U.S. field hospitals stand down, most without treating any Covid-19 patients
npr.org
npr.org
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.
Not quite true, NYC was over stressed and there is at least one mass grave and are still corpses in refrigerator trucks.
Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer.
One can't extrapolate from the success of social distancing to imply that _not_ doing social distance would be less harmful.
>The results of our original experiment turned out to be different than our expectations
To the contrary, the proposed solution worked as expected. The social distancing combined with state-level quick action reduced the severity of the predicted disaster. In addition, people who would normally go to the ER "just in case" did not for fear of contagion. Or because they lost medical insurance. Or because visiting a GP became difficult and so there were fewer referrals. All reducing strain on hospital resources.
Certainly, The predictions of what would happen without out social distancing still stand as the data behind it is unchanged. And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors.
Since Sweden dropped from the narrative when it showed serious differences from its neighbors, it hints that criticism of social distancing is either (justifiably) emotional or (unjustifiably) politically. If it were from an honest appraisal by epidemiologists or economist, there would concrete counter projections and remedies rather than imprecise claims about it's success and ambiguous calls as to what a new policy should be.
It is horrible that the US death total exceeds the Vietnam war and that there is serious economic hardship. That is the terrible truth for natural disasters when no plans are in place (let alone actual preparation) and the response is slow. I hope the lesson from this disaster is that we are prepared next time rather than convincing ourselves nothing serious happened.
The Vietnam war had such an impact because the US military went on such an insane spree of war crimes and civilian massacres that America permanently lost its standing as a moral authority gained in WW2. Two million Vietnamese civilians paid the ultimate price for America's geopolitical theorizing, and the disaster was prolonged for an entire decade because the country was too proud to admit it was in over its head. McNamara and then Nixon knew the war was unwinnable, but the US could not appear defeated. And so the atrocities continued. Many in the US realized all of this and became permanently disillusioned with their country.
Apologies for the off-topic rant but this comparison has been making its way through a lot of circles that really should know better. If you find yourself wishing you knew more about this topic, I recommend the Ken Burns documentary The Vietnam War or the book Kill Everything that Moves.
And, remember disease models did not just predict unmitigated spread. They absolutely incorporated percentages of social distancing into their models. The original imperial college study predicted that a high income county with around 50% social contact reduction would still exceed hospital capacity by 700%.
Cuomo's New York model that predicted 30,000 additional ventilators absolutely incorporated lockdown measures, if they didn't they have some serious explaining to do.
Of course I still agree a lockdown was needed, and agree the lockdown did about as well as it could. But is there any reason to not revisit data and determine if we could do better?
[0] https://www.newsweek.com/new-york-coronavirus-hospitalizatio... [1] https://www.usatoday.com/story/news/2020/04/13/coronavirus-p... [2] https://www.realclearpolitics.com/video/2020/04/14/dfc_ceo_t...
You mean Hart Island, which has been used as a mass grave / “potter’s field” for more than a century and already contained over a million deceased?
Certainly New York was hit especially hard, but it’s sensationalist to refer to “mass graves” when it’s in fact a routine thing.
-- NYC has maybe peaked but the rest of the country is still rising.
NYTimes: "“If you just look at the total number of cases, you’re going to miss what’s underneath it,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It’s not a leveling-off. It’s a painful handoff.”"
https://www.nytimes.com/interactive/2020/05/06/opinion/coron...
Not only that, but as a percentage of population, Sweden's fatality rate is far ahead of that of the USA, and still climbing at a faster rate than America:
https://boogheta.github.io/coronavirus-countries/#deceased&r...
This is inaccurate (at least in implication): this mass grave has been around and in use for 150 years. It's being used more heavily, obviously, but then that's no different than saying "more people than normal are dying in NYC"
I don't know how you can say 'lower than expected'. Many interventions were non-medical, depending on social behaviour (e.g. adhering to social distancing), effectiveness of governance and enforcement, as well as economic and political (e.g. supply of test kits, ventilators). And even then, we were dealing with a new virus, there was limited data about all kinds of variables. For example, if people are intubated twice as long in the US due to high levels of obesity compared to China, you need twice as much ventilator capacity.
Point being, we always had to deal with a very wide confidence interval.
