6 ms·

As an Italian, I really hoped the horror stories that are coming out of Italy right now could help raise awareness of how things could look like when a governme

As an Italian, I really hoped the horror stories that are coming out of Italy right now could help raise awareness of how things could look like when a government reacts too late to this threat. However, it seems every major country is sadly going down the same path: https://twitter.com/MarkJHandley/status/1237119688578138112 https://twitter.com/MarkJHandley/status/1237119688578138112 . I hope you won't have to be as scared as I currently am for my parents. My dad is in one of the categories that has low priority for an ICU bed. Older than 65 and diabetic. If he gets sick and require an ICU chances are he'll die because medics, rightly so, will choose someone with better survival chances.

mrits 7y ago
"will choose someone with better survival chances." How does this differ from the death panels that used to be brought up in the US? Serious question as I didn't follow politics too much when I was younger.
- deleted 7y ago
  [deleted]
- davidw 7y ago
  It's called 'triage'. It's what they do anywhere, including the US, when there are too many casualties to deal with. And it's the doctors deciding based on who is most likely to pull through if they get care, not bureaucrats.
  - jacquesm 7y ago
    That; and who on balance has the most benefit from being saved to begin with. There is a definite negative weight assigned to age, they would rather save a teenager than someone who is 95. (presented without any kind of bias towards whether this practice is good or bad)
  - ggreer 7y ago
    Normal triage is when you prioritize the most seriously injured patients so they don't die waiting for treatment. That's what hospitals typically do. In a mass casualty event, hospitals engage in reverse triage which optimizes for throughput. They prioritize cases that can be discharged quickly so that they can treat as many people as possible. This means they'll label the most serious cases "expectant" and let them die. After all, it's better to save two or three easier people than to squander limited resources on one person who is unlikely to survive. It is extremely rare for hospitals in the US to use reverse triage. I think the most recent time was during Katrina. The stories of that are not pretty.[1] 1. https://www.newsweek.com/vindicated-katrina-doc-tells-her-story-99333 https://www.newsweek.com/vindicated-katrina-doc-tells-her-st...
    - davidw 7y ago
      Yes, that sounds accurate. I am not super familiar with all the terms, as I guess is evident. The second thing is what's happening in a few hospitals in Italy right now and it's gut wrenching for everyone. The staff involved are human too and already stressed and to have to make those kinds of calls is awful. So let's please cancel everything: https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-cancel-everything/607675/ https://www.theatlantic.com/ideas/archive/2020/03/coronaviru...
  - thephyber 7y ago
    > And it's the doctors deciding based on who is most likely to pull through I don’t see a distinction. Both of them are making a “for the good of many over the good of one” decision. The “death panels” rhetoric was just that. In practical terms, we already have death panels both within hospitals and within health insurance companies and neither is terribly transparent.
- CraigJPerry 7y ago
  A death panel is just a political device. The actual problem is just prioritisation of a restricted supply in the face of excess demand. America is still around 28 days away from these decisions though.
  - davidw 7y ago
    Italy went from 0 known cases a month ago to 10,000+ today (with some recovered at this point) in less than a month. We'll be there far sooner, especially given the massive failure at the federal level to do much of anything, and given that the infections in the US are not evenly distributed, but are going to hit certain places first in larger numbers.
    - pixl97 7y ago
      Yes, but those first cases will just fill up the facilities, the cases after that will overflow the system.
      - davidw 7y ago
        That's what everyone is referring to.
  - dchichkov 7y ago
    A quick, very low sample, back of the envelope calculation: 36,000 participants. Out of that, 1 case that was pretty close (underlying condition, medically-induced coma). Assuming that 5% of population goes into similar state, we should expect more than (1 / 5%) = 20 people in milder states. This would be 20 / 36,000 = 0.05% infected, in the sample consistent with RSA conference on Feb 28th. Assuming doubling rate of 5 days, today is March 10th. So ~ 0.5% infected. And log2(100 / 0.5) * 5 = 38. So, Yes. 28 days sounds about right. Disclaimer: very small sample. Definitely not representative. Statistics is broken here. I'm not a medical field professional and not familiar with virology field. I'm a software engineer and researcher with interest in a number of fields. Exposure to the field limited to reading Nature, coding a bit for medical equipment and college-prep for medical school.
- ceejayoz 7y ago
  "Death panels" was the claim that a group of government bureaucrats would decide who lives and dies by denying treatment under something like Obamacare. It was a rather baffling talking point, given that this already happens regularly with private insurers and Medicare approvals in the current system.
- seneca 7y ago
  It's the difference between a doctor, or more likely a highly trained nurse in most facilities, making the decision and government bureaucrat making the decision. It likely also implied the decision being made based on what choice saves the most lives (doctor/nurse) vs what is economically or politically desirable for the decider (bureaucrat).
  - willyt 7y ago
    Where do you get bureaucrats deciding things like that, I've never heard of that before? 60's USSR maybe?
    - penagwin 7y ago
      It's a conversation that sometimes comes up with universal healthcare, for example (I'm not taking a stance here) - "Is it worth spending $$$$ tax payer money on an operation with a 20% success rate on 95 year old who also has diseases X, Y and Z?" If such rules are written then it would be bureaucratic.
    - seneca 7y ago
      I couldn't say whether that happens anywhere, but I believe that's what "death panels" refers to. I wasn't suggesting it's what currently happens.
    - mrits 7y ago
      I think they were answering my question in that this is difference since it is professionals performing triage and not bureaucrats.
- penagwin 7y ago
  Not sure about "death panels" specifically, but like was mentioned, this is called "triage". Basically we don't have resources to help everyone. The resources we do have need to be strategically used, spreading them too thin might not benefit anyone at all. So a tough decision has to be made: "Where do we spend our resources for maximum efficiency?" Not saying that it's the correct decision, that there isn't bad stuff going on, etc. But when health infrastructure is overwhelmed be events such as this, the tough decisions have to be made - you can't save everyone.
- mnm1 7y ago
  The difference is that doctors are making this decision in Italy due to a medical system that is overloaded and cannot treat everyone vs. in the US, the insurance companies are always, not just in times of crisis, making this decision so they can profit more.
- elipsey 7y ago
  Triage is a common medical practice, "death panels" were made up by Sara Palin[1][2]. [1]https://www.politifact.com/article/2009/dec/18/politifact-lie-year-death-panels/ https://www.politifact.com/article/2009/dec/18/politifact-li... [2]https://www.factcheck.org/2009/12/whoppers-of-2009/ https://www.factcheck.org/2009/12/whoppers-of-2009/
- topkai22 7y ago
  The "death panels" actually didn't even refer to triage, it was a reference to a proposal to pay doctors for providing counseling on end of life directives and living wills. The semi-manufactured concern was that doctors would basically be telling people how to end their lives earlier. I only say this is a "semi" manufactured concern rather then a completely fabricated one because I have enough doctor's in my family to know that doctors generally have a view on end of life care that's distinct from the rest of the population. Anyways, that gripe about about a detail of a bill got turned into "Death Panels" and promoted by right wing media into doctors deciding to cut care off in non emergency situations.
everybodyknows 7y ago
Links to on-the-ground sources in Italy would be very welcome.
- MaurizioPz 7y ago
  this is an interview (in italian) of a doctor in Bergamo https://www.corriere.it/cronache/20_marzo_09/coronavirus-scegliamo-chi-curare-chi-no-come-ogni-guerra-196f7d34-617d-11ea-8f33-90c941af0f23.shtml https://www.corriere.it/cronache/20_marzo_09/coronavirus-sce... here you find a translation https://www.reddit.com/r/China_Flu/comments/fga3vs/terrifying_insight_of_italian_doctor_on_the_front/ https://www.reddit.com/r/China_Flu/comments/fga3vs/terrifyin...

mrits 7y ago

"will choose someone with better survival chances." How does this differ from the death panels that used to be brought up in the US? Serious question as I didn't follow politics too much when I was younger.

deleted 7y ago
[deleted]
davidw 7y ago
It's called 'triage'. It's what they do anywhere, including the US, when there are too many casualties to deal with. And it's the doctors deciding based on who is most likely to pull through if they get care, not bureaucrats.
- jacquesm 7y ago
  That; and who on balance has the most benefit from being saved to begin with. There is a definite negative weight assigned to age, they would rather save a teenager than someone who is 95. (presented without any kind of bias towards whether this practice is good or bad)
- ggreer 7y ago
  Normal triage is when you prioritize the most seriously injured patients so they don't die waiting for treatment. That's what hospitals typically do. In a mass casualty event, hospitals engage in reverse triage which optimizes for throughput. They prioritize cases that can be discharged quickly so that they can treat as many people as possible. This means they'll label the most serious cases "expectant" and let them die. After all, it's better to save two or three easier people than to squander limited resources on one person who is unlikely to survive. It is extremely rare for hospitals in the US to use reverse triage. I think the most recent time was during Katrina. The stories of that are not pretty.[1] 1. https://www.newsweek.com/vindicated-katrina-doc-tells-her-story-99333 https://www.newsweek.com/vindicated-katrina-doc-tells-her-st...
  - davidw 7y ago
    Yes, that sounds accurate. I am not super familiar with all the terms, as I guess is evident. The second thing is what's happening in a few hospitals in Italy right now and it's gut wrenching for everyone. The staff involved are human too and already stressed and to have to make those kinds of calls is awful. So let's please cancel everything: https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-cancel-everything/607675/ https://www.theatlantic.com/ideas/archive/2020/03/coronaviru...
- thephyber 7y ago
  > And it's the doctors deciding based on who is most likely to pull through I don’t see a distinction. Both of them are making a “for the good of many over the good of one” decision. The “death panels” rhetoric was just that. In practical terms, we already have death panels both within hospitals and within health insurance companies and neither is terribly transparent.
CraigJPerry 7y ago
A death panel is just a political device. The actual problem is just prioritisation of a restricted supply in the face of excess demand. America is still around 28 days away from these decisions though.
- davidw 7y ago
  Italy went from 0 known cases a month ago to 10,000+ today (with some recovered at this point) in less than a month. We'll be there far sooner, especially given the massive failure at the federal level to do much of anything, and given that the infections in the US are not evenly distributed, but are going to hit certain places first in larger numbers.
  - pixl97 7y ago
    Yes, but those first cases will just fill up the facilities, the cases after that will overflow the system.
    - davidw 7y ago
      That's what everyone is referring to.
- dchichkov 7y ago
  A quick, very low sample, back of the envelope calculation: 36,000 participants. Out of that, 1 case that was pretty close (underlying condition, medically-induced coma). Assuming that 5% of population goes into similar state, we should expect more than (1 / 5%) = 20 people in milder states. This would be 20 / 36,000 = 0.05% infected, in the sample consistent with RSA conference on Feb 28th. Assuming doubling rate of 5 days, today is March 10th. So ~ 0.5% infected. And log2(100 / 0.5) * 5 = 38. So, Yes. 28 days sounds about right. Disclaimer: very small sample. Definitely not representative. Statistics is broken here. I'm not a medical field professional and not familiar with virology field. I'm a software engineer and researcher with interest in a number of fields. Exposure to the field limited to reading Nature, coding a bit for medical equipment and college-prep for medical school.
ceejayoz 7y ago
"Death panels" was the claim that a group of government bureaucrats would decide who lives and dies by denying treatment under something like Obamacare. It was a rather baffling talking point, given that this already happens regularly with private insurers and Medicare approvals in the current system.
seneca 7y ago
It's the difference between a doctor, or more likely a highly trained nurse in most facilities, making the decision and government bureaucrat making the decision. It likely also implied the decision being made based on what choice saves the most lives (doctor/nurse) vs what is economically or politically desirable for the decider (bureaucrat).
- willyt 7y ago
  Where do you get bureaucrats deciding things like that, I've never heard of that before? 60's USSR maybe?
  - penagwin 7y ago
    It's a conversation that sometimes comes up with universal healthcare, for example (I'm not taking a stance here) - "Is it worth spending $$$$ tax payer money on an operation with a 20% success rate on 95 year old who also has diseases X, Y and Z?" If such rules are written then it would be bureaucratic.
  - seneca 7y ago
    I couldn't say whether that happens anywhere, but I believe that's what "death panels" refers to. I wasn't suggesting it's what currently happens.
  - mrits 7y ago
    I think they were answering my question in that this is difference since it is professionals performing triage and not bureaucrats.
penagwin 7y ago
Not sure about "death panels" specifically, but like was mentioned, this is called "triage". Basically we don't have resources to help everyone. The resources we do have need to be strategically used, spreading them too thin might not benefit anyone at all. So a tough decision has to be made: "Where do we spend our resources for maximum efficiency?" Not saying that it's the correct decision, that there isn't bad stuff going on, etc. But when health infrastructure is overwhelmed be events such as this, the tough decisions have to be made - you can't save everyone.
mnm1 7y ago
The difference is that doctors are making this decision in Italy due to a medical system that is overloaded and cannot treat everyone vs. in the US, the insurance companies are always, not just in times of crisis, making this decision so they can profit more.
elipsey 7y ago
Triage is a common medical practice, "death panels" were made up by Sara Palin[1][2]. [1]https://www.politifact.com/article/2009/dec/18/politifact-lie-year-death-panels/ https://www.politifact.com/article/2009/dec/18/politifact-li... [2]https://www.factcheck.org/2009/12/whoppers-of-2009/ https://www.factcheck.org/2009/12/whoppers-of-2009/
topkai22 7y ago
The "death panels" actually didn't even refer to triage, it was a reference to a proposal to pay doctors for providing counseling on end of life directives and living wills. The semi-manufactured concern was that doctors would basically be telling people how to end their lives earlier. I only say this is a "semi" manufactured concern rather then a completely fabricated one because I have enough doctor's in my family to know that doctors generally have a view on end of life care that's distinct from the rest of the population. Anyways, that gripe about about a detail of a bill got turned into "Death Panels" and promoted by right wing media into doctors deciding to cut care off in non emergency situations.

everybodyknows 7y ago

Links to on-the-ground sources in Italy would be very welcome.

MaurizioPz 7y ago
this is an interview (in italian) of a doctor in Bergamo https://www.corriere.it/cronache/20_marzo_09/coronavirus-scegliamo-chi-curare-chi-no-come-ogni-guerra-196f7d34-617d-11ea-8f33-90c941af0f23.shtml https://www.corriere.it/cronache/20_marzo_09/coronavirus-sce... here you find a translation https://www.reddit.com/r/China_Flu/comments/fga3vs/terrifying_insight_of_italian_doctor_on_the_front/ https://www.reddit.com/r/China_Flu/comments/fga3vs/terrifyin...