Boil Some Water
Food Bank Needs Donations
How To Deliver Get Well Cards
Everybody Mask Up
Getting Comfortable With Not Knowing
Talk With Your Family
What Ventilators Can & Can’t Do
Mallard Ice Cream!
BOIL SOME WATER
From Betsy Brown, MD, April 6, 2020
In many older movies, we often hear the directive “boil some water” when a character goes into labor. What do they do with all that water? I am a doctor and I don’t even know. But I do know that everyone wants to help, but often they don’t know what to do. Jamie thinks that is why they are told to boil water. It gives them a job when other wise they feel pretty helpless. And that is the state a lot of us are in right now. We want to help, but for many reasons just aren’t able to feel we can.
But we can help and we are helping. Just today UW’s IHME says COVID-19 in Washington has passed its peak. Amazing, just a few weeks ago we were expected to be in the middle of an overwhelming surge of hospitalized patients with excess deaths and not enough ventilators. And now this data analysis says we are passed the peak. Our governor sent back an extra 400 ventilators because we don’t need them. This is proof that our (your) hand washing, staying at home, and physical distancing is working. Make no mistake, we can’t let up yet, but pat yourself on the back (since no-one else can). It is working in other states too. The projected number of deaths has fallen for the country as whole. Still heartbreaking situations in New York, Detroit, and New Orleans, but there are slivers of hope they are near their peak as well.
But we all need to understand that if we ease up to early, we will have a rebound. There is good article in the New York Times about when to know when it is safe to re-open the nation. Part of that will be when we can actually do more testing for SARS-COV-2, the virus that causes COVID-19, which is slowly being realized.
This is hopeful news and can help us all stay sensible, since we are in it for the long haul. We will all ultimately be affected by this, we will have dear friends or family with the illness that may not survive, many of us are suffering loneliness, and others the fear of losing their income, and more. But make no mistake, your behavior and sacrifice has made a difference.
And you can keep helping. Just today Governor Inslee cancelled all Washington Public Schools for the rest of the year. There will be families that will need emotional, social, and financial support. Find ways to help them. Donate time or money. There are so many people who have lost their jobs and are scared and lonely. If you know anyone that might possibly be there, reach out. If you can spare money or time find ways to help. There are lots of options. Nothing is too small. Sharing a laugh, a photo, a funny cat video will all make a difference.
The thing for me through all of this, despite the weariness of poor leadership and failed policies, is that so many people have been helping and looking for that job to do that can make a difference. They are boiling water and sharing stories, music, ideas, a laugh. Keep it up.
And don’t forget to keep washing your hands.
And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading -Betsy Brown MD
The Volunteer Center would love your help. Opportunities are listed on their website:
FOOD BANK SEEKS DONATIONS
Bellingham Food Bank is seeking specific items to support drive-up food distribution efforts. The following items will be accepted at the Bellingham Food Bank warehouse location:
- Canned food preferred
- Peanut butter/other nut butters
- Dry beans, rice, and pasta: under 2 lb containers
Please, no glass containers or oversized containers. No perishables without appointment. There is a donation bin at 1824 Ellis Street, open weekdays 10-4. Donate on-line at bellinghamfoodbank.org.
HOW TO DELIVER GET WELL CARDS
One big envelope should go in the mail with all of them. Fewer non-essential trips, fewer things for the postal workers and the hospital to handle. I’m guessing that the cards will get to sit for a day or three to be sure nothing can be transmitted.
From Louise Bjornson: Get Well Cards for patients in Isolation can be sent to: Administration, St Joseph Hospital, 2901 Squalicum Parkway, Bellingham. WA. 98225
From Gillian Brightwater: Some of my neighbors & I sent “It must be really hard-you’re not alone-we’re feeling the stress too-thinking of you” cards to residents of Shuksan Healthcare & Rosewood Villa nursing homes. Nursing homes are where people are most often dying. One Shuksan nurse said the cards really helped. Rosewood has the least inside activities as it takes Medicaid elders. A WWU intern told me this while saying they really need stimulation more than most nursing homes.
Rosewood Villa, 702 32nd St B’ham 98225
Shuksan Healthcare, 1530 James St B’ham 98225
EVERYBODY MASK UP
From Ross Osborne: A plain cloth mask, a bandana, anything, works to stop exhaled droplets from traveling. The supposed “best” thing, the N 95 mask has an exhalation valve, which Stops Absolutely Nothing that the person wearing the mask is exhaling. Let’s all try to get this idea out there in a big way: I Protect You; You Protect Me. We are talking about a 180 degree shift in thinking – from “I’ll only protect myself” (or worse, I’m tough, I won’t get sick, I don’t need no sissy mask) to “I’ll do what I can to make sure others are safe.” I was in the hardware store this morning, with my cloth mask on, and a few people were wearing masks. Some were store-bought and some were the homemade cloth kind. But aside from only two men, all the mask wearers were either employees in the store, or women. The majority of people in the store, of course were men, and only two of them had masks on and all the rest did not. They were not keeping a 6-foot distance, they were all talking to each other as if they couldn’t care less that there’s a virus going around. Is it just a macho thing? Do they just not want to look like a pussy with a mask? Some of them certainly have families. The countries where the masks are working, are ones that mandate people wearing them when they are out. It works because everyone does it. I protect you; you protect me. We can do this.
