U.S. Navy relieves commander who wrote letter urging coronavirus action
21 by lawrenceyan | 0 comments on Hacker News.
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Kim Jong-un: fragile and under pressure but he won’t give up
The Observer The North Korean leader’s surprise freeze of his nuclear programme is less a genuine move than a diplomatic manoeuvre,...
Thursday, 2 April 2020
Wednesday, 1 April 2020
Rick and Morty are back in town in new season 4 trailer
There's still a month to go before Rick and Morty returns on May 3 for the second half of its fourth season. It feels more like a lifetime away right now, especially considering how long March was. Fortunately, Adult Swim has dropped a new video to help us with the wait.
In a rollicking trailer set to Thin Lizzy's 'The Boys Are Back In Town,' Rick continues to drag Morty through dangerous interdimensional hijinks in the fourth season's final five episodes. This time, said exploits involve vats of acid, tentacled monsters, S.W.A.T., and running naked and screaming. The duo also get an "unnecessarily badass suit-up" though, so it isn't all terrible. Read more...
More about Trailers, Cartoons, Rick And Morty, Adult Swim, and Entertainmentfrom Mashable https://mashable.com/video/rick-and-morty-season-4-trailer-boys-are-back-in-town/
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'The Magicians' series finale gestures at completion with a pile of gifts
If Syfy's The Magicians were a person, its love language would be gifts.
Its greatest moments were well-earned treats dispensed to an audience careful enough to pay attention, like Season 3's "A Life in the Day" episode that gave Quelliot shippers an entire episode of Quentin and Elliot's love, its infinitely gif-able pop culture references, and the show's many delightful musical numbers. Its weakest moments came when The Magicians failed to tie those moments together and wound up tangled in its own plot ribbon.
It makes sense, then, that the finale starts with a false Christmas. After our heroes are rescued from their latest heist by Santa Claus, the jolly old magician decorates their apartment with Christmas cheer and leaves each character a gift of some significance. It's not Christmas in the show, and the truncated gift-receiving scene highlights how sad it is that The Magicians will never air a full holiday special, but the sentiment behind giving each character one last token set an apt tone for the beginning of the end. Read more...
More about The Magicians, Tv Review, Entertainment, and Movies Tv Showsfrom Mashable https://mashable.com/article/the-magicians-series-finale-review/
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Coronavirus is not the man now dog: YTMND is back, and just in time
The pandemic profoundly alters our sense of time. Quarantine grinds lives to a halt, injecting them with untold levels of stress and acute danger. Monday bleeds into Tuesday, into Friday, into Monday again — the days losing distinction, but still representing tectonic shifts as we squint to better see the coronavirus's devastating effects looming on the horizon.
And then, like a unicorn-shaped floatie drifting into view as we struggle against the waves, You're The Man Now Dog (YTMND) decides to pop back into our lives. Surely, this will not be the thing that saves us, but damn if it isn't a welcome sight. Read more...
More about Memes, Tech, and Web Culturefrom Mashable https://mashable.com/article/ytmnd-is-back/
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My Queens hospital is at the center of America’s coronavirus crisis. Here’s how doctors can prepare.
A medical worker walks past a “Thank You” sign in Queens, New York City, on March 27. | John Nacion/NurPhoto via Getty Images
Assume that everyone at the hospital has Covid-19 until proven otherwise.
“Team 700 to B4.”
Before Covid-19 took over our hospital, I may have heard this page — which summons a medical team because a patient’s heart has stopped — once or twice a week. In the past couple of days, I’ve lost count of how many times I’ve heard it.
One recent page stands out: It was the afternoon of March 23, for a male in his early 30s with no medical problems. We had maxed out on his ventilator settings yet his lungs couldn’t deliver the oxygen his body needed, so his heart had naturally stopped.
