Category Archives: Healthcare

COVID-19 Update 11/14/2020

I had planned a different topic for today, but the increase in COVID-19 cases is too important to wait as the number of cases has jumped. The number of deaths has not increased at the same rate, but there are factors beyond number of cases.

  • Many COVID-19 cases require that the patient receive the high level of care available only in Intensive Care Units (ICUs). In some places we have already exceeded the number of ICU beds and ICU rooms have become double occupancy. In other cases, patients who have suffered a heart attack are moved out of the Cardiac Care Unit so that those beds can be used for COVID-19 patients.
  • Hospital staff is at risk, not only for being infected, but also from physical, mental, or emotional burnout. Dealing with patients who had not taken proper precautions and are now dying is especially hard. Imagine watching someone die as they say, “I wish I would have known,” or, “I wish I had been more careful.”
  • Personal Protective Equipment has been adequate, but as demand increases, the supply may not keep up.

My personal fear is that some people will relax because of the good news regarding vaccines. Unfortunately, the logistics of manufacturing 700 million doses, delivering them while frozen, and administering two doses to everyone takes time. Unfortunately, immunity is not instantaneous and the patient remains susceptible during the time between injection and the body producing its own antibodies.

Some people are anti-vaccine. If there are side effects, additional people may be concerned enough to also avoid the vaccine. A significant portion of the population must be willing to be vaccinated; herd immunity after the 19th century has been achieved by a majority of the population being vaccinated, not by a majority surviving the disease.

So where are we?

Daily deaths still vary depending on day of the week, which is probably due to some paperwork not being filed on weekends. However, there is a significant upward trend over the last few weeks and a moderate increase in the trend line. As ICU beds are filled and some patients shunted to normal beds, this bears watching.

Daily new cases show a significant increase since mid-October, which is also reflected in the trend line.

I get my data from Worldometer, so it’s no surprise that their graph is similar.

Anecdotally, there seem to be more superspreader events, for a variety of reasons. People are weary of the isolation and some do not believe the pandemic is real. Now that the election season is over, I suspect that the main events may be family holiday celebrations.

So, the same advice still holds:

  • Wash your hands
  • Wear a mask
  • Stay at home
  • Maintain social distancing
  • Avoid touching your face

COVID-19 Update 10/31/2020

Food Safety and the Coronavirus Disease 2019 (COVID-19) | FDA

Whether it’s the second wave of the first surge or a second wave, the number of COVID cases has begun to increase significantly.

First the (sort of) good news. Deaths have more or less stabilized at average of just under 900 per day. There are exceptions, such as the 27-29th of October when there were over 1,000 deaths each day.

I cannot comfortably say that this trend will continue. The medical community has learned a lot and become more effective, but this stability in death rates cannot be expected to be maintained as the number of new cases increases. Once the number of cases that require intensive care exceed the available ICU beds, it can be expected that the number of deaths will increase. Reports are that this is already the case in El Paso, Texas where adult patients with non-COVID medical issues are being sent to a pediatric hospital to make beds available for pandemic patients.

DAILY DEATHS

Now for the bad news. The number of new cases per day has begun to significantly increase. Yesterday, new cases exceeded 101,000–a record number.

NEW CASES

Because the data now include over 150 entries, a sudden change over a short period of time tends not immediately impact the trend line. However, if the increase that began in late September continues, the trend will follow.

Other factors to consider include:

  • Preliminary data do not indicate permanent or long term immunity for those who have been infected.
  • Treatment options from hydroxychloroquine to Remdesvir do not seem to cure the disease. The best they have been able to do is to mitigate some of the symptoms. While recovery time was shorter when Remdesvir was administered, death rates among patients treated with Remdesvir were statistically similar to patients treated with a placebo. [Link]
  • COVID-19 outcomes are not limited to death or recovery. So called long-haul patients experience a number of long term–and possibly permanent–changes that impact the quality of life, in some cases severely.

My personal interpretation:

  • New cases will continue to increase until either an effective vaccine or a cure is discovered.
  • Given that a segment of the population chooses to ignore prophylactic measures, such as social distancing and wearing masks, numbers can be expected to continue to rise.
  • Family interaction during the holidays will increase infection rates as some people who are normally careful relax their safety measures due to the overarching importance of families.

