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1/19/21 Update From A Hospital Somewhere in Hell

I have a few moments of privacy due to enough time to walk to a solid cell connection (using hospital wifi to post to Tumblr isn't remotely prudent for a submissive kinky woman).

I have this opportunity because of death. At the moment, our census isn't as full or as unstable because the first wave of the December admissions have died.

I don't know when I'll get my second dose of Moderna. It's being held until we know more about the San Diego episodes.

I have had some relief because the National Guard has been sending us medical staff. We saw many more come rolling in this weekend. But were stunned to learn these extras are "force protection." The National Guard had to send armed soldiers to protect their own uniformed medical units. I cannot begin to process that.

We are overrun by dead bodies that cannot be claimed fast enough because the morgues and funeral homes are overrun now too. It's truly unimaginable.

Please, do the math. Scroll through my blog. Get educated. I wrote multiple pieces warning months ago about this predictable outcome and how to stay safe.

60% of COVID-19 cases in the United States happened AFTER THE ELECTION!

One simply cannot escape exponential growth. Math is math.

Thank you @gentlemenspreference @instructor144 and everyone else for your PMs. I cannot respond as I would wish, but do manage to see them briefly. They are appreciated.

The only way to ensure your survival is to not share air. DO NOT SHARE AIR! You must have layered, tight fitting masks and still be physically distanced by 9, yes NINE, feet. If your mask has gaps, make it 12.

IF YOU ARE HIGH RISK WITH SYMPTOMS, DEMAND THE POLYCLONAL ANTIBODIES. THEY MUST BE INFUSED EARLY TO PREVENT SEVERE DISEASE. YOU DO NOT NEED TO BE HOSPITALIZED TO RECEIVE AN INFUSION. THE MAJORITY OF DOSES ARE GOING UNUSED. THEY ARE OF LITTLE VALUE ONCE YOU'RE IN AN ICU.

There's now multiple variants on the ground here. All are more infectious. Some are more concerning, like L452R. Remember I said previously I suspected a new variant was at work here? Sadly I was correct. We have confirmed both L452R and B.1 1.7 here.

@instructor144 watch for L452R. It's mutation is likely to diminish the vaccines' effectiveness as well as diminish acquired immunity from a previous COVID-19 infection. We don't have the data yet, but the modeling is highly suggestive.

This is another consequence of "letting it rip." We have rolled the evolutionary dice with SARS-COV-2 too many times.

I shouldn't be here. I should be in a lab working to solve how SARS-COV-2 destroys the body so we can develop treatment. Patients deserve better than a lab rat as their physician. But I'm what you're going to get, or worse.

I am physically, emotionally and spiritually exhausted. Some of our staff are quitting. Some are leaving the profession all together. There's a deep sense of abandonment after almost a year. I guess I'm seeing my eventual future if we continue to choose this path.

But for now I must get back to work.

Before I go I want to take an aggressive rhetorical stand.

This is a passive genocide. The majority of patients that die are not White. They are Brown, Black and Native. The majority of those refusing to wear masks and follow the guidelines are White. Our current government has allowed this to happen knowing this data.

If you refuse to wear a mask or tolerate those who do -- you are participating in an act of genocide.

60% of my patients are not White. That is not reflective of the demographics of the population here.

The reasons for these numbers are not relevant in this discussion at the moment. It is enough to know the basic facts.

Wear the damned mask. If you don't, you're a walking gas chamber.

May the odds ever be in your favor.

#tired of getting our butt kicked by covid 19 #passive genocide #covid19 #covid 19 #sars cov 2 #wearamask

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12/30/30 UPDATE FROM HOSPITAL HELL

My privacy is currently limited due to shared quarters and the lack of cell service in the on call room, as is my time, so I'm unable to be more responsive here.

I received my 1st vaccination of Moderna -- sore arm, malaise, mild fever for less than 48 hours. I was able to work through it. I expect the 2nd vaccination to induce a greater immune response, but still to be manageable.

Our hospital system is under siege. Lines of ambulances, tents, refrigerator trucks for morgues, initial crisis standards of care and no end in sight. I'm living in a disaster movie.

