Oxygen Please

When I visit my Doctor for a regular visit the first thing done by a Nurse is to record my ‘vitals’. I cannot remember when it started but a regular reading is my saturated oxygen level, pulse rate and blood pressure. My general doctor is a cardio-pulmonary specialist which probably caused saturated oxygen level to be added quickly to the vitals group. I had occasional breathing congestion for so many years I cannot remember and at one point they, medical profession, gave it the name of COPD. Unfortunately there are many of us with widely varying problems grouped in this category because the first letter stands for Chronic. Whatever the history, oxygen is important and the standard it 95%-100%. For us with ‘conditions’, 90%-100% is good. This value has never indicated a problem for me.

Now I read that Covid-19 can cause a lower value, even to 50%, without showing respiratory distress. What this means for us is that Covid-19 will start by lowering the value before it goes real low and you feel it. I actually did not find any indication that the value drops as the disease worsen only that doctors find the value low!

In an article ‘Can a Pulse Oximeter Save Your Life if You Have COVID-19?’ Dr. Richard Levitan, who’s been an emergency room physician for some 30 years reports his experience with Covid-19 patients durning a stay in an ER of a large NYC hospital. excerpts follow.

A pulse oximeter works by passing beams of light through your finger and calculating blood-oxygen levels based on light absorption.

Dr. Levitan refers to this hard-to-detect type of oxygen deprivation (or hypoxia) as a silent killer. After observing patients during a 10-day volunteering stint in the ER at Bellevue Hospital in Manhattan, he wrote about this aspect of the virus in an opinion piece in The New York Times. I reviewed this article in my post in April. The question is the ‘hard-to-detect’seems to be done regularly by my general doctor every visit. The oxygen depletion may not be apparent immediately because the virus attacks the lungs in such a way that the patient gradually gets less and less oxygen over time, according Levitan. “These patients do not feel like they have breathing difficulty because they slowly adjust to the lower oxygen,” he says. The oximeter may provide a simple way to spot potential health trouble, but it’s not a substitute for a doctor’s consultation. “Why not have one?” he says. “A pulse oximeter is a very easy gadget to use. It’s not costly and it’s not invasive. Within 10 to 15 seconds, you’ll get an oxygen saturation reading. If it plummets below 90, you may need supplemental oxygen.”

Some people with the novel coronavirus have alarmingly low levels of blood oxygen, and they don’t even have a clue that their lives are in danger. They don’t appear to have any major trouble breathing, so they don’t realize how dire their situation may be. The phenomenon has been raising concern among doctors, because these individuals typically need emergency medical attention to survive. “The level of oxygen that these people are reaching can be so low that it’s amazing to me not only that they’re alive, but that they’re often not in distress,” says Richard Levitan, MD, an emergency physician in Littleton, New Hampshire, and the president of Airway Cam Technologies, a company that teaches courses in intubation and airway management. “They may be awake, alert, and even on their cell phones.” According to Levitan, he and other doctors are seeing many coronavirus patients who are breathing fairly well when they check in to the hospital, but upon examination it’s clear they have pneumonia and their lungs are failing to sufficiently oxygenate their blood. A normal blood oxygen reading would be between 95 and 100 percent, according to the Mayo Clinic. Anything under 90 is considered unhealthy. While at Bellevue in March, Levitan saw coronavirus patients with measurements as low as 50 percent. When oxygen levels sink this far, Levitan expects patients to have much more apparent trouble breathing. Instead, these patients were often coming into the ER only after recently noticing a shortness of breath and having been sick with symptoms like fever, cough, upset stomach, and fatigue for a week.

He was perplexed. “If you get this low with your oxygen, your brain doesn’t like it,” he says. “You have respiratory failure, you pass out, or you have a seizure.” But that wasn’t happening with the patients he was seeing. He explains that with COVID-19, the lungs initially remain “compliant,” meaning not yet stiff or heavy with fluid, so they’re able to get rid of carbon dioxide even as their ability to provide oxygen to the body becomes impaired. A buildup of carbon dioxide would cause patients to become lethargic or unconscious. To compensate, individuals breathe faster and deeper, and this change in respiration, Levitan says, increases inflammation in the lungs while also, for a while, masking some symptoms of pneumonia.

