Thread by @medicalaxioms

The #covid2019 Disposition Challenge.

I’ll start with the conclusion. Defend your walls. For the next few months, getting someone out of the hospital is going to be a lot harder than getting them in.

#covid4MDs

Patients are going to come from places where they may not be able to return after a positive test. Even if they aren’t that sick.

Nursing home patients who test positive might not be able to go back there.

Homeless patients who sleep in a shelter and eat in a church room full of people should probably not go back there.

Home Oxygen will be a solution for the not too sick and the getting better. Until it runs out and becomes inaccessible.

Then there is the prisoner.

These problems will require vast solutions and government intervention. We will have to build temporary housing or shelter.

I know it’s not American and we’ve never done it.

If you want a hospital to go to in 30 days, we will have to do it.

In Seattle, nursing homes are emptying out and sending sick patients to the hospital. That does not mean they are ready and willing to accept #COVID2019 positive patients returning from the hospital.

Aside from risk to other patients, there are dwindling staff and dwindling PPE.

#COVID19 seems like an admission problem. In the US it’s going be a discharge problem as well.

For years we have emphasized medical care over social. Now the social is going to stack and freeze the medical.

I’m not a solutions guy. I’m an observant guy. Creating temporary housing for COVID (+) homeless and elderly is going to be a military operation.

Figuring out what to do with the COVID (+) prisoners when there are 2 million people incarcerated in the US is going to require a fundamental change in values.

In summary, the challenges we face getting people out of the hospital will become the challenges getting people in. A healthy patient lying in a bed is the same as a sick person.

Either way you can’t put another patient in that bed.