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So what& #39;s really going on here in NYC?
You& #39;re hearing conflicting information on who is tested, who is admitted, who goes home, and what& #39;s going on inside hospitals.
Let me shed some light. NYC ER docs are a small and collaborative community, so let me share the scoop:
THREAD
You& #39;re hearing conflicting information on who is tested, who is admitted, who goes home, and what& #39;s going on inside hospitals.
Let me shed some light. NYC ER docs are a small and collaborative community, so let me share the scoop:
THREAD
First and foremost:
Anyone & everyone who is sick & presenting to our ERs is evaluated!
Our work in the ER is still subject to the Emergency Medical Treatment and Labor Act (EMTALA). This means EVERY patient gets a medical screening exam & stabilization. Always. No exceptions.
Anyone & everyone who is sick & presenting to our ERs is evaluated!
Our work in the ER is still subject to the Emergency Medical Treatment and Labor Act (EMTALA). This means EVERY patient gets a medical screening exam & stabilization. Always. No exceptions.
Also, to reduce risk to providers & patients, many hospitals have drastically 
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow">https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow">https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow"> telemedicine capacity.
This allows patients to talk to a provider virtually. No exposure for provider or patient.
On these calls, we can often tell who needs to go to the ER. And who doesn& #39;t.
This allows patients to talk to a provider virtually. No exposure for provider or patient.
On these calls, we can often tell who needs to go to the ER. And who doesn& #39;t.
Testing: Who& #39;s Getting It?
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">Almost invariably, the only people getting tested are the patients getting hospitalized.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">Why does that matter? Because hospitals are sending home probable cases every day without any confirmatory testing. We just don& #39;t have the capacity.
Hospitalization: Who& #39;s Getting It?
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">There is NO way we could admit all COVID patients to hospitals. Thankfully we don& #39;t need to.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">Most hospitals have a protocol: even for probable/confirmed COVID patients, if your oxygen saturation is above a certain threshold, you go home.
What about mildly sick patients? What happens if you send one of them home and they get worse?
This happens.
Hospitals are providing follow up. Phone calls. Telemedicine. Some provide pulse oximeters to measure oxygen levels. Some provide oxygen concentrators with education.
This happens.
Hospitals are providing follow up. Phone calls. Telemedicine. Some provide pulse oximeters to measure oxygen levels. Some provide oxygen concentrators with education.
The goal is to keep ALL the really sick patients.
Everyone that NEEDS hospitalization GETS hospitalized. Everywhere. All throughout NYC.
But a lot of people are sick and DON& #39;T need hospitalization. Some with low oxygen. Some with pneumonia-like symptoms or nasty chest X-rays.
Everyone that NEEDS hospitalization GETS hospitalized. Everywhere. All throughout NYC.
But a lot of people are sick and DON& #39;T need hospitalization. Some with low oxygen. Some with pneumonia-like symptoms or nasty chest X-rays.
The bottom line is that anyone who should be admitted IS admitted.
As we plateau or start to decline, hospital admission policies may change.
In summary...
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">Everyone is getting evaluated.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">Not everyone is getting tested.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">Everyone who needs to be admitted is admitted.
As we plateau or start to decline, hospital admission policies may change.
In summary...
Life Support: Who& #39;s Getting It?
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond"> For many patients, mechanical ventilation (life support) is the only thing that save lives.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond"> Let& #39;s be clear - this isn& #39;t being & #39;rationed& #39;
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">With an increase in ventilator supply, we& #39;re in a less precarious position than even a week ago.https://abs.twimg.com/emoji/v2/... draggable="false" alt="😓" title="Face with cold sweat" aria-label="Emoji: Face with cold sweat">
I cannot stress this enough.
Please, please, please.
Take time to think about what you would want if you ever got really sick.
Who would make those decisions for you if you weren& #39;t able?
Would you want to be put on a breathing tube? A ventilator? Chest compressions?
Please, please, please.
Take time to think about what you would want if you ever got really sick.
Who would make those decisions for you if you weren& #39;t able?
Would you want to be put on a breathing tube? A ventilator? Chest compressions?
These are hard & difficult discussions to have.
But trust me, despite how hard it is to have this discussion when you& #39;re healthy, it& #39;s much harder to have when you/your loved one is really sick in the ER, struggling.
In summary:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Small blue diamond" aria-label="Emoji: Small blue diamond">If you need a ventilator, you get a ventilator.
But trust me, despite how hard it is to have this discussion when you& #39;re healthy, it& #39;s much harder to have when you/your loved one is really sick in the ER, struggling.
In summary:
One important thing to recognize right now is that COVID is hitting hard at different spots all around NYC.
One hospital might be & #39;fine& #39; while another a few miles away is inundated.
This virus is exposing the deep structural inequalities inherent in our city and our country.
One hospital might be & #39;fine& #39; while another a few miles away is inundated.
This virus is exposing the deep structural inequalities inherent in our city and our country.
COVID hits harder in the outer boroughs, where NYers without the same financial ability to stay home and socially distance live.
This cannot be overemphasized.
Just look at the maphttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index">
This cannot be overemphasized.
Just look at the map
" title="COVID hits harder in the outer boroughs, where NYers without the same financial ability to stay home and socially distance live.This cannot be overemphasized.Just look at the map https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index">" class="img-responsive" style="max-width:100%;"/>
The result is that COVID has a much greater impact on Hispanic/Latino and black/African American communities in NYC.
Again, this cannot be overemphasized.
Just look at this charthttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index">
Again, this cannot be overemphasized.
Just look at this chart
" title="The result is that COVID has a much greater impact on Hispanic/Latino and black/African American communities in NYC.Again, this cannot be overemphasized.Just look at this chart https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index">" class="img-responsive" style="max-width:100%;"/>
