I love all my nurse colleagues at Good Samaritan Hospital. I could not be more proud of everyone.
Morale is good, in that tired, “we’re in this for each other “ kind of way. My feeling is that those who “show their faces” in the trenches NOW will be respected in the future. If you don’t, that respect will not be given freely.
“We few, we happy few, we band of brothers; For he to-day that sheds his blood with me Shall be my brother; be he ne’er so vile, This day shall gentle his condition: And gentlemen in England now a-bed Shall think themselves accursed they were not here, And hold their manhoods cheap whiles any speaks That fought with us upon Saint Crispin’s day”
We don’t operate on how you feel. We operate on what evidence is, and data is…
Anthony Fauci, MD April 3, 2020
So here it is, my take on what Covid – 19 otherwise known as Corona virus (or just “‘Rohna” by those of us on “the inside” of those hospitals you hear about on TV), is about as of this writing. I fully anticipate that in the future we’ll all look back on these Covid blog posts and rightly say “well that was bullshit”.
To our knowledge, the Corona virus which is in the family of viruses that include the common cold and SARS, started in or around Wuhan China. I don’t know (nor care) whether a guy ate a bat, 5 G towers for your cell phones caused it, a secret CIA research facility released it, or some guy from Massachussetts sold it to the Chinese for pocket money. Most of that is all garbage and, other than adding to the general mis-information around the disease, does nothing but fill your Facebook feed with click-bait fake articles.
It wasn’t mother Earth trying to kill Capitalism either.
It is clear that this virus started some time in late October and the extent of this spread was somehow suppressed until the Chinese government took the extraordinary step of closing down the city of Wuhan and the surrounding area (everybody noticed it then). The spread proceeded from China through traditional routes around the world to the Middle East, across the Mediterranean to Europe, to Britain, to South Amenica, to the West Coast of US and (because of international travel) to New York City. Once it got to NYC all bets are off and now it’s everywhere.
I want to emphaze, that this was NOT an attack on the US by any means but rather a predictable spread of a virus from its origins in Asia and spread throughout the world much in the same manner as the yearly influenza. So comparisons to Flu, in this VERY LIMITED sense, are valid. However, so was the predictability of it’s spread (we knew this was coming).
What makes Covid – 19 dangerous is that it is a “Novel Coronavirus” meaning that people have never been exposed to it before and therefore have no natural herd immunity (everyone else being immune gives you protection – kind of like not getting wet in the rain because everyone around you has very tall umbrellas). So, because of this, this little booger does what all viruses do, it hijacks the mechanisms in the cells of your body for the express sole purpose of reproducing copies of itself and spreading them around. This one in particular seems to like the cells in the lungs and kidneys (Angiotensin Converting Enzyme receptors).
So How Does Rohna Get You and How Do We Treat It?
The immune system has a big cast of characters.
The problem comes mainly with the body’s response to attack. The immune system is set up in two layers, an immediate army of soldiers (white blood cells that engulf and destroy foreign bodies) and the second line of immune cells designed to make antibodies (magic bullets) against viruses. If you’ve had exposure to a virus (or one similar) in the past your body has a template for the the virus, looks it up on “body – google” and manufactures the antibodies that destroy the virus.
If it has never seen it before, it goes into “oh my god what are we going to do?!” mode and begins to unleash primitive methods to kill proteins such as turning up the heat (fever), making cells “leaky” so that all the immune cells can take a shot at the virus (massive swelling and lung damage), and releasing all kinds of toxic chemicals to try to kill the virus (cytokine storm).
Unfortunately, this has the nasty side effect of killing the person.
So the main way to treat this Novel Coronavirus is supportive, we keep the breathing going, we keep the kidneys going, and we try whatever we can to reduce the inflammation while trying to outwait the virus and allow the body to heal.
Chloroquine is an anti-malarial drug that is sometimes used to treat immune disorders (as a second or third line drug) and has hellacious side effects. No one who has ever taken it, likes it. It has been used to try to prevent some of the early viral shedding and to slow down some of the immune response. There are NO STUDIES ABOUT THIS!!! this is all heresay reports from the Chinese (suspect), the Italians and the French (both groups desparate to do something) and unfortunately, the Italians and French stopped giving it to people when they got “too sick” so we don’t know how it works on sick people.
Azithromycin is a nice friendly antibiotic that the Doc gives you when you get a bad bronchitis or sinus infection. It is usually for 5 days and is related to erythromicin (without the nasty stomach upset). It is good to attack any bacterial infections that happen when Covid patient begin to get worse, and it may have some (very little) ability to reduce inflammation.
These are used in combination. However, they both have the nasty effect of increasing the QT interval on the EKG, which means that these two drugs do some slap-dash re-wiring of the conduction systen of the heart that could potentially cause irreversable sudden cardiac death.
EKG tracing labelled
So what can we do?
Stay inside among those who you are exposed to all the time. You can be pretty sure that if you’re all together for more than a week, you are either negative or all of you are positive and didn’t even notice it (yeah that can happen). WASH YA DAMN HANDS! and do it well like on all those interminable TV demonstrations. THIS WILL SAVE YOUR LIFE.
Don’t go out in large groups for now until my guy Tony Fauci (not Dr. Oz) says it’s ok. Wear a personal facemask that covers mouth and nose when in a position that you will be around other people (yuk). If you are by yourself on a run or a walk, then don’t (I carry mine in a pocket when I go running- ya never know). Wear gloves (this is my thing), not necessarily medical gloves (geez don’t throw them on the ground that is disgusting), but regular gloves when you are touching high frequency items outside like doorknobs and such (who knew formal gloves would make a comeback?).
