Might not the virus been detected if the CDC and Trump administration had done their job with providing C-19 test kits
nationally to health care facilities?
Gross incompetence at work.
5
I have to stop reading about it. I resigned to the fact that I will probably get the virus like so many other people. This government is not looking out for me. As a public school employee, I am forced to show up for work with business as usual. No hand sanitizers have been provided to classrooms and the few that are there are empty. Further, there is no public information or guidance what to do if you have symptoms and what to do when they worsen. Call 311? This is a joke. The private lab here in NY is only allowed to test 90 cases a day? You got to be kidding me.
5
Would we be here if Trump had not eliminated the offices and structure in place to handle pandemics in 2018? We’ll never know but one can assume we at least would be in a more advantageous position than we are today. His continued commentary downplaying the epidemic compared to action taken by other countries throughout the world only lead me me to believe he has made America less great now than when he took office.
7
I have some understanding why they did not initially suspect coronavirus, as the thought at that time was you needed some travel exposure. But what is inexcusable is that once considered he was transported without precautions, and all in contact with him were not tested and not quarantined until clear. The NYS department of health is NOT RESPONDING. Cuomo: get DOH TO STEP UP: test, make quarantine rules CLEAR!
2
The coulda woulda shoulda of this article to the lay person is easy to make not knowing how doctors assess a patient. I feel frustrated reading how bad this was handled but I have no idea the challenges inside the hospital.
But to digress, when hospitals decided it was time to become a brand and have taglines like “Amazing Things are Happening Here” you have to realize the hospital’s brand is now prone to scrutiny. And this is very embarrassing mess up for a brand. These are the consequences of marketing health. Maybe hospitals should get out of the marketing business and get back to focusing on health. My two cents...
13
@Will in Tarrytown: Your comment is so right on! Hospitals have been marketing and organizing themselves as if they are hotels ... and setting up false expectations.
4
It is criminal negligence how woefully unprepared the U.S. is for a possible, and now probable, pandemic spread of the covid-19
virus. The blame falls squarely on this administration.
9
So a friend (a good Samaritan) drove him to the Hospital and the valet parked his car. Of all the advice out there, none tells us how to get to the hospital if we have symptoms. I had a wellness physical last week and asked what I should so (entrance to the Doctor's offices told patients we do not test for Corona); the response go to ER. Which ER? The nearest one ; how?; Call 911. Really? There are no specially equipped transport units???
7
They will ultimately walk back his movements and find out where he potentially contracted the virus. At this time, one can only pray that he and those exposed make a full recovery.
2
And still there are not an adequate number of test kits for Americans. Like the existential threat of climate change I think we have breached the point of no return with the coronavirus.
Both situations were preventable if we Americans took the long view instead of simply focusing on tomorrow. The world we are leaving our children and grandchildren is or shortly will be uninhabitable.
8
This is exactly why it is so important to make the correct diagnosis to prevent the surge of any contagious disease. The vast number of infected patients will definitely overwhelm any healthcare infrastructure.
This brings to the question why almost any countries around the world will be able to purchase or obtain adequate number of diagnostic kits for covid-19 case tracing or surveillance purpose except United States ? I have't read or heard any major media address this issue. The initial response was a flaw in the CDC diagnostic kit reagent. This is insufficient because we are in the 7th week period after the first announcement of lock down in Wuhan January 23, 2020.
The next question is how many deaths in the CDC report " Influenza Death 16,000 " for this current season may be attributed to covid-19 ? Just like the patient Mr. Garbuz's diagnosis, it is " just a pneumonia "or misdiagnosed as influenza.
26
@SK I'm assuming the kits are not readily available because 'they' are scrambling for a way to make a quick buck from it...heaven forbid we have socialized medicine,-because then there would be testing...
12
What we need is a thoughtful, well-planned emergency response. We aren’t getting it. I feel like pulling my hair out in fistfuls. It sickens me that the administration’s concern about the market is overriding all common sense over what we will need to treat people who become this ill.
92
All I can say is please let us test patients. We are just being offered the ability to test via Labcorp who is following the new CDC guidelines for private labs-"Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested"
There have been so many obstacles to testing such that to date almost no one honestly has been tested. I am truly hoping that there are not further restrictions for example in the ability to obtain the swab for testing or in clinics limiting the test. Lets use this now to determine the extent of the spread.
46
@Maria Saavedra
Agreed. It would be in hospital's best interest to have an idea of the scope of the problem. In a hospital in Holland, they were having a rash of cases and didn't know where they were coming from. They randomly tested 300 employees and found that almost 10% of them had COVID-19 and none of them had contact with anyone infected or had traveled. Knowing the real numbers would be helpful for hospitals to plan ahead for coverage and move resources and make sure they aren't spreading the disease themselves. (https://www.telegraaf.nl/nieuws/73328782/28-medewerkers-ziekenhuis-tilburg-besmet-met-coronavirus)
A university hospital in Seattle (https://www.npr.org/sections/health-shots/2020/03/08/813501632/seattle-health-care-system-offers-drive-through-coronavirus-testing-for-workers) created a drive by test for their employees.
13
@Sharon Sheppard This is excellent information. So important to share experiences across the world to understand this virus.
8
Those of us with seasonal allergic rhinitis (aka hay fever) are about to be treated like pariahs. Who's gonna believe us when we tell them our runny noses & chain-sneezing are caused by airborne pollens & molds (especially in warmer, windy weather once the trees start budding) and coming into the heated indoors from the colder outdoors? And if we wear masks (or bandannas) we'll only freak others out even worse.
34
@Sandy Infuriatingly, a Times article suggested that people use scented soaps/lotions on their hands to remind themselves not to touch their faces. I'm really sensitive to scents, had to get off the bus the other morning because a guy on board had apparently bathed in Axe. This happens fairly regularly; now, in addition to being late for work, I have to endure the hostility of my fellow passengers when someone's scented products make me sneeze. And I'm allergic to a lot of trees, so that'll be a thing in a few weeks.
14
@Sandy Cover when you cough and sneeze. That keeps most people happy. The rest will want to see your thermometer results.
6
My big question is, Why, when we saw what was happening in China months ago, did we not start mass producing test kits? We are America. We should have been on this. Trump and his administration has let us all down by calling this a democrat hoax and minimizing the threat we all now face. It is scary when even today he says can’t just tell us facts, but has to mention that he stopped flights from China way before anyone else would have, and this has made the number of cases much lower than it would have been....seriously? People are dying and he shows no empathy...Sad.
146
@ChowderSac WHO offered test kits, and CDC decided to use their own...
22
We had a 2 month head start to prepare for this disease. This is negligence.
211
@A New Yorker
Hit the nail on the head!!!
5
It took four days to “think about” the coronavirus?
I’ve been a nurse for a long time. I think it might be fair to say in this case - the doctors should have asked the nursing staff for advice.
349
@MIMA if you don’t have the capacity or permission to test from the cdc guidelines I’m sure that colors ones judgement. If they had enough testing kits for active screening and a plan of action this would not have gone so long
22
@MIMA I do not know where you work, but at my hospital doctors and nurses work in harmony and respect each others’ opinions and input. Please stop propagating the notion from years ago that nurses and doctors are antagonistic or not working collegially.
-from an MD proud to work with terrific nurses and NPs
5
I work in a variety of health care settings, including those that have people who are on isolation precautions, with pulmonary conditions, on oxygen, and quite ill. These patients have diagnoses that have NOT been attributed to the COVID-19 but to other sources found during lab tests. I find that many times, maybe even most of the time, and on some days in each isolation room that I enter, family members do not follow/have removed isolation precaution protection after they have entered the patient's room. Thus masks (to protect the patient) are only covering the nose, or maybe there are no masks at all. The family member may be coughing, or one may walk out, and I hear that person tell another family member that they themselves have not been feeling well. Yes, we educate and reinforce the importance of following precautions when we find these things out. It can be another thing on top of everything else, and can be disheartening to say the least. Thus, sometimes, when I read about these "undetected" COVID-19 cases, I wonder if the patient may have contracted the virus after hospitalization unwittingly through those who have been out and about. I understand that there is a lack of tests, but consider that there may be other sources as well. We are all connected, and are all in this together as an extended part of the patient's team. I do not live in New York, but on the other coast. Thank you in advance for doing your part.
11
As a nurse ,will visits to the hospital please be taken more seriously? Stop with the balloons and flowers... And none of this in and out of the isolation rooms! "Oh, when you get a chance can you bring more masks and gowns for my cousins, nurse?" Curiosity seekers abound. These are just a few gripes...
4
We are not fast and nimble enough. I'm glad that research hospitals like UCSF and Stanford are stepping up and ramping up their version of testing quickly to make it available to more people who need! Also they can set the rules who gets tested, enlarging the sampling size/population to enable data collection of viral behavior and earlier containment. Relying on CDC, federal agencies and administration is too ineffective. Too much bureaucracy and slow to shovel resources.
8
@Bonnie
Even if we were to have used WHO test kits, the CDC's control over the labs where testing occurs would have been terribly burdensome and likely have reached our current roadblock.
The process wasn't opened up until Trump signed that emergency authorization allowing labs anywhere in the world to use the CDC tests.
Now if they could just get the tests out there.
4
@Captain Nemo Covid 19 is 23 to 30 more times likely to be fatal than the flu. That is the difference between a .1% mortality rate and a 2.3%-3% mortality rate.
@Captain Nemo There is a vaccine to prevent the flu; there's not known cure for coronavirus or vaccine to prevent it. Can you see the difference? Have you visited the WHO website for accurate information? Have you consulted with any "real" health and medical scientists?
I give up!
Does ANYBODY read my comments and check their rational basis?
Apparently not, because becoming part of the panicked stampede is apparently more gratifying than spending intellectual energy on critical thinking.
Just don't be surprised when you wake up in a few months and realize how your 401k has been fleeced by the bankers who DID think this through.
3
@Captain Nemo
I can assure you no one wants to hear that this isn't the equivalent of an ebola breakout. I recall reading that the threat to those under 40 was .2%. Still valid.
1
HCPs: I know you're slammed, but please take a minute to read this PubMed article:
PMID: 32129518 DOI: 10.1002/ddr.21656
There are several similar, written by Chinese MDs there also.
Just in case you have any patients with hypertension as well as pneumonia?
3
@PNRN Very interesting...thank you for this
A few hours ago I wrote a comment at 4 PM or so, that I thought would be a 'novel approach' to a novel virus. I raised the question how people might feel about healthy individuals volunteering or choose to be exposed to simply get the virus at the time of their choosing and in so doing reduce the uncertainty in their own lives. And at the same time perhaps diminish contagion in others by setting up a sort of immunity wall in specific communities. It was a debate question- I am not an epidemiologist, but the responses were intelligent and measured. One comment that came up several times is that we do not absolutely know the level of immunity generated by the virus in those that have gotten it. So here I include a link to an article that highlights the possible benefits of utilizing individuals who have 'recovered' for their plasma, so that it can be injected in those who are already sick and perhaps prophylactically, as well. A kind of 'manhattan project' for a new virus. Again, we have seen the disease in the young and healthy to be quite mild, and of course, it would be their choice.
https://www.statnews.com/2020/03/05/how-blood-plasma-from-recovered-patients-could-help-treat-coronavirus/
3
Nothing to worry about, says our Dear Leader. Move along.
8
Time for CDC to be transparent and tell us the total number of infected medical workers and the numbers under quarantine. NYTimes called out China for doing the same so we certainly shouldn’t tolerate this communist Chinese exclusive behavior here.
11
@AmateurHistorian
THEY CAN'T TELL US THAT BECAUSE THEY HAVE failed to set up rational protocols for testing and/or to make enough test kits available on the ground.
That's the whole point of this story: whole health-care systems flying blind because of the incapacity? failure? deliberate refusal? to TEST FOR THE VIRUS.
8
“We haven’t tried anything to contain COVID-19, and we’re all out of ideas.”
— US Healthcare System
13
The article does not say what has happened to Mr. Garbuz. Is he getting better or worse?
14
@nytreader888
It's an N of 1, so on the national level irrelevant, except that speaking as a physician that is, of course, not the case.
The course of his condition is pretty much identical to what it would be if he had influenza pneumonia, with the exception that the NYT would not feature his case in an article.
I wish him and his family the very best, of course.
5
I read today an interview with his wife that said he’s in a coma on a ventilator. NOT just like the flu.
3
@RMP Could be, with severe influenza pneumonia.
2
In light of draconian measures adopted by affected countries we must also ban all public/private gatherings until we get a handle on this demonic plague.
8
The New York Times has spared no criticism and made many ingenious political commentary on China's response to the novel coronavirus that first appeared in Wuhan in December 2019.
This man apparently was sick in late February 2020, and it took four whole days for a wealthy suburban hospital to even diagnose him correctly.
If a western doctor in a wealthy country can misdiagnose this disease despite wall to wall global coverage for the last two months, are you really surprised that some communist bureaucrats would dismiss and cover up the warnings of a "new pandemic" back in December 2019? Perhaps the doctor had faith in US media coverage that implied the "Wuhan" virus only affected Chinese people.