Over the past week, the hospital in Elmhurst, Queens, where I’m a resident in emergency medicine has been inundated with coronavirus patients needing ventilators. On a typical day, we are one of the busiest emergency departments in the country. We take pride in serving one of the most diverse and vulnerable patient populations in the world. Esoteric and rare diseases are common occurrences here. Our sheer volume and diversity also meant that we were uniquely susceptible to a pandemic.
When the first case made its way to New York City, we suspected it was only a matter of time. However, we didn’t expect that we would become a “ground-zero” hospital for Covid-19.
Initially, we just had one patient with a high clinical suspicion for Covid-19, but over time, patients with relatively low or no clinical suspicion without fevers were turning out positive. We learned that the virus’s symptoms vary: Some presented with cholera-like diarrhea with profound dehydration that then progressed to respiratory distress, whereas others had mild headaches with muscle aches.
This taught us one of many valuable lessons early on. As other hospitals around the country prepare for the pandemic to arrive in the coming days, we hope that our first-hand experiences can help them avoid the same mistakes and pitfalls.
Here are six of the most important lessons we’ve learned so far:
1) Assume that everyone at the hospital has Covid-19 until proven otherwise
At the beginning of the pandemic, we underestimated the number of asymptomatic carriers that were admitted for unrelated reasons. We didn’t test these patients, as it wasn’t considered clinically indicated. A lack of testing kits compounded the problem. And the lack of early, widespread mobilization of personal protective equipment (PPE) made it even worse.
The scarcity of PPE meant that we were judicious in using it only for “persons under investigation” (PUI) for Covid-19. This soon proved to be a disastrous and futile policy.
We weren’t using protective equipment for unknown asymptomatic carriers and likely became reservoirs of transmission. It meant that nurses and doctors likely transmitted the disease silently, but to what extent remains largely unknown. The only way to prevent this transmission is by either testing all providers and patients each day or by using PPE for every patient. The latter strategy was far more practical.
2) It is impractical to isolate Covid-19 patients from non-Covid-19 patients
We tried to isolate PUI into our intensive care units (ICUs), but as the hospital became overwhelmed with PUIs, the policy had once again proven to be futile. This, coupled with a large turnaround time to get test results, meant we weren’t able to appropriately triage patients to Covid-19 and non-Covid-19 areas of the hospitals.
Though this may change with the availability of rapid-turnaround tests, the lack of sensitivity of the test made us cautious about sending patients to a non-Covid-19 unit. We thus came to a grim realization: The only way to minimize some transmission was to once again use our PPE for any and all patients.
Over the next several days, as we were coming to grips with our reality, we started seeing a staggering number of patients that needed ventilators. At the beginning of the pandemic, we had predicted that elderly patients or patients with chronic conditions would likely be affected more. Though that has largely been true, we also started increasingly seeing young patients with no medical problems in respiratory arrest, needing a ventilator.
3) Expand the number of ICU beds in your hospital, exponentially
For us, it meant hospital floors that weren’t equipped to manage ICU patients suddenly became mini-ICUs. Sections of the “fast track” in our ER were carved off into ICUs with vented patients. At one point, it even meant transferring patients to nearby hospitals with ICU beds.
Needless to say, that was short-lived as every hospital in NYC soon became inundated with Covid-19 patients. Frankly, we have even explored the option of turning operating rooms into ICUs. Just when we thought we had enough ICU beds, we needed more. My advice is to prepare for the worst and hope for the best.
4) Minimize the exposure to nurses and staff
As all the patients in the ICUs required multiple blood draws, titration of medications, and adjusting ventilator settings on an hour-by-hour basis, the staff had to find ways to minimize our overall exposure to the virus. Early on, we decided to place the ventilator as well as the IV poles outside of the patient rooms while also consolidating all of our critical care procedures in one sitting.
For us, it meant every vented patient had multiple peripheral IV accesses, a central venous catheter as well as an arterial line. This enabled the nurses and doctors to minimize their overall exposures.
