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Tent Village, Ocean Grove. July, 2018. Paul Goldfinger photo. Blogfinger.net. ©

 

From Isak Grove:

Thanks for highlighting the article about ventilators and Coronavirus patients,  since it perfectly frames the most important debate in OG today and that’s not the parking problem. The question is should Tent Village and the Great Auditorium be opened this summer or stay closed for the season?

Without question Tent Village will bring in families from all over the country making social distancing this summer impossible and will result in widespread infections throughout OG sickening many residents.

The OGCMA should be making a statement about their intentions TODAY vs. just holding their breath and ignoring the risks and hoping no one asks.

Regardless of curve flattening etc, Tent Village has more density than many of the crowded parts of NYC and hence will be a major health risk throughout the summer. But then again the OGCMA would make some nice money keeping them open…

 

LANG LANG AND CONRAD POPE    “Marilyn’s Theme”  from the film  My Week With Marilyn

 

 

Tent Village. Ocean Grove. Summer, 2019. Paul Goldfinger © Blogfinger.net.

 

By Paul Goldfinger, MD.  Editor@Blogfinger.net.

Dave. Let’s enlarge the conversation about viral risks in the Grove:

Tent Village is more congested than the typical neighborhoods in the Grove. Also its wonderful lifestyle in the summer is communal and outdoors and would be a magnet for viral transmission. It reminds me of a summer camp and should not be activated this season. Allowing it to reopen will be too risky.

Our homes in the Grove are on small lots, and we are in close proximity to each other, but the risk there is not nearly what it is for the tents.

The most important principal for prevention of Coronavirus is to mitigate human to human contact. So, for example, let’s keep the lid on our porch culture this season.

We should not engage in finger pointing. For example, second homers come in two styles. Those who came here to stay, in order to avoid the dangers in the city, may increase the population somewhat, but they can maintain distancing like everyone else. They just should self-isolate for 14 days after arrival.

Another variable of concern has to do with turnover. We can’t have people coming back and forth from the cities only to stay for a few days. That is a recipe for a new infusion of virus every weekend. Such visitors may be second homers, but there are other worries which are greater.

Short term rentals should be banned until this epidemic is resolved. Airbnb rentals may be one of those gypsy-like groups, although the Airbnb rental business is currently in a state of steep decline due to cancelled reservations.

And the greatest danger to all of us are the mega-events which are planned, throughout the “season” by the CMA and the Chamber of Commercials, and they will draw floods of virus-laden tourists into our town. Human to human contacts will be out of control if those hordes show up.

It will be like Genghis Khan and his horsemen galloping into town in the 13th century, killing the populace, and carrying off the women.

All of those mega-events, such as the forthcoming May Flea Market, must be cancelled.

 

NANCY WILSON:

“See the girl with the red dress on.  She knows how to shake that thing.”  Super Bowl 2020. Shakira. Paul Goldfinger photo from the TV broadcast. Click to enlarge.

 

RAY CHARLES:

For the first time the Goldfingers will not be celebrating Passover in Ocean Grove.   We want to share a Passover greeting sent to us by our good friend Mary of Brick.  She said,

 

“Eileen and Paul

“Wish you a very happy Passover during this unique time.  Stay safe, reminisce about former Passover’s and be thankful.
With love and blessings”

Thank you Mary and we share her wishes with our Jewish friends and family.

 

 

JED MARUM   The Fighting Tigers of Ireland;     “Go Down Moses.”

 

Central Park. New York City Street Series. By Paul Goldfinger ©

Central Park. New York City Street Series. By Paul Goldfinger ©

 

RODNEY CROWELL.  “Even Cowgirls Get the Blues.”

 

Jim of Ft.Myers, Fla. overlooks the irony…Paul Goldfinger © Click to enlarge.

 

So, what is distancing doing to the dating game?  The Velours say love trumps everything else and they do enjoy spontaneity, but they need to schmeer some antimicrobial lotion all over and be very careful.  With the 6 foot rule, there are some anatomic challenges.

 

THE VELOURS:

 

Echoes of Brazil

Echoes of Brazil. By Paul Goldfinger. Copyright.

Echoes of Brazil. By Paul Goldfinger.© Click image for full view. Naples, Florida Botanical Gardens. 2013.

 

SOUNDTRACK. “Dias Azuis” (Blue Days) by Milton Nascimento and the Jobim Trio. Album: Novas Bossas

Tropicana Coop. Ft Myers, Fla.  Smile girls…  Paul Goldfinger photo. 4/6/20

 

MAX BYGRAVES:

Severe cases of Covid-19 are treated with ventilators in China.

By Paul Goldfinger, MD.   Editor@Blogfinger.net

When it comes to medical care, what terrifies me the most is being placed on a ventilator, and I have personally  been through some risky business in the past.  At times I have been intubated (tube down your throat to keep you breathing.)

