When a hospital can’t handle all the patients that come to it, and give its customary level of service, it’s overwhelmed. And that is what happened in New York City…
For gods sake, patients were dying waiting for care in the emergency room, because they waited for hours while the patients ahead of them, in equally desperate straits, were tended to.
Patients in ventilators are typically in ICUs, each patient with their own trained ICU nurse. Ventilated patients at Columbia Presbyterian Queens were in the general acute wards, two to a room, with nurses untrained in handling vented patients supervised by doctors also untrained in handling vented patients, and definitely without one nurse per patient. Vents are tricky and need lots of adjustments, and these patients weren’t getting those adjustments.
New York had to bring in medical personnel from elsewhere, because there weren’t enough in New York or too many of them were getting sick.
Ambulance drivers were instructed not to bring cardiac patients to the hospital if they couldn’t be resuscitated at home, as would normally be the practice.
EMS crews from other parts of the country came to New York to help out.
Hospitals were definitely overwhelmed, and people died because of it. I can’t criticize hospital personnel in the New York area. They were and are doing a hero’s job. But they couldn’t handle everything on their plate, and people died because of it.
What do you think it means for a hospital to be overwhelmed? Patients turned away? Check. Patients dying while waiting for care? Check. Not enough doctors and nurses? Check. What else would be required?
‘No life is expendable’ sure sounds good. But we have to admit to the reality that if we had the current kind of lockdowns we do now every year from October to May we’d save thousands and thousands of people from dying of the flu. But we don’t do that. We have as a society tacitly acknowledged that there will be some loss of life from communicable disease while society functions. No, COVID is not the same as the flu. But claiming we can’t even risk one death isn’t the honest starting point either. We need to own up to that.
I haven’t been following the specifics of countries, like Italy and South Korea, who are reopening. I know CDC guidelines are a US thing and don’t apply to them. But I’m curious, have they met all the same benchmarks that the CDC is recommending here? Or said another way, how closely do the CDC criteria match the criteria used in these other countries?
US government agencies like the FDA, DOT, and EPA value a generic human life between $7.9 million and $9.6 million for the purpose of determining whether the cost of some life saving measures (food and drug safety, automotive safety, pollution control, etc.) is “worth it”.
In theory, one could multiply that number by the number of lives saved by a given action to get an idea whether the action is “worth it”. Of course, that would require an accurate estimate of the number of lives saved, and such estimates may not necessarily be accurate now for COVID-19, and some actions’ effects are somewhat speculative in terms of how many (if any) lives would be saved.
Customary level of service might be consistent for a particular hospital but I don’t think there’s a customary level of service across the breadth of hospitals serving NYC. That a large percentage of deaths in NYC occurred in nursing homes that were forced to take diagnosed Covid patients doesn’t seem customary, I agree.
NYC is one of the most densely populated areas in the US, Fang. Multistory housing, reliant on shoulder to shoulder mass transit, known for all the things that today’s social distancing says are absolute no-nos.
Maybe the rest of the country doesn’t see the same risk in the life they’ve been living out away from the bright lights?
Someone upthread said we won’t know any more about COVID-19 in September than we know now. I hope that is not true, and I don’t think it will be true.
I’m kind of a curious person. I have a lot of questions about COVID-19 that I want to see answered, and I’m confident many will be answered by September 1, and the answers will help us as we continue to open up our economy.
What is the infection fatality rate (the death rate for infected people, including asymptomatic people) for each age group?
How many people are currently infected with COVID-19, in different areas? How many of them have ever been infected?
Does recovering from COVID-19 confer immunity? Does everyone who recovers get immunity?
What's up with kids? Do they get infected at the same rate as adults? Do they infect other kids? Do they infect adults?
Are there really different strains of COVID-19, with different infection rates and/or different virulence?
What fraction of people who recover from COVID-19 in each age group end up with long-term deficits? What fraction end up with permanent deficits?
What fraction of infected people become symptomatic, for each age group? Are symptomatic people more infectious?
Do cloth masks work to protect against infection? Do surgical masks work? Do they work by preventing the wearer from infecting others, or by preventing the wearer from being infected, or some of both? How good are cloth/surgical masks at this job?
What the heck is going on with superspreading? Are some people vastly more infectious than other people? Why? Can we identify people who are likely to be superspreaders? How does superspreading work?
How hard is it to catch COVID-19 outside, six feet away, without a mask? With a mask?
How hard is it to catch COVID-19 outside, three feet away, as you might be when riding a bike with a friend?
What's up with aerosolization? Is that really a significant source of infection?
What the heck is going on with these prison and meatpacking outbreaks? We know the disease is infectious, but why and how is it spreading so fast? What other places share the same dangerous characteristics that are promoting this fast spread?
I’ll come up with more questions, because, as i said, I’m curious. Point is, researchers and public health officials are curious too, and unlike me, they’re going to find the answers. A lot of these questions will be answered soon.
You’ve brought this up several times, but its still bad math as the vast majority of folks dying are the elderly. The $8-$10m applies to an average person yes, but they’d come up with a much lower number if it was applied to the average 80 year old.
Another question that does not seem to be asked often:
What is the infection fatality rate stratified by age and pre-existing condition (diabetes, hypertension, obesity, etc.), rather than age or pre-existing condition? Lots of older people have pre-existing conditions, but do we know if the increased fatality rate is because they are old, or because of their pre-existing conditions?
