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  1. #1681
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    Quote Originally Posted by Milland View Post
    Fine - grown up. Dr. Fauci.

    How are you feeling? Any better, or still in the grips? [I guess you answered that in #1672]
    Dr. Fauci he's cool but I don't think he's gonna last long in Trump's administration (unfortunately).

    All I can say is never had an upper respiratory infection before … It's kinda weird as you don't normally think their is functional lung up there breathing or doing something...

    The reason I call it a "Trixter" is that just when you think you/one is feeling better and just about to turn the corner, it kinda tricks you "kicks/ punches back" in very unexpected ways. It's kinda odd the chest pains I have are very random and when you least expect it almost like a broken rib , or torn or cracked rib type pain, but not quite as bad.

    This is probably taking longer than it should as I don't really have a fever and it's my understanding the body cranks up the heat to kill viruses and it's been odd that my temperature seems "lower " than normal (but steadily climbing day by day) ? So I'm almost wondering if this is one of the "Tricks" the virus has up it's sleeve ? That would be pretty cunning if it can con the body to make as many copies of itself without triggering it's own extinction through elevated temperatures?

    So it comes and goes in waves , I estimate I'm on day 11 ish maybe working backwards to 5 day quieted incubation period.

    Just to be clear my immune system is normally pretty good, always "ready for action" and I don't get colds / flu or get ill (very rare for me).

    So just when you think you are over the "Hump" it then comes back is a worse "wave" particularly at night (for me).

    And then you feel better and think "Ohhh great" I feel better , I can move on get on with stuff , so on and so forth.

    And then it tricks you again, (swinging pendulum).

    I fully expect to eventually turn the corner on this. It's just frustrating.

    That's WHY some kind of anti-body test would be excellent (an accurate one) then you know you can get on with stuff, not spread the disease nor be affected by it. At least for 'Peeps" that get through it especially medical staff.

    Or if by coincidence I have another mystery virus then I KNOW then I still need to be careful.

    The other symptoms come and go almost like the tide.

    Get drained fairly easily.

    Looking forward to getting my energy back.

    @Milland
    Thanks for asking , just so you know I do really appreciate your posts and your general "courage" and fortitude on this forum.

    Ta,

    Eric

    __________________________________________________ ______________________________________

    * The other thing that's odd , normally I would have had a couple of migraines by now (especially with wild barometric weather changes and I haven't had a single one , so my immune system is doing something "Weird" - I don't have any immune deficiency disorders like Hepatitis C etc.

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    Quote Originally Posted by cameraman View Post

    @Milland Thanks for asking , just so you know I do really appreciate your posts and your general "courage" on this forum.

    Ta,

    Eric
    Hey, we'd miss your interesting posts if you kicked off, and since Don gets paid by the forum-word by his advertisers his income would be cut in half.

    Have you actually been to a doctor yet? Your chest pains sound somewhat like what I had around 2011, a "tightness/restriction" of the lungs, especially during deep breathing. While there was some skepticism when I went to the emergency ward and before I had a chest x-ray, it did turn out to be a (bacterial, I think) pneumonia, with filaments (or whatever) growing within the lungs and physically restricting movement.

    While this was quickly treatable with antibiotics (which we know don't work with viruses), if your lungs are similarly affected with a bug that's riding along then it might help you.

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    Quote Originally Posted by EmanuelGoldstein View Post
    No. It was not satire, it was stupid.

    This is not a time for stupid shit.
    Mr. Goldstein, I get you are on the defensive and a little upset at the racist blame name stuff- especially with your world view. I think cams satire pointed out that it is racist blame name bs, not directed at you or Xi - mostly trump et al.
    virus was corona/covid/c19 when it was infecting china and iran with all yalls fake numbers and being no worse than the flu simultaneously <snark font>. Now that the ish is in the fan here they can not understand why there was no warning and why workers need ppe - I mean only evil osha makes us wear that stuff just because. Can not blame osha, and people other than white g-d fearing americans must be at fault (to be fair they still are not sure what pandemic means).
    I appreciate your reporting from the other side, not always a fan of prc bizness practices- then again same here. there is only we, no us vs them in this event.
    Now, wash your hands and stay safe!

    jed

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    Quote Originally Posted by Milland View Post
    Hey, we'd miss your interesting posts if you kicked off, and since Don gets paid by the forum-word by his advertisers his income would be cut in half.

