5 ms·

Eloquently put. Agree 100%. The logical conclusion then is to ramp up your patient care infrastructure proactively: identity and clear the bottlenecks.

reagent_finder 7y ago
Or just cut the budgets.
FPGAhacker 7y ago
Agreed. It seems to me there are, in the main, two problems which include many other problems relating to the general problem.
koheripbal 7y ago
The bottleneck is the number of mechanical ventilators available. Ideally we want someone on a ventilator to be in an ICU and under a doctor's supervision, but in a crisis you can put a ventilator anywhere. A patient with COVID-19, will likely spend about 2 weeks on a ventilator. Unfortunately, there are only about 60-70,000 mechanical ventilators in the entire US (and maybe double that if you include older less automated ones), and about half of them are for neonatal wards. [source](https://www.ncbi.nlm.nih.gov/pubmed/21149215 https://www.ncbi.nlm.nih.gov/pubmed/21149215). 10% of COVID-19 infections require mechanical ventilation. [source](https://clinicaltrials.gov/ct2/show/record/NCT04244591 https://clinicaltrials.gov/ct2/show/record/NCT04244591). This means that if the US encountered an outbreak on the scale of what is happening in China, then we would also quickly run out of ventilators, and the mortality rate would be 2-4x what it would be otherwise, rather than the 1-2% mortality rate everyone is expecting.
- DoctorOetker 7y ago
  Assuming non-containment (starting to look more and more likely), then an unknown fraction of the population will get sick. The Diamond ~~Princess~~ Petri Dish Experiment, shows that at least 218 out of 3700 people are susceptible ( > 5.9% ). If we knew how many of these would eventually need respirators then we could estimate a lower bound on respirators for a 330M population. Working the other way around: 33000 respirators / 330M = 1 / 10 0000 so if 5.9% gets infected and we can only give 0.01% a respirator, then at most 0.17% of covid-positive people can be given a respirator. This assumes they all need their respirators simultaneously (pessimistic) but also assumes the Petri Disk experiment stays at 5.9% (optimistic) EDIT: what kind of query did you use to find the number of respirators in the US? How can I find similar numbers for European countries? How hard is it do DIY a respirator? If we look at the international statistics for dead and serious / critical people per confirmed case, and interpret that as the fraction needing a respirator we get: 22 / 523 = 4.2% of covid-positives seem to need respirators So we expect 4.2% * 5.9% = 0.25% of the population to neeed a respirator, while we only have enough for 0.01%, so assuming perfect triage of who needs it and who doesnt, 24 out of 25 who actually need one won't get one. It seems like we really are heading to a CFR of 4.2% * 24 / 25 such that there will be at least > 5.9% * 4.2% * 24 / 25 deaths, where the 5.9% can only rise depending on Diamond Princess evolution...
  - DoctorOetker 7y ago
    Currently 355 of 3700 Diamond Petri Dish confirmations, so replace 5.9% with 9.6% so if containment fails it looks like 4.2% * 9.6% = ~ 0.4% of the population at large would die.
sgift 7y ago
This leads to situations a society has to be willing to accept without crying how much money is wasted - namely: You will have empty beds/hospital wings/hospitals most of the time. And people will sit around doing 'nothing' aka training for the day when they are needed. I'm not convinced that the current political climate in either Europe or America is prepared to do that.
- occamrazor 7y ago
  > And people will sit around doing 'nothing' aka training for the day when they are needed. This is already an accurate description of most fire departments and militaries around the world. It shouldn’t be too hard to accept that a similar necessity of spare capacity occurs for healthcare.
  - joking 7y ago
    maybe the military, but a typical fire department is orders of magnitude smaller than current health workers force. At least where I live however, flu outbreaks are tipically worked by making the extra workers double their turns an paying them extra hours, as they have the effect of increasing pacients, but also making workers ill. A bit more of capacity would be appreciated, but tell people that you are going to increase taxes and you are going to loose the elections no matter what.
  - donavanm 7y ago
    You are woefully underestimating the size of healthcare compares to emergency services. Neither emergency services nor the military are slack. They are both scaled for sustained operations; peak utilization is made up by volunteers or allied forces/departments. BLS says there are 334K at firefighters at $49k/yr. There are 240k NPs at $113k/ye, 3M RNs at $71k/yr, 728K licensed nurses at $46k/yr, 300K lab techs at $52k/yr, and 1.5M NAs at $28k/yr. Go ahead and double that coat when you include MDs and Admin.
- iovrthoughtthis 7y ago
  Exactly. It’s like server analytics. Averages are less useful than percentiles.
DraftDodger67 7y ago
Why should we be faced with a massive expense to care for the elderly? From the dataset, 80% of deaths were to those over 60 years old, 75% of whom had underlying health issues. Societies around the world are already under a massive burden from excessive healthcare and pension costs to pay for sick and old people. To the contrary, if nCOV was allowed to spread, it would spare the world of this huge burden. Similarly, it doesn't make sense to quarantine huge sections of the planet and shut down workplaces for a virus that only lightly affects young people.

reagent_finder 7y ago

Or just cut the budgets.

