I'm Married to an ER Doc in NYC(superorganizers.substack.com)
superorganizers.substack.com
I'm Married to an ER Doc in NYC
https://superorganizers.substack.com/p/im-married-to-an-emergency-room-doctor
170 comments
Not an ER doc, but a doc in long term care facilities which have been hit particularly hard. Fortunately things have slowed down considerably now, but at its peak it was absolutely nerve racking.
There’s an element to this pandemic which many people working in healthcare have felt. We see patients fall sick often, and we see them die often, although this was at an near overwhelming scale. But what we don’t see often is our own colleagues falling sick and, in some cases, dying. This adds a level of despair that I personally had never experienced before, and adds to the stress of the job.
Which is why when it is written off by some as nothing more than a bad flu season, I get upset. This is something worse, and despite all the research that’s been done in a short time, still something we don’t fully understand - and something that is not over.
This is what I thin many forget when they speak against lockdown and for "heard immunity" - that this would not only result in a huge ammount of unnecessary deaths, but also pretty much wear out if not outright kill a signifficant part of medical personel.
It's basically condemning them to working nonstop for months if not years, watching people die all day long & being in infection danger at all times while at work.
And you can't replace all the people that burn out, get ill or die quickly - training medical professionals takes many years.
It's basically condemning them to working nonstop for months if not years, watching people die all day long & being in infection danger at all times while at work.
And you can't replace all the people that burn out, get ill or die quickly - training medical professionals takes many years.
I think it is more complicated than that.
Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals.
Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serious financial trouble, despite the influx of Covid-19 patients. At a cursory level, I think most people would assume the hospital business is booming, but this assumption couldn't be more wrong.
At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse.
So it is not correct to imagine all hospitals are running at full capacity, and burning out their workers. In fact, many health care professionals are drawing unemployment at this point.
I know this is doesn't make sense at the surface level, but it is something we all need to consider when continuing to advocate for lock-down or stay at home strategies. Our economy depends on movement of people/ goods/ services. That includes hospitals. I wish there was more serious discussion about this, and how we keep things moving as much as possible, while also protecting one another from spreading the virus.
Lock-down alone is not an solution. If your areas hospitals are at risk of reaching capacity, for sure close it down. But almost nowhere in America outside of NY/NJ is there a risk of that right now. We've tried it for a while, but now we have more understanding. Now I want us to re-imagine how we can continue a life of movement, and also reduce risk of infection.
Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals.
Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serious financial trouble, despite the influx of Covid-19 patients. At a cursory level, I think most people would assume the hospital business is booming, but this assumption couldn't be more wrong.
At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse.
So it is not correct to imagine all hospitals are running at full capacity, and burning out their workers. In fact, many health care professionals are drawing unemployment at this point.
I know this is doesn't make sense at the surface level, but it is something we all need to consider when continuing to advocate for lock-down or stay at home strategies. Our economy depends on movement of people/ goods/ services. That includes hospitals. I wish there was more serious discussion about this, and how we keep things moving as much as possible, while also protecting one another from spreading the virus.
Lock-down alone is not an solution. If your areas hospitals are at risk of reaching capacity, for sure close it down. But almost nowhere in America outside of NY/NJ is there a risk of that right now. We've tried it for a while, but now we have more understanding. Now I want us to re-imagine how we can continue a life of movement, and also reduce risk of infection.
Everything you wrote is weird and simply shows that you need a proper health care system over there.
America isn’t going to transform their healthcare market in the next several months.
We can be ideological and let hospitals fail and doctors and nurses get laid off, or we can be pragmatic and focus on what creates the best outcome as we navigate the reality we are in.
We can be ideological and let hospitals fail and doctors and nurses get laid off, or we can be pragmatic and focus on what creates the best outcome as we navigate the reality we are in.
The US cannot even prevent its own law enforcement from maiming innocent citizens, so I would not hold my breath for any healthcare reform.
Americas healthcare system has it's flaws but the benefits amongst others is that it keeps being able to afford to invest in new research and methods and to specialize. It's the advantage of being a profit center.
This is much harder in universal healthcare systems that are cost centers and thus can't just decide to change to a newer better method. Furthermore, the universal healthcare system have to budget who gets what kind of medicine. So while all people gets treated the same way not all illnesses does.
Everything have pros and cons. The US system is much better in some ways and have shortfalls in others and vice versa.
This is much harder in universal healthcare systems that are cost centers and thus can't just decide to change to a newer better method. Furthermore, the universal healthcare system have to budget who gets what kind of medicine. So while all people gets treated the same way not all illnesses does.
Everything have pros and cons. The US system is much better in some ways and have shortfalls in others and vice versa.
I recently had a successful experimental surgery in this countries nationalised health service. Interestingly the idea had come from a study where the surgery I had was a control group and the 'real' group had a stem cell therapy as well. My problem was resolved, the single payer system didn't waste $100,000 on stem cell therapy. Good result. In the privatised system that carried out the original study the additional stem cell therapy is being done. It seems like optimising for profit optimises for cost.
I just wanted to add a story as well - my dad was diagnosed with a very rare type of stomach cancer called GIST about 15 years ago in Poland. At the time, he was one of ~6 other people in the entire country with this diagnosis, and the diagnosis was....bleak to say the least, I think the doctors were cautiously giving him 6-12 months max. However, company Novartis has just certified their "Glivec" drug specifically to use against GIST, since it targets the same cell pathways. Now, the problem - Poland does have nationalized healthcare, but Glivec was insanely expensive - basically a box of Glivec cost around as much as an annual pay for many people in Poland at the time....and my dad had to take two boxes per month. And no, because it hasn't been proven to work against GIST yet, it was not on the list of refunded drugs - so my dad was placed on a controlled trial conducted by the largest oncological hospital in Warsaw, where the study funded the drug for him. Long story short - the drug worked miracles, my dad not only recovered, he lived another decade after that(died of another cancer that sadly didn't have a miracle cure this time).
But - other people in this study didn't get the drug. I don't know if they were given placebo or just something else instead. My point being - they didn't survive, my dad did. After the study was concluded, the drug is now paid for by the national health service and anyone who needs Glivec can get it.
So why isn't this a critique of the nationalized system? Well, because the way I see it - in a private health care system, no one in this group would survive, because no one in Poland could ever afford this treatment. At least some of the people were still given a chance because the system has enough flexibility to at least try new and experimental treatments.
But - other people in this study didn't get the drug. I don't know if they were given placebo or just something else instead. My point being - they didn't survive, my dad did. After the study was concluded, the drug is now paid for by the national health service and anyone who needs Glivec can get it.
So why isn't this a critique of the nationalized system? Well, because the way I see it - in a private health care system, no one in this group would survive, because no one in Poland could ever afford this treatment. At least some of the people were still given a chance because the system has enough flexibility to at least try new and experimental treatments.
You're omitting that it's only a single digit % of the population that gets access to these expensive, specialized treatments.
The US has the best healthcare system in the world--if you're a millionaire.
The US has the best healthcare system in the world--if you're a millionaire.
Anecdotes and all that, but a friend of mine had Deep Brain Stimulation surgery for his essential tremor. The surgery was performed at Stanford and the total bill was in the hundreds of thousands of dollars. His out of pocket charge? ~$1200.
I have a hard time rationalizing his recent experience with the assertion that you have to be a millionaire to receive top-flight care.
I have a hard time rationalizing his recent experience with the assertion that you have to be a millionaire to receive top-flight care.
Your friend must have outstanding insurance. Our out-of-pocket for a standard run-of-the-mill baby delivery with no complications was several thousand dollars--after what I thought was pretty good tech-company provided health insurance. I'll never forget my wife's reaction (who is not from the USA) at how absurd it is that someone would have to pay any money, let alone thousands of dollars, to have a baby.
