Open Your Bible to Covidians...

Not mine; someone sent it to me without an attribution.
"From a nurse, on a forum..."
Effing hilarious.

I don't know who wrote this, but I love them like family.

And the Gods of Nursing and Medicine looked down and spake:

Oh thee of Joint Commission and thee of CMS.

May fuck be upon thee.

Thou hast promoted disposal of the Holy PPE for all these years based upon arbitrary expiration dates. This, in spite of evidence to the contrary by SLEP; In spite of other research; and in spite of common sense. Now, those who provide care must do without.

Lead us not by citation, but deliver us from stoopid. Know now that this must end. Your reign of terror is over.

From this day forth be it known that we shall not comply. We shall not waste. We shall not grovel for you.

Instead, we shall rise up, as one, to administer the Whole Pineapple Suppository of the Just to all transgressors. Sideways.
As it is spaketh, thus shall it be done.

~1st Covidians 1:1~

Amen

Ultimate Pandemic Mix

Enough doom and gloom.
Life is more fun with a soundtrack. Here's one for the next few weeks and months.
Don't be a bunkered-in Branch Covidian, at least not inside your own head.
Tell this virus it picked the wrong goddamned rec room.
Then go forth, and kick its ass.
Humming a tune or three.

For your listening pleasure, we present 14  15  (But wait! There's MORE!) 16 tracks to get through your day, and days to come; the Guardians Of the Galaxy Ultimate Pandemic Mix Vol. 1©:

Everybody was Kung Flu fightin'...

My My My My Corona...

 

I've got a fever, and the only cure is more cowbell...

 

Sh*t Mardi Gras

ZeroHedge thinks all U.S. hospital beds will be filled due to Kung Flu cases by May 8th.

Au contraire, mes amis.

ZeroHedge's Tyler Durden knows what he knows, and doesn't know what he doesn't know.

1) The number of ICU beds already full is closer to 90%, most days, esp. during flu season, i.e. every day since Thanksgiving.

2) There's already a severe shortage of N95 masks, and all protective apparel. With damned close to zero Kung Flu patients hospitalized anywhere. And that's only going to get worse.

3) Because of #1 & #2, there won't be a shortage of hospital beds.
Quite simply, unless you're almost abso-fucking-lutely dying right this minute, you will not be getting a hospital bed.
Now. Then. Ever.

4) Napkin math says you'll need 5M cases of Kung Flu to get 1M who need a hospital. We're currently a long way from 5M cases, even if this doubles every 4-6 days.
(Remember Ebola Math: there are 34 doubles from 1 to Everyone.
The first ten get you to 1000. the second ten get you to 1M. So to get to 5M, you need 23 or so doublings. At 4-6 days per double, that's 92-138 days. So if that's the doubling speed, we will be at 5M cases by June, anyways. Not May. But in a pandemic, doublings speed up and slow down, as the virus hits new pockets of people, and then runs through them.)
Regardless, at some point, we'll get to 1M Kung Flu victims who need a bed.

5) None of that matters, because less than 10% of them will ever get in.

6) Because long before then, we'll either decide to stop seeing them, or hospital care at all will cease to exist, from staff infections, lack of supplies, people who'll stop coming to work, etc.

7) At that point, there will functionally be zero hospital beds.
Either because no one with Kung Flu will be let in, or because there isn't a hospital. I can tell you right now, we aren't going to turn away heart attacks, strokes, and trauma patients so we can see people with Kung Flu, even if they're really effing sick. I've told you, "Don't get this virus." This is why.

If you have URI symptoms, you'll be triaged outside to a tent, and then transmogrified and transported to some CDC-approved empty warehouse, sports arena, convention center, etc., where you'll get the best care you can from totally untrained amateurs, retirees brave enough to risk it, and people too stupid to turn that work down. Think former barristas, people too dumb to pass the TSA civil service exam, and the guys too stupid to make it delivering pizzas or spinning signs. The number of licensed folks there, like doctors or nurses, will be countable on one's thumbs. There will be somewhere between vastly inadequate PPE, to no PPE. They will be short of everything but patients.

And as friend ASM826 at Borepatch's blog has noted, even hospital staff can wear full Level A encapsulating suits in the hospital, but if they aren't wearing them to their front yard decon station, and staying inside afterwards, they're going to get Kung Flu from the general population anyways, in short order.

8) That is an S3 event.
It is not a Shit Show.
It is not a Shit Circus.
It will be a Shit Mardi Gras.

So Tyler's analysis is too cheery by a couple orders of magnitude.

{If you were wondering, the higher levels are, in ascending order, A Shit Riot, A Shit Tsunami, and a Shit Apocalypse.
You do not want to see an S5 or S6 event, believe me.
Moses' ten plagues on Egypt were only an S5. The only S6 in recorded human history was Noah's Flood.}

The $64 Question

Bad, wicked, naughty, evil Zoot.

A month ago I was worried we might have 10-20 cases of Kung Flu. Instead, we have nearly 20 deaths. That means those people got it up to a month ago, from other people who didn't know they had it either.

So far, most of them are elderly, and/or with other co-morbid conditions.

But sooner or later, a relatively healthy 40- or 50-year old with no predisposition is going to croak. Maybe a teacher. Or a school janitor or lunch lady. Then everyone will lose their shit.

The school will be closed. But that person will have infected 40-200 kids, who won't be symptomatic, who will then be locked up at home to infect their whole families, and you'll have a blossom of 1000 cases. Some of whom will still be going to work infected and asymptomatic, and give it to co-workers, who'll give it to their kids, and so on, and so on.