I don't see any of the same scrutiny and criticism of US hospitals, type of government, or even video interviews of the afflicted in this article. Surely the United States merit some criticism since it had foreknowledge of this disease's existence for the last two months and saw its damage in China?
What was it about democracy and transparency being superior in controlling epidemics? Don't tell me the narrative is now going to change to "its China's fault" because it started there.
21
@Rxe12
You think every single person with a cough should be presumed to have the coronavirus?
The doctors did the test and had to wait for the results which always take at least 3-4 days, sometimes up to 7 days.
There is no rapid test available for coronavirus. What exactly do you expect the doctors to do?
And if your answer is to treat every single person with a cough as coronavirus then that's about 15 million people this time of year, and less than 1/2 of 1% of that group has the coronavirus.
Some people need to wake up to reality.
4
@Diana
If they thought to test for corona virus,they considered that possibility,which begs the question ,why no isolation of the patient and protective measures for hospital staff were taken?
5
He didn’t show up at the hospital “with a cough”! He was having serious difficulty breathing, to the point where neighbors rallied and brought him to the hospital. Fever, flu like symptoms, severe shortness of breath, and they didn’t isolate him?? Because he hadn’t traveled recently? Person to person spread was a distinct possibility, and one that would, without question, be a total game changer, indicating the emergency had moved to the next, extremely dangerous, level. From the very beginning of this nightmare we’ve failed to act with foresight, always lagging a few steps behind. It was NOT just a cough he showed up with! We had had PLENTY of time to put in place protocols that would have given the US a better chance of containing this. The rest of the developed world— when they’re not too busy working to test their entire populations (mostly with no cost to the people being tested)— is looking at us aghast.
Lack of available testing early on is impeding containment - and that is likely going to become an understatement.
I developed flu-like symptoms five days after I traveled through Dulles Intl and LGA airports, but I already had the flu in January. I was denied testing by the DOH twice last week. I am certainly not the only one.
I self-isolated and despite feeling better I am taking the precaution to stay home from work this week as well. Although the DOH said I could resume normal life, I found a study in JAMA where patients who were recovered still tested positive up to 13 days after.
I sympathize with Mr. Garbuz and his family. However, given my experience, I believe there have to be many more cases in NYC right now than the number confirmed. These cases are not being monitored and the virus is spreading rapidly.
35
Is there any clue as to how Mr. Garbuz contracted the coronavirus? There has been no word. When he was very ill, he could not be questioned about contacts he'd made beforehand. What about now?
5
Do what South Korea has done and still is doing: test every person who shows flu-like symptoms, even mild symptoms. that's how they have gotten it under control. It amazes me the old saying: "Hope for the best; expect the worst" is dismissed. Here in this country we have dismissed the experiences other countries have had: what to do and what not to do. We have chosen not to do the prudent things in order to nip this disease in the bud. With leaders like Trump the so-called self anointed medical expert, we have nothing to fear!!!
18
What happened to universal precaution? That's all I heard during the early days of H.I.V.
6
I certainly don't blame Mr. Garbuz's neighbour for taking him to the hospital unprotected. He is not a professional and is not expected to know. But the hospital? By March 2 they didn't have a protocol in place for people suffering from flu like symptoms? This is only a few days ago! The virus head been front page headlines for many weeks prior to, with cases already running rampant in Asia, Iran, Italy etc..and American authorities already alarmed. I find that inexcusable for this hospital to be so complacent. Hundreds of other people are probably infected by this poor man.
27
time to use eminent domain to take over some of these newer hotels or empty apartment buildings in NYC, ( they must be losing tourist trade anyway) and turn them into Coronavirus hospitals or 'quarantine locations' and holding centers for people who need testing and admitting to hospitals.....
11
This article should say how the various other people are doing. Plus it should say how the testing was done, since we hear that no test kits are available. In fact, the lack of reporting on what a test kit is in this situation and how these work is close to journalistic malpractice. Us non doctors have been left completely in the dark on the technology of this. Perhaps someone else will weigh in.
12
@Cobble Hill
I can't tell you about coronavirus in particular, since I am not involved in testing that, but I can tell you that I am using similar techniques on a daily basis to perform genetic screening and gene expression analysis, so I know precisely what the error sources, rates of error, dark case, etc with this is.
Currently, the system suffers from a HUGE degree of confirmation bias (i.e. you see what you want to see). Only the people who have a high likelihood of having been exposed to the virus are being tested and that skews the rate of morbidity/mortality insanely toward the red line, which signals extreme danger to anyone who is not looking at such data on a daily basis.
We do not know how many people are actually INFECTED, but never develop symptoms that show up on the radar. From the recent data in New York, that number is probably adding a multiplication factor of at least 100, very likely more.
Once you do that, the mortality rate from Corona virus goes down to <= of that of the seasonal flu.
So at the moment, this looks like a non-event, except that it will recur next year, unless there is a concerted effort to develop a vaccine NOW.
2
@Cobble Hill I agree the lack of reporting on the testing itself has been frustrating. Tests are not created equal. Univ. of WA in Seattle developed their own test and are approved by FDA just now so are ramping up. They can do 4,000 tests a day and don't report to the CDC. The numbers will become more realistic in Seattle soon. Tests from the CDC must go to state labs only. Many of these are less equipped and slow. Guidelines remain a problem. All of the tests performed are throat swabs and nasal swabs. People who are under quarantine because of contact with an infected case are tested several times so the numbers of actual people tested are low for a nation of 327 million people. There are many states and whole regions of the country who have not tested.
6
@Captain Nemo 100% of the passengers and crew of the Diamond Princess were tested. About 700 tested positive, and 8 deaths. Around 1%, and there still are 32 people from the DP in critical condition. That looks nothing like the seasonal flu. About half of the positive tests showed few or no symptoms. So where does the factor of 100 come from, again?
4
Similar situation with the woman who walked into the Vacaville Hospital. She was very ill but CDC guidelines were narrow. Only people with travel to/from China or contact with sick people or from China. No one tested her for Coronavirus. She was admitted, later intubated, then after 4 days was sent to UC Davis Med Center where doctors suspected Corona virus but were unable to test because the CDC controlled testing at that time. It took 12 days to get a confirmation of Corona virus. It is poor guidance from CDC which continues to tell doctors to only test for Coronavirus for suspected patients. The exposure to Corona in and out of the hospitals which is contributing to the spread. Sick people are not being identified soon enough and asymptomatic people not being identified at all that is preventing containment and contributing to clusters of outbreaks.
24
@jeansch they had stricter rule in the beginning because they didn't have enough test kits for all hospitals in the states.
2
Lets hope the put one of their 2 Annililyzer units from Paradigm Convergence in that guys room. It kills 99.99% of all viruses, and it will keep the doctors safe. Their VP said it was worth the money they pay for it and is very underrated in hospitals.
1
It’s the rate of hospital admissions that make the big difference. Most people with the flu don’t go to the hospital. With the coronavirus it’s 15-20%. This is causing a massive run at hospitals and totally overwhelming the system.
This is why China built a 1000 bed hospital in 6 days. A feat I don’t think can be matched with a less authoritarian government.
The fear in the UK and here is a run like is what may happen and will cause the health care system to collapse.
It’s causing Italy’s economy to come to an almost stop just trying to get a handle on it.
May Allah help you if you’re having a stroke or a heart attack or some other serious issue in the middle of all this going on. Italy went from a few cases to having more than China in 3 weeks.
We will know in 30-90 days or so if this comes to pass.
7
@Jeff
If this were more lethal than the flu, we would by now have >200,000 deaths. Deaths, not confirmed cases!
In a few months we will all shake our heads in disbelief at how we reacted to that.
In the meantime, the only people making money of this are the bankers who think rationally, sell short during the height of the panic and then reap the rewards when everyone else is coming back to their senses.
3
@Captain Nemo it has been 2-3 months. Give it time. Flu has been around for years and flu vaccine only 40-60% effective.
@Captain Nemo
How did you dream up 200,000 deaths?
Oh, and selling short at the height of the panic is a way to go broke, not reap rewards. The lowest price is at the height of the panic.
2
I want to emphasize that the important thing is to have distance from other people, wash after contact. Minimize contact with other people right now. Offer this advice to other people, even health care professionals. I lived through the AIDS crisis and these things were done immediately without thinking before anything was known about the disease. Precaution. Reduce contact with other people is a good place to start.
7
This is the biggest case for real universal health coverage that can be made.
19
In Germany and Washington State, they have drive-they testing available. Eager to see that happen in parts of the country that already have cases so we have more accurate numbers and can respond appropriately. We are currently fumbling around in the dark.
16
One Coronavirus case in Davis/Sacramento week before last (likely infected from someone associated with Travis AFB) caused about 125 health care workers to be "self-quarantined" for 14 days--without testing them.
Nothing but the very largest hospitals can easily absorb this big a hit without curtailing service. reducing patients, etc. A very few such cases in any hospital causes it to stop working effectively.
Unlike China, who could grab thousands of workers from across the country to send to Wuhan, we will be hit across the country more or less at once like Northern Italy.
Everyone visiting (or in) a hospital will need to be tested. As medical staff gets the virus and recovers, they should be assigned as part of the "greeting crew" who deals with unscreened new arrivals while they are tested.
"Test readers" need to be trained, equipped, and located at every location that will care for Coronavirus patients. (If the current CDC test requires a few select sites for test reading, the WHO test that does not should be used.)
(Trump's goal of suppressing the number of cases by making the test hard to get and hard to read must stop.)
24
Coronavirus reporting by the New York Times has been off the charts outstanding
Thank you
39
I read a snippet in a comment in this feed about Canada's excellent response to the virus and realized I have no idea how Canada is handling the coronavirus and decided to check it out.
They appear in SO MUCH BETTER SHAPE organisationally and strategically than the many other countries I'm reading about in my 24/7 watchful watching of the situation status.
Still slightly stunned that I had no idea about Canada. All of the other countries (my own included) are still fumbling around not knowing what to do and here's Canada streamlining a response that may just be impressively professional and of benchmark quality.
I'm sure that there are mishaps and broken processes in Canada's fight against the coronavirus, but it's just such a relief to read about something that's working well. I only read snippets, but one of them mentioned that Canada's applied disease control model is based on key learnings from the SARS virus outbreak several years ago.
29
This isn't the protocol. Hospitals can't test pneumonia patients for CV19 -- patients have to qualify for ICU and be intimated first. But isn't that like buying a lock for the barn door once the horses got out? Oh sorry, forgot this whole thing is a Dem Hoax. I wish Impeached President Trump would ask Obama to fix this - given it's his fault.
15
@Ellis Weiner - intimation will spread the virus even more and expose more health care workers to the virus, so the protocol has to change and the ERs won't change them they are waiting for the CDC or their state health dept to issue new guidelines . as usual, way too late to be of use.
6
@lou andrews
love that spellcheck! Intubation.
5
@PNRN yes, my bad and i knew better, i still posted it... maybe the dizziness from my type-A influenza has affected my judgement.
2
Retired MD, here. You can’t diagnose what you don’t think of.
This story is ALL TOO COMMON.
Covid 19 is out.
Get over worries about some industries. Do what public health ppl say, and realize it can happen to you.
26
So true. I’m an emergency physician now under self quarantine after I saw a patient “without risk” last Wednesday and admitted him for pneumonia. Now, 5 days later, we know that it’s in the community here (my patient and 5 others in the county have now tested positive). It’s just like the expert from the UK interviewed by the NYT said a few days ago- once there is one sick person found in a community, there are probably already a thousand cases there.
13
@Dr. Dixie
COVID-19 is everywhere. Instead of freaking out about its spread (it's already spread) we should be looking at how best to deal with those who are infected.
A triage approach to care makes sense now. Healthy Americans not at risk can treat it like the flu with extra care not to spread it. For health care workers and at-risk individuals, different protocols should be developed.
1
I’m a physician and am dealing with the exact same issue in my hometown. The root of the problem is lack of test kits, forcing an unscientific system of rationing. People are not getting tested. If they’re not tested, the right measures to prevent spread are not taken. Therefore, we’re woefully unprepared. That’s the sad truth.
62
It’s so easy for everyone to criticize. This reminds me of the start of HIV, completely baffling to medical professionals at the start. Having HIV was a death sentence. Now you can expect to live an almost full life even with the diagnosis. The medical professionals and workers risk their lives for others being exposed to not yet known illnesses. We need to thank them for their hard work and sacrifices.
It’s a shame that our country’s leadership decided to cut CDC funding by 1/3 and eliminate the Global health unit on the National security council when he took office. Apparently he didn’t think that our history of having epidemics and pandemics was worth the investments and instead put money into the WALL. He further worsened the situation by not wanting to “upset the stock market” and promised unrealistic expectations.
This is the fault with our current administration and those who voted him in.
40
@Mickey
Jeesh, a plague? How could that affect our National Security?
3
No tests = no cases = no action taken.
A calamity.
46
Our nation's "Don't Test, Don't Tell" policy is such a success! By the time spring break is over, we will all be less than six degrees of separation from someone with coronavirus. Then it will be five. Then four. And finally, by the time the federal government releases tests, it will be too late. We will all be exposed and/or infected.
Trump's "Bury your head in the sand and hope it does not interfere with occupancy at my hotels" health policy is going to kill a lot of elderly Americans.