I'm against the concept of privatised healthcare completely but within the privatised paradigm insurance only works properly to share risk across a population. A normal birth is not really an insurable event. Normal births are not a risk (in the sense of risk being a semi random events) since on average each women an America has about 2 in their life. In a privatised system insurance make sense as something to cover the risk of complications during a birth. So in a functioning privatised system with insurance working as it theoretically should any birth whether simple or with huge complications should cost the same amount of money. This is similar to dental most people spend X±Y amount of money over their life on dental work where X is high and Y is low. Insurance only works properly where X is lower and Y is higher (for example getting a rare cancer that costs $1million to treat is a very insurable event). Where dental is covered by 'insurance' the person paying for the insurance policy would be better just paying the dentist directly.
Meanwhile I am glad I live in a society with a nationalized health system where births cost nothing.
Meanwhile I am glad I live in a society with a nationalized health system where births cost nothing.
I have never figured out what "outstanding" insurance is, and my late father was a physician.
I just go with a PPO because that seems less crappy than the alternative. If anyone knows what metric leads to outcomes like my friend's (I'm not being facetious here), I would like to know.
I just go with a PPO because that seems less crappy than the alternative. If anyone knows what metric leads to outcomes like my friend's (I'm not being facetious here), I would like to know.
> At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse.
Nitpick: Over half of US hospitals are nonprofits or government owned [1] though I believe hospitals are vastly outnumbered by private clinics and independent practices. Doesn't change your overall point - even the hospitals run by governments, the Catholic church, and other institutions have budgets and are watching their main incomes disappear without much hope for the near future.
[1] https://www.aha.org/statistics/fast-facts-us-hospitals
Nitpick: Over half of US hospitals are nonprofits or government owned [1] though I believe hospitals are vastly outnumbered by private clinics and independent practices. Doesn't change your overall point - even the hospitals run by governments, the Catholic church, and other institutions have budgets and are watching their main incomes disappear without much hope for the near future.
[1] https://www.aha.org/statistics/fast-facts-us-hospitals
While factually true, this does not defeat the point: those non-profit and public hospitals rely on paid procedures to pay their employees. And yes, those employees are furloughed and laid off en masse.
Government owned or Non-profit isn't as meaningful as you might think. End of the day, hospitals live on Medicare admissions for cash flow (ie. old people) and surgery for profit. Old people are staying home, people aren't hurting themselves on the couch, etc.
Government owned is only meaningful with the Federal government, which has unlimited resources.
Government owned is only meaningful with the Federal government, which has unlimited resources.
Thanks, I see now that I overstated the number of for profit hospitals. You are right, though. They all depend on us using them.
Actually, over half of US hospitals are not-for-profit and another quarter are public. Only a small minority are for-profit. See https://en.m.wikipedia.org/wiki/Non-profit_hospital
This fact is missing something essential; Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Also, it's something of a minor nit - nonprofit corporations need revenue too.
My wife is a nurse for Dignity Health (another "nonprofit" hospital here in California) and has been effectively laid off for the last couple months. It's great that the ER is empty, but in the mean time nurses are struggling and people aren't getting their cancer screenings. If this goes on long enough, our healthcare system will fall apart from atrophy, not from overuse.
My wife is a nurse for Dignity Health (another "nonprofit" hospital here in California) and has been effectively laid off for the last couple months. It's great that the ER is empty, but in the mean time nurses are struggling and people aren't getting their cancer screenings. If this goes on long enough, our healthcare system will fall apart from atrophy, not from overuse.
> This fact is missing something essential; Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term.
Why is that? You don't think they lay people off in Canada or Japan when there's no patients? Even single-payer systems can have private hospitals. They are simply paid by the govt instead of (or really in addition to) by patients. They still need business and to balance the books.
Canada has a similar mix of all kinds of hospitals like the US, though it may be more slanted in some way.
Why is that? You don't think they lay people off in Canada or Japan when there's no patients? Even single-payer systems can have private hospitals. They are simply paid by the govt instead of (or really in addition to) by patients. They still need business and to balance the books.
Canada has a similar mix of all kinds of hospitals like the US, though it may be more slanted in some way.
Kaiser Permanente is a conglomerate that is a consortium of for-profit and not-for-profit entities. The health plans (insurance) and hospitals are not-for-profit. The physicians are organized into for-profit partnerships.
Source: https://en.wikipedia.org/wiki/Kaiser_Permanente#Operations
Source: https://en.wikipedia.org/wiki/Kaiser_Permanente#Operations
>Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term.
Huh? It is exactly what I think of when I use the term non-profit in the context of a healthcare maintenance organization. I truly have no idea what you mean by your quoted statement.
Huh? It is exactly what I think of when I use the term non-profit in the context of a healthcare maintenance organization. I truly have no idea what you mean by your quoted statement.
He/she means: KP generates a lot of money for some important people, and their marketing and management strategy is as aggressive as for-profit institutions
Oh, thanks. well maybe I’m wrong about the amount of for profit hospitals, I’ll look into it. I realize now that I could have left that part out in my rant. Either way, non profits are affected the same way from lack of traffic/ volume.
Lest someone think this is a US thing, this is true in India as well which has a fairly different medical system. Hospitals are struggling to stay afloat and many nurses and ancillary staff have been laid off. Doctors in India are typically independent contractors and not employed by hospitals.
Not only are no non-essential activities happening, many essential ones are also being pushed back and people are dying as a result. There are multiple stories of people not being able to go for dialysis because hospitals insist on a negative COViD test to admit you and authorities don't allow you to get tested if you are not showing COViD symptoms. It is a catch-22 that can be resolved only if you are well-connected or rich.
Also, in knock-on effects, immunization programs are severely impacted, and many infectious diseases are likely to make a huge comeback with the monsoon season since typical mitigating measures for those were put on hold. The non-COViD death toll will be massively above typical years.
Not only are no non-essential activities happening, many essential ones are also being pushed back and people are dying as a result. There are multiple stories of people not being able to go for dialysis because hospitals insist on a negative COViD test to admit you and authorities don't allow you to get tested if you are not showing COViD symptoms. It is a catch-22 that can be resolved only if you are well-connected or rich.
Also, in knock-on effects, immunization programs are severely impacted, and many infectious diseases are likely to make a huge comeback with the monsoon season since typical mitigating measures for those were put on hold. The non-COViD death toll will be massively above typical years.
Am from India & agree on this. Lockdowns helped slow the spread but aren't the perpetual answer. And the side-effects of lock-down (like essential services being pushed back) are taking lives. When evaluating lock-down's pros & cons, it always isn't life vs economy. It often also is Covid fatalities vs other fatalities. Atleast in India, that's happening.
Agreed.
People on the prudent/cautious camp are missing that lockdowns are really last-resort, expensive controls at the bottom of the pyramid, used when better controls fail.
We can't just netflix and chill for the next two years. But we can't just pretend nothing is wrong either!
People on the prudent/cautious camp are missing that lockdowns are really last-resort, expensive controls at the bottom of the pyramid, used when better controls fail.
We can't just netflix and chill for the next two years. But we can't just pretend nothing is wrong either!
Well, that's pretty screwed up. For comparison Czech hospitals also scrapped anything non essential during the worst part of the local outbreak, both to have capacity for treating coronavirus patients and to reduce the chance of infection spreading through hospitals. At the same time a strong lockdown was done country wide.
This was apparently effective with cases limited to a few clusters at the moment & most of the lockdown restrictions removed by now.
Were the hospitals affected ? They did report funding shortfals right after the lockdown due to all the cancelled elective procedures, so the ministry of health simply gave them extra money to cover the lockdown loses. And at the moment most hospitals are back to normal workflow.
Also, the people involved in directly handling the infection got bonuses as a thank you for doing the needed but dangerous work.
This was apparently effective with cases limited to a few clusters at the moment & most of the lockdown restrictions removed by now.
Were the hospitals affected ? They did report funding shortfals right after the lockdown due to all the cancelled elective procedures, so the ministry of health simply gave them extra money to cover the lockdown loses. And at the moment most hospitals are back to normal workflow.
Also, the people involved in directly handling the infection got bonuses as a thank you for doing the needed but dangerous work.
It seems like the root financial problem isn't for-profit versus non-profit, it's pay-per-procedure? This is like paying the fire department based on how many fires they put out. Medicare seems no better.
(I would guess that Kaiser might be doing somewhat better since they're paid monthly but their finances aren't easy to find.)
