Cont: 2019-nCoV / Corona virus Pt 3

[Skeptic Ginger]

I guess some people just feel compelled to make everything about politics. Given the mod direction, though, I'll limit any further remarks to the subject of the thread.

Trump's specific non-actions are part of the pandemic itself.

 

[Darat]

So an irritant to me. The clever people here might have a solution for. We have four bedded bays, all the patients are covid positive. Anything that goes in is contaminated and stays in or is binned unless it can be cleaned. (Or has to be able to be bagged before going in, be removed from the bag afterwards and be able to be surface cleaned.) So if I go into round on the patients or the nurses are in doing observations, we want to go in see all the patients then go out rather than going in and out after seeing each patient and having to use four sets of PPE rather than one set. The difficulty is that the notes and obs charts can't come in, how do we reliably document our findings? Currently observations are written on a scrap of paper, stuck to the inside of the window so that someone outside or yourself can later transcribe them into the charts. I see a patient then go to the door and dictate my exam notes / plans to someone who writes them in the notes after I see each patient.

Is there a better solution? It has to be cheap and quickly available. Walkie talkies aren't approved for use near medical equipment, and are a bit expensive, and may be poor in confidentiality. We are looking to get white boards so we can hold up messages to people outside e.g. 'need a 40% oxygen mask', rather than relying on scrap paper.

Use phones.

ETA why can’t the notes be kept with the patients?

 

[Planigale]

How about a wired intercom? The outside portion could be a wired headset (plug it into a jack outside the room), for patient privacy.

Might not be available off the shelf as one product. Is there anyone there (a home theater hobbyist, maybe) who can throw together a system like that out of off the shelf components?

We spent a quiet hour googling wireless intercoms, that is what we really need, also to let patients communicate to us easily. Wireless ones appear expensive and it is not realistic to wire in intercoms in the middle of an outbreak. If a company could rapidly produce a cheap battery powered short range intercom, with restricted channels so other rooms couldn't listen in they would probably have a market.

 

[Skeptic Ginger]

I've tried googling < Life Care Center in Kirkland covid "staff mortalities"> but failed to find any number. The staff was a good cross section of umm 120 Americans, not the high risk patients, and not frat boys playing beer pong with other people's spittle. And their exposure started a month ago. So a good cohort of what the outcomes might be for the rest of us.

Anybody's google-fu better then mine? (I assume so...)

One visitor contracted it and died. At least one care-giver is still in the hospital, 40+ are infected. It is not over yet to know if those infected workers will die or recover. And one of the ED docs who treated the patients is in ICU and has been for a while now.

There were ~120 patients, not staff. Staff numbers were much higher.

Almost all the patients got infected, so far the death total is 37 and there are probably more that weren't tested..

 

[The Man]

How about a wired intercom? The outside portion could be a wired headset (plug it into a jack outside the room), for patient privacy.

Might not be available off the shelf as one product. Is there anyone there (a home theater hobbyist, maybe) who can throw together a system like that out of off the shelf components?

Off the shelf

https://www.aircraftspruce.com/cata...MI7unq18nA6AIVlYNaBR3YcgyIEAYYBCABEgIkCvD_BwE

https://competitionmotorsport.com/t...MI8e3j38vA6AIVDYiGCh0jxQBNEAQYBSABEgJTVvD_BwE

https://www.schooloutfitters.com/ca...MIiIDasczA6AIVnINaBR01WwX5EAQYAiABEgIB2PD_BwE

https://www.fullcompass.com/prod/05...MIseKeqc7A6AIViYVaBR1ZRgdCEAQYAiABEgIj4vD_BwE

Hey, are there phone jacks in the room? How about speaker phone in the room and dial to the desk.

Can even use phone headset.

https://www.amazon.com/4Call-K263MB...jbGlja1JlZGlyZWN0JmRvTm90TG9nQ2xpY2s9dHJ1ZQ==


Basically all you need is an old stereo unit. Perhaps with phono or aux input (depending on the microphone used) that has a head phone jack. If you don't need two way com.


