Sometimes, as the lawyers say, res ipsa loquitur, meaning “the thing speaks for itself”. I believe these three excepts, both individually and in juxtaposition, say a great deal about the war against coronavirus.
From Jason Van Schoor, flagged in Links yesterday:
First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare…
3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity
4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.
5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.
6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.
7/ We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:
8/ 1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick
2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great
9/ 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2.
4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.
By e-mail, from National Nurses United:
Registered nurses are outraged to learn that the Centers for Disease Control (CDC) on Tuesday further weakened its guidance on measures to contain COVID-19. These changes include, among other things, rolling back personal protective equipment (PPE) standards from N-95 respirators to allow simple surgical masks; not requiring suspected or confirmed COVID-19 patients to be placed in negative pressure isolation rooms at all times; and weakening protections for health care workers collecting diagnostic respiratory specimens. These are moves that National Nurses United nurses say will gravely endanger nurses, health care workers, patients, and our communities…
“If nurses and health care workers aren’t protected, that means patients and the public are not protected,” said Bonnie Castillo, RN and CNA/NNOC and NNU executive director. “This is a major public health crisis of unknown proportions. Now is not the time to be weakening our standards and protections, or cutting corners. Now is the time we should be stepping up our efforts.”..
In addition to lobbying almost every federal health agency, the presidential administration, and members of Congress, and California health agencies to step up protections, NNU recently surveyed RNs nationwide, finding that the vast majority of the nation’s health care facilities are unprepared for COVID-19, with only 29 percent of nurses reporting that their hospitals have a plan in place to isolate a coronavirus patient, and only 30 percent saying their employer has enough personal protective equipment if there is a rapid surge in patients with possible COVID-19 infections.
Many hospitals and healthcare facilities have failed to provide adequate personal protective equipment to nurses working with COVID-19 patients. Some facilities are telling nurses to continue to work while asymptomatic, even though they’ve been exposed to the virus and might be contagious. Testing at hospitals has been sporadic.
From David Wang, a technology expert at a global macro research firm based in Hong Kong and Beijing, from his personal blog at Covid Observations from Beijing, March 11 (I encourage you to read the entire piece):
I see quarantine enforcement. One day in early February, a uniformed municipal employee set up a tent and a table outside my apartment compound, taking the temperatures of everyone leaving and entering. The next day, he gave me a paper slip, saying that I needed to display it every time I came in. It was a good thing that I received that entry card when I did, because I would have to go through a gauntlet of tests to be issued one today. These guards have been the chief enforcers of the quarantines, making sure that those who return from overseas or other provinces have to stay indoors. Given that everyone lives in big apartment compounds, it’s more or less possible to make sure that only approved people are allowed in or out of every residence. From where these enforcers emerged is a mystery. The source of their legal authority to regulate my entry is unclear to me; sometimes the entrance is staffed by volunteers, whom I assume are retired Party members.
I see movement regulations. Every business I enter (whether that’s a restaurant, supermarket, or retailer), someone takes my temperature and asks me to write down my phone number. Taikooli, the large outdoor mall by where I live, has blocked off most entrances to corral people into temperature check zones. Most of the enforcement is low tech: instead of digital tracking, it’s middle-aged men sitting outside apartments working with pen and paper. Digital surveillance exists too. My mobile carrier sent me a text to tell me that it can give me my 14-day location history based on my data usage….Social distancing is encouraged everywhere: at restaurants, where one can’t always sit face-to-face with people; in elevators; and in the office, where no more than a third of people can visit at any time. To enter my office building, I need to fill in a government app with self-reported health data.
I see dubious precautions. The evidence I’m familiar with states that gloves are good protection and that masks are barely so. Most people here wear masks religiously, but fail to wear gloves, and they don’t always wash hands before they eat…..
I see civic spirit….I see rousing propaganda….And I’m seeing a city on the track to recovery.