(I would guess that Kaiser might be doing somewhat better since they're paid monthly but their finances aren't easy to find.)
There are four scenarios at a very high level. It an uber complex system and the amount of time and money wasted in optimizing and managing revenue cycles is almost incalculable. If you compare it to any complex large scale system it's sickening to look at the waste -- even the military looks like an efficient machine in comparison. (In some ways)
Medicare pays on a set scale for performance. If you have a heart attack, they pay a fee for the surgery and x days of hospitalization and x days of rehab. If the hospital gets you home in x-3 days, they make money. If the hospital fucks up and you get an infection and stay for x+10 days, they eat it.
Medicaid is a PPO that pays on a per procedure basis. Their rates suck, but they don't care about quality for the most part. There's a billing optimization process to maximize revenue for poor old people. (Some things are better billed to Medicare, others to Medicaid)
Private insurance pays for whatever they cover at a rate of y+z% over the Medicare rate. The patient gets the bill for whatever else happens.
Uninsured get whatever treatment is legally necessary. They patch you up, take a loss, kick you out and do it again when you come back.
Medicare pays on a set scale for performance. If you have a heart attack, they pay a fee for the surgery and x days of hospitalization and x days of rehab. If the hospital gets you home in x-3 days, they make money. If the hospital fucks up and you get an infection and stay for x+10 days, they eat it.
Medicaid is a PPO that pays on a per procedure basis. Their rates suck, but they don't care about quality for the most part. There's a billing optimization process to maximize revenue for poor old people. (Some things are better billed to Medicare, others to Medicaid)
Private insurance pays for whatever they cover at a rate of y+z% over the Medicare rate. The patient gets the bill for whatever else happens.
Uninsured get whatever treatment is legally necessary. They patch you up, take a loss, kick you out and do it again when you come back.
It's weird that this isn't more widely known. Alot of my friends are in the medical field, and they are taking a beating personally. Stuff like long term 15-20% pay reductions and furloughs in addition to layoffs.
Not only are hospitals for profit, but their part of cartel-like health networks. For some jobs, its hard to jump because 80% of the work is affiliated with two companies regionally.
Not only are hospitals for profit, but their part of cartel-like health networks. For some jobs, its hard to jump because 80% of the work is affiliated with two companies regionally.
"I know this is doesn't make sense at the surface level,"
No it makes perfect sense, and it doesn't matter if it's 'nonprofit or for-profit' - the inefficient use of resources is just the same.
Hospitals are the most expensive places in the world to run, with very highly trained personnel, gear, etc.. In a socialized system, if they are not used, it's a massive inefficiency.
Now imagine a system where 10's of millions of people are in economic pain - but they still have to foot the bill for unused medical services via taxes.
It's just shifting around deck chairs with respect to where the pain will be borne.
No it makes perfect sense, and it doesn't matter if it's 'nonprofit or for-profit' - the inefficient use of resources is just the same.
Hospitals are the most expensive places in the world to run, with very highly trained personnel, gear, etc.. In a socialized system, if they are not used, it's a massive inefficiency.
Now imagine a system where 10's of millions of people are in economic pain - but they still have to foot the bill for unused medical services via taxes.
It's just shifting around deck chairs with respect to where the pain will be borne.
Through US government incompetence we missed our chance to contain and suppress the virus back in February. Now the pandemic is so widespread that it's impractical to do enough contract tracing and isolation to eradicate the virus. In many areas the authorities aren't even bothering to try. So we're on a path to herd immunity whether we like it or not.
Obviously this is a bad state of affairs. But it's important to understand the reality we're in rather than indulging in fantasies.
Obviously this is a bad state of affairs. But it's important to understand the reality we're in rather than indulging in fantasies.
"But it's important to understand the reality we're in rather than indulging in fantasies."
This seems an important point to remember in most US public discussions. If people can't even agree on basic facts, how can you make decisions?
This seems an important point to remember in most US public discussions. If people can't even agree on basic facts, how can you make decisions?
Indeed, the reality for the average person is you're confronted by different authorities that don't agree on facts or goals. The situation seems to promise a series of rolling disasters with Covid just being one.
Say the US gets to herd immunity and the rest of the world has done a really good job at containing the virus, e.g. New Zealand. What are they realistically going to do long term? Shut up their country until a vaccine arrives? Quarantine everyone coming in or going out for two weeks? Who is realistically going to want to travel into or out of there with those kind of restrictions. I seriously wonder if the short term pain isn’t just worth it. It’s cold and calloused but it’s either vaccine or a long drawn out constant state of fear and social distancing. The other option is short burst of mass deaths followed by a return to complete normalcy.
So my question is more like, how are countries that, in say six months, that’s population only have 10% exposed to COVID-19 going to coexist in a global world with countries that are past herd immunity and operating freely again.
So my question is more like, how are countries that, in say six months, that’s population only have 10% exposed to COVID-19 going to coexist in a global world with countries that are past herd immunity and operating freely again.
https://en.m.wikipedia.org/wiki/Post-polio_syndrome
Covid is a new disease. Will it have long term effects?
Covid is a new disease. Will it have long term effects?
There are already articles of people who have recovered that will have to take anti-coagulants for the rest of their life.
Coronavirus are not a new type of disease though.
This one is. Colds seem to be inconsequential (although there are questions about ME). SARS and MERS are rare and were either very deadly or very life altering. Covid seems to fall in the middle. Hopefully the long term effects for the majority will be similar to colds.
No human vaccines have ever been tested for any coronavirus.
Please don't take this as being directed explicitly towards your comment. But why does anyone think there is such a thing as herd immunity for Covid-19?
I've been following the research since December/January on New England Journal of Medicine, Virological.org, Lancet etc. And I think there is not yet enough evidence to suggest that there is immunity conferred by contracting Covid-19.
Does anyone know of any studies claiming that "herd" immunity is even possible with Covid-19? The latest article I could find is: COVID-19 and Postinfection Immunity https://jamanetwork.com/journals/jama/fullarticle/2766097
If there is no immunity or limited immunity conferred from infection then Covid-19 will be with the USA and other countries that have given up on control measures for a long time.
I've been following the research since December/January on New England Journal of Medicine, Virological.org, Lancet etc. And I think there is not yet enough evidence to suggest that there is immunity conferred by contracting Covid-19.
Does anyone know of any studies claiming that "herd" immunity is even possible with Covid-19? The latest article I could find is: COVID-19 and Postinfection Immunity https://jamanetwork.com/journals/jama/fullarticle/2766097
If there is no immunity or limited immunity conferred from infection then Covid-19 will be with the USA and other countries that have given up on control measures for a long time.
> But why does anyone think there is such a thing as herd immunity for Covid-19?
I suppose this depends on what the null hypothesis is? Is the null hypothesis "You have immunity after being infected" or is it "You don't have immunity after being infected". You assume it's the latter and you're saying there's not enough evidence to reject it. But you could just as well assume it is "You have immunity after being infected" and we're gathering evidence to see whether that can be rejected or not.
I suppose this depends on what the null hypothesis is? Is the null hypothesis "You have immunity after being infected" or is it "You don't have immunity after being infected". You assume it's the latter and you're saying there's not enough evidence to reject it. But you could just as well assume it is "You have immunity after being infected" and we're gathering evidence to see whether that can be rejected or not.
You're seriously saying that a "short burst of mass deaths" is a better option than getting your shit together and doing proper social distancing followed by proper contact tracing?
It's great that we've got rid of the virus for now in NZ, but yes, there are many questions, including whether there will still be an incentive to even try for a vaccine once major countries reach herd immunity (if and when that happens).
But it truly astonishes and depresses me that the US - the country that went to the moon, that invented the internet, that built a military capability that literally saved the world in ww2 - seems to have given up.
How hard would it really be to do proper contact tracing in a population of 300 million? Yes it's a big job, a very hard job, but the big jobs, the tough jobs, that's what Americans do!
It's great that we've got rid of the virus for now in NZ, but yes, there are many questions, including whether there will still be an incentive to even try for a vaccine once major countries reach herd immunity (if and when that happens).
