When a health-care system crumbles, this is what it looks like | Hacker News Reader

When a health-care system crumbles, this is what it looks like

theatlantic.com

37 pointsdopylitty57 comments

It's a fair point re: strain on hospitals, but The Atlantic could do without the hysteria and clickbait headlines. They undermine their credibility with nonsense like that.

Hospitals are definitely under a lot of stress at the moment, but that's hardly the same thing as a health-care system "crumbling".

Dude, RTFA. The author is explaining that in a complex system, the signs of failure are hidden by the complexity, but it's still there anyway. A HN reader should understand this. Imagine if the headline was "Why your performance monitoring system should alarm on a 1% increase in the 4th standard deviation of your backend API latency measurement". You'd up ote without even taking it, wouldn't you?

> Hospitals are definitely under a lot of stress at the moment, but that's hardly the same thing as a health-care system "crumbling".

What would you call it then? People not getting the care they need and expect, compound effects over time. How is that not crumbling?

If you get stuck in a traffic jam on a Friday afternoon before a holiday weekend, you don't claim that the highway system is "crumbling". Sometimes you have a temporary surge in the demand for something - that happens. We don't build anything in society to accommodate a worst case scenario, as nice as it would be, it's just not practical. So to answer your question, I would say that the hospitals are currently over capacity.

What you're not realizing is that there are people unnecessarily dying. So yes the system is crumbling. When I'm in a traffic jam I still get to my destination eventually.

Crumbling is a metaphor so of course it is up to some interpretation. For me, the connotation is degradation or destruction that is not temporary.

I guess you're technically right then. I'm glad we figured this out /s

The title of the article is: “Omicron Isn’t Mild for the Health-Care System” - which seems like a fair shake to me. The hacker news submitted title is the clickbait hysteria you are attributing to the Atlantic.

The first sentence is "When a health-care system crumbles, this is what it looks like."

I really gave up on the Atlantic when they titled one article, "Georgia's Experiment with Human Sacrifice." What they meant is that someone was taking an approach to COVID that they didn't like.

Ritual human sacrifice could alternatively be described as someone taking an approach to religion that you don't like.

What title would you prefer?

None, this topic has been written about to death for almost two years now and, as important as it may be, there's nothing new left to say about it. There's no shortage of interesting and newsworthy things going on in the world, we don't need to keep recycling the same few stories.

(Life-saving) COVID-related ICU utilization is highly dynamic wrt infection rates with exacerbations such as this article mentions, so this topic never becomes old.

In fact indifference to current trends may negatively influence social distancing behavior and sequelae, so it still seems worth reporting.

I've seen the narrative that hospitals are being overrun many times over the past two years, but it just doesn't line up with the ICU and inpatient capacity data from Johns Hopkins. Take a look at their "Weekly Hospitalization Trends" dashboard and see for yourself.

https://coronavirus.jhu.edu/data/hospitalization-7-day-trend...

In the US overall, during the entire course of the pandemic, the ICU capacity capacity maxed out at 81% and the inpatient capacity maxed out at 78%. The same is roughly true when you look at the state numbers as well. The only state that I could find that reached 100% ICU capacity was Alabama, and that happened back in August/September. Most states have been running at less than 80% ICU and inpatient capacity for the past year and a half.

I get that ICU capacity is a local issue and that it's possible for individual hospitals to be at max capacity even while the state has excess capacity overall, but to claim that the health-care system as a whole is crumbling just isn't supported by evidence.

I dont think measuring hospital capacity by available beds by themselves is useful. Both parents are doctors and work in different hospitals. Both report a shortage of doctors and nurses and not enough ability to give care to all their patients due to simply not having enough time in the day.

You can have 20% free beds, but only 50% care capacity

That's an interesting point. I created a visualization of the number of hospitals reporting a "critical staff shortage" using the data provided on HealthData.gov. It looks like the number of hospitals reporting a critical staff shortage has been consistently around 10-15% since July of 2020.

https://healthdata.gov/Hospital/Copy-of-of-hospitals-reporti...

Do you think things could be less than ideal before a facility reports a "critical staff shortage"?

And those medical staff being the last line, with, as the article says "no one to take over if I need to tap out".

Collapse comes all at once, unexpectedly. Except for all the warning signs...

I've noticed this idea bothers some people, but I really think we need some sort of deputized health-care worker system set up.

