Hello r/FloridaCoronavirus it's time of the week again for a new Weekly Thread.

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It has not quieted down at the clinic. It's not Covid (we see a few cases that pop positive each week), it's Pneumonia and Bronchitis.

If you read my last post - see here: https://www.reddit.com/r/FloridaCoronavirus/s/hTjOMWd3Ln I explained the particular variety in detail. They don't call it "Community Spread" for no reason, and it is becoming problematic.

Edit: Flu is also out there (so far Flu A) and those that have the beginnings of it always have a sore throat and a fever. I meant to add this, but ignored my notes because the Pneumonia and Bronchitis are more acute. The thing is, with this record, people will be getting post-flu pneumonia. Please safeguard your health by wearing a mask in the doctor's office.

Masking anger is also becoming an issue again, especially with middle age men. For some reason they do not care about the toddler sitting just feet away, or the Navy Vet who came in to have his ulcer looked at.

I once made the mistake of asking if a patient cared whether they spread a deadly pathogen ("Please, put the mask on. There are children here. Don't you care?") and was met with the reply, "Are you accusing me? You have some nerve! How dare you accuse me of not caring?!" Thankfully she left, but I wanted to say, "Ma'am, refusing to wear a mask to protect others implies exactly that." Rats.

Confronting a musclebound, 6' 3" middle aged man is not in my playbook, though. When he took his mask off (after sitting out of sight on purpose) I locked eyes with him, and he smiled. It was the smile of "Try me," like a jackal showing its teeth. The....uhm..."working woman" that he brought in with him had also doffed her mask, and cackled in glee when she saw that I had noticed. She danced around, waving the mask like a handkerchief.

There's a lot of "Me, me, me," and a lot of "I'm too sick to wear a mask," and the oblivious "I'm not going to spread it, I took cough medicine. Have you heard me cough yet? No." sigh

The clinic is full except for around lunch time, when we can usually take a breather. People obviously love their lunch, thank God. The hard part? They wait until we are just about closed to stop by.

One particular visitor scared the pants off me: Mom came in and said the teen had been complaining of back pain and was sent home from school. Mom went back to work - leaving the very sick kid alone...until the pain was so bad that this kid called his Mom home.

I was curious - tried to get eyes on the patient, could not from my seat, so I walked out to look. What I saw gave me chills: A 13 year old kid who was visibly jaundiced, too thin, and could not sit straight. The kid looked like death warmed over. I wanted to scream, but I calmly walked them in, described the obvious symptoms to the nurse, and put his info in. There was no sure diagnosis, but there are a couple of possibles: Acute kidney infection or spinal abscess. But...how do you not know it's an emergency when your kid turns yellow-green and looks like a frozen 6x16 plank?!

Meanwhile, people peppered my desk: "When will we be seen? Can you help me check in? My phone isn't working. I don't know how to use this. Can you call for my ride?" The phone was ringing off the hook. My hands were literally shaking while I was typing and trying to calm the other patients, who seemed like they were mobbing me. "Give me a minute, I am dealing with an emergency." That should have done it - I said it clearly. Nope.

This kind of scenario is played out over and over again, so much that some days I had to abandon my desk to decompress several times. It's getting worse. No one wants to go to the hospital. "The wait will be forever! But there are sick people there! It will cost too much!"

I'm going to remind everyone:

If your 85 year old Mom falls, hits her head and is bleeding: It's an emergency.

If you can't breathe: It's an emergency.

If you have severe abdominal pain: It's an emergency.

If you need your psychiatric meds: Go to the hospital.

If you are diabetic and your toes or fingers turn black: It's an emergency..

If you broke your wrist and your fingers are turning blue: Go to the hospital...It's an emergency.

If your kid passed out twice while at school: It's an emergency.

When you feel chest pain sporadically, and your heart feels like it's leaping, and your left arm goes numb: It's an emergency.

Seriously: I hate it when I get labeled as "The Girl With The Emergency Touch". Only you can save me from this fate, while saving lives.

Please, read this. It is a list of symptoms which require immediate medical intervention: https://medlineplus.gov/ency/article/001927.htm

..................................................................

Covid Stats:

11/01: 1,904

11/08: 2,071

11/15: 1,694

What is this? (Note that the 11/08 number is back up from a previous edit.) My thought is that it was the Halloween Hump. Next big lump? Thanksgiving.