But it truly astonishes and depresses me that the US - the country that went to the moon, that invented the internet, that built a military capability that literally saved the world in ww2 - seems to have given up.
How hard would it really be to do proper contact tracing in a population of 300 million? Yes it's a big job, a very hard job, but the big jobs, the tough jobs, that's what Americans do!
> the US - the country that went to the moon, that invented the internet, that built a military capability that literally saved the world in ww2
two of those are in part result of propaganda
two of those are in part result of propaganda
>> the US - the country that went to the moon, that invented the internet, that built a military capability that literally saved the world in ww2
> two of those are in part result of propaganda
Eh, no.
We (the USA) did really go to the moon, though I know some USA citizens dispute that.
It was really USA universities and corporations (with DARPA funding) that built the foundations of Ethernet, TCP/IP and the Internet. Yes, plenty of contributions from others (including foreign grad students), but still, USA institutions.
The USA produced a lot of war material for all the Allies in WW2. A lot went to the USSR to keep them in the fight. This in no way should diminish the absolutely unprecedented loss and sacrifice of the USSR peoples in the Great Patriotic War, who bore the brunt of it. But without the USA, I really doubt the Allies could have stopped the Axis powers.
Eh, no.
We (the USA) did really go to the moon, though I know some USA citizens dispute that.
It was really USA universities and corporations (with DARPA funding) that built the foundations of Ethernet, TCP/IP and the Internet. Yes, plenty of contributions from others (including foreign grad students), but still, USA institutions.
The USA produced a lot of war material for all the Allies in WW2. A lot went to the USSR to keep them in the fight. This in no way should diminish the absolutely unprecedented loss and sacrifice of the USSR peoples in the Great Patriotic War, who bore the brunt of it. But without the USA, I really doubt the Allies could have stopped the Axis powers.
"I really doubt the Allies could have stopped the Axis powers"
It was a team effort - without combined efforts of the USA and the Soviets (and to a lesser extent the UK) the Axis powers might have prevailed.
It was a team effort - without combined efforts of the USA and the Soviets (and to a lesser extent the UK) the Axis powers might have prevailed.
Wow incredible! Apparently, the USA have also developed the world's most potent propaganda machine.
That has always been the case. George Washington and the cherry tree comes to mind. And so it began.
Sometime near the end of the cold war I realized that the West's propaganda machine was in fact better than the Soviet version. Nobody in the USSR believed "Pravda" but everybody believed the NBC Nightly News. :)
One might argue however that we need such a mechanism since in 2020, as the Scots might say:
"People can ni' agree on the color o' Shite"
Sometime near the end of the cold war I realized that the West's propaganda machine was in fact better than the Soviet version. Nobody in the USSR believed "Pravda" but everybody believed the NBC Nightly News. :)
One might argue however that we need such a mechanism since in 2020, as the Scots might say:
"People can ni' agree on the color o' Shite"
In addition - regarding the European theater, the most important contribution of the US was keeping the USSR to the Elbe, otherwise the entirety of continental Europe would have fallen under communist rule.
I've read a fair bit of military history, and I'm fairly confident the moon landings were not done using a green screen, so please elaborate on which 2 of these are not true.
I said partly. Regarding the internet the US had a central role in developing and implementing the technology and infrastructure, as is testified by the fact that our current domain system is still US-centric, but in a sense they did not invent it.
Regarding defeating the axis and specifically Germany (Italy was not a military colossus) there is data that shows that the USSR had a bigger impact in defeating the nazis.
No one denies the contributions of the US in both of those feats, but also it is undeniable that the narrative isn't always factually true.
Regarding defeating the axis and specifically Germany (Italy was not a military colossus) there is data that shows that the USSR had a bigger impact in defeating the nazis.
No one denies the contributions of the US in both of those feats, but also it is undeniable that the narrative isn't always factually true.
Maybe "saved the world" and "invented" the internet? Because yeah of course, the internet has been "invented"! It was absolutely not a natural evolution of local networking based on known technology...
redis_mlc(2)
>It's basically condemning them to working nonstop for months if not years
how come? wouldn't without lockdown the herd immunity with that R0 would come in like 2-3 months (and during that period the vulnerable people would have to be locked down), while with lockdown we're already 3 months into it without reasonable lockdown based endgame in sight?
how come? wouldn't without lockdown the herd immunity with that R0 would come in like 2-3 months (and during that period the vulnerable people would have to be locked down), while with lockdown we're already 3 months into it without reasonable lockdown based endgame in sight?
The US did not lock down. A portion opted to stay at home if they could afford it, several industries were deemed essential (often with ridiculous inclusions), and the brunt is being borne by folks in poverty. We had between 40% and 60% reduction in urban mobility, much less in rural areas, and an increase in stay at home rates on par with a census block groups median household income. Then we re-opened too early. This is why there is no endgame in site.
There is totally an endgame. Lockdown worked in NYC. That is huge. NYC is crushing the curve. 1 in 600 people in NYC have died of COVID (NOT GOOD). However, it is estimated that 1 in 5 is already immune. That's great news! A huge step towards herd immunity.
It means NYC must do this three times more to get to herd immunity, and strike the right balance each time. Still it is far from safe since people can come from the rest of the country so it’s not a real herd immunity.
Your comment implies that "do[ing] this three times more" would be very difficult. That's totally incorrect. As the level of immunity rises, R0 goes down naturally. The effect is huge at even 20%. Giant at 50%, etc., especially with moderate social distancing. Moreover, there is every reason to believe that some people are just naturally resistant/immune to the virus. I believe Bergamo never got above 57% sero-positivity and even the USS Rosevelt was around 60% sero-positivity. It seems impossible to believe the other 40% weren't exposed. If (okay a big BIG if) 40% just don't ever get COVID, and 50% get it but have mild moderate symptoms (the data strongly supports this), NYC is basically done with this emergency.
Will they be immune in one year? Two?
The data on long-term immunity for COVID is non-existent, that is why the experts are being cautious. However, the data on animal coronavirus vaccines (not COVID) is very suggestive that yes they will be immune in a year and two. Coronaviruses do mutate but do not mutate like the flu virus does.
On the other hand, with social distancing and masks, herd immunity comes at a lower level, even if mask-wearers still suffer >1 R0. So vastly fewer people die.
Simplistically, we don't want to lockdown or distance until we get to whatever that herd immunity level is. And then, a bit past that level, we might want to lockdown hard and then ease up to a steady-state lockdown, and then hold it there until the disease has passed.
The reason we'd lockdown hard and ease up is because, well, a continuity argument -- more lives are saved if you do a week of hard lockdown when 1000000 people are infected than if you wait until 10 cases remain.
Simplistically, we don't want to lockdown or distance until we get to whatever that herd immunity level is. And then, a bit past that level, we might want to lockdown hard and then ease up to a steady-state lockdown, and then hold it there until the disease has passed.
The reason we'd lockdown hard and ease up is because, well, a continuity argument -- more lives are saved if you do a week of hard lockdown when 1000000 people are infected than if you wait until 10 cases remain.
More and more researchers start to believe that the virus (also) spreads as aerosols. They also believe the amount of virus that enters your body affects how sick you get. This might also be the reason that healthy health workers can get sick when they are exposed a lot.
So I have no doubt that working as health worker without enough protective gear is scary when you see healthy collegues getting sick.
But that does not mean that going for herd immunity is a bad thing. We know now that most people even don't know they have the virus when they were just exposed a little bit to it.
And if the virus travels like an aerosol it might even be true that the world wide protests that are going on in the open air won't lead to much more sick people.
But this also means that people inside a bad ventilated building are at risk.
Edit: an example of an article that explains this more in depth: https://www.webmd.com/lung/news/20200527/aerosol-scientist-c...
So I have no doubt that working as health worker without enough protective gear is scary when you see healthy collegues getting sick.
But that does not mean that going for herd immunity is a bad thing. We know now that most people even don't know they have the virus when they were just exposed a little bit to it.
And if the virus travels like an aerosol it might even be true that the world wide protests that are going on in the open air won't lead to much more sick people.
