Overwhelmed hospitals - Printable Version
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Overwhelmed hospitals - BostonCard - 03-17-2020
Good editorial in the WSJ (there may be a paywall) by Scott Gotlieb (former FDA commissioner).
https://www.wsj.com/articles/american-hospitals-can-avoid-italys-fate-11584468045
BC
RE: Overwhelmed hospitals - burger - 03-17-2020
This article has estimated hospitalization rates for different scenarios of spread by city. You can enter your city and see how bad it might get. Even under the best scenarios, a lot of areas' hospitals are going to fill up.
https://projects.propublica.org/graphics/covid-hospitals
RE: Overwhelmed hospitals - M T - 03-18-2020
On Mar 15, Gov. Newsom indicated there were 74,000 hospital beds in California, with a surge capacity of 9,000 more. (I know the AHA indicated 74K beds in acute hospitals in CA.) IIRC, he talked about getting an extra 740 beds in California, but I haven't seen anything more about that this week.
Great, that would jump California from rank #47 all the way up to #42 out of 51 (DC).
3 days later, he is using 88,000 as the number of beds. I don't know where that increase comes from. Accounting differently? or an actual increase?
Before the first community spread patient (who has since died) was announced at El Camino Hospital, I emailed some official there to please get as many beds as they could. When I was there in the fall, my room had only one bed, but was plumbed for 2, and had room for a third bed.
RE: Overwhelmed hospitals - dabigv13 - 03-18-2020
Our hospital opened a closed wing in anticipation and has been discharging aggressively to get beds open. A partner from China has been ordering masks from sources she has over there for our own department and personal use. Our chief handed out our last n95 masks today that he had locked away in his desk. Not sure when we'll get more though supposedly our hospital is ok on PPE. Overall inpatient covid numbers across socal seems low still. I'm hoping social distancing went into place early enough to stop the big crush. Fingers crossed. Did my last surgery today, had to cancel all my electives but this one had to go. It was nice for a brief time to be back doing normal stuff and not in the whirlwind of the oncoming pandemic.
RE: Overwhelmed hospitals - fullmetal - 03-18-2020
Current patients should be glad to get out of hospitals before the storm hits. The China study of 138 patients showed that many contracted the virus while in the hospital for other issues.
RE: Overwhelmed hospitals - M T - 03-18-2020
I'm glad to hear of the wing opening up! That's really good news... but then there's the problem of staffing.
The governor's 19% increase in beds in 3 days is equivalent to an increase by 78 in the number of hospitals. Surely we hadn't built 78 hospitals in 3 days. A wing or two opening up isn't going to explain that many beds.
California announced the release of millions of masks from its reserve more than 2 weeks ago. I believe the number was 5M of its 21M. I believe the governor said there were 416 hospitals in California. That would mean an average of 12,000 N95 masks per hospital. Surely not enough at all and likely not distributed evenly, but it surprises me that a SoCal hospital is out of masks already, before any large influx of patients.
By the way, for those complaining about the federal response of a few 10s of thousands of masks in some instances in another thread, this is what California said about its stock:
Quote:The emergency planning reserves of N95 masks, some of which are past their manufacturer use-by date, have been stored in climate-controlled conditions that preserved the masks’ efficacy. The way the masks have been stored will prevent the degradation of elastic that slips around the ears, a key factor in the CDC and NIOSH’s approval.
These masks are approved for use only in limited, low-risk circumstances, thus relieving pressure on the supply chain of unexpired masks for health care providers caring for confirmed COVID-19 patients and other high-risk situations for infectious diseases.
Also, see this CDC document "Strategies for Optimizing the Supply of N95 Respirators"
RE: Overwhelmed hospitals - burger - 03-19-2020
(03-18-2020, 10:49 PM)M T Wrote: The governor's 19% increase in beds in 3 days is equivalent to an increase by 78 in the number of hospitals. Surely we hadn't built 78 hospitals in 3 days. A wing or two opening up isn't going to explain that many beds.Newsom said a couple of weeks ago that they had contingency plans to turn public facilities like gyms, etc. into temporary hospitals. I don't know how far along they are in actually doing this though. Anyway, maybe that's where the extra numbers are coming from. Or maybe it's just made up. Who knows.
