It's bad out there - Printable Version
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RE: It's bad out there - OutsiderFan - 12-04-2020
(12-04-2020, 04:54 PM)winflop Wrote: I'm curious as to why we haven't heard about governors calling up FEMA to deploy their mobile hospitals to provide additional capacity?
Also, both hospital and ICU capacity is not a fixed number. Many hospitals have rooms or entire wards that have been taken offline/out of service that in a pinch could be re-activated with additional equipment. Regular hospital rooms can also be converted to ICU rooms within 24 hours with additional equipment.
This isn't meant to imply that the situation isn't serious. Only to explain that capacity numbers are somewhat flexible both with federal support via FEMA and with additional equipment and onlining/converting idle capacity.
Dr. Cody answers this question in the presser I posted. Short answer is there aren't enough trained critical care personnel.
RE: It's bad out there - BostonCard - 12-04-2020
(12-04-2020, 04:48 PM)teejers1 Wrote:(12-04-2020, 03:25 PM)BostonCard Wrote: Another sign that things are reaching a breaking point:
https://www.theatlantic.com/health/archive/2020/12/the-worst-case-scenario-is-happening-hospitals-are-overwhelmed/617301/
The ratio of new hospitalizations to new diagnoses is going down. That would be a good thing if the diagnoses are being made earlier or of patients with milder symptoms (because of increased testing), but as the article makes plain, that's not what is going on (as one can tell by observing that the case fatality rate is actually going up). What is happening is that people who might have previously been admitted to the hospital are being turned away (or are deciding not to go to the hospital).
Quote:But ominous no longer fits what we’re observing in the data, because calamity is no longer imminent; it is here. The bulk of evidence now suggests that one of the worst fears of the pandemic—that hospitals would become overwhelmed, leading to needless deaths—is happening now. Americans are dying of COVID-19 who, had they gotten sick a month earlier, would have lived. This is such a searingly ugly idea that it is worth repeating: Americans are likely dying of COVID-19 now who would have survived had they gotten September’s level of medical care.
BC
I understand the urge to paint as bleak a picture as possible - and it is correct that regulators are clamping down.
But it is worth noting that the article you highlight uses words like "suggests," and "likely." Also, your point assumes that the only reason people are deciding not to go to the hospital is because . . . what? There are too many cases there? In other words, what makes you think that hypothetical set of people would have gone to the hospital in September?
I'm most focused on SCC. The situation is certainly deteriorating - it's also true than non-Covid patients (1700) outpace Covid patients (325) by substantial amount. I suspect there can be some interim relief there with non-emergency admits. Separately, the bed numbers were re-set (as were ventilators) to remove surge beds or make number more aligned with staffing availability (IIUTC - but defer to MT on that). I'm good with that as capacity numbers should be realistic, but it's also possible there is upside there.
We may end up in the calamity/Hospital Armageddon many here have . . . predicted. Hopefully people will behave more responsibly and bring the numbers down and that can be avoided.
As an aside, given what I see in day-to-day life in Palo Alto (i.e., universal mask compliance; not a lot of group socializing outside - and if so, pretty responsible at parks), I really wonder what's driving these numbers. One thing that remains alarming: LTCF. In last half of November, 75 cases (and the first half of November was much worse - 145). Wonder how many of those folks end up in SCC hospitals? [And we just got notice that at my mom's facility a staffer tested positive, so the whole place is set for a couple rounds of testing there].
Wasn't my urge to paint as bleak a picture as possible supposed to have been driven by the election?
Hope your mom is ok.
BC
RE: It's bad out there - winflop - 12-04-2020
(12-04-2020, 05:25 PM)OutsiderFan Wrote:(12-04-2020, 04:54 PM)winflop Wrote: I'm curious as to why we haven't heard about governors calling up FEMA to deploy their mobile hospitals to provide additional capacity?
