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The Rules of Pacers Digest
Hello everyone,
Whether your are a long standing forum member or whether you have just registered today, it's a good idea to read and review the rules below so that you have a very good idea of what to expect when you come to Pacers Digest.
A quick note to new members: Your posts will not immediately show up when you make them. An administrator has to approve at least your first post before the forum software will later upgrade your account to the status of a fully-registered member. This usually happens within a couple of hours or so after your post(s) is/are approved, so you may need to be a little patient at first.
Why do we do this? So that it's more difficult for spammers (be they human or robot) to post, and so users who are banned cannot immediately re-register and start dousing people with verbal flames.
Below are the rules of Pacers Digest. After you have read them, you will have a very good sense of where we are coming from, what we expect, what we don't want to see, and how we react to things.
Rule #1
Pacers Digest is intended to be a place to discuss basketball without having to deal with the kinds of behaviors or attitudes that distract people from sticking with the discussion of the topics at hand. These unwanted distractions can come in many forms, and admittedly it can sometimes be tricky to pin down each and every kind that can rear its ugly head, but we feel that the following examples and explanations cover at least a good portion of that ground and should at least give people a pretty good idea of the kinds of things we actively discourage:
"Anyone who __________ is a liar / a fool / an idiot / a blind homer / has their head buried in the sand / a blind hater / doesn't know basketball / doesn't watch the games"
"People with intelligence will agree with me when I say that __________"
"Only stupid people think / believe / do ___________"
"I can't wait to hear something from PosterX when he/she sees that **insert a given incident or current event that will have probably upset or disappointed PosterX here**"
"He/she is just delusional"
"This thread is stupid / worthless / embarrassing"
"I'm going to take a moment to point and
/ laugh at PosterX / GroupOfPeopleY who thought / believed *insert though/belief here*"
"Remember when PosterX said OldCommentY that no longer looks good?"
In general, if a comment goes from purely on topic to something 'ad hominem' (personal jabs, personal shots, attacks, flames, however you want to call it, towards a person, or a group of people, or a given city/state/country of people), those are most likely going to be found intolerable.
We also dissuade passive aggressive behavior. This can be various things, but common examples include statements that are basically meant to imply someone is either stupid or otherwise incapable of holding a rational conversation. This can include (but is not limited to) laughing at someone's conclusions rather than offering an honest rebuttal, asking people what game they were watching, or another common problem is Poster X will say "that player isn't that bad" and then Poster Y will say something akin to "LOL you think that player is good". We're not going to tolerate those kinds of comments out of respect for the community at large and for the sake of trying to just have an honest conversation.
Now, does the above cover absolutely every single kind of distraction that is unwanted? Probably not, but you should by now have a good idea of the general types of things we will be discouraging. The above examples are meant to give you a good feel for / idea of what we're looking for. If something new or different than the above happens to come along and results in the same problem (that being, any other attitude or behavior that ultimately distracts from actually just discussing the topic at hand, or that is otherwise disrespectful to other posters), we can and we will take action to curb this as well, so please don't take this to mean that if you managed to technically avoid saying something exactly like one of the above examples that you are then somehow off the hook.
That all having been said, our goal is to do so in a generally kind and respectful way, and that doesn't mean the moment we see something we don't like that somebody is going to be suspended or banned, either. It just means that at the very least we will probably say something about it, quite possibly snipping out the distracting parts of the post in question while leaving alone the parts that are actually just discussing the topics, and in the event of a repeating or excessive problem, then we will start issuing infractions to try to further discourage further repeat problems, and if it just never seems to improve, then finally suspensions or bans will come into play. We would prefer it never went that far, and most of the time for most of our posters, it won't ever have to.
A slip up every once and a while is pretty normal, but, again, when it becomes repetitive or excessive, something will be done. Something occasional is probably going to be let go (within reason), but when it starts to become habitual or otherwise a pattern, odds are very good that we will step in.
There's always a small minority that like to push people's buttons and/or test their own boundaries with regards to the administrators, and in the case of someone acting like that, please be aware that this is not a court of law, but a private website run by people who are simply trying to do the right thing as they see it. If we feel that you are a special case that needs to be dealt with in an exceptional way because your behavior isn't explicitly mirroring one of our above examples of what we generally discourage, we can and we will take atypical action to prevent this from continuing if you are not cooperative with us.
Also please be aware that you will not be given a pass simply by claiming that you were 'only joking,' because quite honestly, when someone really is just joking, for one thing most people tend to pick up on the joke, including the person or group that is the target of the joke, and for another thing, in the event where an honest joke gets taken seriously and it upsets or angers someone, the person who is truly 'only joking' will quite commonly go out of his / her way to apologize and will try to mend fences. People who are dishonest about their statements being 'jokes' do not do so, and in turn that becomes a clear sign of what is really going on. It's nothing new.
In any case, quite frankly, the overall quality and health of the entire forum's community is more important than any one troublesome user will ever be, regardless of exactly how a problem is exhibiting itself, and if it comes down to us having to make a choice between you versus the greater health and happiness of the entire community, the community of this forum will win every time.
