COVID-19 update from a future frontline

It's been just over 3 weeks since Governor Abbott declared a state of disaster for Texas. By that time we had 39 cases and no death in our state. Today we are at 7,276 cases and 140 fatalities. I live in a small rural community somewhere halfway between San Antonio and Corpus Christi. My county issues a stay-at-home on the 28th of March.  I am the director of the ED and ICU of a small 70 bed hospital and we are part of a larger hospital system. So, decisions are usually made by the corporate office and then trickle down to the individual hospitals. As of today, we have not had a confirmed case of Covid-19 at our facility or our community, yet all counties around us have confirmed a few cases. It is estimated that we are going to see a vast increase in numbers during the next few weeks. So, where do we stand in all of this? We are having the same problems as anybody else. A broken supply chain! No N-95 masks available, no  face shields, not enough gowns! Not yet an issue for us since we have only had 3 or 4 dozen of PUI's, but once the real thing happens we'll be up to our armpits in alligators’. Company policies that clearly not always in line with what Experts recommending. CDC recommendations change daily and are just another frikkin joke, just like during the Ebola crisis. They seem to change their ideas daily and habitually downgrade the risks since they know our healthcare system is not going to win the fight against this enemy. All we are going to do is to minimize the damage and ride it out. Winning it would be eradication and inoculation. Can anybody tell me what some states are going to do with 30-40,000 vents? Just in case you do not know, there has been a shortage of nurses and qualified personnel for years. Who do the politicians and news media think is going to operate those vents? The patient’s families? There ARE NO QUALIFIED PEOPLE! There never have been. Profit-before-People in the healthcare INDUSTRY made sure off that. I listen to the news and no matter if it is left, right or center; it's all a bunch of BS. Smoke and mirrors and ignorance are what got us in this situation. For as long as healthcare is a business driven by profit and traded on the stock exchange we will never be ready. We have to stand up and say enough of the BS and start looking after our sick and hurt. The wealthiest nation in the world and we can't buy thermometers, masks, gowns etc.

So, instead of answering question for those that are looking for help in Answers I have been busy for the last 4 weeks preparing my staff and my units for whatever lies ahead. My goal is to minimize any chance of contamination to anybody. As for our patients and community the only thing we can do for Covid-19 victims is to identify and isolate. All of our treatments will be supportive in nature only since there are no curative interventions yet. Everything we hear on TV or read on social media, is nothing but experimental.

I am in a very fortunate position. I have a President and a CNO that are in total support of protecting our staff and patients. This is our only goal.  Our facility has had an empty wing with 12 private rooms and 2 negative pressure rooms. It was closed years ago due to a decrease in one of our service lines. In the past we’ve used that wing for storage, as well as overflow area for the Emergency Department and ultimately we had it set up for the Ebola crisis which now seems decades ago. I was granted permission to use it as an isolation area for any possible COVID-19 patients.

We also utilized our Decon tent which we will be using for the mild cases, those that can be send home under self quarantine. We erected a larger tent to utilize as an overflow area just in case our county gets hit hard and we can’t keep up. Those will be for moderate cases. At least both tents have AC and the larger one utilize HEPA filtration. All vented patients etc. will be distributed between the ED and ICU in the main building. From a logistical point we got it figured out. Here are the challenges. Not enough beds/cots available. Not enough PPE available and only very limited hardware available for any kind of Telemedicine. Remember, we are a small hospital, we got one Doc working. We will need to utilize technology to our best advantage to make the most of our limited staffing and limited PPE.

We are not NYC or LA so we will never get the help we will need. Anything over 8 vented patients would be a major disaster for us, while others would be happy to only have that many. Nice that Apple now decided to make face-shields and everybody is going to build vents and donate masks etc., but rest assured those will never go to places like ours. No PR value in that for greed driven America. Our staff is prepared to face whatever challenge may come our way and we will prevail. We always do and we always manage.

We were also instrumental in establishing a drive through COVID-19 testing site for our County and if I find some time I ‘ll tell you more about that. We also designed and build a UV sterilization cabinet as outlined and tested on here. There are also two videos that I yet have to convert so I can post on here. They will explain the patient flow a bit better. I know, you all must think it looks like some sort of refugee camp. It’s totally crazy but trust me, it’ll work and we will continue to provide safe patient care as we always do

Outside triage area. This way nobody gets to enter without being checked

This is south Texas. Installing shade cloth is important to our well being.

