Coronavirus

[madodel]

Not so much. People these days refuse to get PCPs/Family Docs. So they use the ER for just about everything.

That is great for hospital revenue, but craptacular for patient care and general well-being.

When I practiced I even saw people that would show up to the ER for their kids annual well-child checks, so they could get their kids signed off on vaccines and go to school. 100% not what the ER is for.

I broke my arm 3 weeks ago and I went to the ER. My wife was like "You should have gone to an urgent care place". My arm was dangling at that point and I knew from her that the ER was empty then because no one was going there. Since I ended up with just a sling maybe I could have gone to a PCP but the whole dangling arm thing was a bit concerning at the time.

My wife isn't seeing many, if any young women in their 20's with chest pain who are having a panic attack which usually is worth mentioning when she gets home, but she says things are getting busy again. Some insurance companies are now not paying for ER visits if they don't really have an emergent medical problem. How most people are supposed to know whether they are having a genuine emergency or not makes that really tough. Considering a lot of people are idiots as it is, not sure how that works.

 

[bkp_duke]

I broke my arm 3 weeks ago and I went to the ER. My wife was like "You should have gone to an urgent care place". My arm was dangling at that point and I knew from her that the ER was empty then because no one was going there. Since I ended up with just a sling maybe I could have gone to a PCP but the whole dangling arm thing was a bit concerning at the time.

My wife isn't seeing many, if any young women in their 20's with chest pain who are having a panic attack which usually is worth mentioning when she gets home, but she says things are getting busy again. Some insurance companies are now not paying for ER visits if they don't really have an emergent medical problem. How most people are supposed to know whether they are having a genuine emergency or not makes that really tough. Considering a lot of people are idiots as it is, not sure how that works.

A broken arm is a lot different than . . . getting vaccines. That was my example.

Plus, if you have a PCP they almost always have an on-call number you can call. "Hey, I'm experiencing X, Y and Z." "Sir, you need to go to the ER right now." vs. "We can deal with that in the morning, please call first things tomorrow when the office opens."

The default now is that many people don't bother having a PCP or calling them and instead just default to 100% for everything is an ER visit.

That's not how the system was setup, and it's not a small driving force for the rapidly increasing cost of care (i.e. if we charge more for the ER, maybe people will think twice about using it for non-emergent stuff).

 

[N5329K]

I was not familiar with "DIC" acronym.

Or maybe call it DED: Disseminated Endothelial Disease. Maybe that would get people’s attention, because right now we are recreating...perfectly...the ineffective patchwork response (some places shut down, some wide open) that gave rise to the steep and far more lethal Wave 2 of the 1918 pandemic. History is not just rhyming. It is repeating itself.
Robin

 

[bkp_duke]

That's precisely how the system is designed to operate. Maybe complain about the administrators and corporate investors rather than poor people getting "truly shitty" healthcare.

This is not correct. The ER is for "emergent" care. It has never been designed for the capacity for non-emergent things which a PCP should care for. Non-emergent visits are actually many fold higher in number, and sending everyone to the ER for everything is dumbassary at its finest.

If you are really that poor, you actually qualify for more free PCP care than someone that is lower-middle class. CHIP 100% covers kids from low-income families and a PCP for them for all well child care in all 50 states. The catch? You have to be pro-active enough to do some paperwork and sign up (it's a one-time thing, but not that hard).

 

[madodel]

A broken arm is a lot different than . . . getting vaccines. That was my example.

Plus, if you have a PCP they almost always have an on-call number you can call. "Hey, I'm experiencing X, Y and Z." "Sir, you need to go to the ER right now." vs. "We can deal with that in the morning, please call first things tomorrow when the office opens."

The default now is that many people don't bother having a PCP or calling them and instead just default to 100% for everything is an ER visit.

That's not how the system was setup, and it's not a small driving force for the rapidly increasing cost of care (i.e. if we charge more for the ER, maybe people will think twice about using it for non-emergent stuff).

Our ER accepted the reality of having a large uninsured population with no PCP and set up a clinic area within the ER so people can be triaged to see a nurse to handle the non-emergency cases.

 

[jerry33]

This is not correct. The ER is for "emergent" care. It has never been designed for the capacity for non-emergent things which a PCP should care for.

Of course, it doesn't help when you call the PCP, the first thing the recording tells you is to go to the ER.

 

[bkp_duke]

Of course, it doesn't help when you call the PCP, the first thing the recording tells you is to go to the ER.

True, I have no fix for stupid, even among doctors.