Lastly, there are also some posters, who are generally great contributors and do not otherwise cause any problems, who sometimes feel it's their place to provoke or to otherwise 'mess with' that small minority of people described in the last paragraph, and while we possibly might understand why you might feel you WANT to do something like that, the truth is we can't actually tolerate that kind of behavior from you any more than we can tolerate the behavior from them. So if we feel that you are trying to provoke those other posters into doing or saying something that will get themselves into trouble, then we will start to view you as a problem as well, because of the same reason as before: The overall health of the forum comes first, and trying to stir the pot with someone like that doesn't help, it just makes it worse. Some will simply disagree with this philosophy, but if so, then so be it because ultimately we have to do what we think is best so long as it's up to us.
If you see a problem that we haven't addressed, the best and most appropriate course for a forum member to take here is to look over to the left of the post in question. See underneath that poster's name, avatar, and other info, down where there's a little triangle with an exclamation point (!) in it? Click that. That allows you to report the post to the admins so we can definitely notice it and give it a look to see what we feel we should do about it. Beyond that, obviously it's human nature sometimes to want to speak up to the poster in question who has bothered you, but we would ask that you try to refrain from doing so because quite often what happens is two or more posters all start going back and forth about the original offending post, and suddenly the entire thread is off topic or otherwise derailed. So while the urge to police it yourself is understandable, it's best to just report it to us and let us handle it. Thank you!
All of the above is going to be subject to a case by case basis, but generally and broadly speaking, this should give everyone a pretty good idea of how things will typically / most often be handled.
Rule #2
If the actions of an administrator inspire you to make a comment, criticism, or express a concern about it, there is a wrong place and a couple of right places to do so.
The wrong place is to do so in the original thread in which the administrator took action. For example, if a post gets an infraction, or a post gets deleted, or a comment within a larger post gets clipped out, in a thread discussing Paul George, the wrong thing to do is to distract from the discussion of Paul George by adding your off topic thoughts on what the administrator did.
The right places to do so are:
A) Start a thread about the specific incident you want to talk about on the Feedback board. This way you are able to express yourself in an area that doesn't throw another thread off topic, and this way others can add their two cents as well if they wish, and additionally if there's something that needs to be said by the administrators, that is where they will respond to it.
B) Send a private message to the administrators, and they can respond to you that way.
If this is done the wrong way, those comments will be deleted, and if it's a repeating problem then it may also receive an infraction as well.
Rule #3
If a poster is bothering you, and an administrator has not or will not deal with that poster to the extent that you would prefer, you have a powerful tool at your disposal, one that has recently been upgraded and is now better than ever: The ability to ignore a user.
When you ignore a user, you will unfortunately still see some hints of their existence (nothing we can do about that), however, it does the following key things:
A) Any post they make will be completely invisible as you scroll through a thread.
B) The new addition to this feature: If someone QUOTES a user you are ignoring, you do not have to read who it was, or what that poster said, unless you go out of your way to click on a link to find out who it is and what they said.
To utilize this feature, from any page on Pacers Digest, scroll to the top of the page, look to the top right where it says 'Settings' and click that. From the settings page, look to the left side of the page where it says 'My Settings', and look down from there until you see 'Edit Ignore List' and click that. From here, it will say 'Add a Member to Your List...' Beneath that, click in the text box to the right of 'User Name', type in or copy & paste the username of the poster you are ignoring, and once their name is in the box, look over to the far right and click the 'Okay' button. All done!
Rule #4
Regarding infractions, currently they carry a value of one point each, and that point will expire in 31 days. If at any point a poster is carrying three points at the same time, that poster will be suspended until the oldest of the three points expires.
Rule #5
When you share or paste content or articles from another website, you must include the URL/link back to where you found it, who wrote it, and what website it's from. Said content will be removed if this doesn't happen.
An example:
If I copy and paste an article from the Indianapolis Star website, I would post something like this:
http://www.linktothearticlegoeshere.com/article
Title of the Article
Author's Name
Indianapolis Star
Rule #6
We cannot tolerate illegal videos on Pacers Digest. This means do not share any links to them, do not mention any websites that host them or link to them, do not describe how to find them in any way, and do not ask about them. Posts doing anything of the sort will be removed, the offenders will be contacted privately, and if the problem becomes habitual, you will be suspended, and if it still persists, you will probably be banned.
The legal means of watching or listening to NBA games are NBA League Pass Broadband (for US, or for International; both cost money) and NBA Audio League Pass (which is free). Look for them on NBA.com.
Rule #7
Provocative statements in a signature, or as an avatar, or as the 'tagline' beneath a poster's username (where it says 'Member' or 'Administrator' by default, if it is not altered) are an unwanted distraction that will more than likely be removed on sight. There can be shades of gray to this, but in general this could be something political or religious that is likely going to provoke or upset people, or otherwise something that is mean-spirited at the expense of a poster, a group of people, or a population.
It may or may not go without saying, but this goes for threads and posts as well, particularly when it's not made on the off-topic board (Market Square).
We do make exceptions if we feel the content is both innocuous and unlikely to cause social problems on the forum (such as wishing someone a Merry Christmas or a Happy Easter), and we also also make exceptions if such topics come up with regards to a sports figure (such as the Lance Stephenson situation bringing up discussions of domestic abuse and the law, or when Jason Collins came out as gay and how that lead to some discussion about gay rights).