Identifying pneumonia early on before it advances can help a patient beat the disease and perhaps avoid more extreme measures like being put on a ventilator. “Through all of medicine, we know that earlier diagnosis and earlier treatment make a difference,” says Levitan. He adds that some of the most effective interventions can also be the least complicated. “For example, giving people oxygen and turning people onto their stomach — what we call proning — can reduce ventilator necessity,” he says. “People come in with oxygen levels in the 50s, and after we’ve turned them on their stomachs and given them oxygen their oxygen levels are in the 90s.” “Fixating on pulse oximeter readings may provide a false sense of security,” warns Albert Rizzo, MD, the chief medical officer for the American Lung Association. “In some cases, they do catch lung problems before you struggle with shortness of breath. However, it is also possible for the device to show healthy oxygen saturation levels even when experiencing trouble breathing, which may lead some individuals to delay seeking urgently needed care.” “Everybody I know has anxiety about this disease,” he says. “One way to give patients assurance that they’re okay is to empower them to self-monitor, and adding pulse oximetry does that.

Future History

Yesterday I found an historical document about about the 20-21 revolution in the United States the Americas. It is an intriguing overview of decade that reformed a country into an even more power and desirable Organization. That which was a part of the former nation by default had been lost thru neglect, and exploited by the power structure in its absence. With the formal reintroduction into the founding documents of the former nation it was reformed and expanded.

During the FREEDOM era of the New Normal period of history it was realized that an assumption present in the forming constitution was based on the character of the leaders of that time that leaders would continue to have integrity as part of their makeup. This was pointed out in the preamble as “… and secure the Blessings of Liberty…” was never explicitly stated and in the statement, “Each House shall be the Judge of the Elections, Returns and Qualifications of its own Members” . Without integrity as part of every person character these freedoms spell disaster.

And it came close in 2019 when something that had been written about for ages showed a little of how bad our imagination had made it. A pandemic, smaller than others to come, started to envelop the earth. It started in other countries but involved the Global Community in a matter of months and therefor included the United States.

This allowed the focus to eventually land on leadership in all countries because all were involved. China, where the pandemic first appeared, locked down the entire country in an effort to control the spread. No one thought about responsibility because it rested in the government as did the power.

ASIDE: The virus strain in this pandemic had one unusual characteristic, it was asynchronous; a person did not contract the virus and noticeable become ill. It took several weeks to be noticed in which time the victim had moved and spread the virus. If it was noticed earlier it was called just a common cold and the victim recovered with no noticeable effects for a very long time.

But in the United States the power and responsibility was a different structure. The power had been divided among several positions in the government. This was to insure balance in objectives of the various positions. This division was intended and stated in the forming document. Keep in mind the primary assumption that leaders would continue to have integrity. Some of the leaders had this character diminished to almost nothing. They followed their own agenda for their own good. Some thought out loud that their agenda was the agenda for the nation. Others new better but nothing because their agenda was totally personal and there integrity as next to nothing. This was also true in the individual business of the members of the states of the United States. Scams became a way-of-life in the area of what you were to believe to the area of what you purchased. One case documented a company that sold millions a product and never delivered more than a token amount. In another case the product never existed!

At one point the highest officer in the country stated that he had the total power… and later stated also that he accepted no responsibility at all. These exemplary statements started the thought process that eventually changed the nation and restored the fact that leaders would continue to have integrity, as part of the constitution of the United States.

The fact became widely know again that the president has no power over the people and never has had. His power is over the States who have power over the people. The example of the national speed limit, a concept that was aimed at safety and conservation of energy in the 20th century, pointed to the last state to accept and post the limit when the ‘stick’ of withholding federal aid for state projects was used to force compliance. It was also pointed out the the president indeed accepted no responsibility when a couple ingested bleach and the only responsible party was themselves.

Another “stick that broke the camel’s back” was a Mayor of a large City ordering businesses to close, which it turned out, he had no power to do. This costs individuals dearly and the city itself much. That area never recovered and the Mayor never accepted responsibility for the results of the order. It was, as I mentioned, cited as another ‘stick’ in the public eye.

Thus began the FREEDOM era of the New Normal period. The movement seems to have no beginning and no end. It did not begin on a date and has never ended. It just appeared in several regions unlike the Civil Rights movement that had a ‘beginning event’. It just grew to the point that the lawmakers knew what they must do to retain power, they needed to take responsibility.

I will continue to add to this as I read and understand.

Miranda rights for Criminals:
You have the right to remain silent. Anything you say can be used against you in court. You have the right to talk to a lawyer for advice before we ask you any questions. You have the right to have a lawyer with you during questioning. If you cannot afford a lawyer, one will be appointed for you before any questioning if you wish. If you decide to answer questions now without a lawyer present, you have the right to stop answering at any time.