[Two disagreeing experts agree on something. Click on the link above for the whole story.] “Cowling and Martin agree that if Americans start wearing masks, it’s vitally important that they are explicitly taught how to use them. We’ve gotten some helpful suggestions for how to make simple, cheap masks at home, which is crucial if we want to avoid encouraging people to snap up N95 masks that health care workers need.”
“But Cowling and Martin say Americans also need detailed information on how to make and wear masks in a way that maximizes the benefit to them and minimizes the risk. That’s going to require videos, advertisements and an all-out push to teach and change behavior, they both said. Until that exists, Martin’s advice is to imagine that, every time you use a mask, there’s something really disgusting that’s gotten on it and that it’s plainly visible. “If you could see it, and it was gross, what would you do? You wouldn’t touch it. You wouldn’t wear it again. You’d wash it in the hottest water you can with strong detergent. Some of that can help,” she said. “
GETTING COMFORTABLE WITH NOT KNOWING
[From the same article, but key advice.]
“Ultimately, the expert advice on masks (and hand-washing, and death tolls, and the proper distance to keep between yourself and others, and … and … and) is to get comfortable with not knowing the right answer. You can (and should) have some trusted advisors. You can (and should) read up on why certain things are or aren’t being recommended. But there are a lot of issues around this virus on which two experts can read the same data and come to different conclusions. For the rest of us, that means accepting that, sometimes, we’ll just have to do the best we can without a clear set of instructions. “That’s one of the best gifts we can give ourselves,” Martin said.”
There are things Ventilators can do, and things they can’t. Right now the use of ventilators is being discussed widely in the medical community. We’re learning more, and advice will continue to change.
For all you people trying to re-use N95 masks, here’s a deep dive into best practices. First and foremost, leave them for hospital workers! If you already have a used one, do this: It looks like owning at least 3, hanging them somewhere dry, and rotating them so the virus has time to die, is this group’s first choice. Hospitals have more options. There is no re-use strategy approved by the manufacturer. https://www.sages.org/n-95-re-use-instructions/
TALK WITH YOUR FAMILY
Don’t make your family decide for you without your input. Talk now about end of life issues. Please have The Conversation with the people who love you most, now. Better you should decide for yourself.
WHAT VENTILATORS CAN & CAN’T DO
I requested further information on ventilators, specifically, What percentage of people put on ventilators for Covid are able to go home and take care of themselves afterwards? Is there a relationship to age in those numbers. I haven’t found answers so far, but here’s what I got as of this afternoon, from Dr Lombard, who teaches the Realities Of Advanced Medical Interventions so we can make informed choices for ourselves.
Ventilators are usually removed when the patient is able to breath on their own again. This is assessed daily by what is called a weaning trial, whereby the ventilator is still connected but does not provide extra help with respiration; if they are able to maintain good oxygenation and ventilation, they are extubated (the endotracheal tube is removed). If not yet “weanable,” they try again the next day and make any changes in their therapy that might help. Patients are also removed from the ventilator when it is evident, day-over-day, that they are deteriorating, will likely not improve and thereby are made comfortable. The focus becomes comfort care.
Patients on ventilators are often delirious due to the severity of the illness causing the respiratory failure but also because most patients on ventilators require IV medications for sedation and even paralysis in order to receive adequate ventilatory support.
The ability for someone to ultimately discharge home and care for themselves is very much dependent on the disease causing the need for ventilation and how long they are on the ventilator. For example, if I had a heart attack and developed fluid in my lungs that was severe enough to require a ventilator, but received prompt treatment I might be extubated the following day. In the case of COVID19 disease, most people are on ventilators for 1-3 weeks and the majority, 65-95% do not survive.
Usually by the time a patient has a tracheotomy they have been in the ICU for 7-14 days. At some point, assuming they continue to improve, they will move out of the ICU and onto a medical/surgical floor. When they are stable there and ready to be discharged most will require rehab or skilled nursing care to hopefully continue their improvement. There are no skilled nursing facilities or rehab units outside of the Seattle area that will accept patients with tracheotomies. This is because they require a higher level of skill and training, for which they do not staff here [in Bellingham].
Here are two updates on the situation at St. Joe’s.
MALLARD ICE CREAM!
Mallard is making pints (and tubs) available for online orders. They’ve got lots of flavors. And Richie just emailed me to say he just made a special batch of Halvah ice cream pints for Passover! Hooray!!! Please tell everybody local that you know who celebrates Passover. You can order and arrange pickup here: https://mallard-ice-cream.square.site/
Found keys on the corner of Indiana and Kulshan. Please inquire at 2929 Kulshan Street. Thank you! Rene Cruz