If Bluetooth is OK you can use a Bluetooth transmitter

https://www.wish.com/product/5abc8e...6AIViYVaBR1ZRgdCEAQYDiABEgKYCfD_BwE&share=web

Or a Bluetooth motorcycle intercom. Naturally you have to keep the one that goes into the room bagged. Not sure how that would effect sound quality.

https://www.google.com/search?q=blu....69i57j0l7.14488j0j4&sourceid=chrome&ie=UTF-8

ETA:

Systems that use the power wiring as the com line {Power Line Carrier (PLC) intercom systems} are available but not without their own draw backs.

https://intertalk-sales.com/index.php?route=product/product&product_id=55

About PLC

https://www.intercomsonline.com/wired-intercom-technology-a/134.htm

 

[pipelineaudio]

We spent a quiet hour googling wireless intercoms, that is what we really need, also to let patients communicate to us easily. Wireless ones appear expensive and it is not realistic to wire in intercoms in the middle of an outbreak. If a company could rapidly produce a cheap battery powered short range intercom, with restricted channels so other rooms couldn't listen in they would probably have a market.

Take them from the &%$%&*(^&*((%&*&*( airlines! I would love to see a squad of nurses ripping them out of planes, that would be awewsome

 

[Thor 2]

It is a time thing, but maybe not for that reason.

Being diagnosed as cured requires a clear test, which can take weeks. On the other hand, some people are in ICU for weeks. I don't know whether anyone's checked the accuracy of Diamond Princess cases, but they've been showing 15 critical for a month.

USA's rate of deaths : current cases is increasing, which is an artifact of the slow onset of severe symptoms.

FTFY

I do not share your certainty about some things The Atheist. Not being gifted with the unerring ability to be right, I tend to suggest that one thing may be so or perhaps not. I have read of some fading rapidly after being infected. Admittedly these seem to be the elderly.

 

[Planigale]

Off the shelf

https://www.aircraftspruce.com/cata...MI7unq18nA6AIVlYNaBR3YcgyIEAYYBCABEgIkCvD_BwE

https://competitionmotorsport.com/t...MI8e3j38vA6AIVDYiGCh0jxQBNEAQYBSABEgJTVvD_BwE

https://www.schooloutfitters.com/ca...MIiIDasczA6AIVnINaBR01WwX5EAQYAiABEgIB2PD_BwE

https://www.fullcompass.com/prod/05...MIseKeqc7A6AIViYVaBR1ZRgdCEAQYAiABEgIj4vD_BwE

Hey, are there phone jacks in the room? How about speaker phone in the room and dial to the desk.

Can even use phone headset.

https://www.amazon.com/4Call-K263MB...jbGlja1JlZGlyZWN0JmRvTm90TG9nQ2xpY2s9dHJ1ZQ==


Basically all you need is an old stereo unit. Perhaps with phono or aux input (depending on the microphone used) that has a head phone jack. If you don't need two way com.


If Bluetooth is OK you can use a Bluetooth transmitter

https://www.wish.com/product/5abc8e...6AIViYVaBR1ZRgdCEAQYDiABEgKYCfD_BwE&share=web

Or a Bluetooth motorcycle intercom. Naturally you have to keep the one that goes into the room bagged. Not sure how that would effect sound quality.

https://www.google.com/search?q=blu....69i57j0l7.14488j0j4&sourceid=chrome&ie=UTF-8

Thanks I'll look through this tomorrow. I have a day off before going on to nights.

It is interesting how rapidly responsive things have come. We are trying to create some 'airlocks'. Yesterday a couple of local builders turned up and said "where do you want us to put the doors then doc?". Normally any alterations to the hospital would be impossible to make, let alone letting a temporary employee say "I think here seems good", and it just happens*. Just for once cost is not an issue, even authority is not an issue, if you need and can justify something at the frontline it happens.

*Normally the ward sister would have the final say but I am operating out of what used to be an orthopaedic ward with an amalgamation of nursing staff and medical staff from various specialities and suddenly find myself the senior person on the ward.

 

[Dr.Sid]

FTFY

I do not share your certainty about some things The Atheist. Not being gifted with the unerring ability to be right, I tend to suggest that one thing may be so or perhaps not. I have read of some fading rapidly after being infected. Admittedly these seem to be the elderly.

There are rapid cases. But most are not. Especially if the healthcare is still available. Good care can keep you alive for much longer, even if your lungs are completely gone. If you believe China's data, their deaths peaked 2 weeks after their new cases peaked. So on average, you die in about 2 weeks.

