Something the article doesn't do a great job of covering is how overall emergency medical incidents went way down more than expected - which is what some of these field hospitals (and the Navy ships) were for.
The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down? Or did people just die at home afraid to go to the hospital?
In SF in normal times, over 50% of trauma cases are from car accidents. My completely unscientific theory is that commuting/traffic is way more stressful and physically taxing than people think.
> The "excess deaths" surpassed COVID-19 fatalities in those states by a combined 4,563 people. Experts suspect that unconfirmed coronavirus cases could be responsible for some of those deaths, but it might also be related to a shift in other causes of death. For example, some doctors speculate people might be dying from illnesses from which they would normally recover because the pandemic has changed access to health care.
> “Our ER, as well as many others, are seeing far fewer patients because people are scared to come in.”
There are graphs.
This has added to a lot of the confusion and misinformation surrounding coronavirus response, since people are hearing that hospitals and ERs around the country are seeing fewer patients -- dramatically fewer, in some cases -- and conflating that with the coronavirus risk being unexpectedly low, which isn't true.
The original risk associated with Covid19 was lack of hospital resources. With most hospitals having plenty of capacity, the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true.
> The fallout from such fear has concerned U.S. doctors for weeks while they have tracked a worrying trend: As the pandemic took hold, the number of patients showing up at hospitals with serious cardiovascular emergencies such as strokes and heart attacks has shrunk dramatically.
> Across the U.S., doctors call the drop-off staggering, unlike anything they've seen. And they worry a new wave of patients is headed their way — people who have delayed care and will be sicker and more injured when they finally arrive in emergency rooms.
My father needs medical help RN but everyone is putting him off just sending RX over phone no (pain pills though) saying "stay home". ASAP they open we all wheeling him in there for a MRI if we have to camp outside in a waiting line so be it.
> The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down? Or did people just die at home afraid to go to the hospital?
It's at this point that the news media needs to look inwards and wonder if they made such a big hysteria over covid that they failed to point out that people should still go to the ER. I bet many of those who died at home had symptoms of heart attacks/strokes, etc, but didn't want to go out of a mistaken sense of magnanimity (I don't want to take the bed of a COVID patient) as well as a false sense that the hospitals were in any danger of being overloaded (they were not, given the steps we took).
I think you've explained why this isn't getting covered well. The news media does not do introspection. They're all rah-rah about their power to change the world and how important it makes them, but they almost never consider the possibility that they could've made it worse.
> false sense that the hospitals were in any danger of being overloaded
They were overloaded in Wuhan, Milan, Madrid and Brussels, and came within a hair of capacity in Paris and New York. What "false sense" are you talking about, exactly? There was real risk. Are you saying that the media reported overloads that didn't exist?
Your argument seems a bit vague to me. You could just as easily argue, with perfectly symmetric evidence, that it's good that "the media" "gave a false sense" of hospital capacity, because it prevented an actual overload of the system. Why is your version better, except that in yours you get to have a more personally pleasing enemy?
Pretty much all criticism of "the media" is like this.
What about option #3 - going to hospital puts you in danger of catching COVID?
If you have pre-existing conditions, catching COVID is a lot more dangerous than if you don't.
Who typically goes to the hospital for medical treatment?
People with pre-existing conditions.
"I don't want to go to the ER, because I might catch COVID from another patient, or doctor" is a very justifiable fear.
This is just the consequence of the virus spreading to the community - not the consequence of mitigating the spread of the virus through the community.
>> which is what some of these field hospitals (and the Navy ships) were for.
Small detail about the navy ships: they are setup for battlefield injuries. The wards are all open (think what you see on old episodes of MASH) with little to no separation between patients. That is fine for traumatic injuries (earthquakes, fires, war etc) but less than useful for control of infectious disease. The plan was for them to take non-covid patients to relieve hospitals but it never really worked out. The risk of a ship becoming a hotspot should one covid infection slip through into an open ward was too great.
This is not entirely correct. The US Comfort in NYC specifically is as you described, but, lost 1/2 it's capacity by setting up with protections between beds. It still saw almost no people because the need just wasn't there. Under 80 people last I heard. I am not aware of any reports that said fear was a factor in it not being used, do you have that source?
> That is fine for traumatic injuries (earthquakes, fires, war etc) but less than useful for control of infectious disease.
Military hospitals (including ship-based hospitals) have been planning and preparing to deal with biological warfare (i.e., communicable diseases) for many, many decades, and even before that they were well acquainted with communicable diseases. It was not uncommon in the past for communicable diseases to kill more soldiers than died in actual combat.
That is one reason the U.S. Public Health Service is a uniformed service -- so their personnel could operate in war zones without the risk of being shot as spies if they were captured.
