Prime Minister Mia Mottley advised the country tonight that Barbados will impose a curfew from 8PM to 6AM starting on Saturday 28 March 2020 until 14 April 2020. On a personal note the Prime Minister also shared she will be MIA for a while because her medical team advised her to undergo a medical procedure…
Prime Minister Mia Mottley advised the country tonight that Barbados will impose a curfew from 8PM to 6AM starting on Saturday 28 March 2020 until 14 April 2020. On a personal note the Prime Minister also shared she will be MIA for a while because her medical team advised her to undergo a medical procedure this coming weekend. Minister of Education Santia Bradshaw will act as prime minister. The blogmaster wishes her well.
This pandemic of a kind not seen in recent history may very well force an alien behaviour by Barbadians necessary to wrestle the beast to the ground. If it is one thing we know, Barbados has of recent deservedly attracted the label- an indisciplined society.
In extraordinary times one must be willing to operate outside the box. The S Korea experience can help to reinforce the idea the decisions in a situation we find ourselves must be evidence based.
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It has been difficult to follow the coronavirus ‘debate’ on BU.
Time has demonstrated that Mia’s initial response to this pandemic was the correct one. It was a calculated risk but fortune smiled on her roll of the dice. A firm and steady hand is what the country needed and a firm and steady hand is what she is provided.
Xxcxcccxcccccc
Ok lets see how forgiving time will be as the numbers continue to rise and the health system is dealt the same fatal blow as international countries
The question of stubbornness and being hard headed would be the rallying cry
I have stepped so far down the crease, that I feel it necessary to swing my bat.
Korea is 38,691 square miles and it’s population is 51.47 million. There is a city in Korea with over 2 million people.
Barbados on the other hand is 166 square miles with 300,000 people.
The small size of the population and area rules out the added value of mass testing.
We cannot just copy the behavior of others.
Social distancing, contact tracing, and hygiene
The numbers will rise no matter what Mia does.
And you would be on the other side of the fence no matter what does.
I am not a supporter or fan of Mia. My opposition to her allows me to objectively evaluate her actions.
We want to leverage the discipline in behaviour exhibited by S Korea how we make decisions. Not sure what is so difficult to comprehend or what it has to do with size.
“With the capacity to test 15,000 people a day, over 316,600 people have been tested in South Korea as of Friday – which amounts to more than 6,150 tests per million inhabitants”.
“Not sure what is so difficult to comprehend or what it has to do with size”..
Look at all the numbers for Korea that were quoted above and see that there is not a clear understanding of what is mass testing.
And in Germany It has a different meaning.
WHERE DO WE STAND AS A PEOPLE BARBADOS?
SURINAME A GLIMPSE INTO ANOTHER SOCIALIST STATE, REELING TOWARDS VENEZUELA!!
SURINAME’S ECONOMIC CRISIS SHUTS DOWN
Mar 27, 2020 – Economy
Suriname ground to a halt yesterday, March 26, as its banks, shops and factories shuttered in a showdown between its beleaguered private sector and its authoritarian government over how to respond to a deepening economic crisis.
The closures brought a new and unpredictable tension to the streets of Paramaribo, the South America nation’s capital. Most people stayed home to comply with measures to fight the coronavirus pandemic.
Paramaribo, Suriname.
https://caribbeanbusinessreport.com/app/uploads/2019/12/Paramaribo-1024×655.jpeg
This has a lot of medical jargon, but if you read it carefully it gives a picture of what front line medical staff are faced with. I was written by an Emergency MD in a New Orleans hospital.
“I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.
Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.
China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.
Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.
Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.
A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.
An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.
Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.
Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won’t make it back.
We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.
Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the “lockdown”, our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.
Treatment
Supportive
worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.
Plaquenil which has weak ACE2 blockade doesn’t appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil’s potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.
We are also using Azithromycin, but are intermittently running out of IV.
Do not give these patient’s standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.
Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.
Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.
Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.
The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn’t often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.
Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.
We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.
One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.
I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.”
@David
Sometime in the future some academic will investigate why some countries were relatively unscathed while others e.g. Italy and Spain (so far) have been devastated by this illness. Why does Hong Kong despite being on the front lines have so few cases as compared to NYC? How about Japan and Singapore? My opinion is that some countries learned the lessons of SARS and were quick to adopt stringent measures while others were laissez faire in their approach. Is it cultural where citizens are more likely to follow directives of local authorities while in the West people are more likely to follow their own dictates (see students on Spring break in Florida).
One thing is certain we don’t know what we don’t know.
john
Corv cases start showing up in china on jan 22md???
Is that what president rump tell you?
@Peter
Do you have the link?
@Sargeant
Those countries you mentioned probably developed immunity.