That's how a pandemic marches onwards.
And it will be everywhere.

Take a pair of ordinary dice. There are only 36 possible combinations (6x6). So the raw chance for any roll is a hair under 3% (2.77% for the anal retentive math geek crowd). If coronavirus only has a 3% chance at being transmitted, every time you're out and about, you're rolling the dice. Except you touch things 1000 times a day, and your face about 500 times. (We'll forget about droplets, mucous membranes, and inhalation vectors from coughing and sneezing people for the moment). So, roll the dice every day, and see how long before snake eyes comes up. Remember those thousands of touches, and 500 times touching your face.

After rolling dice 164 times, your chance of getting snake eyes is 99% probable.

So being out and about, in a world becoming saturated with asymptomatic carriers, you're not just likely to get Kung Flu, you're going to get it .

For probably 80% of all persons, two weeks to a month of PITA. For some of them, they may not even know they have it! For 10-17%, you're going to the hospital. But unless you're dying, you aren't getting in. And about 3 people out of every 100 are going to die from it.

If everybody in CA gets it, that's up to 1.2M deaths. Leaving us with 38.8M swinging Richards afterwards. For Texas, it would be up to 870K dead, and 28M still there. Nationwide, up to 10M dead, and 320M still here.

That's if mortality holds at 3%, and everyone gets it. Juggling those numbers around on the slide rule gets you any answer you want.

Bad for the 10M dead, and the 20-50M hospitalized/laid out, but that's not the catastrophe, per se.

The real problem is, the only way to stop this is to send everyone - everyone - home, until 30 days after the last case gets well or dies. Even the idiots among TPTB will figure this out, after exhausting all other half-assed options (just like in China).

If you do nothing, you lose 10M outright, and 50M who can't work for months, and 100M more out for up to a month, but not all at once.

That's the problem. Either of those options screws the economy like a $2 hooker, which is why the stock market is in freefall, why Italy and China have thrown in the towel, and why Korea and the rest of Europe probably will too, before we figure it out.

And until you self-quarantine, and don't pop positive in the next month, you won't know you don't have it already either.

So the $64 Questions is, how long can you miss work, school etc., and how much money, water, food, medicine, and other necessities do you have, to stay home for what may become a mandatory extended quarantine? Will you have a job to go back to when it's over? Will anyone?

We'll leave the discussion of how you hold a valid general election for the President, 1/3 of the Senate, and the entire Congress amidst this sort of thing, for another time.


Local observation:

I note for informational purposes that the local bookseller, B and N, is suddenly light on disaster/survival/preparedness books, which had formerly just been gathering dust, and is now missing every volume on first aid. Because I check those aisles 2-3X/week, and probably know them better than store staff.

Some people are getting edjumicated, apparently.

-----------------

Also, over at WRSA, one of the He's-who-shall-not-be-named observed accurately that contrary to all dystopian fiction, the stores remain open and unburnt, rather than the popular "stripped to the walls in 48-72 hours".

Allow me to respond:

Food isn’t coming here from China (unlike N95 masks), the trucks are still running, and you’re still free to travel, and not under draconian quarantine.
Yet.

So there isn’t any national emergency, for the moment.
{cf. 1940: Phony War. Compare and contrast with Dunkirk, and the Battle of Britain, a few months later.}

Once you can’t go out, it won’t matter what’s on the shelf. The average person and family has three days' food at home. (If you have more, by definition, you’re above average, just like the kids at Lake Wobegone. That also means somewhere there’s some jackass who has less than three days on hand.)

So, how long do store shelves stay stocked (and not gloriously aflame) when the trucks aren’t rolling, and Trayvon Diversity and his posse go emergency shopping after midnight, with a brick and a machete?

And what happens when people who depend on prescriptions, made from precursors that aren’t coming from China, and haven’t been for the last month or two, start getting shorted on their Rx meds, esp. the ones that
a) keep them alive, or
b) keep them sane and functional?

Just curious.
Feel free to extrapolate at your own leisure, as you see fit, considering those new data points.

Kung Flu Update, Etc.

Peter, over at Bayou Renaissance Man, has put up a post of links. Of the 14+ links he included, we are 3 of them, and Mosby is 1. Go on over there for the other 10 you haven't seen from either of us. RTWT.

--------------

Some people have expressed the hope/belief/fond wish/delusional fairytale expectation that, like many outbreaks, this one will wane once Spring is sprung, and the sun comes out. Look at the John Hopkins map in Peter's post header, and mentally pencil in the equator in that picture.

To wit: Australia (Oz, affectionately) is in late summer. It isn't helping their outbreak a bit. Singapore is equatorial. It hasn't mattered there either.

YMMV, but were I you, I would abandon all hope of weather saving you, and rejoice if it does, which seems entirely unlikely.
Period.

Buckle in for the long haul: this is going to go on a world tour, and may last for a year or more, until it burns through everyone, or they develop a vaccine that's both effective, and can be produced in sufficient quantities.

For perhaps 97% of you, it'll be a minor inconvenience.
For the rest, time to set your affairs in order.



For those playing at home, the correct answer was "What is
'Get the f**k off the subway, and stay your @$$ home...' "

---------------

Responses to my Local Color post indicate that response is similar elsewhere. People are vaguely uneasy, and in some paces approaching full-blown panic, but unlike a hurricane or other problem, haven't yet sussed out that this isn't coming and going, it's coming and staying (see above), and it'll be, or is, everywhere.

At that point, in our humble editorial opinion, when that penny drops, you will begin to see some people lose their collective sh*t. I doubt my readers need advice about stocking their ammo larder for that day, but for those that do, get thee hence, now. And load up.

