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Honest question -- I am trying to see how she and others arrive at these numbers. (Believe me, I'm not a burying my head in the sand ... quite the opposite. I'm

Honest question -- I am trying to see how she and others arrive at these numbers. (Believe me, I'm not a burying my head in the sand ... quite the opposite. I'm very concerned.) Italy has 8,500 who are still sick. And yet, reports are that their medical system (which is good) is completely overwhelmed, to the point where treatable elderly are not even diagnosed [1]. Yet the numbers indicate they have about 3 hospital beds per 1000, or 186,000 beds, which are normally 80% full. So that means, 37,000 beds available. So, 8,500 cases (not all of whom are in the hospital) should not overwhelm 37,000 beds, right? Perhaps the number of _doctors and nurses_ are overwhelmed? Anybody know where to get reliable stats on that? Anybody see what I'm missing? Or do you think I've gotten incorrect info? I'm trying to arrive at a rational prediction of how bad things could be in the US, and how soon. [1] https://twitter.com/jasonvanschoor/status/1237142891077697538 https://twitter.com/jasonvanschoor/status/123714289107769753...

kpozin 7y ago
I would guess that Italy's severe Covid-19 cases and available hospital beds have very different geographic distributions.
oconnore 7y ago
The numbers are based on confirmed cases. The task of confirming cases is not a trivial matter -- you need test kits, and someone to administer them, and the virus doesn't wait around for you to test for it.
semi-extrinsic 7y ago
Yeah, it's not the total number of hospital beds, it's the number of intensive care hosptal beds with associated equipment like ventilators and intubation equipment, chest x-ray capacity, and the number of doctors and nurses familiar with that type of equipment. In my country we have ~12 000 hospital beds total, but only ~400 intensive care beds. Reportedly our capacity for immediately stretching that number is that we can muster ~1 200 intensive care beds. If the need goes beyond that (and everyone is seriously hoping it will not) then we will be overwhelmed like Italy.
- mtsr 7y ago
  This is the right answer. And it’s also why mortality could potentially shoot up to the +/- 7% of patients that need ICU care, if that capacity is exceeded.
- zone411 7y ago
  In the U.S., the number of per-state ICU beds varies quite a bit. When we count the number of older state residents weighted by their mortality rate, some have twice as many beds available for them on per capita basis: https://twitter.com/LechMazur/status/1237545167659253763 https://twitter.com/LechMazur/status/1237545167659253763
- hcknwscommenter 7y ago
  Not only that, but these intensive care beds need to be isolated. Ever been to an ICU? Isolation is not a thing. We can't just go in and tape a bunch of plastic drapes to the walls/ceilings/floors and make these ICU beds isolated. 400 ICU beds is to a first approximation zero isolated ICU beds.
  - Engineering-MD 7y ago
    Well theatres can be used instead which will allow for isolation. In reality the main HDU or ITU will become covid zone and theatres used for non Covid admissions.
- Engineering-MD 7y ago
  There is a possibility of further increasing ventilator numbers by hooking multiple people up to the same machine providing they have similar lung volumes and compliance. It’s not ideal but better than leaving people to die. Of note, shouldn’t be risk of infection as piping has filters built in to prevent ventilators becoming infected.
MrGilbert 7y ago
From what I‘ve read, issues arise because the personnel cannot be treated with vaccines. So even if you have 37k beds, that‘s pointless if you don‘t have the people to treat them. Also, the flu is currently active in europe, which also filled up some of the beds already.
SkyPuncher 7y ago
You're missing distributions/concentrations. 37k beds are available across the entire country. However, the outbreaks are currently relatively concentrated. Some areas might still have capacity while others are overflowing.
- jobigoud 7y ago
  But if someone needs intubation they should be transported to a different location where they will be taken care of, rather than left alone, no?
  - hcknwscommenter 7y ago
    Transporting an intubated patient hundreds of miles to an area not experiencing an outbreak and having a hospital equipped to deal with same is not a trivial task. Moreover, these numbers of ICU beds bandied about are meaningless. Zero, or close to, of those ICU beds are isolated (infection control).
  - tuberelay 7y ago
    Transporting a patient that sick requires a specially trained doctor and nurse, ambulance transfers to helipad/airport, an 8 hour+ return trip, and a high likelihood of giving the disease to a bunch of people at the new centre. If you had all the resources spare to achieve that, you could just keep them probably.
  - flukus 7y ago
