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readyAIMfire53



Joined: 20 Nov 2004
Posts: 5712
Location: Durham, NC


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PostPosted: 03/24/20 12:54 am    ::: Reply Reply with quote

GlennMacGrady wrote:
Luuuc wrote:
Given your previous claim that access to medical facilities makes no difference to survival outcomes, what is your hypothesis about why Italy's death rate is so high? Just an extreme shortfall in testing?


I assume you're asking me about the two sentences you quoted in your previous post. Virtually everything I say in this thread are data or opinions I read about from experts, who frequently disagree with each other.

The longer version of my perhaps ambiguous first sentence is this: Assume there is unlimited hospital space and medical resources. If a spike curve and a flattened curve both have the same areas underneath them, then they both will have the same number of cases over time. And if the number of cases is the same under both curves, there's no reason to assume the number of fatalities will be different over time.

Since I know from your snark that you're not inclined to believe me, I've tried to find one of the authorities who say that. I'll offer this Australian article authored by three mathematicians at the University of Adelaide:

How to flatten the curve of coronavirus, a mathematician explains

Quote:
Health authorities around the world have been unable to completely prevent COVID-19’s spread. If cases double every six days, then hospitals, and intensive care units (ICUs) in particular, will be quickly overwhelmed, leaving patients without the necessary care.

But the growth rate can be slowed by reducing the average number of cases that a single case gives rise to.

In doing so, the same number of people will probably be infected, and the epidemic will last longer, but the number of severe cases will be spread out. This means that if you plot a graph of the number of cases over time, the rising and falling curve is longer but its peak is lower. By “flattening the curve” in this way, ICUs will be less likely to run out of capacity.


See this GIF from the article demonstrating the same area under the curves.

I acknowledged the capacity issue in my second sentence by saying that flattening the curve may, in a real world where hospital resources are insufficient, "result in less of a spiked clog on medical resources and deaths attributable to that clog, the number of which is speculative." I believe my second sentence to be true.

The reasons for Italy's high case numbers and death rates have been amply explored in this thread and the other one, including the lack of capacity. The last two days of decreasing cases may be an indication that Italy has passed the peak of their curve.

On edit: I only brought up the issue of spiked vs. flattened curves to point out that in places where there is no reason to believe that hospital capacity will be an issue, flattening the curve with harsh mitigation measures will not decrease cases or fatalities but will cause all sorts of grave economic and social harm.


Dr. Birx is nothing but a "scientific" face for the Trump agenda. The real truthteller - Fauci - has been removed from the podium. Get info from CDC please. Any scientist Trump lets share the stage is not worth salt. You don't want a "political" post, don't quote garbage from a political plant, because THAT is an overt political act made because you agree with the point of view. If you want to stick to facts, stick to facts. Posting overtly political statements will get you overtly political pushback.



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Luuuc



Joined: 10 Feb 2005
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PostPosted: 03/24/20 1:11 am    ::: Reply Reply with quote

GlennMacGrady wrote:
Luuuc wrote:
Given your previous claim that access to medical facilities makes no difference to survival outcomes, what is your hypothesis about why Italy's death rate is so high? Just an extreme shortfall in testing?


I assume you're asking me about the two sentences you quoted in your previous post. Virtually everything I say in this thread are data or opinions I read about from experts, who frequently disagree with each other.

The longer version of my perhaps ambiguous first sentence is this: Assume there is unlimited hospital space and medical resources. If a spike curve and a flattened curve both have the same areas underneath them, then they both will have the same number of cases over time. And if the number of cases is the same under both curves, there's no reason to assume the number of fatalities will be different over time.

Since I know from your snark that you're not inclined to believe me, I've tried to find one of the authorities who say that. I'll offer this Australian article authored by three mathematicians at the University of Adelaide:

How to flatten the curve of coronavirus, a mathematician explains

Quote:
Health authorities around the world have been unable to completely prevent COVID-19’s spread. If cases double every six days, then hospitals, and intensive care units (ICUs) in particular, will be quickly overwhelmed, leaving patients without the necessary care.

But the growth rate can be slowed by reducing the average number of cases that a single case gives rise to.

In doing so, the same number of people will probably be infected, and the epidemic will last longer, but the number of severe cases will be spread out. This means that if you plot a graph of the number of cases over time, the rising and falling curve is longer but its peak is lower. By “flattening the curve” in this way, ICUs will be less likely to run out of capacity.