>The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down?
besides the deaths-at-home, shouldn't it be considered that the low-impact low-energy lifestyle that is being promoted right now is less strenuous on the body in the short term?
I imagine that the lack of deaths, after deaths-at-home are cancelled from the number, is just seeing a lag time where the lack of physical effort reduces short-term deaths but increases long-term deaths due to lapse in fitness.
How much stress is replaced by "I have no job, and my phone is blowing up with debt collectors, and I have to decide if I buy food or pay bills, do I have corona, etc?"
> Or did people just die at home afraid to go to the hospital?
Probably yes. In the UK there is a significant surge in non covid related deaths above historical stats. Bear in mind also the definition of a covid 19 related death is, err, generous in the first place
Not saying you’re wrong, I do think there would be some of that but I am looking at a way to quantify it, especially since my friend is convinced that the lockdown is worse than the virus.
Now I realise that some people that would normally die are not (car accidents etc), but at the same time if the lockdown itself was causing significant mortality you wouldn’t expect the excess mortality to drop to normal levels, would you? You would expect a small offset from 0 unless the savings from car crashes are exactly the same compared to “lockdown deaths” - and if they are, and the lockdown is saving “extra” lives then is it not still worth it?
We have to wait and see for England to see if it falls back to normal or below normal levels.
I don't know the stats, but I live next to a busy fire station that responds to paramedic calls and is doubled up with trucks due to a COVID outbreak in another house.
Today (a Friday, I am working on my front porch, and heard sirens about 4 times from 7AM-3PM). Typically, that number would be 5x that. It's been like that since mid-march.
All cause mortality is down 9% over the last couple of months in Rome (sorry, on mobile, not easy to add reference which I would have to trawl for) - just to get in front of any covid-seriousness deniers, Rome has not been badly hit.
In Australia, significant decreases in STEMI (serious heart attack presentations) although nothing published yet. Everyone wondering what’s going on - going to be some interesting studies coming out after this in terms of population health and additional/reduced morbidity and mortality
Less pollution, pollution especially PM smaller than 2.5 you get from the tail of an exhaust pipe sitting in front of you in traffic is not good for cardiovascular health and also is known to cause strokes. We have a significant decline in pollution and people driving.
> Or did people just die at home afraid to go to the hospital?
Sadly I think this is a partial answer. Working as a paramedic, for all the times I saw people saying “y’know, maybe I don’t really need to go to the ER”, there were also the people who really did need to but were too scared. Be it 90 year olds with severe lacerations or heart attacks, there was a fear that we had to manage and balance.
Friend of mine is a trauma nurse at Stanford and she said their most common trauma patient is from bicycle accidents. Just an anecdote, but an interesting one.
The awful news - This isn't just NY. This is around me too, where our hospitals have been damn near completely empty with next to 0 infections. I know very specifically of one death where the individual was told to stay home vs going into the empty hospital. He eventually got to the hospital, but it was too late.
The great irony is that, in trying to prevent hospitals from being overwhelmed leading to unnecessary deaths, we cleared out hospitals too soon, to prepare for a surge that never happened, and lead some people to unnecessary suffering and maybe death.
People without jobs had to get surgery now, before their CORBA ran out.
The point isn’t that the curve didn’t exist or that it’s relative magnitude wasn’t higher in some cities. The point is that hospitals generally weren’t overrun, therefore, the measures we took effectively flattened the curve enough that all these overflow medical resources weren’t put to use.
I've heard of some people getting stuff scheduled way out at suburban hospitals, often out of network, and clearing out their health savings accounts to get essential surgery. That's fucked up.
>ER admissions are down 50% or more depending in county.
This isn't as significant as you might think...
There is a large (very large in some communities) percentage of ER visits that aren't for real emergencies; rather, they are used for routine stuff, for which people with good insurance would go to their pediatrician or Urgent Care Clinic.
If you are broke, have crappy or no insurance, and can't afford a scrip of antibiotics, when your kid gets a fever or sore throat, you go to the ER. That's routine for -- I would bet -- hundreds of thousands of people throughout the year.
So I saw, am still seeing, all the doctors and nurses in NYC pleading for help. But there were thousands of empty covid-specific beds open in that state. Why where they not sending patients to these field hospitals? Is this about money? Would private hospitals loose out on payments if they transfered patients?
I feel sorry for the frontline workers in NYC, but I don't know how to reconcile knowledge that there were open covid-specific beds availible just down the road.
> But there were thousands of empty covid-specific beds open in that state. Why where they not sending patients to these field hospitals?
There is a somewhat similar situation in the UK, where hospitals are dealing with a lot of COVID patients, but the 'Nightingale' hospitals, our equivalent of these field hospitals, are mostly empty.