We all suspect new strains are running rampant and that explains the explosive growth. We're seeing younger and healthier patients too.

Deaths are spiking again too.

The new strains are better hunters. Their spike protein is more effective. So less virus needs to be present to cause infection. Remember, the virus will die without a host [you]. A well adapted virus spreads silently and has a lower lethality rate. SARS-COV-2 is an exceptionally well adapted virus. But understand, the greater the R naught, the larger the number of deaths and hospitalizations at one time. It doesn't have to be more lethal in order for there to be more deaths. There are patients dying now that we could have saved three months ago.

I wrote months ago about letting this virus run was rolling the evolutionary dice. Sadly, the odds were not in our favor.

I need you to understand, masks alone are not enough. You must keep distance with masks. Masks must fit tightly. If you don't have access to an N95, layers of tight fitting masks are necessary.

DON'T SHARE AIR.

This will be worse before it's better.

God help us all.

@instructor144 @gentlemenspreference @katsdom I will respond when privacy and time allows.

@instructor144, in your hospital system, if you're seeing patients with negative PCR but "Covid Lung" let your staff know to use a broader PCR test. The standard ones are often missing the new strains. Only the NIH/CDC can officially confirm a new strain, but trust me, it's here.

#tired of getting our butt kicked by covid 19 #covid19 #sars cov 2 #covid 19 #wear the mask #crisis standard of care #stay home

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12/20/20 UPDATE FROM AN OVERRUN HOSPITAL

Staff was dropping faster than we could bring in more. I've been here 24/7 for I don't know how long. Our retired staff has completed the necessary two weeks of CME to get them up and running. So I can finally get some downtime.

We have traveling nurses who were in NYC last spring. They say this is worse.

The rate of increase in admissions is off the charts. Our patients are sicker as well. I cannot comprehend why, even after factoring in the Thanksgiving surge.

Our expected Pfizer vaccine doses were cut. The Moderna delivery scheduled for this week will cover our Pfizer cuts and our intubation teams.

I'm scheduled for my first inoculation Thursday.

If you've tagged or messaged me, I'm sorry, but I simply don't have it to give to go through them right now.

@instructor144 I hope you're faring better than we are.

Please people, stay home. My colleagues are stabilizing motor vehicle accident patients in the ambulance because we don't have anywhere to put them. It took 3 hours to get an open bed for an open fracture.

COVID-19 isn't the only reason you end up in the hospital.

Stay home. Don't share air. Take your prescribed medications on time. Don't fall. Stay hydrated. Eat well. Limit alcohol, sugar and salt. Doing these things will help keep you out the emergency department. Or worse -- our morgue is already full.

#covid19 #covid 19 #tired of getting our butt kicked by covid 19 #update #personal #about me

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Strange Days

I have attended more deaths in the last 10 days than in all of my residency.

I'm an introvert who has spent more continous hours with people in the last month than in the last year.

Then, as I was sitting alone on a bench, I was approached by a headhunter for a major hospital system today wanting me to leave my current position. I'm pretty sure he didn't have any idea about my background.

Pre-Covid, I was working a postdoc NIH research fellowship.

The university hospital system I did my residency in is where I've returned to clinical practice on an emergency basis due to COVID-19. There is a severe shortage of physicians. None of this is what I'm meant to be doing.

We heard the news that New Mexico is now using Crisis Standards of Care. We had a meeting to review ours last week. It's all falling apart amazingly fast.

I was hungry and went into a market to grab something fresh. I was in fresh scrubs, lab coat and a mask. A random stranger said something awful to me and another one thanked me two minutes later.

I can't seem to wrap my mind around the world I'm living in.

12/10/20

#personal #about me

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I saw your post about people giving you shit for your COVID.... claims? I don’t want to call them that because I assume you know what you’re talking about, but it’s very late and I’m tired and word-stupid. Anyway I wanted to tell you my sister is an ICU nurse and I’m adding you to the prayers I say nightly for her safety. What you are doing is nothing short of entering a combat zone and you deserve every good wish.

Thank you @prismatic-bell .

I think you are right. My colleagues who've been working ICU since the beginning of the pandemic have an affect that is indicative of trauma.