Human Rights for Everyone:
You have the Right to remain silent and inert. You have the Responsibility for everything you say or do.

This is implied in the Constiution.

The Good-Bad List

Facebook.com/factcheck – Does respond to users

buyoshenwatch.com – No order sent out.

Americanism Responsibility

Like people — and most anything in life — there are brands that are responsible and ethical, and there are others that are not. Yes, without a doubt, Americanism is a force for good. Its intentions have been perverted, and the protection it offers has disappeared. We have got to do better and find a way to a responsible free market. Taken from this article. https://forge.medium.com/prepare-for-the-ultimate-gaslighting-6a8ce3f0a0e0 And part 2 of the article https://forge.medium.com/the-gaslighting-has-begun-resist-aac3658813d4

Simply by staying in our homes, we have collectively lowered the death rate from a projected 2.2 million American deaths to 63,538 confirmed deaths as of this post. This lower death number is not evidence that this was “no big deal.” Quite the opposite. You and I made that lower number happen. It is confirmation of the power of scale and our own personal power to change the world. Plainly put, we can either honor those 63,538 people by getting our collective shit together and forging ahead anew, or we can go back to clearing the shelves of Walmart, drinking every sugary Coke, and “liking” every duck-lipped Insta post of our favorite Armenian makeup moguls. The choice is ours.

Manipulation Organization

Lyle Hoover, waiting outside for his first haircut since the lockdown, thought it was about time. “As this thing barrels on, I can’t help but think we’re being manipulated.”

“There’s no organization. There’s no real plan. Just open up and we’ll see what happens,” she said.(Tara Brendle) “We all know there’s going to be a resurgence in cases. But if they don’t know what to do, I sure as hell don’t.”

Confidence in the governor was not enhanced when Parson decided to mark the reopening by touring an electrical contractor and a hunting and fishing store without wearing a face mask, in a pointed rejection of federal health recommendations.
“I think it’s up to the individual,” Parson said in response to a question during his afternoon news conference. “I don’t think its government’s role to mandate who wears a mask and who doesn’t.” “I chose not to,” he said. “I don’t think that it is government’s role to mandate who wears one.”
Even as the state endured its largest increase in coronavirus cases on Monday, Missouri’s Republican governor, Mike Parson, decided to press ahead with his plan to allow businesses to reopen and to lift restrictions on social gatherings imposed as the pandemic crept closer six weeks ago.

Last week, Vice President Mike Pence chose not to wear a mask while touring the Mayo Clinic in Rochester, Minnesota, in apparent violation of the medical center’s policy requiring them.

On-going content as it unfolds.

WE Must Due

Monday May 4, 2020. We are letting loose of the virus. It seems like time and it seems too early. For me it is too early. For all of us older seniors, too fat and ugly to run fast enough to stay ahead. And smart enough to realize that there is something hurting our nation more than the virus.

I thought it was apathy. People not caring about what happens. But I don’t that’s on the money either. Why do I feel there is not right? Is it because I personally don’t like what is happening? But I don’t dislike what is happening either?

Then IT hit me! I can’t do anything. Wait, I can’t do anything about IT. Oh I can do, just not do anything about IT. I feel used. Yes that is IT, I feel used! Everyone is using me. The should not be using me. And then I remembered a book I started about a witch hunt and I remembered feeling that I was the person using others. Who were they? OH! women, and men in power were using, taking advantage of, women! And Yep I was indeed a man. Can’t do anything about that either (although some men have tried. BUT another topic). I read it again. “and men in power were using, taking advantage of, women!” If there is anything that I do not have it is power! That was close.

In all the gin joints, in all the places, in all the World, . . . Wait Walter. Don’t go off on a Dream. We will use the same tool we as a country has used for years. Give THEM the Rights they are lacking. It is what we sent to war for. The right not to be English. Right? Right! Right. There was a concept that came before, FREEDOM. Now some try to say that that is the same thing. If you have rights you are FREE. and if you are FREE you have rights. Almost and true are the response to that. Can you see it? The war was for FREEDOM from England not . . . The thing that was added was RIGHTS. and the founding fathers figured that was good because they were good men and good men expect other men to be good. Notice I say men because back in those times men did and women . . .