Now combine that with the fact we're looking to predict an exponential number, rather than something linear, and you can get wildly different outcomes. In New York the doubling time began around 2 days. That meant the difference between hospitalising 50k or 100k was a matter of starting social distancing two days later. The difference between 50k and say 1.6 million, was just 10 days. Hospital resources can't expand that fast, at best you can add 30% extra beds and shift all bed-use to dealing with corona with emergency interventions, but you can't just scale 3000%.
That's where the field hospitals came in. Not because it was guaranteed or fully expected to need them, but because there was a good chance, and there was too little information to conclude they wouldn't be necessary.
What will happen as we try to return to normal yet another situation.
> 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).
It was always a loss-making enterprise, even with centralized distribution.
24 hour news cycles and internet competition isn't a good recipe for in-depth, long-pursuit journalism.
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.
Um... Cuomo said he needed 40k new ventilators to make sure hospitals had all they needed after he instituted a shelter in place order. He needed nowhere near that amount. That is hysteria. I don't understand why this is controversial.
The fact that we were being told to expect Italy/New York levels of hospital overruns ALL OVER the country (hint: field hospitals that hardly got used weren't just deployed in NYC)? And that we're still being told that hospitals ALL OVER the country are in danger of being brought to their knees by re-opening state economies right now? Meanwhile, the nurses that aren't furloughed are making nightly dance videos during their shifts.
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.
The mortality risk of undetected/unaddressed heart problems, etc, far supercedes the risk from COVID-19. You could find some limited examples where that's not true but it is overwhelmingly the case.
It is becoming increasingly clear that the level of panic associated with COVID-19 is absolutely divorced from the ground truths.
But it doesn't just affect non-COVID-19 mortality. It may be that our response is even making COVID-19 mortality worse in some cases:
From https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=rec...):
"Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic." (My note: So the irony here is incredible, these weren't just non-COVID-19 patients afraid to come in but _people who actually had life-threatening COVID-19_.)
And from https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...:
"Third, the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population."
and
"Finally, many people with mental health disorders attend regular outpatient visits for evaluations and prescriptions. However, nationwide regulations on travel and quarantine have resulted in these regular visits becoming more difficult and impractical to attend."
Instead, people had to make do with partial information and many people -- believing incorrectly that their local hospitals were overwhelmed and needed them to stay home -- chose to do so.
And have you ever watched local television news? Millions of Americans do every night. It's the worst of the worst, and their over-the-top tactics are a well worn joke. "Is your refrigerator going to kill you and your children? Tune in at eleven to find out, only on FUTV News".
In my eyes that define is hysteria.
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.
I also remember the take downs of the various antibody studies all pointing to infection being much more widespread than originally thought. As if it was bad news the IFR was going down.
I lack the intelligence to connect the dots but I sincerely feel there's a large bias, if not outright agenda, here to advise prolonging and deepening the economic destruction.
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.
1) Hospitals generally get paid (by someone) for treating patients. So they want to run at 100% capacity, even with covid patients.
2) You can't really just "build an ICU." You can stand up a field hospital that's able to provide similar, degraded services. But it's not going to be the same.
Imagine if someone said "set up a datacenter in a field," and then a customer had a choice to colo their server in a purpose-built DC or your field DC. Which do you think they'd pick?
3) The units that staffed these facilities were heavily augmented by military reserves.
Corpsmen may have non-medical civilian jobs, but what do you think military reserve critical care nurses and doctors do for a living?
If these field hospitals were packed to the brim, all of those people would be locked in place. Possibly while they were needed in their civilian positions, in their home cities (although the military seems to have done a pretty good job about preferentially pulling non-Covid-civilian personnel).
4) Exponential growth with unknown but high R_t. +1 week before we locked down would have looked very different.
... all of that to essentially say that these facilities were designed as surge capacity, in the event they were needed. We intentionally filled up hospitals first.
USD$660M seems like a reasonable price to pay, strictly as insurance, given the very real risk that hospitals would have been overfilled and covid-related mortality would have spiked due to lack of care.
At least some of the reason it didn't treat many patients is that they made it hard to become a patient.
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.