Something i have heard, but do not have a source for, is that the Nightingale hospitals were built on the assumption that COVID patients just needed a bed and a ventilator, but it turns out that COVID causes multiple organ failure, treating which needs a wider range of facilities, and can progress very quickly from respiratory symptoms to that, so they aren't actually much use.
> but it turns out that COVID causes multiple organ failure, treating which needs a wider range of facilities, and can progress very quickly from respiratory symptoms to that, so they aren't actually much use.
Just to be clear, COVID-19 contributes to organ failure in very limited cases from a statistical sense. So this is absolutely something that is happening, but just wanted to be clear that we are not seeing hordes of people keeling over from strokes, organ failure, etc.
It's known that the complications that come into play when the body has entered a cytokine-storm type state are very far-reaching. For the same reason that inflammation is a critical part of the healing process, systemic inflammation can cause incredible damage to organs and other physiological systems.
Quite a few still don't. Check out findthemasks.com for a map of almost 4,000 institutions seeking donations in the US. We also list a number of countries worldwide.
I used to live in new england. No part of NY is further than a few hours drive from any other part of the state, especially during lockdown traffic. The Stony Brook facility was on Long Island, only a 60-mile drive from downtown NYC. An ambulance/bus in a hurry could easily make the drive in under an hour.
>> "It was very disappointing," Gonzalez said. "Everybody was here, ready to work, ready to get patients in."
Many of these hospitals treated literally zero patients. Hospitals weren't overwealmed by people in care homes. They were overwealmed by people in the hospital. I don't see why some subset of those patients couldn't have been shipped to these field hospitals. NY was asking for volunteers to come from all over the country to relieve their struggling hospital system. But there were federal hospitals standing idle a short drive away? Why weren't they loading the not-yet-crititcal patients into busses and taking them to Stony Brook (capacity 1038, patients treated 0)?
I've been wondering a lot about that as well. It seems to me it may be a combination of factors.
1) New York was the area hardest it, it got hit initially, it has incredibly high concentration of people, and since it got hit early we had the least amount of information about the virus. Because of the small geographic area, high population density, and quick spike of infections you get a subset of hospitals strained for resources in that area, but not the whole nation. Similar to pulling a hose and it gets caught on something which makes it harder to pull, it isn't there isn't enough slack in the hose, it is that there isn't enough slack in the hose at one spot.
2) There has been a heavy politicization of the whole 'Rona situation and so different factions are either trying to downplay it, or exacerbate it to try and score political points.
3) Fear gets more clicks than, sunny day stories.
4) Pushing an over the top message of worry may convince people to be more cautious who otherwise wouldn't be. Like if you want a 3% raise, you don't go in and ask your boss for a 3% raise, ask him for 5% or 7% that way he can negotiate you down to a 3% and still feel like he won, and kept you for less than you wanted and you still get what you wanted.
5)There is an alternative possiblity. There is a grand conspiracy by either, the deep state, the Illuminati, the elite, the superwealthy, secret neo-Nazis, the Communists, the bicoastal liberal elite, the CIA, to kill people by the millions using COVID-19 and it turns out the conspiracy is really bad at it.
EDIT:
I also want to make clear I don't want to downplay the situation of various healthcare workers who have been heroically making sacrifice. I believe many of them are honestly expressing their opinion and are worried about PPE or other issues, and may have experienced it; however there are probably hundreds of thousands of people involved in the New York healthcare system, if only 1% of 100,000 people feel overwhelmed at some point and post a video, or send a tweet about it that is 1,000 stories, but may not represent a consensus view.
No one seems to be covering whistle-blowers like Nicole Sirotek except the shitty tabloids. I want some other NYC reporters to investigate/interview all the doctors/nurses that have been brought in from other regions (blured out/anonymously)
Maybe that video is fake, but I am wondering how many of these deaths might be due to malpractice.
I’ve seen it covered only by the NY Post and several tabloids. There are a couple possibilities in my mind. Of course editorial discretion is one, but what if they looked into her story and couldn’t confirm basic facts? It’s hard to write a story around that unless the underlying thing gets a lot of currency. Sometimes newspaper ombudsmen are interested in finding out why a story wasn’t reported. Perhaps send tips there?
Building a field hospital for a pandemic and not needing it is literally dead last in my list of wasteful government expenditures to be angry about. The rationale that lead to making the hospital was incredibly clear, and that we didn’t need said hospital is a source of relief more than anything else.
The problem is much media, and especially social media, is using things like these unused field hospitals to justify that the problem was never that bad to begin with.
Which is exactly what people said would happen if stay-home orders managed to flatten the curve.
I hate this all so much. I am honestly super depressed about how short-sighted many people I know are proving to be.
