COVID-19

[horsewoman]

What @jacob said...
This is my perception of media coverage as well when it comes to European news.

[ertyu]

You run out of ppe, you run out of oxygen, you run out of space. I still remember the Wuhan videos: sick people sat next to each other on the hospital corrdor floor, eyes closed, heads propped on the walls. Every now and then, a person in a chair - an ordinary chair, nothing fancy - with a banged-up oxygen bottle next to them. Every now and then, among those sitting on the floor, dead bodies covered with bedsheets. On the bench outside the hospital, 3 guys are sitting: two dead, the third one clutching at his chest. Iran with the, "we have no space, sorry, we can't help you" notice on the locked up hospital gates. Medics looked shell-shocked even in well-resourced Lombardy, where there were no people sitting on the hospital floor that you had to wind through. RIP.

[J_]

The question I have is... what is the limiting factor in a hospital that makes it overwhelmed?

What I think/see:

Hospitals are not at all ready to deal with contagious illnesses on a massive scale
They are managed like commercial industries so they have hardly any slack in capacity if the normal routine is disturbed
They delay wise precautions if those precautions cost money without a direct pay back time.

For exemple: in Belgium and the Netherlands they are only now! starting to give the nurses and carers (only some) mouth/nose masks! So late that many carers and the people who they care for are now already infected. It works wrong in two directions: less available staff and more cases to nurse.

It is a combination of a society with a general poor health.
And hospitals with no slack in capacity and lack of training.

[theanimal]

Very, very good and powerful first hand account from a doctor in NYC: https://www.nytimes.com/2020/04/14/maga ... -city.html

Another, just as good from a different doctor:
https://www.reddit.com/r/medicine/comme ... _new_york/
https://www.reddit.com/r/medicine/comme ... _new_york/
https://www.reddit.com/r/medicine/comme ... _new_york/
https://www.reddit.com/r/medicine/comme ... _story_of/

[thrifty++]

Holy heck looking at the stats - in Russia the number of daily cases is on a hugely upward trajectory. Consistently growing every day. It looks like is going to be the next place to get hit badly.
Also looks like Singapore is having some sort of second wave. The curve doesn't look flat at all. Lots of new cases every day now.

[Jason]

At this point in the statistical game, deaths due to coronavirus involve opinions. In the US, some states are not designating cause of death to Corona unless the deceased had received a positive test. Others are designating deaths due to Corona based on probable cause. Some states have changed criteria midstream which can explain significant daily spikes. Now that there is evidence that the virus causes not just respiratory damage but organ damage as well, prior deaths may not have been identified accurately and there may be future revision. Politics are obviously involved in the over/under reporting hypotheses because of the different methodologies. I know nothing about autopsy procedure and how it has been impacted during this time.

My guess with Russia is that they are just being more transparent i.e. no longer pneumonia. Reporting statistics significantly below the worldwide mean becomes suspicious, even for them.

[JL13]

ventilators haven't been mentioned much at all in non-US media(!) The US excels in high-tech intensive care, so perhaps putting people on ventilators is a US CYA/standard procedure but not elsewhere?

I've even read that they're not effective for treating COVID, because the issue isn't being able to breath, but the oxygen getting into the bloodstream. I read that CPAP machines are actually more effective at treating this (and much cheaper and less invasive). Surprised we're not ordering millions of these things.

I honestly think the response (we just need lots of ventilators and we'll be ok!) is to help calm the population. "We're working on it, we have something to protect you" is the message that's being sent. Even if it is a placebo or worse.

[Ego]

Ego: there’s no real limiting point, the worst case is that you let bodies rotting in the streets and the vultures will take care of them, just like is happening in Equador at this moment.

On the bench outside the hospital, 3 guys are sitting: two dead, the third one clutching at his chest. Iran with the, "we have no space, sorry, we can't help you" notice on the locked up hospital gates. Medics looked shell-shocked even in well-resourced Lombardy, where there were no people sitting on the hospital floor that you had to wind through. RIP.

Yeah, hyperbole like that is all over the media here too. Forgive my American-centric take but I am in the US so I am generally thinking in US specific terms.

The consensus here seems to be ICU rooms and PPE. The Army Corp of Engineers converted 15,000 hotel rooms and dorms to hospital rooms but, strangely, PPE capacity has not kept pace. Why am I finding this hard to believe? We can convert dorms to ICU rooms with all the negative pressure HVAC that entails but we cannot make plastic gowns and paper masks?

I am rather selective in who I follow on twitter. I was surprised yesterday when about 2/3 of science twitter found some way to mock the people in this photo from the lockdown protests in Ohio.



I admit, back in 2016 I had little compassion for those who clung to their old way of life and failed to adapt to the three decade shift from a manufacturing economy. Now we are experiencing a new shift. It happened over the past three weeks and I know a lot of people who are getting crushed by it. They had no chance to adapt.

Many here on the forums have expressed pride in their ability to successfully isolate. I think maybe some here are not realizing just how much that isolation has isolated them from what is actually happening out there. The true consequences cannot be seen at the grocery store.

[vexed87]

With this in mind, why is the UK government building 7 new field hospitals with a potential capacity of over 10k beds and ordering tens of thousands of ventilators? It seems to me that either:

They didn't overreact, those plans were put in motion incase the worst case scenario panned out. If lifting of restrictions are overzealous or handled badly, they might still be needed. If they didn't operate under worst case assumptions, the Tories wouldn't get back into government for another generation.

