We just received this clip from a nurse who has been in touch with a colleague of hers in NY about what is going on in NY hospitals where they treat COVID patients.
Although grossly understaffed, hundreds of nurses are waiting in hotels until FEMA can fork over the money to get them hired. One of them, who was asked to come on board, wishes she hadn’t. As she puts it: “I want to get out of here. They’re not helping patients; they’re killing them.”
There’s a lot to unpack here. To be frank, my spider-sense started tingling almost from the get-go when we were forced to go into lock-down. Something just didn’t seem “right”. Please understand, I don’t own a tinfoil hat. I have two degrees in health sciences and even though I’m not an epidemiologist, I have studied pandemics and plagues. I wouldn’t have been able to graduate if I didn’t.
So, let me be blunt: the normal protocols were not followed. Instead, extreme measures were taken, including the cratering of the world’s economies. Mark my words, when all is said and done, this will prove to be counterproductive and most likely exacerbated the mortality of the Wuhan virus.
Based on what’s being reported in this clip (watch it now, folks, because I guarantee it won’t be out there long), patients are being put on nasal cannulas. If they require more than 6 liters [Editor Note: Revised] , they intubate them, vent them, or put in a trach. So as not to “spread the virus,” all are on “closed systems,” which means no CPAP or BiPAP. Closed systems cause high barotrauma to the lungs. For many, “being intubated means it’s over.”
The hospitals are not using hydroxychloroquine and/or chloroquine with azithromycin, as one might expect given the high success rate we’ve seen in other hospitals. The FDA mysteriously nixed this protocol 4 days ago because 1% of patients are at increased risk for a hydroxychloroquine or chloroquine QT reaction capable of triggering drug-induced sudden cardiac death. – 1%, folks. If you were dying, why wouldn’t this be an acceptable risk?
Instead of using IVs with zinc or vitamins C, A and D, which have also been proven to be helpful, they’re putting patients on propranolol for sedation and antibiotics (because of infection due to the ventilator). No effort is being made to treat the virus. Patients either get better on their own or they die. They’re not even giving them transfusions, although they know the blood of COVID patients is not oxygenated.
They are reusing the same PPE (personal protective equipment), i.e. gloves, gowns, masks, respirators, goggles and face shields, throughout their entire shifts. They don’t change them when they go from patient to patient, even though patients who are only suspected of having COVID are on the same floors with COVID patients. If the suspected COVD cases don’t have the virus when they come in, they most assuredly have it when they go out, possibly in body bags.
Codes are called when a patient’s vital signs drop to dangerous levels. In this hospital, however, calling a code for a COVID patient is no guarantee teams of people will show up with life saving measures. When they show up here, they won’t even do compressions because they don’t want to spread the virus by pushing air out of a patient’s lungs. Sometimes they don’t even call the codes. They just “leave the patient there to rot.”
They’re losing touch with the idea that these patients are human beings. They use long tubing so they don’t have to go into the patient rooms which means they’re not assessing the patients or conversing with them. Can you imagine being by yourself, terrified you’re going to die and have no one to talk to, even the staff?!
According to this nurse, “crappy nurses” encourage other nurses to be “cappy.” Their documentation is “crappy;” their charting is “crappy”. They pat themselves on the back for taking the risk to show up but at the same time, seem fine with letting people die all around them. In short, there appears to be very little oversight and they’re not doing what other doctors and nurses do around the world to help their patients recover. One ICU doctor was yanked off of YouTube for saying virtually the same thing.
So why does is the State of NY seemingly unconcerned their patients are dying at a much higher rate in their own hospitals? Cuomo dropped the ball on what he needed to have in place at the beginning of the crisis. Is he also dropping the ball, now, when they have what they need but are unable to save their patients?
Please take the time to watch this short (10 minute) video. As I said, I am certain that it will be taken down in short order by the censors at YouTube.
https://www.youtube.com/watch?v=u6X5b8vehx8&feature=share&fbclid=IwAR2n9tRzvEp3qhyoXTRhg3AXyrwMeFXzSdI9B09nklBlqGta-5JziVs2xE8
What can you do? This young nurse recommends you, “buck the system.” (1) Tell the hospital that you have home medication and you want it continued. (Medication that your own doctor can provide.) (2) Refuse ventilation for as long as you can. Ask for less invasive measures. (3) Tell family members your concerns. (4) Have family members request records and transcripts, immediately, should you not make it out or have some lingering complications due to lack of appropriate care.
Lord have mercy.
On top of this troubling revelation, a key frontline doctor just took her own life on account of the conditions under which she’s worked. https://news.sky.com/story/coronavirus-top-new-york-city-doctor-on-front-line-takes-her-own-life-11979778 The linked article fails to mention any of the information revealed in the YouTube clip you included with this post. Make of it what you will.