But this also means that people inside a bad ventilated building are at risk.
Edit: an example of an article that explains this more in depth: https://www.webmd.com/lung/news/20200527/aerosol-scientist-c...
> But that does not mean that going for herd immunity is a bad thing.
One way or the other, end game is herd immunity. But when you let it just "go freely" you overshot - more people then is necessary for herd immunity will get sick.
One way or the other, end game is herd immunity. But when you let it just "go freely" you overshot - more people then is necessary for herd immunity will get sick.
Well the point is: it looks like we can go freely but only when we are not in closed spaces without good ventilation (and low humidity).
Studies [1] have shown that "20 percent of Covid-19 cases accounted for 80 percent of transmissions"
And those 20 percent were mostly 'Superspreading events'. We now know almost all those events were inside in bad ventilated areas.
[1] https://www.nytimes.com/2020/06/02/opinion/coronavirus-super...
Studies [1] have shown that "20 percent of Covid-19 cases accounted for 80 percent of transmissions"
And those 20 percent were mostly 'Superspreading events'. We now know almost all those events were inside in bad ventilated areas.
[1] https://www.nytimes.com/2020/06/02/opinion/coronavirus-super...
I think you are missing the point. We are long past the point of containment. We will get to herd immunity no matter what. The question becomes, how to do it safely. The answer is to have in place sufficient capacity. One can have sufficient capacity easily if R is kept low. There are other ways of getting there (i.e., actually increasing capacity), or a combination thereof.
We will hopefully not get hers immunity. Spain, Italy and Sweden are not close yet and they were pretty close to capacity, same with NYC. There is no safe way to get to herd immunity, it’s vaccine or nothing.
I agree with you. I have yet to see evidence that once somebody is infected, they cannot get re-infected.
Not to mention, the vaccine needs to work on the correct strain AND be administered to what, 70% of the population?
Not to mention, the vaccine needs to work on the correct strain AND be administered to what, 70% of the population?
How do you feel about doctors out cheering on massive crowds of protesters?
> Fortunately things have slowed down considerably now,
I don't get that tho. Supposedly accordingly to all stats, its as bad as its been before. We have 800 to 1,000 death per day and are on record to hit 200k death by September. How come I heard that the pandemic has slowed down yet... according to numbers its been the same.
I don't get that tho. Supposedly accordingly to all stats, its as bad as its been before. We have 800 to 1,000 death per day and are on record to hit 200k death by September. How come I heard that the pandemic has slowed down yet... according to numbers its been the same.
Severity varies greatly by region. Compare NYC and the surrounding areas to the USA as a whole:
https://outbreak.info/epidemiology?location=USA%3BMETRO_3562...
You can see that NYC is way down from the mid-April peak, but the USA as a whole is tailing off much more slowly as new outbreaks elsewhere offset the declines in areas that were initially hit hard.
(But still, note that "way down" for NYC is still around 500 new cases per day.)
You can see that NYC is way down from the mid-April peak, but the USA as a whole is tailing off much more slowly as new outbreaks elsewhere offset the declines in areas that were initially hit hard.
(But still, note that "way down" for NYC is still around 500 new cases per day.)
The number of daily cases nationwide, as well as the number of deaths, has been steadily dropping since the peak:
https://www.washingtonpost.com/graphics/2020/national/corona...
That being said we know practically nothing actionable about the spread of the disease, little more than we did when it started. Clearly the combination of masks and social distancing has slowed the spread but we don’t know how much good if any the masks really do, and we can’t never go outside again. It’s a waiting game, and a game of seeing just how much isolation we can collectively stomach. Unpleasant, and the end is certainly not yet in sight.
https://www.washingtonpost.com/graphics/2020/national/corona...
That being said we know practically nothing actionable about the spread of the disease, little more than we did when it started. Clearly the combination of masks and social distancing has slowed the spread but we don’t know how much good if any the masks really do, and we can’t never go outside again. It’s a waiting game, and a game of seeing just how much isolation we can collectively stomach. Unpleasant, and the end is certainly not yet in sight.
>>we can’t never go outside again
Somebody needs to tell that to Brooklyn residents. Streets are crowded.
Somebody needs to tell that to Brooklyn residents. Streets are crowded.
It seems clear that flatline meant what he wrote, "we can't never go outside again", and not the opposite, "we can't ever go outside again".
Brooklyn residents crowding the streets are agreeing with that sentiment.
Brooklyn residents crowding the streets are agreeing with that sentiment.
My bad. I honestly thought it was just a typo and he actually meant the second quote. Double negatives are really bad.
Streets were crowded in SF's mission tonight too, with many people 1) not wearing masks (or wearing the mask on their chin (!?!)) 2) being in close knit groups.
Fingers crossed I guess, but given that 1) the virus is still around AND 2) we do not have a vaccine AND 3) we do not have herd immunity, I can't say I feel very optimistic about the next month or so.
Fingers crossed I guess, but given that 1) the virus is still around AND 2) we do not have a vaccine AND 3) we do not have herd immunity, I can't say I feel very optimistic about the next month or so.
It's not as bad as it's been. The US new case rate is down to about 65% of peak now. It's not dropping fast, but it's dropping.
But a medical professional's subjective experience is local, and the US is a big place. Some regions are still (sigh) growing, and are indeed "as bad as it's been". But New York is now recording new cases at less than 10% of its peak from April.
Broadly: much of the country, and all of the worst hit areas, have this beaten now, as long as we don't lose control when relaxing lockdown rules. That's good news.
And the areas that don't have it handled well are, at the very least, not growing in an out of control exponential mode. That's good news too.
Stay home. This is the home stretch.
But a medical professional's subjective experience is local, and the US is a big place. Some regions are still (sigh) growing, and are indeed "as bad as it's been". But New York is now recording new cases at less than 10% of its peak from April.
Broadly: much of the country, and all of the worst hit areas, have this beaten now, as long as we don't lose control when relaxing lockdown rules. That's good news.
And the areas that don't have it handled well are, at the very least, not growing in an out of control exponential mode. That's good news too.
Stay home. This is the home stretch.
It's bad. Try this graph to see how bad it really is: https://ourworldindata.org/grapher/new-covid-cases-per-milli...
New infections per capita in the US are not falling and are an order of magnitude higher than in Western Europe. Israel brought new infections down to a few cases/million until they opened schools back up, now they are in line with Western Europe.
The trouble is that there are superspreading events, someone brings the virus to church or university, and everyone present gets it. There are reports of outbreaks in farmworker accomodation and consequent failures of the vegetable harvest. This isn't over at all and only getting worse when cash-strapped universities insist that their students come back on campus in August.
New infections per capita in the US are not falling and are an order of magnitude higher than in Western Europe. Israel brought new infections down to a few cases/million until they opened schools back up, now they are in line with Western Europe.
The trouble is that there are superspreading events, someone brings the virus to church or university, and everyone present gets it. There are reports of outbreaks in farmworker accomodation and consequent failures of the vegetable harvest. This isn't over at all and only getting worse when cash-strapped universities insist that their students come back on campus in August.
Models such as this one are estimating the number of actual infections is many times higher than the confirmed tests... and falling. Though this is projected to turn around again as social distancing ends.
https://covid19.healthdata.org/united-states-of-america
https://covid19.healthdata.org/united-states-of-america
The way things are trending, I expect it to start rising again.
Many southern states are rising rapidly, as well as in the southwest.
Here in NC we're double what we were a month ago in both daily new cases AND current hospitalizations.
https://covid19.ncdhhs.gov/dashboard
Many southern states are rising rapidly, as well as in the southwest.
Here in NC we're double what we were a month ago in both daily new cases AND current hospitalizations.
https://covid19.ncdhhs.gov/dashboard
this is nowhere near any kind of "home stretch", this is the second inning at best. it is rocketing off in many states now, just not the ones in which it initially took off [1]. it will continue to rocket in various regions of the country, over and over again until a vaccine can be distributed to much of the population or when the government is changed to one that can orchestrate contact tracing, isolation and testing at the national level.
