Articles Posted in Emergency Medicine

calguard-225x300When hundreds of thousands of Americans are getting infected with Covid-19 and tens of thousands of die from it, regulatory incrementalism in protecting some of the most vulnerable is simply unacceptable: The latest halting measures by the Centers for Medicare and Medicaid Services do a disservice to the elderly, injured, and sick residents nationwide in nursing homes, long-term care centers, and skilled nursing facilities.

Seema Verma, the agency’s director, has told these institutions that they now must inform residents and their loved ones about Covid-19 infections and deaths in the care facilities, whether the affected individuals are staff members or others housed in the centers.

She only started, however, to respond to coast-to-coast wails about the official silence that has enshrouded the novel coronavirus’ toll on institutional care, with facilities condemned in increasing fashion by critics as infection petri dishes, or as one politician deemed them, “death pits.”

drugsinhand-201x300Whoa, Nelly. For Americans stuffing their heads with vague data about potential drugs to treat Covid-19 — including chloroquine, hydroxychloroquine, azithromycin, remdesivir, ritonavir, lopinavair, Actemra, Oseltamivir, Ribavirin, Umifenovir, interferon, baricitinib, imatinib, dasatinib, nitazoxanide, camostat mesylate, tocilizumab, sarilumab, bevacizumab, fingolimod, and eculizumab — let’s get a little perspective, please.

Let’s put things simply, especially for most ordinary folks who have no desire to play at being pharmaceutical experts: As of this writing, as noted online in a meta-review by the respected Journal of the American Medical Association, this is the reality about drugs for the novel coronavirus:

 “No proven effective therapies for this virus currently exist.”

drscope-300x200The public health restrictions put on much of the nation to battle the Covid-19 pandemic also have created complications for patients’ receiving other kinds of health care — a reality that the nation will need to deal with in the weeks ahead.

Doctors and hospitals will need to see whether their coronavirus case loads are such that they can begin to reconsider providing what were deemed nonessential medical services, including often performed procedures like shoulder, knee, and hip surgeries.

Most hospitals, responding to federal and state requests, put off elective procedures, notably because they did not want to put patients and heightened risk and because medical facilities nationwide have experienced desperate shortages of personal protective equipment and drugs. Some institutions have pressed ahead with operations they have deemed needed, despite questions from critics.

covidtestinggapnyt-300x185Public health experts and many politicians agree that the pursuit of any next steps in dealing with the Covid-19 pandemic will rely on testing, testing, testing. The nation will need significantly more tests, with faster and better results, that show who is infected now. Further, many, many more people will need to take blood antibody tests to determine who was infected with the disease and may have some level of immunity from it.

This is the problem: Weeks after the novel coronavirus swept the nation, infecting hundreds of thousands and killing thousands, the testing available is too scant, takes too long, and — despite much bloviating and promises — is mired in unacceptable ways.

The gulf between the needed level of testing and what is occurring is Grand Canyon sized (see NYT graphic, based on Harvard University research, above), and this is a giant problem in potentially relaxing Covid-19 restrictions now in place.

covidstayhome-sharonmccutcheon-200x300With President Trump, members of his administration, and other politicians shoving back against public health officials’ recommendations on when to get Americans out of their homes and returning to work, the ultimate decision may be up to individuals: Do we give up the existing physical-distancing guidance? Or not?

The data on Covid-19 infections and deaths is still building, but it may be worth reviewing what is known about the disease, whom it afflicts, and how.

Based on the deaths of those diagnosed with the novel coronavirus, it has been deadlier for men than women. It is taking a terrible and disproportionate toll among African Americans, with Latinos afflicted at high rates, too.

hopkinsnursinghome-300x169The news about the institutional care of vulnerable seniors during the Covid-19 pandemic just keeps getting worse in too many unacceptable ways. Just consider:

KIDlogo-300x150Federal watchdogs set a shameful low in 2019, allowing the most kids in almost two decades to die due to defective products before ordering their recall, a noted children’s advocacy group reported.

Kids in Danger (KID), a Chicago-based organization that says it has tracked the child-protection activities of the U.S. Consumer Product Safety Commission (CPSC) since 2002, assailed the agency’s recent performance, asserting that lax oversight contributed to 38 youngsters’ deaths before regulators ordered recalls. That was the highest number fatalities since KID began its tracking, and 37 of the 38 deaths involved inclined infant sleepers, specifically the Fisher-Price Rock ‘n Play and Kids II rocking sleeper.

KID said in a news release about its latest, published annual report:

While alarms have been raised about the nation’s ever-increasing numbers of suicides, mental health experts, educators, and medical researchers also are making urgent pleas for grownups to pay heightened attention to the spike in cases in which youngsters are taking their own lives.

As the independent, nonprofit Kaiser Health News Service reported:

“[S]uicide by children ages 10 to 14 has gone up and up. The suicide rate for that age group almost tripled from 2007 to 2017. Newly released 2018 data from the Centers for Disease Control and Prevention show a 16% increase over the previous year. While experts point to a host of explanations for the alarming rise, scientific proof about cause isn’t conclusive. Some research shows correlations with social media use, cyberbullying and the internet, but studies citing them as a suicide cause are less decisive.”

faucifacegrimace-300x210Even as Covid-19 wreaked unprecedented harms, there also have been actions that might lead even the most jaded observer to cry out:  What were these people thinking?

The pandemic’s global toll has risen to hundreds of thousands of infections and thousands of deaths. The U.S. toll at the end of the third week in March, the New York Times reported, exceeded 21,000 infections and nearly 300 deaths, with 1 in 5 Americans also now living under tough restrictions that have shut non-essential businesses, schools, colleges and universities, restaurants, gyms and health clubs, and sports and cultural events.

In the throes of such calamitous circumstances,  consider:

curveflatten-300x175Across the nation, and throughout the DC region, Americans — finally — have started to come to grips with the gravity of a fast-spreading, new respiratory virus’ infections. The novel coronavirus has infected almost 150,000 internationally, killing thousands as part of what now is officially a global pandemic and a national emergency.

Cases of Covid-19 have been detected in Washington, D.C., Virginia, and Maryland, as public health officials have urged the public to increase safeguards against contracting the disease, notably by staying home and practicing not only hygienic measures (washing their hands, covering their coughs and sneezes, and foregoing handshakes and hugs) but also keeping their distance from others.

Businesses have urged their people to work from home. Schools have shut their doors. Concerts, plays, museums, and cultural events and institutions have closed and canceled. Professional and amateur sports have suspended play. Travel, domestic and international, has screeched to a halt. Panic buying has broken out at groceries and big box warehouse stores.

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