I fear that many future holidays may be remembered in terms of the death of a loved one due to COVID. I have racked my brain trying to identify even a tiny new idea as to how to deal with the pandemic without success. The best I can offer is: 1) wear a mask; 2) maintain social distancing; and 3) practice frequent and thorough handwashing.

COVID-19 Update

I continue to track coronavirus cases, as I have since 24 May 2020. My simple linear progression is no longer adequate for anything more than broad statements. I defer to the experts and their more complex models.

However, as any analyst will tell you, there is still a lot that can be learned from the data, even if the search for future activity is taken off the table. Here are some findings and postulations that I find interesting:

There are a fair number of footnotes to the data. Some states try to backdate cases or events for a variety of reasons. It could be plain old human error, processes that are not robust enough to handle the large numbers of cases, or even an attempt to have better optics.

The daily data always decreases over the weekend. I don’t think fewer people get sick or die on weekends, but I can see the paperwork not being filed until the regular workweek.

The rate of increase for new cases has slowed, but not flattened or showing a decline. It is still showing an increase between now and the end of the year. Similarly, the number of deaths continues to rise, but not as steeply as before, hopefully indicating the benefit of experience by healthcare workers. In other words, they are more effective using the tools they’ve had, rather than a miracle drug, although Remdesivir shows promise.

Remdesivir is expensive—$3,100 for a course of treatment in the US but only $2,340 in other developed countries. The rub here is that US taxpayers reportedly invested $99 million for Gilead Pharmaceuticals to develop the drug.

As of Saturday 10 October 2020, the United States has had 7,945,505 cases of COVID-19 resulting in 219,282 deaths. Another 5,089,842 patients recovered, which means there are still 2,636,381 active cases.  These patients may never recover, but may suffer from COVID-19’s various symptoms for the rest of their lives.

Testing is still an area that is somewhat vague. It is reported that 117,601,422 tests have been administered, but there are many anecdotal tales of people having difficulty getting tested. Reports indicate that elites, whether sports stars or politicians, are tested on a regular basis, while regular citizens are reportedly refused.

I wonder what is considered a COVID-19 test. The most definitive test involves inserting a long swab into the nasopharynx, which is quite unpleasant. I can’t see the elites tolerating this on a daily or weekly basis, so maybe they’re using a less accurate but more tolerable test.

Sadly, I believe we’ve got a long way to go before we can relegate COVID-19 to the history books.

What Can I Do?

The COVID-19 pandemic has played havoc on most people who are not in the ultra-rich 1 percent. Businesses are closing. People have lost jobs. Some will soon leave their homes.

5,909,970 Americans have contracted COVID-19.

180,965 Americans who have lost their lives.

2,707,783 Americans have contracted the disease and have not recovered. Some will die. Some never will recover, experiencing life-altering effects that will diminish their ability to live and work as they did before.

I haven’t seen any definitive studies, but I’d love to know how many wouldn’t have been infected if everyone had accepted that the disease is real and taken appropriate precautions–social distancing, hand washing, and wearing masks. Unfortunately, some think it is a hoax.

However, it is very, very real to 5,909,970 of our fellow citizens–so far.

Take the appropriate precautions.

COVID-19 Update

I’ve blogged in the past about my simplistic projection for the COVID-19 disease. So far, I haven’t been too far off, meaning my projections and actual cases have been reasonably close. I’m moderately surprised. Nevertheless, I’m continuing my project.

I now have about 2 1/2 months of data for new cases per day and new deaths per day. I extended the trend line projections out through the end of the year. Here’s what I’m seeing. The graph above shows the number of deaths per day. For a while it actually appeared to be trending downward, but in the past few weeks, it has dramatically increased. The massive swings from day to day, I believe, are not completely accurate. My theory is that this reflects when the paperwork was actually recorded–not necessarily when the deaths occurred. It may also reflect the delay after the death when an autopsy or other method is necessary to determine the actual cause of death.

In any case, if there is any accuracy to this projection, it’s discouraging that we might soon see more than 1,000 deaths from COVID-19 per day, every day. It’s worse to think that the number of deaths may, in fact, increase.

