Mailvox: notes from the frontlines

A nurse-practitioner from the Midwest:

The hotline for this medical system has been receiving 1500 to 2000 calls per day. It is the job of the various Providers to respond to these calls with a general medical prognosis and directions based on the symptoms the patient has described over the phone. Coronavirus has very specific symptoms and unless those symptoms are present it is unlikely the person has it. If they do have that list of specific symptoms, the patient is then told that they “likely have COVID19 and to continue to quarantine themselves for at least 14 days, and if symptoms get worse to go to the ER.” These patients are NOT being actually tested, nor recorded officially.

This specific medical system is big enough that they have developed their own, internal test for the Coronavirus, however patients are not actually tested unless they have to symptoms sufficiently severe to place them in to Tier 1/ER/ICU levels of care. Such symptoms would be a either a very high fever or problems breathing. Medical Professionals who have been exposed to the Coronavirus are also being tested. The phone system is a fairly effective way of dealing with patients at the volumes that medical professionals are needing to wade through them.

The main takeaways from what I have overhead and know is that Coronavirus cases that aren’t severe aren’t being tested, so what effect this will have on the reported numbers, I’m not sure. Also, that larger hospital and medical systems have developed the tests internally, so whether or not the CDC/HHS or any other Federal agency acquires them in bulk isn’t as urgent as it is being portrayed.

A medical security officer, also in the Midwest:

I went into the EOC and suggested that they push the idea up that since there are literally HUNDREDS of vacant restaurants all over, that they rent them for a song (using eminent domain or even Trump’s emergency declaration) and institute drive-through testing like they have in Korea… Literally powerwash them, slap your signs over theirs and use the drive-through and mic hookups already in place…

The lady who I told, who is a senior nurse and emergency response director, paused, thought for a few seconds and said “Well, that could work, but there’s so much more we have to do than just driving through, we have to take temperatures etc”

All I could think was, “bitch, that’s what the WINDOW is for!  Have a tent by the lane, have them rub the stupid thing on their own forehead!  Jesus, use your goddamn imagination!”

We’re fucking doomed… And it’s due to the same stupidity I saw in the senior leadership in the Army that led me to leave…

A nurse in the Southwest:

I can confirm that ED nurses have been instructed to forgo masks. In our particular situation, I believe that it is mostly due to supply issues. People off the street have come in and stolen boxes of masks that we usually leave sitting around and non-clinical people have come onto the unit and taken them as well. Nevertheless, it is frustrating because, prior to now, we have all worn masks on a regular basis during flu season.

The real idiocy is that our N-95 masks, for which we were all fitted upon hire into the ED, have been slated for provider-use only. We nurses do not have any, yet we are the people that go face-to-face more often than any other. However, there are some options, less than ideal, being made available. I am not completely sympathetic to these decisions but the supply matter has hit us hard and I have some understanding of the motives behind them.

A doctor from the South:

I am a medical doctor and I believe both my wife and I have contracted corona. We were unable to test for it because it was unavailable given the strict guidelines in place at the time. One of the things I noticed on a pathology report I saw from a patient in China are these so-called thick mucous secretions in the lungs . This reminded me of what happens to an asthmatic’s lungs when they are having an attack. For asthmatics, they die because they cannot oxygenate their bodies because there is so much mucous in their lungs.

I thought, why not treat these lung symptoms from corona  the way you would for an asthmatic .The reason for the mucous shouldn’t matter.  One of those ways is to use a medication called albuterol which you nebulize and give yourself a breathing treatment several times a day if necessary.

I had been listening to my wife’s lungs for several day,s and on one day I noticed a decrease in breath sounds in one of her lobes along with some wheezing. This is an indication that mucous was plugging up the bronchiole. A worrisome sign and a harbinger of pneumonia potentially coming. I started her on two treatments a day which immediately caused the mucous to break up. We knew this because she started coughing it up. One day later, her lungs were clear and there was no wheezing. I did it to myself just as a preventive measure one time a day. We continued this for about a week before stopping it. It appears we have recovered from the infection.

A retired nursing director from the South:

The corona virus has exasperated the shortage of nurses.  Many of them are mothers and now that schools and daycare are closed they must stay home to take care of their children.  The state medical system is now short hundreds of nurses. Observation – this is what happens when you have to have two parents working in order to be average middle class, no margin.  Not only have we leaned our supply system with no inventory buffer, but we have done the same to our labor pool.