Additionally:
Same question, but for longer term damage or disability after recovery (e.g. lung or heart damage, loss of taste, etc.).
Around 2003, the EPA did try to use a 37% lower number for people age 65 and older compared to the number they used for people age 18-64. They had to abandon the “senior discount” after considerable backlash – apparently the more reliably voting seniors did not like the idea of being valued less than others.
@ucbalumnus Just eyeballing, it looks like the increasing fatality rate can’t be because of the increased pre-existing conditions only. Those pre-existing conditions don’t rise nearly fast enough with age in the population to get to the rising fatality rates we’re seeing.
Yes, these absolutely are questions for local elected officials. They are for the most part falling on deaf ears. Fortunately they are lifting some restrictions tomorrow. People will now be allowed to go boating, fishing hunting, golfing, camping or play tennis with people they live with. This has hopefully come as many people have been advocating for some changes. In my opinion these low risk and other low risk activities should have been allowed already.
As for low risk businesses. Any business that can limit the amount of people on site, employ social distancing and PPE requirements should be able to be open. Restaurants with very limited indoor or outdoor seating, clothing stores, technology stores, etc. So many small businesses are suffering, why? How is Walmart Home Depot safe but little na and Pa places not? Why can clothing be bought at Walmart but not elsewhere. Someone has picked winners and losers. Why can’t car washes run? Aren’t those workers deserving? I’m just utterly frustrated. I’m lucky enough to be working but many are not and it’s hurting everyone financially.
Ding, ding, ding. Quoting because this right here says a lot.
I couldn’t agree more. We “flattened the curve” to allow hospitals to not be overrun. Unfortunately, people are going to continue to die. We can’t remain in lockdown mode forever. People can attempt to hide from this but in the end I’m not sure how effective that will be. Reference the 59% death rate among nursing home patients in Maryland that have died after contracting in even while locked supposedly safely away.
So your reasoning is that because some companies sneak things into their products in an attempt to spy on us that justifies giving up our right to privacy? It’s a sacrifice to give up a right thousands and thousands of Americans have fought to give us? What they did for us is a sacrifice. That’s not the term I’d use for your proposal.
My observation is that we had a nice neighborhood cul-de-sac happy hour last night, each household stayed 6 feet from the others. All of us have been missing in-person talk with people other than those we live with. One person is a health care worker with fewer patients these days. She still thinks most of us will eventually get it, just like everyone said a couple of months ago.
It’s a sad reflection on our society that so many people don’t want to know if they have been exposed so they can get tested, thus possibly preventing additional spreading of the virus to those they live with and work with. Or family who doesn’t live with them. Or their friends.
Count me as one who would gladly sign up for an app to notify me. I’m staying home now so I don’t become a burden on essential hospital workers and to help keep safe the other essential workers who don’t have the luxury of staying at home.
I’m retired and financially able to stay-at-home indefinitely. MA still has too much covid activity at this time, to start reopening. I’m fine with SAH here.
BUT, I am in favor of reopening gradually in states where covid activity is much lower.
I have family in MS and here’s what I’m seeing there.
MS shut down before seeing many positive cases(~100) but also likely not enough testing.
They were told the the SAH was to “flatten the curve”. But the curve never materialized.
Even as testing ramped up, positive cases and deaths stayed very low. (a good thing)
Hospitals in MS were never overwhelmed.
Meanwhile, thousands of people lost their jobs and/or businesses.
According to CDC criteria, it’s too soon to reopen. Nat’l media is critical of reopening.
People have lost trust in the CDC, media, government, health officials.
Numbers continue to rise in other parts of the country.
Rumors that doctors are being pressured to call any death, a covid death, as states look back and increase their death counts by adding in “presumed” cases (never tested but covid like symptoms).
Just as MS is about to reopen, there’s a “surge” in cases (+10 deaths), which turns out to be a testing backlog. People are suspicious of the timing.
They are not seeing much covid activity in their area, and are suspicious that numbers are inflated in other parts of the country.
Meanwhile, thousands of people are still without their jobs and/or businesses. They don’t want unemployment. They want their jobs. They don’t want to lose businesses they worked hard to build.
It’s becoming very hard for people to continue to buy in to this SAH.
Maybe cases will increase when MS starts to reopen. Maybe not.
If covid cases do increase, maybe there will be more buy-in to SAH. Maybe not.
Not to get too political, but suffice to say, they believe the fear is being manufactured for political reasons. Not sure they’ll ever trust anything related to COVID-19.
Read a big city in the east coast spent $5M to prepare for the “surge”. They got total of 14 patients and now closing it down. $5M came from cutting off art and culture funding in the city.
Another worry - all the folks who will be out of jobs after PPP benefits run out (mid June for me). It’s doubtful our business will be back to a normal level, and I’ll be out of a job. And shortly after that the weekly stimulus payments will end, so I will only be eligible for regular unemployment. I’m afraid companies who were part of the PPP are going to start laying off large numbers of employees.
A neighbor’s mother just died in hospice. She had dementia, and with the lockdown and inability to be visited by her family she deteriorated quickly, believing people were trying to hurt her.
The stories of parents being unable to visit their newborns in the NICU for weeks angers me. Something can’t be figured out?
Some nice news - my niece got a new kitten and brought it to our house for a visit on the porch.