The number of cases per day is the second graph (above). It sort of looks like the curve is turning downward, but the math indicates that overall, it is expected to increase. We’ll have to wait and see how the numbers turn out. I’d prefer it would decrease, but I don’t feel comfortable saying that cases will decrease. (Let’s all cross our fingers!)

Unfortunately, in the media it seems that after a person suffers from COVID-19, the only two outcomes are–1) Death, or 2) Everything returns to normal. Unfortunately, it appears that there are other outcomes.

Some COVID-19 survivors suffer long term effects. Lungs can be damaged to the point that normal life will never again be possible. Some people have suffered from multiple organ failures. Others have experienced vascular problems requiring the amputation of limbs. I do not have access to the data specific to these outcomes, so they may be unusual or they may be common. I just hope it isn’t me.

I hope that the trend reverses. Unfortunately, it is dependent on people religiously committing to wearing masks, maintaining social distances, hand washing, etc.

I’m not optimistic.

 

COVID-19 Experiment

Effective today, 15 July 2020, hospitals and states have been directed to send their COVID-19 data directly to the CORONAVIRUS Task Force in the Department of Health and Human Services rather than the CDC (Center for Disease Control and Prevention). In the past, these data were submitted via the National Healthcare Safety Network, which is a CDC online site, but the information from the Department of Health and Human Services specifically says:
“As of July 15,, 2020, hospitals should no longer report the Covid-19 information in this document to the National Healthcare Safety Network site.”

The instruction can be downloaded here.

It will be interesting to see if this does result in faster, more accurate data. As I’ve pointed out before, there seems to be a delay for COVID-19 data  from weekends. Maybe this will more accurately represent the timing of new cases and new deaths. This may be important if schools reopen next month.

As an experiment, below are graphs depicting the trend lines for new cases and new deaths. It will be interesting to see if the same tend continues. The data is obtained from Worldometer (link) and I began collecting on 24 May, so it represents about a month and a half of data.

New COVID-19 Cases

New COVID-19 Deaths

Pandemic Update – 5 July 2020

As I watch the statistics–new COVID-19 cases and new COVID-19 deaths–there are other observations that present themselves. One is that every weekend the numbers fall in comparison to the weekdays. I attribute this to delays in reporting. Weekend staffing in hospitals and government agencies tend to be lower than during the week, so the cases and deaths get added after the weekend. Numbers tend to run higher early in the week, which I believe is to catch up for the weekend.

Although new cases are increasing in many areas, deaths continue to decline. Among those with the most new cases, Florida started to climb about 24 June, Arizona’s cases began increasing 16 June, with a similar trend in South Carolina. North Carolina, on the other hand, has been on a steady rise since March.

I thought there might be an increase after the Black Lives Matter demonstrations, and I used Minnesota, Washington state, and the District of Columbia as likely examples. I saw no dramatic increases. These demonstrations began 25 May, so we’ve been through two incubation cycles. On television, it appeared that many demonstrators maintained wore masks.

I have no idea where things are headed and I make no sweeping claims based on the statistics I’ve been tracking. However, I believe that facts are important and they are the first step toward solving any problem, including the pandemic.

 

Pandemic

As you may recall, I rely on data* for decision making whenever possible. For some decisions, there are little or no data, but for many others there are an abundance of data. For example, the COVID-19 pandemic provides significant data.

I don’t have the fancy models that the experts use, but once upon a time I seem to recall taking some statistics classes in college and other courses that included statistics. I’ve been tracking the number of new cases of COVIDS-19 and deaths from the disease using Worldometers. Under the principle of KISS–keep it simple, stupid–I use only a linear progression and a 5-day moving average.

Deaths, thank God, continue to decline. Apparently, the medical professionals have figured out how to reduce, if not eliminate, its harshest outcome.

New cases, on the other hand, not only continue to climb, but have recently accelerated. I don’t have sufficient data to guesstimate the reasons; I have my opinions, but there are too many opinion driven events already.

Here are my results:

* Data is plural for datum, although is is often used both as singular or plural.

I Told You So!

Back in my healthcare days, there was a general practice physician who delivered babies, which back then was still quite common. This was long before ultrasound could provide an image of sufficient clarity to determine sex, so the reveal didn’t occur until the baby was born.

