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  #2001  
Old Yesterday, 22:01
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wildman43 wildman43 is offline
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Quote:
Originally Posted by Gsniper View Post
Un biased information from an actual source. F'ing crazy talk.

If we had more access to ACTUAL information we'd all be better off.

Amen
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  #2002  
Old Yesterday, 22:13
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Quote:
Originally Posted by 8654maine View Post
Thanks folks.

But it is biased opinion...mine own. Take it with a grain of salt.

However, know that I wouldn't endanger my family or friends just so I could prove a point.

IOW, if COVID-19 was a willing woman, I'd still perform cunninglingus on it.

Of course, that may change as more data is known.

Ask me in 4 wks.

I also know many folks are hurting economically. The stress of this can not be ignored.

Do what you can for those around you.
Thanks, Brother. I too appreciate, and have been waiting on your expertise and knowledge regarding this matter.
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  #2003  
Old Yesterday, 22:59
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Originally Posted by KS11 View Post
It's almost like they're trying to one-up each other. "10 May for you guys? Oh yeah, well we're shutting down until 10 June! Look how many lives we're saving!"
VA Primaries are June 9.

Coincidence?
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  #2004  
Old Yesterday, 23:44
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I would not expect to have data for some years but, at some point I would like to see infection and mortality rates across professional disciplines/professional groups. RN, Educator, Tow Truck Driver, Bartender etc.

Thank you all.
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  #2005  
Old Today, 01:20
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My niece, next door on the farm does mobile x-rays , mostly for elderly at nursing homes etc. She travels as far south as Prairie Du Chien and as far north as Eau Claire. She is never given much information by the employers, medical staff etc. She only has an indication that a patient is severely ill when the nursing staff has her suit up and don a face shield. Anyhoo, she is putting herself in harms way for not a whole lotta dough!
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  #2006  
Old Today, 01:56
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wildman43 wildman43 is offline
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deleted pm sent instead

Last edited by wildman43; Today at 02:07.
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  #2007  
Old Today, 04:44
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Quote:
Originally Posted by Janitor View Post
Some states are putting teeth into it. I have two reports from clients in California that the police are issuing $1,000 tickets for people straying more than 1 mile from the address appearing on a driver's license.
Where in California is this happening? I'm a cop (in management) and have not heard of this.
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  #2008  
Old Today, 06:36
8654maine 8654maine is offline
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Quote:
Originally Posted by just11b View Post
I quit taking this seriously the moment we were informed that my 2 year old would most likely never receive treatment should things get to a critical point, due to having a neuromuscular disorder. Healthy kids come first I guess. So much for that "oath" huh. I'm sure those that write these policies have a good reason to exclude my child from receiving ventilation care. I would really love to hear the explanation. When I raised my right hand to serve, I swore to protect all Americans, not just those that are born healthy.. SMH
Sorry I didn't see this earlier.

Man, I would not want to be in your shoes. That is rough.

I have a colleague who has a young child with cystic fibrosis. Both parents are emergency docs. Both are scared out of their minds that they will bring that infection home to their child.

I wouldn't want to be on either end of the desk when you had that conversation.

Just keep being the best father for your little guy.
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  #2009  
Old Today, 07:52
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Originally Posted by AKAPete View Post
I got my get past the roadblocks card because the Governor says I'm essential.
I went up I-95 north this morning to stop by my office and it was still pretty busy. It wasn't the usual 5am I-95 traffic by any stretch, but it wasn't zombie apocalypse deserted either.
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  #2010  
Old Today, 08:38
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Quote:
Originally Posted by 8654maine View Post
My experience with COVID-19 so far:

(1) What we are seeing in my corner of the world seems to be vastly different than in NY, CA or other places. My buddy in RI has a different view (he's a scout sniper turned PA).
(2) For the vast majority, COVID-19 is a nothing/mild illness.
(3) The # cases of infected is likely to be vastly underestimated. (4) Many folks have no clue what "airborne" vs "droplets" mean and what masks do. N95 means "removal of 95% of particles 0.3 micron diameter". Airborne means <0.5 micron size. COVID-19 is 0.12 micron. If truly airborne, N95 would be meaningless. I have yet to hear/read of a study that confirms "airborne" transmission.
(5) Be careful of selection bias, i.e. using ICU data to describe the population. This is a skewed view. Almost all labs I've seen about COVID-19 seem to describe ICU patients with ARDS or end organ damage. That is not the majority of patients.
(6) Most people have no clue what an emergency means. We've had to staff tents and triage to deal with a deluge of patients who are "worried well" or "want to get tested because...". A majority of our time, resources and personnel are to handle these folks. Most of these have negative tests but risk exposure to COVID to soothe their angst.
(7) I have yet to hear from an expert opinion why we need to test people who are asymptomatic or even mildly ill. We normally wouldn't do this with Influenza (except for risk factors or Tamiflu use), RSV (except for very young infants or risk factors), mono, etc. I have yet to hear of a rationale for testing non-ill, non-clinically relevant reasons.
(8) OTOH, we have seen some very sick patients. Some with multi organ failure, some crashing respiratory failure. We've had one whose airway was attempted by multiple providers. A cric saved that one. We've also had a few deaths.
(9) When we have a COVID patient and another critically ill patient such as a trauma, MI or stroke, all of you can forget about your waiting times. We do NOT have enough staff to keep throughput going.
(10) I have minimal respect for health admin, public health or others who put "expert" in their description. I'm just a simple country ER doc. A professional should have competence, compassion, and be cool under pressure. Foment of emotion does no one good. I suspect they love all the attention.
(11) These are just my observations. Take it as you will.
Thanks for your post. One reason I like this forum is the depth and breadth of experience; this thread specifically clinically, operationally, policy side, admin, etc. It does paint a better picture.

RE: #3, I heard the best description of the difference between the N95 and a surgical mask yesterday: the N95 is "it's not me, it's you", and the surgical mask is "it's not you, it's me." I see people, clinicians, get wrapped around the axle over this.

RE: #6, that's always been the case,the "worried well." But nobody, and I mean NOBODY, knows what an "emergency" really is.

RE: #7, we stopped testing asymptomatic long ago, and the only people with mild syemptom we're testing are the healthcare workers, and with a RTAT so we can get them back to work quickly.

RE: #10, generally I agree, but in this case, I will disagree: Our admin folks have stepped up. They are fully paying people, even those furloughed. They are also the ones going to bat with the state for suspending certain credentialing (i.e., ACLS for docs who do moderate sedation, etc.). So they have their usefulness.
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  #2011  
Old Today, 08:41
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Originally Posted by Gsniper View Post
Un biased information from an actual source. F'ing crazy talk.

If we had more access to ACTUAL information we'd all be better off.
We've had a metric shit-load of good gouge on here, just have to parse through some of it. Thank God SB is pretty quick to shut down the BS.
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  #2012  
Old Today, 08:52
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Quote:
Originally Posted by Devildoc View Post
We've had a metric shit-load of good gouge on here, just have to parse through some of it. Thank God SB is pretty quick to shut down the BS.
I listened to one of Andy Stumpf's podcasts where he offered that BUD/S is a course designed to identify those who have a capacity to learn under duress.

This thread proves that daily.
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  #2013  
Old Today, 08:56
Gsniper Gsniper is online now
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I didn't mean "here" DevilDoc, I meant that in a general sense as to separating the wheat from the chaff in the news outlets. I've followed this thread all the way and have received most of my actual information and researchable links from here.
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  #2014  
Old Today, 09:02
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Originally Posted by Gsniper View Post
I didn't mean "here" DevilDoc, I meant that in a general sense as to separating the wheat from the chaff in the news outlets. I've followed this thread all the way and have received most of my actual information and researchable links from here.
To clarify, I really didn't take it that way. I totally agree, just pointing out this place is better than a lot of others.
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  #2015  
Old Today, 09:14
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Originally Posted by Devildoc View Post
To clarify, I really didn't take it that way. I totally agree, just pointing out this place is better than ALL THE others.
I had to fix it, because In SOCNET I trust. Amen.
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  #2016  
Old Today, 09:20
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Quote:
Originally Posted by Macka View Post
VA Primaries are June 9.

Coincidence?
Yes itís a coincidence
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  #2017  
Old Today, 09:25
AKAPete AKAPete is online now
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Data, Data, Data and more Data.

But Key Data is now slipping by the wayside and numbers put out by the nightly news are becoming more distorted.

Total cases used to figure many data points? As many have noted here - many who show up with mild symptoms are sent home without being tested. That daily total of new cases is starting to round off at the top. How much of that is based on the now lack of wider testing?

Mortality rate? Again if you limit your testing to those who are sick, at risk or front line health providers it will drive up the mortality rate.

About the only "true" count is deaths and even that can be looked at two ways. The hockey stick total graph sure looks grim but if you look at the daily bar chart it's not shooting up like a rocket.

So a tip of the hat to you in the front lines of this and I'll get back to watching the garden grow.
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  #2018  
Old Today, 09:39
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Quote:
Originally Posted by Macka View Post
VA Primaries are June 9.