This will be setup with rapid triage equipment to identify and isolate

Ready for a privacy fence to keep onlookers away.

Not bad for one days work. It’ll do the trick

Decon tent for assessment of mild cases

Here is our overflow for moderate victims.

Am I concerned about things to come? !&&* yeah but I do believe “That which does not kill us makes us stronger.” We will prevail!

Here is a quick update about what has been going on in my little hospital/community. If we consider COVID-19 the unseen enemy, let me tell you that I have met the enemy. It is just as frightening as anyone could imagine. You just do not know who has it and it is the people that you least expect it who will hand you a surprise. We've had mild as well as severe cases of it and managed to get through this. For now, all off our patients survived. Thankfully my staff is on point and always vigilant. We managed to identify and isolate the patients appropriately without the possibility of us getting infected as well as protected the other patients in my departments by separating them to the right areas. It is scary. We still do have N-95 not because of some amazing corporate healthcare thing but by my staff being prudent and careful with the use as well as reuse on those. We are having critical levels with proper gowns now. No, we are not going to use trash bags but have managed to use our "home built" sterilizer. We manage to sterilize gowns,masks,face shields etc.

As for the efficacy of the sterilizer lights "cabinets", I purchased a photometer to measure the output of the UVC lights in this cabinet. I got an average of 500uW/cm^2 With those numbers we can re-sterilize about 15 masks in 20 minutes. Not bad for us since that is currently the daily max of masks we are using. I built an additional light that we can place in front of the cabinet so as to also do inside/backsides of gowns and masks at the same time.

What really helps us as a small facility is the willingness of Universities/ teaching facilities to share their information as well as experiences. It enabled us to learn from those and to implement processes that are helping us. Also, iFixit's initiative to get as many people involved in providing service manuals etc. for Ventilators that are commonly used makes a big difference. Even so we have not had to refer to those just yet, it provides us with a huge security blanket. We know that repair information is available and we know that there are people/organizations out there that actually do care about us. This just reiterates what we have been saying for decades on iFixit’s Answers as well as the Right to Repair. Being transparent and the sharing of information will always have a positive impact on human lives and our Planet. It makes a difference. Unlike companies like Apple, (of course not the only major corporation that does not care for small town USA) that never followed up/through with any request for assistance. No, free was never asked for. The staff in our hospital ended up providing plenty of old/older iPad's to us that we could then use to connect to our network. We use those to practice tele-medicine which does save us plenty of PPE. Again, it is not corporate America or corporate Healthcare that takes care of patients. It is the frontline staff that makes things happening. Patients do not survive because of corporate policies that are re-written daily on how to reuse masks over and over again. They survive because of the ingenuity that nurses and other staff are using to make sure that people are okay. COVID-19 has not broken the healthcare system, it only showed the general public how broken our system really is. Profit -before-People is the common factor in all of this. Let's squeeze every dime out of this and let's not worry about providers. We can always hire new ones. Let's not fool ourselves. Healthcare is no different than any other industry. Dealing with human lives is treated no different than dealing with any other commodity. As long as it makes money we will continue with this practice.

Best part of this crisis was that corporations, Governments (state and federal) as well as individuals within an organization, got called out. We found the ones that have integrity and ethics as well as those who lack those qualities. We now know who we can trust and rely on. Like my " 'Rona Team"!

These individuals have been doing the public testing in our community Drive-Thru test site since its creation. They are there. Day in, day out no matter how busy, how slow, how hot or how rainy; they are always volunteering their time. Nobody gets paid or reimbursed but everybody is there. That is the integrity, loyalty and devotion that we as human beings and healthcare providers should posses.

Anyhow, this is just an update of the ONGOING pandemic. It is NOT over yet, no matter what our "leaders" are telling us. Please continue to play it smart. WEAR YOUR MASKS, WASH YOUR HANDS AND PRACTICE SOCIAL DISTANCING.