They're not mutually exclusive. It could be (is likely) that the problem never was as bad to begin with and that it was lessened by flattening the curve. Even ERs have been seeing only 40-50% of normal patient numbers and have been cutting staff and shifts. You don't see that except for the fact that experts assumed and/or modeled very very wrong. And that the population has been scared to the unhealthy extent such that they think the virus risk is worse than not seeking treatment for heart attacks and strokes.
There's much we have yet to learn about this thing. We might not figure it out satisfactorily for years. Remember zika?
And it's certainly less severe among those infected than was predicted (at least per capita infections, if not overall). As long as people/ officials/ experts deny that, (or exclusively credit flattening the curve, or fail to admit how wrong they were, where appropriate) don't expect the public to take fear-based guidance from the same sources as credible.
I don't entirely blame the media. Some of this is over-pessimism on public health officials.
For instance in the Bay Area, the SIP's argument was justified primarily from hospital capacity (https://www.sccgov.org/sites/covid19/Pages/order-health-offi...). It wasn't (as has since become) suppress the transmission rate until a test, trace, isolate system can be restored. [1]
Even on April 7, Santa Clara (https://www.mercurynews.com/2020/04/07/coronavirus-santa-cla...) was still projecting 2500-12000 cases by May 1. The higher end of that was highly unlikely even then (that would require cases growing faster than Seattle had been pre-SIP). In retrospect, even the best case scenario was also too pessimistic - at current rates Santa Clara won't hit 2500 until after May 21 -- double the time the "best case" had estimated.
Compare the communication to say Germany or New Zealand, where clear numbers, confidence metrics, range of possibilities, and objectives are outlined.
[1] Which actually has already happened. I'm not exactly sure what the goal is at this point - we have metrics but it's a bit unclear what they are based on (esp. the hard to reach testing numbers).
I'm with you on how depressing it is, my biggest take away from this entire thing so far is that people's ability to link cause and effect is much lower than I had previously estimated.
or, you could be angry that it became highly politicized and many media outlets absolutely overhyped the danger for clicks and political points.
if we'd been more levelheaded, we would have suggested the public should either
1) physically distance, or
2) wear a mask
in enclosed spaces and face-to-face situations.
if you're an essential worker or particularly vulnerable, you'd do both where possible. that's it. that likely would have provided all the risk reduction we needed to get the spread under control.
the message would have been simple, the effects likely as good, and we wouldn't have left a hundred million poeple on the edge of (or in) economic and psychological collapse.
but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want.
I always emphasize to my family that we shut down the whole country, the outbreak was relatively well contained to a few areas, and it has still almost certainly already killed more than 100,000 people and may well kill over 200,000.
Given our extreme response, the high death toll should be more shocking to people.
That's the rub though. You want these to be used. The original goal we were sold is to flatten the curve, which means to use up all the base load capacity, but not exceed the base load capacity. Riding the line of base load capacity was going to be imperfect and we would see usage of these field hospitals as a signal that we are redlining our capacity and need to pull back.
The problem is that the only experts we're listening to are doctors and epidemiologists, when we should also be listening to economists. Both sets of people should be in a room together hashing out policy through an adversarial process that charts a middle ground between two bad outcomes.
Flattening the curve to well below capacity at the expense of further suffocating the economy, just means that we're completing ignoring economic externalities that is going to take years or even more than a decade to fully recover from.
I think people are more upset with the fact that they are unemployed and their states are locked down. The initial request from my governor was "2 weeks to flatten the curve". After two months, and hearing we never reached near capacity, and our local emergency hospital is also winding down, why are we still closed? Now we're told it could until June
It’s more like experts telling you that models predict you’ll need 50 fire extinguishers to put out a kitchen fire, you express skepticism, and you’re branded a science-denying lunatic.
If you trust the same kind of "Scientific Modeling" that create Hurricane Path Predictions. Notorious for being hysterically wrong.
Then sure... that's wonderfully "clear"...
If, instead, you look at "models" and "projections" as junk science that's easy to prove wrong by simply looking at any model and how horribly wrong it's been in the past?
Like... the COVID models have been horribly wrong so far...
Which models on COVID are you referring to that are horribly wrong?
Also curious why you think the US was so badly effected compared to say south korea or thailand?
Do you think it would be safe for everyone to go back to relative normal? What would your prediction of the effect be? What data would you trust to validate that prediction?
I'm asking out of genuine curiosity how someone who I'm assuming is well meaning can get to this position. I'm happy enough to be convinced if your prediction turns out correct as there will be plenty of different states that are going to do a variety of strategies.
I have a really good friend who works for one of the bigger hospital networks in Michigan. He says they are fortunate to have jobs because even though their hospitals are all empty. He told me staff isn’t being let go or furloughed for now but the staff spends their shift walking around and cleaning things. Even without rooms and equipment being used. Just to stay busy.
My wife is an operating room circulating nurse at Beaumont in Michigan (Metro Detroit).
Lots of people without the title of nurse (RN) are furloughed or laid off. Entire hospitals are closed and covid19 patients transferred to other hospitals. Cleaning and supporting staff has been cut down to bare minimums to save costs. She is being sent home early most days due to low volume, impacting her pay too.
She worked covid19 ER shifts receiving walk in patients coughing like hell. That dried up a month ago and she had the choice to stay home or work night shifts on the floor medicating and caring exclusively for covid19 patience. So she did night shifts for two weeks. Now she is back on her regular position, underemployed.
She laughed about the field hospitals. Now, here in Michigan, we are all, including Nurses and hospitals, sitting around most of the day doing nothing and waiting for some miracle.
There was never a capacity issue she knows of. Only shortages of PPE.
To me it appears that the quarentine was effective? Look at the chart above - on March 21st the stay at home order went into effect in michigan. They peaked 2 weeks later at 1200 active cases in the hospital. Now its dropped back to the same amount as just before the stay at home order went into effect.
Underemployed seems like... a good position to be in right now, no?
There are a number of people who didn't get the care they needed because surgeries for critical things like removing rotting teeth or even some heart surgery were marked as non-critical. They should have kept hospitals running, reprioritized their current schedules, and started cancelling once they saw the influx.
The way this was executed was terrible. The whole point was that hospitals didn't get overloaded so people with critical needs can get treated. It's the absolute definition of irony that cancelling everything had the exact same effect.
Surprised to see this comment come so late. It's true. The regular hospitals were hotbeds for covid infections, so it made sense to keep the non-covid patients as separate as possible from the covid ones. Hence, the field hospitals. It would be terrible to come into the hospital with a broken bone and come out of it with the virus. It makes sense to avoid transporting infected patients whenever possible because it could lead to a new outbreak in a different location.
The Navy hospital ship in LA was planned as a reserve for serious non-covid cases. I think because of the early statewide action we didn't need it, but better to plan reserves than to fall short.
In any large complex system, you can't necessarily predict the bottlenecks, but if you want the system to guarantee a high capacity to handle issues, you need to broadly overresrouce the initial layout (esp if the resources take time to line up). This means by definition - even a good plan will have idle resources somewhere.
I'm higher-risk due to past lung disease and have been taking this incredibly seriously due to not wanting to go through pneumonia again.
I've been taking the social distancing stuff seriously, wearing a mask every time I go out, and have taken steps to get deliveries when I can to ensure I maximize the time at home.
The sky's not falling but I am a bit "scared" as you put it.
I'm scared. Not enough to be curled in a ball in the corner, but enough to be taking social distancing seriously. My wife has medical history that puts her at higher risk, plus she's in her 50s (and me in my 40s) so we're both at slightly higher risk just based on age.
People should be scared. This isn't over, and this idiotic preemptive celebration/busines reopening is going to render a lot of our sacrifices in vain.
Readit News
The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down? Or did people just die at home afraid to go to the hospital?
In SF in normal times, over 50% of trauma cases are from car accidents. My completely unscientific theory is that commuting/traffic is way more stressful and physically taxing than people think.
https://www.sfexaminer.com/news/half-of-injuries-treated-at-...
> The "excess deaths" surpassed COVID-19 fatalities in those states by a combined 4,563 people. Experts suspect that unconfirmed coronavirus cases could be responsible for some of those deaths, but it might also be related to a shift in other causes of death. For example, some doctors speculate people might be dying from illnesses from which they would normally recover because the pandemic has changed access to health care.
> “Our ER, as well as many others, are seeing far fewer patients because people are scared to come in.”
There are graphs.
This has added to a lot of the confusion and misinformation surrounding coronavirus response, since people are hearing that hospitals and ERs around the country are seeing fewer patients -- dramatically fewer, in some cases -- and conflating that with the coronavirus risk being unexpectedly low, which isn't true.
> The fallout from such fear has concerned U.S. doctors for weeks while they have tracked a worrying trend: As the pandemic took hold, the number of patients showing up at hospitals with serious cardiovascular emergencies such as strokes and heart attacks has shrunk dramatically.
> Across the U.S., doctors call the drop-off staggering, unlike anything they've seen. And they worry a new wave of patients is headed their way — people who have delayed care and will be sicker and more injured when they finally arrive in emergency rooms.
https://www.npr.org/sections/health-shots/2020/05/06/8504549...
It's at this point that the news media needs to look inwards and wonder if they made such a big hysteria over covid that they failed to point out that people should still go to the ER. I bet many of those who died at home had symptoms of heart attacks/strokes, etc, but didn't want to go out of a mistaken sense of magnanimity (I don't want to take the bed of a COVID patient) as well as a false sense that the hospitals were in any danger of being overloaded (they were not, given the steps we took).
They were overloaded in Wuhan, Milan, Madrid and Brussels, and came within a hair of capacity in Paris and New York. What "false sense" are you talking about, exactly? There was real risk. Are you saying that the media reported overloads that didn't exist?
Your argument seems a bit vague to me. You could just as easily argue, with perfectly symmetric evidence, that it's good that "the media" "gave a false sense" of hospital capacity, because it prevented an actual overload of the system. Why is your version better, except that in yours you get to have a more personally pleasing enemy?
Pretty much all criticism of "the media" is like this.
If you have pre-existing conditions, catching COVID is a lot more dangerous than if you don't.
Who typically goes to the hospital for medical treatment?
People with pre-existing conditions.
"I don't want to go to the ER, because I might catch COVID from another patient, or doctor" is a very justifiable fear.
This is just the consequence of the virus spreading to the community - not the consequence of mitigating the spread of the virus through the community.
Dead Comment
I've had massive downvotes for saying exactly what you suggested.
My favorite reply comment was, "He was joking." No, actually I wasn't.
But I expected that in advance.
Small detail about the navy ships: they are setup for battlefield injuries. The wards are all open (think what you see on old episodes of MASH) with little to no separation between patients. That is fine for traumatic injuries (earthquakes, fires, war etc) but less than useful for control of infectious disease. The plan was for them to take non-covid patients to relieve hospitals but it never really worked out. The risk of a ship becoming a hotspot should one covid infection slip through into an open ward was too great.
Military hospitals (including ship-based hospitals) have been planning and preparing to deal with biological warfare (i.e., communicable diseases) for many, many decades, and even before that they were well acquainted with communicable diseases. It was not uncommon in the past for communicable diseases to kill more soldiers than died in actual combat.
That is one reason the U.S. Public Health Service is a uniformed service -- so their personnel could operate in war zones without the risk of being shot as spies if they were captured.
besides the deaths-at-home, shouldn't it be considered that the low-impact low-energy lifestyle that is being promoted right now is less strenuous on the body in the short term?
I imagine that the lack of deaths, after deaths-at-home are cancelled from the number, is just seeing a lag time where the lack of physical effort reduces short-term deaths but increases long-term deaths due to lapse in fitness.
Probably yes. In the UK there is a significant surge in non covid related deaths above historical stats. Bear in mind also the definition of a covid 19 related death is, err, generous in the first place
https://www.spectator.co.uk/article/non-covid-deaths-are-als...
Here is something I found interesting:
Spain has a “hard lockdown” too. Their excess mortality has returned to a normal level according to momo: https://www.euromomo.eu/graphs-and-maps/
Now I realise that some people that would normally die are not (car accidents etc), but at the same time if the lockdown itself was causing significant mortality you wouldn’t expect the excess mortality to drop to normal levels, would you? You would expect a small offset from 0 unless the savings from car crashes are exactly the same compared to “lockdown deaths” - and if they are, and the lockdown is saving “extra” lives then is it not still worth it?
We have to wait and see for England to see if it falls back to normal or below normal levels.
“Imperial College London’s Neil Ferguson has said, as many of two-thirds of 'Covid deaths' would have happened anyway”
Would these deaths have happened in a massive spike? If not, then it isn’t anything like the same and if so, why?
https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
Today (a Friday, I am working on my front porch, and heard sirens about 4 times from 7AM-3PM). Typically, that number would be 5x that. It's been like that since mid-march.
In Australia, significant decreases in STEMI (serious heart attack presentations) although nothing published yet. Everyone wondering what’s going on - going to be some interesting studies coming out after this in terms of population health and additional/reduced morbidity and mortality
Sadly I think this is a partial answer. Working as a paramedic, for all the times I saw people saying “y’know, maybe I don’t really need to go to the ER”, there were also the people who really did need to but were too scared. Be it 90 year olds with severe lacerations or heart attacks, there was a fear that we had to manage and balance.
Dead Comment
The bad news: bureaucracy and mismanagement prevented hospitals who did need more space from using them.
The awful news: NY recommended people to stay home from the hospital even if they needed care, probably causing extra deaths and complications.
People without jobs had to get surgery now, before their CORBA ran out.
https://www.npr.org/sections/health-shots/2020/05/06/8504549...
This concerns me because my dad has congestive heart failure and can't get proper medical support right now.
What we should be doing is segregating hospitals, keeping some focused on COVID and others focused on non-COVID medical emergencies.
> ER admissions are down 50% or more depending in county.
