Claims And Issues

COVID, COFFEE, AND CAKE.

 

Covid Nursing Homes Workers Refuse to Leave Christmas 2020 (Genaro Molina / Los Angeles Times)

In the middle of the pandemic, my mind is wandering.  I am fortified by coffee and dreaming of cake. 

Unfortunately, my body won't take very much coffee and hardly any cake.

But I can still dream.

    In the middle of the pandemic, I am well aware of COVID-19, much like everyone else.  You could not avoid the talk of it, if you tried.  For me, my prayers are unceasing for the victims, the families, and the medical workers whose lives are all changed in dramatically different ways from the changes I myself have lived with, so far.  They are the ones most dramatically affected by the pandemic.

    But we are all affected, don't kid yourself.  Don't minimize it, either.  The pandemic affects us all, well, at least it affects almost all of us.  But there is no question that it affects a few more than it affects most of us.

    And so I say again, God bless the victims, the families, and the medical workers and give them all the graces they need.  Amen.

Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.

Clear-cutting Catastrophes, Insect Invasions.

(Photo by Dennis J. Wall)

In his article, Gabriel Popkin, "Invasive Insects and Diseases are Killing Our Forests," New York Times, Feb. 6, 2021, Mr. Popkin effectively drives home that there is an insect infestation of our forests.  These secret invaders from other environs treat the trees on our continent as new opportunities for foraging.  In the process, they make the weakened trees targets for other perils including wildfires.

           Couple insect infestation with clear-cutting and you have a recipe for disaster.  Clear-cutting at its bare minimum involves cutting large swaths of forest clear to the ground and replacing all the different trees that have been logged, with acres of one type of tree.

           It is a sure bet that logging operations engaged in clear-cutting pay little attention to the susceptibility of their replacement tree species to insect infestation.  In this way, clear-cutting adds another layer to the risk of wildfires among trees too weak to resist.

           The solution is both to control insect deforestation, as Mr. Popkin clearly points out, and to control human clear-cutting as well.

Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.

COVID REPORT: IMAGINE YOU'RE IN REHAB AFTER YOU'RE TOLD YOU'RE FREE.

 

"A Los Angeles Fire Department crew, amid a sleepless 24-hour shift, gives a report to a County-USC emergency physician on the ambulance ramp." (Dr. Scott Kobner / Los Angeles Times)

The effects of Covid-19 can last for weeks in what might be called the "ordinary" or mild case.

           "Long haulers," as I understand the term, refers to people who have contracted a severe case of Covid and have lingering effects for many weeks.  This seems to me to be different from the description of people who are in the group which have had these severe effects, have been released from the hospital, and yet need rehab long after they have already suffered things like life-threatening organ failure or nerve damage.

"While resuscitating a patient in cardiac arrest, Dr. Molly Grassini stares at the cardiac monitor during a pulse check, hoping her patient shows any signs of life." (Dr. Scott Kobner / Los Angeles Times)

           In severe cases, even after "surviving" a stay in the Intensive Care Unit being treated for Covid, many people need long-term rehabilitation.  Some people experience atrophied muscles, or damage to their kidneys or lungs.  This may require physical rehab because people with these conditions have a hard time leaving home or even getting out of bed.

           Other people come "away" from a stay in ICU in the hospital for Covid, with cognitive issues, even psychological/behavioral changes such as loss of memory, depression, or anxiety.

           There is even a term for this condition:  PICS or post-intensive care syndrome.  It applies particularly to hospitalized Covid patients who may have spent a lot of their time in the ICU on ventilators, under sedation, or have experienced pneumonia turn into acute respiratory distress (extreme difficulty breathing, a syndrome known as ARDS).

"Nurse Doris Roldan, right, reaches for a dose of epinephrine as nurse Jeremy Hill performs CPR and Dr. Ruben Guzman prepares to intubate a patient dying of COVID-19."  (Dr. Scott Kobner / Los Angeles Times)

   The natural feelings of any person in such a situation, having already "conquered" the illness only to realize that it has left its mark on you physically or psychologically or both, have got to include anger tinged with perhaps a sense of despair, and understandably so.  Last night I suffered muscle spasms in my left leg, which I endure from time to time.  Last night, I tried rubbing it and it did not stop the spasms.  In the past, I have tried heat and cold, and they have not worked, either.  My point is not that the muscle spasms I experienced last night in my left leg are somehow on the same order of pain as having Covid-19, but to serve as a stimulus for me to imagine the level of frustration and even bitterness that can confront a person who has survived Covid thanks to the treatment she or he received at an ICU, only to realize that there is more to go through.