People are stupid, and some people only understand reason when both barrels of it are pointing them in the face, wrapped around a load of 00Buck. Be prepared to reason with some people, whether by explaining things to them ever so gently, or buy cutting to the chase, and pulling the triggers on both barrels, as appropriate.

And as Ol' Remus has told you oh so many times,
 

Avoid crowds.

 

The IQ of a mob is the standard IQ, divided by the number of persons present. IOW, a mob of 100 has an IQ of 1. Dress appropriately for that storm, and do try to be elsewhere if one breaks out.

We will post more on this specifically anon.

-----------------

Part of the penny dropping will be people living paycheck to paycheck, or hand to mouth, having the dawning epiphany that work, and income, has now ceased for them for some unknown period of time.

"Today, on the DUH! Channel: surprising new second- and third-order effects of a pandemic that you were too stupid to realize until they swam up and bit you in the ass..."

And it will do so, and they will thereupon freak out. This is because, as we noted in the above point, people are stupid. Even stupider in large groups, which explains most politics in general, btw.

IF (yuuuuuge if) TPTB have any wits, they will declare a force majeure, and halt all payments across the board, for rent, lease, etc., and suspend them for the duration.
Landlords and banks can suck it in the interim, and all your contracts (car payments, credit card balances, etc.) would/should be extended without penalty XX days or months, as necessary. You can pay them off later, when the economy re-starts, as originally planned.

That would be simple, relatively painless, and the most sensible option.

Government being government, it's therefore also the last thing I expect.

You should have a cash float (in your hand, or where you can lay your hands on it without assistance {mayonnaise jar in the flower garden, I'm looking at you}, not locked in a safe deposit box at a bank that may close its doors just when you need it not to) sufficient for between 3 and 12 months of all personal expenses. ALL. Don't have that? (I've been there, and it provided impetus to correct that deficiency, believe me.) Sux to be you, doesn't it? Work on it now, as possible. You should have that anyways, and since long before now. Get cracking.

BTW, part of an actual lockdown quarantine is that if you're infected, or possibly so, you must stay in your home, by order of the Great And Powerful Oz, until further notice.

Which means the only reason the local constables will be coming to your door is not to evict you, plague-ridden, into the street, but to tell you (and your landlord/lessor), to fuck right off, lock you in, and post notice to one and all to leave you be, because you've got much bigger fish to fry at the moment. I can't help you about your food costs or car payment, but the odds of you being tossed out, if you point out you've been coughing up a lung and feel like shit, is right around 0%. It's not like new tenants are going to be looking for your plague-infected digs as their new domicile amidst a pandemic. Just saying.

So relax about the little shit.
Survive WuFlu, and catch up the other payments when happier days dawn on us all.

Take this as a hint to mostly live within your means, and become a believer. I can understand a house and/or a car payment. But credit card debt is infantile, in 90% of all cases. Student loans too, unless you were a STEM major or going into the medical arts, where you'll earn it all back in a few years. Stop being a financial baby.
This is your wake-up call.

------------------

Avoiding crowds:

If you don't have dead tree editions of 100 Deadly Skills by retired SEAL and former NSA spook Clint Emerson, and his companion book, 100 Deadly Skills: Survival Edition, you're simply wrong. Unf**k yourself.

Both of them are chock-a-block full of handy tips from someone who's BTDT and got the t-shirts, from any number of Turd World sh*tholes. All of which advice works just fine in your local area. They are two of the most useful books I've gotten hands on in the last decade.

We therefore advise you to consult the Survival Edition for
No. 082: Escape Social Unrest and Riots.

Risk the crowd to get a copy at Barnes and Noble, or order it online from Amazon.

TL;DR?

Understand the crowd.
Identify points of danger.
Avoid points of danger.
Avoid looters.
Avoid law enforcement.
Get inside.
Get to high ground.
Stay on the perimeter of the event.
Move perpendicular to the flow.
Put buildings between you and the mob.

--------------------------
h/t WRSA and Silicon Graybeard

And from SiG, There's nothing bad that government can't make worse. Like Kung Flu in the U.S.
RTWT.

------------------

 

 Meet "Italian" Gilligan: Diversity Is Our Strength



Not his actual truck. Just his actual attitude.

This is part of why Kung Flu has shut Italy down.
No, really.

They're still digging for Patient Zero there (good luck with that), but this is one potential Typhoid Mary there among several possibilities, at last reports.

Because some people in any crowd are this stupid.

Now, look around your neighborhood, your office, your kids' school, etc., and find the Special Bright Light geniuses.
Make your self-quarantine plans accordingly.


Maybe it's just me, but if someone so much as coughs uncovered in a store, I want to reach for a heavy bludgeon, to teach them current etiquette.
And yes, within a week or two, you'll have to assume it's everywhere.
Sincere best wishes after that point, especially if you do anything involving customer contact. I think you'll be getting some time off, without pay, in short order.

Kung Flu (Covid-19) Update

All the Kung Flu posts for March from the other blog are now cross-posted here.
Anything applicable in future will also be posted here, from now going forward.

To recap:

This ain't "just the flu".
Bog-simple coronavirus (which is 2-4% lethal) is 20-40X more deadly than annual flu (which only kills 0.1%).
It's twice as transmissible as the flu.
It can incubate latent and asymptomatic for 2-14 days, and possibly as long as 24 days.
(Which means those idiotic kabuki theater spot checks at the airport are guaranteed to miss most all virus carriers entering this country infected, virtually guaranteeing us a full pandemic here.)

