We see, every day, some expert on the news telling us that the coronavirus is much worse than the flu. I will stand up to them in a heartbeat. They are idiots.
The Flu, influenza virus, as a world wide epidemic today is quite a bit different than it was in 1918. Yeah, consider the influenza vaccine, consider Tamiflu, consider modern medicine and it’s capabilities to provide oxygen, ventilator support, intensive care support! None of which existed in 1918. To compare coronavirus today, to the flu today is about as STUPID as…
COVID-19 is a novel virus. That means it’s new. In 1918, H1N1 was new. In 2020, not much influenza is new, at least right now (talking influenza vaccine, Tamiflu, Modern ICU technology).
So how can these “experts” compare coronavirus with today’s statistics of the flu? No, lets compare coronavirus with statistics of influenza of 1918, where we had no vaccine for influenza or coronavirus, where we had no Tamiflu or an antiviral for coronavirus and where we had no modern technology that we have today.
I’m sorry, but social distancing is one of the biggest bogus scams sold to the world today. Six feet is not a valid safe distance.
Six miles might, emphasize “might”, be safe. For a respiratory illness. In fact, there is NO SCIENTIFIC RESEARCH that supports this “6 foot rule”. Only bogus media hysteria.
The 6 foot rule, according to a Vanderbilt University Professor is the distance from me that you would have to be to not commingle our expired/inspired air. It totally disregards the micro-drpolets of infectious material that land on solid surfaces in between us that you next touch innocently and then scratch an itchy nose and, voila you just infected yourself despite the 6 foot rule!
Respiratory contagion spread much more vigorously than what your being told.
For the last 3 weeks, the government has wrought devastation on the American economy, all these 6 foot rules and quarantines. Now they want to pay up? There is no way the government can replenish what it has stolen from its citizens. This coronavirus scam has been the greatest scam on American citizens, ever. Two trillion dollars will not come close to compensating Americans for what has been done to them.
Not too long back, maybe a few days, President Trump came out recommending a strategy to combat the spread of coronavirus. Don’t take me wrong, I’m a Trump supporter, not hater, but garbage in yields garbage out. That’s an old computer phrase and even Trump has idiots for advisors.
The advise is good, but he doesn’t own it.
John M. Barry wrote in his excellent book, The Great Influenza, that sometime in September of 1918 (9 months and many deaths into the epidemic) the press posted the following.
“Surgeon General’s Advice to Avoid Influenza Avoid needless crowding… Smother your coughs and sneezes… Your nose not your mouth was made to breathe through… Remember the 3 Cs, clean mouth, clean skin, clean clothes… Food will win the war… Wash your hands before eating…”
There was some other advice from the Surgeon General about constipation, but in today’s terms I take it to mean that too many of our so called experts are full of shit!
Recognize any of that well founded advice? Yeah, but it was given about 100 years ago and not by President Trump or any of his constipated advisors.
Mortality world wide is 4%, mortality in the US is 1.3%. Do you believe Micheal Moore now, that the US has one of the worst health care systems in the world?
I’ve mentioned the asinine Missouri required quarantine law, but guess what? Missouri residents are now not required to get a fishing permit from the Missouri Department of Conservation to fish in Missouri state waters (because of the coronavirus “epidemic”) if you choose to ignore the quarantine orders the state has imposed. Go figure? One state department contradicting another state department’s rule.*
I can’t keep up with this, there is so much rich ignorance out there to post about. Sincerely, your grumpy Uncle Dave.
As I sit here at home in almost house arrest, I have little to do except think about Coronavirus. I have heard that a local community and the state of Missouri have issued a “shelter in place” order.
So, I take the time to look up the Coronavirus stats for Missouri.
From the states website, the Missouri Department of Health and Senior Services , there have been 106 confirmed COVID-19 cases and 3 deaths attributed to it.(1) The population of Missouri in July 2018 was 6,126,452. Acknowledging that there is a backlog of testing and reporting, and some degree of ghosting (those that haven’t come into contact with healthcare) and some degree of transients (travelers that continued on to other places of residence), I still wonder what is going on?