However, once the discussion seems to be more/mostly about the political issues instead of the sports figure or his specific situation, the thread is usually closed.
Rule #8
We prefer self-restraint and/or modesty when making jokes or off topic comments in a sports discussion thread. They can be fun, but sometimes they derail or distract from a topic, and we don't want to see that happen. If we feel it is a problem, we will either delete or move those posts from the thread.
Rule #9
Generally speaking, we try to be a "PG-13" rated board, and we don't want to see sexual content or similarly suggestive content. Vulgarity is a more muddled issue, though again we prefer things to lean more towards "PG-13" than "R". If we feel things have gone too far, we will step in.
Rule #10
We like small signatures, not big signatures. The bigger the signature, the more likely it is an annoying or distracting signature.
Rule #11
Do not advertise anything without talking about it with the administrators first. This includes advertising with your signature, with your avatar, through private messaging, and/or by making a thread or post.
Whether your are a long standing forum member or whether you have just registered today, it's a good idea to read and review the rules below so that you have a very good idea of what to expect when you come to Pacers Digest.
A quick note to new members: Your posts will not immediately show up when you make them. An administrator has to approve at least your first post before the forum software will later upgrade your account to the status of a fully-registered member. This usually happens within a couple of hours or so after your post(s) is/are approved, so you may need to be a little patient at first.
Why do we do this? So that it's more difficult for spammers (be they human or robot) to post, and so users who are banned cannot immediately re-register and start dousing people with verbal flames.
Below are the rules of Pacers Digest. After you have read them, you will have a very good sense of where we are coming from, what we expect, what we don't want to see, and how we react to things.
Rule #1
Pacers Digest is intended to be a place to discuss basketball without having to deal with the kinds of behaviors or attitudes that distract people from sticking with the discussion of the topics at hand. These unwanted distractions can come in many forms, and admittedly it can sometimes be tricky to pin down each and every kind that can rear its ugly head, but we feel that the following examples and explanations cover at least a good portion of that ground and should at least give people a pretty good idea of the kinds of things we actively discourage:
"Anyone who __________ is a liar / a fool / an idiot / a blind homer / has their head buried in the sand / a blind hater / doesn't know basketball / doesn't watch the games"
"People with intelligence will agree with me when I say that __________"
"Only stupid people think / believe / do ___________"
"I can't wait to hear something from PosterX when he/she sees that **insert a given incident or current event that will have probably upset or disappointed PosterX here**"
"He/she is just delusional"
"This thread is stupid / worthless / embarrassing"
"I'm going to take a moment to point and
/ laugh at PosterX / GroupOfPeopleY who thought / believed *insert though/belief here*""Remember when PosterX said OldCommentY that no longer looks good?
"In general, if a comment goes from purely on topic to something 'ad hominem' (personal jabs, personal shots, attacks, flames, however you want to call it, towards a person, or a group of people, or a given city/state/country of people), those are most likely going to be found intolerable.
We also dissuade passive aggressive behavior. This can be various things, but common examples include statements that are basically meant to imply someone is either stupid or otherwise incapable of holding a rational conversation. This can include (but is not limited to) laughing at someone's conclusions rather than offering an honest rebuttal, asking people what game they were watching, or another common problem is Poster X will say "that player isn't that bad" and then Poster Y will say something akin to "LOL you think that player is good". We're not going to tolerate those kinds of comments out of respect for the community at large and for the sake of trying to just have an honest conversation.
Now, does the above cover absolutely every single kind of distraction that is unwanted? Probably not, but you should by now have a good idea of the general types of things we will be discouraging. The above examples are meant to give you a good feel for / idea of what we're looking for. If something new or different than the above happens to come along and results in the same problem (that being, any other attitude or behavior that ultimately distracts from actually just discussing the topic at hand, or that is otherwise disrespectful to other posters), we can and we will take action to curb this as well, so please don't take this to mean that if you managed to technically avoid saying something exactly like one of the above examples that you are then somehow off the hook.
That all having been said, our goal is to do so in a generally kind and respectful way, and that doesn't mean the moment we see something we don't like that somebody is going to be suspended or banned, either. It just means that at the very least we will probably say something about it, quite possibly snipping out the distracting parts of the post in question while leaving alone the parts that are actually just discussing the topics, and in the event of a repeating or excessive problem, then we will start issuing infractions to try to further discourage further repeat problems, and if it just never seems to improve, then finally suspensions or bans will come into play. We would prefer it never went that far, and most of the time for most of our posters, it won't ever have to.
A slip up every once and a while is pretty normal, but, again, when it becomes repetitive or excessive, something will be done. Something occasional is probably going to be let go (within reason), but when it starts to become habitual or otherwise a pattern, odds are very good that we will step in.
There's always a small minority that like to push people's buttons and/or test their own boundaries with regards to the administrators, and in the case of someone acting like that, please be aware that this is not a court of law, but a private website run by people who are simply trying to do the right thing as they see it. If we feel that you are a special case that needs to be dealt with in an exceptional way because your behavior isn't explicitly mirroring one of our above examples of what we generally discourage, we can and we will take atypical action to prevent this from continuing if you are not cooperative with us.