           The more we live with Covid as a society, and the more people we know who experience Covid, the more we learn that having Covid is not like having an ordinary fever, so that when the fever breaks, for example, we can take that as a sign that we are on the mend.  Having a clearer view of what Covid can bring to us if we contract it, can make all the difference.

           A big part of being a Covid-19 patient includes acceptance without resignation.  That can be tough to do, but knowing that it is included in the experience makes us alert to the demands that Covid may make upon us.

The remarkable and newsworthy photographs taken by Dr. Scott Kobler of Covid patients and medical workers in an ICU, along with captions provided via The Los Angeles Times, are a part of this story by Hailey Branson-Potts, Armed With a Camera, a Young ER Doctor Captures the Faces of the COVID War, LOS ANGELES TIMES Online Feb. 15, 2021.

Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.

THE PANDEMIC REPORT: VACCINATIONS ARE COMING. OR ARE THEY?

COVID CHRISTMAS FACETIME (Francine Orr / Los Angeles Times)

I was planning on writing a series.  First, I would write about the patients of COVID.  Next, the medical workers who work with the patients.  Finally, the families.

           My ideas for a series were abruptly put on hold by something that grabbed my immediate attention.   I hope it grabs your attention, too. 

           States have rapidly expanded the categories of people who qualify for vaccines.  I know it does not seem like that to people who are still waiting to qualify, but it is a thing.  It is happening.  More groups of people are qualifying by the day to receive vaccinations.

           At the same time, the previous regime just did not produce enough vaccines by a long shot, for some reason.  Some people want to explore the reasons.  That is not my purpose in this particular article.

           The expanding numbers of people who can get vaccinated, and the small amounts of available vaccine, have been major causes of frustration for those of us who are getting in line for vaccines.  Older people are generally not familiar with computers, and minority groups generally do not have access to computers.    Yet, computers are the default tools for getting an appointment to be vaccinated.  Don't ask why it is that way, perhaps it is the result of worshipping a tool as a god, and a computer is only a tool, not a god.  For whatever reason, like the "missing" vaccines problem, it is the case.

           A few help many navigate the vaccination appointment systems.  These few are computer-savvy while the people they help are not, or these few have the time it takes to navigate the system while the people they help do not, and both:  They are computer-savvy and they have the time.

           It would be useful to update a famous saying from the days of the Battle of Britain, and apply that updated saying today.  "Never before have so many owed so much to so few."

           Here's to "the few."  The whole story is covered in an excellent report by Jennifer Steinhauer, Frustration About Shot Access / A Crossroads Between the Vaccinated and the Waiting, NEW YORK TIMES, Monday, February 15, 2021, at A4.

Please read the disclaimer.  This blog article ©2021 Dennis J. Wall.  All rights reserved.

"THE COVID REPORT": THE PRONING PATIENT EDITION.

COVID Proning (Jae C. Hong / Associated Press)

Can you imagine what proning is?  The term applies to people who cannot breathe.  Medical workers change the patient's position in bed so that, hopefully, she can breathe easier.

           Proning means that you are being turned from lying in bed on your back, to lying in bed on your stomach.  Try that.  Find it easier to breath when you lie on your stomach than when you were lying on your back?

           Proning works in large part because of gravity.  Lying on our  stomachs helps most of us by opening airways in our lungs.  If we have contracted COVID, natural forces that may be compressing our lungs are enhanced by the compressing effects of fluid and inflammation that come from the infection.

           When we human beings lie on our backs, our hearts are now sitting on top of our lungs.  Naturally, the lungs compress in that position.  Our rib cage cannot move the way it usually does when it is flat against the bed.  Flipping over to our stomachs tends to free the back of our lungs to open, allowing our bodies to breathe easier.

           Proning takes much hard work.  And a lot of hands to do it.  Before COVID came, the standard protocol for proning teams sometimes involved as many as 8 workers.  Most of the time, workers were experienced and trained in the technique.

           Proning teams formed before COVID could have fielded a team under traditional sandlot baseball rules, which provide either that the other team provides the missing player (who plays a position carefully chosen by the short-handed team) or that one of the outfields (usually right field) is out of bounds for play.

           The reason for so many hands being involved in proning is what can happen if it is done wrong.  It is the product of anxiety, to be frank about it.  Care has to be exercised during proning lest a patient's breathing tube come loose during the procedure, or a person's intravenous lines detach while she is being moved from her back to her stomach in her hospital bed.

