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With Virus Surge, Dermatologists and Orthopedists Are Drafted for the E.R.




One of the largest hospital networks in New York has given its doctors an ultimatum: either help deal with the coronavirus crush, or stay home without pay.

At other hospitals, too, all hands are being called to deck. Neurosurgeons and cardiologists, orthopedic, dermatology and plastic surgery residents — all have been pulled into emergency rooms and intensive care wards. Receptionists who normally deal with billing are also being told they will be reassigned, to emergency rooms to help screen Covid-19 patients.

This is what the redeployment scramble looks like as hospitals, girding for a surge of coronavirus cases in the next two weeks, face an acute shortage of doctors and nurses trained in intensive care settings.

From cream-of-the-crop surgical specialists to nurses, physician assistants and administrative staff, health care workers who have not done a critical care shift in many years are having to retool themselves overnight — and not always voluntarily. There is pressure from co-workers, guilt about not helping, and fear about the risks to themselves and their families.

“I feel like I’d be pretty clueless in these units actually,” said an orthopedic physician assistant at a Long Island hospital who usually works on elective surgeries. The assistant, who said she had “zero critical care experience,” declined to be identified because she feared she would be fired for speaking publicly.

She and other physician assistants had received an email from their supervisor, who reminded them that another hospital in the area had made the assignments mandatory. “I did not want to go that route but everyone needs to pitch in,” the email said.

Northwell Health, the network that has told its medical staff to redeploy, has 2,900 Covid-19 patients in its 17 hospitals, which include Long Island Jewish Medical Center, Lenox Hill in Manhattan and Staten Island University.

“If you’re employed by us, it is expected you can be reassigned to an area of need,” David Battinelli, Northwell’s chief medical officer, said in an interview. Those who do not agree will be furloughed without pay, he said.

Dr. Battinelli said clinical staff would be reassigned based on their skills and comfort level. All elective surgeries have been canceled across the Northwell network, and only 20 percent of its patients, he estimated, were coming in for non-coronavirus emergencies like heart attacks, strokes and injuries.

Conference rooms, lobbies and some cafeterias were being converted to intensive care units; the network plans to expand its bed capacity by 60 percent.

“Obviously that puts pressure on trying to find staff to support those patients,” said Terry Lynam, a Northwell spokesman. “That’s the biggest concern — to try to get additional staffing.”

On Thursday, Mayor Bill de Blasio called for a national draft of doctors and medical workers to be sent to places where the virus has hit hardest, starting with New York. Some hospital systems had already been pleading for help from outside their networks. On Wednesday, NewYork-Presbyterian Hospital put out a call on Twitter for doctors and nurses, as it tries to expand intensive care units and emergency rooms in its hospitals.

Late last week came an urgent call from Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine in Manhattan, whose faculty work in several New York City hospitals.

“We are running out of ICU trained doctors,” he wrote in bold type in an email to a national medical association, asking for intensive care physicians from other states and promising to cover the cost of travel, housing and meals.

Even before the United States had confirmed cases of the coronavirus, it was facing a growing physician shortage because of its increasing and aging population. A recent study projected a shortfall of between 46,900 and 121,900 physicians by 2032.

Last month, the medical association of critical care physicians warned that Covid-19 would strain the country’s roughly 29,000 intensive-care-trained physicians. “Having an adequate supply of beds and equipment is not enough,” the association, the Society of Critical Care Medicine, wrote in a blog post, adding that “the intensivist deficit will be strongly felt.”

In New York State, the exponential growth of virus patients, with nearly 15,000 hospitalized, has stretched medical workers to their limits, both numerically and psychologically.

Stefan Flores, an emergency room doctor at NewYork-Presbyterian/Columbia University Medical Center, had an orthopedic resident by his side recently, and said specialist doctors were helping monitor patient vitals and doing bedside rounds. On a 12-hour shift, he has had to do as many as six intubations.

“I do think we need more doctors,” Dr. Flores said. “It’s unsafe to deal with the acuity and volume we are dealing with. I’ve been on shifts where I’ve never felt so overwhelmed.”

The anxiety among the redeployed is pouring out on WhatsApp and in text messages. “Now doing ED shifts for the first time in 17 years,” one doctor said on a WhatsApp group chat, referring to the emergency department. “Our ICUs are full and vents are pretty much all being used.”

A neurosurgeon at a Manhattan hospital learned last weekend that he would have to work in an I.C.U. alongside an intensive care doctor. He said he worried that at some point, intensive care doctors would fall sick or be overwhelmed by patients and that non-I.C.U. doctors would be managing ventilated patients.

