Manic of a panic is geopolitical

[xilman]

Covid-19: New variant 'raises R number by up to 0.7'

The Imperial College study suggests transmission of the new variant tripled during England's November lockdown while the previous version was reduced by a third.

Cases of Covid-19 have begun to increase rapidly during the second spike, and the number of cases recorded in a single day reached a new high on Thursday.

"In simpler terms, unless we do something different the new virus strain is going to continue to spread, more infections, more hospitalisations and more deaths."

[storm5510]

I heard on the radio this morning that Los Angeles County, CA, will start doing triage on all incoming COVID-19 cases. Those with the best chances of survival will be treated. The rest will not. Because of the county's medical establishment being swamped, they will be choosing who lives, and who dies. I fear this will be the harsh reality of 2021.

Note: I do not know how valid all of this is. Someone knowing where to look can verify.

[xilman]

Originally Posted by storm5510

I heard on the radio this morning that Los Angeles County, CA, will start doing triage on all incoming COVID-19 cases. Those with the best chances of survival will be treated. The rest will not. Because of the county's medical establishment being swamped, they will be choosing who lives, and who dies. I fear this will be the harsh reality of 2021.

Note: I do not know how valid all of this is. Someone knowing where to look can verify.

I have no idea how accurate the radio report may be but I do know what triage means.

Those with best rate of survival in the absence of medical treatment will not be treated.

Of the remainder, those with the best rate of survival given medical treatment will be treated.

The remainder will not.

[Dr Sardonicus]

[google google] (looks at LA Times stories from December 30 and December 19, and this December 20 NPR story)

One thing that is happening is, hospitals are adopting "crisis care" or "crisis standard of care" practices, such as declining to transport COVID patients who aren't severely ill.

No triage yet, as far as I can tell, but some CA hospitals are planning for it "just in case."

The categories of triage I've heard from previous news reports of mass casualty scenes (using red, yellow, green, white, and black tags respectively) are

• IMMEDIATE - Those who cannot survive without immediate treatment but who have a chance of survival.
• OBSERVATION - Those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.
• WAIT - The "walking wounded" who will need medical care at some point, after more critical injuries have been treated.
• DISMISS - Those with minor injuries for whom a doctor's care is not required.
• EXPECTANT - The deceased and those whose injuries are so extensive that they will not be able to survive given the care that is available.

The START (Simple Triage And Rapid Treatment) system has four categories and also uses colored tags: Red - immediate; Yellow - delayed; Green - minor; Black - deceased

Curiously, my old Merriam-Webster Unabridged does not mention medical triage. The word is in there, but with a different meaning. The etymology included with definitions is one reason I bought the dictionary when the local branch of the public library retired it from its long service on a lectern.

tri'age, n. [F., a culling, selecting, sifting, fr. trier, to pick out. See TRY.] The process of grading marketable produce; specif., the lowest grade of coffee berries, consisting of broken material. Eng.

[a1call]

In Quebec they say they will start deciding who gets medical care and who doesn't when the ICU use reaches 200% which they expect to be shortly. I also heard in the news (can't recall location) that there is so much load on oxygen pipes that pressure is insufficient and some hospitals have requested delivery of mobile oxygen units.

[Uncwilly]

Originally Posted by storm5510

I heard on the radio this morning that Los Angeles County, CA, will start doing triage on all incoming COVID-19 cases.

It is very bad. I know people that work in hospitals in the LA county area.
Here is what one told me on 12/22:

We are moving to being stuck with more and more Covid cases in the emergency department. We have already been using tents for ambulatory/minor COVID case)

When I mentioned about not giving ventilators to the "95 year old little old ladies", they did not try to correct me.

Labour and delivery are happening, as is chemo, dialysis, and other on going treatments.
Case load (number of patients per nurse) for ICU nurses is at or above 50% of what is normally considered the max acceptable. Retired nurses and other medical staff are being begged to come to work. Nursing students are being given work during their clinical training beyond what was the norm before.

Originally Posted by Dr Sardonicus

[google google] (looks at LA Times stories from)

One thing that is happening is, hospitals are adopting "crisis care" or "crisis standard of care" practices, such as declining to transport COVID patients who aren't severely ill.

No triage yet, as far as I can tell, but some CA hospitals are planning for it "just in case."

One of my other sources in the area said that it is very bad. They were (days ago) already delivering a different standard of care. The idea of 'heroic' treatment (using lots of effort to save a single patient) is not happening.

In the last 90 minutes I talked with a 3rd individual that works at a 3rd major hospital. They have been using tents for 2 weeks or more already. (It has been about 2 weeks since the county went to ZERO available ICU beds). They told me that at this 600+ bed facility, only 1 floor of 1 wing was for non-COVID patients. All pediatric beds are now COVID beds, the post op ward is now COVID, all surgeries that can be postponed are. The large auditorium is now all COVID treatment. Nursing staff are breaking down all the time.