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@FC
Social distancing has nothing to do with socialism…. 🙂
I gone
PLT…great article, the frontline doctors/nurses, etc are trying their best, the problems lie with the politicians and their useles politics…they are the ones who screwed and are still continuing to screw everything up for everyone, with the exception of Cuomo of NYC and a few others.
Sargeant 10.02
Well said.
@ TheOgazerts
You are a breath of fresh air in this very sterile discussion.
Here it is we are at a point in time of uncertainty , and some can accuse GoB of making wrong decisions. Decisions that so far concentrated on containment of the Virus and identifying the points of entry of the virus into Barbados. It has also traced potential victims and transmitters. I think that strategy is wise, logical and productive.
@Mr Blogmaster, your link re South Korea was indeed a reminder as the NYT report is the latest of the careful review of S.Korea good practices… and if we take your second point about disciplined behaviour then in the context of good decision making I am confused how the blogger @Theo can so glibly say “Time has demonstrated that Mia’s initial response to this pandemic was the correct one. It was a calculated risk but fortune smiled on her roll of the dice”
One can NEVER accord a decision kudos if one is calling it a dice role… can’t work in practical govt or corporate situations ONLY good in casinos!
And to repeat what has also been said here and otherwise re S.Korea… not only were they positive re testing and solid social distancing but they aggressively used a form of ‘geo-tagging tracing (cell phone blast on persons positives) that has not been replicated (it seems, and likely for HIPAA reasons) in many other locales.
THAT variable was as crucial as any other… it was their comprehensive use of all variables smoothly integrated that set them on their path of success thus far.
This is not a Mia beat-up but we are talking about Barbados and its policy…we did NONE of what S.Korea did as collectively (or indeed individually)….nor did the US nor many others either.
And as we speak…China is grudgingly reporting that previous Covid19 patients are retesting positive again… which causes all sort of scientific surprises.
“Houston, we still have a grave problem!”
@David
Sorry, I have no link. It was sent to me by a medical doctor I know.
This is a grim milestone for our country. COVID-19 deaths in Canada have surpassed the entire SARS total from back in 2003. It has also happened in a shorter period of time.
As of March 28, the government has reported 55 deaths in throughout the country as a result of the virus and the number of confirmed cases reached 4,675.
TheOgazertsMarch 28, 2020 9:41 AM
The numbers will rise no matter what Mia does.
And you would be on the other side of the fence no matter what does.
I am not a supporter or fan of Mia. My opposition to her allows me to objectively evaluate her actions.
cccccvcv
Your first paragraph are littered with excuses and arrogance
Exactly the same thinking that give way for the virus to enter the island and develop strength
It does matter what actions have been taken in prevention
One cannot in their right mind expect to plant oranges and get apples holding on to a plan grounded in a defeatist attitude
Leaders lead with an objection that no matter the outcome the people interest must supersede all others in times of crisis
Saying that this govt did the right things knowing how the virus can be contracted is borderline political hogwash when the facts would now revealed that closing ports of entry to visitors would prevent a catastrophy
Whether they be one or 26 the bottom line meant saving the country and its people from this deadly virus and having all the factors which attributed to contraction
That being contact
@Hants
What are the technocrats whether the infection rate? Has it peaked?
@David
The infection rate in Canada is accelerating rapidly and is far from peaking.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
Chives still alive and so am I! All is well in the Chill Room.
While you see a chance take it!
@DpD
Let me hasten to assure you that (in the current situation) Mia did not/does not know the final outcome of her decisions. There is always an element of uncertainty. She must assign weights to the likelihood to a possible outcomes based on her actionds and then make her decision on what appears to be the less harmful course.
You cannot remove the uncertainty from our life. We can put a nice face on our decision but we must always be aware of “what if”.
What if a different number comes up?
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Sargeant made two points about the South Korea that we cannot reproduce
“My opinion is that some countries learned the lessons of SARS and were quick to adopt stringent measures while others were laissez faire in their approach. ”
This battle is new for us, but populations in the east have been exposed to this situation on a number of occasions. Some of what they do as a sheer reflex action is something that we now have to learn.
“Is it cultural where citizens are more likely to follow directives of local authorities while in the West people are more likely to follow their own dictates (see students on Spring break in Florida).”
Differences in culture. Again Western reaction/responses are different from those who are located in Asia.