 

[KenC]

I once called my mom's PCP at 12:45p on Friday, about symptoms I suspected to be a DVT, due to a new medication. They close at 1pm on Friday's, but the staff don't pick up after 12:30p. The doc on call called back after 3p, recommended going to Urgent Care, and we discussed it for a while. Ultimately, he said UC could do everything to test for DVT that the ER could, so that's where I took my mom. After waiting 45 mins, the UC receptionist told me that their ultrasound tech, etc had gone home already, late Friday afternoon, and that we needed to go to the ER. Drove over to the ER, and told the triage nurse my mom's symptoms, and the triage nurse ordered a blood test and ultrasound, at 4:40pm. 3hrs later we saw the ER doc, and he tells us my mom will have to stay overnight since the ultrasound tech has left for the day. Infuriating. An hour later the ultrasound tech shows up, because when the ER doc had called her, she recognized the name, since she had known my dad, a cardiologist. Yep, my mom had DVT, and they gave her an injection of Lovenox and sent us home. It was now 11:30p.

Took all day to get that done. Brutal.

 

[bkp_duke]

Our ER accepted the reality of having a large uninsured population with no PCP and set up a clinic area within the ER so people can be triaged to see a nurse to handle the non-emergency cases.

Our hospital didn't like that. This is where the "bean counters" got involved. If someone came to the ER, they wanted them to be seen by a physician or nurse practitioner because 1) they could charge more and 2) they didn't want to get sued for a nurse's medical decision.

 

[KenC]

Try tests per confirmed case. Far more representative, as it accounts for the size of the outbreak.

USA currently around 9, and Japan 26. By comparison, Hong Kong (where it is almost eradicated) is 190.

But if you don't test, you don't get any confirmed cases.

 

[NikolaACDC]

And we did it...

 

[FreshPrince]

Not so much. People these days refuse to get PCPs/Family Docs. So they use the ER for just about everything.

That is great for hospital revenue, but craptacular for patient care and general well-being.

When I practiced I even saw people that would show up to the ER for their kids annual well-child checks, so they could get their kids signed off on vaccines and go to school. 100% not what the ER is for.

You're describing system failure, where people come with valid issues but use system in a way that is more costly. They do that because system allows them to or they have no other choice. Maybe some of the parents were advised to go to ER to get wellness check because they did not have insurance.

 

[rxlawdude]

True, I have no fix for stupid, even among doctors.

I'm still shocked that hospital systems don't place an Urgent Care Center on or near campus to triage patients. Seems that would save a helluva lot of resources while freeing up ERs for real, more critical care.

Then again, I've seen "Urgent Care Centers" that wouldn't even remove a splinter ("we're not set up to do minor surgeries"). WTF?

 

[Papafox]

It seems like a big double edged sword for Hawaii since Hawaii's economy is largely dependent on tourism. Being an isolated island chain in the middle of the ocean makes it a great location for keeping the virus out... but the reliance on the tourism industry makes keeping the virus out terrible for the economy. I don't know why anyone would visit if they have to be quarantined in their hotel room for 2 weeks before venturing out. We had been saving for a trip there this winter but that is really looking doubtful right now.

I get the impression, from talking to my in-laws on Oahu, that folks are not happy with Ige and Caldwell despite the low case numbers. I am actually amazed how low the case numbers are... given the strong ties to Asia, older population, and prevalence of multi-generational households in Hawaii I expected a larger outbreak and many more deaths. It is an interesting case study...

Governor Ige ruffled feathers by
* waiting an extra week to shut down international and mainland arrivals after it became evident that COVID19 cases were starting to pop up quickly in Hawaii. I think he wanted the hotels to finish a good spring break before placing quarantine rules.
* suggesting that one way to handle the budget shortfall was to give all state employees including teachers a 20% pay cut
* being too draconian by not lifting restrictions for certain businesses to resume, even when the number of cases shrank to extremely small numbers
* Insisting that all counties run their COVID19 decisions by him for approval. This situation has resulted in the current confusion of what businesses are allowed to reopen.
* Not finding the resources or holding feet to the fire so that unemployment checks get mailed. Even though we're at the end of May, I'm not sure yet whether all the requests for unemployment made in early March have been processed yet. How can the employees of that department go home at regular hours, take weekend and holidays off, while some unemployed are literally depending upon a food bank to keep from starving?
* Keeping restrictions on businesses so tight that people wondered if Hawaii was trying to eliminate the virus entirely before giving the go ahead for certain medium-risk businesses to open, in light of the reality that a return of tourism will undoubtedly be needed and will reinfect the islands.

 

[dfwatt]

From the article:



1637456 cases
97669 deaths

97669/(1637456*5)*100 =~1.2% IFR according to this scientist' estimates.

