Comment by skmurphy | Hacker News Reader

Comment by skmurphy | Hacker News Reader

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Here are two reports that would indicate that the standard of care has been substantially reduced

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-h... "Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air."

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https://www.euronews.com/2020/03/12/coronavirus-italy-doctor... "Another nurse working in Lombardy, the Italian region the worst hit by COVID-19, told Euronews the situation was "dire" and far worse than it is being portrayed in the media.

Speaking to Euronews on the condition of anonymity, she said: "We have hundreds of cases in our hospital. Half of our operating block has been dedicated to COVID-19 patients. The situation is dire. Anesthetists – despite them playing it down a little bit on the media – have to choose who they attach to the machine for ventilation, and who they won’t attach to the machines"

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A first person report from Seattle ICU doctor https://www.facebook.com/marie.e.will/posts/1016307125424515... "Remdesivir might work, some hosps have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, pts improve much more rapidly than expected in usual ARDS. Recommended course is 10d, but due to scarcity all hosps have stopped it when pt clinically out of the woods - none have continued >5d.

I decode this as they have half the amount of Remdesivir they need, only treating for 5 days when recommended course is 10.

The other thing that appears to be going on, and it's also hinted at in report from Seattle, is that old patients are being moved to hospice or "comfort care" who would not have been three months ago because of lack of supplies/personnel/equipment.

Going through your links:

#1 provides no numbers and no details beyond a claim that "They lack machines to ventilate all those gasping for air."

#2 does not even go that far: it speaks of "a huge turnover issue and leaving hospitals at near capacity" (near, not above, contradicting #1)

#3 is from an intensivist in Seattle, Washington, not from Italy.

I chose the Washington Post link because it provides numbers: "Lombardy has just 737 intensive-care beds available for coronavirus patients. More than 600 are filled. [...] The region is racing to bring more beds online; it added 127 on Thursday."

(Lombardy is the region with most cases.)

This is consistent with the claim in your link #2 that hospitals are near capacity (and not above it, as suggested by your link #1).

The point of all this pedantry is simply that I don't think saturation can be invoked yet to explain the high Italian mortality rate.

Addition:

Here's a slightly older Italian source (March 11) which puts nation-wide ICU capacity in Italy at 5090, with 887 in use:

https://www.linkiesta.it/it/article/2020/03/11/italia-corona...

#3 was to show what can happen in one hospital. These patients are hard to transfer. Lombardy is about 9200 sq mi. (about 100 miles square). If you need a ventilator you may not be able to withstand a 50 mile ambulance ride. But I concede I cannot offer conclusive proof that Italy is out of ventilators.

Lombardy started transferring intensive care patients to other regions a week ago:

https://ilmanifesto.it/lombardia-paziente-trasferiti-fuori-r...

from the translation it does not appear they are moving Covid-19 patients: "For the first time, Lombard hospitals have had to resort to the Remote Health Relief Operations Center (CROSS), which intervenes when a region is no longer able to cope with the number of patients and must seek help from other regions. The Civil Protection has ordered that a number of ICU patients in Lombardy for other diseases be transferred to hospitals in neighboring regions."

Note this is first time it's been triggered which indicates it's a difficult and risky process.

Article also notes "The people in charge of intensive care in Lombardy have sent a dramatic appeal to Governor Attilio Fontana: "Healthcare facilities are under greater pressure than any possibility of adequate response", the doctors write. "Despite the enormous commitment of all healthcare personnel and the deployment of all available tools, correct management of the phenomenon is now impossible."

This sounds like a system that's out of ICU beds.

see also https://jamanetwork.com/journals/jama/fullarticle/2763188 "As of March 8, critically ill patients (initially COVID-19–negative patients) have been transferred to receptive ICUs outside the region via a national coordinating emergency office."

> Speaking to Euronews on the condition of anonymity

This should imply heavy fines. Creating panic while covered by anonymity is very easy and it brings no value to society. If officials later on try to bring real numbers nobody listens.

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