I have never been so emotionally drained and physically exhausted.

Pass my good will to your sister please. Physicians are covered in the glory but it's the nurses that deserve it. I am able to do my job because they see to it I can.

12/10/20

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A BRIEF WORD ON EMPLOYER OR BUISNESS MANDATED VACCINATION

All COVID-19 vaccines in the foreseeable future will available inside the United States on an Emergency Use Authorization (EAU).

No employer or business will be in a position to mandate it like the influenza vaccines until a COVID-19 vaccine is fully FDA authorized.

I expect COVID-19 vaccination to become on par with influenza vaccination with the travel industry also requiring vaccination cards and ID. I predict the cruise lines will be first to do so as their very existence will depend on controlling outbreaks of illness.

12/10/20

#tired of getting our butt kicked by covid 19 #covid19 #covid 19 #sars cov 2 #take the vaccine #vaccine #vaccination #vaccine mandate in us

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WHAT IS A "SEVERE ALLERGIC REACTION?"

What You Need To Know About The Pfizer COVID-19 Vaccine Warnings

The UK has added a specific emergency warning to the Pfizer COVID-19 vaccine. Two healthy young healthcare workers had a severe allergic reaction to the vaccine. Both carry some version of an EpiPen because they have a life threatening allergic response called anaphylaxis to something(s) in their lives.

Anaphylaxis is typically an IgE (Immonglobulin E) mediated response that can cause the trachea to swell shut (a gross oversimplification). The EpiPen is a type of injectable adrenaline, which through vasoconstrictor effects, prevents or decreases upper airway mucosal edema (laryngeal edema), hypotension, and shock. In addition, it has important bronchodilator effects and cardiac inotropic and chronotropic effects.

Common expressions of this are peanut allergies, allergies to bee venom, shellfish allergies, and penicillin allergies.

A relatively tiny percentage of the human population experience this type of allergic response for any reason.

The new UK warning is two fold: (1) if you have any history of a severe allergic reaction, especially if you carry an EpiPen, DO NOT take the Pfizer vaccine, and (2) the vaccine should NOT be administered in a facility that cannot provide "resuscitation" -- intubation to protect the airway.

THIS DOES NOT MEAN THE VACCINE IS INHERENTLY DANGEROUS! No more so than say penicillin is.

If these two experienced an anaphylactic reaction, and I suspect they did, it isn't going to impact most recipients. In anaphylaxis, the first exposure to an allergen is the sensitizing event, the subsequent exposure(s) reveal the allergy. Therefore, any unique substances in the vaccine are not the source of anaphylaxis here.

However, it is extremely concerning news in regards to protecting a larger number of people from contracting COVID-19.

There are millions who cannot receive the normal childhood and adult vaccines already. Many vaccines are contraindicated for infants for example. Those that cannot safely be vaccinated rely on herd immunity for protection -- meaning a large enough portion of us are vaccinated so that they receive some meaningful level of protection because the "herd" isn't a vector for transmission. (I'll use this to point out that the anti-vaccers are an ongoing threat to our infants because they weaken herd immunity. Do not allow unvaccinated people anywhere near your baby. Polio and measles are particularly dangerous and on the rise.)

If we now must add to the numbers of humans a vaccine is contraindicated for, the "end" of the pandemic requires even more vaccination cooperation.

12/10/20

#pfizer #take the vaccine #vaccination #covid19 #sars cov 2 #tired of getting our butt kicked by covid 19 #covid 19

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Reblogged 12/7/20

THANK YOU, RESPIRATORY THERAPISTS

I want to take a moment to sing the praises of the unsung heroes -- respiratory therapists.

"Doctors and nurses" are often lauded on the news and in memes, but it is the respiratory therapists that are the most necessary and frontline of the frontline.

I am a better clinician because of the education our RT team is giving me daily.

It's the RT staff that enables those of us called to give care outside our scope of practice to be able to rise to the occasion. Currently in my hospital system we are a mix of MD-PhD subspecialties, pediatric specialties, and orthopedic surgeons.

All of us depend on the RT staff.