 

[Skeptic Ginger]

We spent a quiet hour googling wireless intercoms, that is what we really need, also to let patients communicate to us easily. Wireless ones appear expensive and it is not realistic to wire in intercoms in the middle of an outbreak. If a company could rapidly produce a cheap battery powered short range intercom, with restricted channels so other rooms couldn't listen in they would probably have a market.

My neighbors have a wireless doorbell intercom. Pretty sure it was cheap.

I use a baby monitor for an intercom. It's only one way. Using two to get two way interfere with each other but they make two-way monitors.

https://www.walmart.com/ip/Motorola-MB483-Video-Baby-Monitor-Two-Way-Talk/55394817

https://www.amazon.com/Video-Baby-Monitor-Camera-Audio/dp/B07ZNBVFXG


Not sure what they use at Overlake Hospital here in Bellevue, WA but you can call your nurse on the phone on your bedrail and you get their pager which they can talk to you through. It saves nurse steps having to go into a room answering a call bell to find out what the patient wants. Nurse pagers have a number they write on the whiteboard in the rooms. You can also page the tech if you want something like help to the bathroom.

And they post care notes on the white boards as well.

 

[The Atheist]

A team (set up by the South African government) to examine alternative methods of treating Covid-19 identified an old mechanical, pneumatically driven (no electrics) ventilator developed 40 years ago by British company Penlon.

Another candidate for the Covid Anger thread - that's bloody disgraceful.

Okay, a couple of points here:

1. "known to spread through air"?

My understanding is that this is in very limited circumstances when the virus can become aerosolized, such as certain medical procedures. Otherwise it is mostly passed through droplets, is it not?

I'm not wearing a mask because there aren't any to be had.

I have yet to see definitive evidence that even droplets being inhaled are the major source of infection.

Having mapped a very large number of norovirus outbreaks over many years, the way Covid-19 is spreading is identical to those models and completely unlike influenza models I've seen.

Sure, masks will reduce the chances, but I do not accept breathing in the virus is the major driver.

*I mentioned my wife’s test for the flu came back negative. A week later they did not test me, though my symptoms mirrored hers, albeit behind by about a week. My thought is they had enough negative tests for flu that the working assumption became that this was something else going around.

That's why we desperately need an antibody test. There could be millions of people who have had it and recovered and could be going about their normal business.

Not to mention, donating plasma.

Another point on that vein is NZ's first death, a woman in Greymouth.

Under our absurd testing regime, she didn't get tested because she hadn't been overseas or in contact with a know Covid-19 case. Where she lived is as far in the outback as you can get in NZ - a place where few tourists go and yet she caught it and died of it.

It proves beyond any doubt that the disease has been circulating for weeks prior to our official first community spread.

To me, that says that tens of thousands of Kiwis have had it and wouldn't know with an antibody test.

That doesn't yet exist in this country.

 

[casebro]

One visitor contracted it and died. At least one care-giver is still in the hospital, 40+ are infected. It is not over yet to know if those infected workers will die or recover. And one of the ED docs who treated the patients is in ICU and has been for a while now.

There were ~120 patients, not staff. Staff numbers were much higher.

Almost all the patients got infected, so far the death total is 37 and there are probably more that weren't tested..

The numbers I had heard were 180 patients, 120 staff. 37 dead patients I've seen, they are in the one-foot-in-the-grave cohort. We don't know the medical history of that dead visitor, different cohort. So back to the Staff Cohort, which most closely matches the general population, "those healthy enough to clock in": One month after exposure started: Death rate, zero. Known ICU cases, 1. Let me know when we get more data.

 

[pipelineaudio]

Can't stop the chickenfights! I really want to see legislation where some level of Darwin Award attempt exempts healthcare from risking their lives to work on you

https://www.hawaiinewsnow.com/2020/...s-gatherings-some-large-groups-continue-meet/

 

[rjh01]

So an irritant to me. The clever people here might have a solution for. We have four bedded bays, all the patients are covid positive. Anything that goes in is contaminated and stays in or is binned unless it can be cleaned. (Or has to be able to be bagged before going in, be removed from the bag afterwards and be able to be surface cleaned.) So if I go into round on the patients or the nurses are in doing observations, we want to go in see all the patients then go out rather than going in and out after seeing each patient and having to use four sets of PPE rather than one set. The difficulty is that the notes and obs charts can't come in, how do we reliably document our findings? Currently observations are written on a scrap of paper, stuck to the inside of the window so that someone outside or yourself can later transcribe them into the charts. I see a patient then go to the door and dictate my exam notes / plans to someone who writes them in the notes after I see each patient.