5) Train essential clinical personnel in critical care medicine early
Expanding the physical space and bridging the equipment and testing shortages was one feat, but the unexpected shortage of clinicians and nurses trained in intensive care medicine was another. The sheer volume of patients coupled with nurses and doctors who fell ill to Covid-19 made this a penultimate issue.
In our hospital, training non-ICU nurses and non-intensive doctors in critical care medicine was simply not an option, but a necessity. It meant training cardiologists on complex vent management. Needless to say, when the ER doctors and intensivists fall ill, having a safety net of clinicians trained in parts of intensive-care medicine will be crucial for patient care.
6) Telemedicine is a critical way to decompress your ER and your hospital
As we were inundated with critically ill patients, we also saw an exponential rise in “worried-well patients” requesting an evaluation. Some hospitals have adopted telemedicine where doctors take turns answering questions from patients and triage them on whether they should be sent to the ER or not. This has proven to be effective in decompressing the ER, likely preventing patient-to-patient and clinician-patient transmissions.
However, in a hospital that serves some of the poorest patients like mine, telemedicine is simply not an option. For these hospitals, testing tents outside the hospital have proven somewhat effective, but still not enough to keep up with the demand.
Even with the best of these measures, as of April 1, 1,374 New Yorkers have lost their lives to Covid-19, more than 376 of them in Queens. One-third of the city’s total cases (45,672 as of April 1) are in Queens, too.
As the code team runs to the bedside, the team leader assigns members their roles. They press on the patient’s chest and push all the necessary medications to rescue his heart. After several minutes, just when we felt defeated, the patient’s heart started beating again. We sighed with a sense of relief and looked at each other, knowing that it was only a matter of time until our next code.
Suresh Pavuluri is a resident physician with the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai.
from Vox - All https://www.vox.com/2020/4/1/21203372/coronavirus-deaths-new-york-queens-elmhurst-hospital-doctors-advice
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New top story on Hacker News: Ask HN: I Lost My Job
Ask HN: I Lost My Job
27 by uvw | 10 comments on Hacker News.
About a week ago I was laid off. In 15+ years I am working as developer, I was never considered for a layoff. I am soul searching for a week now, and finally I got over my anger, disappointment and anxiety and ready to move on. I believe it was nothing to do with my performance of skills as a developer. I believe I was expected to perform as a leader on top of solving problems, writing applications and my lack of leadership skills made me not worth my paycheck. In retrospect, higher ups did mention in passing about an year ago about how I need to speak up in meetings etc. I think I don't know how to be a leader at a workplace. So I come here being humbled. If you are a leader/team leader/c-suite people/managers please enlighten me. Or point me towards videos, books, ted talks, internet articles. I want to learn and be a better person and also don't want to repeat the mistakes in a new job.
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27 by uvw | 10 comments on Hacker News.
About a week ago I was laid off. In 15+ years I am working as developer, I was never considered for a layoff. I am soul searching for a week now, and finally I got over my anger, disappointment and anxiety and ready to move on. I believe it was nothing to do with my performance of skills as a developer. I believe I was expected to perform as a leader on top of solving problems, writing applications and my lack of leadership skills made me not worth my paycheck. In retrospect, higher ups did mention in passing about an year ago about how I need to speak up in meetings etc. I think I don't know how to be a leader at a workplace. So I come here being humbled. If you are a leader/team leader/c-suite people/managers please enlighten me. Or point me towards videos, books, ted talks, internet articles. I want to learn and be a better person and also don't want to repeat the mistakes in a new job.
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Is It Too Late to Prevent Mass Unemployment Owing to the Coronavirus?