To all of the respiratory therapists out there, thank you. You are national heroes. You take the greatest risk and are overlooked. You teach and stand up phycians suddenly thrown into the deep end.

I see you. I acknowledge you. I thank you.

I'll also pass on to those of you who use inhalers a warning.

⚠️ albuterol and other bronchodialators are on the critical shortage list of drugs. Our RT staff is instructing every pt at discharge to reorder these meds as early as possible. They are asking us to write scripts that allow for the dispensing of two inhalers. The tight supply and expected worsening of the supply chain will leave many at risk.

If you use prophylactic medications, now is not the time to skip doses.

#tired of getting our butt kicked by covid 19 #asthma #copd #albuterol #respiratory therapists

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There's not enough vaccine for all of us in our COVID-19 ICU. There's less Pfizer than we were told.

I have chosen not to be in the first round to make mine available for other clinicians who are parents. I have no children and am unmarried.

I am incredibly angry to find out that the President chose to buy 50% less of the Pfizer vaccine available to us.

Pfizer says June or July for resupply in the USA. The vaccine left on the table is going to other countries.

I hope that the Moderna vaccine will be made available to me before the end of the month.

@instructor144 your hospital will get less too I believe.

#covid19 #vaccine

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Reblogged 12/6/20

Working 12 hour plus shifts daily. COVID-19 ICU, ED consults and running a code team at least one shift every 4 days.

It's worsening here every day.

I have been asked why I think I know so much about COVID-19 and had my claims challenged.

I am not going to directly engage with science deniers or biological propagandists. I delete and block instead.

I won't give out my CV, but I will give some of my educational and professional background.

I work within the NIH laboratories network. I have an MD-PhD. My current research is what you might label COVID-19 adjacent. I am working on immune responses, endothelial cells and SARS-CoV2 in humans.

I am not a practicing physician in any traditional context. I am a research scientist, one of thousands who quietly plug away at discovery. The patients I see are within my research. I am not directly responsible for their treatment.

I am not a COVID-19 expert, virologist or epidemiologist. My expertise is best described as based in immunology.

Always question biological claims. Science is meant to be challenged.

But do it respectfully.

Do not fill up my inbox with political arguments or rude demands if you want access to my blog.

If I offend you, block me.

If you want to engage in scientific debate, cite references for your claims challengung mine and I will do the same.

But do it respectfully.

#about me

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@mikeepoo I intubate COVID-19 patients and work an ICU code team some shifts. Rushing is my job description.

The two mRNA vaccines have been tested on approximately 30 to 40K of American Guinea Pigs prior to the FDA review board meeting.

I don't have the number of subjects in other countries.

Because these trials are happening simultaneously under a variety of regulatory rubrics, the numbers are far larger than the media mention.

We do in fact KNOW there is a benefit in the reduction of cases of serious COVID-19 disease -- the kind that can lead to hospitalization.

I have no doubt your suggested test subjects will finagle their way to the earliest possible doses, especially of the mRNA ones. I doubt they will admit to it.

I agree that the majority of Americans do not meet the 1A 1B criteria.

As to the how vaccines (or any medications) get approved here, the system is designed to prevent bias leaking in. Hence, a double blind study. The test subjects and those administering the test do not know what's being administered -- either saline or vaccine. Everything is assigned a code number and entered directly into a computer data base. The company itself does NOT have access to this information. In fact, they STILL do not. No one other than outside, independent review board does (and then it was submitted to the FDA review board). This outside body has predetermined dates when they crack open the database and check to see if the data sets have met a predetermined standard. Then they publicly report the top line numbers only to the company. That's why it's been the only publicly released information. Until the FDA approves the EUA, that data is held to protect the ongoing stage clinical trial still ongoing from bias like the placebo effect. When the approve the EUA, the company and the public at large will receive all of it. The independent review board is made up highly trained statisticians, physicians and researchers. That data has been in the hands of the FDA since the day Pfizer and Moderna applied for their EAU.

The date of the public hearings, the board, the company, and scientists will answer all questions and challenges put to them about the data by the FDA. Then the panel will vote, publicly, to approve or deny the application.

There is no secret cabal.

The majority of medical personnel I know do not trust administrative rhetoric or company sales points. Nor should they. They will review the data once released.

