I believe those numbers you are looking at are exactly why Judge Hidalgo moved Harris County to Level 1 Red and issued a SAH advisory. I believe she couldn’t mandate a SAH because only the Governor of a Texas can do that.
The TMC website is very informative. In addition to what was noted above, the positivity rate trend line is pretty steep, with a rate of 20% as of 6/25 based on a 7-day average. I recall when the Northeast was peaking, public health officials said they were looking for something around 10%. The number of tests administered did dip the past few days while the number of positives increased, leading to the increase in positive rate. Perhaps there aren’t enough tests getting administered? I know positive test rate can be misleading.
@JustaMom that mirrors what we’ve been seeing in my area. The bulk of the new cases are in the 20-29 year old group. I don’t know if that’s because they are out and about more and not taking precautions or because they are being exposed in their work places now that hospitality and services have opened up more…
I agree completely, fwiw.
I don’t think that people stopped social distancing or taking things less seriously but when the scientists that you rely on for factual info excuse protesting as a good reason to gather and actively come up with excuses to the point “that doesn’t count because it’s a good cause” really undermines everything else they say. Society may decide it’s more important to protest but not the guys who we depend on for facts. If gathering without masks is okay in any instance without threat of death which has been the mantra then we need to know.
Were they lying then or are they lying now?
Clearly, scientists should not have publicly weighed in on the protests at all. They were going to happen no matter what. Now we are dealing with a lot of mixed messages that are being used as an excuse to engage in behaviors that will further spread the virus.
So Texas Medical Center—which is huge, having about 30,000 patient encounters a day—is now on surge ICU. As I understand it, this means turning regular beds into ICU beds. That doesn’t sound alarming, until you think about who is going to staff those beds. All the regular ICU nurses are already working in the regular ICUs, so they have to either put non-ICU nurses in the new surge ICU, or spread the regular ICU nurses more thinly. All the regular respiratory therapists are already working on the patients they were already in charge of in the regular acute beds and ICU beds, so they too have to be spread more thinly.
Covid patients in the ICU are sicker and more medically complex than a typical ICU patient, but the surge patients are going to get fewer and/or less well trained nurses to take care of them.
Maybe TMC will try to hire outside nurses. But you’ve got to figure that Texas hospitals aren’t the only ones looking for extra trained staff: Arizona is on the case as well, and California, and Florida.
I’d like to know what age groups are in the ICU beds because if it’s 20-29 year olds that includes college aged people…and how does that affect or influence college openings in the fall.
Cardinal Fang:
Last week, Rachel Maddow (yes, I know some of you don’t like her, but to me she is a wicked smart hardworking Bay Area girl) asked a top Houston doctor (sorry can’t remember who) if Houston would look to New York for more doctors/nurses. Cuomo had offered such aid.
The doc said no and that one thing Houston had a surplus of was doctors and nurses. Surprised me to hear that!
Well, I hope they have a surplus of ICU nurses, because you can’t just pull a nurse out of an orthodpedic unit, a cancer unit, or even a stepdown unit and expect them to competently take care of a critically ill patient.
ICU nursing is a complicated specialty, and nurses who have no experience in this specialty would be putting patients’ lives on the line and risking their own licenses. This is the kind of thing that puts fear into my heart-either having to take care of patients when I am not confident in my ability to give expert care or having someone I love being cared for by someone who really doesn’t know what they are doing and shouldn’t be expected to. Making a mistake in ICU can kill people. You increase the odds of that happening by either giving ICU nurses too many patients, or by staffing your unit with nurses who are not trained and experienced in caring for patients in that environment.
Not all hospitals see the covid pts, that was the thing in NYC, some hospitals were not busy. There are nurses and drs furloughed all over the country. Those spare drs are derms, those spare nurses are office nurses. They are not ICU spares, or ER spares, or even acute pt spares. Not that the business model even works that way.
One area that really confuses me is testing and I do believe some direction and greater involvement at the federal level would be helpful. Many areas either don’t have covid testing readily available/accessible or there’s confusion around it. There are multiple tests, some with rapid results and others where one waits days (a week?) for results. Some administered with a swab that practically reaches up to one’s brain and another that’s self administered and the swab doesn’t need to go nearly as high. I have no idea the levels of accuracy and if any one test has a higher level than another.
The same goes for antibody tests. Awhile back I read that Roche was the only manufacturer that could state a 99% accuracy rate. I spent over 90 minutes on the phone one day trying to track down a way to get a Roche antibody test. A Roche representative told me that, while he agreed it was nuts, no one could tell me. A lab that offers Roche as well as other tests told me that my sample would be taken locally but that my sample would be sent off to another site and no one could tell me which manufacturer’s test would actually be used on my sample.