RE: Overwhelmed hospitals - BostonCard - 03-19-2020
The logical thing would be to make hotels into makeshift hospitals. They already have beds, there are plenty of them, and the rooms would be isolated from one another. The last thing you would want is to have a nosocomial infection such as MRSA causing secondary superinfections running through a large ward of patients with Covid-19.
Makeshift hospitals for patients with moderate disease (not requiring ICU care) would keep those patients quarantined, would allow monitoring of their disease and transfer to a higher level of care if needed, and would allow the patients to receive nursing care as needed.
BC
RE: Overwhelmed hospitals - cardcrimson - 03-19-2020
(03-19-2020, 08:21 AM)BostonCard Wrote: The logical thing would be to make hotels into makeshift hospitals. They already have beds, there are plenty of them, and the rooms would be isolated from one another. The last thing you would want is to have a nosocomial infection such as MRSA causing secondary superinfections running through a large ward of patients with Covid-19.
Makeshift hospitals for patients with moderate disease (not requiring ICU care) would keep those patients quarantined, would allow monitoring of their disease and transfer to a higher level of care if needed, and would allow the patients to receive nursing care as needed.
BC
Hotels and dorms. . . .dorms even easier as many have some relation to the government. . . .
RE: Overwhelmed hospitals - burger - 03-19-2020
Newsom's order allowed for takeover of hotels to use as hospital facilities: https://www.sandiegouniontribune.com/news/california/story/2020-03-12/california-governor-gavin-newsom-hotels-medical-facilities-patients-meeting-requirements
Again, I don't know how much has actually been done to make this happen.
RE: Overwhelmed hospitals - chrisk - 03-19-2020
(03-19-2020, 08:48 AM)burger Wrote: Newsom's order allowed for takeover of hotels to use as hospital facilities: https://www.sandiegouniontribune.com/news/california/story/2020-03-12/california-governor-gavin-newsom-hotels-medical-facilities-patients-meeting-requirements
Again, I don't know how much has actually been done to make this happen.
For the last week, the Fairfield in San Carlos has been used for Grand Princess passengers.
RE: Overwhelmed hospitals - magnus - 03-19-2020
(03-19-2020, 08:41 AM)cardcrimson Wrote: Hotels and dorms. . . .dorms even easier as many have some relation to the government. . . .
Was going to add that dorms are also empty right now...but then again, hotels might be too. =(
RE: Overwhelmed hospitals - BostonCard - 03-19-2020
One thing that I've been thinking about on ventilators is the idea of an MVP (minimal viable product). Normally, ventilators are deliberately over-engineered; they have to be flexible enough to be used under a wide variety of circumstances and have a half-dozen modes, and of course have to be able to deal with any contingency (from a patient stopping breathing to the endotracheal tube falling out).
But these aren't normal circumstances, and the choice isn't between a fully baked ventilator and a minimally viable ventilator; they are a choice between the MVP ventilator and no ventilator. If your goal is to produce as many ventilators as possible as fast and as cheap as possible, could you do with stripping out all but one ventilator mode (pressure support), and give the vent two controls: how much pressure to supply during inhalation and what proportion of oxygen to deliver. Maybe you even re-purpose BiPAP devices so that they can be used as makeshift ventilators. The point is just to keep people alive long enough to be put on a full ventilator (or to provide support once a patient is getting better as a transition to extubation).
BC
RE: Overwhelmed hospitals - BostonCard - 03-19-2020
An example of this was using 3D printers to manufacture valves for oxygen masks.
https://www.extremetech.com/extreme/307773-italian-3d-printing-startup-creates-replacement-respirator-valves-for-covid-19-patients?utm_source=email&utm_campaign=whatsnewnow&utm_medium=title
BC
RE: Overwhelmed hospitals - Mick - 03-19-2020
(03-19-2020, 09:41 AM)magnus Wrote:(03-19-2020, 08:41 AM)cardcrimson Wrote: Hotels and dorms. . . .dorms even easier as many have some relation to the government. . . .