Also please be aware that you will not be given a pass simply by claiming that you were 'only joking,' because quite honestly, when someone really is just joking, for one thing most people tend to pick up on the joke, including the person or group that is the target of the joke, and for another thing, in the event where an honest joke gets taken seriously and it upsets or angers someone, the person who is truly 'only joking' will quite commonly go out of his / her way to apologize and will try to mend fences. People who are dishonest about their statements being 'jokes' do not do so, and in turn that becomes a clear sign of what is really going on. It's nothing new.
In any case, quite frankly, the overall quality and health of the entire forum's community is more important than any one troublesome user will ever be, regardless of exactly how a problem is exhibiting itself, and if it comes down to us having to make a choice between you versus the greater health and happiness of the entire community, the community of this forum will win every time.
Lastly, there are also some posters, who are generally great contributors and do not otherwise cause any problems, who sometimes feel it's their place to provoke or to otherwise 'mess with' that small minority of people described in the last paragraph, and while we possibly might understand why you might feel you WANT to do something like that, the truth is we can't actually tolerate that kind of behavior from you any more than we can tolerate the behavior from them. So if we feel that you are trying to provoke those other posters into doing or saying something that will get themselves into trouble, then we will start to view you as a problem as well, because of the same reason as before: The overall health of the forum comes first, and trying to stir the pot with someone like that doesn't help, it just makes it worse. Some will simply disagree with this philosophy, but if so, then so be it because ultimately we have to do what we think is best so long as it's up to us.
If you see a problem that we haven't addressed, the best and most appropriate course for a forum member to take here is to look over to the left of the post in question. See underneath that poster's name, avatar, and other info, down where there's a little triangle with an exclamation point (!) in it? Click that. That allows you to report the post to the admins so we can definitely notice it and give it a look to see what we feel we should do about it. Beyond that, obviously it's human nature sometimes to want to speak up to the poster in question who has bothered you, but we would ask that you try to refrain from doing so because quite often what happens is two or more posters all start going back and forth about the original offending post, and suddenly the entire thread is off topic or otherwise derailed. So while the urge to police it yourself is understandable, it's best to just report it to us and let us handle it. Thank you!
All of the above is going to be subject to a case by case basis, but generally and broadly speaking, this should give everyone a pretty good idea of how things will typically / most often be handled.
Rule #2
If the actions of an administrator inspire you to make a comment, criticism, or express a concern about it, there is a wrong place and a couple of right places to do so.
The wrong place is to do so in the original thread in which the administrator took action. For example, if a post gets an infraction, or a post gets deleted, or a comment within a larger post gets clipped out, in a thread discussing Paul George, the wrong thing to do is to distract from the discussion of Paul George by adding your off topic thoughts on what the administrator did.
The right places to do so are:
A) Start a thread about the specific incident you want to talk about on the Feedback board. This way you are able to express yourself in an area that doesn't throw another thread off topic, and this way others can add their two cents as well if they wish, and additionally if there's something that needs to be said by the administrators, that is where they will respond to it.
B) Send a private message to the administrators, and they can respond to you that way.
If this is done the wrong way, those comments will be deleted, and if it's a repeating problem then it may also receive an infraction as well.
Rule #3
If a poster is bothering you, and an administrator has not or will not deal with that poster to the extent that you would prefer, you have a powerful tool at your disposal, one that has recently been upgraded and is now better than ever: The ability to ignore a user.
When you ignore a user, you will unfortunately still see some hints of their existence (nothing we can do about that), however, it does the following key things:
A) Any post they make will be completely invisible as you scroll through a thread.
B) The new addition to this feature: If someone QUOTES a user you are ignoring, you do not have to read who it was, or what that poster said, unless you go out of your way to click on a link to find out who it is and what they said.
To utilize this feature, from any page on Pacers Digest, scroll to the top of the page, look to the top right where it says 'Settings' and click that. From the settings page, look to the left side of the page where it says 'My Settings', and look down from there until you see 'Edit Ignore List' and click that. From here, it will say 'Add a Member to Your List...' Beneath that, click in the text box to the right of 'User Name', type in or copy & paste the username of the poster you are ignoring, and once their name is in the box, look over to the far right and click the 'Okay' button. All done!
Rule #4
Regarding infractions, currently they carry a value of one point each, and that point will expire in 31 days. If at any point a poster is carrying three points at the same time, that poster will be suspended until the oldest of the three points expires.
Rule #5
When you share or paste content or articles from another website, you must include the URL/link back to where you found it, who wrote it, and what website it's from. Said content will be removed if this doesn't happen.
An example:
If I copy and paste an article from the Indianapolis Star website, I would post something like this:
http://www.linktothearticlegoeshere.com/article
Title of the Article
Author's Name
Indianapolis Star
Rule #6
We cannot tolerate illegal videos on Pacers Digest. This means do not share any links to them, do not mention any websites that host them or link to them, do not describe how to find them in any way, and do not ask about them. Posts doing anything of the sort will be removed, the offenders will be contacted privately, and if the problem becomes habitual, you will be suspended, and if it still persists, you will probably be banned.