47
This same scenario is currently happening all across the country.
23
If this had happened back in January I could understand the cavalier attitude taken by the hospital but this was at a time when they should have been much more alert and aware this might not be the garden variety flu or respiratory problem. We can only hope that by now these lessons have been learned.
23
@Joe B I remember the US early response in January saying China was unprepared and managing it badly...it was new to them and they literally built a hospital in 5 days..the US has has 2 months to prepare and be at least as ready as China...but I guess not....
11
If this is what happens in a 290 bed hospital in a suburb of NYC I hate to think what would happen in my rural town's 23 bed hospital.
I am in the high-risk group, over sixty with a weakened immune system and a chronic illness, and I have my annual appointment to renew my meds tomorrow in a large clinic in a nearby city. I asked if it could be done using telemedicine and it could not. I'll take proper precautions while there, but have to admit I'm not thrilled.
37
@LJ I ma surprised that these annual ring the cash register visits have not been postponed until this crisis is over. They have a fraction of the thoroughness of an annual physical and the time spent on them could be better used to address more pressing needs. Doctors usually say that they are mandatory, how about a temporary executive order to stop these visits until it makes sense to resume them.
13
@Kevin I completely agree. I'm intelligent enough to figure out when I need to see this provider and when I don't. Given the circumstances you would think they would give me a break. I'll talk to them about it tomorrow and maybe some other patients will benefit.
4
@LJ
Meanwhile, and I'm not joking, wear plastic gloves and a mask, and if you can't get them, wear any kind of gloves and a bag over your head.
As a retired homecare RN my thoughts are with those nurses who 7 days a week visit patients and their caregivers at nursing homes, assisted living facilities and their homes. Even at non epidemic times these brave professionals put their health and safety at risk without the precautions available in hospitals. During these times of high risk it takes a special kind of dedication to daily carry on regardless
54
@Christopher Slevin
I suspect home care nurses are going to play a very big role in this virus because testing and quarantine will take place offsite.
3
Their ER is a lax and negligent breeding ground of the unfit leading the unfit and what not to do in an emergency. I am not surprised one bit that they neglected to quarantine upon arrival a patient presenting with pneumonia symptoms during a global pandemic, but instead gave him free rein to walk and then ride throughout the hospital for four whole days. Shame on Presbyterian Hospital for putting their name on the building without training their satellite location with the same world-class healthcare. This hospital is a community liability. Healthcare is not supposed to be more dangerous than safe and certainly not contributing to a pandemic. What they did is a crime.
20
@CK almost all ER's are like that in this country sorry to say. Still here in Oregon our Health Dept officials ares til playing down this infection. what will it take for these people to wake up? "Hope for the best; prepare for the worst". even this is not being done. We are shooting ourselves in the foot repeatedly. No one is paying attention to the crisis in other countries, how NOT to handle things and how to handle things.
10
@CK
It happens that I was in one of the hospitals in the SF Bay area this morning for an outpatient procedure. Nobody (staff or patients) was masked until the doctor actually performed the minor surgery on me.
Masks that actually work (N95 rated) are not available in the volume needed even for the medical team and administrative staff working directly with patients with symptoms suggesting Coronavirus.
Yesterday, my daughter (a schoolteacher) has a cough, fever, and bronchitis--the outpatient clinic she saw had some masks for medical staff, but none for administrative staff. The masks were not N95 rated--so ineffective against Coronavirus. She asked for a Coronavirus test--and was denied, despite presenting with the symptoms. (She did get a flu test and a pneumonia test--both negative.) Message: the Coronavirus test is too rare, too expensive, takes too long to read...operationally, nearly useless for anything other than diagnosing cause of death.
Presbyterian Hospital may share some blame---but we are equipping our soldiers in this war against Coronavirus with stone-age spears against an opponent armed with assault rifles. Hospital staff will soon get the virus--because we have wasted 5 weeks or more as a nation rather than preparing a viable testing process for hospital operations.
20
Cheap, widely available tests are required now. (The WHO sells the test kits for $3.00. Each kit can be used to test up to 92 people.)
Doctors and every other hospital worker must be tested after accidental exposure as soon as it is known.
As this epidemic intensifies, all hospital staff should be tested every few days in any town or region that has community based contagion. (the swabs take only seconds). They way, they can be detected early on--and cleared early on, or isolated early on.
Hourly hospital workers (all of them) must be paid when quarantined. (Possibly with government refunds.)
We desperately need to keep our hospitals functioning--and that includes keeping all employees well and compensated.
All too soon, it will be hospital staff that has already survived one bout of Coronavirus who will be filling the jobs.
33
For anyone is feeling complacent about this disease, they might care to Google ‘An epidemiological disaster is taking place’, to find an article in the Independent newspaper that has an account from an Italian doctor who paints an ominous picture.
12
@lou andrews
Thanks for your effort, but paywall prevents access.
1
I work in a hospital. One of our desktop IT guys is home sick, possibly with this virus. He's been down in the ER a bunch and we've had patients with the virus here.
10
@Joe
Good luck to you, Sir, and thanks.
Bet none of them have been tested--putting you at risk.
3
The lack of widespread testing compared with other countries is a shame on the USA. We are no longer “the best country in the world.”
32
The fundamental need is a widely-available, quick and accurate test for the virus. People are dying because they are not quickly diagnosed, and we have an epidemic because they are inadvertently infecting others. South Korea, Germany and I believe France have widespread DRIVE IN testing. How can we be so far out of synch? The politics of this are disgusting.
27
@Donna Yavorsky our officials don't want to panic people. that's the reason given.. the lamest excuse i've heard and we will pay the price for this PR nonsense
13
@Donna Yavorsky
South Korea has merchants who will sell fast, accurate tests that can be read in any hospital in lots of 100000.
The WHO (World Health Organization) has a test kit that can be used for 92 tests per kit that it sells to rich countries for $3.00/kit (free to poor countries).
The only explanation for the non-availability of tests (and charging $3000 per test for them) that must be read in a specialty lab is a fierce desire to suppress the number of cases--and make somebody obscenely rich.
13
Because for our president, it’s all about keeping the published contagion numbers low for his reputation. He knows that if you can’t access the test, you can’t diagnose...(and hocus-locus)...contagion numbers stay low.
Unfortunately,the lack of preparation makes our richest country in the world look like some pathetic, out-back banana republic.
10
Very sad. All patients displaying respiratory distress and/or /pneumonia like symptoms should be immediately be tested for the corona virus. ( I believe that was done in South Korea.) This case illustrates why test kits and information should be made available to all health care institutions that come in direct contact with patients. Think of all of the lives adversely affected by this one instance of negligence. Yes, lack of test kits is a factor but it is hard to believe that no one at that hospital failed to see a flashing red light.
15
The people in charge of managing this Pandemic are doing a terrible job. On March 3rd anyone with pneumonia should have immediately been tested and quarantined. This incompetence is infuriating and is costing lives.
23
Do not worry folks. It's all going to go away in a few weeks. :-)
5
Promise ?
3
@George Rex Trump did. All over by April.
We ALL knew this was headed our way. WE (our government and medical professionals) should have erred on the side of caution by treating all pneumonia cases as possible COVID-19 cases.
16
People's expectations around testing are unrealistic. The US didn't get the genome from China until January. It's only been 2 months. In the the past, it's taken much longer for the CDC to produce tests.
From Wired.com on 2/4/20 after Trump signed an authorization to speed up the process:
"Today’s emergency authorization is as historic as the outbreak it’s intended to contain. When MERS broke out in Saudi Arabia in June 2012, the FDA didn’t issue its first emergency use authorization for a diagnostic test until the following June. For Zika, it took about seven months after the virus exploded in Brazil.
An FDA exemption took about the same amount of time following the devastating Ebola outbreak in West Africa in 2014.
The speed with which public health officials are now pushing through a new diagnostic test shows just how seriously they’re taking the potentially pandemic threat of 2019-nCoV. It’s also a sign that the world is starting to learn how to deal with an onslaught of new pathogens."
****************
* "The US Fast-Tracked a Coronavirus Test to Speed Up Diagnoses",
https://www.wired.com/story/the-us-fast-tracked-a-coronavirus-test/
4
How do you then explain the massive testing going on in other countries? Please stop.
20
How do you then explain the massive testing going on in other countries? Please stop. The article is dated February 4th and there is still no widespread testing going on!
Wake up.
19
@AACNY Let's not make excuses for ourselves. Anything that countries such as South Korea, Italy, or the UK can do in terms of diagnostic testing, the United States can very reasonably expect itself to do at least as well, if not better. What means could any of those countries possibly have at their disposal that the U.S. doesn't?
I refuse to believe we don't have enough dollars, educated workers, and scientific equipment here to roll out the kind of testing blitz that Americans rightfully expect.
America is capable of fighting smarter and harder to defend against a virus that threatens the nation's health, economy, and national security. I love this country and its people, so I hope we start pronto.
8
How is Mr. Garbuz now? Is he convalescing now that they have identified his infection?
14
Yes, i I also felt some indication of how he is doing now would have been in order. I wish him, his family and all others affected the best!
6
Hospitals need to get with it. Anyone that is suspect for corona should be treated as such. I wish we had a real President who could take control of this situation.
9
@GB Hospitals are with it. The CDC did not think it might be a good idea to test people without a travel history to China or a known history of kissing someone with coronavirus until literally March 4th.
10
@glorynine It is not about testing it is about protection of transmission. Social distancing. Staying away from other people when possible. Washing after contact. Not shaking hands, touching. Simple, common sense. Please add to this list with good information, not bad.
2
Amazing things are happening there
2
This article reveals the huge exposure staff and patients in Lawrence Hospital had. No one else has said it took 4 days for them to suspect corona virus. I am far from a conspiracy theorist but I suspect a very very robust damage control team at Columbia Presbyterian trying to prevent the reality of their situation from getting out. Keep digging.
There is much more to this story.
19
@Brenda Berry MD
Much like the secrecy surrounding the OBGYN at NYU with suspected coronavirus, we need to know more information. Yet only the U.K. Daily Mail is reporting on it.
2
@Brenda Berry MD sounds like they are doing what China did: bury the worst news and make things look like everything is peaches and cream. You don't have to have an oppressive Communist regime to act like one in a democracy or more accurately: a corporate democracy.
3
It seems this was very similar to what happened at the beginning of the Italian outbreak in the middle of February. A man had symptoms which weren't recognised for 36 hours during which he infected several people—patients, medical staff, and members of his family—in the hospital.
https://www.theguardian.com/world/2020/feb/26/coronavirus-inquiry-opens-into-hospitals-at-centre-of-italy-outbreak
8
Yet again per recent times the whole COVID-19 experience is telling us far more about the societal contagion of fear than the underlying medical reality.
The relevant curves are all flattening, asymptoting at levels far short of the dire outcomes being mooted.
Alarmists need to read Anatole Kaletsky on Project Syndicate, 10 March, “Fortunately, in this case, the relevant statistical trends are developing in a much less alarming way than panicked media headlines might suggest.”
And Jeremy Faust [of Brigham and Women’s Hospital / Harvard Medical School], 4 March, “There are many compelling reasons to conclude that SARS-CoV-2, the virus that causes COVID-19, is not nearly as deadly as is currently feared..”
1
@william etheridge
Wow, people keep missing the point.
He didn't die. It's just that no one suspected he had it. That's because it was impossible to test for it so no matter how many cases came by, it couldn't be diagnosed.
Countries around the world are shutting down their economies. This will likely hit us all at once. That's not good. Shortages and deaths will result from that. Experts already predict it the death rate is much lower than it is now currently showing. But they are extremely worried and are predicting catastrophe. Alarmists? I'm beginning to think a significant portion of our population is unable to think logically and clearly about anything.
3
@Ben See what I mean.
@william etheridge If that is indeed the case, it still true remains that Coronavirus is quite easily transmitted and deadly to those populations at risk.
Is it worth shutting down entire economies to battle the virus? I guess it depends what value you place on those lives that are at risk.
5
Hospital personnel apparently do not watch tv. Frightening
4
I had a close relation pass last Spring. On one four-hour afternoon visit I counted 17 different hospital personal approach bedside at one point or another; doctors, nurses, other health care workers, food servers, machine monitors, technicons, etc. Is there a realistic alternative for treating coronavirus victims without SUBSTANTIAL risk to caregivers, service providers? I appreciative the good intentions of this reporting, investigation, etc., but it seems to have opened another can of worms without the hope of remedy.
4
Has this man waived his right to privacy? Did he give permission for his name to be used?
19
I don't think the problem is as much that it was not immediately identified - would the treatment have differed?- but that healthcare professionals did not observe strict precautions in front of a contagious and severe disease. Not only do healthcare professionals catch diseases, they spread them. So no it's not ok to spread coronavirus, but neither is it to spread bacteria or fungi. Proper precautions should be observed all the time and even more so when the symptoms are severe.
2
@Marie: yes, treatment would indeed have been different. The patient would have been placed in a negative pressure isolation room and clinical staff would have worn PPE (personal protective equipment) for airborne precautions. We do not dress out for airborne precautions for each and every patient.
8
Do we know how me Garbuz might have becomes infected in the first place.?
