COVID19 Factors We Should Consider/Current Events COVID19 Factors We Should Consider/Current Events - Page 57

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    Quote Originally Posted by Mark Rippetoe View Post
    Which US hospitals have been "overwhelmed" and what does that look like?
    Currently the ones in NYC and other large cities are starting to become overwhelmed. There is a lack of supplies, PPEs, beds etc. That's what this looks like. What would be your thoughts when non covid patients contract it while in the hospital due to community spread. Certainly the lack of PPEs will only make this worse.


    Quote Originally Posted by Mark Rippetoe View Post
    Yes, the model was wrong. Wrong in your preferred direction, and badly wrong because of flawed assumptions, like models always have.
    Does this give you comfort that we are further along than we expected to be at the beginning of this outbreak? The worst is yet to come.


    Quote Originally Posted by Mark Rippetoe View Post
    Their worst case scenario is 1,382,926, which at the current overestimated mortality rate of 0.012% is 16595 dead people by April 30. Flu season kills 30000. But it's time to shut down the planet.
    There is a flaw in your reasoning where you somehow think the mortality rate is somehow static. It is actually going to be more dynamic. We currently have the benefit that the majority of hospitals haven't hit the critical point yet. What happens in the upcoming weeks with the exponential increase in cases and more and more hospitals start to have dwindling capacity, lack of supplies, PPEs, health care workers becoming infected, communicable spread, etc? Please remember, we are still in the infancy stage of all this. It is going to get worse. But then what do I know, I am simply a healthcare worker in a hospital. On behalf of myself, my fellow colleagues, and our patients; thank you for the concerns. Please quit acting like the worst is behind us

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    Quote Originally Posted by Yngvi View Post
    If any substantive information is released about specific shortages, we can say the shortage is actually real. Until then, it is just speculation about a future shortage.
    I previously linked to an article by doctors at Papa Giovanni XXIII Hospital, which has been overwhelmed. Ventilator shortages lead to the most painful triage decisions, but the shortages in PPE and space are probably more significant.

    Elon Musk asked for specific information on which hospitals and ICUs are currently experiencing shortages. As far as I have seen, the governors of NY or California only provided generalities and political talking points in return.
    Actually, Cuomo provided concrete numbers for the number of additional hospital beds, N95 masks, and ventilators that are needed. You can evaluate whether his requests were legitimate within 2-3 weeks.

  3. #563
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    Quote Originally Posted by Mark Rippetoe View Post
    Were they overwhelmed in 2009 by H1N1? What did it look like then? 1968, when 100,000 died in the US? 1957-58, when 116,000 died in the US? Why didn't we shut down the whole goddamn planet then?
    Those flu pandemics don't seem to have required the same rate of hospitalization as COVID-19, and one of the reasons is probably partial immunity due to previous exposure to similar antigens.

    Quote Originally Posted by Slow Uncle Joe View Post
    A whole lot we don't know about the Wuhan Flu. We DO know it can overwhelm hospitals, as it has done so in China and Italy, and threatens to do so in Washington State and other places. I don't think the Swine Flu ever did that.
    Quote Originally Posted by Mark Rippetoe View Post
    I wonder why.
    Quote Originally Posted by spacediver View Post
    Same question went through my mind this morning (if the swine flu infected so many, how come our health care system didn't collapse even though extreme social distancing measures were not taken?).

    Did a little digging, and turns out that not only was a vaccine able to be delivered within a few months, but about 30 percent of ppl (in particular those over the age of 60) already had partial immunity due to prior exposure to similar viruses.

    Also, as far as I can tell, the case fatality rate of swine flu is about 0.02 percent, which is an order of magnitude or two lower than what covid-19 appears to be, so hospitals wouldn't have been experiencing the same stress levels.

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    Quote Originally Posted by BrunoLawerence View Post
    Currently the ones in NYC and other large cities are starting to become overwhelmed. There is a lack of supplies, PPEs, beds etc. That's what this looks like. What would be your thoughts when non covid patients contract it while in the hospital due to community spread. Certainly the lack of PPEs will only make this worse.
    Lots of people get sick at the hospital. It's one of the big problems with hospitals. Friend of mine's wife lost her hip to a hospital acquired infection a couple of years ago. It would really help if you could get your colleagues to wash their hands like they are supposed to. Take sterile procedure seriously, shit like that.

