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Luuuc
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GlennMacGrady
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cthskzfn
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Location: In a world where a PSYCHOpath like Trump isn't potus.
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 Posted: 03/25/20 10:51 am ::: |
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| <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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| Posted: 03/25/20 11:17 am ::: |
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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. |
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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.
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 03/25/20 11:45 am ::: |
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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. |
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jammerbirdi
Joined: 23 Sep 2004
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| Posted: 03/25/20 11:55 am ::: |
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| 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._________________ Every woman who has ever been presented with a career/sex quid pro quo in the entertainment industry should come forward and simply say, “Me, too.” - jammer The New York Times 10/10/17 |
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cthskzfn
Joined: 21 Nov 2004
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Location: In a world where a PSYCHOpath like Trump isn't potus.
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| Posted: 03/25/20 12:05 pm ::: |
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| 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
Joined: 23 Sep 2004
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| Posted: 03/25/20 12:11 pm ::: |
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| 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. _________________ Every woman who has ever been presented with a career/sex quid pro quo in the entertainment industry should come forward and simply say, “Me, too.” - jammer The New York Times 10/10/17 |
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Genero36
Joined: 24 Apr 2005
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| Posted: 03/25/20 12:28 pm ::: |
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NYC morgues near capacity, DHS briefing warns
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| “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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I'm all for the separation of church and hate.
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FrozenLVFan
Joined: 08 Jul 2014
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| Posted: 03/25/20 1:04 pm ::: |
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| 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.
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cthskzfn
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FrozenLVFan
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| Posted: 03/25/20 2:03 pm ::: |
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| 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. |
All of those decisions were forced by bean-counters at Medicare, managed care organizations, and third party payers, who decided what they were willing to pay for, and not by any overt planning by healthcare providers. (The Medicare program has its fingers in a lot of pies besides paying for seniors' care, one of which is the number of medical students and residents that are trained in this country.)
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 03/25/20 2:08 pm ::: |
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 03/25/20 2:30 pm ::: |
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Let's go, California.
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 03/25/20 3:17 pm ::: |
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| FrozenLVFan wrote: |
| 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. |
All of those decisions were forced by bean-counters at Medicare, managed care organizations, and third party payers, who decided what they were willing to pay for, and not by any overt planning by healthcare providers. |
Do you have any authority to back up that statement. I'm not aware that Medicare or insurance companies tell hospitals how many supplies they can buy, or how many supplies states and the federal government can stockpile.
For example, on the currently hot topic of ventilators, here are the 2015 Ventilator Allocation Guidelines written by the New York Task Force on Life and the Law of the NY Department of Health, a 266 page report. Beginning on p. 28, the report estimates the number of ventilators needed under different pandemic scenarios. On p. 32, the task force recommends against stockpiling for a severe pandemic scenario for financial reasons and because "purchasing additional ventilators beyond a threshold will not save additional lives", because there would be insufficient trained staff to operate them.
This is a clear example of a state making a reasonable stockpiling decision, balancing cost, staff, historic need, and pandemic probabilities against one another, and deciding not to buy additional ventilators. I'm sure all the other states made similar decisions on their own, as did the federal government.
Well, New York and everyone else all guessed wrong. No one was to blame, then or now. All those business decisions were reasonable when made. |
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FrozenLVFan
Joined: 08 Jul 2014
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| Posted: 03/25/20 3:45 pm ::: |
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| GlennMacGrady wrote: |
| FrozenLVFan wrote: |
| 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. |
All of those decisions were forced by bean-counters at Medicare, managed care organizations, and third party payers, who decided what they were willing to pay for, and not by any overt planning by healthcare providers. |
Do you have any authority to back up that statement. I'm not aware that Medicare or insurance companies tell hospitals how many supplies they can buy, or how many supplies states and the federal government can stockpile.
For example, on the currently hot topic of ventilators, here are the 2015 Ventilator Allocation Guidelines written by the New York Task Force on Life and the Law of the NY Department of Health, a 266 page report. Beginning on p. 28, the report estimates the number of ventilators needed under different pandemic scenarios. On p. 32, the task force recommends against stockpiling for a severe pandemic scenario for financial reasons and because "purchasing additional ventilators beyond a threshold will not save additional lives", because there would be insufficient trained staff to operate them.
