Interesting data form one interview.

CDC to slow tests doin at initial stages required three different primers and, hence, make 3 PCR tests. Citing reasons of being much more sure.

But as soon as they needed tests volume to keep exponential curve they dropped this and moved to normal PCR with one primer, hence tripling testing speed on same equipment and people amount.

Considering bodies and refrigerators

Hospitals break multiple medical rules and laws making this show. But it seems like effect won't be full without it.

Btw officials put coronavirus in most dangerous category and prevent most autopies, almost all bodies being cremated across the world (unheard of for such deceases). Btw, this is cremation requirement that made bodies pileup pictures in Italy, as before this they had only small percentage cremated and not it is requirement.

@Vitaliy...."US can use massively small power nuclear weapons during Venezuela invation. They also planned very big number of civil casualities. EU will join US with few ships and lot of bombers."

"US also slowly shipping big amount of small power nuclear weapons near Iran. Coronavirus propaganda peak must coinside with strike on Iran. But EU still ius going mostly against US here."

really Vitaliy....where do get this ? You would have below zero possibility of knowing where the USa is moving nuclear arsenals. You or anyone else you might be talking to. That's so classified, it's beyond classified.

Germany regime tightening

@Vitaliy....even our allies don't get this classified information when it's on a mobile platform like a ship or submarine. Come on, man. It's only declassified public record when there's some debate about platform launch location on foreign soil, or it's been declassified because of age and irrelevancy. And I personally doubt the US would use nuclear weapons on Venezuela for any reason. Nor Iran. There was much internet speculation that small tactical nukes were used in Syria, but it was unsubstantiated internet rumor by disinfo sites like veteranstoday. Of course we used depleted uranium armed conventional weapons in Iraq...a war crime.

The tens of millions of Americans who lack health insurance will be covered by the government if they fall sick with the COVID-19 illness, the US health secretary said Friday.

Easy case of coronavirus treatmens will cost from $42486 to $74310 (for uninsured or not covered in this specific case), this do not include any ventilation usage and alike. For people with severe issues cost will be up to 15x higher.

@Vitaliy...in this respect....I'm like you. About this, I doubt I'm getting it wrong. You might get some insider information about cameras...but americas nuclear weapons arsenal is a long way from cameras. Even russian spies don't know where mobile nuclear weapons are located, much less any russian companies. These are not icbm's in 1962 you could see from satellites, or someone could see being transported ....even if someone you knew could see those images. Small tactical weapons, they fit in a large pelican case. We're not going to nuke the people of Venezuela. We might invade them to get Maduro, like we did Panama, which sadly would be bad enough.... but I don't underestimate the war machine taking advantage of the inability of the american people to even criticize such actions..... https://en.wikipedia.org/wiki/W54 .... https://topdocumentaryfilms.com/the-panama-deception/

emergency room doctor ....copied off of reddit....not good for hydroxychloroquine....sorry for how it formats https://www.reddit.com/r/CoronavirusFOS/comments/fuku0n/er_md_in_new_orleans_explains_suggested_treatment/

I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable. 2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours. 81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient.

Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95% CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated. Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner. Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes. Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal. Disposition

I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation. Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment Supportive worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle. Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post. We are also using Azithromycin, but are intermittently running out of IV. Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed. Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours. The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room. Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis. We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads. One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."

asthma inhalers .... https://www.medicinenet.com/script/main/art.asp?articlekey=229613

@kurth

Stop measuring this stuff in dollars.
Important here is that it is simple construction.
If it is required society must provide it to doctors and workers at important places. All patents must be annulled and documentation requested and if required obtained by force.

Mordor news

• Horrible old style clothing masks - some firms started to make them in very low volume with manual labor, as all manufacturing fo masks had been destroyed and moved to China many years ago
• Cheap masks - stock present in hospitals, but all new contacts failed, so can be out of masks soon.
• N95 and up respirators - fully absent, available from few resellers at 4x-20x price for now
• Full masks - fully absent, available from few resellers at 4x-20x price for now

This is how disaster of capitalism looks.

Quality of masks and filters in China is dropping dramatically now as each firm want to get record profits (filters profits can reach 10000% now and they expect 5x of this).

Australia

Private hospital company Healthe Care has already stood down 800 staff and is putting in doubt 8000 beds at 34 private hospitals across Australia after the federal government cancelled elective surgeries in response to the COVID-19 spread.

Not enough profits. Cited reason.

@Vitaliy...I don't think it, capitalism, will be so easily swept away, unless we decide to reap vengeance on china and start wwiii. In 1970 I was walking down 22nd st in Austin , after the biggest antiwar protest ever seen in texas, and my best friend, who was ysa, overheard a guy saying " the revolutions coming"....and we thought it would happen the next day.haha...my friends still waiting in cambodia. The simple solution for the aussies is temporarily nationalize hospitals , like spain. Mexicos in a similar predicament, but we have a leftist pres and a history of nationalizing industries.