See this GIF from the article demonstrating the same area under the curves.

I acknowledged the capacity issue in my second sentence by saying that flattening the curve may, in a real world where hospital resources are insufficient, "result in less of a spiked clog on medical resources and deaths attributable to that clog, the number of which is speculative." I believe my second sentence to be true.

The reasons for Italy's high case numbers and death rates have been amply explored in this thread and the other one, including the lack of capacity. The last two days of decreasing cases may be an indication that Italy has passed the peak of their curve.

On edit: I only brought up the issue of spiked vs. flattened curves to point out that in places where there is no reason to believe that hospital capacity will be an issue, flattening the curve with harsh mitigation measures will not decrease cases or fatalities but will cause all sorts of grave economic and social harm.


Glenn, the whole curve explanation part is a given. I don't disagree with you on any of that. The whole fundamental premise of the curve illustration is that the overall number of cases is the same!

I will re-quote you with added emphasis to try again
GlennMacGrady wrote:
Dragging out the curve won't decrease the total number of cases or the total number of fatal infections.

Do you see why I have an issue with this sentence? By making that statement/claim, you are effectively saying that admitting anyone with Covid into ICU is pointless because they will either live or die regardless, thus defeating the entire point of flattening the curve.
I assume you've noticed that all the "flatten the curve" illustrations include a horizontal line depicting the capacity of the health care system. You get why that matters, right?



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tfan



Joined: 31 May 2010
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PostPosted: 03/24/20 1:53 am    ::: Reply Reply with quote

FrozenLVFan wrote:
Randy wrote:
There is another problem with the "herd immunity" experiment. CNBC just interviewed the President of Quest Diagnostics. They are one the labs running COVID19 tests. He stated that as yet there is no test for immunities. So there is no way to know if it will even work.


I haven't seen any case reports of patients being reinfected after initial recovery, so I think the assumption is that some immunity is conferred. I'm sure the companies that are working on vaccines are also working on measuring antibody titers.


This article talks about a woman in Japan and a few people in China who may have been re-infected. But I saw someone speculating that the Japanese woman hadn't actually recovered in the first place or something.

https://www.businessinsider.com/wuhan-coronavirus-risk-of-reinfection-2020-2?op=1

I saw a YouTube video where a doctor cites a study that infected 3 monkeys and after they had recovered re-infected them and none of them got it again. He mentions that the virus has mutated but so far not enough that a vaccine or antibodies shouldn't work.


Genero36



Joined: 24 Apr 2005
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PostPosted: 03/24/20 8:31 am    ::: Reply Reply with quote

Quote:
Cuomo estimates that up to 80% of the state’s more than 19.4 million residents will get the coronavirus.


https://www.cnbc.com/2020/03/23/new-york-coronavirus-cases-surge-38percent-overnight-to-20875.html



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GlennMacGrady



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PostPosted: 03/24/20 9:15 am    ::: Reply Reply with quote

Luuuc wrote:
GlennMacGrady wrote:
Luuuc wrote:
Given your previous claim that access to medical facilities makes no difference to survival outcomes, what is your hypothesis about why Italy's death rate is so high? Just an extreme shortfall in testing?


I assume you're asking me about the two sentences you quoted in your previous post. Virtually everything I say in this thread are data or opinions I read about from experts, who frequently disagree with each other.

The longer version of my perhaps ambiguous first sentence is this: Assume there is unlimited hospital space and medical resources. If a spike curve and a flattened curve both have the same areas underneath them, then they both will have the same number of cases over time. And if the number of cases is the same under both curves, there's no reason to assume the number of fatalities will be different over time.

Since I know from your snark that you're not inclined to believe me, I've tried to find one of the authorities who say that. I'll offer this Australian article authored by three mathematicians at the University of Adelaide:

How to flatten the curve of coronavirus, a mathematician explains

Quote:
Health authorities around the world have been unable to completely prevent COVID-19’s spread. If cases double every six days, then hospitals, and intensive care units (ICUs) in particular, will be quickly overwhelmed, leaving patients without the necessary care.

But the growth rate can be slowed by reducing the average number of cases that a single case gives rise to.

In doing so, the same number of people will probably be infected, and the epidemic will last longer, but the number of severe cases will be spread out. This means that if you plot a graph of the number of cases over time, the rising and falling curve is longer but its peak is lower. By “flattening the curve” in this way, ICUs will be less likely to run out of capacity.


See this GIF from the article demonstrating the same area under the curves.