The legal means of watching or listening to NBA games are NBA League Pass Broadband (for US, or for International; both cost money) and NBA Audio League Pass (which is free). Look for them on NBA.com.
Rule #7
Provocative statements in a signature, or as an avatar, or as the 'tagline' beneath a poster's username (where it says 'Member' or 'Administrator' by default, if it is not altered) are an unwanted distraction that will more than likely be removed on sight. There can be shades of gray to this, but in general this could be something political or religious that is likely going to provoke or upset people, or otherwise something that is mean-spirited at the expense of a poster, a group of people, or a population.
It may or may not go without saying, but this goes for threads and posts as well, particularly when it's not made on the off-topic board (Market Square).
We do make exceptions if we feel the content is both innocuous and unlikely to cause social problems on the forum (such as wishing someone a Merry Christmas or a Happy Easter), and we also also make exceptions if such topics come up with regards to a sports figure (such as the Lance Stephenson situation bringing up discussions of domestic abuse and the law, or when Jason Collins came out as gay and how that lead to some discussion about gay rights).
However, once the discussion seems to be more/mostly about the political issues instead of the sports figure or his specific situation, the thread is usually closed.
Rule #8
We prefer self-restraint and/or modesty when making jokes or off topic comments in a sports discussion thread. They can be fun, but sometimes they derail or distract from a topic, and we don't want to see that happen. If we feel it is a problem, we will either delete or move those posts from the thread.
Rule #9
Generally speaking, we try to be a "PG-13" rated board, and we don't want to see sexual content or similarly suggestive content. Vulgarity is a more muddled issue, though again we prefer things to lean more towards "PG-13" than "R". If we feel things have gone too far, we will step in.
Rule #10
We like small signatures, not big signatures. The bigger the signature, the more likely it is an annoying or distracting signature.
Rule #11
Do not advertise anything without talking about it with the administrators first. This includes advertising with your signature, with your avatar, through private messaging, and/or by making a thread or post.
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Another antibodies study. This time Miami.
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So you really think CBS, ABC and NBC are not liberal? Show me links where they praise Trump. I will respond with what I can find with them criticizing him.Originally posted by vapacersfan View Post
OK, I may have a hard time finding that since so much of what I post is to defend against the liberal onslaught from dozens of news outlets, far more than Fox. But I am sure I posted somewhere that Fox used to be pretty fair and balanced with programs like Hannity and Colmes where they debated things on an even playing field. Unfortunately it is now just Hannity and I agree there is a lot of bias while also exposing left wing bias.Originally posted by vapacersfan View Post
Just being real.Originally posted by vapacersfan View Post
I do just that. I take the bad with the good. I've said many, many times I am not a Trump fan and would LOVE to see him impeached and removed the day after he's re-elected. That's not being a good cult follower as some imply that I am. The main issue I have is the attacks he has endured.Originally posted by vapacersfan View Post
Just watch his rallies in the evening. All those liberal "reporters" focus on asking "gotcha questions" rather than delve into anything at all positive about everything he has done. Not one iota of anything positive from liberal MSM and most of the room is attacking him.
I'm fine with people disagreeing on everything except for the fact he is attacked viciously by the "reporters" and really on a day to day basis by MSM. This is the PRIME reason I will vote for him. The unfairness and extreme bias against him. I would vote for maybe half of the Democrats out there but-for the biased attacks on him throughout his first 3 years including the completely partisan impeachment.
So really, if the left had ever treated him fairly and nominated a half-way decent candidate, I wouldn't be voting for Trump in 2020. As it is, I know I will be voting for him and it has less to do with him and more to do with MSM.
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Just to be crystal clear...if you recall. Most people in the GOP were not happy Trump was nominated. John Kasich in particular didn't attend multiple Trump gatherings. Many people and I think even Mitch McConnell originally expressed displeasure.
The cold hard reality is that Trump and his cult followers had enough votes and took over the GOP. Most of the GOP are not pleased about that. It would be much like Bernie taking over the Democratic Party but the Dems would never allow it with their super delegate fix to their system. See, this is why many of us on the right would be pleased to see him impeached and removed and replaced with Mike Pence.
Yet most of you (looking at you V, dal9, vapacerfan, etc) will either not read this post, understand it or admit it's true. You will lump everyone in as a cult follower when a lot of us just hate the MSM and the complete bias more than we dislike Trump. But go ahead with your narrative. I get it. It's easy to avoid the messy truths...Comment
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Just embrace it man don't be ashamed.Originally posted by BlueNGold View Post@WhatTheFFacts: Studies show that sarcasm enhances the ability of the human mind to solve complex problems!
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You're voting for Biden, right? Just embrace him.Originally posted by vnzla81 View Post
Of course you might need to pull him off the latest woman he's groping.Comment
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from vapf's tweet, pretty ****ed if true
Young and middle-aged people, barely sick with covid-19, are dying from strokes
Doctors sound alarm about patients in their 30s and 40s left debilitated or dead. Some didn’t even know they were infected.
April 24, 2020 at 6:36 p.m. EDT
Please Note
The Washington Post is providing this important information about the coronavirus for free. For more free coverage of the coronavirus pandemic, sign up for our daily Coronavirus Updates newsletter where all stories are free to read.