There are some reports that it shows signs of bio-engineering via Ebola and HIV DNA strings, at which point regarding previous info on lethality, transmissibility, etc., all bets are off.
There may even be two separate strains in the wild.
There is no vaccine.
There is no cure.

If half the country gets it, that's up to 4-5M dead, and probably 30-40 million additional hospital admits. Even if 97% of people infected just get a mild to moderate viral infection, we have 330M people here. 2-4% of that number, or even just half of them, is one helluva lot of folks.
In a country with only about 900K hospital beds, and 93K ICU beds, which are 75-90% full 24/7/365, even without this virus.

Unless we, as a country, are incredibly fortunate, this is going to seriously change your day a wee bit. For some time to come.
It may just be a major annoyance. (I wouldn't bet on that, though.)
It may -may- collapse health care for everyone, worst case.
Process that fully, please.

Get your rest. Take your vitamins. Wash your hands.

And even if you PPE up at work, nothing is protecting you from getting it at the mall, from your family, friends, or the last guy who pushed your shopping cart.
Use due diligence.

The only way out of this is through it.
Panic: NO.
Prepare, realistically: Hell yeah.

I'm an ER nurse: bringing order out of chaos isn't a superpower; it's my friggin' job.

Local Color

1) Two people in this county were confirmed positive for Kung Flu today. Didn’t hear if they were the ones who came in our doors last week, or from somewhere else. Can’t decide which answer would be worse.

2) Did a tour of the local boutiques.

WallyWorld Megastore:

Bottled water: completely effing stripped to the bare floor.
Hand sanitizer: All gone. Dust bunnies on the empty shelves.
Masks: You missed that boat 2 weeks ago, and they’re never coming back.
MH freeze-drieds in the sporting goods aisle: bare wall.
Antiseptic wipes: Gone.
Nitrile gloves: a couple of boxes left.
Canned tuna: maybe 10 cans left, total.
Dinty Moore beef stew: ditto.
TP: Took a serious ass-raping, but some left. Bigger packs gone, smaller quantities still available.
Bleach: hammered, but a few bottles still available.
Isopropyl alcohol and Hydrogen peroxide: single digits of each left.
Curiously, the beer aisle and the ammo cabinets were still full; priorities, I guess. Also, even though the water was gone, there were tons of powdered Gatorade, lemonade, Kool-Aid, etc. For those who haven’t done it, drinking plain water day after day after day gets damned old, fast.

Hand sanitizer was totally gone from Target, Home Depot, Office Depot, and three large-chain drug stores. If Purrell was dynamite, you couldn’t find enough in the entire county to blow your nose. And as noted previously, masks of any variety are unobtanium.

HD had huge displays of disinfecting wipes, gloves, and bleach by the entrance.

Office Depot had a pallet of bottled water just sitting there. Costco and Target had none.

Batteries of all sizes plentiful most places. Ditto 1# propane cans.

Nobody appeared to be panic-buying at Costco, and things were average busy at dinnertime.

And from morning to evening, not a single clerk at any store had any idea that Italy has basically tapped out of Europe today. I had a hospital in-service during the day, and when I told the ER docs on duty, they about freaked out at the news, knowing that the shitball is just gaining momentum.

Anybody still betting on this being a nothingburger?
Just curious.

Wednesday Sunshine: Brace For Impact

From the masthead quote today at WRSA:
How many ICU beds are vacant tonight in FUSA, and how long will they remain so?

Ours are full-up, we’re holding ICU patients in the ER for hours/days, and that’s with no Kung Flu cases in either place.

In fact, it’s most days 24/7/365, most places, at least in the 10% of the U.S. population where I move and work.

And three major hospitals in OC put up Kung Flu screening tents outside their hospitals yesterday. We’ll hopefully be #4 or #5 in the county, depending on how long it takes TPTB some places to break suction and pull their heads out.

TPTB locally, at least, are starting to grok that this shit ain’t “just the flu”, that Happygas B.S. ain’t going to cut it, and that the CDC is always going to be two weeks to a month behind the curve, because recto-cranial impaction and civil service levels of competence.

If general hospital visits go up 10%/day because of this, we’re hammered.
If they go up 20%, everyone’s f**ked until it ends.
Period.

And due to lack of space, staff, and PPE, in short order, if you aren’t ICU-sick coming in if/when this gets hot and heavy, you’ll be bounced RTF out. That’s how triage works in a pandemic.

That’s before we talk about staff/EMS calling in sick, or actually getting sick.

When you start seeing agencies dedicate fully-suited hazmat paramedic teams rolling on potential Kung Flu cases 24/7, and delivering them to designated Kung Flu triage/treatment locations, just like they did/do with Ebola in Shitholia and Trashcanistan, Shit will officially be Real.

My guesstimate is that will happen once they lose entire fire crews responding to medical cases to a bout of the Kung Flu. Who then pass it along to their wives and kids. And their spouses’ employers. And their kids’ schools. And then back to their parents. Lather. Rinse. Repeat. Pandemic.

My best guess is that we’re now where Wuhan was in mid-December last.
See where we are in 75 day or so, and re-evaluate.

If none of that happens, happy days.

I’m not betting on happy days, but I’d love to be pleasantly surprised.
YMMV

***UPDATE***:
Italy closing all schools and universities nationwide, for at least two weeks.
TL;DR?: The West has just heard the first rape whistle blow.

Brace for impact.

SHIT JUST GOT REAL.

Natzsofast...



Never done this? Then, like 90+% of those who bought N95s (when you still
could), you have no idea if yours works right for you. But you'll find out with
a live-fire test with Kung Flu, any day now. Well-played.                                