@ Hal March 28, 2020 8:10 AM
I resumed my stroll.. Left the house about 7.10 am. there was young couple behind me who were clenched in a partial embrace. No respect for social distance. Passed “Mint Condition” Cleaners. Workers were hanging around as the person with the keys had not yet arrived. Feel sorry for these workers and wonder how they will manage with the curfew and no wages. Pass Jordan’s Supermarket. The line stretch as far as the Barbados Workers’ Union Credit Union. Cross the bridge. The lines from Popular stretch as far as St. Michael’s Row and back towards the juncture of Marhill street. The line from Cherish stretch as far as Lucas Street. Saw Neville who I had promised to buy a drink. Up to Wednesday, he was suffering from the gout and declined the drink. All of a sudden he wants the drink. Claims that the medication he was given did not work and that when tossed back a drink yesterday ,he was much better. Bought him the drink in Marhill Street. not too far from the pharmacy .We old-talked. Of course he said he was broke . Gave him a couple of dollars. Remembered when I was in a similar situation, how he came to my rescue. Left the watering hole and came abreast of the pharmacy. A Chinese couple was passing. I see them often . They pass through the alley by Ecaf company. The husband ( at least I think he is the husband) walks in front and the wife behind him. They also go and buy from Scotty’s. They do not bother any one. A fellow accosted them saying a lot of offensive words. Told him to leave them alone, that they did not bother people. He switch his attention to me. He knew all the antecedents of my conception. I said nothing but was thinking that If I was carrying I would blow him away( I have this urge to be very violent, I keep it in check.) would not think twice about it. He was lucky that this was Barbados and not the US. Bought a mini of Campari and some sodas. I seldom use the hard stuff at home. It is the way I was brought up. No liquor in the house. Haven’t opened that J. Wray and Nephew. I need to get some prunes to steep in it, to cool it down. Very good that way. As things are, don’t know when I will get the prunes
@ David,
Canada rate of covid 19 infections fluctuate.In British Columbia the spread is decreasing but that could change tomorrow.
s@ Robert
Keep up your walk. Don’t let Barbadian natural aggression get in your way. You are performing a Charles Dickens role during these testing times. In time historical sociologists will appreciate these notes. Keep a comprehensive diary.
Is the south hotel popular for its black pudding open today?
The majority of Barbadians are known to be a docile people.
#fyi
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I have no desire to referee the debate between Mariposa and TheOgazerts. However, I would like to compliment Mariposa on her consistent and incisive criticism aimed at the vacuous position adopted by Mia and her BLP in their management of the Covid-19 pandemic.
Mariposa’s comments at 10.33 are concise, rich in objectivity and reasoning that it would take a human being of Soloman’s wisdom to counterbalance her arguments.
It beggars belief that Barbados should have toed the W.H.O. line towards the monitoring of this virus. Why wait for stage 3 before introducing a lock down when we knew in advance that from as early as January/February (if not before) that this virus had lingered and rampaged its way through a number of countries.
It took the might of the communist Chinese government to ring fence this virus. They showed to the world the perfect template for controlling its spread. Apart from a small number of countries, the vast majority have failed in their duty of care to their people.
So let us close down this debate and conclude that we need to have a complete lockdown of the country and acknowledge that should we witness a sharp rise in the mortality rate then we will be unable to treat our people and that the majority of them will perish without receiving any medical treatment. Barbados does not have the infrastructure to deal with this virus.
Many employees in the tourism industry are currently losing their jobs. The civil servants, however, have a secure job, a secure pension and have even received a big pay rise in 2018. I just cite Simple Simon. She informed us that senior officers receive up to $9,000 a month in pension. It’s something private sector workers can only dream of.
The people therefore ask what solidarity contribution the civil servants are making to solve the crisis. Salary cuts, say 20 percent for 5 years? Overtime? It would also be just to limit civil servants’ pensions to a maximum of 3000 dollars per month. Anyone who pockets $9000 per month in pensions at the taxpayer’s expense is behaving in an unsolidary and indecent manner.
We cannot allow Corona to hit the workers in the private sector with full force, but the civil servants are resting on their privileges.
Why is Senator Caswell silent on this injustice?
Probably was refer to the agression of wabtibg to shoot the guy 🙂
@ robert lucas March 28, 2020 11:02 AM
Very good of you Robert, to behave as a living historian by keeping a diary similar to that of Samuel Pepys.
Hopefully your electronic narrations ‘would’ not reflect the observations made by Pepys about the ‘culling’ made by the plague in the London of his times.
Fortunately for modern man, he has the Internet to keep his social and economic distance.
It’s time an enterprising-thinking Bajan start up a natural and safe food and drink delivery business to prepare for the replacement of the supermarket shopping model as we know it now.
“Can we move the discussion along?”
Good luck.
@Theo, you have highlighted that crucial point in any decision making process: how best to interpret the elements of uncertainty…the known unknowns, in other words!
I have followed Bim’s decisions from afar as too TnT’s…why did the latter make decisions of their uncertainty that were so diametrically different to Bim’s! None of them knew “the final outcome of [their] decisions”.
Ms Mottley’s admin made some decisions that simply defied their OWN WHO staged plans… but heh, if things work out perfectly then hooray!
That’s does NOT mean however that it was excellent process management..just as you said it was a great roll of the dice. That’s scary as a point of reference for ANY leader!