But then spins it into some kind of conspiracy BS:
> ...missing people... ...swept under the COVID rug...
People did not magically recover from heart conditions during lockdown
Those people died, or skipped on critical treatment that would have made their condition improve.
One cannot help but wonder if those missing people are going to be swept under the COVID rug...
Meanwhile, field hospitals sit empty...
This isn't as significant as you might think... There is a large (very large in some communities) percentage of ER visits that aren't for real emergencies; rather, they are used for routine stuff, for which people with good insurance would go to their pediatrician or Urgent Care Clinic.
If you are broke, have crappy or no insurance, and can't afford a scrip of antibiotics, when your kid gets a fever or sore throat, you go to the ER. That's routine for -- I would bet -- hundreds of thousands of people throughout the year.
I feel sorry for the frontline workers in NYC, but I don't know how to reconcile knowledge that there were open covid-specific beds availible just down the road.
There is a somewhat similar situation in the UK, where hospitals are dealing with a lot of COVID patients, but the 'Nightingale' hospitals, our equivalent of these field hospitals, are mostly empty.
Something i have heard, but do not have a source for, is that the Nightingale hospitals were built on the assumption that COVID patients just needed a bed and a ventilator, but it turns out that COVID causes multiple organ failure, treating which needs a wider range of facilities, and can progress very quickly from respiratory symptoms to that, so they aren't actually much use.
Just to be clear, COVID-19 contributes to organ failure in very limited cases from a statistical sense. So this is absolutely something that is happening, but just wanted to be clear that we are not seeing hordes of people keeling over from strokes, organ failure, etc.
It's known that the complications that come into play when the body has entered a cytokine-storm type state are very far-reaching. For the same reason that inflammation is a critical part of the healing process, systemic inflammation can cause incredible damage to organs and other physiological systems.
I used to live in new england. No part of NY is further than a few hours drive from any other part of the state, especially during lockdown traffic. The Stony Brook facility was on Long Island, only a 60-mile drive from downtown NYC. An ambulance/bus in a hurry could easily make the drive in under an hour.
Many of these hospitals treated literally zero patients. Hospitals weren't overwealmed by people in care homes. They were overwealmed by people in the hospital. I don't see why some subset of those patients couldn't have been shipped to these field hospitals. NY was asking for volunteers to come from all over the country to relieve their struggling hospital system. But there were federal hospitals standing idle a short drive away? Why weren't they loading the not-yet-crititcal patients into busses and taking them to Stony Brook (capacity 1038, patients treated 0)?
1) New York was the area hardest it, it got hit initially, it has incredibly high concentration of people, and since it got hit early we had the least amount of information about the virus. Because of the small geographic area, high population density, and quick spike of infections you get a subset of hospitals strained for resources in that area, but not the whole nation. Similar to pulling a hose and it gets caught on something which makes it harder to pull, it isn't there isn't enough slack in the hose, it is that there isn't enough slack in the hose at one spot.
2) There has been a heavy politicization of the whole 'Rona situation and so different factions are either trying to downplay it, or exacerbate it to try and score political points.
3) Fear gets more clicks than, sunny day stories.
4) Pushing an over the top message of worry may convince people to be more cautious who otherwise wouldn't be. Like if you want a 3% raise, you don't go in and ask your boss for a 3% raise, ask him for 5% or 7% that way he can negotiate you down to a 3% and still feel like he won, and kept you for less than you wanted and you still get what you wanted.
5)There is an alternative possiblity. There is a grand conspiracy by either, the deep state, the Illuminati, the elite, the superwealthy, secret neo-Nazis, the Communists, the bicoastal liberal elite, the CIA, to kill people by the millions using COVID-19 and it turns out the conspiracy is really bad at it.
EDIT:
I also want to make clear I don't want to downplay the situation of various healthcare workers who have been heroically making sacrifice. I believe many of them are honestly expressing their opinion and are worried about PPE or other issues, and may have experienced it; however there are probably hundreds of thousands of people involved in the New York healthcare system, if only 1% of 100,000 people feel overwhelmed at some point and post a video, or send a tweet about it that is 1,000 stories, but may not represent a consensus view.
Maybe that video is fake, but I am wondering how many of these deaths might be due to malpractice.
Which is exactly what people said would happen if stay-home orders managed to flatten the curve.
I hate this all so much. I am honestly super depressed about how short-sighted many people I know are proving to be.
There's much we have yet to learn about this thing. We might not figure it out satisfactorily for years. Remember zika?
And it's certainly less severe among those infected than was predicted (at least per capita infections, if not overall). As long as people/ officials/ experts deny that, (or exclusively credit flattening the curve, or fail to admit how wrong they were, where appropriate) don't expect the public to take fear-based guidance from the same sources as credible.