I acknowledged the capacity issue in my second sentence by saying that flattening the curve may, in a real world where hospital resources are insufficient, "result in less of a spiked clog on medical resources and deaths attributable to that clog, the number of which is speculative." I believe my second sentence to be true.

The reasons for Italy's high case numbers and death rates have been amply explored in this thread and the other one, including the lack of capacity. The last two days of decreasing cases may be an indication that Italy has passed the peak of their curve.

On edit: I only brought up the issue of spiked vs. flattened curves to point out that in places where there is no reason to believe that hospital capacity will be an issue, flattening the curve with harsh mitigation measures will not decrease cases or fatalities but will cause all sorts of grave economic and social harm.


Glenn, the whole curve explanation part is a given. I don't disagree with you on any of that. The whole fundamental premise of the curve illustration is that the overall number of cases is the same!

I will re-quote you with added emphasis to try again
GlennMacGrady wrote:
Dragging out the curve won't decrease the total number of cases or the total number of fatal infections.

Do you see why I have an issue with this sentence? By making that statement/claim, you are effectively saying that admitting anyone with Covid into ICU is pointless because they will either live or die regardless, thus defeating the entire point of flattening the curve.


No, I'm not.

Luuuc, I've admitted that my sentence was ambiguous and explained in more detail what I meant: If there is no hospital capacity problem, theoretically there should be the same number of cases and deaths under an unflattened or flattened curve.

I did not say that admitting people into the ICU makes no difference, and don't see how my sentence can possibly be interpreted that way. In both the unflattened and flattened curve, the same number of people go into and are treated in the hospital, under the ideal assumption that there is no capacity problem. I then acknowledge -- now for the third time -- that in the real world, in some places but not others, there will be a capacity problem that will likely result in additional deaths.

That's why different states in the U.S. have taken different approaches to mitigation, which is what they should do. Further, they should ease up on the severe mitigation once there are data showing that hospitals will not be overrun. Based on the data I've been calculating and citing in this thread, it is my opinion that the fear of overwhelmed hospitals is excessive in many places.
Randy



Joined: 08 Oct 2011
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PostPosted: 03/24/20 9:45 am    ::: Reply Reply with quote

Somehow this discussion is starting to remind me of this:

<iframe width="560" height="315" src="https://www.youtube.com/embed/olPAsssli3E" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

Context if you haven't seen the movie.

Quote:
Lime's racket was stealing penicillin from military hospitals, diluting it, and selling it on the black market, leading to many deaths.


https://en.wikipedia.org/wiki/The_Third_Man



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Last edited by Randy on 03/24/20 9:52 am; edited 2 times in total
justintyme



Joined: 08 Jul 2012
Posts: 8207
Location: Northfield, MN


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PostPosted: 03/24/20 9:50 am    ::: Reply Reply with quote

Genero36 wrote:
Quote:
Cuomo estimates that up to 80% of the state’s more than 19.4 million residents will get the coronavirus.


https://www.cnbc.com/2020/03/23/new-york-coronavirus-cases-surge-38percent-overnight-to-20875.html

Tim Walz, the Governor of Minnesota who is also isolating himself atm because one of his aides tested positive, had estimated that even with social distancing they expect 40-80% of Minnesotans to eventually contract the virus.



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FrozenLVFan



Joined: 08 Jul 2014
Posts: 1809



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PostPosted: 03/24/20 10:40 am    ::: Reply Reply with quote

GlennMacGrady wrote:
...Based on the data I've been calculating and citing in this thread, it is my opinion that the fear of overwhelmed hospitals is excessive in many places.


I personally find it difficult to discard the reports from the people on the front lines...the hundreds of healthcare workers that died in China, the physicians rationing healthcare and allowing patients to die without care in Italy, and now our own physicians who are facing the same prospects.

I posted this in the other thread but maybe it's more important here. This Twitter account has several long streams (a bit difficult to follow since he doesn't always number his tweets so they're in reverse order) about the current state of a large NYC ER.

Craig Spencer MD MPH
@Craig_A_Spencer
Director of Global Health in Emergency Medicine @ColumbiaMed/@NYPhospital
and Faculty in Forced Migration & Health @ColumbiaMSPH
| @MSF_USA BoD |#Ebola survivor


readyAIMfire53



Joined: 20 Nov 2004
Posts: 5712
Location: Durham, NC


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PostPosted: 03/24/20 11:34 am    ::: Reply Reply with quote

FrozenLVFan wrote:
GlennMacGrady wrote:
...Based on the data I've been calculating and citing in this thread, it is my opinion that the fear of overwhelmed hospitals is excessive in many places.