That's probably inaccurate. I've been following MOMO's graphs, and the yellow-band portions (most recent weeks) grossly underreport and are subject to upward correction. Data points get larger and larger as they age. For example, "Spain Week 11" was pretty small when first reported (in week 12?), was larger the next week, and larger still a week later.
“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?
About half of Covid deaths are in nursing homes. The median lifespan after entering a nursing home is 5 months, and the mean is 13 months.
Coronavirus is very infectious, so if it enters a nursing home, it could easily spread and wipe out everyone who was on the brink of dearth, or on a fragile state.
And the data is only through April 1. I suspect the excess death rates will be higher nationwide from April 1-May 1.
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.
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.
So yes, we definitely cut down transmission, but it's not clear that we would have incurred excess deaths due to capacity overrun. The biggest botteleneck is the presence of people on invasive ventilation; other clinical outcomes result in either the individual dying quite quickly (imagine a nursing home patient with multiple comorbidities), or in the patient recovering in 1-2 weeks. But there's that uncanny valley of people healthy enough to not immediately die but in bad enough shape that they need these aggressive interventions.
This is a big part of why I think we could have exposed much more people to the virus with only marginal increase in hospitalizations, by encouraging those who are not at risk to live as normally. It also makes it easier to centralize the resources where you do need it. For example it's much more feasible for government programs to handle food delivery, grocery delivery, and all these other logistical concerns when you only need to provide it for 10-40% of the country as opposed to 80% of it.
Serology in NY has shown us that we have maybe 1/8 of the population with antibodies as of a few weeks ago, which does mean that there was room for another doubling or too before transmission started naturally slowing down to a noticeable extent. So we absolutely could have had a lot more patient volume, but again the # of hospitalizations/invasive ventilation cases is much more related to the # of vulnerable people infected as opposed to the number overall.
(The classic argument here is that by fighting transmission in all members of the population, that the at-risk are better protected. For a number of reasons I think such an approach is misguided but I won't go into the full argument against that here)
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 think the effect you're describing does exist, but its certainly not the whole story. The fact is as well there's PLENTY of actual data available on this so we need not even be extrapolating based on our assumptions. The problem is any data that doesn't line up with our assumptions gets discarded because we don't know which datasets are good and reliable.
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.
But, here's one group of case reports that is commonly held up as evidence of the supposed strokes in young people / widespread organ failure / etc:
"Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young" - https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=rec...
EDIT: Oh, or were you referring to sources around the impacts of systemic inflammation? I can certainly provide those if you're interested.
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.
What? Buffalo to NY is 6 hours.
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)?
Meaningless admission/overadmission rates which are clearly vastly wrong/misinterpreted and in turn based on a huge percentage of over 75s being hospitalised and a majority of them in turn needing ventilation.
Except in reality patients of that age are rarely ventilated because they wouldn't survive such an invasive treatment and if they are the recovery is 6-8 months and long and painful and has poor recovery outcomes. That predicate was wrong in the paper.
Secondly the field hospitals built could only receive patients who had no other underlying or exacerbating conditions because the FHs lack the staff and equipment to care for them. Given that practically every person who died from a respiratory covid infection had such issues it rendered them fairly pointless.
The paper also didn't do much to deal with the fact this activity will cause a surge in deaths of non covid related fatalities. Whole other issue
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.
As of today the USA has 75,000+ dead and counting. That is pretty fucking bad.
No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago. Yet very few seem willing to admit that, because (I'm guessing) they think it might mean losing some amount of fear based leverage or control. Or don't want to give people false confidence to disregard rules. Or whatever the motivation.
And the public in general is perceptive of that, especially the ones less inclined to blindly trust government.
When the original concern was overcrowding hospitals, and the new risk is ERs closing or laying off staff from under-use, the nature and magnitude of the healthcare infrastructure risk has completely changed.
Which means either:
1) we were wrong and it isn't as bad as we thought, or
2) that we've been so successful in flattening the curve (and scaring people from going out, including to the hospital for critical treatment), that we've overshot our goal to the point of doing more damage than good. And that's strictly looking at healthcare, before even taking into account economic considerations beyond the hospitals being able to stay open.
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).
Compare that to diseases like Ebola, which we typically clamp down hard and fast on.