    Does this give you comfort that we are further along than we expected to be at the beginning of this outbreak? The worst is yet to come.
    I am not comforted by any of this stupidity. But as bad as your hospital is, the rest of the world around you is going to be worse, and that is a bigger concern to me.

    There is a flaw in your reasoning where you somehow think the mortality rate is somehow static. It is actually going to be more dynamic. We currently have the benefit that the majority of hospitals haven't hit the critical point yet. What happens in the upcoming weeks with the exponential increase in cases and more and more hospitals start to have dwindling capacity, lack of supplies, PPEs, health care workers becoming infected, communicable spread, etc? Please remember, we are still in the infancy stage of all this. It is going to get worse. But then what do I know, I am simply a healthcare worker in a hospital. On behalf of myself, my fellow colleagues, and our patients; thank you for the concerns. Please quit acting like the worst is behind us
    My reasoning is often flawed, but the mortality rate is math. No one thinks we know the total number of cases of COVID19, and therefore no one knows the mortality rate. But it's lower than the estimate, since we can count the bodies pretty effectively. If the mortality rate changes, it will be predominantly a function of increased testing, and the discovery of more cases will drive it down.

    Quote Originally Posted by spacediver View Post
    Those flu pandemics don't seem to have required the same rate of hospitalization as COVID-19, and one of the reasons is probably partial immunity due to previous exposure to similar antigens.
    Required? Or received? Standards change over time.

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    Quote Originally Posted by Mark Rippetoe View Post

    Required? Or received? Standards change over time.
    Based on the factors I brought to attention in my last post (lower mortality rate, vaccine, partial immunity), I imagine the answer is "required".

    Hospitals aren't currently at risk of being overwhelmed by people who don't require medical attention. Triage takes care of that, and triage is about to become a lot steeper and grimmer.

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    Quote Originally Posted by Mark Rippetoe View Post
    Lots of people get sick at the hospital. It's one of the big problems with hospitals. Friend of mine's wife lost her hip to a hospital acquired infection a couple of years ago. It would really help if you could get your colleagues to wash their hands like they are supposed to. Take sterile procedure seriously, shit like that.



    I am not comforted by any of this stupidity. But as bad as your hospital is, the rest of the world around you is going to be worse, and that is a bigger concern to me.



    My reasoning is often flawed, but the mortality rate is math. No one thinks we know the total number of cases of COVID19, and therefore no one knows the mortality rate. But it's lower than the estimate, since we can count the bodies pretty effectively. If the mortality rate changes, it will be predominantly a function of increased testing, and the discovery of more cases will drive it down.



    Required? Or received? Standards change over time.
    I can assure you the morality rate will increase once we get closer to being in the thick of this, we are at the beginning. You can't infer current mortality rates based on a simple percentage at the beginning of the pandemic under optimal conditions (prior to the increased burden on the system) will be the same as they will be once things get worse and the healthcare system is overwhelmed. Mortality will increase as the burden increases and resources are limited.

    The majority of hospitals aren't overwhelmed "yet". Also, how do you propose that we, the healthcare workers, take sterile procedures seriously when there will be a lack of PPEs? It is simply amazing that you quoted a story about your friends wife having passed away from a "hospital acquired infection", yet don't seem to understand the probability of hospital acquired infections will increase given a novel, extremely contagious pathogen being introduced into the hospital that is inadequately prepared to handle. Your disconnect here is simply incomprehensible.

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    Quote Originally Posted by Mark Rippetoe View Post
    Yes, the model was wrong. Wrong in your preferred direction, and badly wrong because of flawed assumptions, like models always have.
    Actually, I would have by far preferred if the model was wrong in the other direction i.e. there were far less cases than estimated. I'm surprised the model was an overestimate as I would have thought the severe interventions would have made a bigger (or even any) reduction from the projection and, with tinfoil hat on, the bias of epidemiologists to overstate the potential outcome. I'm a math graduate with a healthy dose of statistical scepticism and real distrust of some of the modelling assumptions, particularly extrapolating with exponential type behaviour as small errors are greatly magnified.

    I'm just really interested in the policy discussion and measurement of health impacts and economic impacts as various scenarios play out.