7
@MH Community spread...someone who visited/worked at his law firm.
@37Rubydog Thanks. I guess that person had been on a ship, or in Iran, or Italy...?
@37Rubydog
or a passenger of Metro North train, or somebody at Grand Central Station passing by...
1
I was recently in an urgent care facility with a gastrointestinal virus and when I asked the doctor to test me for flu, I also asked if it was possible to test for norovirus. He misheard me, thinking I had said coronavirus and he laughed, “have you been to China lately?”
While in my case there was no reason to suspect Covid-19, it is this dismissive and cavalier attitude that gets us into trouble.
We may not realize it but President Trump’s attitude has an impact. Even if you hate him and think he’s an idiot.
23
Did this poor man survive?
12
Why are we so insular to begin with? This really starts with religion and mass groups.
2
I know a nurse who says hospitals and nursing homes are not even stocked with enough gowns to go into contact precautions patient rooms every time you do it, because nobody follows contact precautions even 50% if the time..
8
Not true. He/she must work in a bad hospital.
3
So let me understand: guy shows up with pneumonia at the end of February, weeks after coronavirus has been global news, and for 4 (four) days none of the doctors think it would be advisable to test?
Criminal incompetence. One of those circumstances when I am proud to be European (albeit resident in the US).
41
@Joker So no such criminal incompetence in Italy (10,000 cases) or France (1700) or Germany (1400)? Be proud to be European and dismissive of Americans all you want, if it makes you feel better, but viruses and stupidity know no boundaries.
11
@Joker
Test with what? We didn't get the genome to create the test until January.
3
Sorry if my comment was offensive.
Unfortunately Italy is just a preview of things to come in the US in a few weeks. That’s why I struggle to understand how this pneumonia case could be overlooked only a week ago or so.
Once the virus is out it’s almost impossible to control, unless you go into large scale lockdown. The progression in Italy has been exponential despite the early lockdown of the 3-4 small towns where the first cases were found. Already too late. Friends in Milan portray the situation as dramatic, with intensive care units overwhelmed, younger patients being triaged for use of ventilators and mortality rates going up. Don’t believe the Chinese low mortality figures, all propaganda.
5
What a train wreck. Between the response from our leader (just ignore it, it will go away) and the mismanagement from a fairly decent hospital, this does not bode well for the mighty USA. We are in for a long hard ride my friends. Buckle your seat belts. My bet is DJT won't be our next president. Even his supporters must be alarmed.
24
The Australian Medicare system-for All- has just introduced a new service for All Australians- free video conferencing with their GP to discuss, from their homes, what some of their reported symptoms may indicate.
10
@Anita
His supporters have developed an immunity to facts.
17
@Anita Your politicization of the health crisis is deplorable. Everyone involved, including the experts surrounding the v.p when he announces a press conference, is doing his/her best, "tant bien que mal"to resolve the crisis and mitigate its effects.It's easy to be a pessimist, a cynic. Just go to any Monoprix in the City of Light , but harder to be an optimist because that means that you will work to make things better.Alexander Harrison would qualify your loosely chosen, irresponsible words as a "verguenza!"Remember the words of the late John Mitchell, who had a home on Pine Street in Port Washington while my family had property at the end of Herbert Avenue:"When the going gets tough, the tough get going!"Ask yourself what are YOU doing to contribute to the commonweal at this perilous time!
1
One other question. How did this guy catch the virus? When it first came out, an article had mentioned he had recently traveled to Florida. Is that where he picked it up? Which means everyone on his flight was exposed?
For whatever reason, NY has lost control of the entire spread. The first patient was easy, she isolated herself, though am not sure if she took public transportation from JFK. But the 2nd case has gone entirely out of control, and as per the governor on Sunday, people are not following quarantine orders. Some people I know have already left the city, and am sure others are contemplating the same.
7
@CacaMera There is no way this is the second case. Merely the second detected case. Airport screening has been a joke. Testing was essentially non-existent prior to this past weekend and is still practically non-existent. People all over the place have symptoms compatible with mild COVID-19, and no-one is being tested. Yet our mayor and governor think we are doing something by locally containing a synagogue in New Rochelle simply because we miraculously ignored CDC guidelines and decided to test a sick patient anyway after 4 days of this thing brewing and contaminating everyone around him. We thought we were doing something by banning travel to places with efficient testing and high detection rates (e.g. South Korea) while ignoring our own domestic flights from known hot zones, because, hey, if you don't test and you don't detect, well then it must not be there.
The response has been a joke. Fifth graders have superior logical reasoning.
2
Why our leaders and the news media continues refer to the Westchester situation "the largest concentration [of cases] on the East Coast", and then respond with a mile-wide facilities lockdown in that area reveals a fundamental misunderstanding, even at this late stage in the game:
The Westchester cluster is simply a cluster of DETECTED cases, and the reason it was detected was because someone from the area presented with a severe case.
Waiting until someone presents with a severe case to start screening a potential cluster is weeks TOO LATE. We are constantly playing catch-up.
The authorities don't understand that the time to detect an incipient cluster is NOW, by screening people with ANY mild symptoms compatible with the disease, or even asymptomatic people.
NYC should select some schools to screen...de Blasio says we don't have to test our kids because they won't get severe disease anyway, but those classrooms are the perfect little petri dishes to spread this thing back to the adult community.
We STILL are kidding ourselves that the only clusters out there are the clusters that we have bothered to test/interrogate.
This will end badly, unless a more proactive screening based approach is used.
DO NOT WAIT FOR SEVERE CASES TO START TESTING and find clusters!
Alas, it is too late to contain.
28
@glorynine "it will end badly." Really? The end is already here. The rough stats are this: in less than 2 months, over 300,000 cases world wide have been detected...now, that is the "opening" of this "play." It is indisputable that in this crises un-named world leaders are either A) denying the reality facing our species, or B) consolidating their power through fear. My point? I'm agreeing with you, but I think Act 2 is going to be far uglier.
4
Also, the teachers— many, many of whom are in the at-risk age group— are sent to work daily in those crowded Petri dishes. Private schools shut down, of course. I teach at NYU, and classes have been switched to online. My sister teaches in a public school (in a particularly stressed/stressful environment), and is feeling pretty bad. What’s the deal with the Teachers Union? Why aren’t they protecting their workers?
Incompetence at the hospitals and the administration is probably one of the reasons why there are so many deaths in both Italy and USA, compared to Japan and Germany.
Sometimes it might be that simple. Let's hope for the best.
4
We Americans knew this was coming, had a sold 8 weeks to prepare and did nothing.
And now we will pay for it.
24
This NP searched PubMed for clues as to ways to prevent Covid-19. Nothing is known for sure yet, but here're 2 interesting premises:
Severe cases of Covid might be related to low levels of Vitamin D. D is often found low in people with COPD--chronic obstructive pulmonary disease. It's also often low in the elderly & patients in nursing homes.
Note that there's some thought that coronaviruses abate with warmer weather. Assumption has been that coronaviruses don't like high temperatures--but maybe it's something else? In warm weather people go outside, with less clothes on & their Vit D levels are raised by sunshine striking their skin.
Note that there was a Covid case in Singapore, but it didn't seem to spread. (Given the climate, I imagine the populace has great D levels.) Haven't heard of cases yet in Africa, S. America, other warm spots. (Doesn't mean they won't get cases; but maybe less?)
So I'm raising my daily dose of D substantially. I want to be high normal, not low!
Also, I found this entry on PubMed from an Israeli microbiologist:
Angiotensin Receptor Blockers as Tentative SARS-CoV-2 Therapeutics
David Gurwitz 1
PMID: 32129518 DOI: 10.1002/ddr.21656
There are half a dozen similar Chinese articles re this on PubMed. Gurwitz recommends a blood pressure med I'm already taking--a cheap, oldie but very goodie called Losartan. ACE inhibitors like Lisinopril replaced its use for many people, but isn't necessarily better for BP.
10
@PNRN Egypt, Algeria, South Africa and other warm climates all have some cases. Of course, that doesn't necessarily mean that their cases spent time in the sun to raise Vitamin D levels and the victims may have travelled elsewhere first.
You have to be careful about taking too much vitamin D3. My doctors has me on it because my levels do tend to be low, but he told me not to take more than 4000 IU a day.
2
@Martin Brooks
@Martin Brooks
You're right, Martin, not everyone in southern countries has normal or high-normal vitamin D levels. For example, D deficiency has been found in Saudi Arabia and Miami, Florida. I don't imagine some Arabic women get a lot of sunshine on their bare skin. And in Miami, again, some people purposely avoid the sun, or are too frail to go to the beach.
I was thinking also, wasn't there a case or two of Covid at the start of this in Hawaii? (travelers from china, I think.) But it hasn't seemed to have spread there, either.
Note also: smoking depletes Vitamin D levels. Guess who's dying in China from Covid? Male smokers.
Anyway, 4000 is a good cautious limit. But if a patient is proven to have a deficiency, the usual medical treatment is 50,000 units ONCE per week, for 7-8 weeks. Then retest the patient's level, and repeat the treatment if he's not yet up to normal.
You can get almost the same results, if you persuade the patient to take 2000 iu's daily. But it may take a few months to get him up to normal.
In this case, speaking ONLY for myself, I want to be sure I'm high-normal rapidly, not in 2-3 months. So I have an OTC bottle of 5000 iu pills I got at the drugstore, and I'm taking one daily, along with a fatty meal to increase absorption. I'll likely buy another bottle of same, once I finish this one, then cut down to 2000 iu daily. Again, that's just me.
Stay safe out there!
4
First, health professionals are truly heroes around the globe through all of this. We are truly appreciative of the work being done on the front lines.
But, I find it unfathomable that so many people and professionals truly thought that somehow New York City (the most international city with thousands of flights every day) had somehow managed to not have any community transmission for months after the first sign of a major outbreak, especially given how communicable this virus is and the extended length of incubation. The whole plan was to wait for someone to show up with significant enough symptoms to warrant going to a doctor and then triangulate that that person should be tested for Coronavirus. That left tons of people funneling out into the city carrying the virus without symptoms or symptoms that presented much later. A true prevention strategy would've done randomized testing at the points of entry.
Right now, I know at least 6 people around the city who are experiencing the horrible hacking cough and fever for the past 2 weeks who have not gone to the doctor, because we're young, likely to recover, and we have already been told by our physicians not to come because they won't be able to test us. Meanwhile, we will just continue to spread the virus during brunch and happy hour because CDC has decided that it's a good idea to wait until someone's in ICU to do the COVID-19 test. Believe me, community transmission is alive and well in Manhattan.
23
@Jamie thank you for sharing, it is really beneficial to hear first hand how things are going in the middle of it. Good luck!
1
@Jamie
Exactly. The CDC is looking a bit lame with their statements of "don't wear a mask", even though the virus spreads through cough and sneeze droplets. That, plus their mandate to have the populace protected, notably health care workers, by having adequate gowns, masks and gloves to distribute in times of epidemic.
There seems to be, at this time, an unprepared CDC and overall health care system. I'm not sure how medicine dropped the ball here. A long time ago, when I was in med school, interning and residency, we all knew to use soap and water, as well as wear gowns and masks around sick, coughing patients. This offered protection to the examiner and the patient. Seems troubling there was no infectious disease consult called sooner, as the article describes fairly rapid worsening of his respiratory condition.
In these times of instant world media, how could an entire staff be so uncurious about this unfortunate man's worsening situation? Am hoping he is staging a comeback; it has been 9 days since his transfer-how about some followup.
4
Well those 6 people that you know could just stay home, you know, to avoid spreading whatever it is that they have, COVID-19 or not. Why people think that they should go out in public when they are sick is beyond me. You don't need a doctor to tell you that you might be contagious.
11
This is extremely scary. And I can’t help but wonder to what degree the federal government has failed to pass along necessary information or simply kept it under wraps.
There must have been errors all along the way here. But primarily it seems that the safety nets Trump erased led to poor communication and a dearth of protocols to make sure patients, like this one, did not fall between the cracks.
The lacks of tests, the complete failure to consider that a highly contagious virus might have spread so fast, so stealthily, the failure to train personnel and provide enough protections for workers... all this trickles down from the incompetence in the White House.
17
If I learned one thing in medical school, it was the importance of a complete assessment of a patient. If you stop after you have diagnosed the patient with pneumonia, you can get into real trouble real fast. OK, the patient has pneumonia, but why? The treatment required for primary tubercular pneumonia or pneumonia from the plague bacillus require radically different treatment and isolation procedures. COVID-19 is not different in this regard, just newer.
Similarly, saying the patient has heart failure or anemia or any one of numerous changes in organ function is equally incomplete. The greatest clinical victories in my career came AFTER I made the most complete assessments and BECAUSE of that action.
We need to remember first principles for each patient we care for.
41
@Doug McNeill
Pneumonia from TB is more typically lobar and more localized and thus looks different from a typically diffuse viral pneumonia on a simple chest X-ray. Also, the course of the disease was surely informative for the DD. Nonetheless, I am sure TB was part of the checklist. But the most likely diagnosis still would have been influenza, RSV or any other respiratory virus... like corona, which was not yet prevalent. Without the ability to test for it, the only option would have been to totally isolate very single patient in the entire US with .... flu symptoms....
