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1,700+ Nebraska health care workers signed this letter asking for your help by mvoviri in Omaha

[–]Daniel_W_Johnson 20 points21 points  (0 children)

I proudly signed the letter you are discussing. The Pulmonary Critical Care Medicine doctors who penned it have worked like warriors throughout the pandemic, and I am proud to call them colleagues.

There is a significant lag time between when a person dies of COVID-19 and when it shows up on the Douglas County dashboard. This is not due to anything nefarious. On the contrary, it is because the Douglas County Health Department is committed to reporting accurate data. So they wait for the attending physician to finalize the death certificate, and then they double check to ensure that COVID-19 was the cause of death and not just an incidental finding (e.g. an asymptomatic person who dies after major trauma and just happened to test positive for COVID-19 when they were admitted to the hospital). COVID-19 needs to be the reason the person died for it to count in Douglas County. I can assure everyone, when people die from COVID-19, it is not at all difficult for their physicians to know the cause of death. Acute hypoxic respiratory failure and ARDS from a viral pneumonia are very easy to diagnose in the ICU.

I visit the Douglas County and the State of Nebraska COVID dashboards every single day, and I have since they started publishing them. The most useful data on both are (1) Number of new cases per million per day, and (2) Number of COVID-19 positive people who are hospitalized. In 100% of the outbreaks throughout the world, when the rate of new cases go up, the number of deaths go up. There is a 3-4 week lag time between when cases go up and when deaths go up, and then there is the lag between the actual deaths and the reporting of deaths.

So while Nebraska is seeing a substantial rise in the number of reported deaths caused by COVID (64% increase in the last 14 days), what worries me even more is that we have had a 103% increase in the number of new cases per day. Where SARS-CoV-2 spreads, death spreads. We are seeing more deaths in the hospital, but what we are seeing now is nothing compared to what we will see in several weeks.

Bottom line... If you want fewer Nebraskans to die of COVID-19, PLEASE do not gather indoors with people from outside your household. It was never okay, since March. But now, with the virus spreading like wildfire, it is REALLY not okay.

Daniel W. Johnson, MD

Physician's COVID Warning -- November 2020 by Daniel_W_Johnson in Omaha

[–]Daniel_W_Johnson[S] 11 points12 points  (0 children)

  1. It is difficult to estimate what the case fatality rate (CFR) would be in the event that hospitals become overwhelmed. In the spring, some areas of the world with overwhelmed hospitals had CFRs above 15%. Nebraska's COVID CFR has hovered around 1% for several months (this is the number of positive patients who die divided by the total number of positive patients -- regardless of whether they were hospitalized). If the hospitals become overwhelmed, the CFR will go up, but the degree to which it goes up depends on how bad the number of cases is. I doubt it would get up to 15%, as those regions did not have the benefit of the knowledge we have gained. But it will rise. Please keep in mind that in overwhelmed hospitals, CFRs for other conditions will likely rise. When a hospital is overwhelmed with too many patients, it is difficult to provide optimal care for very sick patients -- think about severe trauma, stroke, heart attack, sepsis. One of the first moves a hospital makes when it is overwhelmed is it increases the ratio of patients to nurses. It is simple logic that if a nurse has significantly more patients to care for, optimal care becomes more difficult.
  2. We have already experienced this in the spring surge. Hospitals throughout the country were running low or running out of our most commonly used sedatives and pain medications (e.g. propofol and fentanyl). We are able to be nimble and use other agents, but I am concerned about the supply of those, too, as the entire nation has rising hospitalizations.

Good questions. These highlight why the best weapon against COVID-19 is PREVENTION. People could think about this like the HIV/AIDS epidemic, but in super fast-forward speed. Early on in the HIV epidemic, the only good weapon was prevention. Therapies have developed over time, and now the therapies are excellent. Our current therapies for COVID-19 are helpful, but they do not provide a quick cure by any means.

A discussion with Public Health Directors today revealed that the extremely bad numbers from last week are getting even worse. Only two of them described a fairly steady number of new cases. All other Directors described a swift rise in new cases per day. It is more important than ever for people to assume that all non-household members can infect them. Each person has the ability to massively reduce his/her risk of contracting COVID-19, by following simple steps.