Thomas Oxley wasn’t even on call the day he received the page to come to Mount Sinai Beth Israel Hospital in Manhattan. There weren’t enough doctors to treat all the emergency stroke patients, and he was needed in the operating room.
The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head.
Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.
The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.
As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.
“This is crazy,” he remembers telling his boss.
Stroke surge
Reports of strokes in the young and middle-aged — not just at Mount Sinai, but also in many other hospitals in communities hit hard by the novel coronavirus — are the latest twist in our evolving understanding of its connected disease, covid-19. Even as the virus has infected nearly 2.8 million people worldwide and killed about 195,000 as of Friday, its biological mechanisms continue to elude top scientific minds. Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe — impacting nearly every major organ system in the body.
Until recently, there was little hard data on strokes and covid-19.
There was one report out of Wuhan, China, that showed that some hospitalized patients had experienced strokes, with many being seriously ill and elderly. But the linkage was considered more of “a clinical hunch by a lot of really smart people,” said Sherry H-Y Chou, a University of Pittsburgh Medical Center neurologist and critical care doctor.
Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon. The numbers are small, only a few dozen per location, but they provide new insights into what the virus does to our bodies.
A stroke, which is a sudden interruption the blood supply, is a complex problem with numerous causes and presentations. It can be caused by heart problems, clogged arteries due to cholesterol, even substance abuse. Mini-strokes often don’t cause permanent damage and can resolve on their own within 24 hours. But bigger ones can be catastrophic.
The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke. Known as large vessel occlusions, or LVOs, they can obliterate large parts of the brain responsible for movement, speech and decision-making in one blow because they are in the main blood-supplying arteries.
Many researchers suspect strokes in covid-19 patients may be a direct consequence of blood problems that are producing clots all over some people’s bodies.
Clots that form on vessel walls fly upward. One that started in the calves might migrate to the lungs, causing a blockage called a pulmonary embolism that arrests breathing — a known cause of death in covid-19 patients. Clots in or near the heart might lead to a heart attack, another common cause of death. Anything above that would probably go to the brain, leading to a stroke.
Robert Stevens, a critical care doctor at Johns Hopkins Hospital in Baltimore, called strokes “one of the most dramatic manifestations” of the blood-clotting issues. “We’ve also taken care of patients in their 30s with stroke and covid, and this was extremely surprising,” he said.
As coronavirus hospitalizations in New York began to peak in April, emergency medicine physician Howard Greller recorded his reflections. (Whitney Leaming/The Washington Post)
Many doctors expressed worry that as the New York City Fire Department was picking up four times as many people who died at home as normal during the peak of infection that some of the dead had suffered sudden strokes. The truth may never be known because few autopsies were conducted.
Chou said one question is whether the clotting is because of a direct attack on the blood vessels, or a “friendly-fire problem” caused by the patient’s immune response.
“In your body’s attempt to fight off the virus, does the immune response end up hurting your brain?” she asked. Chou is hoping to answer such questions through a review of strokes and other neurological complications in thousands of covid-19 patients treated at 68 medical centers in 17 countries.
Thomas Jefferson University Hospitals, which operates 14 medical centers in Philadelphia, and NYU Langone Health in New York City, found that 12 of their patients treated for large blood blockages in their brains during a three-week period had the virus. Forty percent were under 50, and they had few or no risk factors. Their paper is under review by a medical journal, said Pascal Jabbour, a neurosurgeon at Thomas Jefferson.
Jabbour and his co-author Eytan Raz, an assistant professor of neuroradiology at NYU Langone, said that strokes in covid-19 patients challenge conventional thinking. “We are used to thinking of 60 as a young patient when it comes to large vessel occlusions,” Raz said of the deadliest strokes. “We have never seen so many in their 50s, 40s and late 30s.”
Raz wondered whether they are seeing more young patients because they are more resistant than the elderly to the respiratory distress caused by covid-19: “So they survive the lung side, and in time develop other issues.”
Jabbour said many cases he has treated have unusual characteristics. Brain clots usually appear in the arteries, which carry blood away from the heart. But in covid-19 patients, he is also seeing them in the veins, which carry blood in the opposite direction and are trickier to treat. Some patients are also developing more than one large clot in their heads, which is highly unusual.
“We’ll be treating a blood vessel and it will go fine, but then the patient will have a major stroke” because of a clot in another part of the brain, he said.
The 33-year-old
At Mount Sinai, the largest medical system in New York City, physician-researcher J Mocco said the number of patients coming in with large blood blockages in their brains doubled during the three weeks of the covid-19 surge to more than 32, even as the number of other emergencies fell. More than half of were covid-19 positive.
It isn’t just the number of patients that was unusual. The first wave of the pandemic has hit the elderly and those with heart disease, diabetes, obesity or other preexisting conditions disproportionately. The covid-19 patients treated for stroke at Mount Sinai were younger and mostly without risk factors.
On average, the covid-19 stroke patients were 15 years younger than stroke patients without the virus.
“These are people among the least likely statistically to have a stroke,” Mocco said.
