Coronavirus COVID-19

[Nebraska]

1 hour ago, Extralife said:

My sister and brother-in-law has it now

sorry to hear this. wish them a speedy recovery

[chenGOD]

26 minutes ago, goDel said:

Before I watch the video, lets start by observing that the risk that hospitals are currently overrun with people needing treatment (as opposed to people who panic and think they need treatment!!) is very real. Hope we can all agree on this.

Now we can have some academic discussion about the cause of death. But whatever the conclusion should be, the fact remains that hospitals are full with people with severe complications. More than usual. 

So this whole story about 

 

is fine and all. But *if* the conclusion is, that this spike in hospital-admissions and mortality is not being caused by COVID19, you'd either have to argue that there isn't a spike in the first place and somehow, for whatever reason, Italy is in panic mode just to fuck us off. Or in other words, this is just business as usual. People die all the time. (good luck with making that argument work)

Or, you need to argue there is a spike which just happens to be at the same time this epidemic is around. A coincidence perhaps? And it's a coincidence that it's pretty much regional and incidence appears to spread like a virus? But dear God, no it's not because of Corona because you can only count pneumonia!!! I'm sure there are some academically skilled people who can convincingly argue bananas are straight instead of curved.

In the end, I really don't care for the academic aspect of this discussion. To me the reality is the healthcare system is in risk of having to deal with an overload. 

Not sure if I had this discussion here, or somewhere else, but I'm really not interested in what people or science think about the risk of dying due to COVID19. I'm interested in how we can go back to normal mode. Where there's no risk of overloading the healthcare system. If we're there, I'm happy.

Whether or not I could die from COVID19, to me, is as interesting as knowing the risk of getting in an accident when crossing the street.

So, about this critical thinking, what would you say we should conclude?

As a non-physician, I’d say attempting to identify underlying causes would allow hospitals to divert resources to the appropriate pressure points on the system, allowing us a speedier return to normal and reducing the stress load on hospitals. 
 

Edit: what I would say is this “pandemic” has shown that our hospital systems are woefully underfunded (obvious to many already) and lacking in any sort of surge capacity. 

[danshoebridge]

Arguing EXACTLY what kills people who have covid-19 is not entirely useful at the moment. The general progression is pretty well understood:

Covid-19 damages lungs, both directly and leaving them more prone to follow-up bacterial infection.

This in turn increases the likelihood of bilateral interstitial pneumonia, this is more likely to develop in older people or people with co-morbidities (especially lung or cardiac issues, also obesity)

This cohort of patients are also less likely to be able to fight off pneumonia. Eventual result for the most unwell is unfortunately organ failure and death.

At my hospital, the first fatalities are coming through, they have all had severe co-morbidities so far. Could you argue that their stage 4 cancer killed them rather than the pneumonia? Maybe, but the Covid infection is definitely the reason they died this weekend.

[danshoebridge]

As a follow up, I'd be the first to argue that our hospitals have been woefully underfunded over the last 10 years here in the UK, but there's no way you could build in the sort of redundancy that would cope with the critical care surge they've seen in Italy, for example.

[jules]

I had the worst flu / sickness Ive ever had in my life in early February. I missed 6 days of work. Im wondering if I may have already had it? So hard to know.

[J3FF3R00]

1 minute ago, jules said:

I had the worst flu / sickness Ive ever had in my life in early February. I missed 6 days of work. Im wondering if I may have already had it? So hard to know.

My mom and stepdad had something similar in late January / early February that completely knocked them out for almost a full month. 

I talked to my mom a couple days ago and she was going on about how she may have had it and might be in the clear now. I had to try to convince her not to assume that she had covid-19, even if she might have (which I'm pretty sure she didn't), and to continue living as if she was trying not to catch or spread the coronavirus.

Better safe than sorry.

[ignatius]

1 minute ago, jules said:

I had the worst flu / sickness Ive ever had in my life in early February. I missed 6 days of work. Im wondering if I may have already had it? So hard to know.

yeah.. kind of impossible. the only way i know if i'm getting sick is if the symptoms last. i have underlying health conditions and medication side effects that present as flu like symptoms and fatigue, sore throat, shortness of breath, sudden onset of warm flashes etc.. so i have to constantly assess myself when these things happen. taking my temp like 5 times a day. it's weird. 

in february my mom had strep throat and mega allergy attack. my brother had bronchial stuff w/wet cough etc. 

[chenGOD]

20 minutes ago, danshoebridge said:

Arguing EXACTLY what kills people who have covid-19 is not entirely useful at the moment. The general progression is pretty well understood:

Covid-19 damages lungs, both directly and leaving them more prone to follow-up bacterial infection.

