It's bad out there - Printable Version
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RE: It's bad out there - dabigv13 - 12-18-2020
Most of the ICU patients are in their 50s to 70s. Some in the 80s. The older ones don't last long if they are real sick. Younger folks tend to have more reserve.
RE: It's bad out there - M T - 12-18-2020
I want to be fair about prioritizing health care workers versus residents of SNFs & LTCFs, so in case anybody missed this reasoning:
At least for LTCFs, I believe it is the case that the HCWs bring the disease into the LTCFs. If all the HCWs are vaccinated, then the influx of disease will diminish, and the cases among the residents will drop.
This requires vaccines for nurses/aides, physical therapists, kitchen staff, cleaning crew, maintenance crew, administration, and the occasional doctors. Those people are the people that get access into such facilities.
RE: It's bad out there - Snorlax94 - 12-19-2020
(12-18-2020, 08:39 PM)teejers1 Wrote:(12-17-2020, 08:45 PM)dabigv13 Wrote: LTCF patients may be 40% of the fatalities, but they are a much smaller portion of the ICU cases. Getting them vaccinated will be helpful but we'd still be stretched even if they all already had their shots.
That seems counterintuitive to me - is it because LTCF patients just go from regular hospital bed to the morgue (and skip ICUs altogether)? Or that they never make it to ICUs in the first place and perish at home?
BTW, front page story in Merc today about ridiculous spike in LTCF cases across the state, and identifying some pretty head-shaking numbers at some SCC facilities. It's like for 7 months (after some early gaffes revealed the extreme vulnerability of senior folks) the state (and SCC in particular) did pretty well in containing LTCF cases . . . and then the dam broke. Strange.
I’m not familiar with LTCF’s — I have no family members in one, but could it be that during Thanksgiving families just couldn’t resist visiting elderly extended family?
RE: It's bad out there - dabigv13 - 12-19-2020
https://www.latimes.com/california/story/2020-12-19/los-angeles-county-coronavirus-hospitalization-surge-rationing
This is the situation in LA. And yet the traffic on my way to the hospital is about the same as before the pandemic. Going to be worse than NYC or Italy was in about a week and stay that way for a while, if we are fortunate. If we don't level off soon this will be an unprecedented collapse of the healthcare system in an American city. Really not looking forward to what I'm going to be seeing the next few weeks in the ICU. To ask these nurses and respiratory therapists and doctors who are already at their limit trying to help as many as possible, to be asked for the first time ever in their careers to ration care and take people off therapies...it's really so heartbreaking and infuriating.
RE: It's bad out there - Goose - 12-19-2020
(12-19-2020, 10:34 AM)dabigv13 Wrote: https://www.latimes.com/california/story/2020-12-19/los-angeles-county-coronavirus-hospitalization-surge-rationingAnd yet LA County is not fully SIP. Granted, it will take a week to 10 days for this to help, but given the current situation how can delaying such a step make any sense? If the county fears people just won't do it, ask Newsom to call out the National Guard to enforce it.
This is the situation in LA. And yet the traffic on my way to the hospital is about the same as before the pandemic. Going to be worse than NYC or Italy was in about a week and stay that way for a while, if we are fortunate. If we don't level off soon this will be an unprecedented collapse of the healthcare system in an American city. Really not looking forward to what I'm going to be seeing the next few weeks in the ICU. To ask these nurses and respiratory therapists and doctors who are already at their limit trying to help as many as possible, to be asked for the first time ever in their careers to ration care and take people off therapies...it's really so heartbreaking and infuriating.
As an update, the UK, Germany, and Italy have all issued lockdowns orders of one kind or another. Italy seems to be the most stringent. The UK is stringent, but it is not country-wide, at least not yet.
RE: It's bad out there - Hurlburt88 - 12-20-2020
My understanding is that the UK's recent regional lockdown is nominally due to concerns about the "new variant" that Boris Johnson and others say is more transmissible. Does anyone have a sense of how truly concerning the higher transmissibility of this variant is? Even if not significantly more transmissible, thought crossed my mind that this could be a useful marketing point for governments to ask citizens to double-down on SIP during the holidays.