Opinions expressed are solely my own and do not express the views or opinions of my employer

As we are all slowly realizing, COVID-19 is not going away and we will have to learn to live with it (and sadly some will continue to die because of it) until we have a reliable vaccine. My team and I continue to try to keep people as safe as possible and to identify, isolate and treat those that are infected. This is a humongous challenge due to the politicizing of this pandemic. There is so much mis and dis information out that it makes ones head spin. To say the least, people have truly interesting ideas about this virus. Besides the politicizing of this, COVID-19 has called us out. We now see what happens when healthcare is run as a business. If we continue to put profit before people, we will continue to lose the battle against this and other public health pandemics. Just in my small county, we now had over 1600 cases of COVID-19 and 28 patients have lost their fight against this dreadful virus. It hit us hard since every one of those was known to some of us. These were our neighbors, friends and families.

Because COVID-19 and all the activities that came with this, I was on a self-imposed hiatus. I did try to use Twitter to keep up with some of the great people on here but it just is not the same. Since there is no more that I can do besides the things I am already doing, I decided it is time to once more becoming more active on iFixit. Helping others to repair their devices and saving our landfills and our planet continues to be a priority to me.

Thanks to all of you that have supported my efforts and supported me during this hiatus.

The simple steps everyone can take to help prevent spreading the virus:

Wear a mask (over the nose and mouth);

Practice social distancing by staying at least six feet away;

Wash your hands often with soap and water for at least 20 seconds;

Here is just a brief update about how things are looking in my part of the world. Remember that my county is a small South Texas County. We have around 32,000 people listed as residents. Since my team and I are still the ‘Rona Team for the county we see what is happening on the front of the front lines. We are still tested around 100 people a week and our current rate of positive PCR tests remains to high at 20%. Out local schools and College have gone through multiple lockdowns since the fall due to higher than CDC recommended COVID-19 positive rates. Our community college had to suspend all of their athletics due to a high positive rate. As for those who think that this is all just hype, we had 40 fatalities since April strictly based on a COVID-19 diagnosis and I have been present for about 90% of those. You have not seen anything until you see what a person looks like that simply cannot breath and has to be placed on a ventilator and subsequently dies because of this. Alone, surrounded only by HCP’s in PPE and maybe their loved ones had a chance of having said their goodbyes via Facetime. What a terrible, lonely, sad way of dying. That is 40 above and beyond the fatalities that we have from other causes. I’ve also lost colleagues that have had no comorbidities, to this virus. Stuff like that weighs heavy on one’s psyche What is disturbing for most of us health care providers is the politicization. We do not care about your race, color, language, sexual orientation and least of all your political views. We care for you as a person and a human being. So let us not turn this into politics and keep it what it is: A public health crisis and a pandemic. I am okay with a Querdenker opinion like the one voiced by @einstein333 . I am not okay with thinking for a second that my friends, colleagues and neighbors have suffered and succumb to this in vain. We all must take lessons away from this.

Besides our COVID-19 test site we are now also involved in the planning and hopefully executing the immunization of our residents. We are planning to vaccinate no less than 500 people a day. I know my team and I can do it and our county government as well as employer (even so we all are all volunteers and using our vacation time ;-) is supporting all of this 100%. This somewhat restored my belief in humanity. Keep your fingers crossed that we are going to at least put a dent into this Beast.

Anyhow, iFixit has been my mentally saving grace. It allows me to deal with the stress brought on by this crisis, even so I have not had the mental attitude to do any micro repair. I did repair plenty of TV’s as well as doing some home remodel. You know, things like washer and dryer repair, installing wood burning stove, re-plumbing the MBR etc.,. It is a great way of focusing one’s anger, anxiety and despair into something useful. It clears the mind and helps me to refocus. To me, repairs and Answers are like chicken soup for the soul. The more you do and the more you give, the better you feel. It lifts the heavy, negative clouds that form around ones brain.

Wear your mask, keep your distance and wash your hands properly and often. Stay safe. It is okay if you do not care enough about yourself, but at least you should care about your family, friends and neighbors. They may be people like me that want to just live a little bit longer.

As for all of us, let’s keep repairing and protect our planet by keeping ewaste out of the landfill. Our combined efforts do have an impact, even if it is one device at a time.