This in turn increases the likelihood of bilateral interstitial pneumonia, this is more likely to develop in older people or people with co-morbidities (especially lung or cardiac issues, also obesity)

This cohort of patients are also less likely to be able to fight off pneumonia. Eventual result for the most unwell is unfortunately organ failure and death.

At my hospital, the first fatalities are coming through, they have all had severe co-morbidities so far. Could you argue that their stage 4 cancer killed them rather than the pneumonia? Maybe, but the Covid infection is definitely the reason they died this weekend.

Wouldn’t you want to know what to treat? Covid19 exacerbated existing conditions, but surely it’s important to treat those conditions. As I understand it, the mortality rate for covid19 is like 2%, so you’d want to go after the other factors first surely?

[chenGOD]

15 minutes ago, danshoebridge said:

As a follow up, I'd be the first to argue that our hospitals have been woefully underfunded over the last 10 years here in the UK, but there's no way you could build in the sort of redundancy that would cope with the critical care surge they've seen in Italy, for example.

But that’s exactly the point of knowing what conditions to treat first. How many people were they sending to critical care that only had Covid19 and not other comorbidity factors that shouldn’t have been placed in the ICU?

[danshoebridge]

Wouldn’t you want to know what to treat? Covid19 exacerbated existing conditions, but surely it’s important to treat those conditions. As I understand it, the mortality rate for covid19 is like 2%, so you’d want to go after the other factors first surely?

That's not how it works - these are almost always long-term conditions that have already been identified and are being treated (although there's also no real treatment for 'being old').

What happens is (for example) someone presents with respiratory difficulty, swabbed and test positive for Covid, CT shows bilateral interstitial pneumonia. They also have a history of heart failure and diabetes - these are already being managed and have been for the last few years.

They're in a high risk group, may need ventilation, and may die. There's no magic bullet that will cure their diabetes or heart issues, all the medical team can do is try and keep them alive long enough for their body to recover from the pneumonia.

[chenGOD]

2 minutes ago, danshoebridge said:

That's not how it works - these are almost always long-term conditions that have already been identified and are being treated (although there's also no real treatment for 'being old').

What happens is (for example) someone presents with respiratory difficulty, swabbed and test positive for Covid, CT shows bilateral interstitial pneumonia. They also have a history of heart failure and diabetes - these are already being managed and have been for the last few years.

They're in a high risk group, may need ventilation, and may die. There's no magic bullet that will cure their diabetes or heart issues, all the medical team can do is try and keep them alive long enough for their body to recover from the pneumonia.

Right so you would identify those patients as priority and then put people with only Covid19 lower down on the totem pole. But after identifying their existing comorbidity factors and treating their Covid19 you can direct them to the care facilities more appropriately right?

[Limo]

10 minutes ago, chenGOD said:

Right so you would identify those patients as priority and then put people with only Covid19 lower down on the totem pole. But after identifying their existing comorbidity factors and treating their Covid19 you can direct them to the care facilities more appropriately right?

No, they have contracted pneumonia as a result of catching COVID-19 and having to treat *that* is what causes the hospitals to fill up.

[danshoebridge]

Right so you would identify those patients as priority and then put people with only Covid19 lower down on the totem pole. But after identifying their existing comorbidity factors and treating their Covid19 you can direct them to the care facilities more appropriately right?

Well yeah, if they recover they will continue to have their other conditions managed in the same way they have been. If any new conditions are identified during their time as an inpatient there'll be a referral to the relevant area after they're discharged.

I don't work ICU but there's no 'totem pole' as such. At the moment people are sedated and ventilated if they reach a certain point of acute respiratory distress. When the ventilators run out as seen in Italy it will be the case that younger, healthier people will be given priority.

[Nebraska]

 

[ignatius]

^^ that's been all over portland people's posts. so typical and a true portland experience.  

[cwmbrancity]

2 minutes ago, danshoebridge said:

Well yeah, if they recover they will continue to have their other conditions managed in the same way they have been. If any new conditions are identified during their time as an inpatient there'll be a referral to the relevant area after they're discharged.

I don't work ICU but there's no 'totem pole' as such. At the moment people are sedated and ventilated if they reach a certain point of acute respiratory distress. When the ventilators run out as seen in Italy it will be the case that younger, healthier people will be given priority.