RE: It's bad out there - dabigv13 - 12-20-2020
https://www.latimes.com/california/story/2020-12-20/covid-19-surge-hospital-capacity-full-transfers
Quote:The coronavirus surge was going to kill her.
And she didn’t even have COVID-19.
She had woken up in a pool of blood earlier that day, so Billy had rushed her to Hi-Desert. The facility didn’t have the equipment to take care of Kim, he said. So the attending doctor began to call hospitals across the Inland Empire to see if Kim could be transferred to them.
None could accept her. They were swamped with COVID-19 cases
Everywhere, too full.
“The nurses were extremely distraught, and I’ve never seen them that way,” Billy told me five days later. “The doctor was getting frustrated.”
That’s when Billy volunteered to take Kim in his truck, strap on some off-road lights, and speed down California Route 62 toward Interstate 10. The plan: “get pulled over by police so we could get an escort” to the nearest hospital.
But that Hail Mary never came to pass. Shortly after their phone conversation, Kim’s health quickly deteriorated. She died at age 60, in the arms of Billy and her son.
...........
I asked him what he wanted people to take from Kim’s death. His eyes watered, but his voice was firm.
“I hope they learn,” he said, “that her last days were chaos.”
This sort of thing is happening all over Southern California I'm sure. Tragic.
RE: It's bad out there - magnus - 12-20-2020
I am hearing stories out of Texas with similar inability to treat or transfer leading to death.
Very tragic.
RE: It's bad out there - M T - 12-20-2020
(12-20-2020, 04:19 PM)magnus Wrote: I am hearing stories out of Texas with similar inability to treat or transfer leading to death.Texas is a large state; I mostly only track Houston. Texas Medical Center (a number of hospitals in Houston) is reporting 100% of phase 1 ICU capacity filled = 83% of phase 2 ICU capacity = 64% of phase 3 ICU capacity. 359 COVID in ICU of 1412 in ICU.
Very tragic.
RE: It's bad out there - BostonCard - 12-20-2020
Southern California is now drawing up plans for how they would triage patients if it came to that.
https://www.latimes.com/california/story/2020-12-19/los-angeles-county-coronavirus-hospitalization-surge-rationing
If that's behind a paywall, there is this
https://www.voanews.com/covid-19-pandemic/overwhelmed-california-hospitals-contemplate-rationing-care
Quote:As businesses struggle during what should be a very busy holiday shopping season, many hospitals are preparing for the possibility of rationing care. A document recently circulated among doctors at the four hospitals run by Los Angeles County calls for them to shift strategy: Instead of trying everything to save a life, their goal during the crisis is to save as many patients as possible. That means those less likely to survive won't get the same kind of care offered in normal times.
BC
RE: It's bad out there - magnus - 12-20-2020
(12-20-2020, 04:50 PM)M T Wrote:(12-20-2020, 04:19 PM)magnus Wrote: I am hearing stories out of Texas with similar inability to treat or transfer leading to death.Texas is a large state; I mostly only track Houston. Texas Medical Center (a number of hospitals in Houston) is reporting 100% of phase 1 ICU capacity filled = 83% of phase 2 ICU capacity = 64% of phase 3 ICU capacity. 359 COVID in ICU of 1412 in ICU.
Very tragic.
Your posts are usually very enlightening and very on point, but in this case, I'm not sure what the point of your post was. I'll assume I'm just missing the intent and followup by adding that the story that I heard was from North Texas. (sorry, don't have the exact location). Regardless where it's from, assuming it's true (which I would put confidence at > seemingly true, but unverified twitter post, and < personal experience) it's bad out there. =(
RE: It's bad out there - M T - 12-21-2020
(12-20-2020, 06:34 PM)magnus Wrote:(12-20-2020, 04:50 PM)M T Wrote:(12-20-2020, 04:19 PM)magnus Wrote: I am hearing stories out of Texas with similar inability to treat or transfer leading to death.Texas is a large state; I mostly only track Houston. Texas Medical Center (a number of hospitals in Houston) is reporting 100% of phase 1 ICU capacity filled = 83% of phase 2 ICU capacity = 64% of phase 3 ICU capacity. 359 COVID in ICU of 1412 in ICU.