Also, both hospital and ICU capacity is not a fixed number. Many hospitals have rooms or entire wards that have been taken offline/out of service that in a pinch could be re-activated with additional equipment. Regular hospital rooms can also be converted to ICU rooms within 24 hours with additional equipment.
This isn't meant to imply that the situation isn't serious. Only to explain that capacity numbers are somewhat flexible both with federal support via FEMA and with additional equipment and onlining/converting idle capacity.
Dr. Cody answers this question in the presser I posted. Short answer is there aren't enough trained critical care personnel.
FEMA not only provides infrastructure & facilities but also sources personnel. But perhaps there is a nationwide constraint. If so, that should be part of the answer. Just saying "our hospitals don't have enough staff" is an insufficient answer.
RE: It's bad out there - OutsiderFan - 12-04-2020
(12-04-2020, 05:56 PM)winflop Wrote:(12-04-2020, 05:25 PM)OutsiderFan Wrote:(12-04-2020, 04:54 PM)winflop Wrote: I'm curious as to why we haven't heard about governors calling up FEMA to deploy their mobile hospitals to provide additional capacity?
Also, both hospital and ICU capacity is not a fixed number. Many hospitals have rooms or entire wards that have been taken offline/out of service that in a pinch could be re-activated with additional equipment. Regular hospital rooms can also be converted to ICU rooms within 24 hours with additional equipment.
This isn't meant to imply that the situation isn't serious. Only to explain that capacity numbers are somewhat flexible both with federal support via FEMA and with additional equipment and onlining/converting idle capacity.
Dr. Cody answers this question in the presser I posted. Short answer is there aren't enough trained critical care personnel.
FEMA not only provides infrastructure & facilities but also sources personnel. But perhaps there is a nationwide constraint. If so, that should be part of the answer. Just saying "our hospitals don't have enough staff" is an insufficient answer.
Whether it is insufficient or not, it's still the reality. And there is always going to be a limit to supply at some point.
RE: It's bad out there - winflop - 12-04-2020
(12-04-2020, 06:08 PM)OutsiderFan Wrote:(12-04-2020, 05:56 PM)winflop Wrote:(12-04-2020, 05:25 PM)OutsiderFan Wrote:(12-04-2020, 04:54 PM)winflop Wrote: I'm curious as to why we haven't heard about governors calling up FEMA to deploy their mobile hospitals to provide additional capacity?
Also, both hospital and ICU capacity is not a fixed number. Many hospitals have rooms or entire wards that have been taken offline/out of service that in a pinch could be re-activated with additional equipment. Regular hospital rooms can also be converted to ICU rooms within 24 hours with additional equipment.
This isn't meant to imply that the situation isn't serious. Only to explain that capacity numbers are somewhat flexible both with federal support via FEMA and with additional equipment and onlining/converting idle capacity.
Dr. Cody answers this question in the presser I posted. Short answer is there aren't enough trained critical care personnel.
FEMA not only provides infrastructure & facilities but also sources personnel. But perhaps there is a nationwide constraint. If so, that should be part of the answer. Just saying "our hospitals don't have enough staff" is an insufficient answer.
Whether it is insufficient or not, it's still the reality. And there is always going to be a limit to supply at some point.
I agree. But come out and say that. Don't give a half-donkey's butt answer that only considers local capacity.
RE: It's bad out there - Genuine Realist - 12-04-2020
(12-04-2020, 06:15 PM)winflop Wrote:Not that it ISN'T bad out there, but US media coverage has been relentlessly negative, far more so than other nations.(12-04-2020, 06:08 PM)OutsiderFan Wrote:(12-04-2020, 05:56 PM)winflop Wrote:(12-04-2020, 05:25 PM)OutsiderFan Wrote:(12-04-2020, 04:54 PM)winflop Wrote: I'm curious as to why we haven't heard about governors calling up FEMA to deploy their mobile hospitals to provide additional capacity?