[1] https://www.theguardian.com/world/2020/jun/09/coronavirus-ca...
[1] https://www.theguardian.com/world/2020/jun/09/coronavirus-ca...
Slowed down in his region? It certainly has slowed down considerably in NYC.
[deleted]
I recorded a podcast episode with my brother-in-law, a New York City surgeon, that has become one of my most downloaded. He talks about not knowing important information early, the challenge of going between surgery and home, but most of all, seeing the possibility of having to triage between who might live or die.
We cover non-pandemic stuff too.
https://joshuaspodek.com/guests/michael-turner-dds-md
We cover non-pandemic stuff too.
https://joshuaspodek.com/guests/michael-turner-dds-md
The way things are described make the doctors sound powerless. I've been frustrated by the lack the information on the usefulness of hospitals. The impression I've gotten is that they cannot do much, and if they would go as far as intubation, you're highly likely to die even with intubation.
We can put a patient on oxygen without intubating them. High flow oxygen can provide up to 60 liters per minute. We can prone patients, and provide them with nutrition to help support their immune system. We save many patients with supportive care.
We can’t however cure the virus. And if it progresses far enough then no amount of oxygen will save a patient. These cases are hard because we have to watch someone die without any means to save them. Doing cpr on a patient with covid can feel pointless. If the lungs do work then no amount of chest compressions, oxygen, and cardiac drugs will save that person.
We can’t however cure the virus. And if it progresses far enough then no amount of oxygen will save a patient. These cases are hard because we have to watch someone die without any means to save them. Doing cpr on a patient with covid can feel pointless. If the lungs do work then no amount of chest compressions, oxygen, and cardiac drugs will save that person.
I'm hoping this doesn't come off as snarky but, why can't / don't we tell people to prone at home? As I understand, it's literally just lying down on your stomach.
I first encountered the concept in a new york times article where the interviewed nurse was saying the problem was people got bored and stopped doing it. That sounded... dumb. And as though being prone should be plastered all over the public health recommendations.
I first encountered the concept in a new york times article where the interviewed nurse was saying the problem was people got bored and stopped doing it. That sounded... dumb. And as though being prone should be plastered all over the public health recommendations.
Good question. Proned patients are too sick to survive at home. As soon as the roll onto their back or sit upright they start suffocating and must work for their breath. Because of this they need help caring for themselves. They also are at risk of becoming much worse and needing more oxygen.
> Proned patients are too sick to survive at home.
Proned patients are just people lying on their stomachs, are they not? I get that its something you would recommend to someone who is really low on oxygen, but why aren't people who aren't too sick to survive at home being told to do this also? Is there a downside?
Like if your pulse oximeter starts readying 88 and slowly dropping, its probably a good idea to start proning, in the very least at night while sleeping?
Proned patients are just people lying on their stomachs, are they not? I get that its something you would recommend to someone who is really low on oxygen, but why aren't people who aren't too sick to survive at home being told to do this also? Is there a downside?
Like if your pulse oximeter starts readying 88 and slowly dropping, its probably a good idea to start proning, in the very least at night while sleeping?
There is a lot that doctors can do short of intubation. Take a look at this care protocol.
https://www.evms.edu/covid-19/covid_care_for_clinicians/#d.e...
https://www.evms.edu/covid-19/covid_care_for_clinicians/#d.e...
I have never admitted to a hospital in the US but have heard stories of other folks who have been. I just get a feeling that once you are admitted in a hospital nobody has any power including yourself. Everything is taken over by the "system". This is my biggest fear why I would never want to be hospitalized.
It actually benefits you to have a doctor in the family who is there navigating and talking to the doctors. The doctors are more receptive to each other and listen carefully. Otherwise you are just a number. And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place.
My wife went to the ER (in Manhattan) with septicemia a week after giving birth. She was left lying on a stretcher for 17 hours without as much as water to drink before they finally "found" a room for her. (Thankfully she recovered.)
A few months later, a friend who works at the hospital told me: I wish you had called me, I could have gotten you a room. And I thought: this is just like a third world country, where you need connections to get basic care.
A few months later, a friend who works at the hospital told me: I wish you had called me, I could have gotten you a room. And I thought: this is just like a third world country, where you need connections to get basic care.
You are lucky. People in Quebec hospitals are left in hallways permanently, due to space issues - even before covid.
> And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place.
I have never found this to be the case.
Generally, if I was fighting with a doctor, it was because he was trying to be too aggressive and do too much, not too little.
I have never found this to be the case.
Generally, if I was fighting with a doctor, it was because he was trying to be too aggressive and do too much, not too little.
Clarification : Doctors won't try so hard to do thorough testing of the patient nor would they take a deep look to assess all symptoms.
But if they feel you know medicine or are capable of understanding medicine or have a drive to learn more about your condition, then they will try harder, do more tests, ask more questions, etc.
But if they feel you know medicine or are capable of understanding medicine or have a drive to learn more about your condition, then they will try harder, do more tests, ask more questions, etc.
> I just get a feeling that once you are admitted in a hospital nobody has any power including yourself. Everything is taken over by the "system". This is my biggest fear why I would never want to be hospitalized.
Well, I was admitted and personally walked out with a gall bladder about to explode. Yeah, I was back in the hospital 24 hours later ... not my finest hour. So, I can absolutely confirm that you can be stubborn and buck the system.
I will absolutely defend your ability to spend time and research your treatment when dealing with doctors normally--especially for chronic conditions. Doctors page fault on every patient and if you are being responsible you may very well be better informed than your general practitioner about what is going on with your body.
However, if you are actually admitted to a hospital with something acute, do you really have the wherewithal to diagnose and manage it? By the time I hit the hospital, I was probably on 72 hours with very little sleep and pain that took hydromorphone to even dent. I guarantee I wasn't thinking clearly by then.
The biggest problem with hospitals is that you need an advocate for you, personally. Without someone in the room with you, you won't know if the nurse missed that medication round, isn't paying attention to your increasing temperature, didn't bring you your lunch, etc.
The problem isn't when the system works. The problem is that without someone else there you don't have someone to watch for if the system hiccups.
Well, I was admitted and personally walked out with a gall bladder about to explode. Yeah, I was back in the hospital 24 hours later ... not my finest hour. So, I can absolutely confirm that you can be stubborn and buck the system.
I will absolutely defend your ability to spend time and research your treatment when dealing with doctors normally--especially for chronic conditions. Doctors page fault on every patient and if you are being responsible you may very well be better informed than your general practitioner about what is going on with your body.
However, if you are actually admitted to a hospital with something acute, do you really have the wherewithal to diagnose and manage it? By the time I hit the hospital, I was probably on 72 hours with very little sleep and pain that took hydromorphone to even dent. I guarantee I wasn't thinking clearly by then.
The biggest problem with hospitals is that you need an advocate for you, personally. Without someone in the room with you, you won't know if the nurse missed that medication round, isn't paying attention to your increasing temperature, didn't bring you your lunch, etc.
The problem isn't when the system works. The problem is that without someone else there you don't have someone to watch for if the system hiccups.
That may be true, but I meant powerless to meaningfully improve someone's medical outcome due to COVID, regardless of bureaucratic barriers.
...which is not correct.
Yeah, the odds of death if you have to be put on a ventilator is 88%. It is similar to CPR, in that it works but statistically has a very low chance of success since it is only administered once the situation has deteriorated to near certain death.
88% is definitely not true. That paper retracted that claim.
Thanks a lot for correcting that. I was going off the stat NYC reported at the peak of the pandemic.
Just checked and it is quite the stark difference.
https://www.npr.org/sections/health-shots/2020/05/15/8567680...
Quote from the article
Old information:
Just checked and it is quite the stark difference.
https://www.npr.org/sections/health-shots/2020/05/15/8567680...
Quote from the article
Old information:
Early reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators.
And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%.
The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under *30%* .
And unlike the New York study, only a few patients were still on a ventilator when the data were collected.For others having a hard time reading those quotes on mobile:
Old information:
Early reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators.
And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%.
New information:
The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under 30% .
And unlike the New York study, only a few patients were still on a ventilator when the data were collected.