[ZAFCorrection]

@Ego

The preppers and introverts just had their attitudes and prep validated in a big way. The left-leaning get to dunk on the deplorables. The aspirational class dgaf because white-collar wfh, can afford instacart, and Powell has their back on retirement. The cognitive bias in the short and medium-term of the most educated/wealthy/prepared is going to be towards hyping this thing. When the prep runs low or gets nullified by personal crises, when the non-ghetto jobs start disappearing, and when earnings reports outpace QE; that's when, miraculously, going back to business-as-usual will start seeming like a great idea to everyone.

Also, PPE and oxygen are orders of magnitude easier to make than ventilators. There's certainly some ramp-up time, but we have been going full corona for like a month now. I'm pretty surprised/skeptical if those are actually still serious bottlenecks. Someone screwed up in that case. Maybe all the focus on ventilators.

[ertyu]

Yeah, hyperbole like that is all over the media here too. Forgive my American-centric take but I am in the US so

Not hyperbole for those of us from developing countries mate. Notice you quoted bigato and me. Don't be an insensitive cunt.

[Bankai]

The UK also has a problem with getting a sufficient number of PPE. Bureaucrats gave global shortages as a reason during government press conferences. Also, care homes in the UK are forced to buy in the open market for 3x the usual price as the government's supplies are insufficient.

@Vexed87: makes sense, assuming the main goal of every government is to keep power and the downside to overpreparing is a slight waste of resources with no real consequences other than increased debt while the downside of underpreparing is having labour in power for a decade.

[jacob]

@Augustus - My FIL died from COPD a couple of years ago, so I've spent some time looking at O2% and translating it into symptoms. See altitude graph about half way down: https://www.ultimatekilimanjaro.com/acclimatization.htm At 75% you might be experiencing mild hallucinations with limbs beginning to tint blue but still be able to walk short distances (couch to table) given 30+ mins to recover. At 40% you're near to the point of causing permanent brain damage if it hasn't happened already.

It was my understanding that ventilators were required (or believed to be required) because ARDS prevented nasally administrated oxygen from penetrating the fluid building up in the lungs. Therefore some pressure was required. Maybe proning changes where this fluid accumulates.

I think career risk (<- I don't think this is the right word but similar to what one sees guiding fund manager decisions) is at least somewhat guiding the treatment attempts. It's better to fail conventionally than to risk failing unconventionally. This goes double when human lives are at stake. Patients aren't signing up for out of the left field procedures in the hope that some medical breakthrough happens.

Disclaimer: Speaking from the top of Mt Stupid here.

[George the original one]

Of the 9 USA states under 1000 cases, 3 have not passed their peak: Nebraska, Maine, & North Dakota. Maine had a peak, went down substantially, and now is going up for another peak like Alaska did. Nebraska is still heading upwards at the rate of ~60 new cases per day, so very likely won't be under 1000 cases tomorrow. North Dakota is struggling sideways, like Oregon did for awhile.

[Jin+Guice]

Very, very good and powerful first hand account from a doctor in NYC: https://www.nytimes.com/2020/04/14/maga ... -city.html

This article outlines what hospital collapse is and what we are trying to avoid*. I've lost even more faith in the American media than I had before this pandemic, and the Times clearly has a narrative they are promoting, but I still have faith that an ER doc would give an honest firsthand account.

*It's the first hand account of the day-to-day of an ER doc in NYC, so it's very emotional, long, terrifying and not intended to be a descriptive account of "hospital overwhelm." The doctor's description of her shifts paints a picture of what we've been having trouble defining though.

[George the original one]

3 USA states have, or are, experiencing double peaks: Alaska, Maine, & New Hampshire. Too early to judge whether Idaho & Utah are going to double peak.

[steveo73]

Many here on the forums have expressed pride in their ability to successfully isolate. I think maybe some here are not realizing just how much that isolation has isolated them from what is actually happening out there. The true consequences cannot be seen at the grocery store.

I get what you are stating but I don't think I agree with what I think are your conclusions. Are you stating we should not practice any form of social distancing ? Doesn't this fly in the face of all the information we have in relation to how to manage these situations and not just today but throughout human history. I'm pretty sure that plagues that impact the world or various communities have always been beaten at least initially via social distancing and especially border control.

To me the economic impact is really about how unprepared society is at dealing with this situation.

There is a secondary argument in relation to modelling these scenarios and how they overstate the downside significantly. This to me is simply the scientific modus operandi that operates today where political implications are at the heart of the issue that is being studied. If you want a reaction exaggerate the extent of the downside and the probability of what is to occur.

I also think we always need to be cognizant of the risk. You don't need to be completely risk averse because then nothing will happen. You do though need to realize what is at stake.

I'm really struggling to understand why society including businesses and governments and world organizations ala the WHO haven't been prepared for a pretty small lock down period. I mean this is a high probability event.

[steveo73]

3 USA states have, or are, experiencing double peaks: Alaska, Maine, & New Hampshire. Too early to judge whether Idaho & Utah are going to double peak.

I think the big unknown here is do we get second or more waves of infections and how bad these infections are.

[sky]

If a government is considering lifting a stay at home order, or a quarantine, what would they base that decision on, assuming they are trying to use a scientific approach? A reduction in deaths per day? Estimates of the number of persons who have not yet been exposed to the illness? Do they estimate the total number of deaths over the period of the pandemic and wait until the number of deaths equals X% of total pandemic deaths?

[Fish]

Also, I expect that this topic will have the most posts in the history of ERE boards.

And now tied with the locked Trump thread for first place at 2,196 posts. The Trump thread took 2 years to attain that post count while Covid-19 got there in under 3 months despite various facets of discussion taking place in separate threads.