I'm now very mildly asthmatic and had pneumonia and bronchitis often as a child. I know what not breathing, and chronicly not having a strong respiratory system can be like and most people don't. I think that really factors into why people aren't taking it as seriously, going out whatever.
Contrast that with the fact I basically haven't left my Brooklyn apartment in 8 or 9 weeks even though my asthma and breathing issues largely subsided years ago and I would be considered less than mildly asthmatic now, I imagine other people with my profile are acting similarly.
Plus anecdotally I'm in NYC and since the stay at home order reached full strength the 3 day rolling average of infections has been decreasing. I can only see that being attributed to two things -- mask wearing and stay at home. Mask wearing came later in our lockdown so I'm going to say stay at home has been effective especially with what I've seen the infection number for COVID, I believe that's the R0 (Rt?) number, was something like 2.5 to much higher.
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.
Every discussion involving advertising or app marketing here inevitably attracts tons of comments adopting a let's-be-real-here, this-is-just-how-it-is tone about the realities of the industry. And yet these same people are also experts on the news industry and know the exact opposite is true there, that "de-politicized" or "balanced" news is somehow a thing that is not only possible but stupidly trivial to produce.
I mean, I get it, I utterly despise crabbed, shoddy, stupid journalism, too. But don't pretend there's some trivial fix. It is the way it is because of a combination of economic and ultimately social pressures. It is as much a symptom as a cause.
but as individuals, we each have the capacity to center ourselves emotionally, clear our heads, and think critically about the coercive messages we're being fed. we have that power, and it is effective.
I generally hate the phrase "check your privilege", but in this case it fits perfectly.
regarding trump, luckily our governmental structures are designed to withstand such incompetence. i'm more concerned that the legislative process is torching money in the wrong places.
Given our extreme response, the high death toll should be more shocking to people.
Then the math gets really ugly. If herd immunity requires north of 60% to have been infected, that means 197M Americans. Of those 197M, roughly 5% will require hospitalization, and 1% will die. That equates to 10M hospitalizations and 1.9M deaths. Even being generous and lowering the IFR to .1%, means 190K deaths. Now this make be spread out over the next 7 months, but the butcher's bill will be paid. Hopefully we'll get a vaccine by then, or some therapeutic drugs, but I'm not optimistic.
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.
Maybe we can listen to economists coming out of this too then; On things like
- Healthcare attached to employment
- UBI
- Sick Leave
- Servers wages
- Gig Economy
- Taxation and Austerity
We would have been better off economically if we had listened to much of the general consensus before.
For most of the things you specifically mentioned, there's not much consensus today.
So off by an inch now potentially means being off by miles later on. If the doubling period wasn't lengthened enough, a hospital at 50% capacity will be in serious trouble very soon.
Basically every economist is acknowledging that you can't get the economy back to normal until the health crisis is under control. You can lift the ban on people going to movie theaters and restaurants if you want, but no one is actually going to do it if they don't feel safe doing so. Example: air travel is down 95+% even though there are no laws against flying places.
not a great example. people don't just fly for fun; they are going somewhere to do something. you're not allowed to do most of the stuff that you would travel for in the first place.
The fact that the rhetoric started with one and ended with the other makes the whole process feel dishonest.
All three are very different scenarios that require different strategies and where we should have very different expectations for what is and is not achievable.
People are praising countries like New Zealand, but what's their endgame? Be in a situation where their citizens can't even safely travel from their country until global herd immunity is achieved because every vacation or business trip is a chance to end up being sick far from home?
This isn't going away just like the seasonal flu and common cold are not ever going to go away.
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.
"do you think it would be safe" With the data thats coming out? Yes. Absolutely. COVID is turning out to only be a little more dangerous than the Flu and "lockdowns" are not slowing or stopping the spread of the virus.
"How can someone get to this position"
Honestly... January WHO was saying COVID didn't pass person to person and models were predicting 2.2 million dead in the US alone.
I'm not making a prediction... I'm casting aspersions on the "predictions" that have been used to feed opinions like "do you think it would be safe?" as if we are all going to die - 99.5% of those who get it survive. Worse than the flu but not worth shutting everything down (which hasn't stopped it at all - look at New York).
Personally I know we can protect those who need extra protections (Old, ill, etc) without unproven shutdowns based on faulty models fed with bad data.