Old information:
Early reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators.
And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%.
New information:
The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under 30% .
And unlike the New York study, only a few patients were still on a ventilator when the data were collected.
> The impression I've gotten is that they cannot do much, and if they would go as far as intubation, you're highly likely to die even with intubation.
Anecdotal evidence seems to be that the doctors are getting better at treating the worst Covid patients. It's still not something you want to get, but it's not quite the death sentence it was.
Apparently, high-flow ventilation is a big improvement over intubation, but until everybody had enough/proper protective equipment it simply wasn't on the table (it aerosolizes the virus).
Which drug cocktails help and how to administer them is also improving.
We're not getting a good treatment until monoclonal antibodies or a vaccine, but were not simply standing still, either.
Anecdotal evidence seems to be that the doctors are getting better at treating the worst Covid patients. It's still not something you want to get, but it's not quite the death sentence it was.
Apparently, high-flow ventilation is a big improvement over intubation, but until everybody had enough/proper protective equipment it simply wasn't on the table (it aerosolizes the virus).
Which drug cocktails help and how to administer them is also improving.
We're not getting a good treatment until monoclonal antibodies or a vaccine, but were not simply standing still, either.
[deleted]
> I haven’t hugged my family in over two months — anything to keep them from contracting a virus that could kill them.
It could but they look fairly young and as long as they’ve no comorbidities they’ll be fine.
It could but they look fairly young and as long as they’ve no comorbidities they’ll be fine.
It’s incredibly true. We know coronavirus is only really dangerous to the elderly and those with weakened immunity systems.
So why aren’t we focusing all the attention and effort on protecting the most vulnerable, instead of spreading misinformation like “COVID doesn’t discriminate” (it does) and panicking over schools while sending confirmed positive patients back to nursing homes?
So why aren’t we focusing all the attention and effort on protecting the most vulnerable, instead of spreading misinformation like “COVID doesn’t discriminate” (it does) and panicking over schools while sending confirmed positive patients back to nursing homes?
Coronavirus has a mortality curve by age that looks like the average curve for the population of all other causes. So you're basically saying we shouldn't protect young people of a risk that doubles their chances of dying this year. Should we also get rid of seat belt and helmet laws while we're at it? The total risk there is lower than this.
I agree - this kind of misinformation is so widespread now. It seems completely counter productive.
The other bit of widespread misinformation is the 2m/6ft distancing thing. It's just an arbitrary number.
Weirdly the fearmongering makes me feel like being less careful, not more. The way I see it, if COVID is really so contagious that I'm likely to catch it from a stranger's exhaled breath as I pass them in the street, then I'm guaranteed to catch it eventually, so what's the point?
I'm sure it can technically be transmitted in this way, but what's the actual probability? Tiny enough to not be worth worrying about, I expect.
The other bit of widespread misinformation is the 2m/6ft distancing thing. It's just an arbitrary number.
Weirdly the fearmongering makes me feel like being less careful, not more. The way I see it, if COVID is really so contagious that I'm likely to catch it from a stranger's exhaled breath as I pass them in the street, then I'm guaranteed to catch it eventually, so what's the point?
I'm sure it can technically be transmitted in this way, but what's the actual probability? Tiny enough to not be worth worrying about, I expect.
Tiny exposure to covid (by passing somebody on the street) is exceptionally unlikely to make you sick, but it will help your immune system recognize the enemy. This builds partial immunity and if you get exposed for real at some later point your immune system will be able to kick into gear right away.
Has this been demonstrated? Is this true? Is this really how the immune system works?
Yes, for instance in this 2015 study on influenza: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342672/
Higher initial dose results in worse outcomes. Low dose still helps build immunity. Covid19 should be assumed to work like other RTIs.
(This is also why obsessively washing your hands and cleaning your house with bleach isn't a good idea, because being in too sterile an environment harms your immune system.)
Higher initial dose results in worse outcomes. Low dose still helps build immunity. Covid19 should be assumed to work like other RTIs.
(This is also why obsessively washing your hands and cleaning your house with bleach isn't a good idea, because being in too sterile an environment harms your immune system.)
Wow, conducting this study (and the IRB review) must have been great.
Hm, okay, at first I just saw the very linear response and wasn't sure how that translates low dose still helps build immunity, but then went back and read your comment up thread, which captures it better: the partial sickness gives partial immunity, thus "priming" the body for the full-blown thing.
Though getting the active transmission rate down could be more important in some places.
Hm, okay, at first I just saw the very linear response and wasn't sure how that translates low dose still helps build immunity, but then went back and read your comment up thread, which captures it better: the partial sickness gives partial immunity, thus "priming" the body for the full-blown thing.
Though getting the active transmission rate down could be more important in some places.
There's some evidence that exposure to higher concentrations of the virus can make things much worse. That matches with lots of reports of deaths of otherwise healthy health workers.
Yes, the sad reality is that this doctor is completely delusional about the actual risks of covid because of his first-hand experiences. The news amplifies this kind of hysteria so badly that doctors start believing they and their coworkers might die if they leave their wrists exposed. It would be comical, if it didn't have such a large societal impact.
Reading the title I thought the topic was a marriage with an Entity Relationship document
> When Alex finally gets home, he takes his scrubs off outside our front door and stuffs them into a plastic bag that he ties off tightly. He takes his hospital clogs off and leaves them outside, along with his backpack and coat.
Why do doctors and nurses walk around outside in their hospital scrubs? It was unsanitary even before COVID and I just don't get it. How hard can it be to change into street clothes before leaving the hospital?
I see nurses and doctors in scrubs on public transit, in coffee shops, cafeterias... they are either taking whatever illnesses were in the hospital outside, or taking the dirt and grime of the outside world into the hospital. It's baffling that this behavior is so normalized that it's described as heroic in TFA.
Why do doctors and nurses walk around outside in their hospital scrubs? It was unsanitary even before COVID and I just don't get it. How hard can it be to change into street clothes before leaving the hospital?
I see nurses and doctors in scrubs on public transit, in coffee shops, cafeterias... they are either taking whatever illnesses were in the hospital outside, or taking the dirt and grime of the outside world into the hospital. It's baffling that this behavior is so normalized that it's described as heroic in TFA.
The fact they're worn around so freely should be a hint that they merely look like surgical scrubs, not intended to be used like surgical scrubs.
Realistically, I would think scrubs are common because 1) they've become emblematic of healthcare occupations[1] and 2) they're easier to clean and relatively cheap--they protect the wearer from spills and contamination, not the other way around, and in contrast to traditional nursing uniforms, doctors' white lab coats, etc, they're comparatively disposal, so you can wash them in hot water after every use and then discard them after the fabric wears out.
[1] Undoubtedly because of their association with surgery. I'd bet it all started with some cool surgeon lazily wearing his scrubs around the hospital.
Realistically, I would think scrubs are common because 1) they've become emblematic of healthcare occupations[1] and 2) they're easier to clean and relatively cheap--they protect the wearer from spills and contamination, not the other way around, and in contrast to traditional nursing uniforms, doctors' white lab coats, etc, they're comparatively disposal, so you can wash them in hot water after every use and then discard them after the fabric wears out.
[1] Undoubtedly because of their association with surgery. I'd bet it all started with some cool surgeon lazily wearing his scrubs around the hospital.
Yes, I know surgeons actually change into sterile scrubs before going into surgery, but even "normal" parts of hospitals are biologically filthy. Even the possibility of bringing MRSA into the outside world should merit a change of clothes.
Clothing is probably the least problematic thing. Every time some nurse or doctor uses a keyboard I want to scream. I regularly see doctors use the keyboard, wash their hands, and then use the keyboard again before beginning an examine. Recently I've started to see plastic covers on the keyboards, as if that mattered relative to the order of touching things.
Realistically, cross-contamination in the hospital is almost certainly far more dangerous and consequential. Hospitals are full of infectious people, afterall, and why MRSA is more common in hospitals than in other environments. I'd rather be treated by a garbage man fresh off his route who's more mindful about what he touches after washing his hands and after touching something possibly contaminated, even if his clothes are filthy.
