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Dumb question but what intensive care? Do people need to be on respirators? Need access to drugs only available at ICU? Just curious if any of the things done a

Dumb question but what intensive care? Do people need to be on respirators? Need access to drugs only available at ICU? Just curious if any of the things done at an ICU to prevent death really need to be only at the ICU.

daxorid 7y ago
Yes, mechanical ventilators and in most cases, supplemental oxygen for roughly 18% of patients. We can expect CFR in the US to be fairly low (approx 2%) as long as the availability of these resources permits treatment for all who need it. After saturation, however, the CFR will move asymptotically toward approx 15%. Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. The US has about 62k mechanical ventilators, about half of which are already occupied at any given time, and half of the available ones are purpose-built for infants in NICUs. So let's assume we begin to have a real problem above (62k/4)/0.18 == 86k simultaneous US cases. I'd assume oxygen supplies should be easy to scale up. No idea about scaling up the manufacture of ventilators, or if the (much more numerous, and cheaper) CPAP machines in the US could be used as stand-ins. Perhaps someone more familiar with these devices can chime in.
- paganel 7y ago
  > After saturation, however, the CFR will move asymptotically toward approx 15%. > Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. This would practically be a Denial of Service Attack on any health system, no matter the country in which that health system is based in. Which is why it is so important to try to contain the virus spread before we get to the "move asymptotically toward approx 15%" phase.
- JshWright 7y ago
  CPAP is definitely a viable intervention for ARDS. Some percentage of patients will still end up needing intubation/ventilation, but CPAP is a good way to prevent that in some percentage of cases (esp if used pretty "aggressively" to support the patient while they're still able to breathe on their own, if they get to the point where they can't breathe for themselves effectively enough, then CPAP isn't going to do anything for them)
rolph 7y ago
if you get the dirty end of the stick and your interaction with the virus is an endangering one you will have problems with your organs due to the virus itself and arising complications
paganel 7y ago
As far as I could see in some Twitter videos coming out of China some people need to be on respirators and in a horizontal position. At the limit you can also do that in sports- and concert-halls, which is what the authorities seemed to have done in Wuhan.
- pmoriarty 7y ago
  From what I understand, there just aren't that many artificial respirators/ventilators. Worse, a lot of medical equipment (though not sure about artificial respirators/ventilator) is made in China, whose manufacturing capacity has been drastically affected by this epidemic.
jonplackett 7y ago
I read an article a while back where they said there are a few bands of severity (this was how they treating in China). First level of seriousness was oxygen / respirator. Then for even more serious cases they had to actually oxygenate the blood outside their body. Basically the problem was people can’t breath because of fluid or maybe it’s damage in their lungs so all the treatments of the severe patients were to help that.
KineticLensman 7y ago
The most extreme consequences of infection include acute respiratory distress syndrome (ARDS) and sepsis, which may require ICU-type treatment. See [0] for World Health Organisation guidance on critical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. The majority of patients don't experience such severe consequences. [0] https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected https://www.who.int/publications-detail/clinical-management-...
- AstralStorm 7y ago
  You mean specifically SARS, which is a syndrome not a name of the virus. The really really agent is immune pneumonitis, or cytokine storm related sepsis.
  - KineticLensman 7y ago
    IANAD, but I'm pretty much exactly quoting the linked WHO material (dated 28 January 2020) relating to 2019-nCOV, which describes acute respiratory distress syndrome (ARDS) as something that might need to be managed in an ICU, as per the original question.
enimodas 7y ago
A doctor on youtube went over 3 cases and how they were handled, 2 older people and a younger one. https://www.youtube.com/watch?v=Q0A0LyMru3I https://www.youtube.com/watch?v=Q0A0LyMru3I

daxorid 7y ago

Yes, mechanical ventilators and in most cases, supplemental oxygen for roughly 18% of patients. We can expect CFR in the US to be fairly low (approx 2%) as long as the availability of these resources permits treatment for all who need it. After saturation, however, the CFR will move asymptotically toward approx 15%. Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. The US has about 62k mechanical ventilators, about half of which are already occupied at any given time, and half of the available ones are purpose-built for infants in NICUs. So let's assume we begin to have a real problem above (62k/4)/0.18 == 86k simultaneous US cases. I'd assume oxygen supplies should be easy to scale up. No idea about scaling up the manufacture of ventilators, or if the (much more numerous, and cheaper) CPAP machines in the US could be used as stand-ins. Perhaps someone more familiar with these devices can chime in.

paganel 7y ago
> After saturation, however, the CFR will move asymptotically toward approx 15%. > Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. This would practically be a Denial of Service Attack on any health system, no matter the country in which that health system is based in. Which is why it is so important to try to contain the virus spread before we get to the "move asymptotically toward approx 15%" phase.
JshWright 7y ago
CPAP is definitely a viable intervention for ARDS. Some percentage of patients will still end up needing intubation/ventilation, but CPAP is a good way to prevent that in some percentage of cases (esp if used pretty "aggressively" to support the patient while they're still able to breathe on their own, if they get to the point where they can't breathe for themselves effectively enough, then CPAP isn't going to do anything for them)

rolph 7y ago

if you get the dirty end of the stick and your interaction with the virus is an endangering one you will have problems with your organs due to the virus itself and arising complications

paganel 7y ago

As far as I could see in some Twitter videos coming out of China some people need to be on respirators and in a horizontal position. At the limit you can also do that in sports- and concert-halls, which is what the authorities seemed to have done in Wuhan.

pmoriarty 7y ago
From what I understand, there just aren't that many artificial respirators/ventilators. Worse, a lot of medical equipment (though not sure about artificial respirators/ventilator) is made in China, whose manufacturing capacity has been drastically affected by this epidemic.

jonplackett 7y ago

I read an article a while back where they said there are a few bands of severity (this was how they treating in China). First level of seriousness was oxygen / respirator. Then for even more serious cases they had to actually oxygenate the blood outside their body. Basically the problem was people can’t breath because of fluid or maybe it’s damage in their lungs so all the treatments of the severe patients were to help that.

KineticLensman 7y ago

The most extreme consequences of infection include acute respiratory distress syndrome (ARDS) and sepsis, which may require ICU-type treatment. See [0] for World Health Organisation guidance on critical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. The majority of patients don't experience such severe consequences. [0] https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected https://www.who.int/publications-detail/clinical-management-...

AstralStorm 7y ago
You mean specifically SARS, which is a syndrome not a name of the virus. The really really agent is immune pneumonitis, or cytokine storm related sepsis.
- KineticLensman 7y ago
  IANAD, but I'm pretty much exactly quoting the linked WHO material (dated 28 January 2020) relating to 2019-nCOV, which describes acute respiratory distress syndrome (ARDS) as something that might need to be managed in an ICU, as per the original question.

enimodas 7y ago

A doctor on youtube went over 3 cases and how they were handled, 2 older people and a younger one. https://www.youtube.com/watch?v=Q0A0LyMru3I https://www.youtube.com/watch?v=Q0A0LyMru3I