Why do I feel this way? Because I know that hurricane predictions are "Scientific models" and are wrong just like "market predictions" and all other forms of prediction based models based on past data.
But I've seen higher death rates in public threads as a common theme.
https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate...
"In Italy, the death rate stands at about 13 percent, and in the United States, around 4.3 percent, according to the latest figures on known cases and deaths. Even in South Korea, where widespread testing helped contain the outbreak, 2 percent of people who tested positive for the virus have died, recent data shows."
Granted... those death rates are "known" cases which gets cut when you add no/low symptoms to the "unknown infected".
We are still gathering data and the numbers vary greatly depending on country and testing methods.
Which is my biggest point... it goes from 4%+ down to .5% or lower depending on how you spin the numbers.
Hard to take "projections" seriously with THAT much unknown data.
edit: For the 2.2 million dead projection:
https://www.factcheck.org/2020/03/trump-and-the-coronavirus-...
"The CDC modeled four scenarios and estimated that 200,000 to 1.7 million U.S. residents could die, the Times reported."
"Think of the number: 2.2 — potentially 2.2 million people if we did nothing. If we didn’t do the distancing, if we didn’t do all of the things that we’re doing." -Trump
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?
Underemployed hospitals means a lot of procedures are not happening right now. Lots of chemo and similar things. Those will be facing long waiting lists once the state opens back up. If you even get those patients to come back in the next months. I think the risks are somewhat distorted. If you are skipping chemo because you are scared of Covid19, you may be missing something. And yes, chemo was deemed not essential as far as I can tell. I think they call those excess deaths, and it's very hard to say how those will shape up.
From a resident perspective, I see a flat curve with plenty of capacity, even of ventilators, and still a closed up state. But that's getting us into politics. The governor is following a timeline of opening up to normal maybe within 4-6 month. As long as sections are closed up, you need to sustain comfortable unemployment benefits to keep people even halfway in line to play along. Soon the money for that will run dry. It seems like she can extend stay-at-home orders without democratic agreement, but once the money runs dry, she cannot make a budget by herself. So things will get ugly eventually.
Not for the 10s of millions of families currently in hardship because the parent(s) lost their job.
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.
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.
I also agree with you that its probably a lot more prevalent. We already know that its possible to have no symptoms. But that doesn't take away that for many people it is actually a horrible virus that has killed huge amounts of people and we have no idea how prevalent it actually is because we can't do community testing yet. If you're wrong many more people die.
$690m is bargain for putting a ceiling on the situations these would have been necessary for.
When the economy reopens and people go back to work we will see a second wave of infections.
Unless you think that we can continue dealing with a 20% unemployment rate.
Social distancing will get us to less than R1, but then once we open back up it looks like it will grow past R1. It is going to be here until we get a vaccine or herd immunity.
Yes, most likely it will not get burnt out in the US until we have vaccine, herd immunity or the 3rd option, which is coalition/state/county level containment.
My comment reflected on the subject of these emergency field hospitals. Its A) not efficient to keep these up for the time being B) its unlikely we will be caught underestimating the virus the 2nd/3rd/xth time around.
And something else to just reiterate. There are multiple steps between "keeping the field hospitals operational" and "shutting them down". Just like there are multiple steps between "social distancing" and "opening back up". :)
I only hope the political systems will allow a serious retrospective of the measures and learning from that. I am very afraid that the partisans and conspiracy theorists will take over soon and no rational decisions for the future will be made so we will stay unprepared for the next pandemic.
I don't want to diminish the efforts of the people that built these sites and stood ready to treat patients. That's heroic. My skepticism is aimed at the bosses.
[1] (70% infected to get herd immunity * 0.5% fatality rate * 330 million people = >1 million people).
What does it mean for an intake process to be complicated? Isn’t it straight forward like loading the patient + printouts of medical records into an ambulance, driving to the new place, and then transferring them into a bed?
Next up, I hope we don't end up needing these field hospitals because of states re-opening things too soon.
We didn't flatten the curve enough to make these hospitals useless. We simply didn't use them despite needing them.
Instead, it might imply hospitals were dealing with increased load, perhaps needing more beds than they had but not so much of an increased load to justify implementing and following a plan to use these facilities.