Our founding father need us to replace what was assumed at the time our nation was conceived. The thing that they took, and took for granted, in founding our nation. They took responsibility by signing their names (and credit only because they did not fail).

In the above discussion we expect responsibility to be taken. And when IT is not IT becomes the IT that actually bothers us. Our entire court system, judicial system, corporate system, is in place to Make This Happen. (Well maybe not the corporate system that is in place now because it actually lets executives hide behind the corporate mask.) IT forces the few people convicted to take responsibility for IT. I asked a young girl what she did wrong in school. She said “get caught”. We teach them young. I told her no and explained but life teaches the opposite lesson. If the powerful men in the little story were forced to accept responsibility for taking advantage of women balance would be restored. If the people that first created a computer were forced to accept responsibility for taking advantage of our computer, balance would be restored. If every person using a Right were forced to accept responsibility for All The Actions caused by them balance would be restored. If FREEDOM were forced to balance rights with responsibility for actions caused I would feel better. IT is due!

“Excess deaths”

Excess deaths measure the difference between the number of deaths expected to occur without the pandemic and the number of actual deaths recorded. This accepts the state that “we don’t know” into the figures. This is what is needed at this time. It may have helped to focus on Covid-19 at first but now we need a bigger picture. April 28, 2020 Top Stories from Google Search for US

Google search for - excess deaths worldwide
Coronavirus Is Only Part of the 'Excess Fatality' Mystery
Deaths Spike in New York City and Around the World ...
40,000 Missing Deaths: Tracking the True Toll of the ...
Global coronavirus death toll could be 60% higher than reported
Global Covid-19 Case Fatality Rates - CEBM

Reopen – upset the cart

Society, Commerce, Government, Recreation, … Individual Plans

I was Upset; I see it now.
‘The campaign to “open” America flows from the superrich and their front groups’. What I thought was Grass-Roots is Astro-Turf. This is an Olde political operation.
“A protest against Michigan’s stay-at-home order outside the State Capitol last week” was REALLY a political Rally of a few people. Note the crowds. Me neither. When you something like this look for a picture from a greater perspective, Stand Back, to see the size of the crowds.
The protest might be real but this ain’t it!

We do not need to open/reopen America… NO, America never closed!
ObviousMan points out the above. “Protesting is not listed as an essential activity!”
Unlike France, Italy no one is arrested for going outside but for endangering the public with large gathering ie. megaChurch worship vs the protest above.
We are ready for safe changes. That is the reason this all started in the first place. Each Area of our complex LIFE was changed all at once.
The Medical arena changed but did not close. It became a center.
Politics did not close. It became a center.
State Government held it place to what/where needed. Each location required a unique approach. California actually found it was the starting point not Washington. Does it matter?
Society took a hit and closed, Almost. Church RIGHTs got in the way for some. We never did find out if any bad affect happened. Does it matter?
Recreation seemed to close, at least was hard hit. After Cruise Lines and Spring Breaks settled down recreation turned to walks in the park and runs on trails at a social distance.
Military realized it also had a responsibility for the health of the forces, the navy took the lead on; this. And SO Forth…My lawn care team never stopped cutting grass; Construction of new buildings continued.

Society and commerce have the greatest need to reopen but are not first… Recreation is first with certain areas which are easy to open, and sometimes never closed despite what was said. Stay-at-home never actually ordered any business to close just to follow the social-distancing guidelines. Some of the non-essential businesses, manufacturing, stores, transportation, earning a wage to live, … need to reassign or be reassign as essential to make this easier. This needs to done not officially but personally because workers who personally do not feel safe at work need to stay home and receive compensation if required. I feel this will not be abused, ‘I just feel it’. Gradually households will emerge to shop, play, but not in large groups that may still not be safe with a second wave a probability. NOT at school. I feel that school and classroom should be revised to utilize technology better. There is no need for students to congregate in a classroom to something that is individual in nature. assemble for a purpose as needed to present face-to-face what needs hands-on activity. NOW is the time when we have already stopped the old norm. WE need an individual plan for each area and each individual, us, in the country. The time is YESTERDAY.

