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    COVID 19 UPDATE

    Newsletter. June 4, 2020

    Deborah Bickel – In residence in San Miguel

    Private hospital care services for COVID patients are soon going to run out.



    The time has come to face some hard truths we were only beginning to suspect two weeks ago when I last wrote the May 19th newsletter for Be Well San Miguel. A group of us met Sunday the 3rd, , all of us health care professionals Mexican, Canadian and American. We have a growing concern that there will be very few to none private or public hospital beds remaining as the pandemic continues to infect far more people than the health care system can support. We knew we would have to begin talking about home care options for COVID patients.



    San Miguel is no longer a quiet pocket relatively untouched by the virus.


    Despite what may appear, an opening declared by an astute appraisal of the data on the pandemic, is alarmingly an opening at the peak or possibly before the peak of the epidemic driven by economic and political need. Now more than ever you need to stay at home. Wear masks outside and do your best to keep social distancing. It is now more important than ever.



    All Hospitals in Queretaro are full and working at maximum capacity.


    As you know, no hospital here in SMA takes COVID patients other than to stabilize them and to transport them to higher level facilities. What you didn’t know is that there are are no private hospital beds in Queretaro, as it is now at maximum capacity. As of June 1 there was still room in Celaya. MAC hospital was about half full according to physician sources. There are other good hospitals in Celaya and we are checking for their census. Given the demand in Queretaro and the rising peak of the pandemic combined with the government opening, those hospitals will soon fill up.



    The public hospital for COVID in Leon is full and it is unclear what will happen to the growing number of San Miguel residents that have COVID. Some have died. Surprisingly, a high number of the deaths were of young people with no chronic diseases.



    The Government is ignoring its own data contradicting the sentinel data projections.



    It is indeed puzzling that government health advisors chose to ignore long standing data systems collected routinely, contrary to what is being reported in the Sentinel system. This real life data gave evidence of a pandemic as of yet unplanned for with a far greater impact than predicted and a much greater need of workers, beds, PPE, testing etc. The Sentinel data system is based on faulty and far too limited testing on one out of 10 sick people and those in the hospital who have all signs and symptoms of the virus. A troubling trend is that as the international health journals identify far more symptoms of COVID that would qualify a patient for testing. These are not yet part of the protocol for identifying COVID, hence many who should be tested are not. These figures are coupled with an unreliable multiplier now demonstrated to be far too low. The official multiplier is 1 positive case equals 8. Many health workers state anonymously that the figure should be closer to 15.


    For whatever reasons, government health advisors chose to ignore their own data based on real data conflicting with what was being reported in the Sentinel system. This other data gave evidence of a far greater impact of the disease and predicted serious shortages of workers, beds, ICUs, personal protective equipment (PPE), testing and contact tracing. This data would discredit the rhetoric and data reported to both Mexican and International press, including those outlets reporting via Web and Facebook.



    Reporting from late June 3rd from the Washingon Post concludes:



    Mexico’s government maintains that it is trying to balance public
    health concerns and the economic needs of the large low-income
    population. Critics say authorities failed to communicate the gravity
    of the challenge early on, and took a huge risk in not testing more of
    the population. Many worry whether the fragile health-care system can
    hold up.



    There is now very good evidence of the undercounting in the academic journals as well as foreign press that no lessons nor change in strategies came out of the catastrophic events in Mexico City at the onset of the epidemic. One of the best articles is https://datos.nexos.com.mx/?p=1388 . For those that don’t speak Spanish at a minimum look at the graphic comparing death rates in 2019 in this same time period to those in 2020.



    All official Mexican data sources report that we have not reached the peak of the epidemic. Locally and nationally it is still rising and there will not be enough ICUs, ventilators or even hospital rooms at this point and a worse shortage now and in the near future.



    Home based care for COVID



    We as an informal health provider group decided we needed to offer resources for home COVID care. We have information on getting various key equipment and are searching for nurses that might be willing and able to care for patients in their homes. We are searching for appropriate personal protection gear for those nurses. This home care will be more expensive than usual due to the cost of PPE (protective equipment), the risk involved, and the telemedicine guidance by Dr. Emilio Ramirez.