Although you’re right, the story doesn’t mention anything that was on the YouTube clip, I’m pretty sure she would not have shared all these details with her parents. They are probably not in the medical field. Her focus was the end result: people are dying. I imagine she felt helpless. I do.
It’s hard to get around the fact that a lot of people are dying in NY hospitals. For physicians of Dr. Breen’s caliber, working with “crappy” nurses (if that was the case) and having to watch patients die because they did not received the same treatments that have proven to be successful with other COVID patients, must have been extremely depressing. The question is why?
WHY IS THE DEATH RATE SO HIGH IN NEW YORK? IF THEY AREN’T PRESCRIBING THE SAME TREATMENTS FOR THEIR PATIENTS THAT ARE WORKING FOR OTHER COVID PATIENTS, WHY NOT?
Gail,
FYI … Below please find two articles from the New York Post. The first one is from this Monday and the second one is from today.
In the first article, it states that Dr. Lorna Breen’s father, Philip, is also a Doctor.
METRO
Top Manhattan ER doc commits suicide, shaken by coronavirus onslaught
By Elizabeth Rosner and Kate Sheehy
April 27, 2020 | 5:23pm
https://nypost.com/2020/04/27/manhattan-er-doc-lorna-breen-commits-suicide-shaken-by-coronavirus/
and …
NEWS
Dad of NY doctor Lorna Breen says she ‘was in the trenches’ before suicide
By Yaron Steinbuch
April 29, 2020 | 7:50am
https://nypost.com/2020/04/29/father-of-er-doctor-lorna-breen-she-put-her-life-on-the-line/
So very sad.
In NY, many reasons with high death rates including not knowing how to apply these ventilators (death rate 88%). Also these deaths are now beginning to be labelled Covid “related” deaths. My brother is a doctor here in NY. He told me his hospital is now all Covid patients I told him what they do with the other patients. I kid you not he said, “I dont know they’ve stopped coming”… I further asked what happened to the drug overdoses, heart attack patients, broken bones etc coming to the ER. He responded again, “I dont know they are just not coming like they used to”.
Another thing to add, it seems many believe there is a strict lock down in NY. This is not true. What they did was basically close all leisure businesses as to make you not want to leave your house and just sit watching television. Gyms, movies, churches, hair salons and clothing stores are all closed. But all restaurants are open for take out, Drive in car washes are open, all hardware stores are open, auto parts stores are open. Not only are liquor stores open but they have now allowed bars (if they want) to serve drinks to-go! . You can theoretically call up UBER EATS and they will deliver cocktails to your house from your favorite bar. Those in trades such as carpenters, plumbers, electricians are all working. Construction on the roads still going on etc. You can come and go anywhere as you please.
Dear Orthodox Bishops,
Either step up to the plate and heroically lead your Churches with something other than politically correct claptrap or hand over the Apostolic reigns to someone who will. Take a look around your room and notice the martyrs on the walls. Start acting like them!
In Christ, Mike
They won’t, Mike. 100% of them, across the board, have demonstrated they are the antithesis of martyrs; they are the fearful who will say anything and do anything to appease.
The ONLY jurisdiction I know of in the United States that stood up for what the Church teaches about the Eucharist is Georgia, whose presence in the United States is growing, and will continue to grow, because many, many Orthodox Christians will not remain under a bishop who padlocked the Church to keep us out.
If we converts wanted a watered down version of the Church, we could have remained Protestant. People are just going to stop attending services. Not all at once, but like the bishops, they’ll give themselves a “blessing” to stay home more and more often because, frankly, it’s easier, it’s more hygenic and the bishops told us staying at home is the same. Right?
And as much as the GOA hates their members clinging to the monasteries, what do they expect when the monasteries are the only ones whom one can hold on to when the doors to the Church are closed? When you ask yourselves, “why do people go to monasteries?” THIS is why. They can be trusted to keep the Truth ALIVE when tested.
Bartholomew issued an edict that the monasteries would remain closed to the public, but at least one quietly disobeyed. (I suspect they all did.) They serve a higher AUTHORITY. Bartholomew is not the one they fear.
We kiss and venerate the icons of the Saints because they DIED to keep the Truth alive. No one remembers the names of the people who went through the same revolving door, failing the Church over and over again. And you know what? Neither will God.
Gone are the days when the bishops (at least in this country) realized that God entrusted them with an obligation to take care of His flock. The vast majority of bishops here have flat out FAILED in this regard. They ceased being shepherds. They capitulated to the big bad wolf. The secular world instilled fear in them and they, in turn, instilled fear in us. In some of us. Woe to the bishops who don’t acknowledge their transgression and beg forgiveness. We will not recognize them as our authority. We will find options. We will create options.
“The ONLY jurisdiction I know of in the United States that stood up for what the Church teaches about the Eucharist is Georgia…”
Sorry, but that is utterly hysterical nonsense.
