Wednesday, April 22, 2020

Fatal Attraction

We have no fucking clue about Covid. None.  The New York Times provided a historical timeline of Covid that was the subject of the Frontline on Tuesday. 

We have a massive problem with testing, tracking and tracing as we also will find a crack, a slip or some factor that will never allow for full restoration of our social norms.  This is where we are with a fucking Crazy Dopey Grandpa in charge and his own image that we are fucked. I cannot stress this enough that we have a major problem with the man in charge as he is a fucking idiot. The end.

In the meantime I have long said that once in you will never leave and those who are not healthy and have pre-existing medical issues are given a death sentence once Covid hits and then add to that ventilation it means you will not make it.  If you watch Frontline only one patient survived long term ventilation and that alone was amazing given what I could tell from just observation. But one thing that it will also tell you that there is no pattern, you can be fine one day the next in full blown crisis. So again there is nothing that tells anyone anything about progress and prognosis. And that again centers on testing as most of it is restricted to those exhibiting ALL of the symptoms which means you either lie or you fail to get tested and in turn treated/observed/monitored.

This is the state of health care in America, random, utterly unprepared and utterly unable to handle this crisis.  And much of it is because our Government has failed to provide the guidance, the skills and the ability to waive guidelines and policies in urgent situations.  We are fucked.

In New York’s largest hospital system, 88 percent of coronavirus patients on ventilators didn’t make it
New data shows many of those hospitalized had high blood pressure, obesity or diabetes.

By  Ariana Eunjung Cha
April 22, 2020
The Washington Post

Throughout March, as the pandemic gained momentum in the United States, much of the preparations focused on the breathing machines that were supposed to save everyone’s lives.

New York State Gov. Andrew M. Cuomo and President Trump sparred over how many ventilators the state was short. DIYers brainstormed modifications to treat more patients. And ethicists agonized over how to allocate them fairly if we run out.

Now five weeks into the crisis, a paper published in the journal JAMA about New York State’s largest health system suggests a reality that like so much else about the novel coronavirus, confounds our early expectations

Researchers found that 20 percent of all those hospitalized died — a finding that’s similar to the percentage who perish in normal times among those who are admitted for respiratory distress.)

But the numbers diverge more for the critically ill put on ventilators. Eighty-eight percent of the 320 covid-19 patients on ventilators who were tracked in the study died. That compares with the roughly 80 percent of patients who died on ventilators before the pandemic, according to previous studies — and with the roughly 50 percent death rate some critical care doctors had optimistically hoped when the first cases were diagnosed.

“For those who have a severe enough course to require hospitalization through the emergency department it is a sad number,” said Karina W. Davidson, the study’s lead author and a professor at the Feinstein Institutes for Medical Research at Northwell.

The analysis is the largest and most comprehensive look at outcomes in the United States to be published so far. Researchers looked at the electronic medical records of 5,700 patients infected with covid-19 between Mar. 1 and Apr. 4 who were treated at Northwell Health’s 12 hospitals located in New York City, Long Island, and Westchester County — all epicenters of the outbreak. Sixty percent were male, 40 percent female and the average age was 63.

“It’s important to look to American data as we have different resources in our health care system and different demographics in our populations,” Davidson said.

The paper also found that of those who died, 57 percent had hypertension, 41 percent were obese and 34 percent had diabetes which is consistent with risk factors listed by the Centers for Disease for Control and Prevention. Noticeably absent from the top of the list was asthma. As doctors and researchers have learned more about covid-19, the less it seems that asthma plays a dominant role in outcomes.

One other surprising finding from the study was that 30 percent of the patients sick enough to be admitted to the hospital did not have a fever. Fever is currently listed as the top symptom of covid-19 by the CDC, and for weeks, many testing centers for the virus turned away patients if they did not have one.

Davidson said that as a result of that findings, Northwell is encouraging people with underlying health conditions, such as hypertension and diabetes, who are potentially exposed to the virus and who might not have a fever to consult with a doctor sooner rather than later.

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