People worry and even obsess about infection fatality rate as though it's a precise number when it's not simply due to the fact that the penetration of advanced age and classic comorbidities into your demographic cohort will always have a big influence on Ultimate IFR but in any case, I think those numbers are certainly "in the ballpark." This ain't the flu.

For people still skeptical of this, please see medcram covid 19, units 61, 63, and 72 which includes advanced histopathology of lung samples from influenza and covid-19 (just about the entire series from 61 up covers this fundamental biology). It makes it absolutely clear why this disease is more lethal. Unlike influenza this is an endothelial and therefore pleiotropic disease, and its collapse of the downstream Ace 2 receptor signaling pathway and the resulting disinhibition of the main branch of the renin-angiotensin system contains significant morbidity in terms of elevated oxidative stress, coagulopathy and microangiopathy, all compounding the damage done by the innate immune system. Jointly these processes may describe why we have conjoint lung, cardiovascular & renal vulnerabilities in this disease. These are all places with high endothelial and heavy ACE2 receptor populations.

These things simply are not found in the flu. Folks insisting that this is just the flu or a version thereof simply do not understand the fundamental biology of covid-19 infection. You simply cannot cover over or deny or somehow replace this biological science with something more consonant with your ideological assumptions and framework. Viral diseases are not identical and this disease has fundamental differences with influenza. For folks who simply cannot absorb that message, you would need to ask yourself why it is that basic science is threatening to your view of the world. There is nothing political in the histopathology slide of this disease and its comparison with a matched sample from influenza lung infection.

 

[SageBrush]

Mask wearing in Home Depot today was around 90%
-They do have a note at front of store about county mask order.

I was at my local HD in Albuquerque, NM yesterday. They have an employee posted at the entrance who denies entrance to anybody without a mask. During the 10 minutes or so I was at the entrance she had 3 encounters where she refused admission. The third was two young men who ignored here and entered anyway. In the store the only people I saw without a mask were two employees, and it is not uncommon to see dopes leaving their noses uncovered or wearing the mask on their chins.

Stores are going to have to place informed security at entrances to enforce mask use.

 

[Daniel in SD]

It seems like a big double edged sword for Hawaii since Hawaii's economy is largely dependent on tourism. Being an isolated island chain in the middle of the ocean makes it a great location for keeping the virus out... but the reliance on the tourism industry makes keeping the virus out terrible for the economy. I don't know why anyone would visit if they have to be quarantined in their hotel room for 2 weeks before venturing out. We had been saving for a trip there this winter but that is really looking doubtful right now.

Seems like they could just only allow tourism from countries that have eliminated the virus. The problem cuts both ways. People from countries without COVID aren't going to want to travel to countries with COVID because they'll have to quarantine for 14 days on the return trip (also, most people don't want to catch it!).

 

[TEG]

Not sure what is motivating CA given how strict they’ve been during this whole shutdown process. But, in case others haven’t heard yet, the governor made it official that people can have service at places of worship (at 25% cap or 100pp) and retail stores are allowed to now be open for in-person shopping. Of course, local city and county rules that are stricter can maintain shutdowns, though.
It seems like just a couple weeks ago where it sounded like CA won’t be into phase 2 as just announced until well into summer at least. At this rate, I feel like CA will be having live sporting events and concerts by the end of the year at latest.

Elon dared them to re-open...
Gov. Newsom Addresses Criticism Of Stay-At-Home Orders From Tesla Founder Elon Musk
Gov. Newsom defends California’s coronavirus response after Elon Musk rant
Passing the political hot-potato to the counties...

 

[bkp_duke]

I'm still shocked that hospital systems don't place an Urgent Care Center on or near campus to triage patients. Seems that would save a helluva lot of resources while freeing up ERs for real, more critical care.

Then again, I've seen "Urgent Care Centers" that wouldn't even remove a splinter ("we're not set up to do minor surgeries"). WTF?

It's all about the $$$. An ER can charge a higher CPT than an UC can, and therefore make more money.

The whole system is a *sugar* show because everyone is their only little monopoly and don't actually have to compete against other providers.

 

[bkp_duke]

You're describing system failure, where people come with valid issues but use system in a way that is more costly. They do that because system allows them to or they have no other choice. Maybe some of the parents were advised to go to ER to get wellness check because they did not have insurance.

Yep. One (of many) reasons why I retired and now run my own business. Getting bossed around by the bean counters that had 1/5th the education was one of the last straws for me.

Granted, as anyone in this thread knows, I have an incredibly low threshold for stupidity, so it should come as no surprise that I left medicine with the state it is in currently.