Hello My Fellow Californians:
President Governor Newsom has now outlined the contours of the United States of us, Western Edition. The coalition of California, Oregon, and Washington State, representing about 20% of the US population and immense economic clout, will coordinate strategies for best practices, equipment and idea sharing, and jointly reopening their economies in the post-stage 1 pandemic world.
This clear shot-across-the-failing-federal government’s bow is only exceeded by the three Governators’ conspicuous commitment to science. The word "science” is mentioned approximately a million times in any discussion of their strategies. We will rely on science, we will be guided by the scientists, the plans depend on what the scientists say, and so on. As we know, “science” is a word which infuriates the Honorable Heck-of-a-job-Trumpy, and I like to think that its hilarious omnipresence among the governors’ pronouncements is a deliberate snark on the Western Governators’ part.
Meanwhile, here is our Governator’s six-part plan for when California will come out of hybernation:
- Widespread increase of testing, identifying cases, contact tracing, isolation and quarantine. The Gov has already gotten Apple and Google onboard to put tracking technology on their smart phones. Some serious privacy concerns there for sure.
- Addressing the needs of what he called our most vulnerable populations: Seniors, the homeless, and prisoners.
- Enough protective gear for the work force, the health force, and enough surge capacity for hospitals and ICU units. He is smart enough to know that opening the economy will be followed by a re-emergence of the virus.
- Engage the heavy hitters in California universities and bio tech companies to lead the way in developing therapeutics, vaccines, testing — while the population develops herd immunity.
- Re-imagine our public spaces, our places of employment our schools, our coastline. Now that will be hard.
- Be ready to shelter in place again if needed.
These are big ideas, each one more fraught with difficulties than the one before. But it makes sense, and as the army says, when faced with a crisis, developing a plan, any plan, is better than doing nothing. And it’s a far sight better than that.
BY THE NUMBERS
California has had a rough two days.
California Cases - State, LA County and Bay Area — APril 13-14
|
Number |
Increase |
|
|
Total State cases |
25742 |
+2455 |
|
|
Deaths |
789 |
+108 |
|
|
Total LA County |
10047 |
+855 |
|
|
Deaths |
360 |
+64 |
|
|
Bay Area |
5369 |
+378 |
|
|
Deaths |
147 |
+8 |
|
|
|
|
|
|
|
As of Tuesday, there were more than 2500 cases of Covid-19 among California health care workers.
TESTING
202,208 test results reported. Approximately 13,200 results pending. Still bad.
Testing is cratering everywhere in the country as we run out of swabs and reagents. Thank you, Heck-of-a-job Mikey (Pency).
PREPARING (OR NOT) FOR THE TSUNAMI
- The California nursing home epidemic continues unabated, despite the state’s new “SWAT” teams trying to help limit the contagion. An estimated 1266 sick patients or staff have been identified so far in California’s 1244 skilled nursing facilities. In some counties, an astronomical percentage of the Covid-19 cases are from nursing homes. In some cases, the staff has started simply not showing up. They are underpaid, underappreciated, and in many cases unprotected. Wearing a garbage bag for PPE is just not unacceptable.
What is even more startling: California still has a rule in place that requires nursing homes to accept recovering Covid-19 patients in order to free up hospital beds -- even if the patients are still infectious. This rule is idiotic on its face. “It’s like California has declared war on nursing home residents”, said Michael Connors, an advocate for the California Advocates for Nursing Home Reform. It’s like throwing a lit match into a tinderbox.
The ensuing outcry has forced the state to modify the rule, allowing facilities to reject patients if the facilities lack adequate protective equipment of its workers and ways of preventing transmission. As one administrator said, you send me one patient today, and in two weeks I’ll be sending you 20.
Just FYI, New York is requiring nursing homes to accept Covid-19 patients when public health officials request it. No exceptions. This was so starling to me that I tracked it down. Apparently the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has released guidance stating that nursing homes cannot refuse readmission to a resident solely because they have tested positive for Covid-19. At the same time, the CMS has recommended that facilities stop allowing visitors to limit the introduction of the virus into the homes. This is like preaching against sin on the front porch while running a brothel in the back yard. And this kind of incoherent idiocy may explain why so many people hate the government.
About 1.5 million people reside in nursing homes in this country. They are one of its most vulnerable populations in this pandemic.
thehill.com/…
calmatters.org/…
- In Ventilator news: Lying on your belly can save your life.
Physicians are beginning to think that not every patient with significantly low oxygen saturation (normal is considered 95% or above) needs to be on a ventilator. The stats on intubation are not good. 80% of patients who are put on ventilators don’t make it.
My spouse, who is an osteopathic physician specializing in manual medicine, has been saying for months that improving the excursion of the ribcage and taking pressure off the lungs from the diaphragm and heart would be critically important for covid-19 patients.
It turns out that flipping a patient onto their belly (the “prone” position), does both of these things. ”Proning” (as it is called) has been found to almost immediately and dramatically improve the oxygenation of some desperately ill covid-19 patients because it makes more of the lung available. At Lincoln Hospital in the Bronx, 50 patients had their ox sat levels return to normal after 5 minutes of proning, and only 13 needed ventilators the next day.
Since I knew you would be interested in this, I did a literature search on proning. The efficacy of proning for relieving acute respiratory distress syndrome (ARDS), which is what many Covid-19 patients die from, has been in the research literature for a number of years. Medicine is so in love with technology, sometimes it overlooks the simpler things.
Prone ventilation for adult patients with acute respiratory distress syndrome (2019)
Prone positioning for severe ARDS advised by major societies (2018)
Treatment of ARDS With Prone Positioning (2017)
HOW YOU CAN HELP
- Food banks are desperately in need of food, donations, and volunteers as they have been overwhelmed by the demand. The vast majority of job losses occurring among the most vulnerable among us -low wage workers like hotel housekeepers, cooks, janitors, waiters — exposing the millions of people that Elizabeth Warren and Bernie Sanders have been warning us live one lost paycheck away from financial catastrophe. The California Association of Food Banks has links to places that need help, money, and volunteers. And links on how to get food stamps and other food assistance.
NEWS YOU CAN USE
AND FINALLY —
Wildlife is returning to Yosemite. The animals have come out of hiding as people have disappeared. The bear population has quadrupled. Coyotes have taken up residence by the cabins. The haze from a million visitors is gone. Perhaps, as the Times noted, the valley is like it was when visitors first came there in the 19th century. As Alice Ives Van Schaack wrote in her 1871 journal,
“I felt Heaven itself could not be much lovelier.”