Greetings again to everyone. I'm still not caught up with these coronavirus threads, but I may not ever read all the posts that were mostly about what we could or couldn't get at the grocery store, or whether it's okay to sit on a park bench. If I seem to have overlooked anything more important, please let me know.
I thought particularly of the FAZ interview with the Frankfurt pulmonologist that Norbert called to our attention when this article came out today and was widely syndicated by the AP.
Some doctors are moving away from ventilators to treat coronavirus patients. The reason: Unusually high death rates.
By Mike Stobbe
Associated Press
April 8, 2020 ...
Generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators, experts say. But 80% or more of coronavirus patients placed on the machines in New York City have died, state and city officials say. ...
Similar reports have emerged from China and the United Kingdom. One U.K. report put the figure at 66%. A very small study in Wuhan, the Chinese city where the disease first emerged, said 86% died. ...
... experts do say ventilators can be damaging to a patient over time, as high-pressure oxygen is forced into the tiny air sacs in a patient's lungs. ...
We know that mechanical ventilation is not benign," said Dr. Eddy Fan, an expert on respiratory treatment at Toronto General Hospital. “One of the most important findings in the last few decades is that medical ventilation can worsen lung injury — so we have to be careful how we use it.”
The dangers can be eased by limiting the amount of pressure and the size of breaths delivered by the machine, Fan said. ...
But increasingly, physicians are trying other measures first. One is having patients lie in different positions — including on their stomachs — to allow different parts of the lung to aerate better. Another is giving patients more oxygen through nose tubes or other devices. Some doctors are experimenting with adding nitric oxide to the mix, to help improve blood flow and oxygen to the least damaged parts of the lungs.
https://www.chicagotribune.com/coronavirus/ct...
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There have also been a few more interesting NYT articles lately, so here's another selection.
I thought about Martin and his family when reading about central Queens in New York.
The good advice from nurse Monja Schünemann in her blog also keeps coming back to mind. Once again, she reminded patients to keep making an effort to sit up, drink liquid, and cough up secretions out of the lungs. I thought about her when I read about the 66-year-old NY doctor, alone in his apartment, who could hardly bring himself to get up to eat or drink. But he did apparently have a home pulse oximeter, which seems to be emerging as a key piece of equipment for a few people in high-risk groups or areas with growing disease clusters. (But please, don't everybody order one, we don't need another shortage.)
Finally, in the first article below, about how many Amish workers have helped make face shields and masks for the Cleveland Clinic, I wondered if that might also be one of the factors that partially answers Amy's question about why Ohio seems to be doing so much better than Michigan so far.
The good news in all of this seems to be that the longer it all goes on, the more people are finding new ways to make things that can help.
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In Ohio, the Amish take on the coronavirus
A famously traditional community has mobilized to help hospitals with medical supplies, even as it struggles with reconciling its traditional way of life with the dictates of social distancing ...
SUGARCREEK, Ohio — On April 1, John Miller, a manufacturer here with deep connections to the close-knit Amish community of Central Ohio, got a call from Cleveland Clinic. The hospital system was struggling to find protective face masks for its 55,000 employees, plus visitors. Could his team sew 12,000 masks in two days?
He appealed to Abe Troyer with Keim, a local lumber mill and home goods business and a leader in the Amish community ...
A day later, Mr. Troyer had signed up 60 Amish home seamstresses, and the Cleveland Clinic sewing frolic was on.
https://www.nytimes.com/2020/04/09/us/politic...
'A Tragedy Is Unfolding': Inside New York's Virus Epicenter
In a city ravaged by an epidemic, few places have been as hard hit as central Queens ...
A group of adjoining neighborhoods — Corona, Elmhurst, East Elmhurst and Jackson Heights — have emerged as the epicenter of New York’s raging outbreak.
As of Wednesday, those communities, with a combined population of about 600,000, had recorded more than 7,260 coronavirus cases, according to data collected by the New York City Department of Health and Mental Hygiene. Manhattan, with nearly three times more people, had about 10,860 cases. ...
... health care workers and community leaders say it is indisputable that the pandemic has disproportionately affected the Hispanic day laborers, restaurant workers and cleaners who make up the largest share of the population in an area often celebrated as one of the most diverse places on earth ...
The neighborhoods also have large communities of Indian, Bangladeshi, Chinese, Filipino and Nepali people, and a score of other ethnicities ...
The city-run Elmhurst Hospital Center was one of the earliest and hardest-hit by the virus. Dozens of Covid-19 patients have clogged hallways as they wait for beds, terrified, alone and often unable to communicate in English.
https://www.nytimes.com/2020/04/09/nyregion/c...
For 12 Days a Doctor Lived With Burning Lungs
Each day of recovery from the coronavirus, I feel a little bit stronger ...
I lie on a stretcher, thinking of my two sons. ...
I know that my oxygen saturation plummeting the night before is a sign of advanced pulmonary disease with Covid-19 infection. ...
On March 9, the pandemic still seemed far away. Nobody had gotten ill yet. I attended the last large emergency management system meeting of the Northwell health system in Manhasset, N.Y. ...
That afternoon, I met twice with a group of colleagues. I was feeling so cold. Over the next hour, I became colder with shaky chills. ...
As a 66-year-old, I knew the mortality risks. On Friday, I was taken over by coronavirus malaise. Malaise is a term used by health care workers, but I didn’t fully understand it until I experienced it in my body. Malaise forces you onto the couch or bed, tells you you’re not hungry. The idea of cooking became overwhelming. I lost interest in even cleaning up. ...
Medically, I knew there was no reason to go to the hospital. My vital signs and oxygen levels were fine. I monitored myself a few times a day, but I did realize, in the fog that took over, that I wasn’t eating or drinking much. ...
For 12 days I lived with burning lungs, malaise, no appetite and little gusto for life. One night, my oxygen saturation dipped. The next morning, I called my colleagues for help. An ambulance arrived. ...
The infectious disease doctor ordered a lung CT scan, and the results showed severe, bilateral disease. ...
That afternoon, I stabilized with no further degradation of my oxygen saturation levels. On oxygen, I felt more secure in my breathing. I remained on oxygen and was transferred to a “Covid floor” where I stayed for six days. ...
I have been home now for 13 days. Each day I feel a little bit stronger and more like myself.
https://www.nytimes.com/2020/04/09/opinion/co...
In Scramble for Coronavirus Supplies, Rich Countries Push Poor Aside
Developing nations in Latin America and Africa cannot find enough materials and equipment to test for coronavirus, partly because the United States and Europe are outspending them. ...
https://www.nytimes.com/2020/04/09/world/coro...
Trump Keeps Talking. Some Republicans Don’t Like What They’re Hearing.
Aides and allies increasingly believe the president’s daily briefings are hurting him more than helping, and are urging him to let his medical experts take center stage.
https://www.nytimes.com/2020/04/09/us/politic...
The U.S. Approach to Public Health: Neglect, Panic, Repeat
Time to give new life to an old idea: A strong public health system is the best guarantor of good health.
https://www.nytimes.com/2020/04/09/opinion/co...
Why Coronavirus Cases Have Spiked in Hong Kong, Singapore and Taiwan
https://www.nytimes.com/interactive/2020/04/0...