Was going to add that dorms are also empty right now...but then again, hotels might be too. =(
I don't know that college dorms and hotel room beds are poster children for sanitary conditions...
RE: Overwhelmed hospitals - cardcrimson - 03-19-2020
(03-19-2020, 04:23 PM)Mick Wrote:(03-19-2020, 09:41 AM)magnus Wrote:(03-19-2020, 08:41 AM)cardcrimson Wrote: Hotels and dorms. . . .dorms even easier as many have some relation to the government. . . .
Was going to add that dorms are also empty right now...but then again, hotels might be too. =(
I don't know that college dorms and hotel room beds are poster children for sanitary conditions...
True, but neither are hospitals, frankly speaking.
RE: Overwhelmed hospitals - chrisk - 03-19-2020
(03-19-2020, 04:42 PM)cardcrimson Wrote:(03-19-2020, 04:23 PM)Mick Wrote:(03-19-2020, 09:41 AM)magnus Wrote:(03-19-2020, 08:41 AM)cardcrimson Wrote: Hotels and dorms. . . .dorms even easier as many have some relation to the government. . . .
Was going to add that dorms are also empty right now...but then again, hotels might be too. =(
I don't know that college dorms and hotel room beds are poster children for sanitary conditions...
True, but neither are hospitals, frankly speaking.
The state is taking over Seton Hospital and a large hospital in Southern California.
It is also negotiating with a growing number of hotels.
RE: Overwhelmed hospitals - Snorlax94 - 03-19-2020
(03-19-2020, 11:07 AM)BostonCard Wrote: One thing that I've been thinking about on ventilators is the idea of an MVP (minimal viable product). Normally, ventilators are deliberately over-engineered; they have to be flexible enough to be used under a wide variety of circumstances and have a half-dozen modes, and of course have to be able to deal with any contingency (from a patient stopping breathing to the endotracheal tube falling out).In today’s Johns Hopkins email newsletter, they mentioned a blueprint for mass producing ventilators during pandemics. And, a Stanford guy
But these aren't normal circumstances, and the choice isn't between a fully baked ventilator and a minimally viable ventilator; they are a choice between the MVP ventilator and no ventilator. If your goal is to produce as many ventilators as possible as fast and as cheap as possible, could you do with stripping out all but one ventilator mode (pressure support), and give the vent two controls: how much pressure to supply during inhalation and what proportion of oxygen to deliver. Maybe you even re-purpose BiPAP devices so that they can be used as makeshift ventilators. The point is just to keep people alive long enough to be put on a full ventilator (or to provide support once a patient is getting better as a transition to extubation).
BC
We need more ventilators. Here’s what it will take to get them. (MIT Technology Review) As a Stanford postdoc a decade ago, Matt Callaghan created the designs for a streamlined, low-cost ventilator that hospitals could stockpile, to prepare for the possibility of a global pandemic.
https://www.technologyreview.com/s/615380/we-need-more-ventilators-heres-what-it-will-take-to-get-them/
RE: Overwhelmed hospitals - 2006alum - 03-21-2020
A sobering account from the frontlines:
[tweet]https://twitter.com/PostOpinions/status/1240612319522062336?s=20[/tweet]
RE: Overwhelmed hospitals - BostonCard - 11-17-2020
Resurrecting this old thread because Hospitals are starting to become overwhelmed again.
https://www.theatlantic.com/science/archive/2020/11/third-surge-hospitals-staffing-shortage/617128/
Quote:From November 4 to November 11, 958 hospitals—19 percent of American hospitals—faced a staffing shortage. This week, 1,109 hospitals reported that they expect to face a staffing shortage. That’s 22 percent of all American hospitals.
BC