Allow people to take a six-week course, that lets them do simple patient care and vitals testing, and removes as much rote-work from the actual professionals as possible. While I greatly respect the work that nurses do, I think that a large part of their labor each day is spent on simple tasks.

I think the legal and regulatory landscape is far too complex and rigid to let that happen, though.

Most hospitals have been having back office folks re deploy to do the drudgery for months now. Lots of stuff like stocking rooms, bed setup etc. Ohio has now drafted national gaurd units to help in our hospitals to pick up this slack as well. None of these folks can do direct patient care stuff like blood pressure etc but they can and do pick up nearly everything else.

Those numbers really don’t tell the tale. The problem with looking at raw bed numbers is that all kinds of not so good pressure valve mechanisms go into effect as bed capacity drops, such as:

* cancellation of elective and non-urgent surgeries, including back surgeries

* longer more intense hours for staff

* shipping patients to other hospitals, often out of state

* huge spikes in ER wait times

My personal experience knowing people at multiple levels in health care is that hospitals legitimately have been struggling with capacity issues every time that COVID spiked over the past two years.

There are a few things that this date could be hiding (not saying it does, just that it could). Did they cancel any significant number of non-urgent treatments because of covid? What do they call "staffed beds"? Has the number of staff per bed changed? How much overtime has the staff been doing during these two years?

I also find those numbers interesting.

I, with help from my clerk and my head nurse, called 50 hospitals trying to find available space for a sick patient that required transfer from my small rural facility (we had been at 100% ICU capacity -- only 4 beds -- for weeks, and full more often than not for months).

I called every major hospital in New Mexico, Arizona, Colorado, Utah, and Texas, with several in Nevada and Oklahoma as well. Every one of them reported they had no capacity to accept my patient for transfer.

I looked at the AZ and UT state statistics within a few days and was surprised to see them reporting much more capacity than I had been notified about when trying to find a bed for my patient.

A Reddit thread I started based in part on the experience: https://www.reddit.com/r/medicine/comments/r6bl1u/not_accept...

Our local trauma centers have been so full that local ERs have literally had people die in the ER from treatable conditions (requiring a specialist we don't have) while trying to find a place that could accept a transfer. It has been like this for months. Our hospital had to establish a separate team just to help make phone calls because the physicians were spending hours upon hours of their shift making calls in search of open beds instead of patient care.

I don't understand the discrepancy between my experience and numbers reported by the local state websites, but I think it might be premature to consider their reported data indisputable.

I cover a 15 bed ICU in one of the states you mentioned and have seen the discrepancy as well.

I noticed, starting in 2020, that our hospital's internal ICU bed-available data did not correlate with local press/internet data. I have access to internal, real-time, system-wide ICU bed-available data. (I'll say that we have some where between 10-25 hospitals, don't want to be specific as I don't know what management would think of posts like this on HN). Our internal system-wide data does not correlate very well with state-wide press/internet metrics either.

When on-shift I spend much time trying to find beds for patients as well as fielding calls from other hospitals that are trying to do the same. The data available on the internet and in the press does not reflect the situation in the trenches at all in our region. I'm not sure how it could as our internal situation changes every 10-15 minutes, sometimes, depending on the progress or deterioration of individual patients, staffing availability, discharges home, numbers of people waiting to be cared for, what day of the week it is (Fri, Sat, Sun, Mon are the worst), how bad the roads are, what time of day it is (most people arrive in the afternoon and evening), if a holiday has just ended, if a large/local event has ended (people tolerate terrible symptoms for holidays and events and come to the ER afterwards).

For the entire pandemic, the real-time in-hospital situation has been more dire than is reflected in the press or on data-accumulation sites like Johns Hopkins. It has been exhausting.

Could it be..if you have 10 beds open, but through staff resignations etc..maybe only enough nurses for 8 beds? and that's where the discrepancies lay?

Just looking at ICU doesn't tell the whole picture. Not all covid patients - confirmed or awaiting a test - are place in ICU. ICU beds are a fraction of the total. ICU and vent patients are obviously more likely to die but all those other covid positive patients are still in our hospitals. My hospital now has more positive patients, and patients overall than we ever have in the entire pandemic - or any other time for that matter. We just don't have the staff to maintain these sorts of levels long term, regardless of the beds we have. We aren't necessarily crumbling but it's definitely getting harder and harder.

