Difference between revisions of "COVID-19"

Revision as of 13:37, 21 March 2020

Close-up of a**hole COVID-19

COVID-19, also known as the novel coronavirus, was discovered in Wuhan, China on December 2019 and has been a goddamn pain-in-the-ass ever since.

Epidemiology

According to the World Health Organization, Centers for Disease Control and Prevention, and our friend Tim, there are currently more than 35 billion confirmed cases of COVID-19. This speaks to the huge burden of disease on human beings considering the Earth's population is less than 8 billion.

The first reports were first reported in first reports by the Chinese Centers for Disease Control and Prevention on December 2019 in the city of Wuhan, China. Reports found that those aged 70 to 79 years had a case fatality rate of 8%, those aged 80 years or older had a case fatality rate of 15%, and those already decreased had a case fatality rate of 100%. The first documented U.S. case occurred in a relatively-young patient from Washington State, who returned from Wuhan on January 20, 2020. For Americans, this is when sh*t started to get real.

In a matter of months, COVID-19 had spread to all continents except Antarctica, suggesting that Antarctica has partial immunity. The World Health Organization declared that COVID-19 was officially a pandemic, thus becoming the last major medical society to realize this. With the exception of China, Taiwan, and South Korea, measures aimed at containment have failed. Bribery has failed. Most nations have opted for strategies involving mitigation or masturbation, whichever one means "to reduce the severity or spread."

In the United States, the NBA was suspended when its first player, Rudy Gobert, tested positive for coronavirus. As students or teachers tested positive for COVID-19, schools closed, including New York City's public school system, which is the largest in the country. As patients and health care professionals tested positive for COVID-19, hospitals followed suit and closed as well.^[1] Social distancing was rapidly implemented (Spring Breakers in Florida were exempt), which disrupted orthopedic surgeons the most as they had to suspend bro hugs for 60 days and shelter-in-place at the hospital gym indefinitely.^[2][3] Cases of PTSD spiked in the Anesthesia population on account of Sudoku supply deficits.^[4] Batman was infected, thus becoming the first case of human-to-Batman transmission.^[5] The situation got so dire that the CDC declared "we are effed" while aliens postponed their invasion of Earth due to concerns over COVID-19.^[6][7]

Throughout March, COVID-19 continued to spread at an alarming rate: the Mars rover, Curiosity, tested positive for coronavirus, thus becoming the first case of interplanetary spread; Heaven & Hell tested positive, suggesting that we may still need to practice hand hygiene in the afterlife; and the lost city of Atlantis has tested positive. Though she didn't test positive, the 134-year-old Statue of Liberty sheltered-in-place on Liberty Island given her age puts her at higher risk of complications if infected with COVID-19. Reports suggest that coronavirus is capable of traveling back in time.^[8]

Palliative Care is currently having a family meeting with all 327 million Americans. It is believed consensus will be reached to make the United States DNR. Until that happens, hospitals are scrambling to ensure health care professionals have an adequate supply of ICD-10 codes.^[9]

Virology

Something about betacoronavirus and angiotensin-converting enzyme 2 (ACE2)?

Symptoms

Symptoms can range from no to yes. The most common include fever, nonproductive cough, shortness of breath, myalgias, and anorexia. Less common symptoms include sore throat, rectal prolapse, and urethral discharge. In very rare instances, it can present as a scrotal abscess. The majority of cases are mild, with exception of the deadly ones. The first confirmed U.S. case was a 35-year-old male with minimal medical problems who ended up being hospitalized for 11 days. F**K.

Signs

The most concerning exam finding is the identification of a surgical mask over the patient's mouth. That can't be good.

Unlike other situations, vital signs can be quite useful. Don't be fooled: though the documented respiratory rate reads as 16, it is most likely 17. Objective fever supports subjective fevers and hypoxemia supports a patient's complaint of "I'm feeling hypoxemic." Cardiopulmonary exam findings may include tachycardia, wheezing, or crackles, but that does require making contact with the patient. Chest X-ray is an important diagnostic tool. If Radiology recommends clinical correlation after remarking on pulmonary infiltrates, please defriend them.