Coincidence?
No, there's no way he just picked the 10th out of thin air. Why not June 1st or especially 30 May which would make it a round number of 60 days? Of course he knew what he was doing.
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  #2019  
Old Today, 09:44
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So this is the missing context on our ventilator shortage:

Quote:
The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed.
Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg
The New York TimesMarch 30, 2020, 2:48 PM EDT
President Donald Trump speaks about the coronavirus during a task force news conference at the White House in Washington, March 26, 2020. (Erin Schaff/The New York Times)
President Donald Trump speaks about the coronavirus during a task force news conference at the White House in Washington, March 26, 2020. (Erin Schaff/The New York Times)
More
Thirteen years ago, a group of U.S. public health officials came up with a plan to address what they regarded as one of the medical system’s crucial vulnerabilities: a shortage of ventilators.

The breathing-assistance machines tended to be bulky, expensive and limited in number. The plan was to build a large fleet of inexpensive portable devices to deploy in a flu pandemic or another crisis.


Money was budgeted. A federal contract was signed. Work got underway.

And then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.

That failure delayed the development of an affordable ventilator by at least half a decade, depriving hospitals, states and the federal government of the ability to stock up. The federal government started over in 2014 with another company, whose ventilator was approved only last year and whose products have not yet been delivered.

Today, with the coronavirus ravaging the U.S. health care system, the nation’s emergency response stockpile is still waiting on its first shipment. The scarcity of ventilators has become an emergency, forcing doctors to make life-or-death decisions about who gets to breathe and who does not.

- ADVERTISEMENT -

The stalled efforts to create a new class of cheap, easy-to-use ventilators highlight the perils of outsourcing projects with critical public health implications to private companies; their focus on maximizing profits is not always consistent with the government’s goal of preparing for a future crisis.

“We definitely saw the problem,” said Dr. Thomas Frieden, who ran the Centers for Disease Control and Prevention from 2009 to 2017. “We innovated to try and get a solution. We made really good progress, but it doesn’t appear to have resulted in the volume that we needed.”

The project — code-named Aura — came in the wake of a parade of near-miss pandemics: SARS, MERS, bird flu and swine flu.

Federal officials decided to reevaluate their strategy for the next public health emergency. They considered vaccines, antiviral drugs, protective gear and ventilators, the last line of defense for patients suffering respiratory failure. The federal government’s Strategic National Stockpile had full-service ventilators in its warehouses, but not in the quantities that would be needed to combat a major pandemic.

In 2006, the Department of Health and Human Services established a new division, the Biomedical Advanced Research and Development Authority, with a mandate to prepare medical responses to chemical, biological and nuclear attacks as well as infectious diseases.

In its first year in operation, the research agency considered how to expand the number of ventilators. It estimated that an additional 70,000 machines would be required in a moderate influenza pandemic.

The ventilators in the national stockpile were not ideal. In addition to being big and expensive, they required a lot of training to use. The research agency convened a panel of experts in November 2007 to devise a set of requirements for a new generation of mobile, easy-to-use ventilators.

In 2008, the government requested proposals from companies that were interested in designing and building the ventilators.

The goal was for the machines to be approved by regulators for mass development by 2010 or 2011, according to budget documents that the Department of Health and Human Services submitted to Congress in 2008. After that, the government would buy as many as 40,000 new ventilators and add them to the national stockpile.

The ventilators were to cost less than $3,000 each. The lower the price, the more machines the government would be able to buy.

Companies submitted bids for the Project Aura job. The research agency opted not to go with a large, established device-maker. Instead it chose Newport Medical Instruments, a small outfit in Costa Mesa, California.

Newport, which was owned by a Japanese medical device company, only made ventilators. Being a small, nimble company, Newport executives said, would help it efficiently fulfill the government’s needs.

Ventilators at the time typically went for about $10,000 each, and getting the price down to $3,000 would be tough. But Newport’s executives bet they would be able to make up for any losses by selling the ventilators around the world.

“It would be very prestigious to be recognized as a supplier to the federal government,” said Richard Crawford, who was Newport’s head of research and development at the time. “We thought the international market would be strong, and there is where Newport would have a good profit on the product.”

Federal officials were pleased. In addition to replenishing the national stockpile, “we also thought they’d be so attractive that the commercial market would want to buy them, too,” said Nicole Lurie, who was then the assistant secretary for preparedness and response inside the Department of Health and Human Services.

With luck, the new generation of ventilators would become ubiquitous, helping hospitals nationwide better prepare for a crisis.

