welcome to another MedCram COVID-19 update here we see 180 mm confirmed
total death 70 100 total recovered 79 thousand the map is turning into
basically a red blob I want to go over to the world ometer website and show you
some interesting trends we see here the total cases starting to accelerate once
again because we're reaching an epidemic phase outside of China and if we look
here at total deaths they're also being mirrored if we looked at active cases we
can see here that there was a plateauing even a dropping off as China was
containing what was going on and then outside of China here in Italy South
Korea and now United States we're starting to see increasing number of
those active cases but here's something that's very interesting in the close
cases when we show the graph for that we're actually starting to see that
there is a upturn here in the death rate where they've either gotten better or
they've passed now there's only two reasons that I could see for the death
rate to be increasing either number one the virus is mutating and becoming more
deadly or number two there is a lot less testing and the number of active cases
is going up much more so I suspect given the fact that the death rate is going up
that there are a lot more cases that are just not being picked up out there
because of lack of testing we can see here that in China where there was a
rip-roaring infection of course at the beginning the total cases per million
population was 56 we're seeing a much higher number here in Iran and Spain and
even in South Korea in Italy we don't have that number here but we can see
that those numbers are quite high and will probably be very large in terms of
the United States we're seeing very small numbers the question is whether or
not that's because of lack of testing if we look again at the active cases list
we see here by far the most amount of active cases going on right now is
in Italy and that is the tragedy right now what is going on in Italy because
there are so many active cases happening so quickly
that their healthcare system is being overwhelmed I want to go back to this
notion of flattening the curve I think there's some other things that we need
to talk about so if this represents the amount of patients over time and this
dashed line represents the capacity of the health system then clearly what is
going on right now in Italy is something that looks like this and we can only
hope that it starts to come down quickly what we are trying to do here in the
United States is slow down the rise of this so that we're able to take care of
these patients that are coming into the hospital so the question here is is this
going to be the United States and the question here is is this Italy I think
Italy has already proven itself to be in this kind of a situation and what we are
trying to do in this country is make sure that we stay below that capacity of
our healthcare system because if we have something that looks like this then this
is going to represent the excess deaths and the reason why this would happen is
because of no isolation so if you're wondering why we're doing isolation is
so that we go on a trajectory of this rather than this so in my clinical
practice and in my administrative practice in the medical group that I
work for we have spent a lot of time trying to come up with a surge plan and
a plan to put into place both in the clinic and in the hospital to actually
modify this dotted line for us locally and I'd like to talk about that because
obviously we're smart enough to be able to work on two things at the same time
to get this surge down to flatten the curve but are there ways that we can
raise this bar so that we're ready to meet this in the middle so the question
is is what have we been doing and what are some suggestions that we can give so
let's talk about some of the support that
the purpose of this talk is not only to let health care providers clinics
hospitals out there know what it is that can be done but it's also to let all of
you know that yes your healthcare infrastructure is full of people working
very hard right now to come up with solutions so that we don't have to deal
with this if we get a surge that we can't normally deal with so I'm gonna
divide this into two categories what we would do at the hospital and what we
would do to personnel so these are people and bricks and mortar so the
first thing is setting up the emergency room so that there is a pre triage
outside and that usually involves a tent sometimes you have to get clearance from
your County to be able to treat patients outside of a licensed building usually
that can probably happen by this point if you haven't already gotten that kind
of approval so this tent also allows you to triage people and to put masks on
people who may have kovat 19 and could spread it to other patients in the
emergency room proper or healthcare providers nurses etc inside the hospital
you can set up whole wings that have negative pressure and we've talked about
this before the other thing you need to think about is just setting up more
rooms these rooms can be other negative pressure wings whole wings of the
hospital but you have to have engineering look at the situation look
at the structure and see how they can configure it so that you're dealing with
a negative pressure room as opposed to a positive pressure room like you have in
the operating rooms the other thing that you have to look at is the possibility
that some of your providers might be quarantined because they were exposed to
somebody with kovat 19:00 and so for that you need to think about robots so
robots are basically computers on mechanical wheels that you can wheel
around and they have very powerful microphones speakers and they also have
very powerful cameras so that you can see close up and they use these in
