2 days ago, we were walking Adeline throughout the neighborhood; I told her that this was as good as its gonna get: The daily positive cases from community spread are between 10-20 in Onondaga County, with it’s population of 450,000 people. The hospitalizations have leveled off – 50-60 people are in the hospital at any given time for COVID-related care. 25-33% of hospitalized patients are typically in critical care. This has been the case for the last 3 weeks. There is a little variance here and there, but this is what we can now expect pre-re-opening. She asked me what I thought about it all. I told her that if we didn’t stop distancing in the home now, I don’t see a circumstance when we would. I’m going to continue to see patients. The community numbers will worsen with the phased re-opening of the local economy (to what extent, we […]
The data is starting to come in and CNY is faring pretty well. Coupled with decreased population density, social distancing has been successful. The local hospitals haven’t seen the numbers of patients that were projected by epidemiological models, nor have the seen figures near what I had even calculated. We never had exponential growth. Our 3 major hospitals combined have only rarely had more than 60 COVID-positive patients at any given time. New antibody testing (now up to 15,000 tested statewide) reveals that far less than 3% of the CNY population has had COVID-19. Figures downstate are near 20%. The fatality rate is not going to be as high as was initially feared, although the numbers will be difficult to ascertain with any certainty. There are certainly people who have expired early on who won’t be captured in the data. Then again, this thing is also far more contagious than […]
Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. World Health Organization They should know better. Since the early part of the week, my answer has been the same: “They are far smarter than me. I don’t understand how they’ve come to get their curve to look like that, but it doesn’t make sense to me. I’ll try to figure it out later.” Later is today and today I’m pissed. I would expect better from a high school senior. Seriously. It is that bad. It draws ridiculously unreasonable conclusions that are implausible and defy direct observation. It is meaningless drivel. This isn’t even science; it is bullshit. If this is what passes for epidemiology – and I know better than to think that it does – then we’re […]
When I am reviewing patient cases with my staff, I ask them, “Where are we going with this?” By now, they know that I am asking them when they plan to discharge the patient from home care services. Home care services are necessarily finite. Criteria for coverage includes both necessity and a reasonable expectation that the intervention is going to have a significant impact on the patient’s abilities. Sometimes the patient achieves their goals, warranting discharge. Sometimes the patient plateaus, and the intervention is discontinued without an expectation of continued benefit. Similar considerations need to be made as I frequently re-evaluate the strategies deployed in the home to prevent spread of COVID. The kids and Christine are COVID-free. Considering their enhanced hygiene habits in/out of the home 2 weeks prior to school closures and their vigorous social distancing since, I would be shocked if they were to have any antigens […]
We made a calculated decision. On the evening of March 14, we allowed Austin to go to a friend’s house for a birthday party with 4 other classmates. We knew this was going to be the last time that he would see them face-to-face for a long while. We justified this decision by acknowledging that this same close knit group of 5 kids had already been with each other all week; one extra day probably wasn’t going to make a difference. By that time, either they had COVID or they didn’t. When I picked up Austin, the father approached me and grabbed my hand when I walked in (a hand that I had purposefully left at my side) and put his arm around me and placed it on the opposite shoulder, not hesitating to share with me his disappointment that local school administrators had elected to close the schools. As […]
It’s not the size that matters, but how you use it. Words never spoken to me, I swear. No, really. It’s just an idiom. One week ago today, I walked in and gave Nascentia my things: my clinical bag, my equipment, my electronics, my trunk bin, and my ID badge. 8 months earlier it had seemed like the right move to seek employment with Nascentia. They were looking for a staff therapist and I was miserable, despite my apparent success in middle management. I had an opportunity to not deal with the toxic and back-stabbing personalities in my workplace, make equal money, and work in my car again. No more meetings. No more politics. Just me, one on one with patients again. It was nice. 2 days ago, I sat in the parking lot of my next employer looking at the single entry to a single level building with no […]
I received an email from a friend yesterday. We had been talking back and forth about COVID and they were unconvinced that it was as contagious as it has been made out to be. They wrote, “Figured you might appreciate the first part of this email. I haven’t done my own homework on it, but the editor of this newsletter is someone familiar with big data and statistical measures; making those inferences…a little more accurate; hopefully.“ This is what the body of the article said: The insights about COVID-19 and its spread published in the last three days have been incredible. The increase in data and transparency is allowing us to better understand this virus. The University of Oxford just published some excellent research outlining how quickly the team from Oxford’s Evolutionary Ecology and Infectious Disease group believes COVID-19 has spread. The assumptions used were all reasonable and backed by […]
We expect the COVID-19 hospital demand to peak in 2-3 weeks(1), per Governor Cuomo. In the 5 counties referenced earlier, there are a total of 196 cases of COVID-19(2), as of yesterday afternoon (146 in Onondaga, 4 in Cayuga, 8 in Cortland, 29 in Madison, and 9 in Oswego). 20 patients are currently receiving hospital care in Onondaga County(2), and my guess is that anyone who requires hospitalization from the surrounding area is already included in that figure. The exponential growth in infection rate has seemingly been the same across the globe. The curves in China, Italy, and NYC all look pretty similar … scarily similar. It is easy to look at NYC and see that NYC was at 173 cases on March 10.(3)* If CNY follows the same exact curve, we would be looking at 30,000 cases when this thing peaks in two weeks, more if the peak occurs […]
In July, I left Company A to work for Company B, taking a $5k paycut to return to clinical work … kind of. Company B actually had really low minimum base salary (20% less), but I was only expected to see 5 patients per day and I earned an extra $18k (which would cover the difference) if I serviced 6 patients per day, matching my productivity when I worked as a clinician for Company A. In mid-January, Company B changed expectations to cut their own costs, mandating 6 patients be seen for minimum productivity while at the same time struggling to admit a sufficient number of patients to afford therapists to consistently see 7 patients (not to mention that seeing 7 presents with some quality of care/ethical dilemmas and they were already beginning to remove autonomy from therapists regarding patient care as well). So, folks like me who were working […]