is too late to contain.

 

[HALL85]

Appears to be kinda different than the flu though, no?
If you get the flu, most feel symptoms within 2 days and are contagious for a week. Very few people are walking around spreading the flu once they start to feel symptoms but you can have Covid for weeks without knowing.
For each person that gets the flu, they give it to 1.3 people. For each person that gets Covid, they have it to 2.2.
Doesn't seem that significant until you start to extend that out 10-15 times.

I know tone is hard to convey through text, but I'm really not trying to argue or get political with it, I'm just honestly concerned about what could happen, that we were too late to act and people don't take it seriously enough until it is too late to contain.

Yes, I wasn’t trying to say it is similar to the flu, but rather you need to take steps like with the flu to prevent the spread. The steps with COVID-19 need to be more dramatic as we’ve seen. Looking back, if the travel bans were more broadly implemented and we quarantined towns/communities (like China), it would have contained it more effectively and suppressed the spread. It would have also had a more adverse effect culturally and with the public response in those areas.

Just saw NYC has 50% of cases and 60% of new cases. If it was me, I’d shut the tunnels and bridges, trains in and out and anyone who left NYC in the last two weeks quarantine. NYC has become our Wuhan.

 

[Merge]

https://www.courier-journal.com/sto...er-coronavirus-party-beshear-says/2911870001/

We’re doomed...

 

[NYShoreGuy]

https://covidactnow.org/

 

[HALL85]

https://www.courier-journal.com/sto...er-coronavirus-party-beshear-says/2911870001/

We’re doomed...

Sometimes you can’t teach stupid...

 

[PosterFormallyKnownAsShuathelete]

Looks like SHU's partner Hackensack Meridian developed a 2hr Covid test about 1 week and a half ago.

https://www.shu.edu/medicine/news/u...ium=social&utm_campaign=shu_social_media_fy20

Thought i would have heard more about this.

 

[Section112]

Talked to my neighbor an emergency room nurse at Morristown Memorial last night and their testing is still a 3-day wait unfortunately. She said the ER is jammed with Covid-19 patients now and said be careful out there these folks are really, really sick and she has never seen anything like it. She is in her 38th year of being an ER nurse.

 

[shu09]

China needs to pay for this when it's over. My theory still is that this is a man made virus that got out of the lab.

 

[Merge]

China needs to pay for this when it's over. My theory still is that this is a man made virus that got out of the lab.

Seems unlikely from what I have read about it so far.

https://www.nature.com/articles/s41591-020-0820-9

We can blame Chine for their lack of transparency though. I don't think it is wrong to say they tried to hide what was happening.

That said, not sure how much blame we can place when we were sitting here watching it happen and fail to do anything. The response here in the US was woefully inadequate and the politicians downplaying it may have done just as much if not more damage to US citizens than China's lack of transparency.

 

[Section112]

Insiders at a pharma firm that I know say noone believes China's infected numbers or numbers of actual dead. They all think their numbers are much larger in reality. Noone in the science community believes any of their data on this right now.

 

[Save Continental]

Insiders at a pharma firm that I know say noone believes China's infected numbers or numbers of actual dead. They all think their numbers are much larger in reality. Noone in the science community believes any of their data on this right now.

Yeah, common sense would say all their numbers are complete BS. I shudder to think what the real totals are. They never made any sense as you started to see some of the numbers coming out of the western world.

 

[HALL85]

Seems unlikely from what I have read about it so far.

https://www.nature.com/articles/s41591-020-0820-9

We can blame Chine for their lack of transparency though. I don't think it is wrong to say they tried to hide what was happening.

That said, not sure how much blame we can place when we are sitting here watching it happen and fail to do anything. The response here in the US was woefully inadequate and the politicians downplaying it may have done just as much if not more damage to US citizens than China's lack of transparency.

Your view of this situation is quite interesting. Sitting here watching and doing nothing? You should spend a day in the industry to get a sobering view of the response.

 

[Merge]

Your view of this situation is quite interesting. Sitting here watching and doing nothing? You should spend a day in the industry to get a sobering view of the response.

I could have phrased that better. I was talking about back in January / February when politicians were receiving intelligence reports on the threat.

 

[HALL85]

I could have phrased that better.

Yeah, you could have.

 

[shu09]

Seems unlikely from what I have read about it so far.

https://www.nature.com/articles/s41591-020-0820-9

We can blame Chine for their lack of transparency though. I don't think it is wrong to say they tried to hide what was happening.

That said, not sure how much blame we can place when we are sitting here watching it happen and fail to do anything. The response here in the US was woefully inadequate and the politicians downplaying it may have done just as much if not more damage to US citizens than China's lack of transparency.

That's just not true. The US is doing quite a bit to curb the spread, at both the state and federal levels.

 

[shu09]

Insiders at a pharma firm that I know say noone believes China's infected numbers or numbers of actual dead. They all think their numbers are much larger in reality. Noone in the science community believes any of their data on this right now.

Have you heard anything further from your friend in risk management about this being no mistake? You had posted that on March 1, I'm curious what the thinking is now as that was similar to my thinking from the beginning.

 

[NYShoreGuy]

That's just not true. The US is doing quite a bit to curb the spread, at both the state and federal levels.

Commander in chief feels a majority of people can be out in real life by easter sunday, bit ambitious

 

[shu09]

Commander in chief feels a majority of people can be out in real life by easter sunday, bit ambitious

Two and a half weeks from now, he may not be wrong. I hope he's right. I think the peak will come in the next 7 days and then we will start to plateau and eventually fall.

 

[Section112]

Have you heard anything further from your friend in risk management about this being no mistake? You had posted that on March 1, I'm curious what the thinking is now as that was similar to my thinking from the beginning.

I have from a Pharma insider who has recently spoken to multiple Asian and Docs he works with. Very close family member who has been in Pharma research for 35 years and is now in the middle of all of this. The coincidence of it being released in Wuhan is staggering and many have their theories especially in Asia, but we will probably never know he says.

 

[Section112]

Two and a half weeks from now, he may not be wrong. I hope he's right. I think the peak will come in the next 7 days and then we will start to plateau and eventually fall.

Not from what I am hearing. Trump needs to shut up and let the experts do the talking IMO. The problem is we are just starting to experience the behavior that happened two weeks ago in the US and people are still moving around. There will be outbreaks for a while in different places and some folks are still not paying attention which will extend those outbreaks. And testing is still not where it needs to be. Minimum 30 days but probably more IMO. And if transportation begins too soon there will be additional peaks.

 

[shu09]

Not from what I am hearing. Trump needs to shut up and let the experts do the talking IMO. The problem is we are just starting to experience the behavior that happened two weeks ago in the US and people are still moving around. There will be outbreaks for a while in different places and some folks are still not paying attention which will extend those outbreaks. And testing is still not where it needs to be. Minimum 30 days but probably more IMO. And if transportation begins too soon there will be additional peaks.

Fair enough. It just seems like we have been emphasizing social distancing as a country for longer than two weeks now and should start to see some results.

Trump is looking out for himself, as always. He wants the economy to get going again, because that's the only chance he has of getting re-elected. He's too stupid to realize that if you get everything going again too soon, the problem will be even worse. A prolonged economic downturn and more virus headlines.

 

[Merge]

That's just not true. The US is doing quite a bit to curb the spread, at both the state and federal levels.

Like I said above. I thought it would be clear I was referencing a past point in time... but I should have been clearer.
I have edited my post accordingly.

and I have said in other posts, threads... Our response now is appropriate but we missed the opportunity early on to contain this.

 

[Save Continental]

Commander in chief feels a majority of people can be out in real life by easter sunday, bit ambitious

Let me know how it goes. I'll be in my bunker till we (hopefully) tip off in Walsh in November.

Two and a half weeks from now, he may not be wrong. I hope he's right. I think the peak will come in the next 7 days and then we will start to plateau and eventually fall.

Eh, I think in NJ we're still probably a couple weeks away from peak from what I've been reading. Unfortunately we were late on widespread testing, and don't have the ability to take such draconian measures like total shutdowns in China. Even after the peak there could be some substantial spikes with states staggering their shutdowns and travel to and from all areas of the country.

 

[Section112]

Fair enough. It just seems like we have been emphasizing social distancing as a country for longer than two weeks now and should start to see some results.

Trump is looking out for himself, as always. He wants the economy to get going again, because that's the only chance he has of getting re-elected. He's too stupid to realize that if you get everything going again too soon, the problem will be even worse. A prolonged economic downturn and more virus headlines.