The contract was officially awarded a few months after the H1N1 outbreak, which the CDC estimated infected 60 million and killed 12,000 in the United States, began to taper off in 2010. The contract called for Newport to receive $6.1 million upfront, with the expectation that the government would pay millions more as it bought thousands of machines to fortify the stockpile.

Project Aura was Newport’s first job for the federal government. Things moved quickly and smoothly, employees and federal officials said in interviews.

Every three months, officials with the biomedical research agency would visit Newport’s headquarters. Crawford submitted monthly reports detailing the company’s spending and progress.

The federal officials “would check everything,” he said. “If we said we were buying equipment, they would want to know what it was used for. There were scheduled visits, scheduled requirements and deliverables each month.”

In 2011, Newport shipped three working prototypes from the company’s California plant to Washington for federal officials to review.

Frieden, who ran the CDC at the time, got a demonstration in a small conference room attached to his office.

“I got all excited,” he said. “It was a multiyear effort that had resulted in something that was going to be really useful.”

In April 2012, a senior Health and Human Services official testified before Congress that the program was “on schedule to file for market approval in September 2013.” After that, the machines would go into production.

Then everything changed.

The medical device industry was undergoing rapid consolidation, with one company after another merging with or acquiring other makers. Manufacturers wanted to pitch themselves as one-stop shops for hospitals, which were getting bigger, and that meant offering a broader suite of products. In May 2012, Covidien, a large medical device manufacturer, agreed to buy Newport for just over $100 million.

Covidien — a publicly traded company with sales of $12 billion that year — already sold traditional ventilators, but that was only a small part of its multifaceted businesses. In 2012 alone, Covidien bought five other medical device companies in addition to Newport.

Newport executives and government officials working on the ventilator contract said they immediately noticed a change when Covidien took over. Developing inexpensive portable ventilators no longer seemed like a top priority.

Newport applied in June 2012 for clearance from the Food and Drug Administration to market the device, but two former federal officials said Covidien had demanded additional funding and a higher sales price for the ventilators. The government gave the company an additional $1.4 million, a drop in the bucket for a company of Covidien’s size.

Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business.

Some Newport executives who worked on the project were reassigned to other roles. Others decided to leave the company.

“Up until the time the company sold, I was really happy and excited about the project,” said Hong-Lin Du, Newport’s president at the time of its sale. “Then I was assigned to a different job.”

In 2014, with no ventilators having been delivered to the government, Covidien executives told officials at the biomedical research agency that they wanted to get out of the contract, according to three former federal officials. The executives complained that it was not sufficiently profitable for the company.

The government agreed to cancel the contract. The world was focused at the time on the Ebola outbreak in West Africa. The research agency started over, awarding a new contract for $13.8 million to the giant Dutch company Philips. In 2015, Covidien was sold for $50 billion to another huge medical device company, Medtronic.

Charles Dockendorff, Covidien’s former chief financial officer, said he did not know why the contract had fallen apart.

“I am not aware of that issue,” he said in a text message.

Robert White, president of the minimally invasive therapies group at Medtronic who worked at Covidien during the Newport acquisition, initially said he had no recollection of the Project Aura contract. A Medtronic spokeswoman later said that White was under the impression that the contract had been winding down before Covidien bought Newport.

In a statement Sunday night, after the article was published, Medtronic said, “The prototype ventilator, developed by Newport Medical, would not have been able to meet the specifications required by the government, nor at the price required.” Medtronic said that one problem was that the machine was not going to be usable with newborns.

It wasn’t until July 2019 that the FDA signed off on the new Philips ventilator, the Trilogy Evo. The government ordered 10,000 units in December, setting a delivery date in mid-2020.

As the extent of the spread of the new coronavirus in the United States became clear, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, revealed March 15 that the stockpile had 12,700 ventilators ready to deploy. The government has since sped up maintenance to increase the number available to 16,660 — still fewer than one-quarter of what officials years earlier had estimated would be required in a moderate flu pandemic.

Last week, the Health and Human Services Department contacted ventilator-makers to see how soon they could produce thousands of machines. And it began pressing Philips to speed up its planned shipments.

The stockpile is “still awaiting delivery of the Trilogy Evo,” a Health and Human Services spokeswoman said. “We do not currently have any in inventory, though we are expecting them soon.”

This article originally appeared in The New York Times.

© 2020 The New York Times Company
It's cute how this is heavily used as leverage against the president, when a majority of it occurred under Obama, and the issue was fixed under Trump, before our current issues arose.

I wish he was better at putting this stuff out there.
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