Take a good multi-vitamin with Vitamin C, Zinc, eat right, exercise , and keep up your spirits. Just be a good, healthy adult human.
It’s all going to be OK one day.
A bunch of allegedly healthy adults. I don’t know who they are. They’re standing really close together… makes me nervous. Dammit people spread out and get masks!
In it I was at work (yeah that kind of dream) and we were all dealing with a horrible illness. It attacked seemingly at random and we were all running around trying to cure a disease that we didn’t understand.
Some young people did great, but some others crashed horribly and were put on ventilators. Some old people died quickly, but some smiled at us and asked for more ice cream. I felt like the hospital I was in, was like a rock in a river being overtaken by a flood, we were drowning.
But, I was able to hold hands with the dying and comfort them. I hugged the spouse of the young man on the vent who died. I got to be the object of hatred for the old man whose wife just died in front of him… that’s ok though.
Families asked why.
The country was afraid but united.
Then I woke up… and I remembered it’s worse than my nightmare.
In my last semester of my Master’s Degree, we were asked (told!) to open a WordPress account and start a blog. Over the last year it has sat pretty much ignored as life went on, the way things do when you have no time to reflect. The events of the last month or so have filled my head with so much I have to say, that I was moved dust off the account and then linked it to everything, Facebook, Twitter, and Tumbler. I even threw in the youtube channel in there somewhere. I’m kind of worn out at the end of the day to make those videos for now so… https://healthandhealthpolicy.blog
The subject of health
insurance for all is not a new concept, in fact it goes back to the time
of Theodore Roosevelt whose election platform in 1912 prominently featured
(among other progressive planks) a plan for a National Health Insurance (“Progressive Party Platform of
1912,” 2019). Unfortunately for Roosevelt (and for the country-in my
humble opinion) he was not elected, and the idea of a comprehensive National
Health Plan had to wait until after World War II and into the presidency of
Harry S. Truman.
On November 19, 1945, Truman sent a letter to Congress outlining
the plan for the creation of a National Health Insurance Fund which was to be
open to all Americans. It would have provided for total health care coverage
for individuals, paying for doctor’s visits, hospital stays, laboratory
services, dental care, and nursing services. Suffice it say that this
measure was successfully blocked in congress by the strong lobbying efforts of
multiple Medical Industry special interest groups, primarily among them the
American Medical Association (ironically enough as that group now champions a
single payer system). Taken in context however, this was the period of the
“Red Scare” when anything that even remotely smacked of Communism or its cousin
Socialism (gasp, that word!) was shied away from due to the relentless
hounding and unfounded charges of anti-Americanism brought by Senator Joseph
McCarthy (“Joseph McCarthy
United States Senator,” 2019) and his ilk. These charges could
(and did) ruin careers and destroyed people’s lives. So… the deadly
combination of high-priced lobbyists and McCarthyism quashed the idea of “Nationalized
Medicine” for many years (although Great Britain and Canada started it and
maintain excellent National Health Services to this day).
John F. Kennedy made his own push for a
more limited National Health Plan that would cover seniors after a national
survey showed that 56% of Americans over 65 had no health coverage. But the
events of the early 1960’s conspired to hold that off until president Lyndon
B. Johnson (the master congressional deal maker) was able to get Medicare over
the line and signed in 1965 with coverage for those over 65 beginning in 1966. Harry
Truman and his wife Bess were Medicare recipients numbers 1 and 2.
Timeline
1966 – Medicare Part A (Hospitalization Coverage) and Part B
(Coverage for Doctor’s Visits) begins.
1972 – President Richard Nixon signed into law expanded coverage
to those under 65 with a chronic long-term disability or end stage renal
failure on dialysis (hemodialysis or peritoneal dialysis).
1980 – Home Care Services were added. “Medigap” insurance plans
came under Federal Regulation.
1982 – Hospice Services were added
1988 – Caps placed on Medicare A and B outlay in case of catastrophic
illness. States required to provide funding for Part B premiums for Qualified
Medicare Beneficiaries who are at the poverty line.
1990’s – Medicare Part C enacted. This led to the creation of
Medicare Advantage Plans otherwise known as Managed Medicare.
2000 – People under the age of 65 with ALS can get benefits
without a waiting period if approved for Social Security Disability (SSDI),
normally there is a 24 month wait.
2003 – President George W. Bush enacted Medicare Part D which is
an optional prescription benefit which can be purchased alone, combined with
Medicare part A and B or combined with a Medicare Part C plan (confused yet?).
2010 – Patient Protection and Affordable Care Act (ACA) was
enacted which seeks to decrease costs to Medicare while improving quality of
care.
2015 – Medicare and CHIP Reauthorization Act (MACRA) passed.
Changes the way Medicare pays physicians to try and improve quality of care at
a lower cost to Medicare. Essentially, Doctors must provide better quality of
care or else they get paid less.
Closing thoughts
As of this writing, there were approximately 60.6 million people
on Medicare costing 705.9 billion dollars in 2017 (Anderson, 2019). This is about 20% of
total health spending in the US.
Medicare now stands to account for 18% of the total federal
spending by 2028 with the result that the Part A trust fund will be
depleted and the difference needs to be made up by payroll taxes (not likely to
cover the total Part A spending). As ACA has helped slow the growth in Medicare
spending while improving quality, it is unlikely to “bankrupt Medicare”, but
there must be something done that will provide better quality care, at less
cost, with better coverage for all Americans, returning to the original vision
of Teddy Roosevelt and Harry Truman.
Life, Health, and Policy. 