I had no idea that God imbued you with such gifts, W! How else would you be able to get into my brain and take an inventory of everything “I know of”?
So enlighten us. Which Orthodox jurisdiction in the United States did NOT close their doors to the Faithful out of fear of the virus, assuming we would practice the same social distancing measures we would anywhere else, the only difference being we would be allowed to take the Eucharist:
Ecumenical Patriarchate, et. al
Antiochian Orthodox Christian Archdiocese of North America
Moscow Patriarchate, et, al
Serbian Orthodox Church in the USA and Canada
Romanian Orthodox Archdiocese of America and Canada
Bulgarian Eastern Orthodox Diocese of the USA, Canada and Australia
Orthodox Church in America
Gail, you pretty much have summed up how I feel. I have been trying to keep myself from being scandalized about this and causing myself spiritual despair, but, as I mentioned in a previous comment, all three walmart stores near me are packed, the liquor store has a line out the door, people are at the parks in droves…yet our churches remain closed.
The only parish close to me that has remained open is a ROCOR parish. I also know of a Serbian one that has remained open, with the priest telling me he would rather be arrested then stop giving people sacraments. I fully expect the bishops to cave, especially here in the U.S., after all history has shown us time and time again that the bishops have caved before. The Arian crisis among others is an example. Let’s not forget these famous quotes from St. Athanasius & St. John Chrysostom:
“The floor of Hell is paved with the skulls of bishops.”
“The road to Hell is paved with the bones of priests and monks, and the skulls of bishops are the lamp posts that light the path.”
But, We have to keep in mind that there are many , many bishops across the world, especially in Greece it seems, that have not caved and who have been willing to be arrested or fined to keep the sacraments going. Also, many priests here in the U.S and around the world have done the same, sometimes even in defiance of their bishops. I don’t think most priests here in America are happy about the situation (at least the ones that I know), but, they are obeying their bishop. My spiritual father is in the Greek Archdiocese and is very solidly Orthodox, but, he is not at all happy about this, or the direction the archdiocese is going.
In the end, the jurisdictions that remained strong will grow and the weak ones will not. The cultural Greeks that Archbishop Elpidophoros is catering too will more than likely be in the group that falls away. This may actually be a good thing for the Greek Archdiocese because it will leave the more zealous people (mainly converts I’m guessing) and the monasteries. Hopefully this means they will have more influence. I’m truly trying to find the positives in this and how God is helping us, even if it is hard to see right now.
BTW, I did not realize that the Georgian Church had a big presence here in the U.S? If that is the case I expect them, the Serbians, ROCOR and the Ephrem monasteries to be a beacon. I have some hope in the OCA, but, I think some of those parishes will switch over to ROCOR. I am not sure about the Antiochians, that is my jurisdiction and it is made up largely of converts so it will be interesting to see what will happen with them.
Sorry for the text wall!
I’m with you Petros! I read an article today that a strip club in Oregon has taken a creative approach to re-open by converting into a drive-by stripper club. Strippers and customers wear masks and gloves at all times. The strippers are considered “essential workers.”
And the Churches are still locking us out. Lord have mercy on the souls of these Hierarchs!
Thank you for your comment, Petros. The Georgian Church has a presence. I’m not sure it’s a big presence . . . yet.
https://www.saintnina-monastery.org/ <- Dear Friends of Saint Nina’s,Due to the increasing prevalence of the Coronavirus across North America, our Bishop, His Grace +SABA of the Georgian Apostolic Orthodox Church in North America, has decreed that, effective immediately, all Church Services must be conducted henceforth without laymen. Only Priests and members of Monastic Communities may be present, with no more than ten (10) persons total in attendance.Until further notice, Saint Nina’s Monastery will not be receiving pilgrims or visitors, in accordance with Bishop +SABA’s Blessing.
Cross Georgia off the list, I guess. Diappointing.
“The cultural Greeks that Archbishop Elpidophoros is catering too will more than likely be in the group that falls away. This may actually be a good thing for the Greek Archdiocese because it will leave the more zealous people (mainly converts I’m guessing) and the monasteries.”
Petros,
I am neither Greek not GOA; and though I hear what you are saying about the “cultural Greeks,” I know many Greeks who are not converts (in the colloquial sense of the word) who are far more than ‘cultural’ Orthodox Christians. True, they may be the minority, but they ought not be discounted. They may also be generally obedient to the hierarchy, but when push come to shove they will never compromise the Faith.