As both the patient and health care professional have the potential to quickly decompensate, attention must be paid to both. If both decompensate at the same time and only one bed is available, a game of Rock-Paper-Scissors should decide the outcome.

Differential Diagnosis

1. Upper GI bleed
2. Lower GI bleed
3. Diabetic foot ulcer
4. Aortic stenosis
5. Aortic sclerosis

Diagnosis

Diagnosis is best achieved through diagnostic kits, whose status is currently listed as "theoretical" in the United States despite being 3 months into the pandemic. With the eventual coordination of U.S. private and public sectors, over 1 million flawed kits are expected to be available by the end of March 2020. The optimal specimen is an upper respiratory tract sample obtained via nasopharyngeal swab. The U.S. has had difficulty obtaining appropriate specimens, though this is largely attributable to frontline OB/GYNs collecting samples from the vagina and not the nasopharynx.^[10]

This may not be labelled, but a picture's worth a 1000 words

Prevention

There are no known vaccines at the moment for the public to refuse.

Treatments

Treatment is largely supportive in the form of excess toilet paper.^[11][12] There are currently no known treatments for COVID-19. Interventions such as prayer, screaming "WHY GOD WHY?!" and remdesivir are currently ongoing. A study involving Kaletra (lopinavir/ritonavir) produced disappointing results, as did the ones that looked at sodium bicarb and precordial thumps. There was controversy when French health minister, Olivier Véran, warned that NSAIDs should be avoided In patients with confirmed COVID-19. This recommendation has not been adopted in the United States due to large opposition on behalf of military health care professionals who state that eliminating NSAIDs essentially eliminates all that a military health care professional can offer.^[13]

Special Considerations

• Supply of N95 respirators & surgical masks - Supplies have been dwindling worldwide. U.S. Surgeon General Jerome Adams tweeted "STOP BUYING MASKS!" to Americans, though this had little impact on the American supply chain. Adams ultimately was caught hoarding masks, but their reintroduction into the health care system only bought another week of time.^[14] Decreased availability of N95 respirators has forced health care professionals to use lower quality N94, N93, N92, N91, N90, N89, N88, N87, N86, N85, N84, N83, N82, N81, N80, N79, N78, N77, N76, N75, N74, N73, N72, N71, N70, N69, N68, N67, N66, N65, N64, N63, N62, N61, N60, N59, N58, N57, N56, N55, N54, N53, N52, N51, N50, N49, N48, N47, N46, N45, N44, N43, N42, N41, N40, N39, N38, N37, N36, N35, N34, N33, N32, N31, N30, N29, N28, N27, N26, N25, N24, N23, N22, N21, N20, N19, N18, N17, N16, N15, N14, N13, N12, N11, N10, N9, N8, N7, N6, N5, N4, N3, N2, and N1 masks, and even these are running low. The supply of surgical masks has also been depleted even though COVID-19 hasn't peaked. The Centers for Disease Control and Prevention has suggested the use of homemade PPE such as bandanas and scarves as a last resort. Gomerblog has suggested other creative items should the supply of bandanas and scarves become depleted. Some of these include: sweaty sports cup, jock strap, pantyhose, turtleneck (pulled upwards), winter cap (pulled downwards), Saran Wrap, large condom, tampons (placed in nostrils), ski or SCUBA masks, snorkels, and horse feed bags.^[15]

• Supply of health care professionals - Contact tracing of the first U.S. cases of COVID-19 led to the 2-week self-quarantine of anywhere from 40 to 200 health care workers. In the event of a patient surge, such quarantine protocols would eventually deplete the work force. Subspecialists are the most sensible back-ups given their prior training in medicine or surgery. OB/GYNs have already volunteered their services on the front line, but radiologists are already being drafted, putting them in the unique position of performing their own clinical correlations.^[16] Orthopedic surgeons are relearning ICU things.^[17] In the extreme scenario shortages still persist, first-year medical students, undergraduate students contemplating a career in health care, and toddlers with Fisher-Price stethoscopes will serve as backup.

• Supply of ventilators - It is very possible that the American trajectory of COVID-19 will mimic Northern Italy, leading to a shortage of ventilators. To bridge the gap, the American Medical Student Association will provide medical students to bag those patients until ventilators become available.