A vivid, if unintentional, lesson in context from Borepatch's blog today, with a side-order of why Twatter isn't a good source for anything requiring more than 280 characters or two brain cells.

“Seriously people — STOP BUYING MASKS!” the surgeon general, Jerome M. Adams, said in a tweet on Saturday morning. “They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!” 

Now, either the masks don't help and there's no point in anyone wearing them or they do help and the surgeon general wants to keep available stocks for health care workers. It cannot be both. But if this is the response from the surgeon general, you can stick a fork in it.

When one oversimplifies, it can become an unintentional lie of omission.

An N95 mask is worthless if you haven't been fit-tested to assure it works for you. (And for 25-33% of people right off the bat, it doesn't). For probably 90% of everyone ever, that's shocking news they never knew.

An N95 (or anything else) won't work if you have facial hair that blocks a tight seal.
It requires a bit more than just slapping one on to use it properly.
That knowledge applies to 0% of the general public. If you did time with Uncle Sam, you had it beaten into you vividly during a visit probably annually - to the tear gas chamber with your M17 or M40
series protective mask. Last I looked, prior service applies to something like 3% of the general population. Be generous, and double that info for those who deal with PPE every day at work.
So 90-95% of people have no effing clue about any of this.

That's why it's beyond asinine for Joe Average to get a pallet-load of the things, when he doesn't know Jack or Squat about what's what or why or how or anything else.

You might as well buy him a slide rule, FFS.

I have to get fit-tested every year. When people pilfered the hospital's entire supply of N95 masks last month (yes, really), everyone in the hospital had to get fit-tested again with the new brand. Anyone who was a fail with either brand had to have alternative PPE available to substitute. And we all undergo about three hour's refresher training annually in all the PPE we use, up to and including fully-encapsulated hazmat gear.

So, how much of that have you done? (For most any value of "you", not the OP or bloghost there).
Probably zero seconds, ever, other than buying the box.
Well-played.

And you (times 330M of you) buying up metric buttloads of masks that you don't know how to wear properly, and which may be utterly worthless because of zero training in proper wear, whiskerpuss, or poor fit, and made extra-scarce by China seizing the 3M plant that makes the go-to model in China, and declaring all N95s made there a "strategic national resource" unavailable for exportation until further notice, means there are that many less available for purchase by every hospital in the U.S., for use by the people that need them, and know WTF they're doing.

Now, knowing the rest of the story, go back and read the SG's comments in context.

Because I saw his media appearances, and that's how it was presented by the better media outlets. If you're looking for Twatter to fully inform you, you're short-changing your brain. (Whether anyone on Twatter has one in the first place is an open question. Little worthwhile is conveyed in 280 characters. Great for punchlines for those with tiny minds, but for conveying news you can use, not so much.)

Let's try to tell the tale better than FakeNews, shall we?
Otherwise we're just CNN-lite.

And surgical masks do, indeed, protect other people from your germs. That's why they're cleverly called "surgical masks", and why we slap them on everybody coughing and sneezing in the ER, and why they're worthless as PPE, except to everyone else, to mitigate your slobber and sneeze particles flying everywhere.

N95s and better, by total contrast and design, are specifically to protect the wearer from other people's funk. TB, measles, Ebola, and Kung Flu, for specific examples.

And at least one commenter already posting there didn't know that fundamental difference in PPE, because it's outside their knowledge base.

QED

The surgeon general was spot-on, and his comments and those at the OP illustrate the problem perfectly.

This is the same reason buying any medical gear, or really just about anything, without knowing WTF you're doing with it, isn't helping anyone, least of all yourselves.
If you're going to buy gear, you have to learn how to use it properly.

Gear alone is just stuff.
Gear + training = prepared.
gear + training + experience = gold-star prepared.
Let's deal with this the right way.

Lacking the context of someone "in the biz", I understand why anyone could have missed the bigger picture, and don't expect for a minute poster ASM826 (who ocassionally comments here) meant to misinform anyone. And his further comments in the same post regarding the likely course of spread of this infection remain spot-on, IMHO. As usual, RTWT. There's a reason that blog is on my bloglist.

It also illustrates why, for most people, PPE is a dumb idea, and why you should be focusing on avoidance and self-quarantine, not trying to half-ass how to wade out amidst it. The shortage of N95s will probably save more lives than if we had them in abundance. Just like with Ebola, where 1 in 3 commenters wanted to know how to go out into it and come back home, and God forbid, just like it would be in any CBRN or hazmat event. You can buy a fire truck and an SCBA. It does not therefore make you a firefighter.

If, OTOH, you managed to get N95s before they mostly became unobtanium, make sure yours works, fits, and you know how to use and wear it. Better yet, don't go out and play in it if you can help it in the first place. Otherwise, I'll see you in the ER. I have to play in it. You don't.

Other Business

Don't listen to what I've told you about Kung Flu.
Go read John Mosby's take on his Patreon site.
If you're inclined, sign up, and throw the guy a bone.
There's a reason his site is on my bloglist too.

CDC: Always A Day Late And A Dollar Short

Welcome

So apparently this week (not while I was there), two patients checked into the ER as possible Kung Flu victims.
Here's a snapshot of what happened next:

Are they positive for Kung Flu?
We don't know. Test results pending.
How many friends and family might they have exposed?
We don't know.
Who exposed them?
We don't know.
How long ago were they exposed?
We don't know.
How many staff and patients were exposed?
We don't know.
How many staff were in appropriate isolation PPE when they arrived?
None.
How many wore proper PPE while they were assessed, treated initially, and prior to admission?
Probably nowhere near all of them.
How many of those exposed or possibly exposed are being tracked down, and placed into exposure surveillance, mandatory, voluntary, or anyfuckingkind whatsoever?
None.
How many are in quarantine isolation?
None.