4
@Captain Nemo
Dear Captain: Primary tuberculous pneumonia CAN look just like lobar pneumonia and I have seen it up close although you are correct. The most COMMON tuberculosis infection is a small nidus which then seeds the blood stream and settles in the areas of the body with the highest oxygen levels which is why COMMUNICABLE tuberculosis favors the more aerated upper lobes.
When faced with a pneumonia we can do tests to confirm influenza A and B, collect blood and sputum cultures to look for bacterial infections. verify immunization status to reduce the likelihood of varicella pneumonia, for example, and take as complete travel and exposure history as possible to identify likely but rare causes such as pneumoconioses (e.g. farmer's lung). And, if we get enough tests, we can exclude COVID-19 in real time if first we consider it.
3
@Doug McNeill
Doug,
And that is EXACTLY what I was saying when I wrote 'typically'.
Just as I would first think of hemorrhoids and then colon cancer in that order, when a patient shows up with blood in their stool (not going into IBD here, for clarity reasons).
But with no tests available, and faced with the situation of calling out a total quarantine on your hospital with almost NO cases of corona virus in the country AT THE TIME, what would you have done?
Faced with 10,000:1 odds?
1
It is stunning to me that with the dangers of coronavirus infections that such a case would happen. I would have thought that in March 2020 any serious case of pneumonia or "flu" would be expected to be Covid-19 unless testing proved otherwise.
This is a proven example of a whole cluster of cases resulting either from a lack of test capability or doctors guessing a diagnosis, getting it wrong, and then assuming that the diagnosis is correct with no intelligent skepticism being applied.
This is not an outlier. It is what is expected to happen unless you either test or quarantine -- if no tests are available.
The "buck stops here" Mr. Trump. No more platitudes. No more lies about a million tests. Dig in and make sure there are a million tests, today. China got them; why not the powerful and technologically wonderful United States?
38
@DGP I think part of the problem are these satellite hospitals that belong to bigger hospitals in which the satellites are not necessarily well equipped (and possibly not well trained). Also, these gigantic hospital systems may be harder to manage. Is there anyone at NY Presbyterian who makes the kind of medical policy decisions that gets implemented across all their hospitals and facilities?
NYPresbyterian (formerly Columbia Presbyterian) is considered a great hospital, but in recent years, they seem to be more concerned with opening offices in every neighborhood and affiliating with other hospitals than with concentrating with basic care.
I have had a relative who has been in a number of hospitals recently (not NYP) and they all seem chaotic and disorganized. In spite of electronic records, no one seems to know what's going on and I almost never saw the same doctor (or even the same nurse) twice.
4
@DGP
"I would have thought that in March 2020 any serious case of pneumonia or "flu" would be expected to be Covid-19 unless testing proved otherwise."
Yes, that's the number of test kits that should have been ordered from the WHO or Canada or the other countries that offered them. It should be an easy number to come up with based on historical data. Then times ten the quantity or whatever comfort level based on previous outbreaks. Should have been produced and distributed many weeks ago.
4
Physicians at Mt Sinai hospital have said they are able to distinguish specific patterns in the CT scans of lungs of people with coronavirus, and that it is reliable enough to be used for a diagnosis. Is there a reason why that practice has not taken hold during this period when tests are not widely available?
13
@GY
The scan can tell about severity and certain inflammatory characteristics when someone has pneumonia. So only in the most severe cases. The VAST majority of people infected with coronavirus are asymptomatic or have only upper respiratory symptoms. The CT scans are contraindicated in those cases (aside for the fact that there are not enough scanners for that).
7
Centralized testing by CDC is nuts. Our strength is the 50 States plus hundreds of local health departments. Plus private and college labs. The CDC has published the test protocols let's get to work locally.
20
Well thinking doctors and quality health care is extremely difficult to acquire. No matter how much money you have it still doesn't matter. Technology would not of solved this mystery either.
We hear all the time about how doctors are up to date with everything since they have the power to either keep you alive or let you pass on to the next life. they walk around as untouchable and if they make a mistake that is fatal the entire organization covers it up. Try to get a straight answer from a doctor and you will wait a lifetime.
Health care charges an arm and a leg and you better be in the medical network so don't get sick out of town.
The lawyer is lucky to be alive not everyone has been so fortunate
4
How can such events be prevented? Sure, doctors should have suspected COVID-19, but doctors are busy and fallible. But, this diagnosis would easily have been flagged by a computerized "expert system". Such systems have been available for at least forty years. Engineers wouldn't think of designing a bridge without computer assistance, but doctors like to think that their work is an art.
Every patient should have their medical records (already computerized) examined by a computerized diagnostic system to suggest 'obvious' diagnoses that doctors have missed for whatever reason. There's little downside to this.
13
And yet, all the times my mother was in a hospital or doctor’s office during her last year, the medical staff seemed to spend most of their time staring at computer screens! This profit-hungry medical system is abominable. And, by the way, Joe B, I have never met anyone who “loves” their medical insurance.
It doesn't matter how many people are sick enough to require hospitalization if there are no hospital beds available. The state's largest hospital in my city is usually 98 percent full and people regularly wait 12 hours for hospital beds after the need for admission is determined. Where are they going to go? Small hospitals do not provide intensive care, and it sounds like most providers are going to be in isolation within the next 2 weeks. I predict that many people will die at home because this disease seems to quickly turn serious and their families will be ill prepared to care for them. (If they have someone to care for them).
13
@Sarah A . . . Lack of hospital beds is just a small part of the problem. Temporary infirmaries can be set up pretty quickly. The real problem will be finding enough trained medical people . . . that deficiency can't be remedied quickly. A shortage of the special medical equipment needed to help people who can't breathe will also be a much more serious problem than a shortage of beds.
7
@gardencat
It's my understanding that as a result of NYS Gov. Cuomo's state of emergency, requirements have been loosened to allow more people to conduct tests.
Of course, they would have to be vetted and trained but they need not be nurses or doctors.
1
@AACNY The tests are just a swab in the mouth or nose popped into a glass tube and read within 24 hours. That's how they do it in the drive-in solution they have in South Korea. They phone you back with the answer.
At least that way a lot of the spread can be halted so the hospitals can better cope. All of this is taking time and resources away from the other medical procedures of course, even critical ones,and previous outbreaks had loss of life etc as second-hand effects from the virus.
2
January 31 was when the US made its first bold and correct measure to halt and monitor travelers from affected regions. At that time there should have been other procedures put in place altering hospitals to test whenever anyone came in with pneumonia.
We all know now the testing was flawed - as was our countries policies for protecting the public, including health care workers.
My heart goes out to all impacted by Covid19. The governor of Colorado implemented proactive procedures like drive through testing but admits that we are still behind in testing despite promises from CDC which is not being forthright.
17
@Natalie Warady "January 31 was when the US made its first bold and correct measure to halt and monitor travelers from affected regions." I have a friend whose son returned from Northern Italy--certainly an "affected" region--late last week. He was not questioned on entering the U.S. No one suggested he isolate himself for 14 days. Nothing.
8
I heard a woman call a radio program last week. He brother had traveled to Japan, South Korea and another point in the East. When he returned to his home in San Francisco, no one questioned him at the airport. He got sick and quarantined himself in his bedroom, called the CDC and was told to “sit tight.” Extremely disturbing. The doctor on the program suggested calling his local Board of Health.
6
There is virtually no sympathy for medical providers who are literally on the line. Doctors, nurses and other medical professionals did not sign up for suicide by Corona virus. While tertiary care centers have ample stockpiled protective gear, community medical practices and hospitals have limited access to supplies. In China a disproportionate number of medical professionals died- we should do better then that.
51
As a physician, I'd like to say something, in light of all the "why didn't they think of it sooner" comments.
To date, testing in the US has been highly regulated by the CDC, I think in part because they knew there weren't many test kits to go around. Thus, available tests had to be used "rationally". Specific guidance distributed to clinicians stressed two things: travel history to an affected area, or contact with an affected individual. Outside of that, testing wasn't recommended, and in fact the CDC could theoretically turn down physician requests. This man was a head-scratcher, so to speak, because he didn't have those exposures, and when he first became ill, there was no known community transmission in the US. At that time, it was more rational than it now seems to say, "Nah, it couldn't be COVID. We have to keep looking for other things."
They are frantically trying to ramp up testing now, to make more test kits widely available. (The logistics of all that is another story.) The problem, I think, is we should have been a lot more suspicious of person-to-person spread here in the USA, earlier. And we should have had the testing ramped up and ready to go, millions of kits available, earlier. The fault for that lies squarely with this administration, in my opinion. Other countries, like Canada, had it up and running two months ago.
273
@original ,
“ we should have had the testing ramped up and ready to go, millions of kits available, earlier. The fault for that lies squarely with this administration”
Exactly! Instead the Trump Administration lollygagged and dillydallied and ignored and downplayed the growing evidence that coronavirus would be a problem in the United States because it didn’t fit with their narrative that America was great (again). Instead of quickly creating the hundreds of thousands of test kits we would need based on the proven WHO kit, Trump went golfing.
And here we are.
64
@original
Trump did exactly that -- that is, he put in place emergency authorization to "ramp up" testing.
Trump has dramatically reduced the time it took to develop a test. Contrast his 2-month response with Obama's responses which were from 7-12 months.
1
@AACNY
Sorry, but this isn't true. My husband is an infectious disease researcher who specializes in global health, and I have seen these issues from the inside track.
You're correct that DJT changed a quality-control rule that was put in place, for good reason, after the Ebola crisis. But if Trump's administration thought that would be a problem in ramping up urgent testing, they should have been on that executive order from day 1. They should have been urgently monitoring progress, and adapting as needed. It is categorically untrue that "Trump has dramatically reduced the time it took to develop a test". Check out how Canada has handled it.
42
Just an anecdote here, but this illustrates just how Trumps conflicting and erroneous information is impacting vulnerable people. While interviewing and doing vital signs on a cancer patient today I like to let them know that I have sanitized the room and equipment prior to using it on them. Their response made me take pause, they remarked that they were not really worried about coronavirus and thought it was more of a hoax than anything. If you only listen to propaganda and misinformation then you will not protect yourself adequately, thus your possible infection will then be given to others you contact.
121
Is there any available information on the number of cases that require hospitalization from Cov19 vs. the number of cases confirmed in an area? What is the percentage of hospitalizations vs. survivors?
7
@William Reports out of Italy have indicated a pretty high hospitalization rate of between 10-20%. The challenge is most people who are hospitalized, though most will recover, are requiring 2-3 weeks of care. That quickly eats into hospital bed availability. fatality rates depend on age, but around 2% on average- its very low for below 40 but very high for those above 70 for example. The ultimate toll for the country will depend on its mix of older patients and prevalence of other conditions (i.e. diabetes, heart disease etc).
11
@William This is actually very hard to assess at this time because while the number of hospitalisations is known, the number of recoveries will not be known....ie the hospitalisations is a present number, and recoveries are a future number. As this virus is new it is difficult to predict and as there may be many carriers that are symptom light or have no symptoms at all ( this is common in all corona/influenza outbreaks). Tests and declared numbers such as we see on the news can be influenced by many factors such as availability of test kits, criteria for using them, regional cost issues etc. In general one can assume that the number of carriers is significantly larger than the number of announced cases. One also needs to remember that this virus has a 10-20 day incubation period, so if , say, 4 times the number of 'discovered' cases are wandering about spreading today, we will not see the effect of that spread for 10-20 days. Epidemiology is quite a complicated matter but one thing is certain. Early aggressive action is vital.
7
@William Just looked up the numbers for you here in Italy. As of this evening, 21% of infected persons are presently hospitalized.... another 12% are in the ICU and requiring ventilation. We've had 10,149 total cases (529 more than Monday), 1004 who've recovered, and unfortunately 631 deaths. This.... in the last two weeks.
1
Back in December, before any of us had ever heard of the Coronavirus, a swift-moving URI swept through my daughter's place of work. Cold-like symptoms, rapid onset, chest congestion, shortness of breath, some fever. Everybody caught it and had to take a few days off. Nobody had been to China. Many people at her work had preexisting compromised immune systems.
My daughter caught it from her coworkers, went to the urgent care clinic, and came home with a diagnosis of pneumonia and a handful of medications. She was sick enough, I thought, to be admitted but she was not.
I caught the mystery URI from her, but didn't go to the doctor (I watched for signs of pneumonia as evidenced in the sputum), but I did notice that this virus acted a little differently that the other colds and strains of flu that I have ever had. (I am one of those people who toughs it out instead of getting vaccines or going to the doctor. Dumb, I know, but it is what it is.)
This particular strain of mystery virus swept through the other members of our family, and even one of our cats got it. She was also put on medication after a quick trip to the vet. But we all lived. Whether or not we had the Corona-Virus, I don't know, because the doctors weren't looking for it at the time that my daughter went to Urgent Care. But it could very well have been.
16
@Jackie we had the same thing at our household. Everyone caught it and it took almost three weeks for it to go away. I don’t know what it was but it certainly felt more than just a normal cold. Was yours the same length of time?
8
I had a similar URI in December. Same thing, it swept through my workplace. I wonder the same as you.