All medical interventions, such as being vaccinated, is a math problem in the end. It is a cost benefit analysis of the available options, including doing nothing.

Not all of us have options. The elderly in nursing homes, those that must work in a public indoor setting, and those of us that intubate COVID-19 patients fir example.

If your risk profile allows you to stay home and avoid indoor settings most days while not interacting in person with others who come and go, then your choice to watch and wait carries little cost, provided you are not over 65, overweight or have any other comorbidities.

We are 100% certain contracting COVID-19 is the immunological version of the hunger games.

May the odds ever be in your favor.

WHAT WE DON'T KNOW: vaccine tidbits as of 12/6/20

We don't have data about multiple aspects of COVID-19 vaccination. (Vaccination vs vaccine: The vaccine is what we inject. There are multiple vaccines based on multiple platforms in the works. Vaccination is what happens once any of them is inside a body.)

• Currently, we don't know if vaccination only protects you or if it prevents spread too. Until the data reveal themselves and confirm vaccination prevents spread or 70 to 75% have immunity, we will need to maintain mitigation measures. My current guess on a return to "normal" remains the end of 2021 will look closer to the end of 2019.

• Currently, we don't know how long neutralizing antibodies will remain elevated or even present after vaccination or exposure.

• Currently, we don't know if declining neutralizing antibodies are indicative of declining immunity. Your immune responses are extremely complex and in no way limited to neutralizing antibodies.

• Currently, we don't know if there will be mutations, like with influenza, that will require updated vaccines. Therefore we currently don't know if these vaccines are akin to measles vs tetanus vs influenza.

Why don't we know?

Because we cannot afford to wait years for experimental data to reveal the answers. We know the vaccine is safe and initially effective in preventing SERIOUS disease and death. This is what The Simpsons would call a "Shutup and take my money!" moment.

I am an immunologist. I will be taking one of the mRNA vaccines in two weeks (presumably).

I am hoping after the second dose to have what is commonly known as side effects, but in actuality is an immune system response as desired.

Much of what patients call "symptoms" of most infections are in fact the immune system doing its job. Fever cooks invaders. A runny nose sheds invaders. Diarrhea sheds invaders. Vomiting ejects invaders. Thicker sputum sheds and creates a barrier. Funny colors of runny noses and sputum are usually the after effects of lysing invaders and debris from immunological responses. Grinding out all the various components of an immune response takes energy so being tired and feeling malaise is predictable.

Feeling somewhat bad after a vaccine is actually a good sign that you are achieving immunity at some level.

Humans with autoimmune disorders suffer from immune symptoms without ever encountering an invader. Allergies are your immune system responding to a not threatening substance as if it were.

When you have sneezing, a runny nose and running eyes, all I know is your immune system is responding to something. I have no idea if you are "sick" or not. I have to ask many more questions and run some tests to determine the answer.

Please do not refuse a vaccine because you heard about "side effects" that are exactly the reason you need the vaccine -- an immunological response.

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@instructor144 here's another version of your DFL>DNF>>DNS inequality statement.

Congrats on your trail race win. You are brave and strong.

12/6/20

#144 #144 running

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WHAT WE DON'T KNOW: vaccine tidbits as of 12/6/20

We don't have data about multiple aspects of COVID-19 vaccination. (Vaccination vs vaccine: The vaccine is what we inject. There are multiple vaccines based on multiple platforms in the works. Vaccination is what happens once any of them is inside a body.)

• Currently, we don't know if vaccination only protects you or if it prevents spread too. Until the data reveal themselves and confirm vaccination prevents spread or 70 to 75% have immunity, we will need to maintain mitigation measures. My current guess on a return to "normal" remains the end of 2021 will look closer to the end of 2019.

• Currently, we don't know how long neutralizing antibodies will remain elevated or even present after vaccination or exposure.

• Currently, we don't know if declining neutralizing antibodies are indicative of declining immunity. Your immune responses are extremely complex and in no way limited to neutralizing antibodies.

• Currently, we don't know if there will be mutations, like with influenza, that will require updated vaccines. Therefore we currently don't know if these vaccines are akin to measles vs tetanus vs influenza.