Okay so here is finally some good news. I have received my COVID-19 vaccine this morning. Yay! Now on to get everybody else vaccinated.

So this will be my last update on this topic. We managed to administer around 45,000 shots. Our county has some good numbers at 74% of the population over 65 having been fully vaccinated, 56%of 16 years and over and for now just 5% of the 12-16 year old bracket. We still provide vaccines 3 times a week,

It was a chore but overall very rewarding since people appreciated our efforts. This is what it looked like every morning we held our drive through clinic

. People lined up at 3am for our 9am opening and the time from start to 15 minute wait after vaccination was 20 minutes average. We rocked it and people came from all over Texas because of this. Yes, we even had people flying in to our municipal airport for their vaccines. We went to hold clinics at local refineries and manufacturers; went to small county fire stations and whatever other venue we could get to.

This is the line snaking through the drive-thru

2500 customers each clinic day kept us busy but in a good way. Our community has slowed down with the demand on vaccine and we make sure that anybody that wants it is going to receive it.

Anyhow, this is not the all clear. We are still seeing COVID-19 positive patients but have not had a death in over 2 month. It does look better but we remain vigilant. Yes, masks, hand hygiene and social distancing are still a thing for us. The time has come to look for the new normal since I do not believe we can ever go back to the “old ways”. I believe that this pandemic has validated that we cannot trust any government to take care of us. WE THE PEOPLE have to take the initiative and look out for each other. Elected officials on all levels will have to be challenged, pushed, questioned about what it is that they are doing for us, not the other way around. I elected you, you work for me not some special interest group. This pandemic has shown how broken parts of our system are and how we have been lied too and how these lies have killed people. PPE being the biggest failure of this. It is time for us to move on and to never forget what has happened. Let us be vigilant with our elected official, trust but verify everything they say or do and let them know there will be consequences. The greatest people are those that have shown their compassion and understanding to those that have been hit hardest by this BEAST.

Let’s face it, we ARE our brothers keeper and we will have to take care of each other. Help wherever help is needed and give people a hands up when they are down. Taking care of our planet must be next. I went through a deep freeze in South Texas the way it hadn’t happened in a very long time. Ever worked in a Hospital that has no running water and is on genny power for 5 days? Interesting aromas develop quickly and try to take care of some really sick patients in an environment like that. People dying because of hypothermia, having no water or electricity, broken supply chains when it comes to things we take for granted did make us feel like a third world country. We have seen mother nature’s fury in the likes of a killer Virus and changing climate. We know it will get us in the end if we are going to continue to do things the way we have. Let us clean up our act NOW. We must stop wasting resources, behaving like spoiled brats by always wanting the latest and greatest technology and tossing that which does not please us or is “old” into the trash. NO! MORE! We must go back to the times where people were much smarter about this and fixed stuff instead of throwing it out. We must Reduce, Reuse, Repurpose, Repair and Recycle whatever we can and there is a lot of room to improve on that.

It’s on. Here is my new battle cry “REPAIR IS WAR ON ENTROPY”

As some of you may have noticed, I was once more on an 8 week-long “hiatus”. Not because I got tired of answering questions, loss of interest, or anything like that. I was once again busy trying to keep the Beast in check. The last 8 weeks have been an extreme challenge for our community. It started to get absolutely chaotic around July 14 (ten days past all the July 4th celebrations)

Here is our 3rd wave

This 3rd wave has been the biggest challenge for our local health care system. We had double the amount of ICU patients than our unit can even hold. We allocated empty rooms to become secondary ICU rooms and ALL of our patients were on ventilators. At times we held an additional 10 patients in the Emergency Department on vents. All of our “normal” emergencies did not stop because of COVID-19 either. We still had the traumas, the heart attacks, and strokes on top of all of this. I do not believe that anybody that does not work in this profession can even imagine what this all looked like. Remember, this is not NYC, LA, or Houston. This is rural America. Small town stuff that nobody in the News Media even cares about. You’ll never hear about us “little people” yet we have to deal with this crisis too. All of my staff worked mostly 18hour shifts since staffing has been a challenge throughout this pandemic but worsened over the last couple of months. Nurses are either leaving the acute care settings or are leaving their profession completely because of all the stuff that has been going. The decade-long nursing shortage was never properly addressed in my state and this pandemic shows how broken healthcare really is. We truly had all hands on deck yet there was just never completely enough. No, we do not like to work 80 hours of overtime in two weeks.