Realistically, cross-contamination in the hospital is almost certainly far more dangerous and consequential. Hospitals are full of infectious people, afterall, and why MRSA is more common in hospitals than in other environments. I'd rather be treated by a garbage man fresh off his route who's more mindful about what he touches after washing his hands and after touching something possibly contaminated, even if his clothes are filthy.
The plastic cover can be taken off and washed (in theory) so it should be much less dirty.
I'm sure there's some study indicating that, despite best protocol, many of those keyboard covers are biological weapons equal to any naked keyboard.
> Yes, I know surgeons actually change into sterile scrubs before going into surgery
No, they put clean ones on, then put something sterile over the top. The racks of scrubs are used by everyone. You just grab a pair. You check the crotch doesn't have a hole in it, and that the elastic is still stretchy.
No, they put clean ones on, then put something sterile over the top. The racks of scrubs are used by everyone. You just grab a pair. You check the crotch doesn't have a hole in it, and that the elastic is still stretchy.
For comparison, the number of MRSA deaths in 2017 was 19,832 in the US.
How long MRSA survives outside a host? Does it survive better on regularly cleaned surfaces where there are not much regular bacteria?
It's actually not easy; not every place has facilities for that. Wife is a nurse, and we went through this discussion of the best process when she was an ICU nurse during the Ebola scare five years ago.
Remember too, sometimes folks are on the way to work in their scrubs, not necessarily leaving work.
Remember too, sometimes folks are on the way to work in their scrubs, not necessarily leaving work.
What "facilities"? We're talking about changing clothes. Shower curtain ought to be enough! And the point about going to work in scrubs is also bad: scrubs should be as much about keeping stuff out of the hospital as in.
If a neighborhood yoga studio can provide a place to change, pretty sure any healthcare facility can too.
If a neighborhood yoga studio can provide a place to change, pretty sure any healthcare facility can too.
When's the last time you saw a yoga studio the size of an average hospital? Most hospitals have staff numbering into the hundreds or thousands with 24/7 operations [1]. We're talking large locker room facilities all over the place with many departments getting their own, especially after COVID, which themselves become central points for disease spread since shift changes aren't evenly spread out.
I don't think it's a bad idea to make big investments into such infrastructure now but I think it's completely reasonable it wasn't a priority before.
[1] The average hospital with 50 to 99 beds has a FT+PT staff of about 400 ( beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-hospital-staffing.html ) and half of all hospitals in the US have under 100 beds.
I don't think it's a bad idea to make big investments into such infrastructure now but I think it's completely reasonable it wasn't a priority before.
[1] The average hospital with 50 to 99 beds has a FT+PT staff of about 400 ( beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-hospital-staffing.html ) and half of all hospitals in the US have under 100 beds.
Most bathrooms in hospitals are private.
> Remember too, sometimes folks are on the way to work in their scrubs, not necessarily leaving work.
This is a weird thing to remind the parent of, considering the original comment says
>> they are either taking whatever illnesses were in the hospital outside, or taking the dirt and grime of the outside world into the hospital
This is a weird thing to remind the parent of, considering the original comment says
>> they are either taking whatever illnesses were in the hospital outside, or taking the dirt and grime of the outside world into the hospital
It's really not that hard to change your clothes in a bathroom. Especially in a hospital, where they certainly have a wheelchair accessible large private one. Also, many large hospitals also have a gym, so you could just change there.
The entire staff, though? When they all have to do it at the same time, when a shift changes?
How sanitary is that? A small room that is aerosolizing feces and urine after each flush?
I doubt there is a lid on the toilet.
I doubt there is a lid on the toilet.
Why are they getting their scrubs exposed to the ‘outside’ at all?
Because it isn’t meaningfully dangerous. The inside of hospitals are not sterile. If there is a need for additional cleanliness, scrubs are covered with something that actually is sterile
Outside of theatres the function as a uniform. In operating theatres (most places I’ve worked) if you go outside in theatre scrubs you have to change when you come back in
I can only speak for the docs, but this has something to do with compassion fatigue. The job is hard, and extending your frame of thought to public health concerns like this can be beyond the mental energy we're capable of in a day.
Bad analogy, but its like using a car to get to work instead of riding your bike. Most do it, knowing its worse for the environment.
Bad analogy, but its like using a car to get to work instead of riding your bike. Most do it, knowing its worse for the environment.
Leaving aside the question of changing facilities...
Where do the scrubs get washed, then? Do they need to bring a special bag to transport the scrubs so they can wash them at home? Does the bag need to be washed, too? If they leave the scrubs in the lockers if they "aren't too bad" (ha), how are the lockers cleaned to ensure that they are sanitary when they put their street clothes in? How do you ensure they are sanitary when their street clothes are removed? How does all of this adapt to them changing to street clothes to eat lunch, like you suggest? Are you willing to pay for more doctors/nurses/etc. to cover the changing time for lunch?
Where do the scrubs get washed, then? Do they need to bring a special bag to transport the scrubs so they can wash them at home? Does the bag need to be washed, too? If they leave the scrubs in the lockers if they "aren't too bad" (ha), how are the lockers cleaned to ensure that they are sanitary when they put their street clothes in? How do you ensure they are sanitary when their street clothes are removed? How does all of this adapt to them changing to street clothes to eat lunch, like you suggest? Are you willing to pay for more doctors/nurses/etc. to cover the changing time for lunch?
Ideally they would get washed at the hospital. Hospitals wash massive amounts of linens anyway, I can't imagine the additional expense being material. Mesh bag + name tag costs what, $1?
And if for some reason the clinic doesn't wash linens, well, presumably the scrubs are being washed at home now, so that's always an option. The "special bag" you refer to can be gym bag or a disposable plastic bag. That is still miles less gross than the status quo.
If a gym-goer can be expected to not work out in street clothes/shoes, surely similar standards of hygiene can be expected of healthcare practitioners!
And if for some reason the clinic doesn't wash linens, well, presumably the scrubs are being washed at home now, so that's always an option. The "special bag" you refer to can be gym bag or a disposable plastic bag. That is still miles less gross than the status quo.
If a gym-goer can be expected to not work out in street clothes/shoes, surely similar standards of hygiene can be expected of healthcare practitioners!
This is anecdotal, but a friend of mine who works in healthcare once complained that hospitals used to (years ago) provide a cleaning service for scrubs and lab coats, but now the staff are expected to wash theirs at home.
True procedural scrubs are still washed by the hospital (really in most cases by a contract service provider).
Scrubs you see (assuming you don’t work in a procedural space) are not procedural scrubs. They are just clothing. You can be forgiven for being confused as many of those suits are taken / borrowed / stolen from the procedural scrub supply. This problem is serious enough in some places that scrubs are distributed with a vending machine system that tracks your (limited) allowed balance of outstanding sets.
A long time ago , when nurses and house officers worn uniforms and laundry was on site , non procedural clinical staff were wearing hospital laundered clothing. The uniforms, and the laundry service that went with it, went away decades ago though.
What to wear instead, in non procedural spaces, wasn’t every really clarified. I suspect Grays Anatomy and Scrubs helped to sort it out for this generation (although it’s highly regional and reasonably local) as did the economic importance of procedures.
Scrubs you see (assuming you don’t work in a procedural space) are not procedural scrubs. They are just clothing. You can be forgiven for being confused as many of those suits are taken / borrowed / stolen from the procedural scrub supply. This problem is serious enough in some places that scrubs are distributed with a vending machine system that tracks your (limited) allowed balance of outstanding sets.
A long time ago , when nurses and house officers worn uniforms and laundry was on site , non procedural clinical staff were wearing hospital laundered clothing. The uniforms, and the laundry service that went with it, went away decades ago though.
What to wear instead, in non procedural spaces, wasn’t every really clarified. I suspect Grays Anatomy and Scrubs helped to sort it out for this generation (although it’s highly regional and reasonably local) as did the economic importance of procedures.
Not disagreeing, but Doctors frequently wear suits into and out of hospitals also. And those get washed less frequently than scrubs.
most of them want to show to other people they are doctor.