    We have also identified a new medical service: “Unidad Medica GC”, about 15 minutes out of town toward Queretaro with very high quality ambulances for those who are unable to reach the Red Cross and need transport for stabilization. They can stabilize you onsite and provide transport from their facility to your home. Here is a link to their web site: https://medicagc.mx/#contacto



    Juan Soria, head of our own nursing services at Be Well, is considering making our nurses available for home care. Because the care is 24 hour, nurse availability will be limited. Many of our nurses work at the General Hospital as well, so their ability to work extra hours is limited. Anyone with COVID who will want to use their services would have to pay for their protective equipment gear, called PPE. UNIDAD MEDICA does have nursing care in the home for COVID, but it is limited. We are looking for more nurses willing to provide care.



    Gearing up for providing home based care is a work in process and we are forming a Home Care Team out of a larger informal group of physicians and hope to include several specialties that may be needed for consultations, including cardiologists, psychiatrists, pulmonologists, intensive care and infectious disease specialists.



    Palliative care kit



    Dr. Ramirez is going to prepare several boxes of drugs that can alleviate the most severe panic and fear accompanying severe shortness of breath. These will be distributed as needed to our patients. Our hope is that there will be nurses to assist, but if not, they can be taken without assistance, as long as you aquatint yourself with them before any crisis. We will be available to offer support by telemedicine.



    Critical Resource Book for Home based COVID care


    The Best and only Resource Book for extranjeros waiting out the pandemic in San Miquel Allende is the Home Based Care Book by Kate Greenaway. We are lucky to have her and the handbook as she is a nurse and international health worker with years of experience working with HIV/AIDS in Africa and is a seasoned writer of health materials. I have attached the book to newsletters before, but will attach a link again as it is full of vital information to read NOW, before you need it. It is not long, and each page is rich in useful material



    A quote from Kate:

    Stay vigilant. Stay safe. Keep the faith. One day at a time. The virus is really here now, anywhere and everywhere. Of the 30 cases we’ve identified so far, 27 of them have been “community spread” – which means the patient has no history of travel, no contact with a known COVID-19 case. The infection was picked up somewhere in our community. The patient has no idea where they picked up the infection.



    Finally, if you haven’t already, prepare yourself for the possibility of illness and plan to care for yourself, at home. The vast majority of Covid-19 patients recover at home. But please know that it’s not easy. For many, this is NOT a minor illness. And because it’s so contagious, you will need to be as independent with self-care as possible.



    Accept that there is no rational reason to open up now and that the country has limited resources and is unprepared for the health consequences of the decisions being made now. These decisions are shaped by bad data and are the result of extraordinary pressure internally and from the United States to get both countries producing what is necessary to mutual economic survival with little attention paid to the human toll.



    Stay home, and if you get sick call Be Well.

    Sue Leonard: 415 103 3952
    Deborah Bickel: 415 115 7815




    As I stated in the last newsletter things change on a dime. Or far better said by Robert Frost “what the morning knows the afternoon never suspected”


    Reported by Deborah Bickel from San Miguel de Allende











    Home Care Guide

    Click to Download

    This Guide was developed to support adults with COVID-19 illness (suspected or confirmed) who aim to stay home for the duration of their illness, and their caregivers. It does not replace medical advice and other forms of professional support. We urge each of you living alone to identify someone who can assist you and speak for you if you get very sick. They may not be able to be with you but can help you get things you need and leave them outside the door. It is a short but rich resource for everyone sheltering at home.




    Identified sources of oxygen tanks

    Oxigenos Infra has available tanks. Currently they have 5, but they bring in tanks as needed daily. They provide all the needed equipment. The tank has a regulator indicating when to call for a replacement. Phone 415-121-1713

    Oxígeno Medicinal has concentrators. They have a limited number which are rented by the month. Right now they have 3 which are likely to be returned today, for example, and would need 24 hours to service and disinfect. They provide all the needed equipment. Phone
    415-119-5316.



    Messengers, English speaking

    Nathan 415 149 9092

    Arturo kulander 415 1151885 ,



    Michelle Thorne 415 100 28 20

    Jorge Zamundio and Priscella Zamundio (Priscella speaks excellent English and arranges pick up and deliveries for Jorge) 415 115 6258



    For more information, contact Deborah Bickel, PA MPH at
    415-1157815
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