Yup: here's what the hump looked like last year:

11/27/23: 4,930

11/03/23: 3554

11/10/23: 4,838

Edit: Forecasting based on last year:

11/17/23: 4,441 (it went down after the hump)

11/24/23: 5,780

12/01/23: 6,249

12/08/23: 9,416

12/15/23: 10,009

Thankfully it appears that year by year our numbers are decreasing...but there is in reality no way to know this on our side. Hospitals have slowly been dropping out of giving Covid Stats because it is voluntary. We can watch the wastewater, but that's just painting a broad brush stroke because it can't give us actual numbers of cases (just like hospital stats are only a representation of the total populace). PS: The "winner", once again is Miami Dade, having more cases than any other county!!! At least the counties that start this all appear to be the same.

….……………………………………………………………

I'm taking a well-needed rest. I would really, really appreciate it if you would:

Wear your masks and BE SAFE.

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Things are getting frenetic around the clinic lately.

Yesterday I fielded two emergencies: the first was trouble breathing, and the second was unexplained abdominal pain/tenderness. Later in the day we had two more ED transfers due to trouble breathing. This is happening more and more frequently, to younger (middle aged) patients, not just seniors.

The situation in the waiting room became so concerning that everyone who came in hastily grabbed a surgical mask as soon as they heard one poor patient having an absolute coughing fit in the rest room. Other patients who were somewhat able to control their coughing sat shivering under blankets that they brought themselves.

Whether or not this is Covid or RSV is a mystery, since most patients arrive and say that they "tested for Covid at home", and we do not test for RSV in-clinic. Most patients refuse culturing for send-out tests because "they want medicine now". This approach is often met with either antibiotics, steroids, or just plain OTC cough/cold meds. While temporarily efficient, this prevents administration of correct medication, and often results in a second appointment a week later, when patients complain of worsening symptoms. The terrible thing about this is something I've mentioned before: The Domino Effect. One fairly treatable condition gets worse, new symptoms arise, new pathogens infect, and bodily functions suffer catastrophic failures.

The above approach to determining/not determining a patient's sickness can evolve into an explosion of disease via communal spread: A mother walked into our clinic without a mask, coughed fitfully and actually wheezed. She explained: "My kid got Walking Pneumonia at school. It spread to all the family members and now I think it got me!" *Cue me saying, "Oh, that's terrible! Would you please take a mask?" (Several patients in the corner suddenly slid lower in their seats and involuntarily pinched the nose clips on their surgical masks.)

Community-Spread Pneumonia is back, but they are labelling it "Walking Pneumonia". Patients are catching it without it being associated with another disease, like Flu. Usually pneumonia is caused by post-flu or post-rhinovirus bacterium. This Pneumonia stands alone, capable of spreading all by itself - very quickly within families and social circles. It is spread by children and adults who don't feel fatigued enough to stay home (thus "Walking"). That's when the trouble starts, because it can develop into full-blown, fatal Pneumonia in compromised individuals.

*IE: Read recent respiratory ailments such as Covid and Post-Covid sufferers, COPD, recent Bronchitis and Asthma. Immunocompromised patients are also at risk.

Pneumonia is a deadly pathogen, and so is RSV. Both are rising rapidly in every community in Florida. Flu, on the other hand, seems to be rising in the touristy areas, like Orlando. It likely hitchhiked in on passengers from Northern States.

Another rising star is Norovirus, which incapacitates and rapidly dehydrates victims, often leading to an ED visit for intravenous fluids and a prescription for anti-nausea meds.

I also noticed that Miami is experiencing frequent issues with Hepatitis A, another evil problem that causes severe nausea and dehydration. The scale of it recently is terrible, but this may be a regular occurrence. If you are aware and live and work in Miami, do chime in. I am not sure of the history on Hep A and Miami.

Covid is taking the low road to all of these pathogens for the time being. This doesn't mean it's a good thing, since many of the above cases can be fatal with or without medical intervention.

10/18: 2,260

10/25: 1,898

11/01: 1,904

11/08: 2,067

Edit: As of 1:59am Weds Nov 20th, the numbers have changed to: 11/08: 1,760

Note from the above that Covid in Florida is rising, though rather slowly for now. No suprise, it is highest in Miami-Dade and Orange counties. The next hightest case numbers are in Lee, Polk and Pinellas.