Big problem is everyone is not social distancing. I have multiple examples - someone that works for me who continues to get together with her family (10+ people including her two 80 yr old unhealthy parents who all think this is a conspiracy); neighbors across the street (who let their three college and HS aged boys run all over town with 5-10 kids hanging out together all day); a buddy of mine that let his kid go to Spring break in FL and he just returned last week and stopped by his 82 yr old parents house with his son on the way back from the airport? They walk and live among us. Just a few bad examples of folks I know. Just those interactions above could possibly cause multiple cases - hopefully not. There are so many folks that are not paying attention that can easily ruin all that we are doing by not distancing. We have to keep it up and it will take longer because many are just starting to follow the rules and this will all contribute and lengthen the spike IMO.

If you want to hear a fantastic speech by a Prime Minister that empathetically covers all the bases and spells things out, listen to this one - perfect IMO
https://www.rte.ie/player/movie/ministerial-broadcast/129430567986

 

[NYShoreGuy]

Let me know how it goes. I'll be in my bunker till we (hopefully) tip off in Walsh in November.

Eh, I think in NJ we're still probably a couple weeks away from peak from what I've been reading. Unfortunately we were late on widespread testing, and don't have the ability to take such draconian measures like total shutdowns in China. Even after the peak there could be some substantial spikes with states staggering their shutdowns and travel to and from all areas of the country.

NJ and NY big rises in positives major transit and commerce hub so logically makes sense but we had a real better chance to do more preventive care here, i am just as guilty

 

[Merge]

Big problem is everyone is not social distancing. I have multiple examples - someone that works for me who continues to get together with her family (10+ people including her two 80 yr old unhealthy parents who all think this is a conspiracy); neighbors across the street (who let their three college and HS aged boys run all over town with 5-10 kids hanging out together all day); a buddy of mine that let his kid go to Spring break in FL and he just returned last week and stopped by his 82 yr old parents house with his son on the way back from the airport? They walk and live among us. Just a few bad examples of folks I know. Just those interactions above could possibly cause multiple cases - hopefully not. There are so many folks that are not paying attention that can easily ruin all that we are doing by not distancing. We have to keep it up and it will take longer because many are just starting to follow the rules and this will all contribute and lengthen the spike IMO.

If you want to hear a fantastic speech by a Prime Minister that empathetically covers all the bases and spells things out, listen to this one - perfect IMO
https://www.rte.ie/player/movie/ministerial-broadcast/129430567986

yep, and then extend that out to areas where it hasn't really hit yet.
We're likely still about a week or so away from peak in this area and another couple weeks away from the peak in the US overall.

 

[HALL85]

Big problem is everyone is not social distancing. I have multiple examples - someone that works for me who continues to get together with her family (10+ people including her two 80 yr old unhealthy parents who all think this is a conspiracy); neighbors across the street (who let their three college and HS aged boys run all over town with 5-10 kids hanging out together all day); a buddy of mine that let his kid go to Spring break in FL and he just returned last week and stopped by his 82 yr old parents house with his son on the way back from the airport? They walk and live among us. Just a few bad examples of folks I know. Just those interactions above could possibly cause multiple cases - hopefully not. There are so many folks that are not paying attention that can easily ruin all that we are doing by not distancing. We have to keep it up and it will take longer because many are just starting to follow the rules and this will all contribute and lengthen the spike IMO.

If you want to hear a fantastic speech by a Prime Minister that empathetically covers all the bases and spells things out, listen to this one - perfect IMO
https://www.rte.ie/player/movie/ministerial-broadcast/129430567986

This. The single most effective thing we could have done back in January was a Wuhan type draconian shut-down with stiff consequences. Slippery slope...seriously how would the public have responded back then...people aren’t even listening now.

 

[knowknow456]

As recently as March 14, people were attending a cooking class of about 15 people in NYC. Looking back, they were geniuses since who's going out to a restaurant these days? Those cooking classes are super handy right about now. Really bright people assess the risk as common sense balanced with living your life. It's not that hard really. Everything comes with a risk. If you think about it driving on I-78 is risky. We used to make those decisions every day.

 

[HALL85]

I have from a Pharma insider who has recently spoken to multiple Asian and Docs he works with. Very close family member who has been in Pharma research for 35 years and is now in the middle of all of this. The coincidence of it being released in Wuhan is staggering and many have their theories especially in Asia, but we will probably never know he says.

Have heard similar theory also from someone in Pharma. I’m not a conspiracy theory guy but agree that we will never likely know the real source of this virus.