    Have you actually been to a doctor yet? Your chest pains sound somewhat like what I had around 2011, a "tightness/restriction" of the lungs, especially during deep breathing. While there was some skepticism when I went to the emergency ward and before I had a chest x-ray, it did turn out to be a (bacterial, I think) pneumonia, with filaments (or whatever) growing within the lungs and physically restricting movement.

    While this was quickly treatable with antibiotics (which we know don't work with viruses), if your lungs are similarly affected with a bug that's riding along then it might help you.

    Quote Originally Posted by Milland View Post
    Hey, we'd miss your interesting posts if you kicked off, and since Don gets paid by the forum-word by his advertisers his income would be cut in half.
    Hahah I'd knew there was a reason lol (I know my posts are ridiculously long , long battle to fix that ).

    I think the message has been pretty much that if you can finish a complete sentence with your actual breath then there's no point going to a doctor 'cuz they can't do anything for you until you reach that point.

    It's not super bad (for me) but just don't want to get caught out (obviously).

    Six of one half a dozen of the other as I am trying to judiciously self quarantine... NM health care system is trifle medieval at the beat of times and pretty overloaded / ridiculously long wait times (normally)... So I figure that unless I'm actually at death's door I'm better off staying in my "Compound" / Ranchito.

    when I reach day 14, 15 , 16 and if things get much worse then definitely I'll devise the means the get looked at.

    Also If I find the means to get a test I will let everyone know whether it was randomly one in thousand other "similar" virus OR if it is COVID 19 or one of its newer branched off sisters.

    Thanks for the tip about the X ray... Maybe I get my horse vet to do it lol... (if it shows up on conventional X rays.) Stand down the breezeway of the barn holding a large X ray plate with lead over my goolies while he shoots me with the portable X ray unit lol.

    Today I had an injury of horse and my vet is in his 70's so I couldn't call him out but had my farrier friend look at and test the injured horse … So it seems you always have to find "odd" or weird workaround to just NOT spread this stuff and not accidently kill people. It does get super super super awkward to call on people that one could potentially kill, so I just don't do it, so I take a bit of calm careful slow thinking to solve the new and unusual problems (as they arise) Probably much like everyone else except much slower Slowwww "Panic" (New Mexico - Land of Mañana.). At least we still allowed to get hay for the horses etc. "essential services"* , we were joking which horse we would eat first if things got really bad lol. "No no "Monty" is far too talented and expensive to eat, that client's paint quarter horse over there is first on the menu. ".

    W'ere having to devise weird rituals just to get through the day and not infect people.


    __________________________________________________ _________________________________________

    * I've been in several / numerous near death situations / living on borrowed time so I'm not that phased or desperately worried , it's just waiting for what the virus is gonna do next Like what Dr. Fauci has said but in microcosm "We're on the Viruses' time table ".

    ** There are larger barns with hundred horses (rescue type operations) that rely on donations that are on a smaller acreage ... I do worry what their "Plan" is to feed the horses when all of their clients, customer and volunteers are forbidden to be there and they have zero income / small reserves.

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    Quote Originally Posted by cameraman View Post
    Dr. Fauci he's cool but I don't think he's gonna last long in Trump's administration (unfortunately).

    All I can say is never had an upper respiratory infection before … It's kinda weird as you don't normally think their is functional lung up there breathing or doing something...

    The reason I call it a "Trixter" is that just when you think you/one is feeling better and just about to turn the corner, it kinda tricks you "kicks/ punches back" in very unexpected ways. It's kinda odd the chest pains I have are very random and when you least expect it almost like a broken rib , or torn or cracked rib type pain, but not quite as bad.

    This is probably taking longer than it should as I don't really have a fever and it's my understanding the body cranks up the heat to kill viruses and it's been odd that my temperature seems "lower " than normal (but steadily climbing day by day) ? So I'm almost wondering if this is one of the "Tricks" the virus has up it's sleeve ? That would be pretty cunning if it can con the body to make as many copies of itself without triggering it's own extinction through elevated temperatures?

    So it comes and goes in waves , I estimate I'm on day 11 ish maybe working backwards to 5 day quieted incubation period.