My soapbox for this entirety is responsibility. Other post will give details. The Rights movements of the last century were never completed with the other half of Freedom. It is time for a country that was built on Freedom to demand the Rights and Responsibilities that make up that great concept. Too any individuals Take Rights and Refuse any responsibility. (I won’t mention names here, There are so Many high and low)

This statement was lost in the mass of words ‘We are engaged in a “natural experiment” of differing approaches to the epidemic on a massive scale, and we are likely to see over the coming weeks what the consequences of that will be.’
Florida – With pressure mounting from public health officials and political leaders nationwide, Florida Gov. Ron DeSantis on Wednesday reversed course and ordered residents across the state to stay at home to help reduce the toll of the coronavirus pandemic. The order takes effect at 12:01 a.m. Friday, April 3. DeSantis said what changed his mind was Trump’s call on Sunday for the national social-distancing guidelines to be extended through April because of mathematical models showing how death tolls would soar if the population did not observe the recommended public health guidelines for staying at home. Trump has not issued a national stay-at-home order. Florida Governor Ron DeSantis signed Executive Order 20-91 on April 1 outlining a stay-at-home policy for Floridians.
all persons in Florida shall limit their movements and personal interactions outside of their home to only those necessary to obtain or provide essential services or conduct essential activities.

All businesses or organizations are encouraged to provide delivery, carry-out or curbside service outside of the business or organization, of orders placed online or via telephone, to the greatest extent practicable.
Please make a note of this. It DOES imply that businesses or organizations are encouraged to Stay Open and Be Safe while doing so.

Under Pressure, Florida Governor Finally Orders Residents To Stay Home

Reading On the federal side. https://www.kff.org/coronavirus-policy-watch/stay-at-home-orders-to-fight-covid19/

Tragedy Is Unfolding

I know nobody is reading these post but I am writing, I guess, for me. In this article
‘A Tragedy Is Unfolding’: Inside New York’s Virus Epicenter
“In a city ravaged by an epidemic, few places have been as hard hit as central Queens.”
By Annie Correal and Andrew Jacobs.
Published April 9, 2020 Updated April 10, 2020

In a city ravaged by the coronavirus, few places have suffered as much as central Queens, where a seven-square-mile patch of densely packed immigrant enclaves recorded more than 7,000 cases in the first weeks of the outbreak.

Anil Subba, a Nepali Uber driver from Jackson Heights, Queens, died just hours after doctors at Elmhurst Hospital thought he might be strong enough to be removed from a ventilator.

In the nearby Corona neighborhood, Edison Forero, 44, a restaurant worker from Colombia, was still burning with fever when his housemate demanded he leave his rented room, he said.

Not far away in Jackson Heights, Raziah Begum, a widow and nanny from Bangladesh, worries she will be ill soon.

“We are so hungry, but I am more terrified that I will get sick,” said Ms. Begum, 53, who has diabetes and high blood pressure.

Across the Ocean in Italy:

Isolating the Sick at Home, Italy Stores Up Family Tragedies

“Stay home” measures have helped Italy control the coronavirus, but home is also a dangerous place that may be propping up the infection curve the lockdown was meant to suppress.

ROME — When her middle-aged son got sick, Ruffina Pompei did what she had done for decades, bringing vegetable soup and freshly squeezed orange juice to his room. She slept in an armchair outside his room and changed his clothes. She told her husband, 89, to steer clear.

Her son died in a hospital in the region of Abruzzo on March 29. Her husband died the next day in the same hospital. Ms. Pompei, 82, was also diagnosed with the virus.

Italian households represent “the biggest reservoir of infections,” said Massimo Galli, the director of the infectious diseases department at Luigi Sacco University Hospital in Milan. He called the cases “the possible restarting point of the epidemic in case of a reopening.”

The family acts as a multiplier, said Andrea Crisanti, the top scientific consultant on the virus in the Veneto region. “This is a ticking time bomb,” he said.

The predicament of home infections is emerging not just in Italy but in hot spots across the globe, in Queens and the Paris suburbs, as well as the working-class neighborhoods of Rome and Milan. It is also a problem that local officials and epidemiologists say is getting too little attention, particularly as the government has announced tentative steps toward reopening in early May.

The problem is one the Chinese government bludgeoned quickly. It ordered the roundup of all residents in Wuhan infected with the coronavirus, warehousing them in quarantine camps, sometimes with little care. While that approach may have helped contain the virus, ripping people apart from their homes is anathema to Western democracies, especially Italy, where tight-knit families are the rule.

And don’t ask about Paris just read. Some is data is old but was new once. I just did not see it.

Start at the beginning

The Infection That’s Silently Killing Coronavirus Patients points to something we new from the beginning. Excerpts follow: To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition. Covid pneumonia cases are very different. A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia. Continue reading in a part 2 on May 25.