I personally find it difficult to discard the reports from the people on the front lines...the hundreds of healthcare workers that died in China, the physicians rationing healthcare and allowing patients to die without care in Italy, and now our own physicians who are facing the same prospects.

I posted this in the other thread but maybe it's more important here. This Twitter account has several long streams (a bit difficult to follow since he doesn't always number his tweets so they're in reverse order) about the current state of a large NYC ER.

Craig Spencer MD MPH
@Craig_A_Spencer
Director of Global Health in Emergency Medicine @ColumbiaMed/@NYPhospital
and Faculty in Forced Migration & Health @ColumbiaMSPH
| @MSF_USA BoD |#Ebola survivor


Thanks to you and others who supply facts & urge looking at REAL scientists words about the conditions and what will happen. The actual shortage of hospital beds is real and will happen soon in areas with the biggest numbers. It will happen right here where I live, with 3 great hospitals close by. We will be facing the same decisions as hospitals in Italy - which has MORE hospital beds per capita than the US. This will directly lead to more people dying.

"Just the facts, Ma'am."



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pilight



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PostPosted: 03/24/20 12:19 pm    ::: Reply Reply with quote

Turns out a big piece of the projections for infection are based on a computer model thousands of lines long written 13 years ago in undocumented C for influenza.

https://twitter.com/neil_ferguson/status/1241835454707699713

These models are only as good as the mathematical relations put into the model and the data put into the model. You have to test the snot out of them with real world results over the relevant variations of input data, or they will almost certainly be wrong. If either of those are wrong, mathematical relations or data - even a bit - you can get dramatically incorrect model results.

The modeler is now saying source will be available in 7-10 days.

Not sure why they've delayed the release. It would be very easy to release it immediately and let a team of people document it publicly, so everyone can see what assumptions (and potentially *bugs*) are in the model - what's reasonable and what isn't.



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readyAIMfire53



Joined: 20 Nov 2004
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PostPosted: 03/24/20 2:06 pm    ::: Reply Reply with quote

Sen Rand Paul did not follow recommendations on physical distancing despite knowing he was at very high risk of getting seriously ill with the virus because he was compromised by the lung tissue he lost when a neighbor stabbed him. He found out someone he had close physical contact with was sick with the virus (exposed by not following physical distancing recommendations). He continued not following any protocol to protect others even after developing symptoms himself! Sen Rand Paul did not change his conduct in any way after getting tested (his words), eating in group settings, visiting a workout facility, sitting in Senate Chambers. The people who might have been infected by Sen.Paul are outraged - though they also were not following physical distancing recommendations.

I signed a document stating I would follow isolation recommendations as part of getting tested. I am sticking to every detail. I might be positive. I might have already infected people prior to getting tested, despite following all recommended distancing advice. The # of people I will infect from this point onward will be zero.

How many people in this country are more like the completely selfish Sen Paul? How many find out someone they recently hung out with is sick with the virus and continue close physical contact with other people? The answers to these questions will determine how many will be killed by this virus here in the USA and if skyrocketing numbers will exceed hospital bed capacity, which will contribute to the number of people killed. Not only killed by the virus directly but killed because hospitals will be unable to treat people with other life threatening conditions.



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GlennMacGrady



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PostPosted: 03/24/20 10:57 pm    ::: Reply Reply with quote

Update 13: Changes in 24 Hours since Last Update

U.S.:
- confirmed cases increased by 8,603 (19%) from 46,438 to 55,041
- deaths increased by 204 from 586 to 790
- death rate increased from 1.26% to 1.43%

U.S. deaths each day since March 11 and U.S. cumulative death rate on that day:

?? – 3/11 2.89%
02 – 3/12 2.41%
07 – 3/13 2.16%
10 – 3/14 1.93%
12 – 3/15 1.83%
16 – 3/16 1.82%
23 – 3/17 1.70%
42 – 3/18 1.60%
55 – 3/19 1.44%
55 – 3/20 1.32%
76 – 3/21 1.26%
81 – 3/22 1.25%
169 – 3/23 1.26%
204 – 3/24 1.43%