While I understand and appreciate the free market concept, I do feel frustrated that there’s not greater access and transparency to all of this.
I disagree. Scientists should weigh in on all activities, no matter the politics. They lose credibility if they stay silent on some.
It is interesting which things people see as ‘necessary’. Talking with my friends, they think getting hair and nails done is necessary. I think going to a wide open park is necessary.
I’ve used to shop for clothes for fun. I have a closet full. I now don’t feel the urge to go to the mall to just browse around.
My roots are not as gray as I feared so I can stay away from my colorist for awhile. And plain nails are just fine. I can file them myself.
Changing priorities.
In New York City at the peak, covid ICU patients were taken care of by nurses who were not ICU nurses, and doctors whose specialties were other than taking care of critically ill patients. One week on University of California San Francisco Hospital’s Grand Rounds (which are available on YouTube) oa UCSF doctor who travelled to New York City to help out spoke about his experience.
He was, IIRC, a specialist in intensive care (which I think is called an intensivist). He was in charge of an ICU ward. This ward wasn’t in an ICU; it was a room that was normally used for people just out of surgery. There weren’t separate rooms. The two residents he had were an orthopedics resident and another resident in some non-intensive-care field. His nurses were not specialists in ICU.
He said the patients he saw there were the sickest patients he’d ever taken care of (and remember, his regular job is taking care of people in ICUs). I have no doubt that he, his residents and his nurses worked heroically, doing every single thing they could do, at every minute. But inexperienced people are going to make mistakes, and mistakes with critically ill people mean deaths. If Houston hospitals are staffing surge ICUs with people that are not specialists in ICUs, then mistakes will be made and otherwise avoidable deaths will happen. Not just deaths, either—it’s not as if everyone who comes out of the ICU alive is perfect and ready for a dance marathon. There will be complications that wouldn’t have happened if there had been fewer cases.
When I began my nursing career, I was placed in an ICU nurse residency program. We had six months of intensive classroom time, as well as many hours working under the supervision of an experienced ICU nurse. After six months, we were given one patient only, with an assigned ICU nurse in the wings available for consult (in reality, all the ICU nurses on shift would look after us, like we were little chicks). After a few more months, we were given a full load of 2 patients, but it was understood that we needed to be given the less ill patients if at all possible until we demonstrated the proper level of competency. Even with all that, I literally felt sick with dread on the way to work for a full year and a half. It took a couple of years to feel truly comfortable with my competency, and even then, the difference between my knowledge and expertise was in stark contrast with the really experienced nurses.
An experienced ortho nurse has an advantage over a new nurse in terms of coming into a new specialty. But that nurse would STILL need quite a lot of class time and supervision because ICU nursing is just a completely different specialty. The technology is different, the thought processes are different, the skill sets are different. The risk is high and mistakes in this environment literally kill. If things get so bad that they are having to bring in non ICU nurses to fill the gap, believe me that we are in a bad bad place. When I worked ICU, if you had tried to float me to a labor and delivery unit, I would have quit rather than go. Things are very specialized now, and merely having a nursing license does not make one competent in all things.
Cuomo said today that NY received assistance from 30 different states. He has called other states having problems and asked how they can help. Medical teams, experience, testing, testing software, etc. Expect Covid may well be like a game of whack a mole. Flare ups will happen in different parts of the country and assistance can be provided. We do that with emergency relief. No state has the capacity to rebuild after hurricanes but states that have capacity send crews to help.
Scientists should study and discuss publicly all aspects of dealing with the virus. After all, outside transmissions, whether in a protest or at a farmer’s market, is pretty important information for all of us.
@Nrdsb4, considering putting an experienced non-ICU nurse into a covid ward, how much difference does it make that all the patients have the same disease, which is new to everyone? Obviously (or at least I think it’s obvious anyway) you’d rather have the ICU nurse. But maybe it’s less important to have the ICU nurse, because any nurse, ICU or not, is going to have to learn to handle patients with this new disease. Or maybe it’s more important, because ICU covid patients are sicker than other ICU patients, with multiple organ failures (heart, kidneys, other organs, as well as lungs) and the expert ICU nurse already knows how to handle these different pathologies.
https://www.microbe.tv/twiv/
Daniel griffins part is always necessary listening but really even a NJ ID doc is talking about Houston.
How to read Covid data - our local journalists explain: