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How much do we think healthcare and hospital stability was implicitly factored into this study given that the data was focused in Hubei? Meaning, if hospitals h

How much do we think healthcare and hospital stability was implicitly factored into this study given that the data was focused in Hubei? Meaning, if hospitals had to turn away patients, one would think the death rate would increase. If hospitals could receive all patients, one would presume the death rate would be lower? It's clear health care systems get overloaded even with a low symptomatic case saturation per capita.[0] Related to this, what I haven't seen mentioned or discussed extensively is not only would the fatality rate increase for Covid-19 cases if hospitals are overloaded, but I would assume the fatality rate for _all other needs_ of a hospital would also increase. Does anyone know this has been assessed? (e.g., did Hubei see a notable increase in non-Covid-19 related deaths during this period?) [0] https://www.aljazeera.com/news/2020/03/coronavirus-wreaks-havoc-italy-tests-limits-health-system-200307112350888.html https://www.aljazeera.com/news/2020/03/coronavirus-wreaks-ha...

empath75 7y ago
Italy is seeing similar numbers if not worse.
DocSavage 7y ago
I think we're seeing a small case study of this in the nursing home in Washington. Out of 120 residents, 13 are dead and have been identified with COVID-19. There were 11 more who died at the nursing home since Feb 19 and haven't been tested, but they said on average 3-6 residents die per month. I think the nursing home scenario is probably a worst case given both age and underlying health concerns (unlike elderly still living in their own home or with their families). Given the Seattle area medical infrastructure, this fatality rate can't be explained by overloading of our facilities. I really disliked Fauci's comments that "the risk is low" to the American population, pointing to the rate of infection. He hedges this with some hand waving that it could change at any moment. I thought it was irresponsible to say the risk is low when they hadn't done any real testing and we've actually got outbreaks like in Kirkland. Regarding his comment that the WHO fatality rate is too high because of asymptomatic population and the denominator in reality is much higher. Fine. But he doesn't acknowledge that the numerator might be much higher as well. How many 80+ year olds, especially those with preexisting conditions, die and are assumed to have just passed from old age and the preexisting conditions. It is a characteristic of this virus that the people getting killed are the most likely ones not to raise huge red flags early. So in general, I would've preferred him to not say anything about risk until we actually get more numbers and real testing within our population. The average fatality rate hides the fact that this virus is very dangerous to the elderly.
- bluedino 7y ago
  Nursing homes and other long-term care units also have the lowest quality of care and staff ratings in the industry. Typically plagued by overstaffing, unhappy workers, etc.
- gdubs 7y ago
  I have to agree about the “risk is low” comment. It’s based on a snapshot in time. And besides the hand-waving about an evolving situation — well, it’s the evolving situation part that’s the risk.
dr_dshiv 7y ago
I have a similar question. What percent of 70+ year olds that enter a hospital for cold/flu symptoms end up dying? Without knowing that as baseline, it is hard to meaningfully evaluate the covid19 death rate, especially considering that only the seriously ill are tested (and they don't report the death rate of those who test negative).
- bob33212 7y ago
  Around .5%
  - dr_dshiv 7y ago
    Thanks but no thanks for an uncited number. In this study, about 9% of non-elective geriatric patients admitted to a hospital die. https://academic.oup.com/ageing/article/34/5/467/40349 https://academic.oup.com/ageing/article/34/5/467/40349 In this study, it was closer to 15%. http://www.scielo.br/scielo.php?pid=S1807-59322009000700002&script=sci_arttext http://www.scielo.br/scielo.php?pid=S1807-59322009000700002&... Now, if they only covid19 test people sick enough to be hospitalized, and if most of the deaths are over 70, shouldn't there be a comparison in the death rates to those patients testing negative?
    - bob33212 7y ago
      Not all patients who enter a hospital are admitted for 3+ days.
      - Dylan16807 7y ago
        Okay, so that means we need to ask what percent of flu patients admitted to a hospital are out in less than 3 days. Probably not most of them?
- zaroth 7y ago
  I can tell you that of 200,000 hospital admissions for the flu each year in the US, approximately 20,000 will die, i.e. 10%. To put it another way, if we didn’t have extremely well established flu surveillance networks or even knew what the flu was, and people just started coming to the hospital with ILI and then dying, you would see 200,000 cases with a CFR of 10%. But because we do have widespread, fast, and cheap testing we know that each year 30 million people get the flu and only about 1% go to the hospital, and 10% of those die, so the IFR is about 0.1%.

empath75 7y ago

Italy is seeing similar numbers if not worse.

DocSavage 7y ago

I think we're seeing a small case study of this in the nursing home in Washington. Out of 120 residents, 13 are dead and have been identified with COVID-19. There were 11 more who died at the nursing home since Feb 19 and haven't been tested, but they said on average 3-6 residents die per month. I think the nursing home scenario is probably a worst case given both age and underlying health concerns (unlike elderly still living in their own home or with their families). Given the Seattle area medical infrastructure, this fatality rate can't be explained by overloading of our facilities. I really disliked Fauci's comments that "the risk is low" to the American population, pointing to the rate of infection. He hedges this with some hand waving that it could change at any moment. I thought it was irresponsible to say the risk is low when they hadn't done any real testing and we've actually got outbreaks like in Kirkland. Regarding his comment that the WHO fatality rate is too high because of asymptomatic population and the denominator in reality is much higher. Fine. But he doesn't acknowledge that the numerator might be much higher as well. How many 80+ year olds, especially those with preexisting conditions, die and are assumed to have just passed from old age and the preexisting conditions. It is a characteristic of this virus that the people getting killed are the most likely ones not to raise huge red flags early. So in general, I would've preferred him to not say anything about risk until we actually get more numbers and real testing within our population. The average fatality rate hides the fact that this virus is very dangerous to the elderly.

bluedino 7y ago
Nursing homes and other long-term care units also have the lowest quality of care and staff ratings in the industry. Typically plagued by overstaffing, unhappy workers, etc.
gdubs 7y ago
I have to agree about the “risk is low” comment. It’s based on a snapshot in time. And besides the hand-waving about an evolving situation — well, it’s the evolving situation part that’s the risk.

dr_dshiv 7y ago

I have a similar question. What percent of 70+ year olds that enter a hospital for cold/flu symptoms end up dying? Without knowing that as baseline, it is hard to meaningfully evaluate the covid19 death rate, especially considering that only the seriously ill are tested (and they don't report the death rate of those who test negative).

bob33212 7y ago
Around .5%
- dr_dshiv 7y ago
  Thanks but no thanks for an uncited number. In this study, about 9% of non-elective geriatric patients admitted to a hospital die. https://academic.oup.com/ageing/article/34/5/467/40349 https://academic.oup.com/ageing/article/34/5/467/40349 In this study, it was closer to 15%. http://www.scielo.br/scielo.php?pid=S1807-59322009000700002&script=sci_arttext http://www.scielo.br/scielo.php?pid=S1807-59322009000700002&... Now, if they only covid19 test people sick enough to be hospitalized, and if most of the deaths are over 70, shouldn't there be a comparison in the death rates to those patients testing negative?
  - bob33212 7y ago
    Not all patients who enter a hospital are admitted for 3+ days.
    - Dylan16807 7y ago
      Okay, so that means we need to ask what percent of flu patients admitted to a hospital are out in less than 3 days. Probably not most of them?
zaroth 7y ago
I can tell you that of 200,000 hospital admissions for the flu each year in the US, approximately 20,000 will die, i.e. 10%. To put it another way, if we didn’t have extremely well established flu surveillance networks or even knew what the flu was, and people just started coming to the hospital with ILI and then dying, you would see 200,000 cases with a CFR of 10%. But because we do have widespread, fast, and cheap testing we know that each year 30 million people get the flu and only about 1% go to the hospital, and 10% of those die, so the IFR is about 0.1%.