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    Quote Originally Posted by BrunoLawerence View Post
    I can assure you the morality rate will increase once we get closer to being in the thick of this, we are at the beginning. You can't infer current mortality rates based on a simple percentage at the beginning of the pandemic under optimal conditions (prior to the increased burden on the system) will be the same as they will be once things get worse and the healthcare system is overwhelmed. Mortality will increase as the burden increases and resources are limited.
    If the number of cases, the majority of which are either asymptomatic or very mild, goes up, the death count will have to rise dramatically to make the death rate go up to. Since there are estimates that we are undercounting the infection rate by a factor of between 3 and 100, your hospital is going to really REALLY have to fuck this up, and I don't think they will. But perhaps you know something we don't.

    The majority of hospitals aren't overwhelmed "yet". Also, how do you propose that we, the healthcare workers, take sterile procedures seriously when there will be a lack of PPEs? It is simply amazing that you quoted a story about your friends wife having passed away from a "hospital acquired infection", yet don't seem to understand the probability of hospital acquired infections will increase given a novel, extremely contagious pathogen being introduced into the hospital that is inadequately prepared to handle. Your disconnect here is simply incomprehensible.
    They didn't actually kill her, just her hip. It was incomprehensible. I'm sorry about the PPEs -- I'm just suggesting that you wash your hands more frequently than I've seen the staff do. Because that's where most hospital-acquired infections come from. All hospitals in North America are prepared for hand washing, even if the staff is not.

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    Quote Originally Posted by BrunoLawerence View Post
    Currently the ones in NYC and other large cities are starting to become overwhelmed. There is a lack of supplies, PPEs, beds etc. That's what this looks like. What would be your thoughts when non covid patients contract it while in the hospital due to community spread. Certainly the lack of PPEs will only make this worse.




    Does this give you comfort that we are further along than we expected to be at the beginning of this outbreak? The worst is yet to come.




    There is a flaw in your reasoning where you somehow think the mortality rate is somehow static. It is actually going to be more dynamic. We currently have the benefit that the majority of hospitals haven't hit the critical point yet. What happens in the upcoming weeks with the exponential increase in cases and more and more hospitals start to have dwindling capacity, lack of supplies, PPEs, health care workers becoming infected, communicable spread, etc? Please remember, we are still in the infancy stage of all this. It is going to get worse. But then what do I know, I am simply a healthcare worker in a hospital. On behalf of myself, my fellow colleagues, and our patients; thank you for the concerns. Please quit acting like the worst is behind us
    So the mortality rate continues to fall (precipitously) since the advent of more comprehensive testing. Are you suggesting the mortality rate will rebound? On what basis? Iím sure you can articulate a reasonable answer given your status as a healthcare worker.

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    Quote Originally Posted by Mark Rippetoe View Post
    If the number of cases, the majority of which are either asymptomatic or very mild, goes up, the death count will have to rise dramatically to make the death rate go up to. Since there are estimates that we are undercounting the infection rate by a factor of between 3 and 100, your hospital is going to really REALLY have to fuck this up, and I don't think they will. But perhaps you know something we don't.



    They didn't actually kill her, just her hip. It was incomprehensible. I'm sorry about the PPEs -- I'm just suggesting that you wash your hands more frequently than I've seen the staff do. Because that's where most hospital-acquired infections come from. All hospitals in North America are prepared for hand washing, even if the staff is not.
    But you do also agree that the number of deaths is also going up as well. Being that you seem to be using the flu for your baseline for comparison, do you honestly think that we are measuring/diagnosing every case of the flu? Undiagnosed cases of the flu would also need to be accounted for in these types of comparisons that you are continually making. I am also certain that we also have patients currently dying in the hospital with the cause of death being "respiratory failure" who could also easily have covid that is diagnosed. These also need to be accounted for. All of this affects the math. But simply, trying to extrapolate the math as you are attempting to do this early on is pointless. This is why epidemiologist use statistics and modeling. Those extra buttons on the fancier calculators exist for a reason.

    Also, thanks for your condescending hand washing comment. I am certainly glad we have a certified strength coach helping us out on this one. Medical science and epidemiologists would certainly be lost otherwise. I routinely round on my patients and wash my hands before and after every patient, always have. If I am checking on multiple patients in a row I washed my hands after leaving one patients room, which is outside of your field of view, walk down the hallway a few feet and into the next patients room. Do I need to wash my hands again? or did my hands magically become dirty because you didn't witness it?

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