John Cassidy writes about the threat of mass unemployment that the coronavirus poses in the U.S., and about the stimulus measures being undertaken in the U.S., the U.K., and around the world.
from Everything https://www.newyorker.com/news/our-columnists/is-it-too-late-to-prevent-mass-unemployment-owing-to-the-coronavirus
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from Everything https://www.newyorker.com/news/our-columnists/is-it-too-late-to-prevent-mass-unemployment-owing-to-the-coronavirus
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A New Study Questions the Effectiveness of a Potential “Game Changer” Against the Coronavirus
Jerome Groopman writes on the disappointing findings of new clinical studies of the drug cocktail hydroxychloroquine and azithromycin, which has been touted by President Trump and approved for emergency use by the F.D.A., in treating the coronavirus.
from Everything https://www.newyorker.com/news/daily-comment/a-new-study-questions-the-effectiveness-of-a-potential-game-changer-against-the-coronavirus
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from Everything https://www.newyorker.com/news/daily-comment/a-new-study-questions-the-effectiveness-of-a-potential-game-changer-against-the-coronavirus
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We don’t know yet if lockdowns are working. But we could see results as early as this week.
Times Square, nearly empty on the first day of the New York Stay at Home order. | Photo by Lev Radin/Pacific Press/LightRocket via Getty Images
Why the coronavirus lag time makes it hard to figure out whether social distancing measures are working.
Now that most states have shut down temporarily to combat the coronavirus, our greatest enemy is our own impatience.
The measures taken over the past two weeks in 37 states and parts of eight more hurt. They kill off businesses that are critical to the livelihoods of millions of people. They throw millions of Americans out of work and off their health insurance.
And for a little while longer, it won’t even be clear if they’re doing anything.
“We have sacrificed so much already, but it feels like nothing is working. That’s because it takes weeks to see results. We must stay committed and trust that the social distancing we are enduring now will save thousands of lives,” Dr. Caitlin Rivers at the Johns Hopkins Center for Health Security wrote on March 23.
Here’s why it will take so long for our sacrifices to have visible effects. The thing we’re trying to reduce — new coronavirus infections — is invisible at first. It takes between two and 14 days for a newly infected person to start showing symptoms. After symptoms begin to show, it can take more than a week for them to be eligible for testing (many people are not eligible at all). And then, thanks to backlogs in testing availability, it can take days for them to learn they tested positive.
As a result, every positive test today reflects infections that occurred, on average, a few weeks ago. If shelter-in-place orders worked, we should just start to see their effects this week in the states that acted soonest, and it will take weeks more to see their effects nationwide.
New York’s numbers appear to be falling, but it’s too soon to say that the city has rounded a corner thanks to its March 20 stay-home order — these infections being detected by tests now would nearly all have occurred before the order happened.
In other words, once you shut down your city to fight the virus, you might even see things get worse before they get better. There’s a very real risk that that will discourage us and prompt us to give up. We shouldn’t.
Lag time, explained
Let’s say we lock down a city to prevent the further spread of the coronavirus, and the lockdown works very well, as the one in Wuhan seems to have. Where previously the average infected person spread the disease to two or three other people, after the lockdown in Wuhan it is estimated that each infected person only spread the disease to .32 people.
If we accomplished the same thing, the number of new infections would start declining right away. But here’s the thing: The number of new positive tests? That would keep growing.
Here’s why: Symptoms of the coronavirus typically take some time to start showing after infection. The average incubation period is five to six days but “may range from 2-14 days,” according to the Centers for Disease Control and Prevention. So keep that in mind when thinking about people who are starting to develop symptoms now: Those were people who were exposed to the coronavirus about a week ago, in some cases even longer.
Now, most people cannot get a test as soon as they start to show symptoms. In some parts of the country, in fact, it’s impossible to get a test until you are hospitalized, unless you are a health care worker or are otherwise considered high risk.
The coronavirus has a long course of illness — people are usually sick for a while before they get sick enough to need hospitalization. In one study from China, the average time from symptom onset to hospitalization was nine days, and in another study, difficulty breathing usually surfaced five to 13 days after symptoms started.