A warning from a young patient who wound up in the ICU | Voices from the Pandemic
"This is real. Even if you think you're healthy, it knocks you down," said Janet Mendez, 33, a patient at Mount Sinai Brooklyn Hospital. (Jorge Ribas/The Washington Post)
Mocco, who has spent his career studying strokes and how to treat them, said he was “completely shocked” by the analysis. He noted the link between covid-19 and stroke “is one of the clearest and most profound correlations I’ve come across.”
“This is much too powerful of a signal to be chance or happenstance,” he said.
In a letter to be published in the New England Journal of Medicine next week, the Mount Sinai team details five case studies of young patients who had strokes at home from March 23 to April 7. They make for difficult reading: The victims’ ages are 33, 37, 39, 44 and 49, and they were all home when they began to experience sudden symptoms, including slurred speech, confusion, drooping on one side of the face and a dead feeling in one arm.
One died, two are still hospitalized, one was released to rehabilitation, and one was released home to the care of his brother. Only one of the five, a 33-year-old woman, is able to speak.
Oxley, the interventional neurologist, said one striking aspect of the cases is how long many waited before seeking emergency care.
The 33-year-old woman was previously healthy but had a cough and headache for about a week. Over the course of 28 hours, she noticed her speech was slurred and that she was going numb and weak on her left side but, the researchers wrote, “delayed seeking emergency care due to fear of the covid-19 outbreak.”
It turned out she was already infected.
By the time she arrived at the hospital, a CT scan showed she had two clots in her brain and patchy “ground glass” in her lungs — the opacity in CT scans that is a hallmark of covid-19 infection. She was given two different types of therapy to try to break up the clots and by Day 10, she was well enough to be discharged.
Oxley said the most important thing for people to understand is that large strokes are very treatable. Doctors are often able to reopen blocked blood vessels through techniques such as pulling out clots or inserting stents. But it has to be done quickly, ideally within six hours, but no longer than 24 hours: “The message we are trying to get out is if you have symptoms of stroke, you need to call the ambulance urgently. ”
As for the 44-year-old man Oxley was treating, doctors were able to remove the large clot that day in late March, but the patient is still struggling. As of this week, a little over a month after he arrived in the emergency room, he is still hospitalized.
Last edited by dal9; 04-25-2020, 12:12 PM.Comment
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The Mortuary Science Professor Who Came ‘Out of Nowhere’ to Help N.Y.C.
By Alexandra E. Petri
19-24 minutes
Credit...Stephen Speranza for The New York Times
With New York City funeral homes overwhelmed by the coronavirus, a professor from an upstate town has been transporting bodies so families don’t have to wait weeks for cremation services.
David Penepent walked into the back chapel of a funeral home in Queens on Thursday and surveyed a scene unthinkable before the coronavirus epidemic. Thirty people had been laid out in the chilled room, the bodies held in boxes made of cardboard and wood with “handle with extreme care” printed on the sides in bold, green letters.
One by one, Mr. Penepent, an associate professor of mortuary science, and two of his students wheeled the bodies out on church trucks, first lining them up in the hallway, then bringing them to two vans parked out front. With the help of the home’s staff, they gently laid the boxes in the back of one of the vehicles, the first step in a long journey to a crematory outside the state.
“This is not just moving remains — this is handling people’s loved ones,” Professor Penepent said. “And you have to do it with care and compassion, respect and dignity.”
Since early April, Professor Penepent, 57, and his students have been transporting decedents from overwhelmed funeral homes around New York City to crematories in places as far as Pennsylvania and Vermont, helping grieving families and taking some of the pressure off a system strained by the epidemic.
He calls the operation “Hands with A Heart.”
“It’s a godsend,” said Joe Neufeld Sr., the owner of the Gerard J. Neufeld Funeral Home in Queens, which is just blocks from Elmhurst Hospital Center in one of the hardest hit areas in the country. “He came out of nowhere to save us.”
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Nowhere was, in fact, a town near the Canadian border called Canton, N.Y., where Professor Penepent runs the funeral services administration program at the State University of New York at Canton.
New York State has registered more than 14,800 deaths because of the virus, about 70 percent of which are in New York City. Sandwiched between overflowing hospitals and backed up cemeteries, the city’s funeral homes are at maximum capacity, and the cases keep pouring in.
Of the 50 crematories across the state, only four are in the city, and they are struggling to keep up with demand. Slots are booked weeks in advance.
Easter weekend, Hands with A Heart moved about 70 bodies. Last week, using two vans, Professor Penepent transported 150. This week they expected to take 300.
As the death toll mounted in March, Professor Penepent began reaching out to trade organizations and funeral directors, offering to transport the dead to crematories in upstate New York and in neighboring states that were not seeing the same deluge of cases.
Mr. Neufeld, who did not know Professor Penepent but had heard of SUNY’s mortuary science program, said he was initially “leery and unsure how this was going to work.”
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The funeral homes remain in charge of removing bodies from hospitals, nursing homes or private residences and working with families to file the lengthy paperwork.
Professor Penepent gives each decedent a tracking number to monitor the body from the funeral home to the crematory and back again. They only work with the remains of people who have been identified and whose families have given approval.
They have made trips to crematories in Vermont, Pennsylvania and Connecticut. The remains have then been shipped back to the funeral homes for families to pick them up.