I was corrected earlier in the pandemic: I thought Hospitals LOVED covid because of all the money they got for services.

Someone then pointed out that COVID prevents a lot of really high margin care, substituted instead for drudgery healthcare and is killing the hospital bottom lines.

I suspect what is REALLY going on here is a combination of both the surge of care for the explosive Omicron variant, and the loss of high-margin care is undermining the profitability again.

The four big mafiosos of US healthcare are Health Insurance, Drug/Device makers, Doctors/Hospital Providers, and the Malpractice Trial Lawyers. All four of them have REALLY powerful lobbying arms (even the Trial Lawyers, the least significant revenue wise and numbers wise of the four, but they are lawyers so they know how to gum up the system). They point to everyone else when the question of "why so expensive" comes up.

But it's all about the unsustainable profit margins/revenue structures in the US care system. If you see an article like this, I always suspect it's really about unsustainable profitability whatever complaining entity has setup.

To that end, any future infrastructure bill or covid package you should include a set aside for more doctor residence positions. Of the four factors you mentioned, a lack of doctors is the most significant factor in health care costs and limited availability in the US.

I think this is possible because it benefits three of the four groups that you mentioned to the detriment doctors. It even helps Hospital providers by driving down cost

This is part of the problem with the argument around hospitals being overrun. People don't have any context with what it means.

In reality it's not hospitals being 110% maxed out. It's hospitals inching closer to capacity at 80, 85, 90% which then requires hospital workers to start taking into account triage. It means elective surgeries and people that don't need help right now end up getting pushed back, even if they still need help that day or will die.

Daniel Wilkinson died as a result of not getting treatment for something that is very easily treatable in a hospital [1] during the last wave. Multiple hospitals across multiple states couldn't admit him. This is what it means when the healthcare system crumbles: People start dying from otherwise treatable problems.

[1] https://www.click2houston.com/news/local/2021/08/28/houston-...

From what you're saying, I'm inclined to agree as well. It seems like the media is constantly panicking about ICU bed levels but we can just as easily go online and look at the publicly available numbers ourselves and see that it's a different story.

I wonder if hospitals being overrun is not because of ICU bed capacity, but the support staff needed to support those beds.

The beds can be there, but if nobody is there to take care of them, it's a whole other issue. Not sure how anybody is measuring "capacity" (whether it's the physical beds themselves as the metric, or if it includes support staff)

I don't think there's any "right" answer here, which sucks. Hopefully this pandemic gets done and over with this year.

You are correct, in my hospital system beds haven't been an issue since the early days of covid. Staff is the big issue. We are consistently over 100% nurse utilization. Having an open bed is useless if we can't put you in it and subsequently take care of you in a timely manner.

The worldometers on recent cases is a MASSIVE SPIKE. It could be the prevalence of home testing, or it is just that omicron is that transmissable.

(Daily new cases graph is a fair way down):

https://www.worldometers.info/coronavirus/country/us/

that is 300% worse than the worst point of the worst outbreak we had of COVID before.

The death rate spike trails the case surges, so that will tell me personally how bad omicron is.

I had predicted we reach a million deaths in April or so based on a post-christmas surge matching the previous year's surge.

This virus is amazing in how well it is adapted to attack American social and political structures. It kills people we don't care about (medically vulnerable, elderly, poor) while almost being completely asymptomatic in the young and vibrant (and socially influential, all we care about is pretty young people in the US). So it undermines political support that would stop it.

Yeah the current spike is well over 100 more cases per day for my hospitals than either of the previous spikes. It's pretty nuts. That's a ton of additional inpatients.

People are mostly not reporting home rapid test results.

I'm seeing a different headline: "Omicron Isn’t Mild for the Health-Care System"

Just need to look at Canada right now...

I am an ignorant American; can you elaborate?

Much of Canada is back to being locked down (ie. businesses and schools closed) for the whole population (not just unvaxxed) due to our healthcare system crumbling.

It's unearthed the sad truth that Canadian healthcare has far less total capacity than either the US or really any EU country as we're now one of the few places on earth back into lock-down.

I'm physically in the Czech Republic right now - life is normal. I know the US isn't locked down. No where in the EU is right now. But Canada is...