See the rates:

https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=Covid19.Dataviewer

*I do not like to be so cautionary about the situation, but I feel it my duty to inform you. Having been accused of being too concerned with pathogenic spread has gotten me kicked off the occasional sub. The phrases, "I have a good immune system," and "I take turmeric and immine-boost tea, zinc, extra vitamin D," or (newer) "An extra raw garlic clove a day," make me wince. Being more proactive than just "Staying home when sick" and washing one's hands occasionally is not enough. Taking your vitamins can be helpful, but it is not an ironclad substitute for being more careful. See my recommendations below.

If you are interested in seeing the waste water database of pathogens in your area, here is the URL:

https://data.wastewaterscan.org/

Tap on the bubbles, and when you have selected the area, tap on "view dashboard". You can scroll through the pathogens listed above the panel by swiping and tapping on the pathogen name.

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**Please see a medical practitioner if you feel ill. Do not wait. Ask if there are tests available via send out culture if your tests all come up negative. Most insurances will.pay for them if the practioner orders them. Many won't order them if you are not pro-active, so ask. It's easy: when the nurse returns after running you swab and says, "Well, you're negative for everything we quick test for," *in that moment, when they take a breath, say: "I would like you to take a culture." They may look surprised. Ignore it, and be insistent that you would like to try to identify the bug that's affecting you. Simple. You will have to be swabbed again, but it will give you peace of mind and the correct medication for what ails you in just a few days. It could save you days/weeks out of work, and possibly buy you a few more months/years on the Earth. A mere moment of discomfort may positively affect your health for the rest of your life. It's worth it.

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Since Covid spread in the clinic is not the main concern in lack of staffing, attention to the control of overtime hours is. The lack of staffing has not been addressed due to our owner corporation's attitude: "There is plenty of staff to go around. Just recruit staff from neighboring clinics and hospitals to cover shifts."

The fact of the matter is that there is not adequate staffing, and a quick look at Sunstar EMS Hospital Status often shows the inadequacies quite clearly through daily diverts to neighboring non-HCA hospitals in the area. Control of overtime is preventing the younger, newer, more able-bodied staff from helping out.

The squeeze is on, making both clinical and non-clinical employees absolutely miserable. Personnel are dropping out like flies, and those that have taken their place, all wide-eyed and new, are taken unaware.

......................................

I do not often discuss medical politics beyond Florida, but we are facing a new danger: the systematic destruction of the Medicaid and Medicare Insurances, as well as the possible destruction of the Health and Human Services Departments throughout the US.

The plan is to further sell off this critical infrastructure to private corporations (more than they have previously), thus expunging the government of oversight and funding.

New rules will be placed on vaccination, preventative health care, and hospital care.

My recommendation to you all is that you immediately take control of your future health and the health of your families by obtaining any and all available and past-due vaccinations, by getting thorough physical assessments regardless of cost, and maintaining supplies of prescription medications up to the maximum (90 days). Please make appointments with your primary care doctor/nurse and specialists as soon as possible or pay for the service out of pocket in order to be seen more quickly (I know, this is cost prohibitive - but you will be much more ready and healthy before the advent of the coming administration.

......................................

In the meantime, you all know my mantra:

MASK UP and be safe.

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Hello r/FloridaCoronavirus it's time of the week again for a new Weekly Thread.

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Hello r/FloridaCoronavirus it's time of the week again for a new Weekly Thread.

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Hello r/FloridaCoronavirus it's time of the week again for a new Weekly Thread.

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Is there any doctor or clinic that’s doing leading edge work on understanding long covid?

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As you can see, most of our hospitals are temporarily closed due to location (in evacuation zones). While many of these hospitals are attempting to divert, they are still seeing walk-in and ambulance delivered patients: EX: Morton Plant Listed as "Closed", but they have at least 2 ambulance delivered emergency patients.

The most frequent issue is FALLS. This is due to panic, slippery wet surfaces, and people performing tasks that they would not ordinarily do.