The New York State Funeral Directors Association and the Metropolitan Funeral Directors Association are covering expenses for the trips, Professor Penepent said.
On Good Friday, John D’Arienzo of D’Arienzo Funeral Home in Brooklyn sent the remains of five people to a crematory in Vermont through Hands with A Heart. The ashes were returned that Monday afternoon — much quicker than the three-week wait the families would have had to endure for a slot at a local crematory.
“Their loved ones are back in Brooklyn, secure and waiting for them to pick them up,” Mr. D’Arienzo said. “And I have nine other families that I am able to help because David lightened my workload.”
That same day, Hands with A Heart took 20 bodies from Mr. Neufeld’s funeral home for cremation out of state. They came again the next day to take 20 more.
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Professor Penepent, an outgoing man with a storehouse of jokes, answers his phone “Dr. Penepent” (he has a doctorate of philosophy) and uses expressions like “We’re all jiggy,” meaning “We are good to go.”
He does not come from a family of funeral directors. His father was a business owner and his mother a factory worker. As a youth, he liked drama and played the violin, a talent his father hoped would become a career.
Professor Penepent had other ideas. He considered becoming a priest. “It didn’t quite work out — my wife wouldn’t accept it,” he joked. He also thought about becoming a therapist. But when his grandmother died, he noticed how caring and compassionate the funeral director was. He discovered his vocation.
“Funeral directing is spiritual, holy work,” he said. “The families entrust in us their most prized possession: their loved one. And that is sacred.”
Professor Penepent got his license in 1993. The next year, he was a young director at The Leonard Memorial Funeral Home in Glen Ellyn, Ill., when a Chicago-bound airplane crashed in Roselawn, Ind., about 90 miles south of his town, killing 68 people on board.
Volunteers were called in to aid with recovery efforts. Mr. Penepent said he spent a week working at a makeshift morgue set up in an armory, processing human remains for identification. It was there that he learned the tracking system he is using today.
Though he wanted to own his own funeral home and bring his three children on board — “I had this whole legacy plan,” he said — they, too, had other ideas. Eventually, Professor Penepent found a home in SUNY at Canton, where he has worked for the past eight years.
Two of his students, Felicidad Christensen, 21, and Dylan Halmy, 20, have been putting in long days with Professor Penepent. “If I can handle this, I can handle anything the business might throw at me,” Ms. Christensen said.
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At 5:15 p.m. on Thursday, the three had loaded about 30 bodies into one of the vans, which Mr. Halmy, the other student-volunteer, would be driving to Pennsylvania alone.
Professor Penepent hopped into the other van. From a lunchbox on the seat beside him, he pulled out glassware with homemade Jell-O — strawberry-flavored, topped with Cool Whip. It is his favorite snack, and he had packed a double supply for the road. “This is the thing the kids talk about — ‘He’s quirky,’” he said. “I am quirky, and I love it.”
He and Ms. Christensen had one more pickup that night, which they planned to transport to a crematory in Connecticut early the next morning. Then it would be back to the city, where the work would start all over again. It would be exhausting, but Professor Penepent said he did not mind.
“The only thing I want is to know that families who are grieving are able to put their loved ones to rest and that we can bring a little bit of closure to a very tragic situation,” he said.
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In my personal opinion, Trump made a gaffe. Instead of swallowing his pride and admitting that he said something incorrect, he decided to play offense. So he says that it was intentional sarcasm to save face and to “own the libs”. This has been an ongoing theme with Donald J. Trump, and it makes it difficult to defend him. Not that I necessarily want to defend him, but I am trying to stay neutral and objective...Originally posted by vapacersfan View Post
Jim Acosta✔@Acosta
Cleanup on aisle six from the press secretary who says the media took Trump’s disinfectant comments “out of context.”
24K
4:41 PM - Apr 24, 2020Originally posted by Natston;n3510291Comment
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Gaffe? nah the guy is just as dumb as a rock.Originally posted by Natston View Post@WhatTheFFacts: Studies show that sarcasm enhances the ability of the human mind to solve complex problems!Comment
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Misspeaking is a human condition that afflicts everyone regardless of their intelligence. Leaders of all people should know how to react accordingly regardless of how dumb they are. This is a behavioral issue that doesn’t warrant much sympathy because he reaps what he sows...Originally posted by vnzla81 View PostOriginally posted by Natston;n3510291Comment
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check the date on this one too
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Speaking of avoiding messy truths.Originally posted by BlueNGold View Post
Find me one post where I called you a cult follower and I will give you my next paycheck (hint: you cant and wont).
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We are talking about the same guy that looked at a solar eclipse straight up, the same guy that said wind turbines cause cancer, the same guy that told us that Puerto Rico is an island surrounded by water, dumbest leader of a country right now and is not even close.Originally posted by Natston View Post@WhatTheFFacts: Studies show that sarcasm enhances the ability of the human mind to solve complex problems!Comment
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Quoting for emphasis.Originally posted by BlueNGold View Post
Its not a
rally. Its a press briefing from the HIGHEST ELECTED POLITICAL OFFICE about a MEDICAL PANDEMIC. The fact he has made them rallies (and the fact you openly accept them as rallies) is a problem
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