Field hospitals were never designed to handle covid patients in the first place.
We don't know that, as weird as that sounds. We have no idea if there's significant or lasting immunity from having it, whether it's seasonal like the flu, or what the longterm behavior of the virus and it's likelihood to evolve is.
Which makes having longterm plans very difficult because we don't know what we should be planning for.
We also don't know how lockdowns caused it to evolve.
https://twitter.com/Kingfreespeech/status/125862859092672921...
This is false. Tends of thousands of people died and many more suffered unnecessarily because the federal government refused to take timely action. We did as well as we did for as long as we did through heroic efforts by state governments, local governments, and NGOs.
To claim that we were somehow prepared and executed on a preparedness plan is at best a dangerous misreading of the events, and at worst outright political propaganda.
Which is what you're doing right now with that comment.
Edit: also my statements are factual as far as I can tell. We had since January to prepare, and instead our leaders -- political party aside -- decided to fuck around and play misinformation games with the public instead.
Also, the Imperial College paper was one of the more extreme models. It is the one that supposedly scared the White House and lots of states into action. In this way, it was not a best case estimate, but was self-selected to be an outlier.
It's great to hear they weren't used heavily. It was great that they were set up too.
Instead we should see this as really positive: we were working to make sure that if stay-at-home (which has cost far more than $600M) didn't work we would have space to treat people, and then we kept the infections low enough that we didn't need to use it.
> They praised the Army Corps for quickly providing thousands of extra beds, but experts said there wasn't enough planning to make sure these field hospitals could be put to use once they were finished.
>The Army Corps limited the competition in awarding the projects to speed the process, which usually takes six to nine months, according to agency documents. Officials noted they were able to complete the contract award for the Stony Brook project in a "little more than three days."
>The two Long Island field hospitals were completed in late April. They never opened to the public and didn't treat any patients.
>The plan was for the Javits Center to take patients from overwhelmed hospitals in the city. But in practice it wasn't that easy. Some hospitals complained that the intake process was too complicated. And they sent few patients to Javits — even as they resorted to treating patients in the hallways.
Seemingly like all of the US coronavirus reactions we dragged our feet at multiple points, had no reliable central coordination, and large sums of money was made against the backdrop of human suffering.
Not really. It just does the usual cowardly trick of complaining about something by selectively citing cherry-picked experts. Rather than this quote salad I'd very much prefer honest, direct criticism where the outlet or the authors make it clear what is their stance and why.
That is the responsible thing to do. It wouldn't present opinion as news (as is the case with this article) and it would give a better opportunity for people to respond to criticism.
I agree with you, this article is not that. If you listen to any economist, healthcare provider, or logistics expert, they will all tell you that this was the prudent choice given the worst-case tail scenario, and that this resource is one that has continuing value for some time.
But this article takes all that information and manages to paint that information in a negative light. It is "an opinion of the author" piece that even manages to express the opposite opinion FROM the expert opinions it reports.
That's just the headline, and the people who write the articles famously don't write the headlines, but still, the headline is a bad headline.
The motivating event is that we're starting to decommission these facilities, but the author instead chooses to emphasize how much they cost and how few patients were treated.
Also, in the big picture this cost is trivial. 660m is less than $2 per person. Compare that to the 3T bailout or so (numbers change so quickly I can't keep up), which is around $10,000 per person.
>we kept the infections low enough that we didn't need to use it.
The article specifically said the hospitals were needed despite being unused. The problem was existing hospitals didn't have policies in place to use them, so instead doctors were treating patients in overrun hallways while these beds lay empty.
For the first go-around, with minimal available data, that seems like the much better way to err - it would've been very, very difficult to fix a mistake in the other direction. We've got more data now, and can do a better job of toeing the line with upcoming waves.
It's not like we can't unflatten the curve if we really want to.
All my life I have had this weird thought: If someday aliens will come down and tell us to move some random huge mountain 10 miles to the left, in one month (it doesn't have to look the same). If we can't do it they will wipe us out. I wonder if we would be able to pull together and somehow do it. And then my mind thinks through all the crazy iterations of ways to start trying. I keep thinking that we will globally waste 2 weeks planning it.
I guess not everyone is threatened by death in Covid, but it does seem amazing some of the things we have been able to pull together during this.