That means that, in the parts of the US where most patients aren’t tested for the coronavirus until they are hospitalized, a patient may be tested 14 days after they were infected — five days for the average patient to show symptoms and nine days after that to end up in the hospital.
Finally, tests don’t always get results right away. There are some testing sites that advertise same-day turnaround, but other labs are backlogged, and in many parts of the country results take longer. Rand Paul’s positive test for coronavirus reportedly took six days to come back.
Add it all up, and it will take at least two weeks, likely longer, for a coronavirus infection to be reported in official statistics.
That means that it will look — for weeks — like the measures we’re taking now like self-quarantines, school closures, and social distancing are not working, even if they are. And if they’re not actually working? Same thing — we won’t know just yet. The data out of the San Francisco Bay Area (which issued its shelter-in-place order on March 17) and New York (March 20) over the next week will be critical to understanding how stay-home orders work. We should watch those numbers closely to understand our next steps.
Experience from other countries
On January 23, China locked down the city of Wuhan amid a growing epidemic. On that date, the country had 830 cases. Much of the rest of Hubei province locked down later that week, and then restrictions were imposed on the whole country.
For the next few weeks, things got worse. By February 13, the country had 63,851 cases — most of them in Wuhan’s Hubei province. But things were starting to turn around. That day, China reported 5,090 new cases — more than on any previous day (except the day of a one-time change in the types of cases reported). On February 14, however, officials reported 2,641 new cases. On the 15th, 2,008. New case numbers kept declining from there; China now reports no new local transmission cases (though they could be either missing some or hiding some, experts don’t think they’re hiding a full-blown epidemic.)
Take a look at that gap again: The peak of new cases came fully three weeks after the lockdown started. In Italy, it’s starting to look like the same dynamic is at work.
“These big social distancing measures take time to work,” Johns Hopkins Center for Health Security director Tom Inglesby tweeted March 23. “The impact of big interventions in Wuhan China took about 3 wks to start to reverse things. And then everyday after the situation got better.”
Should the US expect the same thing?
Not necessarily. Some things are definitely different. The US implemented social distancing measures more gradually than Wuhan, which escalated quickly from few restrictions to a full lockdown. No place in the US is employing measures as strict as Wuhan’s. China separated symptomatic people from their families and locked people in their houses. Enforcement of stay-at-home orders has, so far, been lax in the US.
But if our measures suffice to reduce transmission so that each new patient infects less than one person, it wouldn’t be surprising if the overall trajectory of the disease in a city like New York looks somewhat like China’s, with cases peaking three weeks after the measures went into place. That would put us into early April. (There are some signs that cases are flattening already, only a week after the stay-home order, but it remains to be seen if these gains will last, and it’s probably a mistake this early to attribute them primarily to the stay-home order.)
Graphs like this one are cited as evidence that the Bay Area’s shelter-in-place policy has worked, when they largely reflect infections from before shelter-in-place went into effect.
In other parts of the country, where those measures haven’t yet been put into place, the peak is even farther off.
“We know when this started. We can get a good estimate on when it will end,” former FDA Commissioner Scott Gottlieb argued on March 24, projecting a peak in New York in two to three weeks.
It’s difficult to be patient and wait for that. The costs of social distancing measures — upended routines, shuttered stores and restaurants, lost jobs, vulnerable people put at risk — are apparent already, while the benefits aren’t. Social distancing measures save lives, but the lives they save are a month away while the lives they throw into turmoil are visible right now.
Unsurprisingly, there is overwhelming pressure to identify results from these measures right now. And preliminary data that looks good is not hard to find. Articles have proliferated comparing states that implemented social distancing to states that didn’t, or declaring that early data shows California’s stay-at-home order is working.
It’s tempting to draw those conclusions. But it’s really too early to say any of those things with certainty. The numbers published today reflect measures taken in the first weeks of March — before the stay-home orders began. They don’t reflect the effects of the lockdowns, or even, in many states, the school closures. The states that are doing well cannot credit their success to measures they’ve taken in the last few weeks, and the states that have imposed such measures shouldn’t expect results yet.