On his first shift, the neurosurgeon, who declined to be identified for fear of retribution, was assigned a N-95 mask and told to use it indefinitely. Several times an hour, code blue alerts were called out on the hospital loudspeaker, indicating a medical emergency. “Everybody is dug in for the long haul,” he said.

Health and Wellness

I have started to do Yoga, Hiit at home, and what am I, or I start to notice, after a few sessions, the abdomen and legs firmer?




Give the profile of Irene Alda on Instagram has been the best thing that could have happened to me now that I am so much time at home. This yoga instructor teaches a discipline that is defined as Yiit, that is to say, yoga+hiit. For those that missed workout in the fitness room, the TRX, the machines of strength and dumbbells, the possibility to practice this discipline at home is a real gift because it has it ALL:

· You do not need any itemwork with your own body. Great, if you don’t have gym gear at home.

· Incorporates cardioperfect for our heart to pump and to move the oxygen, so complicated when you can’t even walk.

· You work a lot of the flexibility so that the body acquires a very harmoniouswithout mark too the muscles.

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Health and Wellness

How Bubonic Plague Has Helped Russia Fight the Coronavirus




MOSCOW — In a remote alpine meadow in Kyrgyzstan a few years ago, a teenage boy killed and skinned a marmot. Five days later, his parents carried the sweating, delirious boy to a village hospital where he died of bubonic plague.

Like a ghost from the medieval past, the plague still makes occasional, unwelcome appearances in remote regions of the former Soviet Union, where it survives today in wild rodents.

Over the centuries, with improved public hygiene, the plague declined as a threat. Today, as a bacterial infection, it is treatable with antibiotics, if caught in time.

But the plague was still a lethal menace in the 1920s and also an embarrassment for the Soviet Union, which established a specialized state agency to track and contain it.

Successors to that agency still exist in Russia and in half a dozen other countries that were once Soviet republics, and, with their ready quarantine plans and trained personnel, they have become a mainstay of the regional response to the coronavirus.

“Of course, it helped” early on, said Ravshan Maimulov, director of a regional antiplague service in Kyrgyzstan who examined the teenage plague victim when he died in 2013. He used the same quarantine plan that he had instituted after the boy’s death to respond to the coronavirus in March.

When the 15-year-old had arrived at the village hospital, “the body was still damp from sweat and I felt swelling under the armpits and chin,” Mr. Maimulov said. But the boy was too far gone to save, and he died within hours.

Mr. Maimulov, 57, trained at a Russian antiplague institute called Microbe. After the boy’s death, he had the authority to immediately put in motion plans for a lockdown, even though at that point they had only a partial diagnosis.

He relayed the news to a regional governor in code — they would need to implement “Formula 100” — lest word leak and inhabitants of the village, Ichke-Zhergez, should try to flee before the door slammed shut.

“We needed to prevent them all from running away,” he said. By the next morning, police checkpoints were in place and the village was sealed.

On his recommendation, the authorities in the surrounding Issyk-Kul region used the same approach in March in introducing coronavirus lockdowns. “We worked under the operative plan for the plague,” Mr. Maimulov said in a telephone interview. The region of about half a million people has reported three coronavirus cases, he said. Kyrgyzstan has reported five deaths.

Russia maintains 13 antiplague centers, from the Far East to the Caucasus Mountains, five plague research institutes and multiple field stations. In March, the authorities moved new laboratory equipment into the antiplague center in Moscow to expand its ability to test for coronavirus.

The Microbe institute, originally dedicated wholly to bubonic plague but later expanded to tackle other infections such as cholera, yellow fever, anthrax and tularemia, models the spread of the coronavirus.

Starting in January, directors of antiplague centers in the Eurasian Economic Union, the Moscow-led trade alliance of Armenia, Belarus, Kazakhstan, Kyrgyzstan and Russia, held conference calls about the coronavirus. And a plague institute in Odessa, Ukraine, is among agencies responding to the coronavirus there, officials said.

“The very fact that Russia and the other former Soviet states are, exactly, former Soviet states means a common legacy,” in health care, said Dmitri Trenin, director of the Carnegie Moscow Center. A legacy of focus on epidemics helped, he said. Soviet health care had haphazard success at treating individuals but “could respond like the military to epidemics,” he noted.

Other analysts of former Soviet medical services say that, in the longer term, the Soviet legacy will prove no gift. The capacity to counter epidemics had degraded while little was done to improve an ability to treat patients, according to Yevgeny S. Gontmakher, a professor at the Higher School of Economics and an authority on Russian health care.

“The plague doctors were the elite of a hundred years ago, not today,” he said.

In Kyrgyzstan, Mr. Maimulov works in a wooden laboratory in what had been, until a few weeks ago, the medical backwater of plague control. Most years, he plans for campaigns of spraying insecticide into rodent burrows, to kill fleas and slow the spread in animals.