The categories of triage I've heard from previous news reports of mass casualty scenes (using red, yellow, green, white, and black tags respectively) are

Originally Posted by xilman

I have no idea how accurate the radio report may be but I do know what triage means.

Those with best rate of survival in the absence of medical treatment will not be treated.

Of the remainder, those with the best rate of survival given medical treatment will be treated.

The remainder will not.

I have been trained in disaster field response. In the field those 3 categories are the rough sorts. Someone that needs help eventually. Those that a level of care that is available will save their life/prevent further irreversible loss. Those who would require more help than is available, or the care for them would cost others their lives. CPR might be used sparingly in such a situation (because those revived might continue to require care, which would require others not to get care), if you are 30 or under you might get it, over 60, not likely.

The level at care in the hospitals in the Los Angeles area for those that are seriously ill with COVID is being managed differently than before. People will/have died for lack of available resources. It will get worse for at least 2 weeks to 2 months before it plateaus.

[Uncwilly]

I just got a snapchat from someone working at one of those hospitals: They are working outdoors today. I asked if the term triage is appropriate to be used about current level of care. They confirmed that to be correct.

[Dr Sardonicus]

Originally Posted by Uncwilly

The level at care in the hospitals in the Los Angeles area for those that are seriously ill with COVID is being managed differently than before. People will/have died for lack of available resources. It will get worse for at least 2 weeks to 2 months before it plateaus.

These June 2020 California Department of Public health guidelines (complete with cover letter) entitled

California SARS-CoV-2
Pandemic Crisis Care
Guidelines

include the following:

Surge capacity is described across a spectrum of three categories (Figure 1):

• Conventional: Usual resources and level of care provided. For example, during a surge in patients, maximizing bed occupancy and calling in additional staff to assist.
• Contingency: Provision of functionally equivalent care that may incur a small risk to patients. Care provided is adapted from usual practices. For example, boarding critical care patients in post-anesthesia care areas using less traditional, but appropriate resources.
• Crisis: Disaster strategies used when demand forces choices that pose a significant risk to patients but is the best that can be offered under the circumstances. For example, cot-based care, severe staffing restrictions, or restrictions on use of certain medications or other resources.

I transcribed the text imaged in Figure 1:

Conventional:

• Space - usual beds fully utilized
• Staff - usual staff, including called in off duty
• Supplies - Usual or cache/stockpiled
• Level of care - usual care

Contingency:

• Space - PACU or pre-op beds used. Singles conversion to doubles
• Staff - Longer shifts, different staff configurations and supervision
• Supplies - Conserve, adapt, substitute, re-use supplies
• Level of care - Functionally equivalent care, but may be delayed

Crisis:

• Space - cot-based care, ICU-level care in stepdown or monitored units
• Staff - significant changes in nursing and MD ratios, major changes in clinical responsibilities
• Supplies - Rationing of select supplies and therapies
• Level of care - Crisis care, may have to triage medical care and ventilators

[tServo]

I just read an article explaining that rural and small town health professionals are leaving in droves because the communities they live in and serve have turned against them, They are getting death threats and being socially ostracized for doing such horrible things as wearing masks and practicing social distancing and advocating that the general public do the same.

https://www.npr.org/2020/12/28/95086...from-small-tow

[Dr Sardonicus]

This L.A. Times story is not encouraging. Some healthcare workers refuse to take COVID-19 vaccine, even with priority access

They are frontline workers with top-priority access to the COVID-19 vaccine, but they are refusing to take it.

At St. Elizabeth Community Hospital in Tehama County, fewer than half of the 700 hospital workers eligible for the vaccine were willing to take the shot when it was first offered. At Providence Holy Cross Medical Center in Mission Hills, one in five frontline nurses and doctors have declined the shot. Roughly 20% to 40% of L.A. County's frontline workers who were offered the vaccine did the same, according to county public health officials.

So many frontline workers in Riverside County have refused the vaccine — an estimated 50% — that hospital and public officials met to strategize how best to distribute the unused doses, Public Health Director Kim Saruwatari said.
<snip>

[storm5510]

I believe I opened a can of worms above. Perhaps this was a can which needed to be opened. What happens in L.A. County may be duplicated in smaller areas as time passes.

Would it be too harsh to say that any healthcare worker who refuses the vaccine would forfeit their job? At my last doctor visit, the nurse to took my vitals and preliminary information clearly stated that she would not take it, and neither would her children. Do these people fear the vaccine because it was developed so rapidly? It may be they have a sit-back-and-wait mentality. They want to see how it affects others before they take it themselves.

There is something I have thought about, but not seen addressed: Is it possible for a person to be a carrier and never become ill?