    Just to be clear my immune system is normally pretty good, always "ready for action" and I don't get colds / flu or get ill (very rare for me).

    So just when you think you are over the "Hump" it then comes back is a worse "wave" particularly at night (for me).

    And then you feel better and think "Ohhh great" I feel better , I can move on get on with stuff , so on and so forth.

    And then it tricks you again, (swinging pendulum).

    I fully expect to eventually turn the corner on this. It's just frustrating.

    That's WHY some kind of anti-body test would be excellent (an accurate one) then you know you can get on with stuff, not spread the disease nor be affected by it. At least for 'Peeps" that get through it especially medical staff.

    Or if by coincidence I have another mystery virus then I KNOW then I still need to be careful.

    The other symptoms come and go almost like the tide.

    Get drained fairly easily.

    Looking forward to getting my energy back.

    @Milland
    Thanks for asking , just so you know I do really appreciate your posts and your general "courage" and fortitude on this forum.

    Ta,

    Eric

    __________________________________________________ ______________________________________

    * The other thing that's odd , normally I would have had a couple of migraines by now (especially with wild barometric weather changes and I haven't had a single one , so my immune system is doing something "Weird" - I don't have any immune deficiency disorders like Hepatitis C etc.
    12 days for me since first weird symptoms now, started with itchy throat, chest pain, overnight get slight fewer.

    First 3 days feeling quite exhausted, slight chest pain and feeling like there is 2 lbs weight on chest. SpO2 (pulse oximeter) was giving 94-95% numbers on worst days, now appear to be back to 98%. Stomach felt ”unsettled” but that could be also because of large amounts of rye bread

    Also hoping for antibody tests to become available, would be nice to know if I already had it.

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    Stay reasonably well, get better, Cameraman. You too, MattiJ. And TR, you feeling exponentially better yet?

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    Quote Originally Posted by MattiJ View Post
    12 days for me since first weird symptoms now, started with itchy throat, chest pain, overnight get slight fewer.

    First 3 days feeling quite exhausted, slight chest pain and feeling like there is 2 lbs weight on chest. SpO2 (pulse oximeter) was giving 94-95% numbers on worst days, now appear to be back to 98%. Stomach felt ”unsettled” but that could be also because of large amounts of rye bread

    Also hoping for antibody tests to become available, would be nice to know if I already had it.
    That's something I've never liked - rye bread.

    I hope you are soon back to normal and, if in fact you have it, it's one of the milder cases.

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    Quote Originally Posted by MattiJ View Post
    12 days for me since first weird symptoms now, started with itchy throat, chest pain, overnight get slight fewer.

    First 3 days feeling quite exhausted, slight chest pain and feeling like there is 2 lbs weight on chest. SpO2 (pulse oximeter) was giving 94-95% numbers on worst days, now appear to be back to 98%. Stomach felt ”unsettled” but that could be also because of large amounts of rye bread

    Also hoping for antibody tests to become available, would be nice to know if I already had it.
    Thanks for the share,

    I was thinking that for me Garlick cheeze and salami, had the runs for 5 or 6 days then it went away (runs) then after wards I'm think definitely viral not food. So maybe not Rye bread ? Maybe maybe not ? (apparently out of China that was one of the reported additional symptoms. The sh*ts, not rye bread :-) ).

    Lost apetite first 5 days of symtoms - not interested in food , just three cups of tea and ritz crackers a day. (normally I'm a serious espresso guy one big-ish / proper "Meal of the day" every other day - That's my normal thing. ).

    Slightly nauchous most of the time or after I eat something but not too bad.


    Have you noticed the No SMELL thing ?


    First 4 days I'm holding lemons up to my nose tryin to smell them , or I eat wallnuts and all I can taste is the "Bitterness" and nothing else.

    It's really weird it's like tasting in black and white ? rather than full spectrum color.

    Have you noticed any itchy ness under in or around one or both eyes ?

    3Am tp 5am is the worst time for me.

    @MattiJ that's interesting what you are saying about your chest.

    I had runny nose and sore throat that phases in and out. ~ But mild sniffles and occasional sneeze . When the membranes of my nose moisten get slightly runny that's when the no sense of smell / 85% reduction kicks in. Randomly one of the more 'Odd" symptoms / idiosyncrasies of the Covid 19 + the comorbidity -or whatever of conjunctivitis / pink eye symptoms.