What’s important to remember is that if the numbers suddenly get worse in a state that recently implemented stay-at-home measures, it won’t prove that stay-at-home doesn’t work. The confirmed cases we are seeing today are largely people infected a few weeks ago, and the data on how well our current measures are working won’t be available for a while.
“For a while it will feel like nothing is working but it takes time,” Rivers wrote March 23.
When things are changing as rapidly as they are with this crisis — and when families are struggling with lost jobs, wiped retirement accounts, sick loved ones, and closed schools — the few weeks we’ll need to wait before case numbers hopefully start declining feel like an eternity. But the best thing we can do is help our cities develop a plan for the next stage of virus response, support essential workers, stay home, and wait.
Sign up for the Future Perfect newsletter and we’ll send you a roundup of ideas and solutions for tackling the world’s biggest challenges — and how to get better at doing good.
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from Vox - All https://www.vox.com/future-perfect/2020/3/26/21191702/coronavirus-lockdowns-stay-home-new-cases
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My Queens hospital is at the center of America’s coronavirus crisis. Here’s how doctors can prepare.
A medical worker walks past a “Thank You” sign in Queens, New York City, on March 27. | John Nacion/NurPhoto via Getty Images
Assume that everyone at the hospital has Covid-19 until proven otherwise.
“Team 700 to B4.”
Before Covid-19 took over our hospital, I may have heard this page — which summons a medical team because a patient’s heart has stopped — once or twice a week. In the past couple of days, I’ve lost count of how many times I’ve heard it.
One recent page stands out: It was the afternoon of March 23, for a male in his early 30s with no medical problems. We had maxed out on his ventilator settings yet his lungs couldn’t deliver the oxygen his body needed, so his heart had naturally stopped.
Over the past week, the hospital in Elmhurst, Queens, where I’m a resident in emergency medicine has been inundated with coronavirus patients needing ventilators. On a typical day, we are one of the busiest emergency departments in the country. We take pride in serving one of the most diverse and vulnerable patient populations in the world. Esoteric and rare diseases are common occurrences here. Our sheer volume and diversity also meant that we were uniquely susceptible to a pandemic.
When the first case made its way to New York City, we suspected it was only a matter of time. However, we didn’t expect that we would become a “ground-zero” hospital for Covid-19.
Initially, we just had one patient with a high clinical suspicion for Covid-19, but over time, patients with relatively low or no clinical suspicion without fevers were turning out positive. We learned that the virus’s symptoms vary: Some presented with cholera-like diarrhea with profound dehydration that then progressed to respiratory distress, whereas others had mild headaches with muscle aches.
This taught us one of many valuable lessons early on. As other hospitals around the country prepare for the pandemic to arrive in the coming days, we hope that our first-hand experiences can help them avoid the same mistakes and pitfalls.
Here are six of the most important lessons we’ve learned so far:
1) Assume that everyone at the hospital has Covid-19 until proven otherwise
At the beginning of the pandemic, we underestimated the number of asymptomatic carriers that were admitted for unrelated reasons. We didn’t test these patients, as it wasn’t considered clinically indicated. A lack of testing kits compounded the problem. And the lack of early, widespread mobilization of personal protective equipment (PPE) made it even worse.
The scarcity of PPE meant that we were judicious in using it only for “persons under investigation” (PUI) for Covid-19. This soon proved to be a disastrous and futile policy.
We weren’t using protective equipment for unknown asymptomatic carriers and likely became reservoirs of transmission. It meant that nurses and doctors likely transmitted the disease silently, but to what extent remains largely unknown. The only way to prevent this transmission is by either testing all providers and patients each day or by using PPE for every patient. The latter strategy was far more practical.