I think a huge part of the problem is that over the past few decades, modern (and especially Western) society has adopted a zero-risk mentality. We see this lots of places in our culture… Examples: If 1 in 10,000 teenagers experiences gender dysphoria and thinks that he/she is “transgendered,” there’s a huge cultural push to make *all* bathrooms/locker rooms unisex to accommodate the 1 in 10,000. If a surgery has a 1 in 100 risk of serious complication or death, if a patient dies as result of a high-risk surgery, our legal system allows the family to sue the health care team. If 1 in 10,000 female military members can meet the male physical fitness test standards, then the military decides to make the physical fitness test standards no different between men and women (as is the case with the Army’s new PT test that is scheduled to roll out this fall… there are no separate standards for men vs women).
Public policy now is geared to accommodate the *rare exceptions,* rather than the overwhelming majority or norm.
We see this zero-risk mentality in our society, and now even in our churches. Because of the chance that a child may unknowingly infect his grandparent who may get sick of coronavirus, *all* schools and playgrounds must be closed.
Likewise, I imagine that many bishops and clergy may think that if one of their elder parishioners may be infected by an asymptomatic person at church, then that merits closing all churches. There certainly are Orthodox parishes that have lost parishioners to COVID-19 in North America.
I completely understand this compassion on the part of the bishops/clergy, though I don’t agree with the “cancel all church” response. Does God want no one to go to church because some elderly grandparent/parent, pappou, or babushka might get infected at coffee hour? I don’t think so. For the same reason that I don’t think that He does not want me to refrain from doing a required medical procedure because 1 in 1,000 cases will statistically see a complication.
Makes far more sense to encourage elderly and at-risk parishioners to stay home and to encourage those who come to church to use hygiene precautions. However, our nation did not choose this model as the way we decided to manage risk. We decided to close *everything.*
Societies in years past understood that life is not zero-risk. But our culture insists on pretending that we can make life zero-risk — “yes we can do it, dammit!” American exceptionalism on steroids?
However, we cannot make life zero-risk. I feel that God might say to me, if I refused to do a medical procedure because I feared too much that someone might get hurt, “You fool! I granted you talent, education, and training to care for people created in My image, and you refuse to do what I entrusted to you because someone may get hurt?”
Mitigate risk and protect those most at risk. But cancel all church? Seems as crazy as closing all sectors of society. (Now who would do that….)
APT, I like what you’ve said here. Some ideas came to me as I was reading it:
The zero-risk society goes hand-in-glove with the utopian society, which is what the progressive world we now live in is. One of the many problems with this is that those who are sufficiently invested in a utopian world view are necessarily out of alignment with theology. As a result, utopianists are, at best, kidding themselves, and at worst, acting in bad faith, while using sweet sounding ideas in order to deceive. In either case, it can’t be good.
Moreover, I was listening to a talk the other day that deconstructed Darwinism. One of the ways in which the man giving the talk did this was to attack the assertion of scientism that it views things from a purely unbiased state, which the talker stated was impossible, given that we all take presuppositions into any venture, especially once we’ve reached the age of adulthood. With that, he then analysed the social environment of Darwin’s time; namely, that the Anglo was at the apex of humanity and would lead everyone else to salvation.
As this view was not only pervasive but agreeable to Darwin himself, the talker came to the conclusion that Darwin’s theory could not have been free of this bias, making it all the more plausible (in Darwin’s mind) that things go from simple to complex. As this view of things has gained more and more traction over time, and to the point where ‘everything in its place’ is overturned, we’re probably at the point where it’s impossible to expect that our response to a pandemic would be sensible.
Where those driving the response to the virus are merely utopianists who kid themselves, we’re now at a stage in humanity where not one more person should have so much as bad day, let alone get sick and die. And where those driving things are only using utopia towards more sinister ends, they truly must believe they’re becoming gods. In either case, this is the milieu that informs everyone’s thinking; and we’re not going to get good science etc. out of that.
Steven,
Thank you for putting these thoughts into words way better than I could have.
Yes I most certainly agree with you. For the utopian secularists who run modern western society and who dominate the media/Wall Street/academia/politics, there is simply no room in that worldview for diseases that can kill a certain percentage of the population, no matter what we do, which we cannot control.
Even if the data eventually show that the coronavirus fatality rate is, say 0.2%, if 25% of the American population are exposed to coronavirus (25% of the American population (330 million) is 82.5 million), 0.2% of 82.5 million is 165,000. That’s still a lot of deaths to not have control over.
My personal opinion is that much of the media/societal “freak out” or fear/panic is a manifestation of the fact that we as a society are now confronted “in our faces” with the fact that we don’t really have control over death. Most of the time, we live in delusion that we can control life and death. That delusion is at the heart of planned “euthanasia,” of Planned Parenthood as an organization, of legal abortion on demand, and of our detailed planning of when we get pregnant, etc.
As Christians, though, we view death as a vanquished enemy. Not that we look forward to it, and we all, including those of us in medicine/surgery, go to great lengths to try to keep it away — death is not “natural” — but death does not have the power over us that it has over many of our non-Christian friends. For that, I have compassion for them that they fear death so greatly. What a terrible way to live. As Fr Tom Hopko used to say, living with such a fear of death is merely existing — it is not living as God intended us to live.