The Healthcare system is not even close to crumbling, even in Quebec where 150% bed occupation rates were normal even before covid. You are mistaking a huge, baseless overreaction with the reality on the ground. And that was the case even before the ridiculous, clownish measures our incompetent government decided to put in place

Source: Both of my parents work in the covid ward of the biggest hospital in quebec ( CHUM)

> even in Quebec where 150% bed occupation rates were normal even before covid

If you don't call that crumbling then what is? The literal walls falling down?

All sorts of medical procedures are being cancelled, Covid tests aren't being done, there's not enough staff, etc... That isn't the norm in developed countries, FYI.

I'm literally in another country, following my partner around as she has a million medical appointments (she's pregnant and hasn't been home in 2 years). Right now, during Covid, their system is working better than Canada's has during my lifetime. She gets appointments within a day. Shows up, no wait. Nothing gets cancelled. The clinics/hospitals aren't close to full. Everything is quick and works well.

What a bunch of nonsense. Do you have any proof of that? I'm in Canada right now and as far as I know, "lockdowns" are not the norm. Ontario yes, much of Canada, no.

Ontario and Quebec account for like 2/3 of the population... Both are locked down.

As for my assertions of Canadian healthcare capacity, OECD keeps stats, we're basically at the bottom.

I guess we can argue what constitutes a lockdown but somehow I think that involves not being allowed to go out which this is not.

Quebec: https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Pr...

Ontario: https://covid-19.ontario.ca/public-health-measures

Business closures are the most damaging aspect.

The current level of 'restrictions' if you don't like the word lockdown are harsher than any EU country (except Netherlands) and the US currently.

The strain on Canada's healthcare system is frankly, embarassing. Hell, our healthcare system was embarassing before the pandemic.

That is a good point

BC locked down as well

No it's not.

Source: I'm in BC

Netherlands are in lockdown as well; at the tail end of letting delta run wild and with our health care at it's limits due to that we started it as Omicron was just getting started. Shortage of staff, beds and care has been pretty consistently high and getting worse here as well as in Canada apparently. We basically introduced capitalism into our health care system back in the day with insurers etc. subsequently optimizing away all of the (under normal circumstances) superfluous capacity. Strangely we still don't seem to have made any real improvements to our capacity since Corona started and have mostly just experienced loss of staff instead similar to what this article describes.

Ah, missed that one.

Biden is such a balerine.

Once upon a time he ran his campaign on "I will beat Covid". [0]

Once Omicron appeared, he pivoted - "Opps, we didn't expect" that[1]. Cool story bro, it was discovered at the end November.

And now he pivoted one more time, shamelessly claiming: "there is no federal solution to COVID"[2]

Pivot, Pivot, Pivot, no delivery, crisis after crisis with no solution. Is there one competent person in this administration?

[0] - https://joebiden.com/notes-from-joe-together-we-will-defeat-...

[1] - https://thehill.com/homenews/administration/586401-harris-sa...

[2] - https://eu.usatoday.com/story/opinion/2021/12/28/covid-biden...

What does this have to do with the article? Are you suggesting that stricter Covid regulations imposed by the federal government could have curtailed some of the struggles the health care providers are experiencing now?

>> Are you suggesting that stricter Covid regulations imposed by the federal government could have curtailed some of the struggles the health care providers are experiencing now?

Yes, I do. I live in the Netherlands and we have the 2020-ish lockdown right now, basically nothing except of groceries and pharmacies is open. And that seems to be a good strategy - https://nltimes.nl/2022/01/07/dutch-covid-hospitalizations-n... Once we get through the Omicron wave, we will smoothly reopen.

The US Federal Government is extremely limited in its ability to impose lockdowns or other NPIs on the states, much in the same way that in 2020, Trump could not force them to be open. The US system of government grants these rights to the individual states, most of which have removed the restrictions and/or delegated the decisions to cities and counties.

The limited amount of restrictions imposed by the Fed are already being challenged and overturned in courts.

Biden could declare national emergency using Public Health Service Act

https://en.wikipedia.org/wiki/Public_Health_Service_Act

Dems still have slim majority in the house, so they could authorize Biden to do that.

I don't think that the US population is willing to go through another lock down, both vaccinated and unvaccinated alike.

Last time the financial cost was immense, and we have yet to recover.

He is just keeping one of his campaign promises.

https://www.salon.com/2019/06/19/joe-biden-to-rich-donors-no...

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