Coronavirus and Walt Disney World general discussion

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durangojim

Well-Known Member
oh, I’m not blaming the doctors.
I understand and agree with the idea of if we tested everyone with symptoms we’d see the mortality rate go way down. It’s just not possible right now, not to mention many outpatient clinic including all six of my offices have stopped seeing patients in person and have a changed to virtual visits so as not to contribute to the spread.
 
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Giss Neric

Well-Known Member


I'm seeing this more now, checking their temperature before even entering their premises/establishments like this

2020_02_27_87538_1582779043._large.jpg
 

celluloid

Well-Known Member

The issue is much like the masks, they are not doing much if anything. If someone feels fine and comes to work every day, they could be spreading it as well as customers that have it and feel fine with no symptoms.

It means very little though.medically speaking unless this is for health in general besides this virus. Those who are Asymptomatic are being said to spread it more. Someone feels fine, has no symptoms including no fever spreads it and never knew they had it. The guy checking the temperature of people is doing more damage then likely not checking at all.
 

OrlandoRising

Well-Known Member
There seems like there was a change in the feel of this ordeal late today. The growing confidence and reporting that chloroquine is cv19 killer and the much improved coordination of federal and state government, and finally the increase in discussion about opening things up. There are still major hurdles but I just get the feeling that the outlook has shifted more towards getting back to normal.

WHO to launch multinational trial to jumpstart search for coronavirus drugs

Bayer preps U.S. donation of malaria med chloroquine to help in COVID-19 fight: report

Speaking as a health care journalist (that's my day job), the best hope in the short-term is to find an existing treatment, already demonstrated to be safe for humans, that is effective against COVID-19. Vaccine is still the permanent solution.
 

Rimmit

Well-Known Member
I understand and agree with the idea of we tested everyone with symptoms we’d see the mortality rate go way down. It’s just not possible right now, not to mention many outpatient clinic including all six of my offices have stopped seeing patients in person and have a changed to virtual visits so as not to contribute to the spread.

Our hospital system has cancelled all well visits as well and are encouraging providers to either do tele visits or just a quick conversation and just put in for the refills. Relaxed all refill requirements on scheduled drugs. Stopped elective procedures and have converted them to ICUs. We’ve accounted for all our PPE and it’s basically on lockdown except for when absolutely needed.

Our testing guidelines are not very broad either. Basically if flu and strep negative and no travel history and not getting admitted, go home and self quarantine for 14 days. It also takes us 4 days to get results back as we send to the state. At our last Med staff meeting on Monday we discussed using a private option like lab Corp or Mayo, as they said we could get those back in likely 2 days. Haven’t been on service since that meeting and haven’t heard if we went private or not.

Point is, we are definitely not testing many people, so we have no idea where we truly stand.
 

DKampy

Well-Known Member
where were all these people who need hospital beds before we started testing...it seems if you need a hospital bed you need a bed
 

Rimmit

Well-Known Member
where were all these people who need hospital beds before we started testing...it seems if you need a hospital bed you need a bed

They were admitted, just not considered a “ corona case”. They were likely diagnosed something like “culture negative sepsis” or “Acute Respiratory Distress Syndrome”. In medicine common things are common. We don’t look for zebras in a crowd of horses.

It takes a LOT of abnormal cases for a clinician to start seeing a pattern develop. Just having an extra admission or two isn’t going to perk any ears. HOWEVER, if you suddenly start getting flooded with cases in which your flu test is negative, blood culture is negative, and a respiratory viral panel is negative and they all hit at the same time, you are going to start to think, “Hmmm.... this is weird.”

So you ask where were the cases before. Right in plain sight. Just misdiagnosed as we had never heard of or had a test for Coronavirus. One extra admission or two isnt going to immediately make a clinician think “Oh, this must be some new virus than can cause a worldwide pandemic.” That’s just not how medicine works.

Ignorance is bliss.
 

durangojim

Well-Known Member
Our hospital system has cancelled all well visits as well and are encouraging providers to either do tele visits or just a quick conversation and just put in for the refills. Relaxed all refill requirements on scheduled drugs. Stopped elective procedures and have converted them to ICUs. We’ve accounted for all our PPE and it’s basically on lockdown except for when absolutely needed.

Our testing guidelines are not very broad either. Basically if flu and strep negative and no travel history and not getting admitted, go home and self quarantine for 14 days. It also takes us 4 days to get results back as we send to the state. At our last Med staff meeting on Monday we discussed using a private option like lab Corp or Mayo, as they said we could get those back in likely 2 days. Haven’t been on service since that meeting and haven’t heard if we went private or not.

Point is, we are definitely not testing many people, so we have no idea where we truly stand.
Yep. Thank God the government relaxed the requirements for televisits or I think a lot of patients would find their doctors out of business in a month
 

durangojim

Well-Known Member
They were admitted, just not considered a “ corona case”. They were likely diagnosed something like “culture negative sepsis” or “Acute Respiratory Distress Syndrome”. In medicine common things are common. We don’t look for zebras in a crowd of horses.

It takes a LOT of abnormal cases for a clinician to start seeing a pattern develop. Just having an extra admission or two isn’t going to perk any ears. HOWEVER, if you suddenly start getting flooded with cases in which your flu test is negative, blood culture is negative, and a respiratory viral panel is negative and they all hit at the same time, you are going to start to think, “Hmmm.... this is weird.”

So you ask where were the cases before. Right in plain sight. Just misdiagnosed as we had never heard of or had a test for Coronavirus. One extra admission or two isnt going to immediately make a clinician think “Oh, this must be some new virus than can cause a worldwide pandemic.” That’s just not how medicine works.

Ignorance is bliss.
Yes. Especially since this is still flu season and so many of the symptoms overlap. I’m a family doc and I still don’t know if I could discern covid from flu based on symptoms alone.
 