    Any odd blisters under your eyes that you never had before or white head ? (like even just one ?) …

    I lost my voice for the first time in my life three days ago - came back.

    The dry cough ? It seems at least for me to be absurdly dry ? (In NM its super dry to begin with) It's hard to figure out if one's lungs are "supposed" to fill up with fluid or something then how come such a ludicrously dry cough ???

    Sorry to ask. ?

    @MattiJ Hope you get to feel better and turn the corner rapidly , And "Ditto" on Antibody tests (Big time :-) )


    Eric

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    Quote Originally Posted by PeteM View Post
    Stay reasonably well, get better, Cameraman. You too, MattiJ. And TR, you feeling exponentially better yet?
    Thanks man , stay safe and smart.

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    Quote Originally Posted by cameraman View Post

    Have you noticed the No SMELL thing ?
    Haven't had any problems with sense of smell.
    Overall quite mild disease for me(whatever it is after all), normal influenza usually hammers me 20x worse than this. (for me normal to get 105F fewer on flu)
    Just slooow progress, 12 days now and still slight chest pain. Chest pain seems to come and go, never really more than mild annoyance.
    I'll take this any day over last enterovirus, lost permanently half of the hearing on the left ear with that and our daughters fingernails peeled off.

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    CamMan, your descriptions really do sound like the CV, so please be extra careful with anyone that visits. But at least it doesn't sound as aggressive as it's been for the unfortunates, so let's trust you'll be around for a lot longer.

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    Hi

    I see it has only been 15 days since a skeptic started this thread.
    The USA is now leading the world in Covid19 cases. Given the shortage of testing kits in the USA added to the number of people who can't afford testing or/and the treatment, it is likely that the actual number of cases in the USA is much higher than reported.

    It is easy to see that premature reopening for business in the USA being promoted by Trump will only accelerate the spread of the virus. Other 1st world government understands that a healthy economy requires a healthy workforce. That's why other 1st world countries, including my own, are implementing complete lock downs.

    Many countries are limiting entry through their borders to their own citizens, who must then go into isolation for 14 days. If the USA gives up on limiting the spread of Covid19, those travel restrictions are likely to exclude or limit international travel by Americans. International travelers will be reluctant to go to the USA knowing that they will have to go into isolation after returning to their home country. Expected travel restrictions to and from the USA will have a major impact on US businesses.

    Premature reopening for business is likely to initiate a massive spike in Covid19 cases that will overwhelm the health system, resulting any many needless deaths on a 3rd world scale. The risk is that a premature attempt to restart the economy will end up smashing the economy. If that happens, it will adversely affect the international economy. The on-going supply of toilet paper will be the least problem to worry about.

    This is one time that I hope I am completely wrong about everything.

    Dazz

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    Quote Originally Posted by MattiJ View Post
    Haven't had any problems with sense of smell.
    Overall quite mild disease for me(whatever it is after all), normal influenza usually hammers me 20x worse than this. (for me normal to get 105F fewer on flu)
    Just slooow progress, 12 days now and still slight chest pain. Chest pain seems to come and go, never really more than mild annoyance.
    I'll take this any day over last enterovirus, lost permanently half of the hearing on the left ear with that and our daughters fingernails peeled off.
    Holy smokes ! That sucks big time ~ enterovirus + loss of hearing … [that must be very disorienting :-( ].

    Finger nails eeeeeek. (I hope your daughter's finger nails grew back ?)

    I don't know your age range. I'm now 50, yay.

    The one thing that I'm looking out for is the "sudden turn" for the worst at the very last phase when things can (in some instances) become very unstable very quickly/ critical (at least that's what I've been told from many different sources.)

    So it's like "Come on " "Do whatever it is you are gonna do " "Like put me in the hospital or just quietly exit stage left Mr Virus." "Pick one already !!! " ).

    How are things in Finland - Health care resources etc. any testing offered / allowed etc. Do doctors make house calls still in Finland ?

    Cheers,

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    And one lesson I hope we learn from this is that some basic medical-goods infrastructure MUST be available within every region of the country. The ability to make filter masks, gloves and basic medical gowns and other PPE, even some bio-labs for testing kits manufacture once protocols are established - all this should be considered vital, and part of the national "Armory".