Hope resources like this gaff in Liverpool are utilised, seems even more of a piss take than possible 

https://www.liverpoolecho.co.uk/news/liverpool-news/revealed-unbelievable-cost-keeping-liverpools-16249133

[ignatius]

reading on reddit about people dealing w/their boomer and boomer adjacent parents basically ignoring all the stay at home orders and saying shit like "it's my god given right to do what i want" and not doing any social distancing etc despite lockdown orders. in USA of course. 

various responses to their parents are:

"I'll  miss you"

"can you make sure your affairs are in order so i don't have to deal with a mess when you die?"

 

[goDel]

1 hour ago, chenGOD said:

Edit: what I would say is this “pandemic” has shown that our hospital systems are woefully underfunded (obvious to many already) and lacking in any sort of surge capacity. 

Disagree. You imply that it would be realistic to fund the system such that there wouldn't be any problem under the current (abnormal!!) circumstances. Frankly, it makes no sense to always have this kind of peak capacity available. That's like driving a car with an extra tank on your roof with 1000 liter extra gasoline just in case you unexpectedly need to drive to the other side of the planet.

The system in Italy (the northern region) is known as a high quality system. Want to argue that a woefully underfunded system could be high quality? Madness.

Also note, if you look at the healthcare system from an economic point of view - and especially hospitals - you see most of the costs are structural (as opposed to variable). Meaning that the costs don't scale with the volume. Whether you treat 100 patients or 1000 patients in a hospital, the yearly budget wouldn't change much. There's a required amount of people that need to work in a hospital and the hospital itself is mostly bricks and a couple of expensive machines. It's by definition a sector with low flexibility in terms of peak capacity. It's not like IT, where you can insta-call in some extra server capacity to keep up with peak demand.

And the suggestion that what we're currently seeing is in the same ballpark as "any sort of surge" is crazy as well, btw. 

Finally, yes margins in hospitals are spread thin. But this is including costs for what has proven to be reasonable peak capacity. Where reasonable means what we have had some kind of experience with in the past, and what you'd expect could happen in the future. What's happening now....nobody would have though this could be possible. Not at this scale and with this speed. This is simply unheard of.

What the implications will be for our healthcare systems in the future (eg. in terms of budget) is still not clear, I'd argue. Even with what we're seeing, it's not nearly as obvious as you seem to suggest, I'd argue. We can't buy ourselves out of this.

This is generally speaking, of course. Because this might be different for each country. But generally speaking, budgets of healthcare systems is one of those things thats always a discussion. This holds for most, if not all western countries. Some more than others perhaps. But it's more likely all systems have equal peak capacity, regardless of margins. Believe it or not. Reason is that in western countries you could argue there's an equal chance of needing relatively equal amounts of peak capacity. It's not a silly idea to regard it a constant. Which is good btw, as we know hospital systems mostly consist of those structural costs mentioned earlier. So it's relatively straightforward to budget peak capacity. (in the case of being reasonable about it, that is)

[Nebraska]

if we get a cure that's worse than the problem, we'll have a real problem. wish people can understand this

[Zephyr_Nova]

 

[ignatius]

bill gates

Quote

“There really is no middle ground, and it’s very tough to say to people, ‘Hey, keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner. We want you to keep spending because there’s maybe a politician who thinks GDP growth is all that counts,’” Gates said in an interview with TED Tuesday. “It’s very irresponsible for somebody to suggest that we can have the best of both worlds.”

https://www.vox.com/recode/2020/3/24/21192638/coronavirus-bill-gates-trump-reopen-business?fbclid=IwAR1lanDA4IN9WmrAP_ShniVvylE4eaqV64QtTU3uw7u7EOuQ5UyYis_4X_w

[YEK]

The couple above me have decided to quarantine from each other cause one of them is an older guy and the other younger one is still working. It's going to be great for their relationship I'm sure.

[Soloman Tump]

4000 capacity temporary hospital opening in London on Monday, thousands of extra NHS staff being drafted in.... This will get worse.....

https://www.bbc.co.uk/news/health-52018477

[Silent Member]

the sceptics remind me of this guy 

 

[chenGOD]

1 hour ago, rhmilo said:

No, they have contracted pneumonia as a result of catching COVID-19 and having to treat *that* is what causes the hospitals to fill up.

Yes but not everybody with pneumonia needs to go to the icu. 

1 hour ago, danshoebridge said:

I don't work ICU but there's no 'totem pole' as such. At the moment people are sedated and ventilated if they reach a certain point of acute respiratory distress. When the ventilators run out as seen in Italy it will be the case that younger, healthier people will be given priority.

Surely they do triage, just like they do in ER?