Also, both hospital and ICU capacity is not a fixed number. Many hospitals have rooms or entire wards that have been taken offline/out of service that in a pinch could be re-activated with additional equipment. Regular hospital rooms can also be converted to ICU rooms within 24 hours with additional equipment.
This isn't meant to imply that the situation isn't serious. Only to explain that capacity numbers are somewhat flexible both with federal support via FEMA and with additional equipment and onlining/converting idle capacity.
Dr. Cody answers this question in the presser I posted. Short answer is there aren't enough trained critical care personnel.
FEMA not only provides infrastructure & facilities but also sources personnel. But perhaps there is a nationwide constraint. If so, that should be part of the answer. Just saying "our hospitals don't have enough staff" is an insufficient answer.
Whether it is insufficient or not, it's still the reality. And there is always going to be a limit to supply at some point.
I agree. But come out and say that. Don't give a half-donkey's butt answer that only considers local capacity.
https://fortune.com/2020/11/29/covid-19-news-coverage-us-negative-stories
RE: It's bad out there - DocSavage87 - 12-04-2020
Another anecdote: My mother told me her 67 yo friend got COVID-19 after attending Thanksgiving at her daughter's home. She supposedly was using mitigation techniques before the holidays.
RE: It's bad out there - BostonCard - 12-04-2020
[tweet]https://twitter.com/COVID19Tracking/status/1335016621111345152?s=20[/tweet]
225,000 new cases (a new record); the 7-day average is 177,500
101,000 people hospitalized (also a record)
2,563 people died, with the 7-day average about to hit 2000 for the first time since the spring peak.
If you want some good news, it looks like cases and hospitalizations have peaked in the midwest, which was the first region to be hit with this new wave. So, some of the hardest hit states are getting some relief, with hospitalizations down in the Dakotas, Nebraska, Iowa, Illinois, and Wisconsin, and more or less flat in the rest of the midwest. Deaths are still rising everywhere, as would be expected for a trailing indicator.
Given that the midwest was a couple weeks ahead of the west coast, we may be looking at a peak in a couple weeks, which would be welcome news indeed. Still, based on current trends, we are probably looking at a record 3,000+ deaths a day around the peak, which would be devastating.
BC
RE: It's bad out there - teejers1 - 12-04-2020
(12-04-2020, 05:45 PM)BostonCard Wrote: Wasn't my urge to paint as bleak a picture as possible supposed to have been driven by the election?
Hope your mom is ok.
BC
Not yours, in particular.
And GR's article - which confirms common sense, particularly the reporting on education in US - reveals that the negative stories are due to . . . the readers' wants and desires:
Or as the researchers say, “Our results suggest that U.S. major outlets publish unusually negative COVID-19 stories in response to reader demand and interest.” That tracks with the findings of a bevy of research about negativity bias in human psychology: People gravitate toward and tend to remember bad news.
Great. We live in a country of Eeyores! Or Chicken Littles . . . or both.
P.S. Second time a positive test has cropped up at my mom's facility during the pandemic. First time all patients tested negative, so I'm optimistic.
P.P.S. As for Doc's anecdote - unfortunately, expect there will be many more such transmission stories.
RE: It's bad out there - BostonCard - 12-04-2020
In light of the previous posts about news in the US...
https://www.washingtonpost.com/health/2020/12/03/911-ambulance-services-breaking-point/
It really is rough out there. I was just on a call with three ID and critical care colleagues across the country. They are pretty close to their limits. The system hasn't hit its breaking point yet, but the red lights are flashing, and, of course, the problem is that what we are seeing now reflects infections that were transmitted a week ago, so action now won't make a dent on cases for another week, hospitalizations for two, and deaths for about three.