For instance in the Bay Area, the SIP's argument was justified primarily from hospital capacity (https://www.sccgov.org/sites/covid19/Pages/order-health-offi...). It wasn't (as has since become) suppress the transmission rate until a test, trace, isolate system can be restored. [1]
Even on April 7, Santa Clara (https://www.mercurynews.com/2020/04/07/coronavirus-santa-cla...) was still projecting 2500-12000 cases by May 1. The higher end of that was highly unlikely even then (that would require cases growing faster than Seattle had been pre-SIP). In retrospect, even the best case scenario was also too pessimistic - at current rates Santa Clara won't hit 2500 until after May 21 -- double the time the "best case" had estimated.
Compare the communication to say Germany or New Zealand, where clear numbers, confidence metrics, range of possibilities, and objectives are outlined.
[1] Which actually has already happened. I'm not exactly sure what the goal is at this point - we have metrics but it's a bit unclear what they are based on (esp. the hard to reach testing numbers).
if we'd been more levelheaded, we would have suggested the public should either
1) physically distance, or
2) wear a mask
in enclosed spaces and face-to-face situations.
if you're an essential worker or particularly vulnerable, you'd do both where possible. that's it. that likely would have provided all the risk reduction we needed to get the spread under control.
the message would have been simple, the effects likely as good, and we wouldn't have left a hundred million poeple on the edge of (or in) economic and psychological collapse.
but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want.
Given our extreme response, the high death toll should be more shocking to people.
The problem is that the only experts we're listening to are doctors and epidemiologists, when we should also be listening to economists. Both sets of people should be in a room together hashing out policy through an adversarial process that charts a middle ground between two bad outcomes.
Flattening the curve to well below capacity at the expense of further suffocating the economy, just means that we're completing ignoring economic externalities that is going to take years or even more than a decade to fully recover from.
Dead Comment
If you trust the same kind of "Scientific Modeling" that create Hurricane Path Predictions. Notorious for being hysterically wrong.
Then sure... that's wonderfully "clear"...
If, instead, you look at "models" and "projections" as junk science that's easy to prove wrong by simply looking at any model and how horribly wrong it's been in the past?
Like... the COVID models have been horribly wrong so far...
Then no... it's not "incredibly clear"
Also curious why you think the US was so badly effected compared to say south korea or thailand?
Do you think it would be safe for everyone to go back to relative normal? What would your prediction of the effect be? What data would you trust to validate that prediction?
I'm asking out of genuine curiosity how someone who I'm assuming is well meaning can get to this position. I'm happy enough to be convinced if your prediction turns out correct as there will be plenty of different states that are going to do a variety of strategies.
Dead Comment
She worked covid19 ER shifts receiving walk in patients coughing like hell. That dried up a month ago and she had the choice to stay home or work night shifts on the floor medicating and caring exclusively for covid19 patience. So she did night shifts for two weeks. Now she is back on her regular position, underemployed.
She laughed about the field hospitals. Now, here in Michigan, we are all, including Nurses and hospitals, sitting around most of the day doing nothing and waiting for some miracle.
There was never a capacity issue she knows of. Only shortages of PPE.
Beaumont has their own stat sheet which is interesting: https://www.beaumont.org/health-wellness/coronavirus
To me it appears that the quarentine was effective? Look at the chart above - on March 21st the stay at home order went into effect in michigan. They peaked 2 weeks later at 1200 active cases in the hospital. Now its dropped back to the same amount as just before the stay at home order went into effect.
Underemployed seems like... a good position to be in right now, no?
The way this was executed was terrible. The whole point was that hospitals didn't get overloaded so people with critical needs can get treated. It's the absolute definition of irony that cancelling everything had the exact same effect.
Incubation periods and exponential growth mean by the time you see the influx, it's potentially already too late to avoid becoming overwhelmed.
Dead Comment
The plan was to help take on non-covid case load from primary hospitals in the region that they were deployed to.
THAT'S why these hospitals were all empty in the first place. It all comes back to what a shitshow testing is in this country.
In any large complex system, you can't necessarily predict the bottlenecks, but if you want the system to guarantee a high capacity to handle issues, you need to broadly overresrouce the initial layout (esp if the resources take time to line up). This means by definition - even a good plan will have idle resources somewhere.
Sociologists are learning a lot from this situation
I've been taking the social distancing stuff seriously, wearing a mask every time I go out, and have taken steps to get deliveries when I can to ensure I maximize the time at home.
The sky's not falling but I am a bit "scared" as you put it.
I'm scared. Not enough to be curled in a ball in the corner, but enough to be taking social distancing seriously. My wife has medical history that puts her at higher risk, plus she's in her 50s (and me in my 40s) so we're both at slightly higher risk just based on age.