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Comment by icelancer | Hacker News Reader

>> 1. To flatten the infection curve, in order to keep healthcare systems from becoming overwhelmed like those in northern Italy.

Very few regions have had anything close to overwhelmed hospitals. More regions have had to lay off hospital staff than have been overwhelmed. Some like UW medicine now face a $500 million budget shortfall due to the ban on elective procedures.

Social distancing measures may have an effect on r_t as low as 0.1 per analysis by Nate Silver. Others show a negative or no correlation between government lockdowns and reduction of r_t.

It is fair to question if these lockdowns - as instituted - have done anything.

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> More regions have had to lay off hospital staff than have been overwhelmed.

That's a bit of a red herring. Hospitals aren't laying off ER and ICU staff. They're furloughing in areas like dermatology, plastic surgery, and the like - parts of the hospital that see largely elective procedures.

> furloughing in areas like dermatology, plastic surgery, and the like

Stop. This is incredibly misleading.

Elective just means that you can choose the time to do the surgery. It doesn't mean they are optional for health.

Elective surgeries include inguinal hernia surgery, cataract surgery, mastectomy for breast cancer, kidney transplant, and hip surgery.

Most surgeries are elective.

Don't minimize this as a bunch of delayed facelifts.

I'd be happy to wager there are substantially more dermatology visits in your average hospital than there are kidney transplants.

There's a range of severity in "elective" procedures, certainly. There are a lot of procedures folks will willingly postpone right now, and it's not surprising that hospitals are furloughing staff that service them.

It is disingenuous to suggest that furloughs in these elective areas demonstrate an excess of capacity in the ER/ICU.

Dermatology is real medicine with real consequences. Even Jerry Seinfeld found out the hard way: https://youtu.be/EmzM0bz3PWc

Certainly, but you'll likely find it has a higher proportion of elective procedures that can be held off than, say, the NICU.

Which will mean that department's staff - docs, nurses, receptionists, billers, cleaners, etc. - will be more likely to be on the furlough lists than the ER or ICU.

You are making a lot assumptions about what is / isn't considered elective based on your own personal priors/biases. Look at this list:

https://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Operat...

Knee replacements, hip replacements, even Coronary artery bypass graft can be considered "elective" if there is not an urgent need.

Focusing on hospital stays misses an enormous aspect of what hospitals do; routine visits, outpatient procedures, etc. There are plenty of reasons one might visit a hospital for something elective that doesn't show up as a "hospital stay" from that link.

My kids get eye exams at the hospital. My son's allergist is there. These visits can wait, and they make up a lot of a hospital's business; the staff in those areas have little to do at the moment.

Kidney transplants are considered essential surgery, not elective procedures according to the DHHS. [1] I would be incredibly surprised if any other transplant surgery was considered elective since time is usually of the essence in transplants.

[1] “We are grateful to the Administration for clarifying that transplantations are an essential surgery which can be performed safely if a hospital feels they have the staff and resources available during the COVID-19 crisis,” said Joseph Vassalotti, MD, Chief Medical Officer, National Kidney Foundation. https://www.kidney.org/news/national-kidney-foundation-urges...

You've completely missed the point that elective does not mean non-essential.

And you've argued in bad faith by using an emotionally charged procedure as "evidence" for your argument.

As someone with a pregnant wife, I'd also like to mention that birthing classes, breastfeeding classes, etc. are also not available at the moment.

My wife has had to "visit" an OB/GYN over Zoom.

I don't know how effective or not midwives and such are (I really should get on that...) but women are having to go without them or choose to go without having fathers by their sides. Some places have stopped any visitors from being present.

There are potentially long term health impacts from the above changes, I'd imagine.

Not all of what a hospital deals with is immediately life threatening, though putting it off can certainly make it so.

A midwife is a person who delivers the baby. Maybe you're thinking of doulas? If so, New York indicated doulas wouldn't be counted as visitors, but essential healthcare staff ( https://www.governor.ny.gov/news/secretary-governor-melissa-... ); it's worth looking up how your state and/or hospital is handling this. NY also apparently settled on "dads can attend, but should plan to stay in the hospital rather than popping in and out". ( https://gothamist.com/news/all-ny-hospitals-must-now-let-par... )

Hospitals are rightly trying to figure out what rules make sense. It's not surprising there's some uncertainty, and adjustments will be made as we learn more.

> Maybe you're thinking of doulas?

Yes, that's right -- sorry for the mix up.

> If so, New York indicated doulas wouldn't be counted as visitors, but essential healthcare staff

Thanks for sharing, but that's seemingly not the policy in the actual hospitals that I can see.

From NYU Langone's visitor policy (https://nyulangone.org/patient-family-support/visiting-hours):

> Labor and delivery patients are permitted one visitor throughout the labor, delivery, and postpartum period, which can include a partner, family member, doula, or other support person. The visitor cannot be rotated.

It seems like there is no option to have both a doula and the father present.

I honestly have no idea if we would even use a doula--I've done approximately zero research into them at this point--but it's a pretty hard choice to make at the moment.

> $500 million budget shortfall due to the ban on elective procedures.

I feel like that's a symptom of a much larger problem...

It looks like all of LA County has about 30 empty ICU beds today. To me that seems pretty low (although not "overwhelmed").

The entire hospital staff doesn't just sit around waiting for a pandemic. Most elective procedures have been postponed during this. Large portions of the healthcare system are idle _because_ everyone is at home. The parts of the hospital that can handle the symptoms of the virus are what we're trying to reduce the burden on.

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