Naturally, soon-to-be parents back then were as interested in knowing as much about their child as parents are today. This physician’s solution was to tell the mother during a routine prenatal visit that her baby was a boy. At the same time, he’d write in her chart “girl.”

After the birth, if it was a boy, he’d say, “I told you so.” If it was a girl, he’d show her the entry in the chart.

[If I had a clever segue, it would go here.]

I have been trying to avoid most of the alleged news–and that refers to every single outlet, from ABC to Zee in India because my blood pressure is high enough already, thank you. The news reports are:

  • The COVID-19 pandemic will be around for years if not centuries.
  • We’ll have a vaccination in a few months and COVID-19 will be obliterated.
  • Mail-in ballots suffer from voter fraud.
  • Some states have been using mail-in ballots with no problems; the President and his Press Secretary vote by mail and have done so for years..
  • The economy is great–look at the stock market.
  • The economy is terrible–look at unemployment.

Like that old doctor, I think the only thing to believe is the news media is positioning itself to be able to say, “I told you so.”

Life and Death

According to https://www.worldometers.info/coronavirus/country/us/, we’ve now experienced over 100,000 deaths. Our leaders response? They are too busy arguing among themselves, apparently for the sake of arguing.

It’s like someone in a swimming pool is drowning. The lifeguards do not act as they argue whether it is better to use the pool hook, a flotation device, or to jump in and help them.

They can’t agree, so the unfortunate individual drowns. The lifeguards then explain that whichever measure they would have chosen doesn’t matter, because the swimmer died anyway.

It Will Never Be a Movie

If the Coronavirus COVID-19 were a movie treatment, it probably never would get made. Look at the plot elements:

  1. A deadly disease begins in a faraway city known for both selling live exotic animals for food and for having a secret government lab.
  2. The disease is viral. Viruses, unlike bacteria, do not respond to antibiotics. Since a virus is not actually alive, it cannot be killed, only neutralized.
  3. The disease preferentially attacks the poor, minorities, the aged, females, and people with pre-existing medical problems.
  4. Some who are infected by the disease show no symptoms, but are carriers of the disease and can transmit it to others.
  5. Some of those infected exhibit flu-like symptoms, are misdiagnosed. The defining symptom, death, follows soon thereafter.
  6. Some adult patients show no obvious symptoms, except upon examination, it is discovered that their oxygen levels are dangerously low, which can lead to death.
  7. Children, at first were believed to be asymptomatic, later many develop a whole host of symptoms that are completely different from those experienced by adults.
  8. Politicians, faith healers, scammers, etc. seize the opportunity to amass wealth and/or power.
  9. Much of the protective equipment, drugs, and medical supplies needed to handle the disease are produced in the country from which the disease originated. Many US companies had moved manufacturing offshore to save money; there is insufficient manufacturing capacity in the US.
  10. Scientific experts advice is ignored while the Internet and other sources promote a variety of alleged cures, treatments, and religious talismans–none of which seem successful.
  11. There is insufficient capacity to test all suspected cases, so the number of people affected are likely under reported. Some cases are only diagnosed after death, when an autopsy is performed.
  12. State and local governments discourage people from engaging in activities that spread the disease, encourage the use of masks to protect others, and maintaining a six foot buffer between people.
  13. With workers unable to do their jobs, the economy suffers. People are laid off or lose their jobs.
  14. The number of confirmed cases in the US approaches 1.5 million confirmed cases, with nearly 90,000 deaths. These numbers only include patients who were tested or otherwise diagnosed.
  15. Some claim the disease is caused by a new cellular telephone system; others call it a hoax; still others see it as a conspiracy to restrict constitutional rights.
  16. Armed dissidents, encouraged by a variety of sources, protest the social distancing, stay-at-home orders at the state capitals, clustering in large groups, usually without masks.
  17. In the meantime, the country from which the disease arose and several of its allies launch cyberattacks on the US to steal medical secrets relating to healing or preventing the disease–and anything else they come across, once they get inside a computer.
  18. As US cases seem to slow their rate of growth, state and local governments relax social separation. People immediately return to pre-pandemic behaviors and the dissidents declare victory.

