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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

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

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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

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Ready for a privacy fence to keep onlookers away.

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

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Decon tent for assessment of mild cases

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Here is our overflow for moderate victims.

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

Update 05/10/2020

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.

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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.

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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"!

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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

Update (09/06/2020)

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;

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@oldturkey03 - How are you doing? Sixty Minutes had a good segment on Texas Hospitals struggling with COVID-19.

I hope you are well.

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Welcome back, Mike! Excited to have you. Thank you so much for your service and for the lives that you have been caretaking. This is not an easy time, and heroes like you are how we are getting through it.

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Thank you Kyle. I really appreciate that.

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Dear Mike,

So very good to hear from you and the update on your activities. The least of your worries should be iFixit. Over the last 9-10 years the answer data base that has been built can answer 95% of all the questions coming in. Views of those answers is up as people have nothing else to do but fix the things they’ve been putting off. @danj and @jayeff have really been putting in the hours and the site is fine without us. Personally ministry has had me pretty covered up as people are scared and worried about and losing loved ones and their own lives. Maybe it’s time for a change in the values of our society. Many think the catching away of the bride will be this week and then the 14 year tribulation period. What I have found more strange is that people seem to be more concerned about what will happen to their pets when they die or are raptured than what will happen to their relatives. At my age, if I get this virus, I have little hope of getting out of it alive and I’m fine with that. I have a good relationship with the Lord and like you, have lived a long time in giving of what little knowledge I have to others. I have enjoyed so much our camaraderie over the last ten years. You are a dear soul and a very close friend. I pray the Lord Bless you and keep you and make His face to shine upon you. May He lift up His Countenance upon you and give you peace this day and forevermore.

Richard

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Thank you my friend for your kind words. Let's not give up without a good fight yet.....;-)

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@mayer - Have you heard anything on Mike?

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@oldturkey03 & @mayer

Here in the Boston things are very different! Streets are mostly empty from the normal hustle and bustle of city life. All we hear is the wailing call of the ambulances and EMT’s, like the howling wolf’s in the hills. It is very un-nerving not knowing who is being whisked away.

Both of you are lucky! You haven’t seen this invisible death dragon yet. You still have time to prepare!

@oldturkey03 you need to get as much PPE as you can. If you can’t find the material you’ll need to find people locally who can make it. Look at the community for gloves (and if they have them N95 masks) and anything that can be used like large garbage bags. Don’t forget cleaning products! Cleaning down the surfaces was another hole our hospitals hit. Foggers & sprayers can’t be used around patients.

We had a large group sewing masks and another group making face shields for the EMT & Hospital’s as soon as we heard how bad it was Filling the Gap: Unique Charlestown Fabricator Transitions Fast to Making Face Shields. The effort is now focused on the community with the masks as we now need to wear them when going out. Our Mayor has evoked a requirement for masks and a curfew during the night.

Many of the nurses and doctors themselves have now gotten infected, many are still working as the numbers of inbound patients is already stretching our hospitals ability to handle the traffic. Some hospitals had no PPE after the first few weeks! They where using cotton rags for face masks and ski goggles! It was that bad! Our medical workers are the real heroes, Our local and state government is doing what it can, now the feds … …. …. Where is the PPE and the needed respirators we where shipped all we got was 10,000 N95 masks for all of Boston and 100 old respirators boxes stained with water and mold. They needed to be taken apart and cleaned! So thats it! still waiting ……. While NY was in greater need they too didn’t get what they needed. And their hospital staff is also falling to the side as they too didn’t have the needed PPE to protect them from the start. Thats our fed slow to react and then boosting they have.

As you likely heard our governor had to fly in N95 masks from China! After not one, but two sizable orders where confiscated by the feds (I do wonder where it all went).

The states are bidding against them selves and then having to pay a middle man here in the states for the privilege! Somebody is getting very rich here! And its not the makers of the products or the shippers, its someone’s cronies! I’m sure someone will investigate this when the crisis is over.

I was watching my temp but the dam battery died! And now I have a few symptoms, not sure if its seasonal allergies getting to me or …

I was good! I was not going out and the few times I did for food, I kept my distance and wiped my self down and what I could with a mild bleach. If it hits me it’s likely a one way ticket. Answering questions keeps my mind busy.

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Please stay safe and virus free!

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Hi Mike,

Greetings from NY. It sounds like you have a tremendous amount on your plate. In regards to PPE, try to find Scuba masks. Reach out to Formlabs and MasksOn about their scuba-helmet-to-filter adapter. Engineers from Formlabs, Onshape, iRobot and many others are teaming up to mass produce adapters to re-purpose scuba masks for hospital use.

https://formlabs.com/covid-19-response/

https://maskson.org/

Scuba masks have the benefit of a full face seal that could be tested with a fit-test machine. Formlabs is working with Brigham and Women's Hospital (BWH), Massachusetts General Hospital and several others to get them onto the front line. They should also offer a higher level of protection than a normal N95 disposable mask could offer.

If you are able to get a supply of scuba masks, this is a very promising solution. This is not a rushed thrown together solution, it looks like the best alternative to a full face mask. I can imagine the protection factor of a scuba mask if significantly better than a disposable n95.

Also, in regards to N95 disposable mask cleaning & reusing, it is a tricky subject. You cant douse them in alcohol or bleach because it negates the charged nature of the blown particulate polypropelene layers. Here's a good scientific summarized report with several additional links that are excellent:

https://m.box.com/shared_item/https%3A%2...

Otherwise, Battelle has a concentrated hydrogen peroxide vapor cleaning process that has been Okay-ed by the FDA:

https://www.battelle.org/newsroom/news-d...

https://twitter.com/Battelle/status/1247...