Why don't we know?

Because we cannot afford to wait years for experimental data to reveal the answers. We know the vaccine is safe and initially effective in preventing SERIOUS disease and death. This is what The Simpsons would call a "Shutup and take my money!" moment.

I am an immunologist. I will be taking one of the mRNA vaccines in two weeks (presumably).

I am hoping after the second dose to have what is commonly known as side effects, but in actuality is an immune system response as desired.

Much of what patients call "symptoms" of most infections are in fact the immune system doing its job. Fever cooks invaders. A runny nose sheds invaders. Diarrhea sheds invaders. Vomiting ejects invaders. Thicker sputum sheds and creates a barrier. Funny colors of runny noses and sputum are usually the after effects of lysing invaders and debris from immunological responses. Grinding out all the various components of an immune response takes energy so being tired and feeling malaise is predictable.

Feeling somewhat bad after a vaccine is actually a good sign that you are achieving immunity at some level.

Humans with autoimmune disorders suffer from immune symptoms without ever encountering an invader. Allergies are your immune system responding to a not threatening substance as if it were.

When you have sneezing, a runny nose and running eyes, all I know is your immune system is responding to something. I have no idea if you are "sick" or not. I have to ask many more questions and run some tests to determine the answer.

Please do not refuse a vaccine because you heard about "side effects" that are exactly the reason you need the vaccine -- an immunological response.

#take the vaccine #covid19 #sars cov2 #tired of getting our butt kicked by covid 19 #wear the mask #vaccination #vaccine #mrna #covid 19

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Why Wear A Mask?

SARS-COV-2 filled droplets, fluid dynamics and the physics of exhalation shown in a quick video. 6ft isn't enough distance. It's based on experimental data from the 1930's.

The biggest problem is that the youngest, healthiest COVID-19 positive people are the least likely to develop symptoms while simultaneously being highly efficient virus factories explosively exhaling it into the environment.

Today I intubated a patient, somebody's wife and mother, in a God damned hallway. It took another 3 hours to get a COVID-19 ICU bed.

Can you imagine running a code in a hallway?

When I initially evaluated her, she told me they had a family dinner to meet her son's new girlfriend. This was her only recent outside her immediate bubble contact. The son has since tested positive with no symptoms. He's the only one in the family positive.

When you choose to not wear a mask, you are choosing to be a willing participant in the destruction of America and the health care system. You are not a patriot. WWJD? He'd walk the extra mile to wear a mask. Wearing a mask would be considered a mitzvah. Or a Fard if you prefer.  ["you shall love your neighbor as yourself" -- Leviticus 19:18] Certainly not wearing one is adharma.

Don't do this to your family. Whatever you celebrate this Holiday season, I'm sure God isn't looking to you for a human sacrifice.

If not for yourself, then for your mother.

Wear the mask ALWAYS when people outside your immediate bubble are present. Eat more than 6ft apart from outsiders. Wash your hands. Avoid indoor settings with outsiders whenever possible. Stay as safe as possible by avoiding activities that risk you needing an ICU bed.

You don't want to code in a hallway with a lab rat for a physician assisted by a 4th year medical student.

12/4/20

#tired of getting our butt kicked by covid 19 #covid19 #sars cov2 #covid 19 #i'd kill to only be exhausted

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Reblogged 12/3/20

RAPID AND SALIVA BASED COVID-19 TESTING; What You Need To Know

Let's start with understanding tests in general. We are scooping up some part of mucous and looking for SARS-CoV2 particles.

The first limitation is the sensitivity of the test of itself. There is a minimum amount required in order to ping as positive. The second limitation is chance. We have to get mucous that contains enough particles. Not all goblet cells are hosting and pumping out virus. The third limitation is one based on accurately identifying the virus. The fourth limitation is the nature of the virus itself and how it invades the body. You can read about that here.

Your status affects the accuracy of these rapid tests as well. They are less accurate (more FALSE NEGATIVES) in a person without symptoms. Remember, the virus prefers to invade your goblet cells in your sinuses and it takes time to work its way into more and deeper goblet cells. So it's in your deep sinuses the first and greatest amounts are likely to be found.

All of this is why we ask you to self quarantine for a few days even after an initial negative result if you have been exposed -- we're waiting to see if symptoms develop to give us an extra measure of certainty.

None of these are as accurate as the deep nasal swab PCR test. In that test, we scrape ground zero of the viral invasion zone. Then we run a type of genetic test to confirm the identity of SARS-CoV2. Remember, there are common cold coronavirus types too. This test is both highly sensitive and highly accurate, even in asymptomatic and presymptomatic persons. But it too is limited. You could have only been just infected and not producing enough virus for our swab to pick up yet.

I write to urge you to only rely on the PCR testing and rigid isolation protocols prior to sharing an indoor Thanksgiving [edited] HOLIDAY with anyone over 60, overweight, diabetic, takes an ACE2 based medication, has HBP, any cardiovascular history, any pulmonary issues such as asthma or COPD, or any immune health issues (autoimmune disease or compromised). Any of these put someone at risk.

If you are symptomatic, these non PCR tests are really quite good at confirming COVID-19. They were not designed as a travel pass. Do not treat them as such.

Speaking of symptoms, fever is not necessarily a primary nor early symptom. The variety of symptoms are explained by where the virus sets up shop in a particular body best. Your body has goblet cells all over the place, especially ears/nose/throat/lungs which give the most common symptoms. But also your entire gastrointestinal tract. I suspect this will turn out to be why cruise and navy ships are such successful super spreader locations, not just proximity. Their waste water systems are giant collection and storage systems of mucous. (Just imagine the force of the spray of any commercial toilet in a public restroom. This is not the place to adjust your mask.)

PLEASE be mindful and care for those you love.

The best practice is to stay home. But if you refuse to do that, harm mitigation practices need to be in place.

If you are infected, you are most infectious in the three days prior to your first symptom.

No one wants to look up from a hospital bed and see me. Or a terrified 4th year medical student. But we're what you're going to get because there's not enough experienced clinicians to go around. There is no replacement for clinical experience. The MD of my MD-PhD isn't any different, but my lessened clinical experience means you don't get the best care, just the best care available in the winter surge of an out of control pandemic.

May the odds ever be in your favor.

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COVID-19 WARD UPDATE:

12/2/20

The last 36 hours are a blur for me.

7 intubations, 4 deaths and 12 step down transfers.

I lost count of the codes.

When I left, I had 2 heading in the wrong direction.

I'm hitting the pillow for at least 8 hours here in the dirty doc quarters.

I work with a traveling nurse who responded to NYC last spring. She shared videos of shift change. When we left, she said "no one remembers us now."

So I'm asking anyone who lives near a hospital experiencing this winter surge, maybe get in your car at shift change and honk your good will?

Maybe send thank you notes and Christmas cards to the hospital departments?

Maybe post videos on social media and tag your hospital?

I'm fresh from the lab, but most of the staff have been in the trenches since March. The level of their exhaustion runs deep.

Anything you can think of do let them see and feel support will go a long way.

Please, please, please -- I'm begging you -- do everything possible to stay safe. Winter sports and driving increases trauma. We don't have the beds, equipment and personnel to treat you. Properly wear and handle your mask. Correctly wash your hands often. Stay at least 6ft away from others. Stay out of indoor gatherings whenever possible.

#tired of getting our butt kicked by covid 19 #covid19 #covid 19 #sars cov 2 #wear the mask

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Reblogged 11/2/20 via queue

Watch "Doctor recreates what COVID patients see in the moments before they die" on YouTube

Using all of your accessory muscles in an attempt to breathe after BiPAP and high flow oxygen begin failing while the sounds of drowning in your own fluids echo in the now crowded room.

Alarms sounding, nurses calling out numbers and a doctor calling for the intubation cart.

There's no time to call home and say "I love you" or "goodbye."

It was quick, unexpected. You seemed to be doing well enough.

Until you weren't.

Hopefully your last thoughts aren't "Oh my God, this is what happened to Mom. If only ..."

PLEASE WEAR THE MASK, KEEP YOUR DISTANCE AND WASH YOUR HANDS FREQUENTLY