Christ is risen, and death is vanquished!
We’re on the same page, again, APT.
And yes: Truly, He is Risen!
Just a quick edit: its if they have to be put on 6 *liters,* not meters.
Truly horrifying to listen to. I am an RN and really wish I could say I’m surprised, but I’ve worked in places where healthcare workers cut certain corners as mentioned as a routine practice, even not under the kind of stress they are currently under. I hope people do heed this advice.
I also would like to emphasize the importance of getting the meds you want by saying *its a home medication.* That is the only way to get it and you have to insist and insist until they do it. Act like you are going to blow if you dont get that vitamin c or whatever. That was very good advice. [Editor Note: Bolded and italicized for emphasis.]
I am especially horrified to hear they are intubating people who need only 6 L of oxygen.
One last word in sympathy of some of the workers: compassion fatigue does happen and, while people are ultimately in charge of their own behaviors and choices, most if not all of these peope are hourly workers and have no safety net if they lose theur job. They are assigned probably a ridiculous number of patients and therefore forced to start triaging patient care. You cant refuse a patient assignment in order to have a safer number of patients so you are forced to take care of as many patients as they give you, regardless of how it’s humanly impossible to take care of so many incredibly sick people. If you leave during your shift, you can have your license threatened because its considered patient abandonment.
There are definitely lazy, crappy nurses, and they are probably being lazier and crappier than ever. I feel horrible for the good or okay ones who are being put in a position where the only coping mechanism is apathy, and they are faced with making very unethical decisions in order to “get the job done” for that shift. I can tell you from experience, managing a large patient load where everyone has timed antibiotics and possibly IV antibiotics is very, very challenging, and in some cases nearly impossible.
Thank you, S, for the correction. I appreciate it. I also appreciate your frank acknowledgement that there can be problems like the ones the PA described.
After some thinking last night, I wanted to add: if you do expect or desire to take certain medications *as home medications* in the hospital, I would attempt to procure a prescription (maybe over the phone even, or by email) from your primary care doctor. Even just touch base with them and write down the supplements or meds as suggestions.
I say this because I guarantee that if I see this advice more than a couple of times online, hospitals will catch on and start requiring you to prove in some way that a physician has okayed your home therapeutics.
Just a word to the wise. Be over prepared if possible. If it were me, I would call my PCP as soon as I got a tickle in my throat and ask for a home treatment plan such as those mentioned, vitamin d, c, etc, with a plan for whatever else if you have to go to the hospital, especially if you have any risk factors such as older age. Make a list if you can of the meds and dosages and number of times a day you take stuff so you can hand it over to have them copy the many, many times they will probably ask you about home medications. An extra consideration is to emphasize that you want the meds to continue in IV form should that end up being the only way you can take meds. I have rarely seen IV vitamin C given in my 4 years of working in hospitals (maybe a small handful of times, and never ever high dose vitamin c), but they won’t make sure you have that since it’s extra work for everyone to give IV meds like that, and forget about it if they think its “extra” or unnecessary. Better safe than sorry.
As for the suggestion to ask for medical records right away: do this, but realize they won’t probably give the records to you or your family until after you discharge. Ask for the paperwork as soon as you go to the ER or are admitted, because a lot of times they make the process/paperwork much harder if you have to submit the paperwork after you are discharged from the hospital. Check all the boxes for the types of records you want to receive. You’ll want the full file, especially if you want to file a lawsuit later and want to help a lawyer with handing over documents right away.
Very good advice, S. So much better to be over prepared.
I saw this video yesterday and – while I am not really taken by people when they give the old ‘my friend is a …’ or ‘I know someone that…’ – I think this is pretty believable, given everything else we know.
Some woke guy in the comments mentioned that they’re taking in homeless people and killing them. Again, far-fetched, but I wouldn’t put it past these people; Pizzagate is real and these are the kind of people who are running things.
I stumbled across Roosh’s Twitter earliuer. He posted this: https://twitter.com/rooshv/status/1253489059487457282
Staged counter-protests!
Life as we know it is completely fake. All I wanted was some Bernie Communism just to try and feel real for once, and even that was taken from me.
Propranolol or propofol for sedation on vent?
I couldn’t tell what she said on the video. I thought she said propranolol because it is associated with a significant reduction in doses of sedatives and analgesia that may be a useful adjuvant for managing delirium and agitation in the ICU. George, I believe, said it was probably propofol which they use when they put people on a vent.
I think the video has been taken down. I couldn’t access it to listen to it again. I’ll check again tomorrow and change it if she said something different.