This is a clear example of a state making a reasonable stockpiling decision, balancing cost, staff, historic need, and pandemic probabilities against one another, and deciding not to buy additional ventilators. I'm sure all the other states made similar decisions on their own, as did the federal government.
Well, New York and everyone else all guessed wrong. No one was to blame, then or now. All those business decisions were reasonable when made. |
I started to write a volume about hospital reimbursement and funding for physician training, etc., but the bottom line is that whoever controls the purse strings controls what a hospital can purchase and how many physicians are trained.
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readyAIMfire53
Joined: 20 Nov 2004
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Location: Durham, NC
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| Posted: 03/25/20 4:56 pm ::: |
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| GlennMacGrady wrote: |
| FrozenLVFan wrote: |
| 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. |
All of those decisions were forced by bean-counters at Medicare, managed care organizations, and third party payers, who decided what they were willing to pay for, and not by any overt planning by healthcare providers. |
Do you have any authority to back up that statement. I'm not aware that Medicare or insurance companies tell hospitals how many supplies they can buy, or how many supplies states and the federal government can stockpile.
For example, on the currently hot topic of ventilators, here are the 2015 Ventilator Allocation Guidelines written by the New York Task Force on Life and the Law of the NY Department of Health, a 266 page report. Beginning on p. 28, the report estimates the number of ventilators needed under different pandemic scenarios. On p. 32, the task force recommends against stockpiling for a severe pandemic scenario for financial reasons and because "purchasing additional ventilators beyond a threshold will not save additional lives", because there would be insufficient trained staff to operate them.
This is a clear example of a state making a reasonable stockpiling decision, balancing cost, staff, historic need, and pandemic probabilities against one another, and deciding not to buy additional ventilators. I'm sure all the other states made similar decisions on their own, as did the federal government.
Well, New York and everyone else all guessed wrong. No one was to blame, then or now. All those business decisions were reasonable when made. |
This is also an example of why it was crucial to our national security to maintain and listen to a pandemic task force at the national level. Professionals who spend their professional lives only on how to prepare for a pandemic. Professionals who continue to analyze and learn from the Ebola virus - how to save lives. What might be needed.
Disbanding that national security task force saved a little money (like the cost of one wheel of one bomber). And we'll see what the death cost is.
#1 priority of our leaders is keeping us safe. Disbanding this task force is complete and total failure of leadership and is endangering US lives.
_________________
Follow your passion and your life will be true down to your core.
~rAf
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FrozenLVFan
Joined: 08 Jul 2014
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| Posted: 03/25/20 5:28 pm ::: |
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| Does anyone know the stats on survival for people who are sick enough to be hospitalized? Sick enough to be intubated?
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threadkiller1201
Joined: 19 Sep 2005
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| Posted: 03/25/20 6:57 pm ::: |
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| FrozenLVFan wrote: |
| Does anyone know the stats on survival for people who are sick enough to be hospitalized? Sick enough to be intubated? |
I think I read the stats out of China were 50% of critical patients survived, but I need to go find that reference.
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Randy
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Howee
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FrozenLVFan
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Genero36
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GlennMacGrady
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| Posted: 03/25/20 10:50 pm ::: |
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Update 14: Changes in 24 Hours since Last Update
U.S.:
- confirmed cases increased by 13,977 (25%) from 55,041 to 69,018
- deaths increased by 251 from 790 to 1,041
- death rate increased from 1.43% to 1.50%
U.S. deaths each day since March 11 and U.S. cumulative death rate on that day:
? – 3/11 2.89%
2 – 3/12 2.41%
7 – 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%
251 – 3/25 1.50%
The reason for the death rate increase the last three days is likely because New York accounts for 48% of the confirmed cases and the attack rate in NY (28%) is about 3.5 times higher than in the rest of the country (8%). The only explanation I've heard for this is that the virus may have been circulating in NY for weeks longer than originally thought.
The U.S. is only 5,400 cases behind second place Italy and may take that spot tomorrow. |
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