• COVID-19's effect on global markets - COVID-19 has arrested economic activity, causing markets to crash worldwide. The United States has been trying to combat recession through multiple routes. The Federal Reserve Bank of New York has slashed interest rates to near zero and plans to buy back $500 billion in Treasury and security-backed bonds. It is also considering pushing 1 amp of bicarb. Congress has rapidly approved stimulus packages aimed at providing Americans with more toilet paper and Xanax (alprazolam).^[18][19] It speaks volumes that all of the blame thus far has been directed at COVID-19, not Anesthesia, suggesting that the apocalypse has in fact arrived.

• Match Day: March 20, 2020 - Amidst social distancing, fourth-year medical students weren't able to congregate at their respective medical schools on this momentous day, instead moving their ceremonies and celebrations online. This did not dampen their spirits as they all were excited to learn that they had matched at their respective No. 1 COVID-19 hotspot.^[20] Some students hope to inoculate themselves with novel coronavirus immediately after Match Day in the hopes it doesn't interrupt workflow starting on July 1. Other students wish to hold out and get infected at their new residency program.

Are We Totally Screwed?

Oh, most definitely.

Current CDC Guidelines

• Wash your hands for at least 20 minutes
• Repeat
• Stay inside but if you need to venture out for food or medications, keep at least 1 mile between yourself and others
• Cover your cough or sneeze (unless the people around you are confirmed COVID-positive, in which case don't worry about it)
• Move to other oxygen-positive, COVID-negative planet

Resources

• Gomerblog's "An Orthopedic Surgeon Explains Coronavirus"
• Gomerblog's COVID-19 Doomsday Playlist

Related Topics

• Airborne Precautions
• Contact Precautions
• Cough
• Dyspnea
• Endotracheal Tube
• Hand Sanitizer
• Handwashing
• Pneumonia

References

1. ↑ U.S. Hospitals to Close After Patients Test Positive for COVID-19 (Gomerblog)
2. ↑ COVID-19 Update: Orthopods Suspend Bro Hugs for 60 Days (Gomerblog)
3. ↑ Orthopaedic Surgeons Directed to Shelter in Hospital Gym Until COVID-19 Clears (Gomerblog)
4. ↑ COVID-19: Self-Quarantined Anesthesiologist Running Dangerous Low on Sudoku Supplies (Gomerblog)
5. ↑ Breaking: Batman Diagnosed with COVID-19 (Gomerblog)
6. ↑ COVID-19: CDC Says “We’re Totally Effed” in a Zombie Apocalypse (Gomerblog)
7. ↑ Aliens Postpone Earth Invasion Due to Coronavirus Concerns (Gomerblog)
8. ↑ WHO Warns Outbreaks In Victorian England Confirm Coronavirus Capable Of Spreading Through Time (The Onion)
9. ↑ Supply of ICD-10 Codes for COVID-19 “Dangerously Low” (Gomerblog)
10. ↑ Habit, I Guess: OB/GYNs Accidentally Swabbing Vaginas for COVID-19 (Gomerblog)
11. ↑ Study: ‘Brilliant Butthole Sign’ Diagnostic of TP Hoarding (Gomerblog)
12. ↑ Breaking: COVID-19 Found in Toilet Paper (Gomerblog)
13. ↑ Military Doctors Petrified if Motrin Found to Worsen Coronavirus (Gomerblog)
14. ↑ COVID-19: U.S. Surgeon General Caught Hoarding All of Nation’s Masks (Gomerblog)
15. ↑ COVID-19 Tips: What to Do When No Facemasks Are Available (Gomerblog)
16. ↑ Radiologist Drafted Into Direct Patient Care, Forced to Perform Own Clinical Correlation (Gomerblog)
17. ↑ Orthopaedic Surgeons Attempting to “Re-learn” ICU Things (Gomerblog)
18. ↑ COVID-19: House Relief Package to Provide Billions & Billions of Dollars of Toilet Paper (Gomerblog)
19. ↑ COVID-19: Congress to Send 1,000 Pills of Xanax to Every American (Gomerblog)
20. ↑ Match Day! Med Students Find Out Where They’ll Be Ruling-Out COVID-19 on July 1st (Gomerblog)

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