    There are very few resources dedicated to long distance patient transfer at the best of times. If you pulled away regularly ambulance services and somehow equipped them to handle infection control you'd barely be breaking out of the single digits of patient transfers on a good day.
vkou 7y ago
1. Those beds aren't just lying around empty. They are used at close to capacity during normal hospital operation. 2. Most of Italy's cases are in a part of it. They are not evenly distributed among the country. Hospital beds, on the other hand, are. 3. Most of those beds are not ICU beds. If you have COVID-19, and you're sick enough to need to go to the hospital, you need to go to an ICU bed.
- hcknwscommenter 7y ago
  A typical ICU bed in a U.S. hospital is not isolated in any way. I've seen four to a room, all in close proximity. This can't work for COVID-19. Number of generic ICU beds is meaningless as almost all of those beds are totally inappropriate for a highly infections disease with high mortality rate. The problem is much worse than you posit.
  - londons_explore 7y ago
    No need for isolation if all the people in a hospital have COVID-19. Just move all other patients elsewhere, and use staff who have all already had the infection.
mikorym 7y ago
I think the 60–70% is a misquote. The original is in German, but I can't say what it means exactly. They are currently at 0.0000175%. I think it's more a warning that an "estimate".
- mtsr 7y ago
  This virus is so easily transmitted that one needs a significant percentage of the population to be resistant before new epidemics won’t happen every time it is reintroduced. So 60-70%. With a little luck there’s a still larger group of asymptotic infections, because otherwise we are going to have to put up with large numbers of ICU patients for a long time.
- JanSt 7y ago
  The estimate is from Prof. Drosten of the Charité in Berlin, a highly regarded virologe. His lab developed the first diagnostic corona test. Before that they also developed the tests for SARS, Zika and MERS.
  - mikorym 7y ago
    Meaning that they are quoting from steady states in a model that uses differential equations. I am saying that the news article is misquoting the science. Merkel didn't make a prediction, she made a comment about epidemiology.
- hatenberg 7y ago
  It's not - 70% percent as an upper bound is a function of herd immunity kicking in.
  - mikorym 7y ago
    Yes, but as the upper bound for the whole of Germany or for a part of Germany? That is what the issue is about. In terms of likeliness for this is accurate. The chances of the whole of Germany being the improper subset here is the issue. My point is that they make it sound like a prediction. Edit: My point is that this is science about epidemiology, it's not a prediction.
qznc 7y ago
I saw that number as the usual spread of the seasonal flu pandemics. My guess is she generalized it to COVID-19.
molmalo 7y ago
> I'm trying to arrive at a rational prediction of how bad things could be in the US, and how soon. As a whole, USA is around 11.5 days behind Italy. (some others say 14 days) https://mobile.twitter.com/MarkJHandley/status/1237144386569416712 https://mobile.twitter.com/MarkJHandley/status/1237144386569... But this is not so simple to translate, because of the very different sizes between USA and Italy (population, geography, and pop density), and the resources available (if the federal gov finally reacts). So, while that chart counts the cases per country, maybe the best thing here would be to consider the evolution in a single state, instead of the whole country.
- hcknwscommenter 7y ago
  City by city may be more relevant considering how much less dense USA is outside of high concentration urban areas (and even really inside such areas).
fiblye 7y ago
It’s honestly impressive how I seen daily predictions of infections in single countries exceeding the entire confirmed infected global population by 100x. It’s either the idea that this is a generally mild virus with some random severe cases and basically we’re all already infected, or this is going to be an endless, multi year spread and they’re accounting for that.
- flukus 7y ago
  > It’s either the idea that this is a generally mild virus with some random severe cases and basically we’re all already infected, or this is going to be an endless, multi year spread and they’re accounting for that. It's partly the latter, but it's mostly just the result of exponential growth. The number of confirmed cases doubles every ~5 days, if that continues there are over a billion infections in 10 weeks. Whether it plays out that way or not depends on our containment efforts.
xbmcuser 7y ago
The bed count is for all of Italy where as all the seriously sick are in 1 or 2 places. Italy has already reached a point where doctors have to decide who to save and where to spend the resources as they don't have enough. 3 days ago all the beds were occupied but they were still getting 200+ new critical patients a day
pkaye 7y ago
You have to look at ICU beds per capita and that is a lot less. This gives some estimates: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/
cjbprime 7y ago
How many spare ventilators do they have?