2) It is impractical to isolate Covid-19 patients from non-Covid-19 patients
We tried to isolate PUI into our intensive care units (ICUs), but as the hospital became overwhelmed with PUIs, the policy had once again proven to be futile. This, coupled with a large turnaround time to get test results, meant we weren’t able to appropriately triage patients to Covid-19 and non-Covid-19 areas of the hospitals.
Though this may change with the availability of rapid-turnaround tests, the lack of sensitivity of the test made us cautious about sending patients to a non-Covid-19 unit. We thus came to a grim realization: The only way to minimize some transmission was to once again use our PPE for any and all patients.
Over the next several days, as we were coming to grips with our reality, we started seeing a staggering number of patients that needed ventilators. At the beginning of the pandemic, we had predicted that elderly patients or patients with chronic conditions would likely be affected more. Though that has largely been true, we also started increasingly seeing young patients with no medical problems in respiratory arrest, needing a ventilator.
3) Expand the number of ICU beds in your hospital, exponentially
For us, it meant hospital floors that weren’t equipped to manage ICU patients suddenly became mini-ICUs. Sections of the “fast track” in our ER were carved off into ICUs with vented patients. At one point, it even meant transferring patients to nearby hospitals with ICU beds.
Needless to say, that was short-lived as every hospital in NYC soon became inundated with Covid-19 patients. Frankly, we have even explored the option of turning operating rooms into ICUs. Just when we thought we had enough ICU beds, we needed more. My advice is to prepare for the worst and hope for the best.
4) Minimize the exposure to nurses and staff
As all the patients in the ICUs required multiple blood draws, titration of medications, and adjusting ventilator settings on an hour-by-hour basis, the staff had to find ways to minimize our overall exposure to the virus. Early on, we decided to place the ventilator as well as the IV poles outside of the patient rooms while also consolidating all of our critical care procedures in one sitting.
For us, it meant every vented patient had multiple peripheral IV accesses, a central venous catheter as well as an arterial line. This enabled the nurses and doctors to minimize their overall exposures.
5) Train essential clinical personnel in critical care medicine early
Expanding the physical space and bridging the equipment and testing shortages was one feat, but the unexpected shortage of clinicians and nurses trained in intensive care medicine was another. The sheer volume of patients coupled with nurses and doctors who fell ill to Covid-19 made this a penultimate issue.
In our hospital, training non-ICU nurses and non-intensive doctors in critical care medicine was simply not an option, but a necessity. It meant training cardiologists on complex vent management. Needless to say, when the ER doctors and intensivists fall ill, having a safety net of clinicians trained in parts of intensive-care medicine will be crucial for patient care.
6) Telemedicine is a critical way to decompress your ER and your hospital
As we were inundated with critically ill patients, we also saw an exponential rise in “worried-well patients” requesting an evaluation. Some hospitals have adopted telemedicine where doctors take turns answering questions from patients and triage them on whether they should be sent to the ER or not. This has proven to be effective in decompressing the ER, likely preventing patient-to-patient and clinician-patient transmissions.
However, in a hospital that serves some of the poorest patients like mine, telemedicine is simply not an option. For these hospitals, testing tents outside the hospital have proven somewhat effective, but still not enough to keep up with the demand.
Even with the best of these measures, as of April 1, 1,374 New Yorkers have lost their lives to Covid-19, more than 376 of them in Queens. One-third of the city’s total cases (45,672 as of April 1) are in Queens, too.
As the code team runs to the bedside, the team leader assigns members their roles. They press on the patient’s chest and push all the necessary medications to rescue his heart. After several minutes, just when we felt defeated, the patient’s heart started beating again. We sighed with a sense of relief and looked at each other, knowing that it was only a matter of time until our next code.
Suresh Pavuluri is a resident physician with the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai.
from Vox - All https://www.vox.com/2020/4/1/21203372/coronavirus-in-new-york-queens-elmhurst-hospital-doctors-advice
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