Dr. Birx said today that the U.S. has now done more testing in the last eight days than S. Korea has done in the last eight weeks, surpassing the test total of the former world leader. And the U.S. testing capacity will continue to increase substantially, including self-tests, which will save PPE's, and 45 minute tests. Also under development are blood tests that can determine whether someone has gained immunity. Those people could immediately go back into the workforce because they can't be carriers.
readyAIMfire53



Joined: 20 Nov 2004
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Location: Durham, NC


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PostPosted: 03/25/20 1:03 am    ::: Reply Reply with quote

GlennMacGrady wrote:
Update 13: Changes in 24 Hours since Last Update

U.S.:
- confirmed cases increased by 8,603 (19%) from 46,438 to 55,041
- deaths increased by 204 from 586 to 790
- death rate increased from 1.26% to 1.43%

U.S. deaths each day since March 11 and U.S. cumulative death rate on that day:

?? – 3/11 2.89%
02 – 3/12 2.41%
07 – 3/13 2.16%
10 – 3/14 1.93%
12 – 3/15 1.83%
16 – 3/16 1.82%
23 – 3/17 1.70%
42 – 3/18 1.60%
55 – 3/19 1.44%
55 – 3/20 1.32%
76 – 3/21 1.26%
81 – 3/22 1.25%
169 – 3/23 1.26%
204 – 3/24 1.43%

Dr. Birx said today that the U.S. has now done more testing in the last eight days than S. Korea has done in the last eight weeks, surpassing the test total of the former world leader. And the U.S. testing capacity will continue to increase substantially, including self-tests, which will save PPE's, and 45 minute tests. Also under development are blood tests that can determine whether someone has gained immunity. Those people could immediately go back into the workforce because they can't be carriers.


US has WAY more people than S.Korea. Anything that doesn't include percentages or per capita are of absolutely no use. Also the timing of when S. Korea did those tests. They did it at the BEGINNING of the upward curve and enforced isolation and resulted in a flattened curve. The US has the fastest increase and sharpest rise of any country in the world.

And let's talk about testing. TWO months since the first case appeared in the US and the US is finally testing by tens of thousands instead of hundreds. Two months. And current wait time of 4-7 days when other countries can get results in 4 hours is absolutely Unacceptable for a country spouting widely to have "the best health care in the world."

And, trust me, if I could know the results right now - either way - I'd be WAY better off than having to live in isolated limbo land a few more days. Yes, I'm more than a little angry right now about the failure of my country to do better than this. To be lagging so far behind the world in a way that impacts me personally is inexcusable. Not when we are finding out how many so-called leaders KNEW two months ago what was in front unless they took decisive action. They took action, all right. They personally sold off their stocks while all sticking to the story of "we'll be fine." WE are not fine. I am not fine.

One more tidbit - 50% of people testing positive in California are age 18-49. They are tested after showing symptoms, when the horse is already out of the barn.



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tfan



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PostPosted: 03/25/20 2:35 am    ::: Reply Reply with quote

Worldwide:
Confirmed: 422,829
Recovered: 109,102 (USA recovered 354)
Died: 18,909




Last edited by tfan on 03/25/20 4:39 am; edited 1 time in total
Luuuc



Joined: 10 Feb 2005
Posts: 20179



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PostPosted: 03/25/20 3:43 am    ::: Reply Reply with quote

readyAIMfire53 wrote:
US has WAY more people than S.Korea. Anything that doesn't include percentages or per capita are of absolutely no use. Also the timing of when S. Korea did those tests. They did it at the BEGINNING of the upward curve and enforced isolation and resulted in a flattened curve. The US has the fastest increase and sharpest rise of any country in the world.

And let's talk about testing. TWO months since the first case appeared in the US and the US is finally testing by tens of thousands instead of hundreds. Two months. And current wait time of 4-7 days when other countries can get results in 4 hours is absolutely Unacceptable for a country spouting widely to have "the best health care in the world."

Bingo.
I really don't think USA has anything to brag about when it comes to testing. Dr. Birx is not fooling anyone with that spin above. Just more blatantly twisted numbers.
The chart below, from here, is a few days old, but still damning.
Forgetting per capita, how did the USA manage to perform fewer *total* tests than Australia to that point? It beggars belief.




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GlennMacGrady



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PostPosted: 03/25/20 10:27 am    ::: Reply Reply with quote



https://www.sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19
cthskzfn



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PostPosted: 03/25/20 10:51 am    ::: Reply Reply with quote

<iframe width="853" height="480" src="https://www.youtube.com/embed/wjGq1SsuPwU" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>



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FrozenLVFan



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PostPosted: 03/25/20 11:17 am    ::: Reply Reply with quote

GlennMacGrady wrote:


https://www.sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19


Catchy graph. How about the meat of that article?

