Covid19

[jimcav]

Are hospitals claiming Covid deaths ($13k Medicare payout) when they should be claiming pneumonia ($5k)? Maybe.

Issue of reimbursement notwithstanding, pneumonia is simply a term for lung infection. The combination of infection and inflammatory response in a "pneumonia" causes the damage to the air sacs of the lungs. COVID-19 on its own cab cause a pneumonia, and also damages the lungs so that the body is susceptible to a secondary (from another pathogen) pneumonia. The secondary pneumonia would not be an issue if not for COVID-19

There is some evidence that using certain ventilator settings actually makes the damage worse. I just started reading an article about the "Vermontilator" which is a simplified ventilator with only one type of air delivery setting (as opposed to the typical multi-function, multi-modal ICU ventilator). I've just started the article, but it is exactly the type of American "can-do" attitude that this crisis needs.

[Todd Amunrud]

The null value is the most difficult sell.

Bingo. We’ve always stated were going to look like lazy nobody physicians in our small community hospital if we do this right. Early conversations with our only ophthalmologist included "joking" about her role learning intubation, vent settings, etc... fortunately, so far, for our group it’s just been an early joke. Ask providers who learned vent settings watching google in hard hit hospitals. This has been a tough sell. Personally, I stand to lose up to 35% of my salary this year(and part of me is okay with that). We’re trying to talk about moving away from a production model.

[Too Tall]

This is worth reading as a data point made more credible because the military does test rigorously and the supplicants have much less leeway in their personal mobility than civilians.

Re-infection is troubling to be certain if valid changes the calculus.

13 USS Theodore Roosevelt sailors test positive after recovering from Covid-19 - POLITICO

[j44ke]

Thanks TT.

[j44ke]

Amazing

How a Nurse Who Gives Last Rites Spends His Sundays - The New York Times

[Mark Kelly]

This is worth reading as a data point made more credible because the military does test rigorously and the supplicants have much less leeway in their personal mobility than civilians.

The result is troubling if these were re-infections. That is not certain, the numbers are still in line with the known incidence of false negatives.

[Too Tall]

The result is troubling if these were re-infections. That is not certain, the numbers are still in line with the known incidence of false negatives.

I'm with you on that. My fur stood on end they are exhibiting typical symptoms. If we get real lucky there will be some data resulting.

[cny rider]

Issue of reimbursement notwithstanding, pneumonia is simply a term for lung infection. The combination of infection and inflammatory response in a "pneumonia" causes the damage to the air sacs of the lungs. COVID-19 on its own cab cause a pneumonia, and also damages the lungs so that the body is susceptible to a secondary (from another pathogen) pneumonia. The secondary pneumonia would not be an issue if not for COVID-19

There is some evidence that using certain ventilator settings actually makes the damage worse. I just started reading an article about the "Vermontilator" which is a simplified ventilator with only one type of air delivery setting (as opposed to the typical multi-function, multi-modal ICU ventilator). I've just started the article, but it is exactly the type of American "can-do" attitude that this crisis needs.

Reimbursement and cause of death statistics are not as closely tied as some here seem to think.
When a patient is admitted to the hospital a provisional diagnosis is entered, and used for initial billing purposes.
Then "stuff happens", and additional new and ongoing billing codes are generated. They mostly come from a coder, not directly from the people providing the care.
Those charges get submitted to Medicare, Medicaid, or whatever insurer the patient has.

When a patient dies, the physician fills out a death certificate and submits it to their state registry.
The death numbers you see in the news are almost all from the physician and hospital reporting of COVID cases, not from coding and billing info.
You can do research using coding databases, but generally after the fact because it takes a long time for all that info to aggregate.

[thollandpe]

Cardiac issues kill significantly more people every year (650k in 2017), but we sure as shit aren't shutting down Bojangles or Cookout or In n Out, and grocery stores still sell an awful lot of sugar and salt laden foods.

If my heart arteries have narrowed to capillaries from years of cheeseburger abuse and I call 911 as v-fib is turning out the lights, I’m not going to spread my heart disease. Even if I accidentally smear barbecue sauce on the paramedics. The ambulance driver, orderlies, nurses, doctors, x-ray techs, candy stripers, janitors, and HVAC mechanics have exactly the same chance of cardiovascular issues as they had before they met me.

I need a beer.

Cheers.

[mzilliox]

we did the partial reopen thing here on friday. went to the farmers market yesterday with our masks, maybe 5% wearing masks. no social distance. the partial reopen signaled here, nothing to worry about, its all over. but we haven't had many cases, yet we still get a few. maybe thats rural population? maybe luck? but its not over, i was surprised to see how quickly things turned. oh, and dont worry much about the economy, everyone seemed to be back to spending as fast as they could. interesting times ahead

the unknowns lead folks to conspiracy, i get it, but usually the easy answer is the right one, everyone is just as confused as you are.