The patients are in isolation while test results are pending, and the staff in-hospital are dealing with them appropriately.
Now.

But  no one is taking this seriously, nor did they before Thing 1 and Thing 2 showed up last week.

You'll know TPTB are taking this seriously when they start sending out dedicated EMS rigs to deal with pickups, already wearing Ebola-style hazmat gear.
And when hospitals have separate triage and assessment areas, let alone treatment areas, for potential Kung Flu cases.
We have none of that.
No one does.
Anywhere.

There are already two healthcare workers in NorCal testing positive for Kung Flu.
From whom?
We don't know.
From how long ago?
We don't know.
How many other people were exposed going back how long?
We don't know.

This is a shit show.
It's going to get shittier.

And this is not "just like the flu".

But it is just like 5000 other ERs across America.

Let's ask Dallas Health Presbyterian how that worked out with Ebola.

And FYI: Two weeks ago, the entire hospital staff had to be re-fit tested for N95 masks (after we had already done so once) because exactly as noted in this post at WRSA, all the N95 masks in the entire hospital grew legs and walked out the door.

They re-supplied with another model two weeks ago, just before they disappeared nationwide, and N95s are now doled out and kept in full lockdown until needed.

COVID-19 (Kung Flu) Updates

You've now got everything from my other blog from January/February regarding Kung Flu.
(Which is a much better popular tag than "COVID-19" PC b.s. If you disagree, kindly lump it.) If you just popped here first, it's everything from yesterday and today, which is why there's (shocker!) twentyish new posts in two days here.

My apologies about the YouTube vids that don't seem to be crossing over, as apparently today Google stopped supporting their linkage. (Jackholes!) They are still available on the original posts.

Tomorrow, I'll drag over the March Kung Flu posts, and from here on out, I'll cross-post them on both sites, as appropriate.
And I'll check in here a bit more frequently than bi-annually.

A Failure Of Imagination. And Of Common Sense.

h/t Blue Collar Prepping



Plague Doctor: Roll +10 Health Points during Contagion.

First, go read this post.
No, really, go. Read.
All of it.
Then come back.

___________________

All done?

I have no problem with the Dr.'s C.V. and bona fides.
She has quite the resume for dealing with some aspects of coronavirus, and related questions about the burgeoning Kung Flu pandemic. And some good, solid, useful information on several aspects.

But she's guilty of some rather important and significant misstatements.
I do not call them lies of omission, because I can't ascribe motivation and intent to what she wrote.

Much of it is correct, as far as it goes.
But some key points are rather woefully lacking in Reality.

¶ Nine:

"The government is currently screening people coming off of international flights from known risk zones, or coming across the border, and then diverting the people who need it to medical facilities that can handle it."

1) The fact that they're doing point-of-care one-time testing, on a disease that incubates for 2-14 days, and perhaps as many as 24 or 28, guarantees the spread of asymptomatic virus carriers into the country, to propagate it hither and yon widespread in a few days, to a couple of weeks. This is the bio-defense version of putting the entire defensive team on the line of scrimmage, and then looking shocked and dismayed when the other team passes over their heads for 3000 yards, and beats you 210-0. Your tax dollars at work.

Sorry Doc, I'm not feeling very de-stressed, fearless, or anxiety-free yet. Maybe you need to go back for some post-doc work on bedside manner and common sense. Just saying.

2) The natural consequence of #1, above is that in short order, there will be no more medical facilities that "can handle it". We've covered this here. The internet moves fast; try and keep up.

¶ Ten:

"Yes, you should go out and replace basic supplies you’re out of, plus a little extra - not because society is about to break down, but because you might be stuck in the house for a week feeling like absolute trash and too bombed on cold medication to drive or operate anything more complex than a can opener and a microwave."

3) Sorry, but after #2 becomes reality, "a week" of supplies isn't going to cut it. And once health care goes down in a pandemic, FFS, society is, in fact, in the process of breaking down.
And then people won't risk going to work, because they don't want to get sick. And/or the CDC closes things down, like they've already said they will. Public facilities, schools, businesses. But I'm sure the police, fire department, EMS, water, power, gas, telephone service, radio, TV, trash collection, and whatever else you imagine, will be magically unaffected by this, because no one could possibly decide that staying home, healthy, with their families was more important than keeping your fantasies about how society will behave alive amidst a crisis unprecedented in a century or more. Your crystal ball is a bit hazy, isn't it?

¶ Eleven

"In extreme situations, schools or workplaces may close under the guidance of local government or management - think snow days."

4) Um, no. Think snow months. Plural. If TPTB close schools and businesses, over a disease that can incubate for two weeks, perhaps a month, no one's going to call off a day or three. They're going to call it off until a month after the last recorded case. Like you do if you got your medical diploma from someplace other than online. Otherwise, you're just ringing the dinner bell for serial waves of pandemic, and guaranteeing re-infection by some, which at last report, has a wee tendency to cause sudden cardiac arrest and death.
Now I'm really not feeling fearless and anxiety-free at all. Are you sure you're a real doctor?

5) And snow months means that "a week" of extra supplies, once again, isn't going to cut it. So maybe start talking about two, three, or six months. Maybe all year. Which, as people watch their 401Ks melt down daily, may bring on even more anxiety among the really susceptible-to-this-virus retirees. Don'tcha think???