Quote:
The 2018 AHA data indicate that there are 5256 AHA-registered community hospitals in the United States. Of these, 2704 (51.4%) deliver ICU services (Figure 3). These hospitals have 534,964 staffed (operational) acute care beds, including 96,596 ICU beds (Table 1), accounting for a median 16.7% of all hospital beds. The ICU beds can be categorized as adult, pediatric, or neonatal. There are 68,558 adult beds (medical-surgical 46,795, cardiac 14,445, and other ICU 7318), 5137 pediatric ICU beds, and 22,901 neonatal ICU beds. Additionally, there are 25,157 step-down beds, and 1183 burn beds.


Quote:
Supply of mechanical ventilators in U.S. acute care hospitals: Based on a 2009 survey of AHA hospitals, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators.10,11 Approximately 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply.10 The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8567 continuous positive airway pressure units.

Centers for Disease Control and Prevention Strategic National Stockpile (SNS) and other ventilator sources: The SNS has an estimated 12,700 ventilators for emergency deployment, according to recent public announcements from National Institutes of Health officials.12 These devices are also not full featured but offer basic ventilatory modes. In simulation testing they performed very well despite long-term storage.13 Accessing the SNS requires hospital administrators to request that state health officials ask for access to this equipment. SNS can deliver ventilators within 24-36 hours of the federal decision to deploy them. States may have their own ventilator stockpiles as well.14 Respiratory therapy departments also rent ventilators from local companies to meet either baseline and/or seasonal demand, further expanding their supply. Additionally, many modern anesthesia machines are capable of ventilating patients and can be used to increase hospitals' surge capacity.

The addition of older hospital ventilators, SNS ventilators, and anesthesia machines increases the absolute number of ventilators to possibly above 200,000 units nationally. Many of the additional and older ventilators, however, may not be capable of sustained use or of adequately supporting patients with severe acute respiratory failure. Also, supplies for these ventilators may be unavailable due to interruptions in the international supply chain... U.S. hospitals could absorb a maximum of 26,000 to 56,000 additional ventilators at the peak of a national pandemic, as safe use of ventilators requires trained personnel.


Quote:
Staffing to care for critically ill patients: As large numbers of critically ill patients are admitted to ICU, step-down, and other expansion beds, it must be determined who will care for them. Having an adequate supply of beds and equipment is not enough. Based on AHA 2015 data, there are 28,808 intensivists who are privileged to deliver care in the ICUs of U.S. acute care hospitals. Intensivists are physicians with training in one of several primary specialties (eg, internal medicine, anesthesiology, emergency medicine, surgery, pediatrics ) and additional specialized critical care training. However, 48% of acute care hospitals have no intensivists on their staffs.3 Based on the demands of the critically ill COVID-19 patient, the intensivist deficit will be strongly felt. Additionally, there are an estimated 34,000 critical care advanced practice providers (APPs) available to care for critically ill patients.18 Other physicians with hospital privileges, especially those with previous exposure to critical care training or overlapping skill sets, may be pressed into service as outpatient clinics and elective surgery are suspended. All other ICU staff (eg, APPs, nurses, pharmacists, respiratory therapists) will also be in short supply. Without these key members of the ICU team, high-quality critical care cannot be adequately delivered. Moreover, an indeterminate number of experienced ICU staff may become ill, further straining the system as need and capacity surge.

At forecasted crisis levels, we estimate that the projected shortages of intensivists, critical care APPs and nurses, and respiratory therapists trained in mechanical ventilation would limit care of critically ill ventilated patients.


We can quibble about the percentage of the population that will acquire the virus and the percentage of those that will require critical care, but even the most conservative estimates place the number well above the ICU resources that are available. While the number of ventilators is a shrieking point for the media, the availability of qualified medical personnel is an even larger issue particularly as many of our providers succumb to the disease themselves.


GlennMacGrady



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PostPosted: 03/25/20 11:45 am    ::: Reply Reply with quote

Is the graph about beds wrong? It certainly contradicts statements I've read in the media.

We know that no one in the U.S. stocked sufficient supplies, or has sufficient trained personnel, for a world-wide pandemic -- not at the hospital level, community level, state level, or federal level, or anywhere else in the world. Those were all independent capacity decisions made by experts on all these levels over decades, presumably based on projections from historical needs, that seemed sufficiently prudent when made.