In case anyone needs a refresher, make sure folks brush up on mask fit checks, they are extremely important in these times. Also, scold anyone that is not clean-shaven (I've had to remind my brother many times lol)

I wish you strength, health, safety, and rest. Wishing you the best,

-Anthony

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Anthony, thank you so much. Great idea with the scuba mask. I‘ll get together with my bosses tomorrow and need to check it out. Sad part we are now having positives in my community. Winter is coming.....

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@oldturkey03 Best of luck to you and everything you do. Godspeed.

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@oldturkey03 As an old surgical tech from 50 years ago, all the masks were cloth and came right out of an autoclave, reused till they wore out.

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Update: Streis V-pro Hydrogen peroxide vapor machines have been ok-ed by the FDA for mask sterilization. Useful to know if anyone's hospital already has these machines.

www.medicaldesignandoutsourcing.com/steris-wins-fda-nod-to-sterilize-used-respirators-in-hospitals/

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I work off of logic not BS news reports.  Let's look at the facts.  In Italy they say today they have 135,586 cases of the virus.  Those are cases in progress, they have not concluded.  Now lets look at the real numbers of those that have caught it and either died or survived (that's the real statistics) Recovered 24.392 Deaths 17,127.  That is the real conclusive ratio.  That is a total of 41,519 that have had a conclusion to the virus.  They either died or recovered.  So what percentage of the total died?  41.25% died 58.75% survived.  Your government does not want you to realize this.

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@mayer - One of the biggest problem is accurate numbers! As an example John Hopkins - COVID-19 fancy viewer has stale information. As my city has higher numbers and the NewYork numbers have eclipsed what they are showing. Even the WHO web site is willfully off as well.

The next issue is the process of reporting its self is just not able to collect the real numbers and then you have the politics of not wanting to either scare the populous or telling other countries how bad they where hit. Both Italy and China have faced these issues of under reporting.

In war we hear the term "The Fog of War' thats also true here. We won't get a good handle on the true numbers until the COVID-19 war is really over.

The key now is breaking the transmission to bring the numbers down. Even then we still won't be out of the woods! Until we have a way to inoculate for COVID-19 it will flare up infecting still again! I pray it doesn't morph like the Flu. That would make it hard to kill outright. Maybe the herculean efforts now to find a cure will also help up kill the Flu as well.

Stay safe Mayer!

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We have 15,698 confirmed cases and 323 deaths in Florida. so ~4.86% death rate here. However, I am using the John Hopkins counter since it's the easiest to work with. I think the heat is helping with how well we're doing.

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Hey there @oldturkey03

It’s just been a crazy and almost unreal time. I hope you had a good Easter weekend and are staying safe. You and your team are doing the best that you can, yet it’s a shame that your hard work and sacrifices are “appreciated” through media and marketing campaigns instead of supplying medical facilities with enough stock to get through this pandemic. It’s also completely absurd that there are people out there protesting the stay-at-home orders and blocking entries and exits to the hospitals when we’re quickly approaching 30,000 deaths.

In some good news, we’ve been working really hard on uploading medical device documentation as much and as fast as possible. We’ve got more files to sort through, but thankfully our team of volunteers are helping us get this done. As of now, we’ve almost got documentation on 20 different device categories with many more to come.

Thanks for all of your hard work and go get ‘em! We will all prevail!

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Well things are still not good here in the North East The latest news on the coronavirus outbreak in New England

There is no way we will be able to relax things for most of the summer.

Getting hair cuts will take some doing, as I doubt we will survive without them soon. My dogs are also in desperate need now for a good bath and cut.

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Hi everyone! I hope things get better soon. While I may be a bit young to understand the whole content of the post, I certainly tried. I don’t know what to say about it, sadly. I honestly just hope that everyone here stays healthy. Sorry if I seem ignorant.

For me, School has been cancelled for the rest of the year.

starting Monday, we will be doing graded assignments online. We missed about 3 weeks now I think? the past month or so has been a blur. during that time we just had optional assignments. I’m worried about how things will go missing the actual lessons. I may not be as impacted as all you have been. I’ll stop going on about my issues and stuff.

Anyway, Here’s an interesting video from bill gates after the Ebola pandemic:

https://www.youtube.com/watch?v=6Af6b_wy...

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The next wave may not be the virus its self but the lack of man power to keep the food industry working!

Here in Boston we are still seeing massive shortages of basic foods and supplies. Some of it I’m sure is panic buying but a lot of it is the inability to process and produce the raw materials coming from the farms.

We see massive waste in all facets at the farms milking herds being culled, chickens turkeys, pigs & steer euthanized and buried. Farmers plowing under all kinds of vegetables and fruits which can’t be harvested and fields left unplanted!

To add to that some produce still needs to be hand picked like tomatoes, melons & squashes. The work force tended to be laborers from outside of the country as the pay was low and working conditions are hard. As all work visas have been canceled who is doing this work?

The work force across all of the low paying jobs are often living in larger households or barracks on a farm, a ripe place for transmission of a contagious virus!

We need to develop better regional farming and better housing for all!

Here in the cities we are working on creating what we call freedom gardens. Taking over unused plots of land that can be fenced off to create raised bed planters to grow vegetables and fruits!

We are also looking at what we need to do to get our local farmers more productive and help develop new lands for farming. We are also looking at processing facilities and warehousing locally as come this winter food will be in short supply if we can’t get the larger agriculture and food producers working at full production soon.

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oldturkey03 will be eternally grateful.
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