The thing is, I'm actually quite optimistic on the near term horizon. If the midwest is the lead, things are going to start getting better in a couple weeks. After that, we will start to have people vaccinated, which will cut down on outbreaks at care homes, which will have a dramatic effect on deaths (if you can eliminate the 40% of deaths that come from people in care homes, that is quite significant). By January, high risk individuals will be getting vaccinated, by February it will be opened up further and you will start to see immunity in some subpopulations by March. By April, the vaccine will be made available to any adult who wants it, and most adults who want to get vaccinated will be vaccinated by June. At that point, I expect cases to have declined dramatically (an order of magnitude or more, and deaths even further), at which point most restrictions will be pulled back. By July, we ought to have widespread herd immunity and we will only have sporadic outbreaks; I expect by summer we will be able to go to our pre-pandemic behavior (though I'm guessing some behaviors will be permanently altered).
That's why, from my perspective, anything we can do to reduce spread now will avert deaths entirely, and why I feel like we ought to be redoubling our efforts to bring the pandemic under control.
BC
BTW, here's something that puts things into perspective:
Number of Americans killed on 9/11: 2,977
Number of Americans killed at Pearl Harbor: 2,403
Number of Americans killed by COVID-19 on Friday: 2,563
BC
RE: It's bad out there - 2006alum - 12-05-2020
Isn't the issue less about hospital beds than medical personnel to staff them? My sense is that staffing shortages are likely to be more a problem than physical bed space?
RE: It's bad out there - OutsiderFan - 12-05-2020
(12-05-2020, 04:39 AM)2006alum Wrote: Isn't the issue less about hospital beds than medical personnel to staff them? My sense is that staffing shortages are likely to be more a problem than physical bed space?
Yes. It seems "beds" is being used as a catchall term. You can easily report a number of beds. Much more nebulous and difficult to indicate how many ICU trained personnel are available, especially because they can conceivably come from anywhere.
RE: It's bad out there - BostonCard - 12-06-2020
[tweet]https://twitter.com/COVID19Tracking/status/1335742695688478721?s=20[/tweet]
7-day averages in new cases, hospitalizations, and deaths are at record highs (deaths higher than in the spring). It does look like things have plateaued in the midwest.
BC
RE: It's bad out there - fullmetal - 12-07-2020
(12-04-2020, 05:56 PM)winflop Wrote: FEMA not only provides infrastructure & facilities but also sources personnel. But perhaps there is a nationwide constraint. If so, that should be part of the answer. Just saying "our hospitals don't have enough staff" is an insufficient answer.
I don't think FEMA sources personnel. I'd need to see a citation for that.
"Our hospitals don't have enough staff" is absolutely a sufficient answer if you kept tabs on the initial covid wave and how staffing needs were addressed. Because hospitals are a patchwork of private/public/hybrid entities, they each have their own set of protocols, software, and resources that external staff need to get trained up on and qualified to operate. Contract personnel are pretty expensive too...I'm certain that hospitals are loathe to take on the additional contracts needed to staff up extra covid wards. The real problem is that the supply of contract healthcare workers available to travel is not sufficient anymore since too many regions are under staffing duress. We just don't have enough trained personnel to travel to all the affected areas.
The docs/nurses/techs on this board can jump in if I'm off base.
RE: It's bad out there - Goose - 12-07-2020
This is an interesting input from Dr. Scott Morrow. I think it may reflect the feelings of many on this board. I understand where he is coming from (I think) and believe his point of view deserves a hearing. That said, Reff in San Mateo County is 1.21. Not looking good.
https://www.smchealth.org/health-officer-updates/december-7-2020-health-officer-statement
RE: It's bad out there - 2006alum - 12-08-2020
(12-07-2020, 09:14 PM)Goose Wrote: This is an interesting input from Dr. Scott Morrow. I think it may reflect the feelings of many on this board. I understand where he is coming from (I think) and believe his point of view deserves a hearing. That said, Reff in San Mateo County is 1.21. Not looking good.
https://www.smchealth.org/health-officer-updates/december-7-2020-health-officer-statement
Thanks for sharing, and an interesting perspective. I can't tell if he's driven more by principled objections or more of an apologist "what can we do, people won't follow us anyway" mindset. But I agree with him that some of the activities permitted or excluded are so inconsistent as to undermine the overarching message. And interesting that he doesn't seem to think there's an easy case for leaving schools open when most everything else is shut. I do wonder what medical personnel think about such an approach.