Very tragic.
Your posts are usually very enlightening and very on point, but in this case, I'm not sure what the point of your post was. I'll assume I'm just missing the intent and followup by adding that the story that I heard was from North Texas. (sorry, don't have the exact location). Regardless where it's from, assuming it's true (which I would put confidence at > seemingly true, but unverified twitter post, and < personal experience) it's bad out there. =(
Sorry that I wasn't clear.
I couldn't tell where in Texas you were referring. (Both Texas & California are big places. Saying it is snowing in Texas/California would not be contradictory to saying it is a sunny & warm in Texas/California.) In the past, others & I have given updates on Houston when it was so bad in June/July. When I saw your post, I quickly went to the Houston mega-medical center site to see whether they had a bad surge when I wasn't looking. I posted their current info as a data point.
I would imagine that the smaller towns would be sending overflow to the big medical centers in HOU, DFW, San Antonio. North & West Texas may be too far to transport except by air. But the big medical centers will eventually fill, so those are important places to watch. North Texas probably triages in Amarillo.
Judging from this news article out of Austin, Texas has restrictions that trigger on <15% hospital (not just ICU) beds available. At first glance, such a policy seems reasonable, but there is a lot of wiggle room in what that full capacity means. (It mentions 8 regions under restrictions: Amarillo, Lubbock, Abilene, El Paso, Dallas-Fort Worth, Midland-Odessa, Waco and Laredo. A hospital in Abilene is mentioned that is out of ICU beds.) See that news article for reported ICU availability in Texas.
The Univ. of Minnesota tracks bed usage by COVID patients, but does not attempt to give bed availability. Of course, it is subject to Garbage In, Garbage Out... San Mateo county numbers at the state level presumably are garbage. This site indicates that San Mateo county has 73% of its ICU beds occupied by COVID patients. The SMC site indicates 27 out of 68 occupied ICU beds are COVID, with 6 empty beds.
RE: It's bad out there - Goose - 12-21-2020
Just as a reference of what it takes to avoid this situation, take a look at
https://www.yahoo.com/news/explainer-australia-scrambles-track-christmas-050341976.html
No direct analogy in geography, but it would be like shutting down Half Moon Bay, Pacifica and all the surrounding area with cops on all the roads. There are about 250K people in the Northern Beaches area. Not happening in SMC IMHO.
RE: It's bad out there - Maple Leaf - 12-21-2020
Not good for Fresno County. Have friends who are ER and ICU doctors in Fresno, the county suffer from a doctor shortage in general and it is more acute with specialists, this is true for all of Central California.
https://covidactnow.org/us/california-ca/county/fresno_county?s=1460419#explore-chart
Fresno County, California
Fresno County, California has about 154 ICU beds. Based on best available data, we estimate that 55% (84) are currently occupied by non-COVID patients. Of the 70 ICU beds remaining, 115 are needed by COVID cases, or >100% of available beds. This suggests hospitals cannot absorb a wave of new COVID infections without substantial surge capacity. Aggressive action urgently needed.
RE: It's bad out there - Goose - 12-24-2020
Another example of how difficult it is to manage this epidemic even in places that have responded "well".
https://www.yahoo.com/news/korea-pm-says-highest-daily-001235245.html
It is also interesting to note that Taiwan has identified an EVA pilot (who is a New Zealander) as the source of a COVID-19 cases.
https://onemileatatime.com/eva-air-fires-pilot-coronavirus/
The pilot lied about his contacts and where he had actually been (the USA) to authorities. Somewhat of a commentary on the nature of compliance in non-Asian societies IMHO. NOTE: Donald Trump was not involved.