I’ve always considered myself to be a fairly tolerant person; my name isn’t Karen and I don’t feel any particular need to speak to the manager. In this I take after the maternal grandmother; the one who never made scenes upon receiving bad or abusive customer service. The paternal grandmother would and did, although in Granny Dodie’s defense, she didn’t take umbrage over small and inadvertent offenses and usually got some kind of satisfaction or apology from indulging in recreational Karenism. Granny Jessie would gather up her dignity, depart the scene of the offense quietly … and then never, ever return. No threats, no other complaint, no talk with the manager. Granny Jessie was just gone and relentless in determination to never darken that door again.
Media
Adventures in Social Media – Mil-Vet Version
As I retired from a relatively uneventful career in the peacetime Air Force in 1997, I’ve been out of the military for longer than I was in it. I don’t hang around so much in military veteran circles online as I did early in the decade afterwards, when my daughter was serving in the Marines after 9/11 and deployed to Kuwait and Iraq. But she does venture into veteran social media circles, on a local basis through organizations and outlets like Bourbiz, Grunt Style, Ranger Up, and Black Rifle Coffee … and she called my attention to what amounts to a dumpster fire ongoing in veteran circles. Holy heck, it’s more a raging nuclear inferno than your plain ordinary social media dumpster fire. Read the series of articles, she said, it’s jaw-dropping and so I did. Oh. My. G*d. I thought the Vietnam-era “stolen valor” incidents so thoroughly documented in this book were the far frozen limit, but this Steele character appears to have ventured into hitherto unexplored dimensions.
The Dark Night of Fascism…
…is said to always be descending on America but landing in Europe … but in the instance of this Wuhan Coronavirus pandemic, a peculiar variant of it looks to be landing in Michigan, New Jersey and Virginia, seeing as those states have been blessed with governors breaking all land speed records in getting in touch with their inner authoritarian. One might be forgiven for suspecting that their motivation is not so much for keeping those vulnerable to the newly-improved Chinese respiratory crud in quarantine, but one might also be forgiven for a healthy sense of suspicion; that governors like … Gretchen “Karen the Governator” Whitmer are actually making a frantic display of authority, in a pathetic attempt to demonstrate that they can, actually, make wise use of such authority. Karen the Governator is additionally challenged by the prospect of being theoretically in the running to be nommed to the VP slot in Joe Biden’s hapless campaign for the office of president of these United and temporarily locked-down States. Sigh the thing about authority, class, good taste, or being a lady is that if you must make an overt demonstration of those qualities to the masses then you don’t possess them at all. While it’s absolutely fine that a real-life Natasha Fatale has lost the Russian accent and taken on the onerous duties of being the elected governor of Michigan, going all overboard like the bossiest boss of the most nightmare HOA imaginable (I’m all about building a second career!) … is not a good look. Demanding that retail outlets which are already open and have customers withing not sell garden seeds, flooring, and baby car seats on the grounds that such are non-essential is bloody insane. And illogical.
Madness and Maddow
The Navy hospital ships promised by President Trump to deploy to New York and Los Angeles arrived on-station as ordered a few days ago. MSNBC’s Rachel Maddow, presumed for some obscure-to-me reason to be associated with the provision of news to the public, and most recently famed through peddling Russian conspiracy theories regarding Trump’s election for the past three years, had ridiculed the President’s proposed schedule as “nonsense. ” She, or whatever pronoun she goes by, had loudly and publicly claimed that it would be “weeks” before the hospital ships arrived. Instead, the hospital ships arrived more or less to schedule. A lesser news-person would have the decency to be embarrassed over how transparent a prediction-flop this was. Not this Maddow person, it appears. This is not a good thing, and not for the reason first assumed. PBS’ Yamiche “Rolie-Polie-Olie” Alcindor baldly admitted, and in nicer words, that the name of the game for the national establishment news media is “Get Trump!” and anything goes, fair or foul (mostly foul) will serve that end. Well, really those of us who have been paying attention, especially for the last decade and a half (or longer) have known very well that the name of the game as far as the establishment national news media is concerned, is to enthusiastically smear Republicans and their conservative supporters (no matter how mild or harmless) the pretext, and to excuse Democrats and their supporters, no matter how vile the offense and actions. Nothing new here, move along. SSDD, as we used to say in my active duty days. (Same sh*t, Different Day.)
Texas Aggie Doctor Reports — Clinical Pearls Covid 19 for ER practitioners
The following information is from a front line ER doctor using the handle of ‘nawlinsag’ on a Texas Aggie web site. I’ve included the link below. I’ve also included the complete text of his post in full in hopes medical professionals and lay people could get the most benefit from his observations of the course of COVID-19 in a small front line Louisiana hospital.
Short form: This is not the flu. It is a horror show of death and disablement that is crowding out all other medical care including an immediate downgrade of life saving cardiac care. Only on in seven people put on ventalators in this hospital is surviving, and then only after 10-t0-12 days of ventalator support.
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I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.
I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.
Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.
China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.
Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.
Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.
A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.
An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.
Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.