4 ms·

but what about the risks of over-selling this disease? Look at Italy for example. I've read self-reports from healthcare workers claiming 200% hospital capaci

by toolz 7y ago

but what about the risks of over-selling this disease? Look at Italy for example. I've read self-reports from healthcare workers claiming 200% hospital capacity. I can only image the needless death resulting from such panic. Mind you that isn't covid 19 putting them over-capacity. In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds. So it seems incredibly unlikely anything but panic is to blame for such absurdly high over capacity.

adventured 7y ago
Your 10% premise is wrong because you're conflating intensive care capacity and regular hospital beds. You can't just put Covid patients in with the general hospital population and it isn't trivial to convert other hospital beds to the requirements of Covid while ensuring you keep everyone else in the hospital safe from infection. Lombardy does not have anywhere near enough intensive care capacity to handle the cases they've already seen, much less anything further. You can see that in the death rate, it's happening because they can't care for the volume of older intensive care patients properly. They don't have the medical infrastructure capacity to do it. That's why Italy and other European nations such as France have an extreme variance in mortality rates, despite France and Italy both having similarly old populations. Germany is even older than Italy and I'm skeptical we're going to see anywhere near a 6% mortality rate there (their rate is very low so far). Italy's mortality rate has been abnormally high from the first few thousand cases in, when it quickly began overloading their healthcare system in Lombardy.
- toolz 7y ago
  A quick google suggests around 15% of hospital beds are ICU and covid 19 cases that end up in the hospital, only 5% end up in ICU. So that's an interesting line of thinking but it lacks supporting evidence that covid 19 is overwhelming ICU. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 edit to address your edit: The mortality rate is often wildly inflated with new diseases. That's because most people don't seem to understand real mortality rate vs confirmed cases mortality rate. Obviously when a disease is new the confirmed cases will be confirmed against the people showing serious symptoms. Then when you pretend deaths/confirmed cases == mortality rate you end up with a wildly inflated mortality rate. Until we understand how many people are asymptomatic we won't have a real mortality rate that is reliable.
  - spac 7y ago
    The ICU beds are also taken by all the other sick people. Only a minority is actually free. And people don’t end up in the ICU because they panic: I spoke to several Italian hospital doctors and they are overwhelmed by the troves of patients who can’t breathe.
    - toolz 7y ago
      I just read an article that claimed Lombardy has 737 ICU beds available for covid 19. Given Italy has a 3.18 beds per 1000 people that means they have less than 3% of their hospital beds available for covid 19 patients. That's absurd. In relation the USA has roughly 14% of their beds as ICU beds according to a reference from https://www.sccm.org/Communications/Critical-Care-Statistics https://www.sccm.org/Communications/Critical-Care-Statistics
      - creato 7y ago
        You seem to think that for some reason, ICU beds go unused except in a situation like this? ICU capacity is probably built to meet some fraction of demand in normal circumstances. Those beds weren't all unused before this outbreak started. 737 ICU beds available isn't the same as the total number of ICU beds. Normal health problems that need hospital treatment (strokes, heart attacks, car accidents, etc.) are still happening during this outbreak (well, car accidents are probably reduced now with Italy's lockdown protocols).
        gpderetta 7y ago
        Someone else posted else thread that in UK at any time 80% of all ICU beds are in use. It is likely a similar percentage in Italy.
    - kaitai 7y ago
      Right: we do have those ICU beds because people are in them. Toolz, I just don't understand your math. You seem to assume that a neonatal ICU bed is just as good for a 55-year-old man as an adult one, and that no one is going to have any other ICU-needing illnesses for the duration of this epidemic. That's quite puzzling. Can you support these ideas?
danso 7y ago
> In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds. Do you have a source for this comment? This WaPo story from 6 hours ago says differently: https://www.washingtonpost.com/world/europe/italy-coronavirus-patients-lombardy-hospitals/2020/03/12/36041dc6-63ce-11ea-8a8e-5c5336b32760_story.html https://www.washingtonpost.com/world/europe/italy-coronaviru... > Giulio Gallera, Lombardy’s health chief, said Thursday that the region would reach its capacity in “five, six or seven days,” even if it tried to add more beds in hospital “cellars.” In an interview with Italy’s La7 channel, Gallera described the possibility of adding 500 intensive-care beds at Milan’s expo center, the kind of rapidly assembled zone that China created in the hard-hit Wuhan area.
- toolz 7y ago
  lombardy has 7280 confirmed cases [1] lombary has a population of 10MM (wikipedia) italy has 3.18 hospital beds per 1000 [2] the math for that adds up to 31,800 hospital beds 7280 confirmed cases is 22% - so my sources were off or wiki is wrong as originally I recall reading lombardy has a 16MM population. I will say that your article claims they haven't run out of ICU beds yet but that number is surprisingly high for ICU needs to cover covid 19. The article implies 600 ICU cases from covid 19 - that's over 12% ICU from confirmed covid 19 cases, which is more than twice what china reported. It's also very surprising how few ICU beds they have allocated towards ICU.... The USA has something like 14% of hospital beds as ICU beds [3] but Italy appears to only have have less than 3% of their beds available for covid 19 ICU [1] https://www.statista.com/statistics/1099375/coronavirus-cases-by-region-in-italy/ https://www.statista.com/statistics/1099375/coronavirus-case... [2] https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp... [3] https://www.sccm.org/Communications/Critical-Care-Statistics https://www.sccm.org/Communications/Critical-Care-Statistics
  - mlinsey 7y ago
    Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season most of those beds are already filled. The hospitals may be extrapolating the growth rate of the disease and realizing how soon they will have problems. Or given the nature of the outbreak it could be that even within Lombardy there are areas with much higher concentrations of cases, like there are more cases, inc. per capita, in Wuhan than other cities in Hubei. What's not plausible is ICU beds being taken up by people who don't have the disease (maybe miild-to-moderate flus or bad colds) and are just panicking. Emergency room lines, sure. Test shortages, absolutely. But hospitals will not put someone who's just scared and doesn't even need to be admitted at all into the ICU.
grey-area 7y ago
Hospitals worldwide have very little spare capacity and even less spare ICU capacity. A normal hospital bed isn’t going to help much. They are very likely to be overwhelmed, especially in countries that have not been able to delay initial spread due to lack of testing and containment. This probably won’t kill millions (though it could worst case) but hospitals being overwhelmed would lead to an exponential rise in deaths, and many deaths from other causes as other treatments are abandoned. The situation is serious and will require significant measures to bring it under control, it is not yet being taken seriously enough in the US.
- dr_dshiv 7y ago
  Are ICUs even helpful against the disease? I wonder if any triage experiments are being run with randomization.
  - lultimouomo 7y ago
    When you have ADRS ICU treatement is pretty much the only thing keeping you alive. "Randomized trial" in this context means russian roulette - if you don't get a ventilator you'll die almost certainly. Evidence [0] (partly based on COVID-19, parly on MERS) also says that NIV has a significantly worse outcome than ventilation. People are already getting NIV in some hospitals because they ran out of tubed ventilators. [0] https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf?sfvrsn=bc7da517_6&download=true https://www.who.int/docs/default-source/coronaviruse/clinica...