    Let's not forget this period. I know it sounds unlikely at the moment, but we have the collective memory of a senile goldfish for most things. The early 2020's mustn't be forgotten or ignored!

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    there was a report that over half of the infected people lost a sense of smell for a while

    I think (again, not a doctor) symptoms and severity of illness greatly depends on where the virus entered your body, and the initial dosage, if you get lots of it deep inside the lungs from spray in the air, then trouble is expected, but if you get it from touching something and then touch your face, the replication rate is slower and your body immune system can react to it much more controlled and gradual fashion resulting in the "mild" case, the immune response overreaction is what causes most problems in the critical cases

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    Quote Originally Posted by Milland View Post
    CamMan, your descriptions really do sound like the CV, so please be extra careful with anyone that visits. But at least it doesn't sound as aggressive as it's been for the unfortunates, so let's trust you'll be around for a lot longer.
    Thanks man / @Milland ,

    I'm not worried, just frustrated waiting for the other shoe to "drop".

    My wife in Denver is much more worried than I am.

    I've been through all kinds of cancer scares with my x-spouse , and nearly killed a few times myslef etc. etc. so I don't get that "world is tilted on a weird angle" feeling of impending doom with this "mediocre set of Coid 19 like symptoms" .

    I'm fairly lucky that those closest to me are well taken care of and right now I don't have any young children.

    If I get run over by a bus it's not the "end of the world" for sure. Strangely that's always been my ambition to be able to "exit" and everything else carries on just fine without me... I.e. not have things be 100% dependent on my continued existence. That's not easy to arrange so I'm very sympathetic to folks that have just gotten "fired" from the Food'n Bev industry that have families to feed and rent to pay etc.

    I fully expect to recover (sneak through this) just need to make sure I don't make any obvious blunders or f*ck ups lol

    It used to be that in the U.K. 15 years ago I had much older friends that were very sick "The" wife with Lupus + complications and the husband with heart conditions and every time they went into the NHS hospital (Norwich/Norfolk) one spouse or another would have to intervene to stop an NHS hospital error form killing their spouse. My "evil-ish" mother won't go anywhere near a hospital for similar reasons... But with Boris Johnson and the NHS task force and some really smart "Peeps" from good universities it'll be great if they pull of the testing kit thing (a real victory and hopefully bring real quality to the test). So in spite of all that I'm kinda rooting for them. But similarly I know the potential cost of various blunders and f*ck ups, ~ So I'm just trying to make sure I am reasonably responsible enough (to those closest to me that I don't 'eff up / slip up and get caught out ;-) ).

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    Quote Originally Posted by cameraman View Post
    Holy smokes ! That sucks big time ~ enterovirus + loss of hearing … [that must be very disorienting :-( ].

    Finger nails eeeeeek. (I hope your daughter's finger nails grew back ?)

    I don't know your age range. I'm now 50, yay.

    The one thing that I'm looking out for is the "sudden turn" for the worst at the very last phase when things can (in some instances) become very unstable very quickly/ critical (at least that's what I've been told from many different sources.)

    So it's like "Come on " "Do whatever it is you are gonna do " "Like put me in the hospital or just quietly exit stage left Mr Virus." "Pick one already !!! " ).

    How are things in Finland - Health care resources etc. any testing offered / allowed etc. Do doctors make house calls still in Finland ?

    Cheers,
    Fingernails grow back after enterovirus just fine but it's pretty gross at some point.
    Just turn 40 so by no means any risk age.

    Situation in Finland is "under progress", 7 reported deaths, 20-30 people in ICU, 100 hospitalized patients and ~1000 verified infections.
    Testing limited to more serious hospital cases and any healthcare professionals with symptoms. (Most tests probably done to healthcare workers with runny nose.)

    Anesthesia ventilators/operating theatres already prepped for coronavirus care and even veterinarians with ventilators listed..
    Also first time since WWII that government has opened the PPE reserves in NESA (National Emergency Supply Agency). Also first time with martial law and various other things

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    Quote Originally Posted by dazz View Post
    Hi

    I see it has only been 15 days since a skeptic started this thread.
    The USA is now leading the world in Covid19 cases. Given the shortage of testing kits in the USA added to the number of people who can't afford testing or/and the treatment, it is likely that the actual number of cases in the USA is much higher than reported.