5
@Jackie It probably was not. Why? Because there is another completely independent way of analysing COVID 19 by something called phylogenetic analysis. Basically as the virus replicates it makes errors. The number of errors and the variance of those give clues as to how fast and how often the virus changes as it replicates. This can also be regressed backwards by analysing COVID 19 from different sources and working back to a common ancestor. With the replication rate known, these analyses give an approximate date for the first human carrier at 6th Dec 2019. Nevertheless it sounds like a really horrible and somewhat similar virus. There are in fact many Corona viruses.
9
I work at this hospital and several of my coworkers were placed on quarantine. This article does not accurately portray the decision-making that went on in the case. At the time there were no cases endemic to the US and CDC guidelines only allowed testing on patients who had recently come from an affected country, which this patient had not. Now that there is an outbreak in full swing it is easy to diagnose it in retrospect but at the time it was not believed that COVID-19 had reached the US. The patient was not initially placed on isolation precautions but once the case was seen to be abnormal he was.
The doctors, nurses, and other workers at Lawrence hospital are continuing to work every day, taking extra shifts to cover for their quarantined friends and coworkers. The hospital is safe and the outbreak has been contained. In these times of great stress and confusion I ask my fellow New Yorkers to do their best to remain calm and remember the sacrifices being made by medical workers across the country as we do our best to keep everyone healthy and safe.
239
@Zack MD Thank you for your perspective. It’s helpful to read first-hand experiences. I appreciate everything health care workers are doing; I am truly grateful for the work you all do, every day.
60
@Zack MD I disagree. Donald Drumpf was peddling the trope you describe, but experts we're saying the opposite.
Conflating politicians and scientists is an error.
10
@Zack MD All our thanks for the courage and professionalism in a time of crisis and unexpected demands
10
Like their slogan says, amazing things are happening at NY Presbyterian e.g., doctors not even thinking about a patient with corona virus symptoms having the virus at the height of concern about the virus. Wow.
Best wishes to Mr. Garbuz.
11
I was initially confident that actions taken by state and local heath departments would override Trump and his administration’s wackiness, but I no longer trust that assumption. This story - and others - are counter to fundamental public heath principles of surveillance and control of communicable disease. First year public heath students could do better. It is profoundly embarrassing and troubling.
25
The virus has been circulating in the US since January 19, and this patient is the tip of the iceberg as far as community acquired disease. Many people have been exposed, never got sick and are immune. We need immune panels like we have for many other illnesses. These show whether there is recent exposure (IgM), old exposure (IgG), and active virus in the blood. In this manner we can tell who has been exposed and is immune, who hasn't been exposed, and who actively has the virus. With this tool, we wouldnt have to indiscriminately shut our whole society down. Normal life can resume for many people. We should make every effort to make an immune panel for this virus.
42
@Eric Karp
Yes, but even IgMs will not be informative within the first 2 weeks of an infection, IgGs will only tell us who was exposed in the past.
So these data will be very useful in retrospect to determine how fast and how far the virus has spread through the population, it would do little to stem the current panic that has gripped homo sapiens.
4
Are there cost effective ways of testing IgM and IgG in a vulnerable population? Or a WBC count? Would that help?
Too bad Theranos was a sham
@Eric Karp
Hmmm. I am not sure that they have established that recovered persons become immune.
This article from the NYT touches on this:
https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html
2
in San Francisco, the Department of Public Health is still requiring that in order to be tested you have to have contact with a confirmed Covid-19 patient within the last 14 days or that you already be hospitalized with pneumonia.
20
@BlueBird WIthin a week or two from now, it won't be prudent and reasonable to expect foreign travel to be a determining factor. In the news today, an employee of Barclays and one from Blackrock, both working in NYC, tested positive. They possibly have been around the city in their normal daily commute, errands, restaurants, interacting with many people along the way. So has the Uber driver, or the paramedic, also from NYC. The promised tests cannot come soon enough.
7
"Without any special precautions, he was loaded into an ambulance on Sunday night and driven into the borough. "
This entire thing is very disturbing. How could doctors not suspect the virus Feb. 27th, when the headlines had been raging for weeks by then?
Among other things, everyone I know is avoiding going to their doctors because their offices are either at Cornell or across the street, and the above quote isn't helping. Bottom line, many people will suffer the consequences of this mishandling, even if they don't catch the virus.
27
@CacaMera
It wasn't mishandled. It was "unknown".
You cannot test for something of which you are unaware, nor can you produce a test when you don't have the genome.
This demand for full information -- in retrospect, in the case of producing tests -- is unrealistic. Time to stop complaining and accept that our system is working at breakneck speed.
They're actually doing an amazing job.
7
This sounds like an incredibly deadly pathogen. I realize reports are that children are largely immune and 80 percent are mild, but the severe cases look quite catastrophic.
Perhaps Russ Limbaugh might want to walk back his comments about the virus being akin to the common cold?
Perhaps Fox News hosts might want to walk back their comments?
46
@Yankelnevich You're kidding, right? FOX never apologizes for any of its thousands of lies and mis-characterizations.
8
Nothing a good lawsuit and sponsor loss can’t fix
1
Can anyone explain the rationale behind trump’s policy of not testing Americans for Coronavirus?
Oh, I mean apart from “I like the numbers where they are now”.
37
On the day he went to the hospital, the virus had already spread to 57 countries, and there were 56 cases on the west coast, including 3 new cases of "community spread."
Two days before that, the Chinese had published results of a study that said CT scans were actually more effective at diagnosing the virus than tests.
Hindsight is 20/20. But it is legitimate to wonder what New York hospitals were doing to prepare for what they must have known was inevitable. When the CEO of NY Presbyterian makes $7.3 million per year, and American healthcare is touted by the AHA the best in the world, why were people were marveling at the man's suffocating suffering and his spider web lung scans, instead of erring on the side of caution.
One wonders what the heck US hospitals are doing with all this money we pay them and how others are treating incoming cases. Hopefully this report shows other hospitals how they could do better. But, too bad they didn't know it already.
57
@Sherry
Well an anesthesiologist makes between $400-500K. Doctors and Surgeons much more. Don’t forget all the administration staff ...
1
@Joe D Doctors and surgeons don't make much more than anesthesiologists. Doctors who aren't anesthesiologists or surgeons almost always make much less, and surgeons often make less. Admin makes beans.
2
This sorry tale, happening only several days ago demonstrates why doctors must not have tunnel vision and only test a patient for Coronavirus if they have travelled abroad. This is dangerous and flawed thinking, which in this instance has caused widespread infection with this deadly virus to this patients family, staff and other patients, should not be followed in future.
Was this dangerous treatment offered by this hospital informed by the rationing of testing kits because of the incompetence of the Trump Government?
I was also shocked to note that there are only 1,200 hospital beds in New York and I assume that many of these are occupied routinely by other patients. This is not good news if there is a large scale epidemic.
18
@Koret We have to remember that the doctors weren't the ones deciding who could be tested - it was the CDC who was very limiting initially. Without foreign travel or known contact, they weren't providing the test...
8
@Zsuzsa
They seem to have been helpful in Africa with Ebola. Let's all hope the CDC can get on their game soon. "we're all sooo busy" is something one hates to hear from the waiter at dinner and also the doctor attending to you. As one commenter stated earlier, each patient deserves a complete history and physical, not what has become the norm in most emergency departments, maximizing throughput. Hire more ER physician staff, even if that means the CEO compensation could fall below the stated $7.3M annual compensation. The focus on patient throughput and billing and most of all money, is a sad and troubling turn in medicine
1
I’m not a medical person, but I find it astounding that the hospital staff didn’t suspect coronavirus and quarantine and test Mr. Garbuv immediately. I lay the blame, though, at the Trump Administration’s weak, belated and self-serving response (which continues) to the reports of the epidemic coming out of China. They could and should have reacted quickly and strongly weeks earlier.
Thank goodness for Dr. Fauci and the other scientists and medical professionals who are doing the right thing. Unfortunately they have to fight the stupidity and disinformation of the Trump Administration along with COVID-19.
23
@Eric FYI - sick patients don’t get quarantined, they get isolated. People who are exposed and potentially incubating an infectious disease get quarantined.
3
The hospital should prepare for lawsuits. The word that comes to my mind is ‘complete negligence’.
12
Can't have an epidemic if you can't test for it. The logic of politics.
56
Why aren't states like New Jersey posting the locations of where people who have the corona virus, so the general public knows where not to possibly travel?
Governor Murphy and his administration is should have this information on NJ.gov, but it isn't, and if it is it isn't that easy to find.
8
Did this individual have underlying conditions that would have led to pneumonia from COVID-19? I wish the author included this in the article.
10
Awful to see how far behind the US is in doing broadly available testing.
The CDC should be making state and local data available, but they won’t or can’t. Some smart, thoughtful journalists and analysts have started their own public service project to make state level data available here: https://docs.google.com/spreadsheets/u/1/d/18oVRrHj3c183mHmq3m89_163yuYltLNlOmPerQ18E8w/htmlview?sle=true#
Sending my wishes to Lawrence Garbuz and his family for a full recovery.
14
The NYS DOH is disorganized and ineffective. I am a New Rochelle medical doctor with an influenza like illness, flu swab negative who has treated a number of patients from the Young Israel synagogue. I was told that I would be tested 5 days ago have yet to be contacted by the DOH.
This does not look promising for the future.
80
Don’t worry NYC. Just refer to De Blasio’s press conference a few days ago, someone practically has to cough directly in your face to transmit it. And it only lives on surfaces for a few minutes.....cannot believe he wasn’t called out on that 5 minutes of misinformation. Good luck NYC
14
@William C this appears to be extremely contagious. Anyone in the same room with a person who is coughing, or has close contact, is at risk.
3
@GY exactly. So why has no one called out De Blasio ? His comments were completely negligent. If he were a republican, they would be criminal.
2
I have heard that Mr. Garbuz traveled to Israel before going to Miami and that he may have picked up the virus in Israel. This is important information for anyone considering going to Israel, or is now there and may be returning in the next weeks.
I have also heard that Mr. Garbuz participates in groups on the upper West side of Manhattan several times during the week before he was hospitalized. Can someone check with the City and find out whether the information is accurate? Privacy is important, but we need to know where this patient went and who should be tested or may now be at risk.
I hope that Mr. Garbuz recovers completely and send best wishes to him and his family
14
The CDC needs new up-to-date guidelines, sent out pronto to every hospital & health care facility in the nation. So slow, so behind the ball, a sluggishness that is killing Americans & spreading this pandemic. Stop looking for travel to China or Italy before thinking of the new virus! It is here, it is widespread in areas, it is spreading everywhere...anyone with sudden respiratory systems....first check, with a test (the one trump promises us all are available to everyone), should be for the coronavirus. Why is Robert Redfield still in charge?? Deadly mistakes have built up left & right. We are flailing, we are failing. Stay home if you can. Absolutely stop traveling, don’t wait for the CDC to tell you, it will be too late, do it. Be careful, far more careful, far more wary, far more wise, than our government.
14
Who is actually in charge?
8
@Robin Sullivan
Dr Pence, our vice president. sleep well tonight.
2
If health care workers don't have the brain power to know who could have corona virus, they're going to get sick themselves, and die -and the rest will have to deal with quarantine.
3
How can this have happened only 2 weeks ago? He presented at hospital admission with pneumonia during a potentially global pandemic that presents as pneumonia!!!
What chance do we have against preventing a pandemic if this is the state of hospital admissions? I truly hope all hospitals locked on on corona virus by now.
20
Just a point of information, for what it’s worth. Intubation does NOT lead to virus being aerosolized. All modern day ventilators have HEPA filters on the outflow and do not release droplets. It would be crazy if not, because there are MANY more infectious and more common bugs routinely managed in the hospital without extra precautions during intubation. The much more commonly used nebulizers, which are frequently given to all comers with respiratory distress (before resorting to intubation) DO create aerosols and are purposefully avoided in cases of suspected Covid.
9
Hmmm, I’m guessing you have never been present during an intubation.
3
As a physician ( and I know I speak for many others) I am frustrated that there is no quickly available test to make the diagnosis. I could have already seen a patient with a mild cough and no other symptoms who may become sicker and have COVID- 19. Or, it could be a cold....
46
This is another reason why my plan should be offered (and I hope this 'moderator' will allow it for the debate.)
No vaccine is in the works for a year or so, and w/o extensive testing, no one knows their risk profile, and many lives are on hold. I think we should seriously consider allowing the young and healthy to intentionally expose themselves to the virus, so that they get it on their terms, and following their illness, they become immune and unable to spread the virus. Doctors can certify their good health before their exposure and of course medical care should be offered if needed. (given the demographic of who volunteers for this exposure, the medical care should be infinitesimally rare.) Those of us who are older but have no health issues should also be allowed to acquire the virus on our terms. The experiment can start with a few hundred of thousand, and increase as we learn the exposure is safe and with very little lethal consequences. Many of us are going to get this virus anyway, why not allow us to choose when to minimize the disruption in our lives. We will also be doing the altruistic thing by providing society with a band of immunized.
6
@boji3
The common cold is a coronavirus. Correct me if I'm wrong, but I don't think contracting a cold once, confers life-long immunity. Anyone out there know for sure?