The fear is that the would take down this video before we could document what was on it so I did it for George. Any errors were mine. I implement large systems in healthcare, mostly Quality measures for Medicaid on the provider side. I’m not a clinician.
I think the “takeaway” is that they’re not really treating COVID.
To all: the reason I instructed Gail to put this out ASAP was because I was worried that YouTube would take it down (as they have so many others). While we like to get things as accurate as possible every now and then we screw up (e.g. meters instead of liters). Things like that can be rectified.
That’s not the point: thanks to the monopolization of “free” information *(i.e. Google, Facebook, YouTube, etc.), we now know that censorship is far more sophisticated than in the past. As such, information must be gotten out ASAP before the New Censors take it down.
A case in point was the Larry King Live interview with Tara Reade’s mother back in 1993 in which she corroborated her daughter’s allegations against “a high-ranking senator). YouTube suppressed it but someone within the last 48 hrs was able to find it and publish it.
It’s a Brave New World, folks.
The nurse practitioner in the video states “propofol,” which is very commonly used for ICU sedation. Michael Jackson was (tragically) all too familiar with it. (Propranolol, a nonselective betablocker, is not used for sedation.)
George & Gail –
the horror movie ? is also, thought of crazy Joe Biden with Hillary back in WH!
& what’s up with those Orthodox Christians still voting Democrat? Or leftist clergymen like Nathanael of Chicago — he should join Episcopalians. Bottom line: The Left despises ALL tenets of Orthodox faith…
& what’s up with The National Herald staff forever praising Joe Biden (though owner of TNH Antonios Diamataris is for Trump) … as psychiatrists have long said, but PC activists have tried to stifle:
Liberalism IS a Mental Disorder —
GO TRUMP! ??⭐️
HELP! Here are the nine states that still have a ban on in-person services:
Alaska
California
Idaho
Illinois
Minnesota
New Jersey
New York
Vermont
Washington
George,
Thanks for posting this video. I think it highlights, as I’ve read elsewhere, the significant discrepancies in healthcare delivered among various socioeconomic backgrounds in America.
Not everyone in NYC can be hospitalized at Mount Sinai, at Columbia Presbyterian, or at Weill Cornell Medical Center. These medical centers are world class and deliver fantastic health care.
Rather, the overwhelming majority of deaths in NYC are happening in the under- or un-insured parts of the city, and among the homeless. Hence, she talks about people dying as “having no family” which is true for many/most homeless. It’s absolutely the case that patients with advanced/systemic COVID who have significant pulmonary disease often do worse with mechanical ventilation and if managed per the ARDSnet protocol, which is commonly used for other patients with ARDS in medical ICUs. Nasal cannula or noninvasive positive-pressure ventilation (CPAP, BiPAP), time, and TLC is often best for COVID patients with significant pulmonary disease.
However our country doesn’t have a national health system, thus there is no centralized authority to “draft” excellent ICU docs from Omaha, Nebraska, whose COVID units remain empty, to go to these poor hospitals in NYC to pick up the slack. Communication among local, city, state, and federal entities is terrible and often non-existent. That excellent ICU doc in Omaha likely couldn’t even get approval from his healthcare employer to go to NYC to help if he wanted to. Many excellent military ICU docs who were sent to NYC did not much of anything.
I assume that these poor and underserved hospitals may be doing the best they can with what they have, but coronavirus certainly is bringing economic disparities and a highly dysfunctional healthcare system to light.
I’m not sure why the media is not talking much about the economic factors related to dying of COVID, but if you have advanced COVID, you are much more likely to die in an underserved hospital in Queens than you are at Weill Cornell Medical Center in Manhattan.
Just as the Spanish flu 100 years ago was one of the motivators to develop national health care systems in countries across Europe, I suspect that coronavirus may be what finally pushes America toward some sort of nationalized healthcare system over the next several years.
I could be wrong (and probably am!), but many times glaring inconsistencies and devastations like this drive significant change. A hundred years ago, the federal government in D.C. felt no need or reason to serve as a “safety net” for Americans whose livelihoods were wiped out by disease, floods, tornadoes, etc. You very much were on your own, with whatever help local organizations or charities provided. After the 1920s and the devastating Mississippi river floods, the perspective of the federal government’s role started to change. Court rulings prior to this time (with respect to what is the federal government’s role) sound downright cruel when viewed against modern sensibilities.
When it comes to something like this there should be a single command center that controls the decisions of all healthcare institutions, regardless of where people are or who they work for. In a catastrophic emergency, the needs of the country come first. If a central agency orders an Omaha doctor to go to NYC, he should be able to go to NYC.