by toolz 7y ago

adventured 7y ago

Your 10% premise is wrong because you're conflating intensive care capacity and regular hospital beds. You can't just put Covid patients in with the general hospital population and it isn't trivial to convert other hospital beds to the requirements of Covid while ensuring you keep everyone else in the hospital safe from infection. Lombardy does not have anywhere near enough intensive care capacity to handle the cases they've already seen, much less anything further. You can see that in the death rate, it's happening because they can't care for the volume of older intensive care patients properly. They don't have the medical infrastructure capacity to do it. That's why Italy and other European nations such as France have an extreme variance in mortality rates, despite France and Italy both having similarly old populations. Germany is even older than Italy and I'm skeptical we're going to see anywhere near a 6% mortality rate there (their rate is very low so far). Italy's mortality rate has been abnormally high from the first few thousand cases in, when it quickly began overloading their healthcare system in Lombardy.

toolz 7y ago
A quick google suggests around 15% of hospital beds are ICU and covid 19 cases that end up in the hospital, only 5% end up in ICU. So that's an interesting line of thinking but it lacks supporting evidence that covid 19 is overwhelming ICU. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 edit to address your edit: The mortality rate is often wildly inflated with new diseases. That's because most people don't seem to understand real mortality rate vs confirmed cases mortality rate. Obviously when a disease is new the confirmed cases will be confirmed against the people showing serious symptoms. Then when you pretend deaths/confirmed cases == mortality rate you end up with a wildly inflated mortality rate. Until we understand how many people are asymptomatic we won't have a real mortality rate that is reliable.
- spac 7y ago
  The ICU beds are also taken by all the other sick people. Only a minority is actually free. And people don’t end up in the ICU because they panic: I spoke to several Italian hospital doctors and they are overwhelmed by the troves of patients who can’t breathe.
  - toolz 7y ago
    I just read an article that claimed Lombardy has 737 ICU beds available for covid 19. Given Italy has a 3.18 beds per 1000 people that means they have less than 3% of their hospital beds available for covid 19 patients. That's absurd. In relation the USA has roughly 14% of their beds as ICU beds according to a reference from https://www.sccm.org/Communications/Critical-Care-Statistics https://www.sccm.org/Communications/Critical-Care-Statistics
    - creato 7y ago
      You seem to think that for some reason, ICU beds go unused except in a situation like this? ICU capacity is probably built to meet some fraction of demand in normal circumstances. Those beds weren't all unused before this outbreak started. 737 ICU beds available isn't the same as the total number of ICU beds. Normal health problems that need hospital treatment (strokes, heart attacks, car accidents, etc.) are still happening during this outbreak (well, car accidents are probably reduced now with Italy's lockdown protocols).
      - gpderetta 7y ago
        Someone else posted else thread that in UK at any time 80% of all ICU beds are in use. It is likely a similar percentage in Italy.
  - kaitai 7y ago
    Right: we do have those ICU beds because people are in them. Toolz, I just don't understand your math. You seem to assume that a neonatal ICU bed is just as good for a 55-year-old man as an adult one, and that no one is going to have any other ICU-needing illnesses for the duration of this epidemic. That's quite puzzling. Can you support these ideas?