So, I check with the CDC’s website for mortality statistics for the state of Missouri. Some of the causes of death in Missouri as of 2017.(2)
Heart disease 14,820
Cancer 12,971
Chronic lower respiratory disease 3940
Influenza 1,281
Firearm, homicide, drug OD 3329
What did the governor of Missouri do about these? Order a “shelter in place”, house arrest? Nothing?
The black plague, the influenza epidemic of 1918, WWII, Korea, Vietnam, H1N1, Obama. Shit, the world has survived pestilence and plague forever and we, at least some of us, are still here. Go figure?
Even speaking to my personal experience, I have survived horrendous sand storms, racial tension, public education, Vietnam, hurricanes, floods, influenza, Ebola, and the worst divorced-dad prejudice in the existence of the world.
Coronavirus? This is a piece of cake. This is like the end of the world. Right?
Coronavirus is a RNA virus. In layman’s terms, that means it is less sophisticated, less predictable and less organized than DNA viruses, but not. The influenza virus, human immunodeficiency virus (HIV) and coronavirus are RNA viruses. For comparison, influenza and HIV are similar but very different. Influenza virus mutates at an extremely high rate, but on it’s surface. This makes it very difficult to predict things like contagiousness, whereas HIV mutates rapidly, but not on it’s surface, making it much easier to predict. We don’t know, yet, how this new coronavirus is going to act.
In February of 1918, a new (probably) influenza virus developed in Haskell county, Kansas. From there it spread around the world, killing an estimated 150 million people. Read the previous sentence again and think about that number a minute. That was the worst pandemic, ever. It killed more people than AIDS, the black plague and every other disease and war man has ever known.
So, what about coronavirus (COVID-19). At this very moment (3/16/20), we don’t know. As of March 14, 2020, there has been a very steady mortality rate of 3.7%. Seasonal influenza mortality rates range from 15-25%, and pandemic influenza mortality rates range 25-50%. Seasonal influenza means what we experience every year.
But if you watch the news, coronavirus seems to be the deadliest plague to hit mankind, ever. Give me a break. Even the “conservative” Fox News is posting complaints about canceled sports programs, rock concerts, spring break venues and quarantine efforts for old geezers like me. Nothing about it’s mortality, because it isn’t. Right now, there have been 3700 cases in the US with 68 deaths. In 2016, there were over 35,000 deaths due to vehicle accidents, and about that many deaths due to influenza.
The concept of quarantine as a control measure, at this late point, is ridiculous. Locking old geezers up will kill them. They won’t have food or medical supplies for their old geezer illnesses, and will die from those. Unless you deliver their food and toilet paper by medically sterile drones, then you will be introducing coronavirus to a captive audience from the stock boys packaging their delivery! These stupid attempts to restrict exposure, after exposure has already occurred…- we will just let the word stupid stand.
With any respiratory viral illness, who will suffer the most? The largest sub-portion of the population. Right now, that is the old geezers and some of the young. Baby boomers (lots of babies were made when the guys came home from WWII) still make up a very large portion of the population. And, they are mostly all sick with old-people diseases. Cancer, COPD, asthma, diabetes, hypertension, heart disease, etc. And, the young not so healthy. The kids that survived birth insult and defects that in earlier times would have died in utero or shortly after birth. They, too, are highly susceptible to respiratory disease.
But at this point, what does it matter. Unlike the flu, there is no vaccine and there is no Tamiflu for the coronavirus. As far as I am concerned, I can’t do anything about it if I do get it. I just wish the news outlets and the government would pony up and quit lying to us.
The real story from your grumpy Uncle Dave.
The Great Influenza, The Epic Story of the Deadliest Plague in History, John M Barry, Penguin Books, 2004.
www.foxnews.com
www.cdc.gov/coronavirus/2019-nCoV/index.html
Want to read more about this, here is Coronalie-2.