One of the greatest failures I see in all this is the passing of the buck. Statements like: “It’s the governor’s job to get the ventilators; if you don’t have them it’s because you weren’t prepared” or, “It’s the president who dropped the ball; they didn’t stockpile enough” There is too much finger pointing. And is is REALLY annoying to have to bargain to get the resources needed into the hands that need it. There should be none of this “tit for tat” stuff, i.e. “If you pass X,Y,Z, then we’ll agree to help the American people survive this economic mess, but if you don’t, we’re not going to let you move forward.”
Finally, if Washington can’t say anything nice about the man (or woman) in charge, they should hold their tongue until after the crisis has passed. The last thing the “kids” need to hear is “mommy and daddy” fighting. – You know how some families have a money jar and if you say a bad word, you have to put $.50? We should have a national “money jar”. If anyone in Washington says something derogatory about a legislator, president, judge, etc. just to poke them in the eye about the crisis, they should have to put $500,000 in the money jar, which should then go to the American people. We have enough problems without the back stabbing and bickering.
I don’t know that a universal healthcare system like what we see in the UK or Canada, would be of much help in something like this. The poorest and sickest would still be lined up in the halls with everyone else. Interestingly, the poor often have the best care when it comes to their physicians. It amazes me how many physicians are really not as motivated by money as some believe. I have worked with many provider engagement programs and in terms of incentives, there are really only two things that motivate doctors. Their overriding concern is patient outcomes. A distant second is wanting to be the best among their peers who work with similar populations. But you would know this because you’re clearly one the the “good guys”.
Maybe you can help explain this to us. Why aren’t all hospitals using relatively cheap solutions like hydroxychloroquine and vitamins to help COVID patients? Another question, why all the need for the ventilators? Based on what I’ve been reading, they seemingly hurt more patients than they help. If the blood needs to be oxygenated, why not give transfusions or do something else that addresses the problem? In other words, why aren’t all hospitals doing the same things to combat COVID? I know they have mechanisms in place for docs in rural settings where they can meet with physicians via Skype (or something similar) to consult on cases they may not normally see. I’m wondering if they are doing that with COVID so physicians can talk with other physicians, who may have more experience with COVID patients, to talk about what’s working and what’s not working.
I realize we don’t have a universal healthcare system, but we do have very large databases which spit out data that is then massaged into “guidelines” (which, as you and I both know, aren’t really “guidelines” because if you don’t follow them you don’t get paid) through NCQA & CMS on how to treat patients. So, why aren’t we using the same protocols across the board? I guess a better question is, do we have mandatory practices that are being used across the board? If some hospitals are using off-label solutions that seem to be working better than anything else we have, why aren’t all hospitals using them? – Or, are they? Maybe what this young PA reported is just not true or maybe the patients that have the “crappy” nurses are also too far along for these novel things to work. Seems to me if that’s the case, they should have sections of a hospital that operate more like a hospice and families should be allowed to visit if they’re willing to take the risk. It’s not like this is the first contagious disease we’ve ever dealt with. If the impact to 90% of the population is relatively mild, they should let people be with their loved ones when they’re dying for pete’s sake!
Hi Gail,
You raise a lot of fantastic points and questions, as always. I certainly don’t have the answers, but here are my thoughts to some of them.
“…there should be a single command center that controls the decisions of all healthcare institutions, regardless of where people are or who they work for.”
This would essentially be part of a national health system. I don’t think there is any way to have a “single command center” that can control hospitals and physicians without mandating that all hospitals be part of some national, centrally-controlled, network. This kind of system is not what the United States has currently.
“One of the greatest failures I see in all this is the passing of the buck.”
Yes, it’s tragic that underneath all of the coronavirus illness/death, there remains politics. Everyone in positions of authority is thinking about the upcoming election season. But because we don’t have a NHS, I don’t think that Trump has as much power as many thinks he does. Though he makes a fantastic boogeyman for many to blame (blame = a means by which we try to regain control in an uncontrollable situation).
“Why aren’t all hospitals using relatively cheap solutions like hydroxychloroquine and vitamins to help COVID patients”
I don’t know. At my medical center, we aren’t seeing much COVID, but our infectious disease specialists are definitely using HCQ to treat the COVID that we have. Why they don’t do this everywhere, I don’t know. Ultimately the attending and consultating physicians decide the therapy on each patient. If a hospital is overwhelmed with COVID and doesn’t have well trained attendings directing care, well, you get what you get. That’s why it is so crucial for patients and their families to be engaged, ask questions, and not to be passive players in the patient experience.
“I guess a better question is, do we have mandatory practices that are being used across the board?”
Generally, there are no aggressive practices that are reviewing charts in detail so fast to provide quick real-time feedback, aside from informal friendly peer feedback of what you see your colleagues doing. Every medical center must have some sort of regular peer review to ensure that physicians’ care is competent and maintains standards of practice, but peer review of charts happens once a month or so — not on a daily basis. In overwhelmed systems, it’s easy for some things to get missed or details to get lost. Take New York for example: it’s just reality that not every hospital has the top-notch quality care that you’d get at Mount Sinai or Columbia.