danso 7y ago

> In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds. Do you have a source for this comment? This WaPo story from 6 hours ago says differently: https://www.washingtonpost.com/world/europe/italy-coronavirus-patients-lombardy-hospitals/2020/03/12/36041dc6-63ce-11ea-8a8e-5c5336b32760_story.html https://www.washingtonpost.com/world/europe/italy-coronaviru... > Giulio Gallera, Lombardy’s health chief, said Thursday that the region would reach its capacity in “five, six or seven days,” even if it tried to add more beds in hospital “cellars.” In an interview with Italy’s La7 channel, Gallera described the possibility of adding 500 intensive-care beds at Milan’s expo center, the kind of rapidly assembled zone that China created in the hard-hit Wuhan area.

toolz 7y ago
lombardy has 7280 confirmed cases [1] lombary has a population of 10MM (wikipedia) italy has 3.18 hospital beds per 1000 [2] the math for that adds up to 31,800 hospital beds 7280 confirmed cases is 22% - so my sources were off or wiki is wrong as originally I recall reading lombardy has a 16MM population. I will say that your article claims they haven't run out of ICU beds yet but that number is surprisingly high for ICU needs to cover covid 19. The article implies 600 ICU cases from covid 19 - that's over 12% ICU from confirmed covid 19 cases, which is more than twice what china reported. It's also very surprising how few ICU beds they have allocated towards ICU.... The USA has something like 14% of hospital beds as ICU beds [3] but Italy appears to only have have less than 3% of their beds available for covid 19 ICU [1] https://www.statista.com/statistics/1099375/coronavirus-cases-by-region-in-italy/ https://www.statista.com/statistics/1099375/coronavirus-case... [2] https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp... [3] https://www.sccm.org/Communications/Critical-Care-Statistics https://www.sccm.org/Communications/Critical-Care-Statistics
- mlinsey 7y ago
  Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season most of those beds are already filled. The hospitals may be extrapolating the growth rate of the disease and realizing how soon they will have problems. Or given the nature of the outbreak it could be that even within Lombardy there are areas with much higher concentrations of cases, like there are more cases, inc. per capita, in Wuhan than other cities in Hubei. What's not plausible is ICU beds being taken up by people who don't have the disease (maybe miild-to-moderate flus or bad colds) and are just panicking. Emergency room lines, sure. Test shortages, absolutely. But hospitals will not put someone who's just scared and doesn't even need to be admitted at all into the ICU.

grey-area 7y ago

Hospitals worldwide have very little spare capacity and even less spare ICU capacity. A normal hospital bed isn’t going to help much. They are very likely to be overwhelmed, especially in countries that have not been able to delay initial spread due to lack of testing and containment. This probably won’t kill millions (though it could worst case) but hospitals being overwhelmed would lead to an exponential rise in deaths, and many deaths from other causes as other treatments are abandoned. The situation is serious and will require significant measures to bring it under control, it is not yet being taken seriously enough in the US.

dr_dshiv 7y ago
Are ICUs even helpful against the disease? I wonder if any triage experiments are being run with randomization.
- lultimouomo 7y ago
  When you have ADRS ICU treatement is pretty much the only thing keeping you alive. "Randomized trial" in this context means russian roulette - if you don't get a ventilator you'll die almost certainly. Evidence [0] (partly based on COVID-19, parly on MERS) also says that NIV has a significantly worse outcome than ventilation. People are already getting NIV in some hospitals because they ran out of tubed ventilators. [0] https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf?sfvrsn=bc7da517_6&download=true https://www.who.int/docs/default-source/coronaviruse/clinica...