Warning: This post relies heavily on Wikipedia for definitions.
Warning: There is some math involved.
When I was in training, my wife called to talk about something or other and was astounded at the background noise. I was working on a pediatric floor that had an old ward-like layout (one big room with the beds separated by curtains instead of private rooms). She said, “How can you work with that much noise and be so sensitive to noise at home?” Since then I have been fascinated with the culture of noise in medical situations, especially the Emergency Department.
Measuring Sound
That interest was recently rekindled so, I down-loaded an app for my phone that measures decibel readings and gathered some readings. I also obtained some comparison sample readings from da ‘net. But decibel is a fickle wench. It is apparently a logarithmic scale and therefore it cannot be summed up by simple addition (pun intended). Therefore multiple devices do not add like simple math. So, 2 devices producing 50 decibels each do not produce 100 decibels. They are a multiple of 2 and the log of 2 is .301. To obtain the decibel, increase .301 x 10=3.5. Then, 3.5 + 50=53.Straight forward, right? Not to me.1
Table of ED Alarm Sounds
Home 28 db
Heart rate monitor 59 db
Conversation in the work area 45-77 db
General ED area 45 db
Moderately loud 60 db
General ED at shift change 63 db
Nurse call light 66 db
Escape alarm 78 db
Zamboni 78 db
Loud 90 db
Very loud 100 db
Painfully loud 120 db
That’s Alarming
Wikipedia says, “An alarm device or system of alarm devices gives an audible, visual or other form of alarm signal about a problem or condition.”2 But, nowhere on the site does it mention heart monitors with heart rate alarms, blood pressure alarms, pulse-ox alarms, any of the multiple alarms on ventilators or bipap machines. Nowhere is there mention of the escape alarms for those patients that are under police, court or civil custody. There is no consideration for the patient call alarm (really a nurse call alarm, but who wants to fight with tradition). Each alarm has it’s unique tone, rhythm, volume, pitch and cadence. At any one time there might be no alarms sounding, 10 alarms of the same type sounding at once or 10 different types of alarms sounding at once.
When an alarm engages one needs to ask, Is it real or are the alarm parameters set correctly (or not)? When the alarm turns on or off, I have experienced that the parameters are often not entered correctly. For example, say our institution sees 60K patients/yr and 40% are pediatrics, that’s 24,000 pediatric patients/yr and 3/4 of the nurses don’t know what the normal pediatric HR, BP values are for a given age. Of course, not all pediatric patients end up on a monitor, but enough do that it contributes to the cacophony.
The Ground Rules
Sound is a vibration that propagates as an acoustic wave, through a transmission medium such as a gas, liquid or solid.3
A musical tone is characterized by its duration, pitch, intensity (or loudness), and timbre (or quality). It may be simple (sinusoidal) or complex (2 or more simple tones).4
Rhythm has a general meaning of regular recurrence or pattern in time.5
There are various definitions of volume/amplitude …, which are all functions of the magnitude of the differences between the variable’s extreme values.6
Harmonic cadence is a progression of (at least) two chords that concludes a phrase, section, or piece of music.7
Pitch …is the quality that makes it possible to judge sounds as “higher” and “lower” in the sense associated with musical melodies.8
Noise is unwanted sound judged to be unpleasant, loud or disruptive to hearing. From a physics standpoint, noise is indistinguishable from sound…9
Noise pollution is a…noise with harmful impact on the activity of human or animal life.10
We have 7 primary variables, each with a huge number of secondary variables within the primary variable. I don’t want to think about calculating the number of combinations that could be had to create a unique alarm sound.
And then, there is the affect that electronically generated sound effects electronically received sound. Hearing aids folks. For some reason these alarms have a masking effect through a hearing aid that causes the reception of human generated sound to be less than optimal. In other words, when the alarms go off, a hearing aid wearer can’t hear another’s voice. As you will read below, there isn’t much time in an ED when an alarm isn’t going off, somewhere or everywhere.