COVID Proning and Supinating (Hilary Swift / New York Times)

           But the rules regarding proning have changed since COVID arrived.  There just aren't enough workers.  Since the pandemic began, proning teams have sometimes been fielded with only 3 or 4 people.

           Another way to look at proning is that before COVID, proning was used for only about 15% of patients diagnosed with acute respiratory-distress syndrome (ARDS) and embedded with breathing tubes accordingly.  The technique can result in compressing nerves in limbs including shoulders and legs.  This increases the chance of disability.

           There is also reportedly a lot of evidence that proning actually decreases the patients' life-spans.

           The jury is out on whether proning shortens COVID patients' life-spans, or to what degree proning COVID patients results in disabilities, but in the meantime there may not be any good options but to go ahead and prone the COVID patients.  Proning can save our lives today even if we are uncertain what it will do to us tomorrow.

           Obviously, proning is a procedure of choice only when there do not seem to be any better alternatives.

           In terms of procedures, supinating is the opposite of proning.  Like proning, supinating still applies to people who cannot breathe, but the term means something different than proning does.  That term, supinating, refers instead to changing a patient's position in bed from lying on her stomach, to lying on her back.

           In my case, I prefer to lie on my back.  I sleep on my back or on my side in fact.  Having tried a few positions on my back and on my side as an experiment for this article, it is easier for me to breathe when I am in those positions.  So proning is an extreme measure.

COVID19 ICU Help Turning Sign (Marcus Yam / Los Angeles Times)

           So extreme that proning carries with it important protocols.  It's used during the coronavirus pandemic because hospitals have never had so many patients at the same time that are so sick that their lungs have essentially stopped functioning.  Respiratory distress is the chief sign that the coronavirus is present.  At the present time, the anxieties involved with proning patients including the possible after-effects of the procedure, pale in comparison to a patient's inability to breathe because of COVID.

Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.

"THE COVID REPORT". PART ONE, Continued: I IMAGINE I'M A PATIENT.

COVID ICU (Francine Orr / Los Angeles Times)

  The Imagined Beginning, Continued.

This article is written as an act of imagining what COVID patients go through.[1] 

    A mild infection of COVID lasts for 1 to 2 weeks.  According to the reports, severe infections last much longer, 6 weeks or more.  People with severe cases of COVID often sustain heart damage for the rest of their lives.  Worldwide, the latest statistics reveal that 1% of COVID victims die.

    These things do not compare well with my experience in a cast when I tore knee ligaments and cartilage during high school football.  When my convalescent time was up, my cast came off and I was back on my feet.  Rehab, probably, but no severe infections, no chills to speak of, and certainly no heart damage.

    When I try to imagine the experience of having COVID, the experience I have had in my own life that comes closest, I think, is having had pneumonia and bronchitis. 

    When I had pneumonia and bronchitis, I had them at the same time according to the docs.  I recall night sweats and intense fevers.  My bed sheets had to be changed every day because they were wringing wet with my sweat.

Outside an ICU Treating Covid (Francine Orr / Los Angeles Times)

During the night, I was often awake.  There was nothing for me to do but think and pray.  During the day, I could not concentrate.  Reading has always been one of my greatest pleasures and I could not do it.  I could not read because I could not concentrate.  I would try to read, but little or nothing stuck with me.

    Staring at the ceiling.  Staring into space, staring at nothing much, really.  Closing my eyes and staring at nothing at all.  This is how I spent much of that time.  I guess I kept my glasses on most of the time during the day, which would be normal of course, but there was not a lot of variety to see in my sickroom.   This is part of what it was like, as I recall now, from my experience with pneumonia and bronchitis.

    Is this what it is like for COVID patients?  Just lying there, waiting for the joy of reading to return, with nothing to think about except feverish thoughts, sometimes repeated over and over again, forgotten nearly as soon as they happened or when the fever came down?

    Breathing came hard at times.  Expectorating was part of my program at that time.  That means coughing up phlegm.  At first I expectorated occasionally, and after a while it happened on a pretty regular basis.  I recall the wastebaskets vividly.  I forget if we used something to induce my spitting up phlegm, but in my recollection of the event we did not have to. 

COVID ICU Treatment (Bernat Armangue / Associated Press)

Is this what it is like for many COVID patients who try to catch their breath?  Is this what it is like for lots of COVID patients who try to breathe, but whose breathing is hampered by the virus?

    There was nothing for me to do but get through it.

    There was no refining the experience, no way out of it except to go through it.  My mother did what mothers do, and she tried many things to make my condition at least tolerable.  She is the one who changed the bedsheets every day I had the pneumonia and bronchitis, for example.  Her many efforts came at a cost, looking back on it, to her own sleep and health all while she held down a full-time job.  What she did helped, a great deal.