FPGAhacker 7y ago

Agreed. It seems to me there are, in the main, two problems which include many other problems relating to the general problem.

koheripbal 7y ago

The bottleneck is the number of mechanical ventilators available. Ideally we want someone on a ventilator to be in an ICU and under a doctor's supervision, but in a crisis you can put a ventilator anywhere. A patient with COVID-19, will likely spend about 2 weeks on a ventilator. Unfortunately, there are only about 60-70,000 mechanical ventilators in the entire US (and maybe double that if you include older less automated ones), and about half of them are for neonatal wards. [source](https://www.ncbi.nlm.nih.gov/pubmed/21149215 https://www.ncbi.nlm.nih.gov/pubmed/21149215). 10% of COVID-19 infections require mechanical ventilation. [source](https://clinicaltrials.gov/ct2/show/record/NCT04244591 https://clinicaltrials.gov/ct2/show/record/NCT04244591). This means that if the US encountered an outbreak on the scale of what is happening in China, then we would also quickly run out of ventilators, and the mortality rate would be 2-4x what it would be otherwise, rather than the 1-2% mortality rate everyone is expecting.

DoctorOetker 7y ago
Assuming non-containment (starting to look more and more likely), then an unknown fraction of the population will get sick. The Diamond ~~Princess~~ Petri Dish Experiment, shows that at least 218 out of 3700 people are susceptible ( > 5.9% ). If we knew how many of these would eventually need respirators then we could estimate a lower bound on respirators for a 330M population. Working the other way around: 33000 respirators / 330M = 1 / 10 0000 so if 5.9% gets infected and we can only give 0.01% a respirator, then at most 0.17% of covid-positive people can be given a respirator. This assumes they all need their respirators simultaneously (pessimistic) but also assumes the Petri Disk experiment stays at 5.9% (optimistic) EDIT: what kind of query did you use to find the number of respirators in the US? How can I find similar numbers for European countries? How hard is it do DIY a respirator? If we look at the international statistics for dead and serious / critical people per confirmed case, and interpret that as the fraction needing a respirator we get: 22 / 523 = 4.2% of covid-positives seem to need respirators So we expect 4.2% * 5.9% = 0.25% of the population to neeed a respirator, while we only have enough for 0.01%, so assuming perfect triage of who needs it and who doesnt, 24 out of 25 who actually need one won't get one. It seems like we really are heading to a CFR of 4.2% * 24 / 25 such that there will be at least > 5.9% * 4.2% * 24 / 25 deaths, where the 5.9% can only rise depending on Diamond Princess evolution...
- DoctorOetker 7y ago
  Currently 355 of 3700 Diamond Petri Dish confirmations, so replace 5.9% with 9.6% so if containment fails it looks like 4.2% * 9.6% = ~ 0.4% of the population at large would die.

sgift 7y ago

This leads to situations a society has to be willing to accept without crying how much money is wasted - namely: You will have empty beds/hospital wings/hospitals most of the time. And people will sit around doing 'nothing' aka training for the day when they are needed. I'm not convinced that the current political climate in either Europe or America is prepared to do that.

occamrazor 7y ago
> And people will sit around doing 'nothing' aka training for the day when they are needed. This is already an accurate description of most fire departments and militaries around the world. It shouldn’t be too hard to accept that a similar necessity of spare capacity occurs for healthcare.
- joking 7y ago
  maybe the military, but a typical fire department is orders of magnitude smaller than current health workers force. At least where I live however, flu outbreaks are tipically worked by making the extra workers double their turns an paying them extra hours, as they have the effect of increasing pacients, but also making workers ill. A bit more of capacity would be appreciated, but tell people that you are going to increase taxes and you are going to loose the elections no matter what.
- donavanm 7y ago
  You are woefully underestimating the size of healthcare compares to emergency services. Neither emergency services nor the military are slack. They are both scaled for sustained operations; peak utilization is made up by volunteers or allied forces/departments. BLS says there are 334K at firefighters at $49k/yr. There are 240k NPs at $113k/ye, 3M RNs at $71k/yr, 728K licensed nurses at $46k/yr, 300K lab techs at $52k/yr, and 1.5M NAs at $28k/yr. Go ahead and double that coat when you include MDs and Admin.
iovrthoughtthis 7y ago
Exactly. It’s like server analytics. Averages are less useful than percentiles.

DraftDodger67 7y ago

Why should we be faced with a massive expense to care for the elderly? From the dataset, 80% of deaths were to those over 60 years old, 75% of whom had underlying health issues. Societies around the world are already under a massive burden from excessive healthcare and pension costs to pay for sick and old people. To the contrary, if nCOV was allowed to spread, it would spare the world of this huge burden. Similarly, it doesn't make sense to quarantine huge sections of the planet and shut down workplaces for a virus that only lightly affects young people.