It doesn't help anything to whine and finger-point about these obvious and universal facts. The serious issues are how to ration the available assets and skills and how to procure more.
jammerbirdi



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PostPosted: 03/25/20 11:55 am    ::: Reply Reply with quote

GlennMacGrady wrote:
Is the graph about beds wrong? It certainly contradicts statements I've read in the media.

We know that no one in the U.S. stocked sufficient supplies, or has sufficient trained personnel, for a world-wide pandemic -- not at the hospital level, community level, state level, or federal level, or anywhere else in the world. Those were all independent capacity decisions made by experts on all these levels over decades, presumably based on projections from historical needs, that seemed sufficiently prudent when made.

It doesn't help anything to whine and finger-point about these obvious and universal facts. The serious issues are how to ration the available assets and skills and how to procure more.


This and again on many other components of this crisis. But maybe there's some therapeutic value to whining and finger-pointing.



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PostPosted: 03/25/20 12:05 pm    ::: Reply Reply with quote

jammerbirdi wrote:
But maybe there's some therapeutic value to whining and finger-pointing.



I wonder if it's as much as burying head in sand.



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jammerbirdi



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PostPosted: 03/25/20 12:11 pm    ::: Reply Reply with quote

cthskzfn wrote:
jammerbirdi wrote:
But maybe there's some therapeutic value to whining and finger-pointing.



I wonder if it's as much as burying head in sand.


And who pray tell is doing that?

Change of subject:

Contrary to my reputation for wordiness I can explain everything that’s happening in each of our active threads here on Area 51 with just five words.

This is who we are.



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Genero36



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PostPosted: 03/25/20 12:28 pm    ::: Reply Reply with quote

NYC morgues near capacity, DHS briefing warns

Quote:
“All hospitals within the city tend to have small morgue spaces, so it’s possible that with the capacity of hospitals in New York City, there may be an expectation … that they’ll run out of morgue space,” Worthy-Davis added.


Quote:
An official with Bellevue Hospital said that a temporary morgue outside NYC Health + Hospitals/Bellevue in Manhattan has in recent days been stood up to help house the remains of COVID-19 victims. The New York Post first reported the news.

Another issue for responders will be handling significantly more burials and cremations than is typical. Federal assistance may be available to help with that potential challenge, and it would need to work in tandem with state and local officials.


https://www.politico.com/news/2020/03/25/dhs-briefing-nyc-morgues-near-capacity-148259



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PostPosted: 03/25/20 1:04 pm    ::: Reply Reply with quote

GlennMacGrady wrote:
...The serious issues are how to ration the available assets and skills and how to procure more.


The NEJM article that I linked above has a considered algorithm for rationing resources (primarily staffed ICU beds) and the SCCM article discusses scrounging ventilators and retraining personnel. They both concluded that it's not going to be enough.

Three big problems lie with...
...inadequate hospital space, because we can't build hospitals fast enough and it's hard to retrofit a school or office building with the HVAC, plumbing, and compressed gas systems to care for the critically ill. We need to find some large, under construction buildings that are already erected and fit them with those systems, but that would still take months.
...inadequate equipment, the manufacture of which is crippled by our outsourced supply chains. We need to hope that our American companies can brainstorm ways around that, and we really need a czar to cut through the red tape and make sure everything we need is being manufactured, because it won't do any good to make ventilators and have no tubing that fits them.
...inadequate staff. It takes 13-15 years of post-secondary education to fully train a physician in critical care, ~7-8 years for a PA, ~6 years for an RN. A lot of semi-trained people are going to be taking care of patients. Medical students and retirees are being pressed into additional service. I've heard that there are significant numbers of Filipino nurses in the US who aren't working because they can't get credentialed and we need to cut through that red tape as well. The months that it typically takes for any state to license a physician or nurse just won't work.


cthskzfn



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PostPosted: 03/25/20 1:15 pm    ::: Reply Reply with quote

jammerbirdi wrote:
cthskzfn wrote:
jammerbirdi wrote:
But maybe there's some therapeutic value to whining and finger-pointing.



I wonder if it's as much as burying head in sand.


And who pray tell is doing that?



Well, even I had the decorum not to ask who's "whining and finger-pointing". Wink

To answer your question- those that approve of Trump's handling of the pandemic.



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