Rimmit

Well-Known Member
Yes. Especially since this is still flu season and so many of the symptoms overlap. I’m a family doc and I still don’t know if I could discern covid from flu based on symptoms alone.
There is zero chance I would have made that diagnosis. If a baby came in at DOL 7 or something, I would have assumed late onset sepsis, HSV, RSV or flu. After that all comes back negative and they showed ground glass opacifies consistent with RDS on the CXR I would maybe have started thinking a super rare surfactant b protein deficiency, or something.

Definitely on a board exam would not have picked e.) possible pandemic apocalyptic level Coronavirus. Would definitely have missed that one.
 
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DisneyCane

Well-Known Member
Pakistan is using the DisneyCane method of letting life go on as it is, get everyone infected and isolate old people.
At least we'll have data about how that strategy works vs. what we're doing here.

My biggest issue is that the "lockdown" method does not rid the country/world of the virus. It "flattens the curve" while the restrictions are in place. They seem to be banking on a natural slowing of spread when the "season" ends in April or May to keep the tail of the curve suppressed.

The whole cycle will start again until there is a vaccine. I just don't think you can shut the world down again in November. At some point there will be civil unrest because the government won't be able to keep sending out checks to keep everyone from freaking out.

I can't remember who posted this article earlier but it is written by an actual expert at Stanford and backed with facts. Amazingly a lot of what he states are points I was making last week when people kept insisting I'm wrong and we have all the data we need.

https://www.statnews.com/2020/03/17...e-are-making-decisions-without-reliable-data/
 

durangojim

Well-Known Member
I am NICU. There is zero chance I would have made that diagnosis. If a baby came in at DOL 7 or something, I would have assumed late onset sepsis, HSV, RSV or flu. After that all comes back negative and they showed ground glass opacifies consistent with RDS on the CXR I would maybe have started thinking a super rare surfactant b protein deficiency, or something.

Definitely on a board exam would not have picked e.) possible pandemic apocalyptic level Coronavirus. Would definitely have missed that one.
I think we all just got ran over by a stampede of zebras. One positive is all my patients are willing to try this new form of healthcare. They’re just happy to have docs that want to take care of them any way they can.
 

lazyboy97o

Well-Known Member
Fair enough, then they should be releasing those economic models and inherent assumptions to show that so we can review/debate their conclusions. I certainly didn't hear the mayor of San Francisco running down the model variables and quoting the financials when she shut down the city.
It would be good to see more information but it’s also something you can start to look at yourself.

16% of Americans are over 65, and more are working now than ever.

10.5% of Americans have diabetes.

Approximately 8% have asthma.

6.7% of adults over 20 have coronary artery disease.

6.4% have been diagnosed with COPD but that number is believed to be low.

I have no idea how many Americans are typically pregnant at any given moment, but I have seen the huge maternity wings at hospitals.

While there is definitely overlap in those numbers, especially with those over 65, would it be unreasonable to assume that we could easily be looking at 20% - 25% of the US population who are known to be a high risk? That big group of people over 65 also tend to have more discretionary income and hold more senior positions in businesses, so them alone would be a hit to the travel industry.

Schools may not seem like they are an issue, but how many teachers fall into one of those groups? How many kids? How many kids have parents or siblings that fall into a high risk group? Kids whose parents work with high risk individuals? The same goes for universities. Americans have been having kids later in life and young adults are living with their parents longer, meaning you have greater overlap between the age groups who are low risk and high risk.

How much economic activity in a place like Washington DC grinds to a halt because all three branches of the federal government are in isolation?

While it may be a good discussion point going forward, even hospitals and medical offices are not designed for isolating such large groups. Hospitals no longer have wings, they have floors and everybody going to pulmonology is walking through the same lobby and riding in the same elevators as everyone else. General practitioners see people of all ages and risk. These places not only have doctors and nurses of varying degrees of risk, but entire support staffs that would also have to isolate. Even doctors or staff related to groups generally considered low risk, like general pediatrics, may themselves be high risk and have to isolate. That’s an automatic strain on capacity just as a preventative measure.

Since this started as a Walt Disney World focused thread, in the world of entertainment you have single individuals who employ entire staffs but if that individual is not working, then nobody works. How many bands still performing live are now in their 60s and 70s? Huge shows commanding top dollar ticket prices that would still get shut down because the band is in isolation. There are television shows like Schitt’s Creek that star actors who would be in isolation and likely suspending production.

Yes, this doesn’t give as sort of exact model but it’s a relatively easy thought exercise that shows the compounded effects of isolating “only” those considered to be at a high risk. And these people must be more truly isolated because you are allowing what appears to be a highly contagious virus to run rampant in the remaining population. Letting the virus run rampant among the lower risk groups will also have an economic impact because “mild” symptoms means not requiring hospitalization, so that is still a lot of people getting sick and missing work. Then there are the longer impacts of what could be lung damage even among those with mild cases.
 
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DisneyCane

Well-Known Member
So gotta comment... Yes, simple Surgical masks do NOT do much to protect YOU. They are actually desighned to protect the "patient" FROM you.

But consider the "Asia Experiment": EVERYONE wears a Surgical Mask - or they end up arrested :). Given a whole different "Social Attitude" in most Asian Countries? This works. But the message is "protect your neighbor".

Now we HAVE N95's, and even gloves & goggles. So far? STARTING to use the N95's.... But that's a "protect me". We would rather see a mandate for anyone in public to wear a surgical mask - cheaper & easier to make. Could be a stretch... in the US we would have to establish an attitude of "care for the other guy" :(. Make it a patriotic duty? Could work.
Asian culture tends to be more respectful of elders and authority. People in the US won't even cover their cough. I doubt they will wear masks to protect others.
 
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