And I can't believe I'm saying this, but Josh Hawley may be the one of the few In Congress who get it: we need to send more $ to the people, and now. Maybe he and AOC could team up to form an anti-Boomer, anti-Wall Street, under-50 coalition of the willing...
RE: It's bad out there - Farm93 - 12-08-2020
(12-04-2020, 06:28 PM)Genuine Realist Wrote:The coverage is not really that hard to understand(12-04-2020, 06:15 PM)winflop Wrote:Not that it ISN'T bad out there, but US media coverage has been relentlessly negative, far more so than other nations.(12-04-2020, 06:08 PM)OutsiderFan Wrote:(12-04-2020, 05:56 PM)winflop Wrote:(12-04-2020, 05:25 PM)OutsiderFan Wrote: Dr. Cody answers this question in the presser I posted. Short answer is there aren't enough trained critical care personnel.
FEMA not only provides infrastructure & facilities but also sources personnel. But perhaps there is a nationwide constraint. If so, that should be part of the answer. Just saying "our hospitals don't have enough staff" is an insufficient answer.
Whether it is insufficient or not, it's still the reality. And there is always going to be a limit to supply at some point.
I agree. But come out and say that. Don't give a half-donkey's butt answer that only considers local capacity.
https://fortune.com/2020/11/29/covid-19-news-coverage-us-negative-stories
1 - The US news market is more commercial than most other nations. Bad news sells. Good news doesn't.
2 - The US news market is largely in decline - Pushing good news almost certainly means unemployment for the author and even publisher.
3 - Few countries, if any, in the world are underperforming their pandemic capabilities given economic and health care resources as the USA. So that failure is rather shocking. Shocking stories sell especially well.
FWIW - The negative story rate makes sense to me, and still I would not have imagined that hospitals around the USA would convert their parking structures into temporary COVID-19 units. Reading about that is far more interesting than reading that the USA is doing better with this pandemic on a death per capita basis than a few major northern hemisphere nations the UK, Spain and Italy.
The sports comparable would be for local media coverage to imply that the 11th place Pac-12 basketball coach is doing better than the 12th place team. When we all know the story that would get the clicks would be to speculate on coaches that could replace that 11th place coach soon. The 11th place team may even win from time to time, but that wouldn't mean the overall coverage would suddenly become positive for that soon to be fired coach.
The USA situation is a bit like that 11th place team/coaching situation. We are doing better than a few countries and have done a few things well from time to time, but the bigger story remains covering the failures of our approach and our, now-fired, leader.
RE: It's bad out there - 82 Card - 12-08-2020
(12-08-2020, 04:22 AM)2006alum Wrote: And I can't believe I'm saying this, but Josh Hawley may be the one of the few In Congress who get it: we need to send more $ to the people, and now. Maybe he and AOC could team up to form an anti-Boomer, anti-Wall Street, under-50 coalition of the willing...
Why anti-Boomer? This Boomer is all for helping out people disproportionately affected or who were already in need before the pandemic. What I don't want to see is a bunch of tax money going to money bags that are doing quite well already.
RE: It's bad out there - 82 Card - 12-09-2020
Another awful day. Today is the first day that daily death count went over 3k. Covid Tracking project shows 211,027 new cases and 3,054 deaths. Worldometers.net shows 225,234 new cases and 3,243 deaths. Hospitalizations hit a new record. California new cases were over 30k for first time.
RE: It's bad out there - Farm93 - 12-09-2020
The Thanksgiving related case acceleration appears to be kicking in now. A bit scary, but at this point hopefully it will be scary enough for Americans to avoid a similar move for Christmas.