    Still, there was nothing for me to do but get through the pneumonia and bronchitis.  After a week or two, I got better.  I recovered. 

    From those experiences, I can try to imagine what a mild case of the Covid might feel like. 

    However, I cannot even imagine what a severe case feels like.  For one thing, I have never been on a respirator despite my difficulties breathing in the past.  Being on a respirator is one of the signs of severe COVID infection.

    Another sign is when the patient and her loved ones learn what "proning" and "supining" mean to their lives and to the lives of the medical workers who help them.   We shall see proning and supining, through words and pictures, in the days ahead.  Unfortunately, so will many COVID patients, their families, and their caregivers.

To be continued.  Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.

 

[1] The many symptoms of COVID are mentioned in many articles published over the last 11 or 12 months.  See also the article posted here,  "THE COVID REPORT."  PART ONE:  THE PATIENTS.  The Beginning.  That was written as a summary of what patients, doctors, nurses, and families have reported about their real-life experiences with having or treating COVID from the onset through the first several days following admission to the hospital.

"THE COVID REPORT". PART ONE: I AM A PATIENT.

(Jae C. Hong / Associated Press)

  The Beginning, Imagined.

I have never been a COVID patient, but I want to understand what it is like to be one.  Imagination must thankfully take the place of the virus for me.

           The many symptoms of COVID are mentioned in many articles published over the last 10 or 11 months.  See also the article posted here this week, "THE COVID REPORT."  PART ONE:  THE PATIENTS.  The Beginning.  That was written as a summary of what patients, doctors, nurses, and families have reported about their real-life experiences with having or treating COVID from the onset through the first several days following admission to the hospital.

           The present article is written as an act of imagining what COVID patients go through during that time.  If I get COVID, I imagine that I will probably run a fever for days.  Some people run a fever of 103º or more for three or four days before they go to the hospital.  I can imagine what it is like to have such a fever, because I have experienced my own bedsheets wringing with sweat.  Wringing with sweat the way a face cloth in a sink is wringing with water, so that they both need to be wrung out. 

           I imagine too that I will have chills to go with this fever, if I get COVID.  Chills are part of my own experience with fever, so I know what chills can do to a body.  I have also gone septic as they say, when it is impossible it seems either to stop shaking or to feel warm.

           And then from among all the other symptoms that so many people get (and so many people don't get) with COVID, I expect that I will have fatigue and sleep deprivation.  However, I also expect that I may not recognize the difference any time soon after the onset of COVID.  Perhaps because of the stage of my life, or because I am a cancer survivor, or for other reasons, fatigue and sleep deprivation are often my companions.  Unlike the effects of fatigue and sleep deprivation on COVID patients, which can be severe, I will have to imagine fatigue so great that I cannot concentrate on watching the television and to imagine sleep deprivation so great because it is the result of aches all over my body, particularly in my joints.

           The key symptom of COVID, shortness of breath in the sense of difficulty breathing, is frightening to me.  I don't believe that I have ever experienced shortness of breath in that extreme.  Oh, sure, I have experienced shortness of breath during and after exercise and things like that.  However, that is not what people mean when they talk about difficulty breathing because they have COVID.

(Victor J. Blue / New York Times)
     

    They mean gasping for air.  Sometimes they mean that they have so much difficulty in breathing on their own that they need outside help, a machine like a respirator, in order to breathe.  I have difficulty imagining  that from my own experience.

           I am left to imagine that from the experiences of others, from the experiences of people who have had COVID and from the experiences of people who have treated COVID, but there are few stories and understandably there are no videos that I have yet found showing exactly how respirators make COVID patients able to breathe.  It may be too personal an experience, having a respirator help you breathe.  I do know it is so extreme a procedure that at his press conferences in 2020, New York Governor Andrew Cuomo said that if you have to be on a respirator, that's pretty much it for you because your chances of surviving COVID are not good after you have been put on a respirator.

           That does not help me imagine it any better.  It does add to making the difficulty breathing part of COVID scary.

           But wait a minute.  I had pneumonia and bronchitis together when I was in high school.  I just remembered.  That was a time of wringing sweats, chills, high fever, and many times, difficulty breathing.  That may be comparable to having a mild case of COVID, sufficient at least for the task of imaging what having COVID would be like.

           So far, I continue to be fortunate to only imagine what having COVID is like.

To be continued.  Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.

"THE COVID REPORT." PART ONE: THE PATIENTS.

