All things political. Coronavirus Edition. (1 Viewer)

[Maxp]

I fear we are really going to be in a bad place due to the obvious cuts to the federal agencies that deal with infectious disease, but also the negative effect the Affordable Care act has had on non urban hospitals. Our front line defenses are ineffectual and our ability to treat the populous is probably at an all time low. Factor in the cost of healthcare and I can see our system crashing. What do you think about the politics of this virus?

 

[Dragon]

So, neither you or I know much about the Italian healthcare system, so let's put aside projections for a second and look at actual numbers...

According to the tracker that's being followed over at the EE, current serious or critical cases in all of Italy stand at 1328. I would think that is the number of people currently hospitalized for covid-19. If 1328 patients are going to throw a huge wrench on the healthcare system of a country with a population of 60 million, then I think there is something very wrong with that healthcare system.

Remember that population density and distances is also a factor when it comes to number of ICU beds. We are at the same level as Italy with a little more than 12,5 ICU beds/100K population. But every hospital with ICU beds in the country is reachable within 2 hours so we have previously not had need for more. Since crime, and especially gun related crime is not really a problem here, those patients rarely take up beds in ICU We also have wards that is not quite ICU but can accomodate more seriously ill people, but they don't have ventilators which is needed with this infection.

So what the government has done is more or less closed the country, to slow down the rate of infections. It hopefully leads to a more flat infection curve while simulaneously gaining valuable time to convert some of those in-between wards to provide ventilation services if need be.

 

[RobF]

On critical care beds, let's look at some real data, albeit from England.

https://www.england.nhs.uk/statisti...and-urgent-operations-cancelled-2019-20-data/

The most recent data is from January. It tell us, across England, there were 4,123 adult critical care beds. And 3,423 of them were occupied on the last Thursday of the reporting period. That's 83%, leaving just 700 free.

Italy and England have broadly similar populations. So you should be able to see that, yes, 1,328 extra patients absolutely can throw a huge wrench on a healthcare system. The need for critical care is, generally, rare. There aren't that many beds because they're not ordinarily needed. So there simply aren't thousands of extra critical care beds waiting around, especially during flu season. If you have a highly contagious virus that puts between 5 and 10% of the infected into intensive care, then as soon as you're getting into the tens of thousands of cases for a country the size of Italy or England, you're going to be hitting problems, localised first, then national if the problem isn't addressed.

There'd be more margin outside of flu season, but again, if the epidemic isn't sufficiently addressed, you're still going to run out of capacity.

As for Italy's situation, here's a very recent article from the Lancet addressing just that: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30627-9/fulltext - it's pretty informative. Here's an extract:

In Italy, we have approximately 5200 beds in intensive care units. Of those, as of March 11, 1028 are already devoted to patients with SARS-CoV-2 infection, and in the near future this number will progressively increase to the point that thousands of beds will soon be occupied by patients with COVID-19. Given that the mortality of patients who are critically ill with SARS-CoV-2 pneumonia is high and that the survival time of non-survivors is 1–2 weeks, the number of people infected in Italy will probably impose a major strain on critical care facilities in our hospitals, some of which do not have adequate resources or staff to deal with this emergency. In the Lombardy region, despite extraordinary efforts to restrict the movement of people at the expense of the Italian economy, we are dealing with an even greater fear—that the number of patients who present to the emergency room will become much greater than the system can cope with. The number of intensive care beds necessary to give the maximum number of patients the chance to be treated will reach several thousand, but the exact number is still a matter of discussion among experts. Health-care professionals have been working day and night since Feb 20, and in doing so around 20% (n=350) of them have become infected, and some have died. Lombardy is responding to the lack of beds for patients with COVID-19 by sending patients who need intensive care but are not infected with COVID-19 to hospitals outside of the region to contain the virus.​

 

[Lapaz]

Italy waited until 9 MAR to take nationwide efforts, but by that point, they already had over 9,000 cases. Now they have over 21,000 cases. They were obviously spreading it before the clamped down. It'll be interesting to see how well the clamp down controls the further spread. By contrast, China clamped down on 23 JAN when they only had 259 cases, yet their cases ballooned to over 80,000, which is a 32,000% increase. After about 6 weeks, they're new daily cases are so small as to not register on the Worldometer. The thing about China is that they've tested almost everyone, and their measures were draconian, not voluntary, so it's hard to say whether Italy and other countries will see similar results or even worse. If Italian cases were to grow similarly, they will have nearly 3,000,000 cases within a few weeks, but that's a lot better than the seasonal flu which would probably reach 20,000,000 cases, so the clamp down is warranted.

Similarly, we're sitting at about 2500 cases, so by clamping down now, if we assume we're not going to do better than China, then we can hope to keep the cases below 1,000,000. We have to quarantine to limit the spread, because we don't want this to spread like the seasonal flu, but the problem is I don't know what kinds of problem all of the quarantines will have on services. The best thing we have going for us is that the disease will probably spread more slowly as the weather warms-up.

 

[SystemShock]

ICU

So, just to clarify, I said if all were hospitalized, not necessarily in ICU.

 

[MT15]

The real problem is the ICU beds, though, not hospital beds. That’s what will be too scarce to cover the demand. People with the virus who get very ill often need ICU beds, due to the characteristics of the type of pneumonia caused. They need ventilators, and ICU beds, and there aren’t enough of them to cover the need, as projected.

 

[JimEverett]

Italy waited until 9 MAR to take nationwide efforts, but by that point, they already had over 9,000 cases. Now they have over 21,000 cases. They were obviously spreading it before the clamped down. It'll be interesting to see how well the clamp down controls the further spread. By contrast, China clamped down on 23 JAN when they only had 259 cases, yet their cases ballooned to over 80,000, which is a 32,000% increase. After about 6 weeks, they're new daily cases are so small as to not register on the Worldometer. The thing about China is that they've tested almost everyone, and their measures were draconian, not voluntary, so it's hard to say whether Italy and other countries will see similar results or even worse. If Italian cases were to grow similarly, they will have nearly 3,000,000 cases within a few weeks, but that's a lot better than the seasonal flu which would probably reach 20,000,000 cases, so the clamp down is warranted.

Similarly, we're sitting at about 2500 cases, so by clamping down now, if we assume we're not going to do better than China, then we can hope to keep the cases below 1,000,000. We have to quarantine to limit the spread, because we don't want this to spread like the seasonal flu, but the problem is I don't know what kinds of problem all of the quarantines will have on services. The best thing we have going for us is that the disease will probably spread more slowly as the weather warms-up.

As an aside - what source do you use for the numbers? For example, you are saying Italy has 21,000 cases. Your numbers always seem a day or so ahead of the numbers I get from Johns Hopkins so I would rather use your source.

 

[insidejob]

I guess they are going to lose their forking mind, because there is a comparison to be made.

The viruses spread in similar fashion.
The spread of the viruses can be prevented in similar fashion.
The viruses present similar symptoms.
Both viruses attack the respiratory system
The viruses create similar conditions (pneumonia).
The high risk groups (respiratory, heart issues) that are susceptible to one would be susceptible to the other as well.

Yeah, because half of the world shuts down every flu season.

 

[V Chip]

I'm still in shock that Americans will be able to be treated for this free of charge.

Guess it took stocks tanking to get the attention of Republicans to the joke that is American health care

No, no, no -- Trump said that in his address to the nation, but in a complete shock, it turns out to not be true.

 

[Lapaz]

As an aside - what source do you use for the numbers? For example, you are saying Italy has 21,000 cases. Your numbers always seem a day or so ahead of the numbers I get from Johns Hopkins so I would rather use your source.

Here you go https://www.worldometers.info/coronavirus/country/italy/

 

[superchuck500]

 

[superchuck500]

Here you go https://www.worldometers.info/coronavirus/country/italy/

I have been using this one as well. At first, BNO was the best combination of speed and sourced accuracy - but worldometer’s site eclipsed BNO when the news outside of Asia became dominant.

Worldometer uses GMT for daily totals so it is standardized. New numbers are sourced and the news feed is actually attempted at being organized.

The Johns Hopkins site has always been behind on numbers because I don’t think it’s set up for immediacy - it’s more about quality/accuracy, but I think the margin for error at worldometers is pretty low, and it is managed for more timely dissemination.

 

[superchuck500]

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[wardorican]

A quick look at the CDC website shows that the CDC itself compares this to the flu: https://www.cdc.gov/coronavirus/2019-ncov/summary.html

You should consider taking a slightly slower look.

All I see is them discussing their preparation for deadlier flu pandemics as being useful for how they go about their investigations and containment efforts. They used the Spanish flu as an example.

There is nothing being stated that actual compares the virus to the flu. It only discuses that they can use those approaches and lessons for combating this virus, because it is respiratory in nature.

To further the point (bad idea?), the doctor is likely just upset at the people saying "it's just the flu, why are we closing", etc etc. I think that's the lens you need to view this with. Not that it is or isn't devoid of similarities.

 

[wardorican]

We can't agree on what to call it and we can't even agree on what we can compare it too. Strange times.
On a side, I found it interesting that the Spanish flu, are we allowed to call it that?, killed an unusual amount of young adults.

A third of the population caught it (without air travel), and about 5-10 percent of them died. That's about 3% of the world population.

I wonder if the young were so affected because soldiers and sailors were the only ones in close proximity to catch it. Probably not the best medical care for those at war.

 

[not2rich]

Completely infuriating.

And the ramping up of testing we've been promised on Friday? Any indication as to when THAT'S actually going to happen?

I'm 99% sure at this point that the delays in widespread testing are intentional, in order to keep the numbers down and HOPE that the epidemic coming isn't catastrophically bad.

My wife works in health care, and had a previously healthy patient die on Friday. She's pretty sure it was Coronavirus related based on the symptoms the patient reported, but it won't go down as a statistic because no testing was done before death.

 

[Heathen]

Up to 15 people here with the virus in SLC, 19 in the state.

My luck usually sucks with this sort of thing as im a social butterfly but trying to stay in as much as i can and resist the urge to go out with friends. Bleh

 

[Heathen]

Its also hard to believe were about to have a bunch of primaries with a pandemic in full swing.

What could go wrong?

 

[JRad]

Its also hard to believe were about to have a bunch of primaries with a pandemic in full swing.

What could go wrong?

Not that Louisiana’s democratic primary actually matters (I’ll take a shot at the EC any chance I get), but moving the elections back was a good move. I’m curious if other states will start to follow suit. I did hear (NPR pods) other states are pushing hard for people to use mail/absentee ballots.

Times like these really make me wish we had an “infallible” remote voting method.