hospitals where they need a neurologist 24 hours a day but they don't have one
this is the way that they do it for joke centers but this could also be very
helpful if you have a physician who's quarantine at home and can't come into
the hospital but you still need their expertise the last thing that I want to
talk about our ventilators so a couple of things on ventilators number one
there are disposable ventilators that you can get fairly cheap and number two
is this idea of hooking up multiple patients to ventilators this is an
off-label use but it's something that has been done before in an acute surge
situation so here's a really cool video that I want you to see and I'm gonna put
a link to in the description where dr. Babcock an emergency room physician
describes in detail how you can take a regular ventilator and actually hook up
numerous people to this ventilator and it looks as though there are companies
that are responding to this video that are actually putting together kits that
allow you to readily put ventilators into rooms that allow you to ventilate
multiple patients so I think every hospital in the country should be
looking at this possibility as a quick way of temporarily if you need to
ventilate patients when you don't have enough ventilators until you do have
enough ventilators so let's talk about personnel what do we do if we don't have
enough doctors primary care doctors typically working in the clinic are
seeing well patients that's not a priority during a surge we can take
primary care physicians and get them into the hospital many years ago before
hospitalist this is what primary care physicians did they worked in the
hospital and in the clinic and even though they might be a little bit rusty
some of them are probably well suited to work in the hospital and those are the
ones that we could select you would have to waive privileges in an acute
situation and usually Hospital bylaws allow for that sort of thing especially
if it is approved by the chief of staff what about primary care doctors or
clinic patients in general a lot of those things can be dealt with over the
phone so should you be having elderly patients coming to your office sitting
in waiting rooms if it is something that can be dealt with over the phone call
them up and deal with it over the phone there are some insurance
companies that will actually even pay for that kind of a visit if that's what
you're doing and obviously they're gonna be visits that you just have to see so
these are patients that are being worked out for cancer timely application of
tests and reviewing of those tests can be done very quickly but again there are
still a lot of things that can be done over the phone and if that is the case
then that's what should be done what about in the intensive care unit well
there are hospitalists people that work in the hospital but not necessarily in
the intensive care unit that can help out in the ICU if it becomes very
crowded so hospitalists into the intensive care unit to help out the
intensivists who are there so again you're working a little bit out of your
area of expertise but the risks associated with that are far outweighed
by the benefits of taking care of people during the surge what about students so
this is what happens on a daily basis in teaching hospitals you have students you
have residents they're able to meet the surge demand not so much if you have a
private hospital where there are no students or residents but is it possible
for students to come in to those hospitals to help that has to do with
laws that has to do with credentialing and you have to see if those things can
be waived to help out in a specific case or cases where you have a surge and you
need help what about bringing in other doctors so that's exactly what's going
on right now here in the United States usually a doctor is licensed to practice
medicine in a specific state what has happened is some of those state
requirements have been waived so doctors can travel to other states to help out
in surge situations right now in the United States not every state is
impacted the same as other states are and so it's possible that doctors from
states that are not being impacted could come to those states that are being
impacted so that they can help that's kind of what's going on actually right
now in Italy but to a much larger extent because you can see the doctors in Italy
are having a very difficult time handling this surge and help is coming
from a very unlikely source it's actually coming from China try
an immense amount of experience in dealing with this coronavirus you can
see here in this article which we'll put a link to in the description below so
this article goes on to talk about all of the help and the resources that's
coming from China to help out in Italy which has the most active cases in the
world right now the Italian Minister Luigi de Mayo told
Rai television our doctors don't need anyone to teach them in their job but
the Chinese doctors were the first to treat the virus and they can bring their
experience and this folks is what it's going to be about when we're talking
about a world pandemic of a deadly virus we're gonna have to help each other out
if we're gonna be able to get through this together the recipe for success if
we're going to be able to fight effectively kovat 19 is going to come
from two different parties number one the doctors the nurses the respiratory
therapists the hospitals they are going to have to increase the bar in terms of
what we are able to do in terms of our healthcare abilities but it's not just
they're also we're going to need help from the public at large to continue
isolation to make sure that we're able to flatten that curve so that's at the
end of the day we can take care of everybody that we need to take care of
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