Please folks, slow down and think about what you're doing, whether it's safe, and taking precautions to complete your tasks in the safest way possible. If you must do something you need to on a ladder, work with a spotter. By spotter I mean someone physically strong, an adult (not a senior), quick, and able to catch you in the event that you fall.

At this point (3pm) you should have completed your outdoor preparations.

Do not drive - STAY OFF THE ROADS. In my area alone (W. Pasco) there have been two accidents already. I'm hearing the sirens to another call right now.

The first outer bands of Milton are already hitting with gusts up to 43mph in Pasco. Wind gusts in Tampa have exceeded 35mph. This will take down tree limbs, blow trash cans into the street, and toss outdoor furniture around. This is just the beginning.

Wind gusts in excess of 90 mph are expected North, they will obviously be worse the closer you are to Sarasota/Tampa (in excess of 110 mph).

The above illustrates the need to stay home and hunker down unless you are in an evacuation zone or a wood home, manufactured home, mobile home or other non-hurricane rated structure. Between now and 5pm will be the last window of opportunity to get to a shelter, as gusts will become much more frequent, and flooding has already begun.

After dark it will become increasingly difficult for first responders to handle calls. At some point between 8pm and 2am, they may cease to respond. The hurricane will make landfall overnight.

If you lose power, turn off your junction box. It will prevent problems with overloads and prevent fires when the lines are being hooked up again.

Keep in touch with your neighbors via text. You may need them, or they may need you.

Please heed all calls to evacuate. There is still time.

Be safe.

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Has anyone had luck with this recently? I need to take my mask off for an appointment at a new doctor and I’m not sure how well my request is going to go over. I’m traveling from another state for surgery that requires some tests beforehand.

Our insurance wouldn't cover the shots at first. I know a lot of people have been experiencing this. Try again! My wife and I just got Pfizer jabs at CVS and it was covered. Glad I didn't pay for one a couple weeks ago.
Anyone else having better luck getting the shots covered now that its been several weeks?
Very happy to have these jabs with the holidays coming. Happy to report the Pfizer dose seems VERY mild this round. My arm isn't even sore just a bit of a stiffness where the injection was done.

Whelp, it looks like we may have a situation on our hands. Northern Hospitals will probably go back to OLMC (Online Medical Command) shortly, given the number of diverts.

I have been monitoring the hospitals all weekend long, and it really wasn't bad. For some reason Monday turned into a sh*t show.

Having worked the weekend, I was surprised at the lack of injuries (chainsaw and whatnot from trying to clear debris), and lack of rashes, cuts and bruises from walking through flood water.

My guess is that everyone hunkered down till the waters subsided and then dove in head first into their damaged homes today.

.......................................

Just to inform briefly: COVID is absolutely quieting down. The vast majority of cases are amongst the elderly population, who are socializing as usual, sans masks.

I have noticed an increase in ear infections among children and middle aged adults. This is concerning - none mentioned using the pool or swimming. Many had sinus pain/headache as a secondary symptom. None wished to test for COVID, though our providers may have run a few of their swabs through the paces anyway. Very few tested positive, but most were early (1-5 days) I to their symptoms.

The hospital data is encouraging:

09/06: 10,182

09/13: 7,026

09/20: 5,333

Wastewater testing has also shown very good reduction, though it has bobbing a tiny bit recently. Even Tampa looks good.

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A word on the hurricane and help available: if you go to my profile and check my posts there is one in the r/Florida sub for help with everything from hot showers to food, to finding a place to stay. If anyone needs help and cannot find the post, DM me. I will help you get the links.

At the moment I am still reeling from the devistation in FL, GA, NC and SC. I had to cut myself from it at one point, because diving into it head first searching for info about missing friends has made me a bit sick.

I truly hope everyone here in Florida is cared for in the aftermath of Helene. Please be careful and do not take on more work than you can handle. Clearing out a flooded home is dreadful work. I know, I did it on LI after Irene in 2011, and it was horrendous.

A reminder: the silt, mud, and mold you will encounter as well as the insects are not good for your health. Wear appropriate garments to safeguard yourself (good boots, jeans, and at least long sleeves rolled up). If in a moldy house, wear a mask. Handling moldy objects? Wear gloves. Drink plenty of water and take frequent breaks. Wear bug repellent if possible and do not work past sundown. Wait till dawn to start working, also...gottah avoid mosquitoes.