The screenplay ends here. The audience is left in limbo, unsure whether the disease is indeed winding down, or preparing for a second wave. Unsure as to the future of the economy.

As I said at the beginning, no studio would ever consider wasting time on a script for this scenario.

COVID-19 Fuss

I don’t know what all the fuss is about. Maybe I just look at things differently.

After years of working, spending five days each week lusting for weekends when I could be home.

I like being home.

Then there’s the mask thing. I’m not particularly grotesque, but, in my opinion, I look better with any type of mask than I do without. Bruce Wayne felt the same way.

So, what’s the fuss? Tell me what’s a happening.

It’s Not About You

https://upload.wikimedia.org/wikipedia/commons/7/77/Sneeze.JPG

“The right to swing my fist ends where the other man’s nose begins.”
                                                                                  – Oliver Wendell Holmes

Wearing a mask in public is not to protect the mask wearer from germs. It’s to keep germs from being transmitted to others. COVID-19 is a respiratory disease and is contracted by inhaling the virus.

A sneeze is a veritable biological weapon. Whatever is in your mouth and nasal system is sprayed as an aerosol, covering an area well beyond the social distance of six feet. In fact, it appears to be well over 20 feet. The droplets can remain suspended in the air for several minutes When they settle, pathogens are deposited on surfaces with a virus that can last up to several days.

National Geographic has an interesting article.

Some decry that their rights are being violated by pandemic restrictions, such as face masks.

Using Supreme Court Justice Holmes logic, your right to go without a mask also ends where my nose begins.

 

 

COVID-19 Special Circumstances

Some of the rules for avoiding COVID-19 have the usual confusing special circumstances that need clarifying:

Is it okay to touch your face when you’re in the shower?

Speaking of showers, do you need to wash your hands before taking a shower, after taking a shower, or both?

Do couples who live together and sleep in the same bed need to stand six-feet apart in public to avoid being criticized?

If your family has more than 10 members living in the same house, do number 11 and above have to leave and find somewhere else to live?

Sorry, I may be getting silly after self-isolating, but so far I’m still healthy!

Hleath Caer

I spent many years in healthcare, as a technologist, as a manager, and even worked for a major medical equipment company, managing the techs who would demonstrate and teach radiologic technologists how to use the latest, greatest equipment.

I’m glad those days are over–especially my time in management. It was awful enough when hospitals established their own collection agencies–complete with a stable of lawyers, of course. Now, as clinicians try to help patients in the midst of the COVID-19 pandemic, hospital administrations do not help. Instead, they throw up roadblocks.

In some hospitals, health care workers have been forbidden from wearing masks as protection in the hallways.

In at least one hospital, personal protective gear was at a premium, so nurses put up a GoFundMe site and purchased masks, surgical shoe coverings, etc. Rather than appreciating the lengths that the nurses would go to help their patients, one nurse was suspended for distributing the unauthorized products.

We could blame it on the stable of lawyers, but they don’t actually decide. They advise, lean heavily against the possibility of a mega-million dollar hospital experiencing a couple thousand dollar judgement. They do add to administrators’ hesitance about making decisions.

As a former Fellow of the American College of Healthcare Executives with all kinds of letters after my name, here’s my suggestion.

  • If it helps the patients, do it. Combat doctors and medics save many lives doing what needs to be done, not what the book says.
  • If you are not actively involved in patient care, your job is to grease the skids for those who are.
  • If you, or the person most important to you–parent, spouse, child–were the patient, would you want care delayed or withheld because of such stupid reasons?

Oh, and maybe have the administrators, lawyers, etc. assist by having actual contact with patients. They may not be qualified to provide patient care, but they can transport patients, clean and stock rooms, etc. Every other healthcare worker has and probably is doing such tasks today. If administrator and their staff feel it is beneath them, then they are in the wrong business.

C’mon people.

 

 

Random Thoughts

There’s no specific theme or topic–just goofy stuff that has gone through my head as I self-isolate.