Is there a better solution? It has to be cheap and quickly available. Walkie talkies aren't approved for use near medical equipment, and are a bit expensive, and may be poor in confidentiality. We are looking to get white boards so we can hold up messages to people outside e.g. 'need a 40% oxygen mask', rather than relying on scrap paper.

Keep all your notes on you while you do the rounds. Then at the end someone is at the other side of the glass where you put the notes. The moment you put the notes up, they transcribe them. As soon as they have finished you take them down, then get out. That way no unauthorised person will see the notes.

 

[Meadmaker]

There's something I would love to see.

Testing is really important, still. Someday, we'll be back to containment levels. In some rural areas of the country, we still are. There are several Michigan counties with no known cases. If one pops up, test them, test their friends. Do all that.

But, can we? What's the status of testing?

I would love to see a news article whose focus was simply on what tests are available. Who is making more? How many people can we test as time goes on? How expensive are the tests? How long do they take? In other words, I would love to see an article about testing that simply focused on testing, and didn't mention the names of anyone who either holds elective office or wants to hold it in the future.

 

[JeanTate]

Good NYT article on how the Chinese system set up after SARS, to give early warning of exactly the sort of zoonotic threat like SARS-COV-2, failed: “China Created a Fail-Safe System to Track Contagions. It Failed.”

&#)*@&$) for some reason I don’t seem to be able to post a link ...

 

[The Man]

Thanks I'll look through this tomorrow. I have a day off before going on to nights.

It is interesting how rapidly responsive things have come. We are trying to create some 'airlocks'. Yesterday a couple of local builders turned up and said "where do you want us to put the doors then doc?". Normally any alterations to the hospital would be impossible to make, let alone letting a temporary employee say "I think here seems good", and it just happens*. Just for once cost is not an issue, even authority is not an issue, if you need and can justify something at the frontline it happens.

*Normally the ward sister would have the final say but I am operating out of what used to be an orthopaedic ward with an amalgamation of nursing staff and medical staff from various specialities and suddenly find myself the senior person on the ward.

What's your per unit target cost? If Bluetooth is OK...



https://www.amazon.com/Aluratek-AIS...ix=bluetooth+microphone,automotive,167&sr=1-5


here is a Bluetooth receive with built in microphone so wired head phones would receive from a paired Bluetooth device. The mic output could be feed into a bluetooth transmitter to feed back to another paired device. Since the units output would include the first paired device's output you wouldn't want it to feedback to the same device.

Back in the 80's I used an old mini cassette tape dictaphone that feed into an FM transmitter (that was normally used to connect my discman to my car stereo) to listen remotely. My supervisor and our engineering manager were cutting me out of a patent for a product I designed.

ETA:

A single paired device could be used as long as headphones are used there so its mic would not pick up its own output.

 

[smartcooky]

Yes we had though about an old phone and blue tooth connecting it. But that calls for an awful lot of old phones! There are lots of four bedded bays, the single rooms are less of an issue.

Write the notes directly on the window with a whiteboard marker. The person on the outside, photographs it with a smartphone (it will be back to front to them so they flip the image with an editing app) and PXTs it to the transcriber. When done, wipe off the note and move to the next one.

This way, there is no need for materials such as notepaper or forms inside the quarantine that require disposal. The only things that need to be carried from room to room are a whiteboard marker and a wiper. You could even set up each window with a pre-written "form" using a spirit based permanent marker, with the whiteboard marker being used to fill in the form. Only the variable data gets wiped.

 

[pzkpfw]

... You could even set up each window with a pre-written "form" using a spirit based permanent marker, with the whiteboard marker being used to fill in the form. Only the variable data gets wiped.

The form could be done in whiteboard marker, on the other side of the glass. Easy to clean/change.

 

[TellyKNeasuss]

Good NYT article on how the Chinese system set up after SARS, to give early warning of exactly the sort of zoonotic threat like SARS-COV-2, failed: “China Created a Fail-Safe System to Track Contagions. It Failed.”

&#)*@&$) for some reason I don’t seem to be able to post a link ...

https://www.nytimes.com/2020/03/29/...YUGeeDCLAXCAjHb9oLAbSf3xMkA7lhd1t4ZscR4uEcLA4