If you scratch yourself on something dirty, clean the wound well, and consider your last tetanus shot - if you can't remember when - get another. All Urgent Cares carry them.

Please Be Safe out there.

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URL to use: https://covidtests.gov/

I just ordered for myself, and it worked. They will begin shipping on Sept. 30th.

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It's been a bit rough lately due to a dreadful lack of staff, both in īreception and clinical. Lack enough that we are unable to provide some services. Some staff were out sick recently. To soften the blow in administration I've worked everyday for a week, filling in as much as possible. Being home is a luxury.

Nevermind the staff; we have begun seeing near 70 patients a day, often seen by just one practitioner.

The pace on some days has increased way beyond our staff's ability to handle, often resulting in long wait times during hours of high traffic, like mid-morning and after school. 2 hours at those times is typical.

We're seeing the usual ear infections in kids, followed by the same for them with parasites and lacerations.

The young Moms and Dads are catching stuff from their kids. We had one adult flu case, possibly the first in a long time. They've also got Strep, and COVID. Surprisingly few norovirus cases for this time in the school year.

The middle aged to young seniors are developing COVID + Community Spread Pneumonia at a shocking rate. Several arrived complaining of coughs that have gotten progressively worse over the course of 2 - 4 months. X-rays reveal scarring and fluid in the lungs often, resulting in some ED transfers. Complaints of sleepiness, fatigue and dizziness caused by Low O2 are becoming more frequent.

Interestingly, a practitioner wrote a few Paxlovid RXs and a lesser-known antiviral, Molnupiravir (Lagevrio). It's for mild symptoms of COVID in people with underlying conditions. The side effects seem quite similar to Paxlovid, including bitter aftertaste. Claims during studies and in advertising state that it reduces the chance of developing Long-Covid. I'll have to look into that.

As befits the oncoming season, the waiting room echoed with coughing for nearly the whole day, every day.

Many patients missed their target day testing for COVID and insisted that the test they took a day after being exposed was gospel. "It was negative. I don't have COVID." Sometimes I try to explain testing, sometimes I can't get a word in edgewise. Frankly my dears - I just barely care anymore if they want to live in a fantasy.

For your sake: I really hope I don't see you in my clinic. Wear a good mask, (yes, wash your hands), get vaccinated, and please:

Be safe.

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In 2023, the Florida Legislature passed Title XXXII Chapter 456.62 into law. It's titled "Communication of COVID-19 treatment alternatives."

(3) In determining which alternative medications to present to a patient for purposes of obtaining informed consent, the health care practitioner must include any medications currently authorized or approved by the United States Food and Drug Administration for the treatment of COVID-19 and use his or her best clinical judgment to identify any alternative medications that could reasonably be expected to benefit the patient.

The legislature added a number of anti-mask, anti-vax, and pro-horse paste provisions as part of this bill.

381.00316 Discrimination by governmental and business entities based on health care choices; prohibition.—(1)(a) It is the intent of the Legislature that Floridians be free from mandated facial coverings, mandates of any kind relating to vaccines as provided in this section, and discrimination based on such vaccination status.

Depending on the interpretation of the law by the provider's organization, this can have a chilling effect on effective FDA-approved treatments where they have the provider ask for a waiver before prescribing treatments.

I may have heard about this news last year, but it's just shocking to personally see some of the effects a year later.

I checked with a local chain pharmacy and a Covid vaccine without insurance is $200. I just quit my job so I don’t have insurance at the moment and I certainly can’t afford that. I checked vaccines.gov and they had no information on affordable shots anywhere. I live in Florida so I’m not expecting much from our county health department as our state Surgeon General is against Covid vaccines. Does anyone have any information on how or where to acquire an affordable Covid booster? Thank you.

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Novavax available at many CVS locations. They want you to schedule appt online.

Frustrated: It's the only word I can think of to sum up my thoughts, the general atmosphere at the clinic, and the attitude of our providers.

We are suffering another year and another prolonged season of habitual denial and ignorance of SARS-CoV-2, on the part of the DOH, patients, businesses, corporations, caretakers, nurses, and medical doctors.