[Todd Amunrud]

A Pediatrician Treating Adults In The COVID-19 Pandemic Remembers His Patients : NPR


This is what needs to be communicated over and over that it isn’t “just like influenza" and why I left my comment above. Some of us who haven’t done adult ICU care since medical school(~17 years ago for me) are being prepped for it. We expect a surge due to poor social distancing, but I hope I’m wrong.

[Too Tall]

A Pediatrician Treating Adults In The COVID-19 Pandemic Remembers His Patients : NPR


This is what needs to be communicated over and over that it isn’t “just like influenza" and why I left my comment above. Some of us who haven’t done adult ICU care since medical school(~17 years ago for me) are being prepped for it. We expect a surge due to poor social distancing, but I hope I’m wrong.

What he said times infinity. Since this is the non-politcal thread I'll save my rage for that.

[mzilliox]

A Pediatrician Treating Adults In The COVID-19 Pandemic Remembers His Patients : NPR


This is what needs to be communicated over and over that it isn’t “just like influenza" and why I left my comment above. Some of us who haven’t done adult ICU care since medical school(~17 years ago for me) are being prepped for it. We expect a surge due to poor social distancing, but I hope I’m wrong.

people do seem to have this "you die or everything is fine "take on the disease. people are not keeping in mind the potential long term effects of contracting, not dying, and having to live life. some say its something like lymes disease after healing. My wife is doing contact tracing here, and during our "partial reopen, aka return to normal" she fully expecting an ctual outbreak, since we havent had one yet. Of course we hope shes wrong. Time as they say, tells the tale. stay safe out there.

[beeatnik]

Tale of Two O's

Oregon
Population: 4,218,000
Total Cases: 3612
Deaths: 137
Total Tests: 92121
Tests/1M pop: 21841

Orange County
Population: 3,179, 950
Cases: 4222
Deaths: 86
Total Tests: 69981
Tests/1M pop: 22006

Latino enclaves hit punishingly hard by coronavirus in Oregon, new data show - oregonlive.com

Coronavirus hits lower-income Latinos hardest in Orange County, study finds – Orange County Register

[Mark Kelly]

we did the partial reopen thing here on friday. went to the farmers market yesterday with our masks, maybe 5% wearing masks. no social distance. the partial reopen signaled here, nothing to worry about, its all over.

I think that's a cultural thing. Over here we are starting to reopen, having been a lot more cautious* and most people are still observing distancing , avoiding greetings etc. Not so much with the masks, they were never a thing here anyway.


* An interesting stat: our two countries are reopening at the same time but at very different response stages; over the past ten days there have been about 15,000 deaths in the USA and precisely one over here. Yes you have 15 times the population but that still gives a per capita rate 1000 times higher.

[gregl]

Judging from my social media feeds, we are screwed until a vaccine or effective antivirals are developed. First pleasant spring weekend in CNY and all I see are people enjoying themselves in groups and parents trying to figure out how to start up their kids’ spring sports. It will be interesting to see what the infection curves look like in two weeks. One neighbor told me how concerned he was about his son’s upcoming football season. He admitted he was more devastated than his son was. With human life a lower priority than high school sports and summer parties, we have no hope to lessen the suffering this virus will cause.

Greg

[guido]

Where Chronic Health Conditions and Coronavirus Could Collide - The New York Times

" As the new coronavirus continues to spread over the next months, and maybe even years, it could exact a heavy new toll in areas of the United States that have not yet seen major outbreaks but have high rates of diabetes, obesity, high blood pressure and other chronic health conditions.

Large parts of the South and Appalachia are especially vulnerable, according to a health-risk index created for The New York Times by PolicyMap, a company that analyzes local health data. The index for the first time identifies counties with high rates of the underlying conditions that increase residents’ risk of becoming severely ill if they are infected with the coronavirus.

Even in lower-risk counties, a significant proportion of the population is living with these conditions."

[gt6267a]

A little lemonade in a tough time?

NYT: bike-shortage-coronavirus

[j44ke]

Trump is taking hydroxychloroquine as a preventative. Obviously there are people who take hydroxychloroquine to manage lupus and deal with malaria, and they don't have heart events that cause their death. And he has a doctor managing his care, perhaps on an hour to hour basis due to the viral conditions in the White House.

But isn't it medically strange that a doctor would prescribe a drug that has not been shown to work against covid19 AND has possible dangerous side effects? And isn't it strange that the Secret Service would sign-off on the doctor's prescription of that drug to a standing President as a prophylaxis?

I know there is a French doctor who claims success with this medication. But isn't that doctor prescribing it as a form of early stage treatment? Has Trump tested positive for covid19?

[ides1056]

from your lips to God's ears