Advice from a nurse in Texas

Advice from a nurse in Texas

is from a ICU nurse In 


evening. If you are tagged in this you are family, or very close to
my family. I hope that you will take my words to heart and listen.

have been in healthcare all my life, and now, over 30 years in I am
now an ICU nurse practitioner dealing with critical illness and life
support issues. Those of you who have come to me for advice in the
past know that I am a straight shooter and i have never bullshitted
you on matters of health. With that in mind….here we go.

is here. In America. NOW. Circulating in communities, both detected
and undetected. There is no stopping it. COVID19 is a respiratory
illness caused by SARS-CoV2, a new (novel is the scientific word)
strain of coronavirus that has emerged in humans since December 2019.
It is related to the SARS virus that circulated in 2002-3. We got
lucky then. Our luck is not so good this time.

is not the flu. It doesn’t feel like the flu. And it is deadlier than
the flu by every measure we have undertaken in affected countries. It
will make the rounds and many of us will catch it. Most of us wont
have a problem with it however… a significant number of us will get
fairly sick and may need hospitalization… of those about half of
those hospitalized will likely end up in the ICU and possibly on
breathing machines… and of those sickest, there will be deaths.
COVID19 at its best is showing a 0.8% mortality rate, which is 3x
worse than the flu. That is in countries that have extensive testing
and detected both the well AND unwell who are positive for the
SARS-CoV2 virus, which causes the COVID19 illness.

are 350 million folks in america, roughly. People are throwing around
this number of “less than one percent”. Well let me tell
you: Do the math. A very small percentage of a very large number is
STILL a large number.

of the Flu involve your body feeling like everything hurts, and you
got run over by a mack truck and you just feel awful.. in addition to
upper respiratory symptoms.

is different. You may or may not have a runny nose and fever. A sore
throat becomes a major common finding.. then it gets in the lungs. A
dry, nonproductive cough is common, followed or accompanied by
shortness of breath. The shortness of breath is what is triggering
hospital visits, and the folks presenting to the hospitals show low
oxygen levels (oxygen saturations) and chest imaging typically shows
a bilateral diffuse pneumonia (Double pneumonia for the laypeople).

only proven effective therapies are supportive- Oxygen, and positive
pressure ventilation… either with a cpap/bipap machine or with a
mechanical ventilator attached to a breathing tube. There is no cure.
Your body has to fight it off and it has to run its course. There is
no Tamiflu equivalent that works for this. There are some smart
medical folks out there spitballing some ideas, but nothing is proven
to work. So like every other viral illness you have gotten, you have
to ride it out and hope your body is strong enough.

and children are making out fairly Ok.. even if they test positive
they havent been dying of it in China, in Italy… however healthy
young adults, even athletic types, in their 30’s-50’s are coming in
very sick and some are dying. From there, the older one is, the
higher the hospitalization rates and the mortality rates.

out of China shows that it was killing men more than women, but one
thing to note is that in China, older men are invariably tobacco
smokers. Information out of Italy appears to show the obese are
having a worse time with it. In general, blood pressure and diabetes
are associated with higher rates of severe illness and death. In
particular, people takeing ACE Inhibitors or ARB’s for their blood
pressure (the drugs ending in “pril” like lisinopril, or
“sartan” like valsartan) seem to be having a worse time.
This makes sense since both of these classes of medicine affect cells
in the lungs, which SARS CoV2 is thought to also affect.

biggest danger right now, and the reason why I am writing this, and
tagging you… is that this will “explode” here like it has
in Italy, Iran and how it did in China.

only have so many hospital beds. We only have so many ICU beds. We
only have so many ventilators.. and we only have so many trained
staff who can care for the patients. If this blows up massively
beyond the ability of the health care system to treat and rescue
patients, people who COULD have lived will simply die.

italy they have an excellent national healthcare system with about
5000 ICU beds, and per capita have more doctors and hospital beds
than we do here in the US. Of course, the US is bigger and has more
total beds, and ventilators… but again.. less per capita. In italy,
in Lombardy (the state/province) and in Milan… they have simply run
out of ventilators. Doctors are faced with having too many people who
cant breathe anymore, and not enough breathing machines to put them
on. They are literally deciding on the spot who might live and who
will die. They aren’t doing CPR or anything else futile for the COVID
patients. They dont have the staff or capacity to do so.

a lot more horrible stuff I could tell you about whats happening, but
the short version is this – if we exceed the capacity to manage this,
people who should have lived will die.

brings us to here, now, in the US. COVID is here. It WILL sweep the
nation. There was never anything we could have done to stop it
because of the way we live and conduct business. BUT what we have to

we SLOW IT DOWN, so that the number of unwell and critically ill dont
explode, and overwhelm the system, then everyone has a fighting
chance. Give time for flu season to end and get flu patients out of
the hospital. Give time for the first wave of Covid patients to get
well enough to get out of the hospital.

to SLOW IT DOWN… practice frequent handwashing. Dont touch your
face, nose or eyes without washing your hands first. Frequently
disinfect common surfaces.

SOCIAL DISTANCING. COVID LOVES A CROWD. If you are gonna spread this
disease around lets spread it to only one or two people not 100
people at a time. Stay away from large groups. Lets lay off the
rodeos, the ball games, the big parties, the night clubs. Do small
groups.. or stay home. If you go out, and touch common surfaces,
clean your hands before touching your face. On a bus in china, one
person gave it to 8 other people, including one who got on 30 mins
after the index case left the bus.

you are sick, stay home. Dont visit other vulnerable folks. If it
gets in your household, accept that its there and try not to give it
to your aunts, uncles and grandparents. Stay home, dont go to school.

the elders reading this. I need you to stay home as if your life
depends on it. Because it very well does. Your age group is the one
having the worst time with this. And if it gets bad, all I can say is
that in Italy this week, if you were crashing and over 60, they
didn’t even consider offering a vent to them. So please, elders, Stay
home, skip church, avoid visiting large numbers of people. Skip the
lodge meeting . And if you are adamant that your wings will not be
clipped, then please make sure your will is updated, and you’ve given
a copy to your kids.

none of this says “panic” or “buy bottled water and
toilet paper”. I’m asking for everyone to take a deep breath and
be smart.

caring about your 401k. In a year or two it will be back. The
airlines and cruise lines will get bailed out. The economy is going
to tank no matter what, so quit worrying about it. Right now the
decision is do we want a tanked economy with a low body count or a
high body count.

are all in this together. Wash your hands. Cover your mouth. Practice
social distancing. Stay away from large crowds. Be smart. Stay home
if sick. Dont hoard or steal medical supplies. We need them
desperately at the hospital.

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