Hospital admissions during the last 2 months

Delta is a different Beast altogether. This one gets people critically ill within the first 2 weeks of contracting it. Most patients require hospitalization after day 10 of having been tested positive. No matter what medication we administered no matter how much specialized care these patients received, the progression of the illness took its own course and took some very rapid and unexpected turns. We did notice that the population mostly affected in this wave was the middle age group 30-50 years olds. This corresponds to the group that has the lowest amount of vaccinated citizens, and it showed. Less than 3% of vaccinated patients were hospitalized or vented. Having multiple Code Blue in a single day for days at a time wears one out pretty quick. Physically and mentally that is. This strain is so deadly it’s almost unimaginable that this is the 21st century. 40% of all fatalities in our county since the beginning of the pandemic in April of 2020 died during the last 8 weeks. That is an awful number for a small county like ours.

Yet we seem to have managed. All of my team stayed physically healthy yet most certainly will we show signs of hurt souls and will carry invisible scars for a long time. Even through all of this, we volunteer our lunchtime and a few hours each week to continue to swab our community for COVID to identify those at risk and still manage to vaccinate people. We still drive to those that can’t come to us to swab and vaccinate. We are doing this with the full support of our Hospital executives and our Community leaders. Everybody pitches in and helps out wherever they can. I have seen enough misery in the last 8 weeks to last me two lifetimes but have also seen that a crisis like the one we have can bring out the best in people. When your team becomes an intrinsic part of you and everybody has each other’s back to ensure everybody is safe and gets to go home to their own family, you know that you are part of something much bigger than anything else you will ever experience (reminded me a lot of another special group I was once part of over 30 years ago). “We all want to help one another. Human beings are like that. We want to live by each other's happiness, not by each other's misery. We don't want to hate and despise one another. In this world there is room for everyone, and the good earth is rich and can provide for everyone. “

Thank you for letting me briefly express what the last 2 months were like and I did not mean to keep rambling on. I guess it just helps to get some of this out in the open and no more waiting to exhale. I guess sometimes I just have to fix myself too.

Now it’s time to get back to the fun part of helping people out and time to continue to fix this planet one device at a time. Remember that “REPAIR IS WAR ON ENTROPY”

So, here we go again. Actually it would probably be more accurate to say that here we still go with being careless. I was not aware that anybody had sounded the all clear on COVID-19. Yes, that is 19 we are now entering 22. We are entering our 3rd year of this pandemic and it seems we really are not taking lessons. We need to stop ;listening to the so called “experts” about Omicron being milder. It is far more infectious than previous strains and thus more people will get sick. Agreeable those that get it, do not suffer from the emergent need of respiratory support but they are ill enough to crowd our nations emergency departments. At my department that currently makes up about 80% of beds occupied by COVID-19 patients. Which would be okay if those were the only emergencies. IT IS NOT. We still have all the other life threatening illnesses to deal with as well. There is not enough room and staff to take care of all of those patients. There are no rooms in tertiary care facilities. Heart attacks, Strokes and other life threatening events cannot be transferred to where they should go. Those patients are now waiting in any local ED for days. Everybody does their best to keep people alive but we cannot fix you. Let’s stop this insanity! Stop looking at main street media for answers. Stop looking at our governments for solutions. Let’s get back to basics and let us take responsibility for our own health and welfare. We all know what to do. Mask! Social Distancing! Hand washing! Vaccinate! It is not rocket science. Your health care workers are tired! We have nothing left to give! This is what it looks like for me!

Friends, Colleagues and everybody else that may read this: STOP! We can no longer accommodate people who repeatedly demonstrate that they have no respect for others and won’t follow even the most basic common sense recommendations.

Personally, I am getting to old for this. To old for getting my backside kicked for so long. It wore me out. I need my “fix” of Answers to keep me sane. My pledge to fight the WAR ON ENTROPY is chicken-soup for my soul. Thank you for letting me vent. Stay safe.