I agree that we need to figure out how to allow families to visit loved ones, somehow, with careful testing and screening. A long-term measure to mitigate risk over the next 1-2 years has to be figuring out how to test and monitor hospital and nursing home workers, who are always easy vectors to transmit any disease (not only coronavirus) to elderly or sick patients.
Thank you for your prompt reply, Doctor. – I’ve never seen anything like this (pandemic), obviously, but the one thing that has saved me over the years is having good physicians. I contracted pseudomonas in the sphenoid canal in the early 80s for which there was no antibiotic. They wanted to go into my face in 8 places and scape off the bone hoping they could get it all. They said if I didn’t agree, I would lose my eyesight in a couple of days and die within 10 when it reached my brain. I called my allergist and asked him to prescribe the most prednisone my body could stand so my sinuses would drain, which he did and because he did, I was able to avoid the disfiguring surgery.
When it comes to your health, it is good to surround yourself with good physicians who will at least listen to you. – I may not be the best patient, though. One doctor told me I was exactly like one of his other patients: Bette Davis!
I had to leave a job in 2015 and I came down with appendicitis before they got around to giving me my COBRA papers. I suddenly found myself on Medicaid. and it was only THEN that I realized, after having worked with Medicaid programs most of my career, how vulnerable patients are with government run programs. My surgeon was good but I couldn’t find a regular doctor to save my life. They weren’t paid enough. You’d see them one day and they would be gone the next. I had a horrible experience. This was in CA. I had one friend who had stage 4 ovarian cancer and had to wait 6 weeks for a hysterectomy. By then, it had metastasized. This is what I think of when I think of National Healthcare.
When people say we can have “Medicare For All” they don’t understand what they’re talking about because it would be unaffordable. They could have different plans under Medicare. If you receive federal funds for anything, you have to follow CMS guidelines so they’re pretty much calling the shots anyway. I think it’s got to be really frustrating for doctors because they can’t really practice medicine anymore. It’s getting to be a one-size-fits all kind of system unless you want to be buried in paperwork trying to justify everything.
I probably recommended this before but if you haven’t seen it, watch the documentary called Code Black. It’s a real eye opener about how much the practice of medicine has changed with HIPAA and all the Quality measures they have in place now. It’s a great movie. That hospital was one of my accounts for a brief period of time back in the day and it was exactly how it is in the movie. The doctors LOVED it! They thrived on the adrenaline. It made them feel alive. To me, it looked like a MASH unit but a lot of people survived and you didn’t see hordes of people camping out in emergency rooms like we do now. https://www.amazon.com/Code-Black-Andrew-Eads/dp/B00TYBAAYW
Gail,
APT: “You raise a lot of fantastic points and questions, as always. ”
Indeed!
Gail, your experience in the 80s and the rest in yur comment reminds me a tangent matter which I heard the other day, and I couldn’t believe my ears.
The expert, I forgot who he is, was talking about the main causes of death.
And somewhere near the top of the list he placed the cause of death because of doctor’s mistakes! Is this true? Have you ever heard such a thing and do you have any links?
This is also tangent to the Coronavirus when we hear opposing opinions by doctors.
I can’t say that I have, Ioannis, but I haven’t seen all that many charts. I’m on the Business side. But I can tell you I’ve seen two doctors go at over a patient, which went in the patient’s chart, and what they said to each other should never have been immortalized on paper. – So, yeah, I can see a doctor doing that.
When a patient dies, it really gets to them. But admittedly, I’m biased. I’ve never had a bad experience working with a physician. They’re not insecure like middle managers can be and they’re very specific about what they want so there are few misunderstandings.
They’re also very compassionate people.
I was doing a project for the Chief Medical Officer of a Fortune 500 company and I was to host a very important meeting for him. Something like 20 health plan administrators were supposed to be there. I had been with my father who was ill and when I got back to the airport, my car was dead. I had to call into the meeting and he had to kind of wing it in my absence. I was sure I was going to get fired. I told my boss how sorry I was. He looked at me and said, “Gail, you don’t think this was your fault do you? If we had been paying you enough you wouldn’t have such a crappy car!” I think he was serious, too.
Looks like the real (canonical) Ukrainian Church stepped into the breach and actually helped people who were suffering:
https://orthochristian.com/130836.html
Here’s Tom Friedman’s analysis which largely agrees with the Ha’aretz story above. Long story short, the Swedes didn’t have a lock-down:
https://www.nytimes.com/2020/04/28/opinion/coronavirus-sweden.html
OK, I realize you’re not gonna be able to read it because it’s in Hebrew, but the Israeli author admits that the Swedes were right and the Israelis wrong:
https://www.haaretz.co.il/opinions/.premium-1.8816252