(Irfan Khan  / Los Angeles Times)

The beginning.

I want to say at the beginning why I am writing this piece.  I am doing this to keep my focus as a writer, of course, but more importantly I am doing this to keep my focus as a potential patient of COVID-19 in a pandemic.

If I get the Covid, my symptoms will be too many to choose from, too many to list in a short piece like this.  These symptoms have escaped my memory, truth be told, because there are so darned many of them.

Before I mention the common-denominator-symptom or the one symptom known to be common to every case of COVID-19 so far, I will mention a few others that not every Covid patient has.

Very common symptoms include fever.  Some patients run a relatively high fever of 103 or 104 degrees for days.  But not all.

A cough is another common symptom.  What shows up as a sign of Covid infection is much more than an everyday cough.  The sign of Covid is a cough that is not helped for days by over-the-counter products that have ordinarily been effective for you in the past, like Advil or Tylenol.  That kind of a cough is a common symptom of the Covid.  But not always.

Fatigue is also a common symptom of Covid.  Again, not simple fatigue in the case of COVID, mind you, but fatigue that hits you so hard that you cannot watch TV because you cannot concentrate even that much.  But this does not happen with every Covid patient.

Then, of course, there are lost senses of smell, taste, and often, feeling in fingers or toes.  But again, not every Covid patient loses these senses or has these experiences.

(Jae C. Heng / Associated Press)

The one symptom that all Covid patients seem to have, along with one or more of the other symptoms, is shortness of breath.  That phrase, "shortness of breath," separates the mild cases from the severe cases.

Most people with mild cases of COVID-19 should rest and isolate from neighbors and the general population, and they can do so at home.  That is what most of us do anyway even if we do not have a case of Covid at all.

However, if "shortness of breath" means for you that you have difficulty breathing, there are one of two solutions that should be taken immediately:  Call 911 or go to a hospital Emergency Department under your own power.

COVID is mostly transmitted through the air.  This bit of knowledge illustrates how much the world knows about COVID that the world did not know 10 or 11 months ago, when the COVID virus started announcing its presence in the world population.

We know now -- or think we do, realizing more or less that our knowledge is accumulating and ongoing, not given to us like a post or a tweet that doesn't depend on facts -- that people inhale the virus when it is transmitted by someone else's cough, sneeze, speech, or song.

Less often, a person can catch the Covid from touching something or a surface, and then touching their face.  Thus, the urgent need to wear masks--for them who are in the world around you and for yourself alike.

Once established, COVID hangs around in mild cases for 1 to 2 weeks.  That is one marker for what kind of COVID case you have got, but you pretty much know even without that marker if you have a severe case.

Severe cases of COVID last for 6 weeks or more.  And their effects may last even longer.  Some people experience heart or nerve damage for the rest of their lives.  Some people die from the COVID.  About 1% worldwide of people diagnosed with COVID die.

At every stage, COVID can flip from good to bad in an instant.  This is consistent with knowing so little about this virus.  This is something to keep in mind when I personally might feel tempted to ask what seems to me like basic questions, namely, whether I should go to the hospital or if it is okay for me to stay home, and how I can tell when the time is right for either one.

Before I can answer these questions, I should keep something else in mind:  This is not the flu, no matter who told me otherwise and no matter how many times they said it.

Going to the hospital is the flip side of the same question as when it is no longer wise for me to stay home.  One of the other things that we have learned during this pandemic, and we have learned it at a cost, is that most patients wait too long to make this decision, hospital vs. home, until they are really sick.

(Francine Orr / Los Angeles Times)

That said, a sure sign of which way to go is to head to the hospital if your oxygen levels drop.  I learned that you and I can measure our oxygen levels with a simple device that can be purchased online, called a "fingertip oxygen meter."  Quick searches came up with various prices online at different sites, running from $20 to $55.

One Covid patient, an E.R. doc, knew that it was time for him to go to the hospital when his oxygen levels dropped to 82.  A normal range is apparently 95-100.  The day before the doc's oxygen levels dropped to 82, his oxygen levels were so good that it looked like he was coming out of it.

Another measurement of your ability to breathe is called "lung compliance," which means that your longs are elastic enough to breathe air in and let it out.  Standard measures are over 100 for healthy people, and under 30 for people with severe respiratory failure.

How can people who are not doctors or do not have machines that measure these things, tell that their oxygen levels are dropping dangerously?

Don't wait for a machine to measure you.  If you cannot breathe without difficulty, that's all the test result you may need to tell you that your oxygen levels are dropping.

©2021 Dennis J. Wall.  All rights reserved.