The disease cannot be fully stamped out. “They are rodents, they reproduce quickly,” he said. “It’s not worthwhile to kill them.”

The family of the 15-year-old boy were herding sheep in the mountains and trapping marmots for fur as a sideline. The boy skinned the marmot with a razor blade. Though the Black Death typically spreads by flea bite, in this instance the boy caught it simply by nicking his finger.

Eventually, 32 villages were put under quarantine while about 700 nurses went door to door looking for infection. Marmot hides were collected and burned. But the antiplague team had acted quickly enough. The boy was the only confirmed case.

Oleg Matsnev contributed reporting.

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Health and Wellness

A strength training and cardio that you can do at home in 15 minutes




That we are confined does not mean that we train: it is one of the key guidelines to maintain a healthy life style, also in these circumstances. So, today I bring you this training that combines strength work and cardioto get a full workout without the need to use more material objects that you have at home.

This training, although we followed, consists of two parts: an anaerobic, in which we will seek to increase the strength due to our body weight and other cardiovascular to finish the training. All training will be able to complete from the same room of our house.

We begin with the part of strength in which we will perform the following exercises one after another without stretching a lot of break times. We will not set a specific time, but the idea is that you will not recover at all between sets and you get to the next series somewhat tiredbut you can complete it.







Funds triceps on chair






Remo table



And finally we ended up with a small interval training of high intensity with a structure Tabata in which we will do a single exercise. In this case we opted for the burpees since this is an exercise very complete and in addition, with little time, it will speed up our body and help to burn a lot of calories. If you want to, you can choose another: the skipping, the hopping with jumping rope or jumping jacks are good examples.

Choose the exercise that we choose we will do six or eight sets of 20 seconds of work and 10 seconds of rest, thus completing between three and four minutes of cardiovascular work.

As always, so you can be sure to perform each exercise properly we will explain them one by one.

A cardio workout without jumps, and without material with exercises to do in your own home


We started working our legs with a squats free of weight and deep. We put the feet with a separation similar to the width of our shoulders, the soles of the feet well supported on the floor and the toes facing forward.

In this position we bring the buttocks back slightly, while keeping your back as upright as possible at all times and flex the knees to perform a movement similar to that which we would want to sit in a chair that was behind us. Keep in mind that the weight must fall on our heels and not on the toe.

Funds triceps on chair


To work our arms, mainly the back, we’re going to make funds with a chair or on a chair. We place ourselves in front of the chair or armchair, we support the hands with the fingers facing forward and support our feet on the ground.

From this position flexionaremos our elbows until they form an angle of about 90 °, directing always our elbows back. After, we will stretch our elbows to return to the initial position.

Remember, if you are a beginner, you can put your knees bent and your feet close to your glutes for ease of movement, loading and less weight. If you’re already an expert, keep your legs straight and feet clear of the buttocks.

15-minutes of training material with exercises to put your abs to the point at home


push-ups chest-workout-at-home

To work the pectoral there is nothing better than a few pushups at home. We can do them with your feet flat, if we have strength, or on our knees if we are beginners or we are unable to complete the 12 repetitions.

We will stand on the floor with the palms of your hands directly beneath your shoulders, and the forefoot of both feet or knees on the floor. In this position flexing our elbows, guiding them backuntil the chest touch the ground and return to stretch your arms to complete one repetition.

Remo table

To work our back home we will perform a rowing invested using a table and our body weight. We will stand under the table (you can also use a chair, though you will have less travel in the motion), and hold both sides of the table with the hands.

In this position we force by bending our elbows and getting close to our chest to the table all possible: it is a movement of pull similar to the rowing that we can do in the gym or in a dominated. Then down, controlling the movement until your arms are fully stretched to complete a repetition.


We ended up with this cardiovascular exercise in format Tabatathat will help us to finish the training by burning calories. The burpees put together different movements to work virtually the whole body: a squat, a push and a vertical jump. Remember that in this training we’ll do six to eight sets of 20 seconds of work and 10 rest.

We begin standing in a relaxed position, with the legs open to the width of our hip. Perform a squat and we support our hands in the soil: with a leap, we carry our legs backward up into a pushup position or plank front. From there, we made a bending, touching our chest with the floor, or relying directly on the floor if we are newbies. We return to the pushup position and, with a jump, collect the legs forward: we go back to stand up and chain a vertical jump, to help us bringing our arms up.

This article was originally posted by Victor Falcon in march of 2019 and has been revised for republication.

Videos | Tutograma and Vitónica
Image | iStock
In Vitónica | A circuit of functional training that you can do in your own home

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