Wednesday, 18 March 2020

Advice from a nurse in Texas


This is from a ICU nurse In 
Texas.............



Good evening. If you are tagged in this you are family, or very close to my family. I hope that you will take my words to heart and listen.

I have been in healthcare all my life, and now, over 30 years in I am now an ICU nurse practitioner dealing with critical illness and life support issues. Those of you who have come to me for advice in the past know that I am a straight shooter and i have never bullshitted you on matters of health. With that in mind....here we go.

COVID19 is here. In America. NOW. Circulating in communities, both detected and undetected. There is no stopping it. COVID19 is a respiratory illness caused by SARS-CoV2, a new (novel is the scientific word) strain of coronavirus that has emerged in humans since December 2019. It is related to the SARS virus that circulated in 2002-3. We got lucky then. Our luck is not so good this time.


It is not the flu. It doesn't feel like the flu. And it is deadlier than the flu by every measure we have undertaken in affected countries. It will make the rounds and many of us will catch it. Most of us wont have a problem with it however... a significant number of us will get fairly sick and may need hospitalization... of those about half of those hospitalized will likely end up in the ICU and possibly on breathing machines... and of those sickest, there will be deaths. COVID19 at its best is showing a 0.8% mortality rate, which is 3x worse than the flu. That is in countries that have extensive testing and detected both the well AND unwell who are positive for the SARS-CoV2 virus, which causes the COVID19 illness.

There are 350 million folks in america, roughly. People are throwing around this number of "less than one percent". Well let me tell you: Do the math. A very small percentage of a very large number is STILL a large number.


Symptoms of the Flu involve your body feeling like everything hurts, and you got run over by a mack truck and you just feel awful.. in addition to upper respiratory symptoms.

COVID19 is different. You may or may not have a runny nose and fever. A sore throat becomes a major common finding.. then it gets in the lungs. A dry, nonproductive cough is common, followed or accompanied by shortness of breath. The shortness of breath is what is triggering hospital visits, and the folks presenting to the hospitals show low oxygen levels (oxygen saturations) and chest imaging typically shows a bilateral diffuse pneumonia (Double pneumonia for the laypeople).

The only proven effective therapies are supportive- Oxygen, and positive pressure ventilation... either with a cpap/bipap machine or with a mechanical ventilator attached to a breathing tube. There is no cure. Your body has to fight it off and it has to run its course. There is no Tamiflu equivalent that works for this. There are some smart medical folks out there spitballing some ideas, but nothing is proven to work. So like every other viral illness you have gotten, you have to ride it out and hope your body is strong enough.

Babies and children are making out fairly Ok.. even if they test positive they havent been dying of it in China, in Italy... however healthy young adults, even athletic types, in their 30's-50's are coming in very sick and some are dying. From there, the older one is, the higher the hospitalization rates and the mortality rates.

Information out of China shows that it was killing men more than women, but one thing to note is that in China, older men are invariably tobacco smokers. Information out of Italy appears to show the obese are having a worse time with it. In general, blood pressure and diabetes are associated with higher rates of severe illness and death. In particular, people takeing ACE Inhibitors or ARB's for their blood pressure (the drugs ending in "pril" like lisinopril, or "sartan" like valsartan) seem to be having a worse time. This makes sense since both of these classes of medicine affect cells in the lungs, which SARS CoV2 is thought to also affect.

The biggest danger right now, and the reason why I am writing this, and tagging you... is that this will "explode" here like it has in Italy, Iran and how it did in China.

We only have so many hospital beds. We only have so many ICU beds. We only have so many ventilators.. and we only have so many trained staff who can care for the patients. If this blows up massively beyond the ability of the health care system to treat and rescue patients, people who COULD have lived will simply die.

In italy they have an excellent national healthcare system with about 5000 ICU beds, and per capita have more doctors and hospital beds than we do here in the US. Of course, the US is bigger and has more total beds, and ventilators... but again.. less per capita. In italy, in Lombardy (the state/province) and in Milan... they have simply run out of ventilators. Doctors are faced with having too many people who cant breathe anymore, and not enough breathing machines to put them on. They are literally deciding on the spot who might live and who will die. They aren't doing CPR or anything else futile for the COVID patients. They dont have the staff or capacity to do so.

There's a lot more horrible stuff I could tell you about whats happening, but the short version is this - if we exceed the capacity to manage this, people who should have lived will die.

Which brings us to here, now, in the US. COVID is here. It WILL sweep the nation. There was never anything we could have done to stop it because of the way we live and conduct business. BUT what we have to do is SLOW IT DOWN.

IF we SLOW IT DOWN, so that the number of unwell and critically ill dont explode, and overwhelm the system, then everyone has a fighting chance. Give time for flu season to end and get flu patients out of the hospital. Give time for the first wave of Covid patients to get well enough to get out of the hospital.

So.. to SLOW IT DOWN... practice frequent handwashing. Dont touch your face, nose or eyes without washing your hands first. Frequently disinfect common surfaces.

PRACTICE SOCIAL DISTANCING. COVID LOVES A CROWD. If you are gonna spread this disease around lets spread it to only one or two people not 100 people at a time. Stay away from large groups. Lets lay off the rodeos, the ball games, the big parties, the night clubs. Do small groups.. or stay home. If you go out, and touch common surfaces, clean your hands before touching your face. On a bus in china, one person gave it to 8 other people, including one who got on 30 mins after the index case left the bus.

If you are sick, stay home. Dont visit other vulnerable folks. If it gets in your household, accept that its there and try not to give it to your aunts, uncles and grandparents. Stay home, dont go to school.


For the elders reading this. I need you to stay home as if your life depends on it. Because it very well does. Your age group is the one having the worst time with this. And if it gets bad, all I can say is that in Italy this week, if you were crashing and over 60, they didn't even consider offering a vent to them. So please, elders, Stay home, skip church, avoid visiting large numbers of people. Skip the lodge meeting . And if you are adamant that your wings will not be clipped, then please make sure your will is updated, and you've given a copy to your kids.

Now.. none of this says "panic" or "buy bottled water and toilet paper". I'm asking for everyone to take a deep breath and be smart.

Quit caring about your 401k. In a year or two it will be back. The airlines and cruise lines will get bailed out. The economy is going to tank no matter what, so quit worrying about it. Right now the decision is do we want a tanked economy with a low body count or a high body count.

We are all in this together. Wash your hands. Cover your mouth. Practice social distancing. Stay away from large crowds. Be smart. Stay home if sick. Dont hoard or steal medical supplies. We need them desperately at the hospital.

No comments:

Post a comment