We prepared for a worst case scenario for a developing situation we knew very little about, and ended up not needing it. This should be viewed as a good thing.
EDIT: let me make it clear what I'm saying/implying. Saying stuff about opportunity cost means that you think that this wasn't necessary. Given the fears of overrunning hospitals, I can't see anyone being able to justify not doing this except in hindsight.
Policy makers should adopt some of the modeling tricks from Wall St. and Silicon Valley. Manage risk. Assess sure things and long shots, feed in the parameters, then allocate resources appropriately.
We need better financial instruments, novel forms of insurance, put a price on resilience, to counterbalance the drive towards lean efficiency. So that key suppliers can maintain capacity without assuming all of the risk, for instance.
With flattening the curve I suspect we'd want to keep the field hospitals due to the lag time in knowing the actual infection and hospitalization rates.
Edit: you can see from several posts here that building these things really did bring a lot of emotional comfort to people, which is an important part of dealing with a crisis. People really underestimate psychology in an emergency.
The primary theme of this pandemic is that we don't know almost anything about what is happening or what is going to happen. The list of wrong predictions can and has filled thousands of column inches and hours of briefings.
We expanded our healthcare capacity because of Italy and the humanitarian crisis that was occurring there. It had nothing to do with emotion. If it made people feel nice then I suppose that was a minor unintended benefit.
Just look at Remdesivir, or however it's spelled. The news corps are pushing that as a possible treatment. Except guess what? It doesn't seem to reduce your chances of dying. Worth noting, pharma companies are major advertisers for news networks. It's all been bullshit.
As a leader you really have to take a deep breath and not let emotions get the better of you.
Over-preparedness and knee-jerk reactions can hurt you.
I'm glad we didn't fulfill the request for 30k ventilators and take away from other states/countries that needed it.
Was the extra capacity good value? Was there any corruption?
During these highly emotional times I think it's more important than ever to stay rational, and question our governments.
Wasting tax payer money that could've been invested in things like increasing PPE production for existing hospitals.
The core of the issue is that we couldn't ramp up testing fast enough, leaving us completely blind and then we relied on models that believed the infection was moving far more aggressively than it was.
That leads to overcorrection and lots of cost.
There are tons of other possibilities here. There simply isn't enough data, and won't be until Feb 2021 where we can retroactively look back at data that is cleaned, pruned and properly averaged.
That would be a reasonable conclusion, perhaps, if the curve was flattening somewhat informally, and not specifically in places that have stronger lockdowns.
> That there's no evidence social distancing did anything at all
There’s reams of evidence in data across the world, and comparing locations in the US, that distancing has a substantial effect. Even most of the nutballs clamoring for radical reopening, like the President and his Republican allies, acknowledge that there is a trade-off in reopening, but argue that the lives to be lost from COVID-19 are a price worth paying for the near-term economic gains.
Test results are available to those in power.
The data is around, it's just not public because - I warrant - politicians can't manipulate the story if the public has the full data.
It's generally a good habit to do a little bit of simple arithmetic to see if the claims you are making pass a basic sanity check. If 20% of Americans already have antibodies, then how come NYC has 10x as many deaths per capita as the rest of the country? Did 200% of New Yorkers get infected?
You can prove that scenario wrong by testing (if number of 'already infected' is relatively low then this hypothesis would be wrong and the risk of further peaks is higher; I don't have enough data to attempt to disprove such a hypothesis.
Misattribution of cause
Different countries went into lockdown at different times. When did each one's curve start to flatten in relation to their lockdowns?
You cannot honestly believe this. 'Trending exponential' is such a useless buzzword. Exponential growth is only scary depending on the exponent itself. Our models on what that exponent were were absolutely, completely off by orders of magnitude. Just look at Sweden, they were estimating 40k deaths by now and only have three thousand something.
Certainly, early action helped flatten the curve, but the original estimates for what the curve would be were incredibly off. There was no overwhelming of hospitals in the US at all, despite warnings that they were imminent, even with behavioral changes. Our country's scientific advisers need to look inward at this point and figure out what went wrong with the models.