kpozin 7y ago

I would guess that Italy's severe Covid-19 cases and available hospital beds have very different geographic distributions.

oconnore 7y ago

The numbers are based on confirmed cases. The task of confirming cases is not a trivial matter -- you need test kits, and someone to administer them, and the virus doesn't wait around for you to test for it.

semi-extrinsic 7y ago

Yeah, it's not the total number of hospital beds, it's the number of intensive care hosptal beds with associated equipment like ventilators and intubation equipment, chest x-ray capacity, and the number of doctors and nurses familiar with that type of equipment. In my country we have ~12 000 hospital beds total, but only ~400 intensive care beds. Reportedly our capacity for immediately stretching that number is that we can muster ~1 200 intensive care beds. If the need goes beyond that (and everyone is seriously hoping it will not) then we will be overwhelmed like Italy.

mtsr 7y ago
This is the right answer. And it’s also why mortality could potentially shoot up to the +/- 7% of patients that need ICU care, if that capacity is exceeded.
zone411 7y ago
In the U.S., the number of per-state ICU beds varies quite a bit. When we count the number of older state residents weighted by their mortality rate, some have twice as many beds available for them on per capita basis: https://twitter.com/LechMazur/status/1237545167659253763 https://twitter.com/LechMazur/status/1237545167659253763
hcknwscommenter 7y ago
Not only that, but these intensive care beds need to be isolated. Ever been to an ICU? Isolation is not a thing. We can't just go in and tape a bunch of plastic drapes to the walls/ceilings/floors and make these ICU beds isolated. 400 ICU beds is to a first approximation zero isolated ICU beds.
- Engineering-MD 7y ago
  Well theatres can be used instead which will allow for isolation. In reality the main HDU or ITU will become covid zone and theatres used for non Covid admissions.
Engineering-MD 7y ago
There is a possibility of further increasing ventilator numbers by hooking multiple people up to the same machine providing they have similar lung volumes and compliance. It’s not ideal but better than leaving people to die. Of note, shouldn’t be risk of infection as piping has filters built in to prevent ventilators becoming infected.

MrGilbert 7y ago

From what I‘ve read, issues arise because the personnel cannot be treated with vaccines. So even if you have 37k beds, that‘s pointless if you don‘t have the people to treat them. Also, the flu is currently active in europe, which also filled up some of the beds already.

SkyPuncher 7y ago

You're missing distributions/concentrations. 37k beds are available across the entire country. However, the outbreaks are currently relatively concentrated. Some areas might still have capacity while others are overflowing.

jobigoud 7y ago
But if someone needs intubation they should be transported to a different location where they will be taken care of, rather than left alone, no?
- hcknwscommenter 7y ago
  Transporting an intubated patient hundreds of miles to an area not experiencing an outbreak and having a hospital equipped to deal with same is not a trivial task. Moreover, these numbers of ICU beds bandied about are meaningless. Zero, or close to, of those ICU beds are isolated (infection control).
- tuberelay 7y ago
  Transporting a patient that sick requires a specially trained doctor and nurse, ambulance transfers to helipad/airport, an 8 hour+ return trip, and a high likelihood of giving the disease to a bunch of people at the new centre. If you had all the resources spare to achieve that, you could just keep them probably.
- flukus 7y ago
  There are very few resources dedicated to long distance patient transfer at the best of times. If you pulled away regularly ambulance services and somehow equipped them to handle infection control you'd barely be breaking out of the single digits of patient transfers on a good day.