The clinic is full of sniffling, coughing, extremely fatigued and annoyed children and adults. Occasionally one of them walks in wearing an adequate mask, sometimes worn correctly, but often unsealed and donned incorrectly. These are usually the home-tested, positive result cases. The rest walk in, seemingly oblivious to the fact that they harbor a deadly infectious disease.

When prompted to take a mostly inadequate surgical mask, they guffaw at themselves for forgetting and make a million excuses for their behaviour, look at me with consternation, sigh, or do as they are told without a blink.

Everyone is sick with something. If they aren't, they are in clinic for a laceration, an infected wound, abdominal pain, or a fall. The rest are job testing - and they rarely wear masks while waiting, but they do grab masks when the room is full of uncontrollably coughing patients.

I am astounded at the number of ER transfers I am getting per day. People arriving so sick that they cannot stand up, seniors with fall injuries, persons bleeding excessively from orifices, you name it. The fear of the ER continues, despite that fact that our clinic is just as risky.

Our providers and nurses are sometimes out for weeks at a time. They return with chronic coughs that they can barely rid themselves of before succombing to another infection. The young ones bounce back faster than the older clinicians, of course.

Whether or not our providers and nurses are aware of the cumulative effects of numerous COVID infections per year remains mirky. As a person "untrained" in medical science, one cannot just ask them this without a verbal altercation and a writeup. It's practically against policy.

A momentary lapse in my control happened when my coworker insisted that a patient was told that it was okay to return to work the same day that she was diagnosed with COVID. The patient was still feverish. I absentmindedly reminded my coworker that CDC recommendations were not what she just spewed, and was met with an "I know what the CDC rules are, and so does the provider! Don't lecture me!"

My retort was silence. I knew I'd be written up. My coworker then quietly crawled from her seat to secretly discuss the situation with the provider (both are the office tattletales), who informed her that his orders were not what she thought, and informed her of the correct CDC regulations for infectious disease exposure and prevention.

Did I get an "I'm sorry, I was wrong. I will call the patient back to correct my disinformation,"? Nope. Not one word, from either the provider or my coworker. No writeup, either. I still want to post the recommendations prominently in my area, but know if I do, I may risk a writeup. "No unofficial signage," is the order from on high. The best we have is "Cover your cough and wash your hands," which has been the mantra of infectious respiratory disease since Spanish Flu.

We admit it every day that we work: we are tired of dealing with unnecessary and avoidable sickness, yet no one cares discuss masking or vaccination unless the patient is the caretaker of someone who is immunocompromised or elderly, and asks the question specifically. Otherwise, masking is entirely ignored beyond the printed patient "return to work" instructions (which patients don't read), providers wearing their own choice of mask, and the surgical masks given out to obviously infectious patients.

Every day I hear or read of patients seeking medical advice and treatment in a safe and sterile atmosphere - and getting pushback for attempts to protect themselves. The situation appears to be getting worse, with more and more doctors ignoring infectious disease protocol, and more patients disregarding the same.

In Florida it is close to impossible to force a doctor to observe protocol. The best response might be to leave their office immediately and file a complaint with the American Board of Medicine; do not bother with the State Board; or file to both just to be thorough. This will not prompt swift action, but trying is better than allowing the possible outcome.

..................................................................

Please - if you can, get your updated vaccinations. Wear a good mask whenever possible and instruct yourself and others in correct donning and doffing of respirator-style masks.

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Despite the lower numbers of hospital detected positive COVID patients (down to around 11,000 per week vs 13,000), the number of in-clinic positive patients is high. Respiratory emergencies involving middle aged to elderly patients is rampant.

Detection of COVID infection in-hospital is extremely high in the 64+ age group, lesser but equivalent (nearly the same) for 12-60 years, and thankfully much less amongst infants.

Deaths continue to mount up (in the hundreds - (08/09/24 showing 200 just that week), with the elderly 64+ being the most counted. Horrifying but not unexpected, the highest deaths were in Palm Beach. If you are a senior and value your life, avoid that county at all costs.

Second only to Palm Beach for senior deaths are Orange and Broward Counties, Miami-Dade, and even Hernando is topping the charts.

Do not discount deaths in the 40-49 year old, 50-59 year old, and 60-64 year old brackets. They are still happening - the older you are, the more at risk you are.

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If you have any questions about exposure, risk, masking, vaccination, infectiousness, or treatment, please post them.

Be Safe.