13
@boji3 andEveryone please don’t speculate here. I don’t think any of us should be having this discussion on a newspaper article comment section. First of all it’s more complicated than a blanket statement that one becomes immune and can’t affect others. Second would you want your young healthy loved ones be the first such patient type to die from it?
4
@PNRN No immunity to it from prior exposure to common cold viruses. No immunity for this variant as this is the first known wave of human exposure to it, as reported by researchers in China. That is why it is called the "novel" coronavirus.
2
We live within a 10-minute walk from Lawrence. Should we be doing anything special? Also, the hospital is a five-minute walk from the Bronxville Metro North train station; workers in scrubs are regularly on those trains. Will something be done there?
16
There are methods available today which can identify numerous pathogens using molecular diagnostic techniques in a matter of hours, not days. This aids in the differential diagnosis of diseases like COVID 19, or other forms of pneumonia. We know that the CDC dropped the ball at the start of this epidemic but state health departments compound the problem by slowing approval of new molecular testing that are both fast and accurate. Hospitals must then stop using diagnostic testing methods (cultures for example) that were cutting edge 100 years ago. It can't be just about money.
17
About fifty five years ago, it took the medical profession nine days to figure out that the one hundred and four degree temperature I was running, after a pinning for a slipped epiphysis was manifesting itself with a staph infection at the operative site! Obviously, the handling of this Coronavirus proves, we are All Essentially, Still On Our Own!!!
17
Riding the subway, if someone coughs, everyone thinks about the coronavirus and moves away. (if possible) Yet, a man enters a hospital with those symptoms and it occurs to nobody for four days? It makes no sense whatsoever.
129
@Gary I emailed my doctor at Kaiser Permanente in Oakland because I've been sick for more than a week with dry cough, headache, malaise (no fever). I mentioned that I'd been in close contact with four friends/family members who were in China (not Wuhan) during the outbreak. I felt it was my responsibility to write to her. Of course she told me they can't test me because none of the people who came home from China are positive. But they weren't tested either. South Korea is containing its epidemic, we are not. Shame on Trump and capitalism.
8
They've only tested nine people who were in contact with him in the hospital. This is very very scary that we still can't figure out how to test a couple hundred people. We have no idea what the scale of it is already without testing people whether they have symptoms or not.
50
“A spokeswoman for NewYork-Presbyterian Hospital, which owns Lawrence Hospital, declined to say whether staff members in the room at the time were wearing protective gear such as N95 respirator face masks, which offer more protection against the new coronavirus than surgical masks."
I hope hospitals don’t put health care workers in risky situations for thinking in terms of profit first mode
Their healthcare workers are their most valuable asset
There could have been a intake area for coronavirus suspecting patients and not exposed the entire hospital and staff
20
The hospital’s most valuable asset is the spokeswoman who “declined to say”.
7
@KDC Masks are in limited supply... This is what happens when everything is imported.
2
One of the most under-reported statistics of this outbreak is the number of people in need of ICU stays. Especially in rural areas, many ICUs will not have the capacity to ventilate even a dozen or so patients at a time nor keep them isolated. Transferring to a bigger facility will come with its own set of risks. It's a scary time.
50
It is insane that a patient with cough, fever and respiratory distress wouldn't be immediately tested for coronavirus before admission.
91
@dr. c.c. Remember, as of a week ago only patients who traveled to “high risk countries” were considered at risk. We are now a high risk country. What a difference a week makes.
81
@dr. c.c.
Cough, fever, respiratory distress? And let's guess Flu negative.
Guess what? That's thousands of patients across the country every winter.
4
@Meghan I
I’m not a health care professional but more than a week ago I was reading about need for
*alerts for any suspicious or severe pneumonia* and also the importance of
*CT scans that show GGO* as Covid 19 indicators even more sure than PCR tests - this was globally publicly available info from the outbreak even before the WHO report.
I realize I have too much time to read this stuff, and I should not Monday quarterback for these good hospital folks who are desperately needed.
But I hope we are getting past the stage where several days and dozens of healthcare workers pulled offline is the cost of one nursing home or hospital exposure.
Seattle, New Rochelle - OK, enough already. Procedures, people! Even as testing is slow, there is some good evidence out there.
9
My thoughts and prayers are with Mr. Garbuz and his family and all of the healthcare workers (and their families) who treated him. This is such devastating news and so heartbreaking on so many levels. May science prevail over this vicious virus
42
This is the moment when providing a healthcare and financial safety net to everyone is literally life and death. We are fundamentally interconnected.
92
We had a respiratory outbreak at the nursing home I work at just this past weekend. Was told that at the time the state could test 40-50 people a day in the entire state, and we would need to have people be “sicker and not getting better” before they would consider testing. We did subsequently isolate another (non-flu) virus in several patients which is likely responsible. It’s a huge problem: run of the mill respiratory outbreaks happen all the time in nursing homes- the chances of this being Covid-19 were low, but the consequences of delaying testing if it had turned out to be that would have been disastrous. Another Kirkland will happen soon- it’s a master of when and where.
The Boston Globe just reported a several day delay in getting patients tested in a hospital in the western (non-urban) part of the state due to paucity of test availability, and presumably low suspicion. They later detrected five positive cases and who knows how many people exposed.
We need to have increased testing capacity and utilization on a massive scale.
71
@Susan You can blame the White House for the lack of testing kits and lab capacity suited to the process.
17
I travel a moderate amount for work. We had a planning meeting for some upcoming travel, and naturally the topic of coronavirus came up in discussion.
With calm, I expressed concern regarding the 14 day incubation period, spread by infected with mild cases (unbeknownst to them), and spread by the asymptomatic infected. We do not know what we do not know.
There is a difference between being proactive in your outlook and being panicked and contributing to hysteria. Much of the panic here in the states is probably at a level greater than reality, but at the same time, the reporting and efforts of our institutions have lagged behind reality. Unfortunately for many people including some colleagues of mine, it takes HINDSIGHT to appreciate the gravity of a situation. We are now having to accomplish our work remotely due to cancellation of onsite meetings.
This article demonstrates how even a single unknown case of the virus can contribute tremendously to its spread - and the consequences of this will be counted in human lives.
48
Everyone voting against Bernie apparently likes our healthcare system. Kick the can down the road for healthcare and the environment. The DNC is Republican lite - warm on the outside (smiles and words) and cruel on the inside (policies). Let the DNC merge with the GOP and let’s start a new progressive party with compassion on the inside and out.
17
@How Much Is Enough?
Actually many of us vote against him because his plan is not feasible. Medicare only pays 60% of the cost of care, providers make up for it by getting more from private insurance. How will Medicare for all work?
Also many of us are happy with our health care, especially those of use who already have Medicare. And we vote way more than the younger folks do.
14
@How Much Is Enough? Bernie is all about free stuff and no idea how to deliver it. He would be a worse disaster than Trump, if that is possible. Agree with you on DNC. The only one to vote for, holding your nose, is Joe B.
5
There are provinces in Canada that have done more testing than the entire US until recently. And guess what? Still no widespread outbreak even with daily flights still coming from China and Italy.
32
@Mike As of yet, hopefully, it will stay that way; however, this is an organic, rapidly evolving situation. With the statistics on this viral infection- 80% mild; perhaps as many 25% asymptomatic ( silent carriers, the Chinese MDs came to call them) and only 20% ill enough to seek medical attention, combined with a test that is not 100% reliable until viral loads reach a certain point, it's too early to say what the next few weeks will bring. Consider how recently Italy had just a small cluster cases versus the situation there now. What happened to the old saying " An ounce of prevention is worth a pound of cure"? Apprently frogotten in the Age of Reality TV,eh...
5
It's very telling that in the photograph accompanying this article, the supply of masks for patients to put on before entering the healthcare facility appears to be empty of masks.
13
This administration, and Republicans in general, will not prepare for the future, just react to the past so that the wealth can get wealthier. We won't spend money on preparedness. We just hope nothing happens so we can give more tax breaks to the 0.1%. No health care for people who can't afford it. No paid sick leave so minimum wager worker in fast food can stay home instead of spreading infections. Now that it is clear that the spread of infections not only hurts minimum wage earners, but also reduces the value of stock portfolios of t he .1%, perhaps we can provide universal health care and paid sick time.
28
Wide spread testing protocols should have been the first priority when the extent of it’s contagiousness became clear in January. The bumbling response, more concern for the health of the stock market instead of the people and, the attempt to trivialize the seriousness by this administration is the reason why we have no idea today how widespread it already is. The deaths in Washington could have been prevented had there been widespread testing protocols and test kits in place in time.
37
COVID19 started coming to the awareness of the medical community certainly by start-January. I was in an Information Technology security role and had to know something about pandemics. How could medical facilities and nursing homes not have any sense or awareness of their risks and exposures?
26
Pardon me for thinking the hospital must be inhospitable to nurses, treats them not as resources but as doctor's helpers. I can't imagine an experienced Nurse Practitioner or Nurse forgetting about COVID 19 in such circumstances.
The story presents pneumonia and COVID 19 as mutually exclusive. I used to smoke (long time passing) and when traveling, I would get a virus on a flight, which would irritate my upper respiratory tract to the point where a bacterial infection would take hold.
Questions for experts: Is this happening with COVID 19? Is there evidence anti-virals like Tamiflu can lessen the illness?
6
@Frank McNeil and everyone please look to established trusted sources for such information. I don’t think any of us should be having this discussion on a newspaper article comment section.
... and then the extremely infectious patient was transported to a more populous location. Glad to know we're on top of this :(
14
Unbelievable. I've been saying to my husband for weeks that they should be testing every patient that comes to the emergency room with anything respiratory. PLUS I truly wonder whether even today ERs in NYC are equipped to deal with people coming in with symptoms and not infecting everyone in the waiting room or the exam rooms. There should be a separate section for both entry and examination and everyone equipped to not be exposed. If you've been to an ER in the past year or two you know how many people you have to work your way through to get examined. This is ridiculous. I'm not a doc or epidemiologist or hospital director and I predicted this weeks ago. Oh, and if I were running this city, I'd set up specific ambulances for taking people with symptoms to the ER.
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@SPK, here in RI the word is that you can only be tested by the State Health Department in Providence (as a drive-through), and only if you meet some mysterious criteria, and that emergency rooms, let alone doctor's offices, do not have tests. I hate to sound like a conspiracy theorist, but it appears the US infection numbers seem relatively low because people simply cannot get tested--not enough tests and testing sites, and protocols for testing that are too strict. This is the government's fault, and could be by design as much as incompetence.
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@BKB You are not a conspiracy theorist. That is what is going on, in every country to some degree. Countries like S.Korea, Italy, Taiwan are closer to their real number because of all the testing they've done. Taiwan has gotten Grade A marks from global experts for their response. Because of the slow response to testing, the US #s are far off...by...100%? 1000%? Nobody knows yet. Covid-19 is very tricky. Spreads easily, outcomes range from mild flu to death. It's war time to beat this thing and put it behind us.
12
No word yet of any underlying condition and he is only 50 years old. Time to use our own reading and common sense in taking precautions especially given how little testing has happened yet on this country.
33
@Kathleen It's been widely reported -- for days-- that this man had underlying health issues. Read a little more.
1
Hindsight is always 20-20, but clearly the U.S. has had numerous wake up calls not only in this case, but in the hard-hit nursing home in Kirkland and on the virus-incubating Princess cruise line. Maybe it's time to employ our best infectious-disease practices out of the starting gate, assume anyone with VURI symptoms could have covid-19, and treat them accordingly. I suspect this is easier said than done. But every case missed for days on end spreads this novel coronavirus to far too many non-suspecting others.
24
Hospitals in my state are still not testing unless you meet very specific criteria such as having been in an impacted country, or had contact with a known COVID-19 patient.
Sort of hard to know who to test if we are not testing to identify community spread patients. They are essentially still looking for 1 degree of contact.
IF we had been testing like South Korea or Italy this man's infection would have been identified before so many health care worker were exposed.
As more health care workers are exposed, due to lack of testing, and shortage of protective gear such as masks, then we will be in a world of hurt. A hospital bed is no good unless we have the health care workers to care for the patients.
51
This is also the hospital used by Sarah Lawrence College for everyday emergencies and health and wellness. It is mere blocks from the College. My son, a current student, has been treated there on several occasions. Very disheartening.
24
I saw on the national news that radiologists have identified a rather unique xray signature for this disease compared to pneumonia. I wonder why that isn't being shared with radiologists who evaluate the xrays of patients presenting pneumonia symptoms? Some of these basic steps seem to be obvious but are not being done, leaving me to think we are not at all prepared to deal with this systemically in the healthcare system.
62
@Bob Myers, the pattern is little cobwebs all over versus traditional pneumonia that destroys one part of slung. Unfortunately that detail only became widespread a few weeks ago and after his case (though it likely the cobweb x-ray got Columbia to immediatel rest for Coronavirus.
15
@Bob Myers
I am a radiologist, I have knowledge of the situation described in the article, and I have seen a chest CT for a patient diagnosed with COVID-19 a few days ago.
The abnormalities on the CT we reviewed are nonspecific (i.e. they can be caused by numerous conditions) and I am skeptical of any claim that the imaging findings can land an accurate diagnosis.