vkou 7y ago

1. Those beds aren't just lying around empty. They are used at close to capacity during normal hospital operation. 2. Most of Italy's cases are in a part of it. They are not evenly distributed among the country. Hospital beds, on the other hand, are. 3. Most of those beds are not ICU beds. If you have COVID-19, and you're sick enough to need to go to the hospital, you need to go to an ICU bed.

hcknwscommenter 7y ago
A typical ICU bed in a U.S. hospital is not isolated in any way. I've seen four to a room, all in close proximity. This can't work for COVID-19. Number of generic ICU beds is meaningless as almost all of those beds are totally inappropriate for a highly infections disease with high mortality rate. The problem is much worse than you posit.
- londons_explore 7y ago
  No need for isolation if all the people in a hospital have COVID-19. Just move all other patients elsewhere, and use staff who have all already had the infection.

mikorym 7y ago

I think the 60–70% is a misquote. The original is in German, but I can't say what it means exactly. They are currently at 0.0000175%. I think it's more a warning that an "estimate".

mtsr 7y ago
This virus is so easily transmitted that one needs a significant percentage of the population to be resistant before new epidemics won’t happen every time it is reintroduced. So 60-70%. With a little luck there’s a still larger group of asymptotic infections, because otherwise we are going to have to put up with large numbers of ICU patients for a long time.
JanSt 7y ago
The estimate is from Prof. Drosten of the Charité in Berlin, a highly regarded virologe. His lab developed the first diagnostic corona test. Before that they also developed the tests for SARS, Zika and MERS.
- mikorym 7y ago
  Meaning that they are quoting from steady states in a model that uses differential equations. I am saying that the news article is misquoting the science. Merkel didn't make a prediction, she made a comment about epidemiology.
hatenberg 7y ago
It's not - 70% percent as an upper bound is a function of herd immunity kicking in.
- mikorym 7y ago
  Yes, but as the upper bound for the whole of Germany or for a part of Germany? That is what the issue is about. In terms of likeliness for this is accurate. The chances of the whole of Germany being the improper subset here is the issue. My point is that they make it sound like a prediction. Edit: My point is that this is science about epidemiology, it's not a prediction.

qznc 7y ago

I saw that number as the usual spread of the seasonal flu pandemics. My guess is she generalized it to COVID-19.

molmalo 7y ago

> I'm trying to arrive at a rational prediction of how bad things could be in the US, and how soon. As a whole, USA is around 11.5 days behind Italy. (some others say 14 days) https://mobile.twitter.com/MarkJHandley/status/1237144386569416712 https://mobile.twitter.com/MarkJHandley/status/1237144386569... But this is not so simple to translate, because of the very different sizes between USA and Italy (population, geography, and pop density), and the resources available (if the federal gov finally reacts). So, while that chart counts the cases per country, maybe the best thing here would be to consider the evolution in a single state, instead of the whole country.

hcknwscommenter 7y ago
City by city may be more relevant considering how much less dense USA is outside of high concentration urban areas (and even really inside such areas).

fiblye 7y ago

It’s honestly impressive how I seen daily predictions of infections in single countries exceeding the entire confirmed infected global population by 100x. It’s either the idea that this is a generally mild virus with some random severe cases and basically we’re all already infected, or this is going to be an endless, multi year spread and they’re accounting for that.

flukus 7y ago
> It’s either the idea that this is a generally mild virus with some random severe cases and basically we’re all already infected, or this is going to be an endless, multi year spread and they’re accounting for that. It's partly the latter, but it's mostly just the result of exponential growth. The number of confirmed cases doubles every ~5 days, if that continues there are over a billion infections in 10 weeks. Whether it plays out that way or not depends on our containment efforts.

xbmcuser 7y ago

The bed count is for all of Italy where as all the seriously sick are in 1 or 2 places. Italy has already reached a point where doctors have to decide who to save and where to spend the resources as they don't have enough. 3 days ago all the beds were occupied but they were still getting 200+ new critical patients a day

pkaye 7y ago

You have to look at ICU beds per capita and that is a lot less. This gives some estimates: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/

cjbprime 7y ago

How many spare ventilators do they have?