1. There’s no understanding the lengths people will go through to take advantage of others. A museum near Amsterdam closed because of the COVID-19 emergency. Someone–or several someones–broke in and stole a Vincent van Gogh painting, The Parsonage Garden at Neunen.  As near as I can tell, except for artwork that the Nazis looted, there are less than a dozen masterpieces that have been stolen and not recovered.

Imagine if the thieves had put their time and talent to work doing something worthwhile. Then again, maybe they think that they look good in fluorescent orange jumpsuits.

2. The hospital ships USNS Comfort and USNS Mercy supporting New York and Los Angeles are amazing. They started out as commercial supertankers, and if memory serves correctly, were cut in half to make them longer. USNS indicates that the ship is owned by the US Navy, but is not a commissioned vessel. The crew is a combination of military and civilian mariners under the direction of the Military Sealift Command.

The 1000 bed medical facility is under the command of a captain from the Navy Medical Corps or Navy Nurse Corps. Each has a complement of diagnostic and treatment facilities including radiology, CT Scan, 12 operating rooms, and a burn care unit.

Years ago, I had the opportunity to visit the USNS Mercy and she’s an awesome ship. Both have helicopter landing pas for patients being medevaced. The trauma receiving area–similar to an emergency room–has its deck painted red, an old tradition so blood isn’t as obvious. After all, these were built to support combat casualties.

 

Rules of Acquisition

The Ferengi appeared as aliens in several Star Trek iterations. They were the ultimate business people who frequently quoted from their 286 rules of acquisition. I’ve heard they were originally planned as the villains for Star Trek: The Next Generation, but came across as more silly than intimidating.

In my favorite interaction, one Frengi asks, “What if this becomes a war?” The other replies, “Rule 34.”

The first responds “Ahhh, war is good for business. But, but, what if it doesn’t lead to war?” The response is “Rule 35.”

“Ahhh, peace is good for business.”

Today there are real Ferengi; not as exotic looking, but every bit as greedy:

  • People pretending to be employees with the Centers for Disease Control and Prevention are knocking on doors, wearing white lab coats, telling residents that they’re testing for COVID-19. Then they rob them.
  • A former White House advisor asked if people staying home to avoid the virus is worth the economic consequences.
  • Senators dumped stocks after being briefed on the coronavirus, but before that information was released to the general population.
  • All kinds of scammers are selling phony medications or religious talismans.

Oh, wait. Rule 14.  “Anything stolen is pure profit.”

Premeditated Twinkie Offenses

I have no inherent dislike or paranoia about guns. I served in a war zone and carried a weapon. I like to go to a range and plunk at targets.

However, there are those today who are purchasing guns to protect their “stuff” in the event of shortages. It’s disturbing to think that anyone would kill another person over a loaf of bread, a side of beef, or a twinkie.* Talk about premeditated murder.

Somewhere around 250-280 AD, there was a pandemic–probably smallpox. The Roman death rate was around 30 percent, but in areas with a Christian presence it dropped to 10 percent. Why? The Romans deserted their sick friends and relatives to avoid catching the disease. Christians, even knowing that they might catch the disease, cared for one another.

 

* These are probably the same people who physically fought their way through the crowd to grab 18 cases of toilet paper.

Sorry, I Don’t Believe in Reality

Well, actually I do, but there are apparently many others who do not. The coronavirus COVID 19 is the current pressing example. People are dying–why wouldn’t you believe in it?

Easy.

If someone has a radio talk show or a podcast that makes money for them, there’s more money in denying reality than accepting it.

KACHING!

As a human being, I am embarrassed. It may not be as profitable, but it is more human to help one another instead of leeching off others’ misfortune.

Medical Mayhem

One of the problems with medical issues is that scientists’ and physicians’ assessments must constantly be revised. As additional facts are uncovered, logical conclusions are changed. That is difficult for some people to accept.

For example, 1.2 + 1.2 when rounded is two. However, if additional research adds a mere .1 to the equation, the answer would be rounded up to three. This is how science works.

This is how reality works. This is how life works.

The view of the effects of coronavirus is changing as more data are available.  This is good. This is how the intellectual process works. This is a time for thought, not emotion.

Viruses are unaffected by opinions, polls, or politics. So too are suffering and death. It is by keeping an open mind, examining the facts, re-examining the facts, and focusing on facts that we can progress.