¶ Twelve

"Again, this is not Hollywood-style “civil unrest” with people running, screaming, and looting while armed officers break up any groups larger than three..."

6) Oh, really??
Ever been to Chicagostan? Baltimoronia? Detroitistan? District of Criminals? St. Louis? Philly? Newark? South Central L.A.? Oakland? Anywhere, really.
I mean, FFS, Chicago has more shooting casualties every year than the wars in Iraq and Afghanistan ever did, even at the heights of those conflicts (a truth which really pisses OIF/OEF vets off royally when I point that out), and the people there don't even have Interceptor vests, MRAPs, M-4 rifles, close air support, or any supporting fires, most days.

Now, doc, have you ever been there (for any value of there) when they're pissed off?
Like when the market's closed.
Not the stock market; I mean the supermarket. Or supermarkets, plural.

Or when their EBT cards haven't been reloaded, because non-essential employees (and a lot of more essential ones) aren't coming to work to do that?
Didja figure they'd quietly starve in silence?
Or do you think they might go "shopping", with bricks, torches, and machetes?

What about when the police are running things at 1/2 or 1/3 staff?
How do you see civil unrest under those conditions, doc? Have we gotten maybe just a wee bit out of your depth of expertise here? Just asking. Nothing personal.

I've been in two, count 'em, two, city-wide riots. And those were little ones, compared to what we'd see in a months-long pandemic with societal degradation. Both of them affected Hollywood directly, BTW. So maybe a bit less pooh-poohing, and a little more shut-up-and-give-your-eyes-and-ears-a-chance-when-you-don't-know-WTF-you're-talking-about, if you catch my drift.


This will never actually happen. It is unpossible in America.
I read it on the Internet, so it must be true.

¶ Thirteen

" Not surprisingly, mortality has been much higher at the epicenter of the outbreak, where things happened very fast and new patients were met with already-exhausted healthcare resources. Remember that proper medical management, even if there’s no cure, is a significant factor in reducing the death toll. Medical centers and public health workers here in the U.S. are doing quite a lot of work behind the scenes to make sure that our resources are ready to meet the challenge, which is an advantage that the first round of patients in Wuhan didn’t have."

7) Got it.
American health care is first rate.
We can handle a major crisis.
We've got this.
You'll perhaps understand if I mention we've been sold these same Magic Beans at least once before. {Hint: It didn't work out well for the city involved. Or the hospital. Or the employees there. Definitely not for Patient Zero. Or, really...anyone. Maybe they didn't cover this in your anxiety-reducing and fear-allaying curriculum. Kind of a big hole in the course work, i'n'it?}

Now, I'm a fair guy. Most of the basic information, on point, from the good Dr. regarding the actual virus is good stuff.
So you should, indeed, still RTWT.
Glean the nuggets of actual good information out of it. There are a number of them there.

But be aware that when most people get beyond their expertise, they run neck-deep into spurious bullshit, and trip over their Confirmation Bias that "Things have never gotten SHTF bad, so they won't this time, either." Good for your blood pressure, yes, but not so good when you might be re-arranging deck chairs on the Titanic, and listening to the orchestra entertain the passengers milling about in life preservers on the Boat Deck. Especially not when you should have been ripping doors off their hinges and building rafts.

Maybe everything will be magical unicorns pooping strawberry-scented welfare checks and rubies the size of charcoal briquettes.
Or maybe things are going to get a lot worse, and we've only begun the initial tipover on that rollercoaster, with the bottom of things quite a long scary way down.

You get one chance to prepare ahead for Bad Times.
That ends once they happen.

Now, you tell me, would you rather be over-prepared, or under-prepared?
This exam will be graded pass/fail.

My End Of The Stick

1) Orange County declared a health emergency yesterday. I have no wild idea what that means, and I've worked health care here for 20 years, including about 2/3rds of the E.R.s in the county. Best guess, it simply means TPTB in the county have officially freaked the f**k out about the slow roll out of Kung Flu we've been covering here for over a month, and which we warned our own hospital management about, in detail, over two weeks ago was going to put a serious cramp in our ability to treat patients, indefinitely, even if we never had to treat a single case of Kung Flu in person.

2) Observe the picture above this post. That's at the hospital with the largest ED in the county, 50+ beds. It's the second busiest ED in CA, most years, at over 120K visits/yr.
I have some wee experience inside that ER. So what's wrong with that pic?
Look at the sign.
English. Spanish. Nifty.

But.
OC has a yuuuuuuuuuuge Asian population.
Garbage Garden Grove and Westminster were selected to receive Vietnamese refugees and boat people in 1975. There are now miles-long sections of the main boulevards where you can drive for miles and not see a single English sign. There is also a huge Loatian and Cambodian sub-community there and in adjacent cities.
Anaheim has Chinese in small mountains, both Mandarin-speaking from Beijing and the hinterlands, and Cantonese-speaking from the teeming coastal cities like Shanghai and Hong Kong. (What? You didn't know "Chinese" isn't a language? That there are ten major dialect groups , and that they are mutually unintelligible to each other with a hundred miles of distance, all across China? You're as smart as most health administrators.)
Fullerton is literally teeming with Koreans, who have nearly displaced Hispanics as the #2-ranking minority population. This is in no small part because of the state college and university there.
Irvine's student body, like all the UCs, has a huge Asian sub-population, both students and faculty.
Orange has a large population of Gujarati-speaking Indians.
Then there are Filipinos everywhere, as well as Indonesians, Thais, and every other stray cat and dog from Noah's Ark. Many of whom (especially elderly ones) speak about zero English.