The curve in parts of the US without a strong lockdown isn't flattening. NYC just dominated the counts so much that it makes the whole country look like it is flattening if you don't break things out. There's similar indications in data from international experience
So, there's a lot more basis for conclusions than “anti-tiger rock” situation.
\https://news.ycombinator.com/threads?id=narogab
In that discussion I somehow lost whatever karma I had on this BB. Despite being polite and reasonable I was blasted into oblivion by some jerk(s). But with my now (-2) karma I am not above being jerky myself by pointing out that I was right, crooked-v was wrong, and any "field hospitals" the US Army made would indeed be, as I stated then, _field_ _hospitals_ and nothing like what "crooked-v" (https://news.ycombinator.com/user?id=crooked-v ) envisioned:
"Making these spaces fit the physical needs of these hospitals (massive power requirements for equipment, hallways and elevators with certain amounts of clearance for transporting patients, extremely well-controlled ventilation systems, sanitizable surfaces everywhere, rooms laid out with central access for doctors and nurses) would take so much time and effort that it would be more money- and time-efficient to build new buildings with the expertise of a group practiced in building new, reasonably high-quality buildings as fast as possible... like, say, the Army...These need to be modern hospitals, not 19th-century sanitariums where patients just get dumped into a bed and left to die or recover on their own."
- crooked-v, being wrong, wrong, wrong
- narogab, being a jerk and an asshole (but almost always, a _correct asshole).[God, it feels good to let go of that knife].
Oh that makes so much sense.
A similar thing happened here in the UK, we converted an exhibition centre (actually several in different cities) into Covid facilities. In the end we only used a few hundred beds and soon shut them down. What made the difference wasnt that we already had enough beds, but that other mitigating contingencies such as converting other smaller facilities into emergency hospitals happened fast enough, and moving patients out to less heavily hit areas softened the crunch more than anticipated.
I don't think preparing these extra facilities was a mistake at all. There are tons of unknowns and random variables in the progression of an epidemic, if we had needed those beds and din't have them more people would have died, possibly a lot of people. Complaining about waste is exactly like complaining about there being any empty beds in any hospital at any time. We plan for peak demand, including contingencies which may never come. It's like complaining that the military have any soldiers at all that never shot at an enemy, or bullets that never killed anyone. If we'd gone through the epidemic and there hadn't been any spare capacity, we'd used exactly as many beds as we had, that would have been bad preparation.
People are rightly upset by 'mask gougers' why would they not in the face of 'hospital bed gougers' charging $500 000 / bed?
Resource utilization always matters, even in the face of life and death, costs have to be justifiable in the context of risk.
I agree that given unknowns, we have to err on one side, but there are and were ways to deal with such unknowns, for example, we have Spain, Italy, Korea etc. as guides.
It's also possible to 'stage' the creation of such projects without having to fully build them out, putting stages in places as necessary.
A 'million or 1/2 million dollars a bed' is utterly outrageous gouging, there's no rationalization for it whatsoever.
There were credible scenarios, which could not have been discounted at the time, in which that capacity would have been needed. Spain set up emergency hospitals in convention centres, and a morgue in an ice rink. Those were exactly the model we prepared to follow in the UK.
As for the costs structure of the US model, frankly I have no idea. The NHS here works completely differently, suppliers do price gouge we're not immune to it, but that sort of thing can't really happen at the bed-provision level as that's an administrative rather than commercial issue.
I would agree that AECOM made out like a bandit on their field hospital contracts.
I'm extra scared about the virus, because I know that I would get to a place like this, and I don't have the confidence that I would get the right treatment. I have heared of other people as well who would rather stay at home as much as they can, even if they can't breathe well.
But then when somebody needs the ICU, he really needs it fast, and at that time it's too late to go to hospital.
Taxpayer money wasted on a knee-jerk reaction by an emotional governor.
Glad he didn't get the 30k ventilators he wanted as well.
edit: Many people told him he didn't need that many before the fact.
I think it's perfectly fine to be critical of a governor if we're critical of our president.
A leader should have some sort of vision into the future.
This information simply didn't exist and was highly hypothetical at the time ventilators were being requested.
However, no one knew if the shelter in place order would even work.
That 1/10000th of the budget could have went to nursing homes or other critical areas.
No matter how much a trillion is, several hundred million dollars is still a lot of money...