I accept the point that the Asians may be more aware of how best to handle this stuff because of prior SARS and similar … however, I refute the related argument that Bajans may be less “likely to follow directives of local authorities” for national crisis issues.
Are these the SAME Bajans who buckled down (in the main) to directives for hurricane preparedness in the last few years… (yes, they were outliers who didnt obey as they were too in S. Korea with the religious group)…but had the local admin implemented strict protocols then I expect that Bajans in the main would HAVE complied.
The relevance and importance of life is being exposed to adversity (in any form) … that allows a strong degree of transference to another episode of adversity… surely a hurricane is quite different from a virus spread but preparing for and seeing the outcome of a devastating hurricane (in Jamaica and The Bahamas in recent years) has surely allowed Bajans to have a bit more discipline about strong govt diections!
This should have little at this point in our collective maturation to do with cultural nuances only!
“The infection rate in Canada is accelerating rapidly and is far from peaking.”
Italy has not even peaked yet, neither has Spain and they seem to be dying nearly one thousand a day, UK is right behind them by at least one week now, they are catching up.
The majority of Barbadians are known to be a docile people.
Xxxxxxxx
THE MAJORITY OF BAJANS ARE VERY GULLIBLE AND AGGRESSIVE
Speak for yourself.
By next week this will be a completely different number….remember, Italy tried it’s very best from day one to contain it while cousin Boris was playing hide and seek like Mia..
“In the bleakest day so far for Britain’s coronavirus crisis, the death toll leapt by 260 in just 24 hours. The latest figures show the virus has claimed 1,019 lives in the UK, a jump from 759 on the previous day. It is by far the biggest daily increase with the previous biggest spike being 181 on Friday. A total of 120,776 coronavirus tests have taken place since the outbreak began and 17,089 have come back positive. Government advisers said stricter social distancing policies may have to be rolled out next month if the grim figures continued to rise. It comes as NHS staff will be tested for coronavirus from next week and Chessington World of Adventures car park (main) is turned into drive-thru swab centre for medics.”
And it nah picking and choosing neither..
“The princess, of the Bourbon-Parma Royal Family in Spain, passed away yesterday. It comes as Spain registered a record number of coronavirus deaths in a single-day period with the army now being handed emergency powers to transfer bodies.”
@ Hal March 28, 2020 11:19 AM
I do not know. What I do know is that the souse Saturday with Larry Mayers is still on. Larry will be in contact with the souse maker by phone and the souse is supposed to bought by drive through means. If I remember correctly the souse place is in St, Thomas.
@ David March 28, 2020 11:34 AM
That is the problem with Barbadians. Too docile.
TLSN March 28, 2020 11:42 AM
Suggest you take the data with caution.
@ Robert Lucas
Can you help me with some information on legionaires disease and how it’s transmitted please?
john2
March 28, 2020 10:07 AM
john
Corv cases start showing up in china on jan 22md???
Is that what president rump tell you?
+++++++++++++++++++++++
I use this link for numbers.
https://www.worldometers.info/coronavirus/
This one for China.
https://www.worldometers.info/coronavirus/country/china/
You will see China started reporting cases on 22nd January and on that date it reported 571 cases with 8 deaths.
@Robert Lucas,
Man, Lucas, these eye witness accounts are brilliant just like i said yesterday, replete with personal anecdotes. v descriptive writing like i would expect from a Cawmerian as was the timely intervention re the Chinese couple- again nothing short of what i would expect from a Cawmerian..well except from Miller lol. keep it up man. David should reserve a separate thread for this, man. what set were u in? is Michael Lucas related to u?
This link will give you the USA by state.
As you will see about 1/2 of the cases are in New York, 52K/112K.
The next worse state is New Jersey probably because it is contiguous and people are fleeing New York and carrying it to New Jersey, 8K/112K.
You will see that Rhode Island has enacted laws to prevent New Yorkers coming there.
Rhode Island has 203 cases and ZERO deaths.
Think Florida is complaining too.
Trump has no option but to consider quarantining both New York and New Jersey.
https://www.worldometers.info/coronavirus/country/us/
Man, if only Cuomo had canceled the celebrations when he had the chance.
One positive, new cases in New York down by 1,200, 6K today vs 7.2K yesterday.
Might be fewer tests, not all reported up to now or moved to another state.
New York was the site of a mass casualty.
The point is we make an error if we do not look at the state by state data.
Total new cases for the US yesterday was 18K vs today. 8K but I don’t know if all states are up to date.
Could be cause for optimism.
If you look at the map for Canada you will see a few centres.
My guess is that it will be the cities that kept Chinese New Year celebrations and attracted the virus.
There has been a slight fall in new cases between yesterday and today.
Need to wait and see if all reports in.
Canada has approximately a 1% death rate, deaths/total cases
New York has a death rate of 1.4%.
As more testing is done the death rate will fall as the denominator expands.
The blogmaster invites you to join the discussion.