That is fairly routine for general anesthesia, under the watchful eye of an anesthesiologist, but it is almost always temporary, and the patient’s memory is usually only of a sore throat afterwards. So, in many situations, the ventilator is used until some reversible factor, for example sustained effects of anesthesia, is resolved.

But if you are critically ill in an ICU and require a temporary breathing machine  (ventilator) for a longer period of time, then you cannot remain conscious because it is intolerable. So they induce a sustained coma.

Years ago I can remember seeing patients’ hands being tied down for that, and then we would use IV sedatives to keep them unconscious.  Usually the ventilator would not be needed for a long time because given the opportunity, we would fix the problem, and normal respiration could resume, so we would extubate the patient, support breathing with oxygen, and allow him to wake up.   Thank goodness for the induced coma of recent years.

But the Coronavirus is a horrible organism that can damage and even destroy a victim’s lungs causing dependency on the ventilator usually for 7-10 days or less or longer. The lucky ones will show some improvement over time allowing removal from the machine.  But others develop complications, especially in high risk groups, and they may die before the ventilator could be implemented or while it is being used.

Or they may be stuck on the machine with no way out. Then the decision of taking someone off the ventilator is discussed.

The mortality rate for those on ventilators is 50-80% based on some recent observations.  The patients most at risk of dying are the elderly and those with underlying medical issues including heart failure, prior heart attacks, reduced immune responses as with chemotherapy, diabetes, hypertension, and chronic lung disease.

And then, for some, even if they are removed from the machine, there may be lingering severe complications and long term rehab or admission to nursing facilities.

An internist from Georgetown University Medical School, Dr. Kathryn Dreger, posted a “no holds barred” piece in the New York Times today.   It is painful to read, but  it is important to do so because you never know  when that miserable situation might land in your lap.

Here is the link below:

 

Editor’s note.  Paul Goldfinger, MD

So, is it a death sentence?  Well, there are individual situations, but suffice it to say that if a doctor recommends this approach, make sure you understand what the chances are that your loved one will benefit.

Of all who have symptoms of COVID-19, only 10% need hospitalization, and a minority would need the  ICU and a ventilator.  Some will “come off” within 7-10 days, but many will not. The exact numbers are not yet available.

For those who can be removed from the machine, some don’t do well afterwards. Being in that coma often has long-lasting consequences if the person survives.

From the National Post in Canada comes this statement:  “But as the number of Canadians made critically ill by the virus ticks up, some patients or their families are actually foregoing entirely the often-harrowing treatment afforded by ICUs and breathing machines.

“A number of elderly patients have died in long-term care homes rather than submit to intensive therapy that might have only made their passing more painful and uncomfortable.”

From Barnes Hospital in St. Louis:   “Most coronavirus patients who end up on ventilators go on to die, according to several small studies from the U.S., China and Europe. The mortality in that group at Barnes is 50-80%.”

“It’s very concerning to see how many patients who require ventilation do not make it out of the hospital,” says Dr.Tiffany Osborne, a critical care specialist at Washington University in St. Louis who has been caring for coronavirus patients at Barnes-Jewish Hospital.”

At Cornell Medical Center in NYC  it is reported that the “vast majority in their ICU come off the ventilators.”  But coming off the machine doesn’t necessarily equate with survival.

And from Maimonides Hospital in Brooklyn, as reported by the NY Post, an Emergency Medicine doctor is saying that the ventilators being used for CUVID-19 patients are being set with excessively high pressures which may be contributing to lung damage. Blogfinger has  no verification of that claim.

And some of the patients who continue to live can’t be taken off the mechanical breathing machines.

What should families do?

One approach is to invoke a  preexisting legal advanced directive that says,  “No machines to keep me alive.”  Or “Do not resuscitate if my heart stops,” but that might require interpretation by the next of kin after discussion with physicians.

A compromise would be to tell your next of kin to refuse or halt ventilators if the condition is or has become hopeless to a high degree. Perhaps a person could write a letter to that effect.

We have heard a great deal about how important it is to build and distribute ventilators all over the US and even the world. But understand that ventilator support is not a cure.

 

 

Wesley Lake. Ocean Grove, New Jersey. Paul Goldfinger photo

Wesley Lake. Ocean Grove (L), New Jersey. Paul Goldfinger photo 2012  ©

The Citizen Patrol folks who monitor nocturnal Ocean Grove  get to see quite a few night- time creatures like raccoons, possums and some shadowy people.

But, if you go out and about and study the light, you will see the moon reflecting on the ocean and you will see the lights on the boardwalk, but there are other sights to see, such as the lights twinkling in and about Wesley Lake.

Those of you who have low light digital cameras, you might want to walk the streets of the Grove and check out the night scene.  Watch your shutter speed.  If it is below 30, make your ISO setting higher   (ie more sensitive.)   This will keep your image from blurring.—Paul

MICHAEL CRAWFORD  “The Music of the Night”  from Andrew Lloyd Webber’s Phantom of the Opera:

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