HIPPA
The Health Insurance Portability and Accountability Act of 1996 …”was created primarily to modernize the flow of healthcare information, stipulate how Personally Identifiable Information is maintained by the healthcare and healthcare insurance industries[, how it] should be protected from fraud and theft, and address limitations on healthcare insurance coverage.” Basically, in common use it governs confidentially of all patient care.11
In the Emergency Department we have 39 rooms crammed into a tight space (for 39 rooms) and for some reason, the doors are mostly left open. Even while the nurse, doctor or other staff ask their questions and examine the patient. To the patients and family in the adjacent rooms, it’s like watching a live YouTube reality show. So, even if the noise level may be on the level of normal conversation, the noise pollution may have more impact than the providers are aware of. And then there are the hard of hearing, to whom one has to yell, “When did you last have a bowel movement, Mr Smith?”
The ED is usually a noisy, hectic, fast paced place. This often leaves the staff dependent on communicating verbally, in a loud verbal interchange. Did I mention that most of the nearby patients and family are listening with rapt attention? Sitting at the nurses desk, Nurse #1 loudly asks Nurse #2, “Did you hear about Bobbie Jo at the party last night? Man, was she smashed. I’m surprised she made it to work today.”
Alarm Fatigue
Surely you’ve heard of Aesop’s Fable, The Boy Who Cried Wolf? It is a survival technique of humans, actually all animals of prey, that if a threat happens over and over with no harm occurring, then the event must be safe. Consider the attraction of cats or dogs to humans. I don’t think this is true, but it’s a nice segue into this section. But I had you for a second there, didn’t I?
If you hear the same alarm many times during your 12 hour shift, and most of them are false alarms, you tend to tune them out. For example, almost every husband is accused of selective hearing by the 10th year of marriage, if not sooner. For 37 years it has amazed me that medical staff tend to ignore alarms at work. But, I admit that I cannot remember one single incident that a bad outcome occurred. That must mean that medical staff have an innate ability to sense when things go south. I can think of innumerable times that one or another staff just happened to walk in when something bad occurred, before the alarms went off.
But, sitting there surfing the net on your cell or buying your next couch on Amazon while alarms are blaring just doesn’t seem right.
Non-alarm Machine Noise
An ER is like the rest of the hospital in that it needs to be cleaned and maintained (and are still one of the filthiest places on earth). To sweep and mop by hand is tiresome and expensive. So our hospital has a Zamboni-like floor cleaning machine. It is one of the loudest machines in the department, throwing the sign out front, “Quiet – Hospital Zone”, out the door.12
The staff work area has 21 computer work stations plus a few COWs (meaning a computer on wheels. A term which locally has been banned because a patient might take offense if they took the term out of context. I guess a bovine cow might also, but hey). There is a computer work station in all of the 39 rooms. There are portable fans and space heaters at many of the work stations. The American Hospital Association reports that there are 5,564 hospitals in the US. There are bigger and there are smaller but I consider ours is about average in size. That’s a lot of white noise. Save your money and just listen to your computer if you want generated white noise.
Every one of these devices emit sound. Sometime in the future this sound/noise may be considered sound/noise pollution. There was a case where a man was arrested in New York City for discharging a firearm in the city. He shot his computer. Maybe it was too loud or too obnoxious. The term “going postal” was a term derived from the fairly common occurrence, in the 1970-1980’s, of disgruntled postal workers (USPS) showing up at work with a gun and shooting a few fellow workers or bosses. We all know of the the recent horror of students taking guns to school and shooting fellow students or teachers.
Someday, you might see the term going “medical” come into use. If it does, I think it will be found to be because of the toxic nature of noise pollution in the ED.
From your grumpy Uncle Dave. Deaf to the human voice but keen on the alarms, what with hearing aids and all.