You tell me, but it you're trying to get the word out on a potential pandemic, coming from mainland China, you'd think you'd take a stab at the larger ethnic populations, particularly posting signage for Mandarin and Cantonese speakers. So much for Providence Health Care's common sense. And they now own that hospital, and three affiliated large hospitals in the county. For just one example.
Pooch: screwed.

3) As we noted on these pages a few days ago, unless you were in China, or had direct known contact with known lab-tested infectees, the CDCidiots names "no identifiable risk". Problem being, with a 2-14 (and perhaps as much as 24- or 28-) day incubation period, during some amount of which you're contagious but asymptomatic, you could easily be infected, and be third-, fourth-, fifth-, or Nth-level removed from the person who the CDCidiots think is the main hazard. This kind of rank official stupidity is a recipe to grow this to full-blown pandemic in a few weeks.

4) A poster noted in comments to the previous post that there are about 930K hospital beds in the US, and 93K ICU beds. I have no basis to dispute those numbers, so we'll stipulate for the record they're reasonably accurate. But low-end, this is going to create 1.5M deaths nationwide, if it distributes like flu, and maintains a 3% mortality. (That's 30X the annual flu numbers.) And at 3% mortality, it will create up to 15 million hospitalizations, and 30M hospital visits.
And hospitals, IMH experience, run from 80%-100% full most of the time now, from heart attacks, strokes, trauma, and the other rainbow of human frailty that feeds me and keeps a roof over my head, as it has for over 25 years.

So trying to shoehorn another 15M patients into 930K hospital beds, and 93K ICU beds (our ICU, e.g., is frequently full-up most days already) is going to totally collapse health care in this country as you know it. For everything. For everyone.

Suffice it to say we won't be installing bunk beds in the hospital patient rooms.

We'll be on society-wide China-style lockdowns long before then, and IDC if you pop up hospital wards in gymnasiums or sports stadiums, because you aren't going to squat and crap out 1-2M doctors and nurses overnight to treat the patients in those beds.
Not. Going. To. Happen. Ever.

As Rummy famously told you in 2002, "You go to war with the army you have, not with the one you wish you had."

Those people are going to go untreated, or poorly treated, just like in China, and the rest of the Turd World.

Wrap your heads around that reality.

"So what, Aesop?"

So what is, a number of those people are going to die.
Numbers you're not used to seeing, even if it's "only" 3% or so.
(Which is sheer heaven compared to Ebola's 66-90% rate).
In a busy trauma center, 1-2 deaths is a busy day.
Now double that.
For all of this coming year, potentially.

And the people shafted volun-told to care for them are going to fail, miserably, probably get infected themselves due to lack of training, lack of experience, lack of equipment, and simply being overwhelmed. Making the whole problem that much worse.

Ad hoc treatment centers, if this turns into pandemic, are going to look like the MV Death Princess, minus the swimming pool and cocktail lounges.

I repeat:

There will be no ICU care if this goes full pandemic.

None. Nada. Zip. Niente. Bupkus. Zilch. Zero.

We fight for 5 beds/night in a busy trauma center, now, every day.
We routinely hold 1-4 ICU admits and 5 or more telemetry admissions all night long in the ER (making ER care that much harder to get too, for those sitting outside trying to get in - and that includes ambulances - sh*t rolls downhill), hoping that some patients either improve (and get downgraded) or else simply move to the morgue, in order to open up beds after morning shift change.
Sometimes that happens, sometimes it doesn't.

When it's really bad, we go on diversion, dumping all ambulances onto the other hospitals in the area.
Until they choke and close too.
Once everybody closes, everybody's open again. But there's still no beds, so they sit on a gurney, in the hall, for as long as it takes. Hours, even.

Add on 10-20 WuFlu victims/day/all of 2020, at least 1/3 to 1/2 of them needing admission, possibly ICU beds, and ventilator support, times every ER you ever heard of, and you can cancel Christmas.
Literally.

If you're not at least ICU sick (the only thing worse is Forest Lawn sick, btw) when you come in, you're probably never going to get a hospital bed.

The beds we have will be used to try and save those almost dead.
Anything less is going to get re-routed to some half-assed minimally-staffed mega-disaster-plex, someplace like Angel Stadium, the Pond, or some other huge parking lot location closed for the duration because of public infection risks. Staffed by who-knows-who. Retirees and kids, if they're lucky. Maybe military and the Notional Guard, if they're screwed into it. Possibly nobody.
And run with the same management care, expertise, and diligence that gets you the Post Office, the DMV, and the TSA, 24/7/365. Good times.

If this gets that ugly, go long on shroud and bulldozer stocks.
Short sports franchises, theme parks, airlines, and resort hotel chains.
Think the travel industry starting on 9/12/01.

5) Now, therefore, based on what you now know, think on what you might want to be putting aside for yourselves for, say, the rest of 2020. Maybe into Spring 2021.

If you take care of yourself now, before it's a problem, you won't be part of it down the road, and I won't see your happy @$$ in my hospital, nor will any one of my colleagues.

Don't be That Guy. No, REALLY. Just DON'T. M'kay?

And remember this little chat and explanation the next time some official spokeshole starts blowing happygas on you from out between his butt cheeks, and tells you "American health care is first-rate, and we can handle this." Like they told you about Ebola, right before it showed up in Dallas in 2014. And American health care totally blew that right out its @$$. 

And on that cheerful note, I bid you happy thoughts.
Now go shopping.

And if this turns into a nothingburger, with only a mild impact, remember that the stuff doesn't go bad on your shelves. It just means you can eat for next year at last year's prices.
Win-win.

Qwitcherbitchin and get busy.