I know the public is scared. Our patients and their families are right to expect exceptional care from us. But this article portrays the people on the front line in an unfairly poor light. We are shocked by how quickly and unexpectedly this arrived in our communities.
Many hospital staff throughout the city have certainly already been unknowingly exposed and infected.
Many with known contact have been quarantined and their colleagues are already working heavy, tiring shifts.
As I speak all of us in the healthcare machine are working frantically to tighten the net and do our best for the patients. We are preparing for a situation in which we are very likely to be quarantined or even infected, but I have yet to see a single person retreat from his or her responsibility to the community.
283
Why are we “shocked at how quickly this has arrived and spread in our communities”? This has been coming for us since January. China went to extreme measures to stop the spread. We watched the numbers double every several days yet couldn’t get a reliable test or PPE in place.
We can’t even get people to stop going on vacation for spring break. We need a national coordinate response that Mike Pence is not providing.
48
It still IS just pneumonia.
Whether from influenza, RSV, adenovirus or coronavirus, the clinical manifestation is quite similar and so is the mode of transmission.
I wonder whether the same story would have been written, if they had found out that it was influenza and not coronavirus that was causing the pneumonia. Because there are >100 such stories with a lethal outcome that can be written for the flu every single day in the US alone.
Almost no difference.
Please stop feeding this irrational panic.
12
@Captain Nemo except that it isn't pneumonia, it's SARS, brought on by a new cornavirus that we don't fully understand.
Fear is a rational response to the unknown, made worse by a national response that's contradictory, shifting and only addressing (so far) the stock market more than human health and the underlying US economy.
Detailed information is a much needed remedy to the mystery around Covid-19, and for many people--including myself--facts abate fear, not induce it.
58
@Jeong Yeob Kim Couldn't agree more! Information is power. It's the inconsistency and confusing nature of much of what we hear about covid-19 that provokes anxiety and fear.
15
@Jeong Yeob Kim
The facts are clear. SARS had a probable CASE/mortality rate of ~10%, MERS of almost 30%.
https://www.who.int/csr/sars/en/WHOconsensus.pdf
The SEVERE case/mortality ratio for the flu worldwide for the last year was 13%. (Severe defined as requiring hospitalization).
Virtually IDENTICAL to COVID-19 now.
I don't remember the planet shutting down a year ago, although 650,000 people died of the flu.
5
No one seems to worry that Mr. G traveled to and from his work by metro north’s new haven line.... are those who took the same trains being told to be very vigilant?
67
Don’t rely on TV or the White House for info about Covid19. Read the WHO site. This is very contagious. It spreads easily. People are contagious before they show obvious symptoms. The biggest problem US has is the CDC shipped erroneous test kits, and we didn’t realize how easily it spreads so we weren’t testing enough people anyway. Still aren’t. South Korea is getting a handle on spread because they figured out testing.
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@TD A larger problem is having 1% of the number of N95 masks projected to be needed by medical staff over the next year (3 1/2 billion). Many of those masks are imported from China where production stopped, and demand is exceeding supply (ditto other countries) so shipments aren't occurring.
They don't benefit the non-medical population, yet we allowed our big box stores to sell them to a panicked public, and hospitals are literally about to run out.
Flatly, should have been foreseen.
17
@TD I read that they are using drive through fast food restaurants for testing sites......SMART!
7
“I think it is from this that he was run down and susceptible to the illness he acquired.“
is that all it was? Just working hard and being run down? Because that is really terrifying. Unless I’m mistaken, I haven’t read anywhere, definitively, whether or not he had any type of underlying condition. It might be useful to know.
38
Wouldn't it be useful to have tests available?
42
@DataDrivenFP Not in this case. The doctors thought he "only" had pneumonia, and would not have tested for the corona virus.
2
@DataDrivenFP
As of next year, coronavirus will surely be part of the rapid test kits that are currently used to do a quick flu diagnosis. And which, by the way, are also only 70% accurate. Lots of false negatives.
I find it remarkable that the entire world is coming to a standstill now, while the flu, which kills more people each year than coronavirus, no longer even evokes a shrug.
Let's all take a deep breath and go back to our normal lives.
2
@Bokmal, they could not test independently at that time and the CDC was limiting tests to those arriving from specific countries.
3
Scary. I met a doctor in his office last week. I put his hand out to shake mine. I was abhorred.
7
Having tests easily available to every caregiver is vital. It's hard to believe that in the USA in 2020, this was not done already.
Additionally, they should test a limited sample of the general population to see how many currently have the virus OR have had the virus and recovered (check antibodies).
A statistically significant sample of all ages - regardless of whether they have symptoms or have traveled - to assess the spread of the virus to the population at large. Maybe it's not as bad as people think, or maybe it's worse, but in either case it will give a clearer picture that can steer policy for hospitals and the government. It also would give the rest of us a better picture as well.
140
@Concerned NYer It’s not hard to believe because the Trump administration has intentionally sabotaged federal agencies. This is the logical result. As with Hurricane Maria they will simply downplay the extent of death and destruction with help from illegitimate media outlets.
99
@Concerned NYer
There is no antibody test for Covid-19 yet. The currently available test detects the presence of viral particles, not antibodies. They will probably do large-scale testing for statistical purposes after the epidemic is hopefully got under control.
6
@Concerned NYer Several weeks ago the Netherlands had 10 labs capable of performing the tests and 40 GP's testing everyone that came in with cold or flu symptoms - a statistically significant sample for that country. [Can't provide a link -- either WP or NYT]
6
But how can you test every single Pneumonia of unknown cause - which would be a majority of them ? Most of the patients are placed on broad spectrum antibiotics that cover community based Pneumonia unless you have a pattern that goes against it . But that is usually someone who is immunocompromised or has exposures that are unusual etc. The indication to do a more invasive test like a bronchoscopy if the sputum cultures are negative are very few.
A lawyer walking in with a pneumonia in NY without a travel history or known COVID 19 exposure does not meet the guidelines to get tested. Pneumonia in the winter is one of the most common reasons for people getting admitted to a hospital.
If there is a change in the Guidelines - every single hospital admission with a Pneumonia or a Bronchitis gets tested for COVID 19 and the government makes the test kits widely available- that’s a different story.
But as per the politicians, it is all under control . Otherwise why are political rallies still going on - business as usual ?
58
@Matt From what I read, the coronavirus can lead to pneumonia, so perhaps we should be testing everyone who presents with pneumonia to determine if the cause of their illness is the virus. The government, weeks ago, should have made test kits widely available.
Their having failed to get test kits out in the early weeks and still having far too few test kits available, I certainly don't trust them to control the guidelines for testing. Trump wants the disease numbers to be kept low and the sycophants who spend more time praising the great leader than providing us with information surely have some trepidation about bringing the number of tests up because that will lead to more identified infections and the President to explode with anger and frustration as he already has done. The CDC has even quit reporting how many tests have been done, but it is certainly far, far fewer than in any other countries in the world where the disease is present and the health care system is modern.
32
@Matt The airports were not taking any precautions regarding people coming in from countries known to have high infection rates.
That started getting known last week. This week an infected student arrived at O'Hare FROM ITALY, presumably took a subway into the heart of Chicago, and then an Amtrak to St Louis before she was found to be infected.
Excuse me, what?!!!
22
@Matt
NYC finally received 23,000 new kits Saturday, up from our original 1,000 (for a city of 8.6 million). We only tested 100 people last week, less than 2,000 nationwide. By comparison, South Korea, 1/6th our size, has tested 100,000 people.
When we have a president who doesn't want to let a cruise ship with confirmed cases dock bc it is bad for our numbers. well, what more can I say. If we had tested 1,000 people last week, our number of confirmed cases would definitely be higher.
Lack of testing early on has impeded containment - and that will likely be an understatement. Unfortunately I was denied testing - along with many people - last week due to stringent guidelines. Some of us probably don't have it, but surely some of us do and we've been given little guidance, no monitoring, no "disease detectives" - and I work in an itinerant capacity in seven different locations from midtown to downtown. Luckily, I self-isolated and continue to remain home this week as an extra precaution. But some people, like that idiot in Boston are going to display selfish ignorance and the CV will spread like wildfire.
5
Sounds like this care team missed the boat. Previously healthy 50 year olds do not just get pneumonia and wind up on a ventilator. As his condition progressively worsened, there were more and more missed opportunities to consider the novel coronavirus.
I hope an unexplained pneumonia that results in ARDS now prompts consideration of coronavirus.
And how about some reporting on these drug trials that are using HIV meds against the coronavirus. Anything seem to help?
79
@Herman I didn't see anything that specifically said he was previously healthy. It would be very nice to know if he had any underlying helath issues such as asthma.
9
@Herman
Previously healthy 50 year olds can also end up on a ventilator with influenza pneumonia. You cannot extrapolate from an N of 1 that coronavirus is worse than influenza. Nothing that is out there so far indicates that it is worse. Clinically they appear to be equivalent.
The difference lies in the reporting. Report every case of the flu with similar headlines and coronavirus will disappear from the radar within 2 days.
14
Absolutely crazy that after having been in news for so long, hospital workers missed diagnosis right under their noses. I suppose at that time it was considered an overseas issue.
90
@Curious
Is very puzzling to me that it took them so long to diagnose this patient.That they only relied on the
lack of history of overseas travel.By the middle of
February a lot of information about the characteristics
of the disease were coming out of China to raise suspicions.
9
@Faliron
Why is this puzzling?
The doctors at the hospital relied on the explicit guidance of the CDC, who are supposed to be the experts, and who forbade testing of anyone who had not travelled to China (later expanded to Italy, South Korea, Japan, and Iran), and had not been directly exposed to a confirmed case, as there was no possibility of infection otherwise.
Even if one or two suspected it, what could they do? The CDC had a monopoly on testing.
Could the CDC have been wrong? Impossible. They are the source of all the best information.
Or, as Chico Marx once remarked, "Who you gonna believe, me or your own eyes?"
4
If people had chicken pox on their face after getting the virus, it would be a walk in the park to isolate. But with news that someone can have the virus and not show signs for 5 days, it appears that closer to 40% of our country's population will eventually get this virus.
And while most will just suffer the effects of a bad cold or flu, the 20% who struggle and end up in intensive care, isolation, or worse means a whole lot of of sick people.
If you can hunker down and work from home, do it. If you can order your supplies to avoid going out, do it.
And if you can try and enjoy each day that you are apparently healthy, avoiding crowds, do it.
98
This is scary. They should be taking precautions with all patients and just assume they could have it, especially with patients that have respiratory issues.
Another thing is, the patient is only 50 and I assume in fairly good health. It took over very quickly. Yikes!
113
@Cncrnd45 I am in Seattle......I am still hearing this is the media making things up.
I am thankful my 90 year old father was not in a "health" center, but at home with family.
11
@Cncrnd45
"They should be taking precautions with all patients and just assume they could have it..."
No offense, Cncrnd, but what precautions?
If we were to use an N-95 mask and gown with every patient, the US would use up its entire supply in less than a week. Then what?
And what about testing? The CDC seems proud to tell us that they have processed several hundred tests a day.
Multiply that by a thousand to get the the capacity of several hundred thousand that we need to be able to do to test everyone we would need to test.
By the time we get to where we are able to respond as we should have at the beginning, everyone will have already gotten this disease.
2
I can only imagine how terrifying this must be for Mr. Garbuz, his family, and everyone who tried to help him.
I hope he recovers quickly and completely.
415
@MDF And, all those health care workers who took care of him all along the way.
23
Yet another example of how testing, which should have been widely available in the US by the end of February, could have prevented multiple people from acquiring and spreading this disease.
It's becoming more and more clear based on reports from northern Italy, which by the way has one of the highest rated health systems in Europe and with just about universal coverage, is being overwhelmed by this disease.
As an American living abroad, I can't imagine the havoc that will be caused back in the States when clipboard-toting administrators are demanding nonexistent health insurance coverage info from patients coughing all over the emergency room at the local hospital.
There are as many proven cases in the US now as there were in Italy on February 27, just over a week and a half ago. And the US is only now beginning to ramp up testing.
364
@R.A. Incorrect in this case. The caregivers never expected CV-19 or to even test for it.
Agree that we need more tests available.
4
@William R.A. Is not wrong on this one. I am certain that some providers did wonder, however at the time CDC guidelines did not allow for testing without “high risk international travel” or known case exposure.
39
@R.A.
For each CV19 death, there's about 1000 other cases in the community, which tells us the known cases are about 1/20 of the actual cases.
14
This is a case in point about why easy and free access to test kits and helping health care workers accurately know when to suspect COVID-19 are paramount. If we don't solve this problem NOW, our nation will look like Italy within a few weeks or less. The time for pre-emptive action (testing) is now.
182
@Amanda Malachesky I think there is a good chance that if we were testing appropriately, we would find that our nation already DOES look like Italy.
306
@Kristin H In the absence of adequate testing in the US, it would be helpful to know how many patients with pneumonia are being admitted to hospitals around the country.
21
@Amanda Malachesky
Here in Seattle, the other epi-center of the virus, the University of Washington lab doing testing says he can do twice as many, but doctors are not ordering them. It is a puzzle.
32