    It is easy to see that premature reopening for business in the USA being promoted by Trump will only accelerate the spread of the virus. Other 1st world government understands that a healthy economy requires a healthy workforce. That's why other 1st world countries, including my own, are implementing complete lock downs.

    Many countries are limiting entry through their borders to their own citizens, who must then go into isolation for 14 days. If the USA gives up on limiting the spread of Covid19, those travel restrictions are likely to exclude or limit international travel by Americans. International travelers will be reluctant to go to the USA knowing that they will have to go into isolation after returning to their home country. Expected travel restrictions to and from the USA will have a major impact on US businesses.

    Premature reopening for business is likely to initiate a massive spike in Covid19 cases that will overwhelm the health system, resulting any many needless deaths on a 3rd world scale. The risk is that a premature attempt to restart the economy will end up smashing the economy. If that happens, it will adversely affect the international economy. The on-going supply of toilet paper will be the least problem to worry about.

    This is one time that I hope I am completely wrong about everything.

    Dazz
    Hi to New Zealand...

    I think Trump has this idea like War of the Worlds that the Earth based (home team) microbes kill the alien invaders (from another planet) when all conventional human warfare techniques fail; the final scene where the world rejoices singing hymns in bombed out churches ~ except in reverse... Trump defeats the virus and the world rejoices and sings hymns on Easter Sunday (praising the golden one).

    Total madness, but that won't happen. [I'm not sure why he doesn't get the numerics of the situation ? ]. Hard to visualize why "He " "Thinks" that everything is "cured" for good and everybody can bundle in to a church cheek by jowl by April 12th … 2020 ?

    There will for sure be rolling "Lock downs" "Pump the brakes" " intermittent curve squashing" possibly for as long as two years... (maybe/ maybe not ?)

    It's gonna be interesting to see when the curve starts to tip or flatten / abate or reach some kind of "Apex" in NYC ~ So far nowhere in sight ?

    It is a little weird how the Big data analytics are going to try and strike a balance between chaos caused by "Virus" versus Economic chaos that also have human casualties / morbidities associated with it as well. (outside of Trump's wishes for the "Stock-Market" and broader based economic aims separate from the value of human life ?)

    It's weird time to be alive but when was it not a weird time ? (broad strokes).

    Hope New Zealand does a great job with all this !

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    Quote Originally Posted by dgfoster View Post
    Just in case anyone still thinks this virus is just another form of the "flu," and that we really don't need respirators, here is a note intended for docs in other areas of the country from an ER doc working in New Orleans (sorry for some of the medical jargon but for those not so versed in that jargon, the gist is still quite clear)

    "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"

    And this thing is just getting started. The best thing we can all do is to take social isolation very very seriously. Try to save the ventilator for someone else by not occupying one yourself.

    Denis














    waiting for scottl to come and tell us this is fake.......

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    Quote Originally Posted by CarbideBob View Post
    Florida sucks in the summer. You need AC everywhere and don't want to mow the lawn after 9 AM.
    How do you live in that, plus you never see snow.
    Really, no snowman in the front yard? No skiing, no sledding and you probably don't now what a snowmobile is.
    A snowmobile is like a wave runner out on the ocean but so much better.
    Yes you do not get to ride with a dolphin pod here or have them wake surf on the boat or smaller you which is crazy fun.
    I do so much love Daytona and the other side south tip around Naples when not crowded with nutso but.....
    Not meaning to be bad or prissy to you or our members in the area. Different strokes, we all have a like.
    Florida great, Michigan maybe neat

    Us up north come to Florida often to visit or vacation, few do the opposite.
    It is only 20 to 24 hours in the car.
    Bob
    Seadoos are fun also. There are people I grew up with using window fans in the houses they grew up in as they returned home to care for their parents.

    They usually have air conditioning window units. It rains frequently and that both adds humidity and cools things down a bit. You would find it very cold at times yet snow is rare.

    Shade trees are important and swimming also. Daytona is fun. The best thing is that anywhere in Florida the ocean is not far away plus there are Great Lakes, rivers, and springs here. Lots of bluegrass and music festivals. You ought to check out renting a nice air conditioned place on the Suanee River it is like most other places in Florida. It is for good reason so many retire here. My family has been here for several generations.


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